Ritchie’s still stuck in 1948

A Tory MP has suggested the solution to the NHS crisis is to increase National Insurance. It is staggering how wrong such a person can be.

That is because there are three solutions to the NHS crisis. The first is to reduce demand. The best way, by far, to do that is to improve the lives of those making the biggest demands on it. The most certain way to do that is by increasing the incomes of those least well off in our communities and to reduce inequality.

As they believed back then – the costs of the NHS would fall as people were treated, became healthier and lived longer lives.

This isn’t how it works out. People who live longer consume more health care. The greatest consumers of health and or social care are of course those who didn’t die of poverty, fags or booze but survived to spend a decade with Alzheimer’s.

So The Murphaloon is entirely ignorant of the basics of health economics too then.

97 thoughts on “Ritchie’s still stuck in 1948”

  1. “The Murphaloon is entirely ignorant of the basics of health economics too”.

    Well, if he knew anything about it, it would spoil a perfect record – utter ignorance of everything.

  2. That should of course have read: The best way, by far, to do that is to end the lives of those making the biggest demands on it.

    I’m not convinced that Murphy’s problem here is a lack of understanding of health economics – a subject which, like so many other subjects, is no doubt entirely obscure to him.

    It is more a basic misunderstanding of an inexorable aspect of the human condition, death, and the constraints on “improvement” imposed by nature.

  3. The best way, by far, to do that is to improve the lives of those making the biggest demands on it.

    Best for whom, I wonder? Presumably those doing the bossing around. Of course, this is the primary reason the NHS model is so popular with the Left: it gives them a handy excuse to micromanage everyone’s lives.

  4. Healthcare ‘needs’ are like Peer Gynt’s onion – there’s always another layer. This has been understood since at least the 70s, and yet the Murphatollah is unaware of it. It’s extraordinary how he pontificates before doing even a small amount of background reading.

  5. “this is the primary reason the NHS model is so popular with the Left: it gives them a handy excuse to micromanage everyone’s lives.”

    Exactly.

  6. As a GP friend put it to me, the biggest demands on the NHS is not treating the sick but the time taken up by having to allay the fears of the “worried well”.

  7. Since the revolutionary Mrs Thatcher pushed back the State and encouraged the private sector to take over everything, people must be so well off in the bountiful prosperity dazzlingly organised by Dominic Chappell et al that they can easily pay for health care, even after paying high rents and mortgages.(All that bother when the whole system collapsed during the Big Short Crisis circa 2008 is well behind us .Don’t worry, a whole new crisis is being organised by the best brains in the City.)

  8. DBC – interesting to note your departure from simply parroting the standard orthodoxy and exploring an exciting new vein of something a little like sarcasm.

    Do you have any news of Arnie?

  9. I see Murphy is writing another book with Nov as target date for publication.

    Van Patten will be pleased, being just in time for him to ask for it as a Christmas present, to be treasured for years to come.

  10. @DBC Reed

    Of course, it should never be forgotten that Mrs T had a secret plan to privatise the NHS. Those on the Left said so in 1979. You probably did if you were around then. She had the same plan again in 1983 and 1987. Then John Major had the same plan in 1992. As did Cameron in 2010 and 2015. I expect Theresa May has the same secret plan.

    Just as well the Conservatives seem so bad at implementing their plan as here we are 37 years after the secret plan was first put in place and the Conservatives have been in power for 24 of those years and they still haven’t got the job done.

  11. DBC Reed – another pathetic little got nowt unable to stand on his own two feet without the crutch of the curajus state.

  12. @ Henry Crun, I don’t give a feck if my GP thinks I’m wasting her time, I pay for it, I’ll use it if there is the slightest chance not doing so means I’m going to become another statistic of a bloke who dies at 45 because they didn’t want to bother their GP.

  13. How do left-wingers conceptualise their NHS jeremiads? Is it constantly being destroyed by the Tories and remade by Labour like something out of Hindu philosophy? Or do noble bands of left-wingers constantly defeat the evil Tories like He-Man and his chums defeating Skeletor? Or does it lack the rationality of either story?

  14. Anyone who has pets (and thus knows what vets charge) will know the UK public are the biggest hypocrites going – they’ll pay through the nose for Fido and Tiddle’s insurance every month, and cough up eye watering amounts for their horse’s ailments, but suggest they pay a tenner to visit their GP or have to pay an insurance premium towards their own healthcare and they hit the roof.

  15. DBC – You are joking of course – everybody knows that privatisation is the only possible solution with a chance of providing acceptable healthcare at affordable cost.

    The problem is the left has managed to create this religious zeal against the idea which ensures it won’t happen soon (it’ll happen eventually of course because it is inevitable), which means as with all the left’s efforts that the poor will suffer most.

    Again.

    You bastards.

  16. “As a GP friend put it to me, the biggest demands on the NHS is not treating the sick but the time taken up by having to allay the fears of the “worried well”.”

    I suspect that your friend imagines that all the NHS has the same experience as GPs. I doubt if it does.

    Anyway, back to Spud. One of his answers to the “NHS crisis” (what, another one?) is to “reduce inequality”. We’re all equal in the grave; is that what he wants?

  17. “As a GP friend put it to me, the biggest demands on the NHS is not treating the sick but the time taken up by having to allay the fears of the “worried well”.”

    If the Ministry of Health would shut up about how normal every day things give us cancer, I’m sure that pressure would ease as well.

  18. @Jim, when I lived in France, I had insurance to top up the social charges. It’s normal in France. However, I object in the UK for one very good reason – I have already paid dearly for the service. It’s paying twice that I object to.

    Incidentally, the French system is an example of private providers working alongside state ones in a system that is partially funded through the eye-watering social charges and insurance. You do get what you pay for, though…

    Any objection to private providers in healthcare provision is purely ideological. Having experienced it elsewhere, I’m perfectly happy for private providers to deliver services within the NHS.

  19. Having experienced it elsewhere, I’m perfectly happy for private providers to deliver services within the NHS.

    So is everybody, they just don’t know it: GPs. The morons who insist no aspect of the NHS should be privatised are usually completely unaware that GPs are private businesses.

  20. @Longrider, all those “NHS is my religion” types who were threatening to move to France would have been in for a rude shock had they not just been full of piss and wind 😀

  21. The MP is correct, increasing NIC is the best way to solve the NHS crisis.

    Employee NIC should be increased to the true level required completely to fund the NHS.

    The population would then see exactly how much their ‘World Class’ NHS was costing them, comparative to the ‘service’ they received, and they might just then realise that free market, competitive private providers, funded by free market private insurance (as it was prior to 1911) not only would be cheaper but produce higher consumer-driven quality.

    Being directly responsible for the cost of one’s healthcare, then will influence people’s decisions on lifestyle. If they have lifestyles which likely result in higher healthcare intervention and thus more cost to them, they can either decide to bear that cost, or reduce it by changing their lifestyle – so others do not get stuck with the bill.

    The usual squad of liars would not then be able to tell a population unaware of the actual cost to them, that they would not be able to afford the free market alternative.

    What kind of idiots pay for something without knowing the cost? Answer: near the entire population of the UK.

  22. If the NHS system is cheaper then we do not need to raise spending to the European average as Owen Smith is claiming….

  23. Andrew, we do have a partially privatised NHS.
    Been to see an NHS employed GP recently? Be rare – for a couple of decades most have been employed by private companies, often set up by the surgery GPs themselves as a partnership or company.
    Been in an end of life facility? Hospices are often done because enough people do not think the NHS is up to the job. They get some funding per patient from the NHS but it can be less than half the per unit cost to the hospice.

    Privatisation appears to be alive and well in the NHS.

    With people preferring it.

    As for the health service itself, a lot of resources goes on keeping ‘marginal’ patients alive. Cancer treatments, A&E services, good old heart attacks etc. People that would not be alive without treatment. Some of us using NHS services/drugs regularly for the rest of our lives.

  24. Every other country in northwest Europe spends a larger proportion of GDP on healthcare than the UK. It’s a fantasy to imagine that privatisation saves money.

    Perhaps, but it is not a fantasy to suppose one could get better healthcare for the same money if parts of the NHS were subject to competition. I don’t suppose anyone saves money by getting their glasses frames from Vision Express rather than NHS, but people think they are getting vastly better value for money.

  25. “Every other country in northwest Europe spends a larger proportion of GDP on healthcare than the UK. It’s a fantasy to imagine that privatisation saves money.”

    It wouldn’t matter how much we poured into the NHS, it would still be shit. The incentives are all wrong. There is no incentive for its staff to give good service beyond their own personal desire to do so, and there is no incentive for the patients to modify their behaviour in order to make their healthcare costs lower. The whole thing is built on perverse incentives, which is understandable, its pretty much pure socialism.

  26. We spend about the EU average, making Citizen Smith’s promise laughable like all his others.

    Abolishing employers’ NICs and putting the full whack on to employees is a good idea. Re-name it the NHS Tax. And make it clear that it is hypothecated. The NHS costs about 8% of GDP, so the NHS Tax would be what, about 15-20% of wage-earners’ salaries? That should concentrate minds.

  27. “If the Ministry of Health would shut up about how normal every day things give us cancer, I’m sure that pressure would ease as well”

    This. Public Health and the Government cannot incite an absurd health panic in the population and then complain about ‘unnecessary’ visits to GPs or A&E. No safe level of drinking, bacon gives you cancer, etc etc. Just shut the fuck up.

    You can have a phlegmatic population or you can have hysteria, not both.

  28. Bloke in North Dorset

    “Every other country in northwest Europe spends a larger proportion of GDP on healthcare than the UK. It’s a fantasy to imagine that privatisation saves money.”

    I assume you mean for similar or worse outcomes? If that is the case then why haven’t they copied the NHS to save money? If they are that conic ally stupid then just as well we’ve voted to leave.

    Of course it could be that they pay more through choice to get much better outcomes, better than if they spent the same amount on an NHS model. Given that I don’t think the Germans are economically stupid I’d put money on it that they reckon they get better outcomes € for €.

    And as mentioned above, provide a credible link that shows the Tories want to privatise the NHS. They may want to use the market to provide some competition to encourage innovation and drive down costs, but that doesn’t mean they are doing away with single payer free at the point of delivery model which is the poin f he NHS.

  29. SJW

    “Every other country in northwest Europe spends a larger proportion of GDP on healthcare than the UK. It’s a fantasy to imagine that privatisation saves money.”

    For true believers, either the NHS is under-funded and so provides sub-standard service or it is a model of efficiency delivering high quality healthcare more cheaply than comparable countries. Which is it? It can’t be both.

  30. @ DBC Reed
    I have been paying for *other people’s* healthcare all my working life.
    Sorry to trouble you with facts but Mrs Thatcher refused to privatise Royal Mail or British Rail when these ideas were proposed to her. Under Mrs Thatcher the real income of the working class rose faster than under any Labour government in history so if there had been a continuation of this growth then the average working man would be enjoying bountiful; prosperity but without the high rents and mortgages that are the consequence of the tripling in house prices in 1997-2007 under New Labour due to their creating vast extra demand without any extra supply.
    New Labour’s policies increased demand for housing by around one million dwelling units [immigration from Eastern Europe where Blair waived the delay offered so the number of UK residents born outside the UK rose by *3 million* between the 2001 and 2011 censuses and increasing by more than a million the number of youngsters living away from home nine months a year]

  31. …it is not a fantasy to suppose one could get better healthcare for the same money if parts of the NHS were subject to competition.

    Perhaps. Parts of the NHS are subject to competition. ISTCs seem to be a more expensive way to get a similar quality of healthcare.

    But in order to experiment with this sort of thing, we spend billions every year on the admin needed to operate a market.

    There is no incentive for its staff to give good service beyond their own personal desire to do so…
    How are staff incentives any different if a hospital is privately owned?

    …there is no incentive for the patients to modify their behaviour in order to make their healthcare costs lower.
    You mean that if we had a privatised system obesity rates would fall to US levels?

    either the NHS is under-funded and so provides sub-standard service or it is a model of efficiency delivering high quality healthcare more cheaply than comparable countries. Which is it?
    It’s underfunded, and would provide a better service, particularly in regard to waiting times, with more money. It’s also efficient in healthcare per dollar.

  32. “No safe level of drinking, bacon gives you cancer, ”

    Is that the cheap supermarket stuff; when you try frying it produces a pan full of liquid with a small piece of meat floating in it? Usually packaged as Traditionally Home Cured?
    It certainly doesn’t give you a decent bacon sandwich, either.

  33. But in order to experiment with this sort of thing, we spend billions every year on the admin needed to operate a market.

    Funny how other countries manage to encourage competition between service providers without spending billions on internal admin, isn’t it?

  34. How are staff incentives any different if a hospital is privately owned?

    Because patients might go to the hospital next door and they’ll eventually be out of a job.

  35. Jim
    August 29, 2016 at 10:42 am
    Anyone who has pets…

    Actually Jim, I find that health insurance for my two kitties is affordable and I get excellent service from my local vet. My cats enjoy better healthcare than I do.

  36. …there is no incentive for the patients to modify their behaviour in order to make their healthcare costs lower.
    You mean that if we had a privatised system obesity rates would fall to US levels?

    No, he means not going to the GP or even A&E for a mild case of the sniffles.

  37. I recall last time I was in a GP office in UK, in the waiting room were 2 posters next to each other, one warning about meningitis and warning signs, the other about not wasting doctors time over minor ailments. Unfortunately the overlap between the symptoms listed in both were significant, so which were you supposed to observe.

  38. It would help a lot if the NHS was efficient.

    Father in law was bed blocking for better part of 2 months. He spent several weeks in the discharge ward.
    Rails on the stairs and several items of equipment were identified in the first week as needed. The rails were fitted less than 2 weeks later. After 2 months he was sent home by patient transport with no equipment whatsoever. We had to chase that up next day and he just got half what was identified as him needing.

    He had multiple assessments by several staff, each time he moved beds it seems he had a fresh assessment of walking ability, home care etc. Social worker assigned to him while he was in and insisted he get carers coming in 4 times a day.
    In no way were they needed and took a lot of effort to get round her.
    The sheer wastage of bed blocking for weeks at a time… and it was the NHS causing the bed blocking, not any other body.

  39. “How are staff incentives any different if a hospital is privately owned”

    What Tim Newman said. People don’t have a burning desire to be the best supermarket employee either. But the knowledge (by the management at least) that every customer you treat badly is one customer (and their £££) you’re not getting back tends to concentrate minds.

    ” I find that health insurance for my two kitties is affordable and I get excellent service from my local vet. My cats enjoy better healthcare than I do.”

    I agree, my vet gives great service too. I can get an appointment at any time of day or night, if needed. I’ll pay through the nose of course if I want to see the vet at 3am, but thats my choice. My point wasn’t that vets give bad service, its that people are prepared to pay for that, they don’t seem prepared to pay for their own medical care, and expect it to be ‘free’, ie mainly paid for by someone else. Which is why I’d like to see an ‘NHS tax’ then everyone can see exactly how much they are paying.

  40. @Jim
    To further concentrate everyone’s minds perhaps the NHS tax could be variable based on people’s health risks? Smokers, salad dodgers, bikers, lager drinkers, etc to pay more.

  41. @Jim

    +1 on both your posts.

    To mentioned supermarkets’ staff, saved me doing so.

    NHS will never improve efficiency or quality until there is competition and the distinct possibility of being sacked.

    NHS Dentists are private businesses and paid per treatment. The few state run NHS dental clinics employ salaried dentists who do very little work.

    Cheers

  42. @Street Sparrow

    Bikers are a valuable resource for the NHS. They provide a reliable source of mostly young healthy organs.

    They should be paid, not taxed more.

    Perhaps VAT zero rating & no VED on motorcycles would be a good move.

    Disclosure: I’m a biker and speed freak – 5mph short of the 200mph medal.

  43. With supermarkets the product is reasonably standardised and there are many repeat customers, for many healthcare operations this is not the case.

    Competition requires good quality information so that market clearing can occur.

    I’m not saying that competition does not help, but it has to be pretty carefully worked out. Most of the stuff brought in by Labour was pretty disastrous. I’m not really convinced that the NHS as it presently exists is capable of creating a proper market.

  44. Bravefart

    I have no doubt I will get a copy of ‘Dirty Secrets’ – it was good to see William
    mcgonagall reappear to wish him well!

    Tim – appreciate there are limits on your time but the post ‘A riposte to Ed Balls’ is a De Beers shipment of gems – there could be enough for about twenty posts. I would reckon the subsequent riposte to the ‘stuck in a neo-lieral time warp’ Observer would also yield a few corkers….

  45. Street Sparrow – and for those of us with medical issues such that we would pay high insurance except not being able to afford it?
    Going to ask someone with a stroke living on basic state pension to pay a lot?
    My health risks are such I cannot get life insurance and the cost of health insurance privately to cover me per year is higher than any salary I’ve ever been paid. Gross.

  46. Bloke in Costa Rica

    How many multiples of the cost of just going and buying one from PC Direct would it take for the NHS to provide a printer?

  47. “to improve the lives of those making the biggest demands on it. The most certain way to do that is by increasing the incomes of those least well off in our communities and to reduce inequality.”

    Is there a statistical study of the age where a net-contributor to the NHS becomes a net-consumer?

  48. ‘This isn’t how it works out. People who live longer consume more health care. The greatest consumers of health and or social care are of course those who didn’t die of poverty, fags or booze but survived to spend a decade with Alzheimer’s.’

    I call absolute bollocks on that.

    Do the math.

  49. “It’s underfunded, and would provide a better service, particularly in regard to waiting times, with more money. It’s also efficient in healthcare per dollar.”

    It can NEVER going to to be properly funded because demand is unlimited, because a lot of people who work there don’t actually give a shit (my wife works in the system, it’s an outrage) and because it’s other people’s money. Some bits work well, but they are the exception.

    Other european countries spend a lot more, and as a French person, I can tell you that it can be as shit there as it is here except it costs a lot more. Have you ever noticed that “pharmacies” in France, ie chemist shops, are always modern and you have 1 every 100 yds?

    For example, the “free at the point of delivery” concept has to be dispensed with, even if it is only a token payment.

  50. Funny how other countries manage to encourage competition between service providers without spending billions on internal admin, isn’t it?
    They don’t. The NHS used to have very low admin costs.

    Because patients might go to the hospital next door and they’ll eventually be out of a job.
    NHS patients can choose which hospital to go to.

    Social worker assigned to him while he was in and insisted he get carers coming in 4 times a day.
    Social workers are not part of the NHS.

    I work in the NHS. I don’t even have a printer that works.

    Of course I don’t know the circumstances there. But I’ll take a guess that you work for one of the 65% of NHS Trusts which is over budget. And that management has chosen to transfer its equipment budget to cover running costs.

  51. Andy,

    ‘I work in the NHS.

    I don’t even have a printer that works.’

    What bit of making people better requires a printer ?

    Wouldn’t sacking everybody in the NHS who requires a printer save a shedload of cash and improve patient outcomes ?

  52. “How are [government monopoly] staff incentives any different if a hospital is privately owned?”

    Jesus Christ. Teenager alert.

    They say there’s no such thing as a stupid question, however there are those which demonstrate that the person hasn’t the faintest clue about a subject. Which might be fine, except when, like you, they also hold strongly held beliefs on the same issue.

    Question: How are the staff incentives at privately-owned car factories different from those which operated at British Leyland?

    More broadly: How are staff incentives at any monopoly different from those which apply in competitive markets, where customers can choose between alternatives providers and where the worst providers are forced out of business?

    The effect of incentives on choices and behaviour is one of the most essential tenets of economics. Indeed, together with prices as a coordination mechanism, they go most of the way in explaining the difference between the efficiency and economic dynamism of free societies and the wastage and permanent depression of Socialism (whilst under Communism, of course, the main perceived incentive was to shoot supposed “saboteurs.”)

  53. Regarding vet care we had unfortunately to take the kitten my daughter had adopted into the vets who recommended it be moved to a critical care facility if it was to stand any chance, that runs at around $2,500 for the first day and $1,500 to $2,000 for subsequent days depending on level of treatment. Horrible to have to make value decisions, but remixed me that when my wife was an ICU nurse for 15 years she commented she would see beds not available for people with a chance because relatives wouldn’t let go and insisted on multiple resuscitation etc for hopeless cases in their 80’s and 90’s

  54. wat dabney

    ‘ where the worst providers are forced out of business?’

    Why would I, as an employee of business A, give a fuck whether business A survives against business B ?

    I shovel shit for A, If A collapses I will shovel shit for B, it’s not like the management of either will shovel shit for anybody (or even themselves if their lives depended on it) so my job is safe.

  55. BniC

    it’s a cat, queens will have between 6 and 10 kittens in a litter 3 to 4 times per year, value of a kitten = 0, piss taking by vets = priceless.

  56. Jesus Christ. Teenager alert.

    Well quite. Lots of free-market slogans, no thought about the actual question. Healthcare prices as a co-ordinating mechanism???

    Hospitals are not supermarkets, nor are they car plants. Healthcare is different, whatever financial system is in place.

  57. – “I shovel shit for A, If A collapses I will shovel shit for B, it’s not like the management of either will shovel shit for anybody (or even themselves if their lives depended on it) so my job is safe.”

    Because everyone’s a skilled IT contractor in high demand with no dependents who can up-sticks at the drop of a hat and move across country to an equivalent gig, aren’t they.

    Is that what you explain to BHS staff who are distressed about losing their jobs? That it’s of absolutely no consequence because they can all just turn up next morning for equivalent jobs at their competitors?

    And there they were worried about how they were going to pay the rent/mortgage this month.

    The way you ludicrously dismiss the consequences of redundancy does rather suggest you still live with your parents.

  58. – “Hospitals are not supermarkets, nor are they car plants. Healthcare is different, whatever financial system is in place.”

    I’m afraid your wishing or asserting something doesn’t make it true. There is no reason to imagine for one second that the seismic powers of incentives are somehow magically suspended when it comes to healthcare delivery.

  59. I agree with you about argument by assertion, so let’s talk about actual cases. I get a job stacking shelves in Tesco. And I work hard for fear that if I don’t they’ll go bust? Obviously not. Perhaps there’s an element of that four levels up the hierarchy, but lower down there have to be structural incentives. And in a hospital the ability to create those is entirely independent of the funding model.

    Still, all those earthquakes must be achieving something. Here‘s a paper which looks at what. The answer is that for-profit hospitals charge higher prices for worse care.

  60. Bloke in Costa Rica

    It’s a bloody sight easier to sack a shelf-stacker than an NHS employee (AKA ‘key worker’).

  61. @SJW

    ” (shall I) I work hard for fear that if I don’t they’ll go bust? Obviously not.”

    I’m not going to hire you then: that’s a terrible interview response.

    (Although, as ever BiCR, callsit. However, isn’t the real problem that none of these incentives exist *strongly* in large inefficient bureaucracies. And doesn’t the lack of strong incentives itself show that a business is inefficient and failing?)

  62. NHS patients can choose which hospital to go to.

    Yes, and Tesco customers can choose which supermarket to shop in, but it wouldn’t help much if their only option is another branch of Tesco, would it? Of course, you’re smart enough to know this, you’re just being a twat.

  63. They don’t.

    No? Do you have a table comparing total admin costs across different countries’ health systems?

    They don’t. The NHS used to have very low admin costs.

    Oddly, back when the state was smaller and government wasn’t pumping so much money into the NHS, admin costs were lower. Funny, that.

  64. Have you ever noticed that “pharmacies” in France, ie chemist shops, are always modern and you have 1 every 100 yds?

    Indeed, and any prescription you’re given – no matter how minor the ailment – has you leaving the pharmacie with at least 4 boxes of enough stuff to last you a year. Plus, they’ll be a queue of at least 3 people when you walk in.

    The French system can be shit, and is expensive. But what I like about it is you can go direct to a specialist and choose whichever practice or hospital you like, there’s none of the this “gatekeeper” shit by a GP.

  65. Hospitals are not supermarkets, nor are they car plants. Healthcare is different, whatever financial system is in place.

    No, it’s not. But having lived in countries with competing hospitals and doctors, I can assure you that when it comes to choosing a hospital or a doctor, the first thing you do is ask around and get some feedback as to standard of care, attentiveness of doctors, reputation, etc. So regardless of the differences between supermarkets and hospitals*, the competition element still exists for many aspects of healthcare and helps maintain standards.

    *Which was only brought up because some twat – you – needed the principles of competition explained to you in Noddy-language.

  66. The answer is that for-profit hospitals charge higher prices for worse care.

    Nice strawman you’ve built there. Nobody is saying for-profit hospitals are better than not-for-profit hospitals. What most sensible people are saying is that there needs to be competition between healthcare providers in order to maintain standards: the actual form of these providers is irrelevant.

  67. “Why would I, as an employee of business A, give a fuck whether business A survives against business B ?”

    If you’re a shelf stacker at Tesco, you likely don’t.
    But you’re totally ignoring the role of management in business. Up the management hierarchy there’ll be someone who cares intently that business A survives. Because THEIR job depends on it. So whether you keep your job, or not, will be dependent on whether you’re facilitating THEM keeping THEIR job.

    And that, in a nutshell, is what’s wrong with the NHS. There is no level in management that’s likely to lose their job due to underperformance. No incentives.

  68. The real problem with the NHS isn’t whether nurses work hard enough or not. It’s about effective management of their time and money in the NHS.

    I did a small consulting job for the NHS. Visiting nurses or whatever they’re called. The management had nurses driving across town instead of giving them appointments near each other. They had no sat navs when they cost about £200. They were incompetent at utilising time, booking high grade nurses to do things juniors could do, then finding they had no available people for things requiring higher grade nurses.

    This stuff is just basic management of people doing mobile support.

    Oh and despite backing it up easily with data, our reports just never got implemented. So yet more money pissed away.

  69. It’s about effective management of their time and money in the NHS.</em?

    Which is the case in any large bureaucracy or organisation with a top-down management style. The NHS is simply too big to be managed effectively.

  70. SJW,

    An enterprise operating in a competitive environment is infinitely more likely to identify your laziness and fire you than would a fat monopoly. And that same commercial enterprise would also be vastly more likely to automate-away your non-skilled task.

    Why do you think it is that the one thing state employees fear more than anything else is privatisation? It’s because they understand very clearly that the days of over-manning, jobs-for-life and all manner of inefficiencies are coming to an end.

    – “Here‘s a paper which looks at what. The answer is that for-profit hospitals charge higher prices for worse care”

    …than non-profits, which operate in exactly the same competitive market environment.

    And it’s that competition which is the essential component in all this.

    Non-profits in fact need to return a profit just as much as any private healthcare business if they are to continue operating. The only difference is that the profit is not returned to any owners but is spent by the trust.

    ‘CEO pay soars at top not-for-profits’
    http://www.modernhealthcare.com/article/20150808/magazine/308089988

  71. Vets are the biggest advertisement for the NHS: £50 for treatment consisting of a few antibiotics. Everybody can do the cost benefit comparison for the life changing expense of a fully privatised system for members of the family.Or read up accounts of the fabulous American system “I’m so glad to be living in the USA..” (They stuck him in gaol.)
    I don’t know why you stuckists don’t play to your strengths such as the fully privatised British housing market .There you have a case: a fantastic amount of private money goes into that! All money well spent! Some of the most fabulous looking bits of bare earth anywhere!!
    @John 77 It is not accurate to describe New Labour policies , anything to do with Blair, as left-wing.

  72. DBC Reed – those few antibiotics, same production cost per unit and sales as the human variety? Same employed staff using them or dispensing them?

  73. @ DBC Reed
    There are two groups of veterinary surgeries operating within walking distance of me. Neither charges £50 for treating a small animal (I can’t remember how much but it was never more than I had in my pocket, so it can’t have been). Is it down to competition? Or just because I live in the real world where vets don’t charge more than anyone is likely to pay?

    “It is not accurate to describe New Labour policies , anything to do with Blair, as left-wing.”
    Firstly, I didn’t but secondly it is. Requiring the Bank of england to manage a minimum level of inflation is straight out of Karl Marx. Decreeing aNational minimum wage so that anyone who didn’t produce value-added of £X an hour was unemployable in the private sector and would be forced into the underclass is right in line with Arthur’s Scargill’s plans to create an army of miltants to introduce SWP rule by force. Running a structural budget of 9% of GDP was beyond the tolerance of the ex-communist Denis Healey. Need I go on?

  74. there needs to be competition between healthcare providers in order to maintain standards: the actual form of these providers is irrelevant.
    So you didn’t mean what you said about competition between NHS hospitals not working.

    …back when the state was smaller and government wasn’t pumping so much money into the NHS, admin costs were lower.

    No, that’s not the explanation. In 1979, admin costs were about 5% of spending, now they’re about 14% (link).
    There’s room for argument about whether international comparisons (here‘s one) compare like for like, but one thing that’s clear is that admin costs are significantly lower in Scotland than in England. Not surprisingly, it costs money to operate a market.

  75. So you didn’t mean what you said about competition between NHS hospitals not working.

    This has already been patiently explained to you: competition between NHS hospitals is like competition between two branches of Tesco, i.e. there is no competition.

    No, that’s not the explanation.

    This is an assertion.

    In 1979, admin costs were about 5% of spending, now they’re about 14%

    I’ll repeat myself: oddly, back when the state was smaller and government wasn’t pumping so much money into the NHS, admin costs were lower. Funny, that.

    There’s room for argument about whether international comparisons (here‘s one) compare like for like

    No, that is a table comparing admin costs in hospitals. I was talking about the overall admin costs of a healthcare system, as indeed were you.

    Not surprisingly, it costs money to operate a market.

    This is pure assertion unsupported by facts.

  76. You’re seriously arguing that all the accounting and bid processes needed to operate a market are free? Do you get unicorns with that?

    …competition between NHS hospitals…is no competition
    I can choose which hospital to go to for some procedure. I ask around, and I’m advised that hospital X does it better than hospital Y. So I choose hospital X. How is that not competition?

  77. You’re seriously arguing that all the accounting and bid processes needed to operate a market are free

    Eh? Two independent entities set up and are in competition with each other. Customers choose which one to go to. Where are the bidding and accounting processes in this situation?

    I can choose which hospital to go to for some procedure. I ask around, and I’m advised that hospital X does it better than hospital Y. So I choose hospital X. How is that not competition?

    Because it is being provided by the same entity – the NHS. You might as well say going having the choice between Waitrose in Wapping and Waitrose in Bermondsey means there is competition between the two supermarkets.

  78. J77 Please reference where Marx said governments should manage a minimum level of inflation. How about a maximum level of inflation?What are you talking about?
    Your comments about a minimum wage apply to Osborne’s efforts as well. In ignoring Osborne’s NMW levels the employers are indulging in economic sabotage just the same as the unions were supposed to have ignored Heath’s squealing about inflation.
    What is “a structural budget of 9%?”
    Still no response to the challenge to explain how we are benefiting from the Conservative Party’s main/only policy for 35 years : to keep house price inflation above the general inflationary level at all times.

  79. Because it is being provided by the same entity – the NHS. You might as well say going having the choice between Waitrose in Wapping and Waitrose in Bermondsey means there is competition between the two supermarkets.

    Try to remember that hospitals are not like supermarkets.

    If you want to go to a different supermarket it’s probably for keener pricing or a different range of goods. Two supermarkets in the same chain will be much the same in those respects.

    If you want to go to a different hospital it’s not going to be because it’s cheaper, it’s because you think you’ll get better treatment. And there’s nothing about the business model which makes all doctors/nurses/operating theatres/wards the same from one hospital to the next.

  80. Two independent entities set up and are in competition with each other. Customers choose which one to go to. Where are the bidding and accounting processes in this situation?

    The price has to paid to the provider out of the appropriate budget.

    I won’t write an account of the NHS tendering process. Google could help you.


  81. Try to remember that hospitals are not like supermarkets.

    Trust me, I’d rather not be using the analogy but I need to simplify it as much as I can to get you to understand. The comparison is only to demonstrate that two outlets from the same provider does not constitute competition. But then I’ve said this already, haven’t I?

    If you want to go to a different hospital it’s not going to be because it’s cheaper, it’s because you think you’ll get better treatment.

    Wrong: price plays a crucial role too. You’re so wrong on this it’s not even worth arguing with you. But bear in mind I live in a place where I can and do choose hospitals and other medical services.

  82. I won’t write an account of the NHS tendering process.

    Thats probably wise, given I’ve not asked you to. But I’ll leave you to labour under the impression that competition between rival service providers is more expensive than monopolies because of admin and tendering costs.

  83. @ DBC Reed
    Marx said “crush the middle classes betwennthe upper and nether grindstones of taxation and inflation” or words to that effect. There is no upper limit to inflation because the BoE has no mechanism that can counteract the impact of a doubling in the oil price – the Governor just has to write to the chancellor to say that inflation is a bit high.
    Osborne frequently gets things wrong – that does NOT excuse Blair.
    Alastair Darling stated that brown had run a structural budget deficit of 9% of GDP. He handed Osborne a budget deficit (including some cyclical effects of 10.3% of GDP)
    What challenge? What policy?
    House prices trebled in ten years under New Labour from 1997 to 2007. When David Cameron proposed a mild relaxation of planning laws to ease the housing shortage all the other parties attacked him – so blaming the Conservatives for rising house prices sounds like chutzpah.
    You may not have noticed that the Conservative Party issued a manifesto last year with a raft of policies – one of which was to protect the value of the old age pension from the ravages of inflation – did you voluntarily surrender your pension to reduce the budget deficit?

  84. @SJW: I’ll simplify it for you – when an NHS hospital can go the same way as BHS, Woolworths, Rover, Marconi, Kiwk Save, Dixons, British Steel (what still left of it) etc etc etc etc, then the people working therein may take customer service and efficiency with slightly more seriousness than they do today.

    If you had a job for life and a local monopoly how hard do you think you’d work to reduce costs, increase efficiency and keep the customer happy?

  85. @J77 Oh so the Conservative policy of encouraging house price inflation is their attempt to follow Marx. Interesting.
    Certainly very successful because it has crushed the country between the upper and nether grindstones very effectively.
    Doubtful if your detestation of running budget deficits would have done much good in the endless financial crises we now enjoy.Had you attitude prevailed post 2008 when the super brains backed-up with really whiz computers failed to notice the, in technical parlance , “fucking big” “Big Short” American house price bubble, we would no doubt have had the violent Marxist sort-out you envisage.

  86. I’ll simplify it for you…

    You should make things as simple as possible, but not simpler.

    And healthcare economics are difficult. We know that the incentives in the USA incline for-profit hospitals to game the system. We know (those of us who talk to them) that healthcare professionals are motivated by altruism as well as by financial incentives.

    I’m disappointed that most commentators here are unwilling to address the issues. It may be that more competition could improve UK healthcare, but not if it’s implemented by free-market dogmatists reciting irrelevancies about supermarkets.

  87. @ DBC Reed
    JM Keynes advised running a budget deficit during economic downturns and a surplus during upturns. The bubble in the UK economy that made it so vulnerable to trhe bursting of the bubble was due to Brown’s *structural deficit* not a cyclical deficit. You are probably too old to take Economics GCSE but maybe there are some young people near you who can explain the difference between a cyclical budget deficit and a structural one.
    I should never have got into a 2008 situation because I was pointing out the flaws in Brown’s policies in 2002 (and earlier when he mandated an increase in NHS pay but not in the NHS busget to pay for it).

  88. @J 77
    The Skeptical Libertarian ,Daniel Bier does a useful job in tracking down the “millstones” quotation you ascribe to Marx but which is, apparently ,more frequently credited to Lenin.
    As I suspected, no trace of it can be found in the primary communist sources- as is so often the case when right wing critics claim to be quoting lefties.
    However it is not all bad news :according to Bier’s exhaustive research the quote appears to originate in the work of the Land Tax heresiarch himself Henry George (in” Progress and Poverty”: “Private ownership of land is the nether millstone .Material progress is the upper millstone. Between them ,with an increasing pressure ,the working classes are being ground.”)
    So not only do you get your facts wrong, but you make my case for me by mistakenly pointing to the clearest and most eloquent statement of the Land Tax argument

  89. I was quoting thousand of lefties, not righties, who claimed to be quoting Marx. I admit that I cannot read “Das Kapital” because I never learnt German, so I took their word for it. Who else should I believe? I *never* take right-wingers words on Marx, or Lenin, or Mao, or Hitler.

    I do not want to abolish the Welfare State. I can manage without it because I inherited an ability to do maths, so have earned some money and an occupational pension, and a physique which, while clearly inferior to my father’s, means that I could get a job as a labourer if all pensions and savings were abolished overnight, but I do not want to see the suffering that would result. The Welfare State costs more than all rental income in the UK, so replacing income tax etc with LVT would require swingeing cuts in the Welfare State.

    Go along to your local U3A or other social for elderly people and tell them you want LVT and to abolish the Old Age Pension and the NHS.

  90. @J Clearly you have not consulted the work of Mark Wadsworth, right wing Brexiteer and master of the Maths, who has prepared a tax simplification paper centring on LVT for the Bow Group .He is a professional tax advisor and answers all queries such as yours with panache, on an ongoing basis.

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