UK Health Service Fears Huge Legal Fight Over Unwanted Contracts

DMandPenfold writes "The Department of Health is concerned that Fujitsu, CSC and BT would team up against it in a multibillion pound legal fight, should it decide to scrap the disastrous NHS National Program for IT. Fujitsu walked away from a £709 million contract in 2008, and remains locked in legal wrangling with the government over claims for the majority of the value. Today, MPs urged the government to seriously consider abandoning the program and therefore to consider terminating the remaining CSC and BT contracts, worth £3 billion and £1 billion respectively."

Comments

related?

[rbrausse]

I read the summary and "disastrous NHS National Program for IT" reminds me of UK Taxpayers' Money Getting Wasted On IT Spending.

both sides are to blame here - government agencies are often really bad in project management and contractors are abusing this...

Re:related?

[TheRaven64]

This is a different kind of problem. The government generates huge sets of requirements and then gives a contract to a company with a track record of failing to meet the requirements, then acts surprised when the project fails.

The NHS system is particularly irritating, because their current system is a room full of folders containing paper. It would be trivial to deploy a database system to store the more relevant information (although the storage requirements if you want to store x-rays and CT scans get insane) in a way that's easy for doctors to access. The software is only a couple of months work for a single programmer and could be deployed by the existing IT staff. It would then make life easier for everyone involved.

Instead, the government specifies a system with an insane list of requirements for a huge number of unusual use cases, and then wonders why the project fails.

Re:related?

[myurr]

Whilst you trivialise the problem to a degree (scalability and reliability of an NHS sized system is not trivial) it still shouldn't take a small team more than a few months, and a budget in the hundreds of thousands of pounds, to build such a system. This could then be incrementally evolved over time on a budget in the hundreds of thousands per annum (maybe low millions depending on speed of development). You do then have the data entry problem to consider, but that is surmountable for a fraction of the budget of these big IT solutions.

However that's not how the government thinks. They want to go all encompassing from day one, speccing out a bloated and unworkable unholy mess that the end user doesn't want or need, and certainly doesn't understand, that takes a budget several orders of magnitude more than is required. Then throughout the project more and more people will hear about it and give their input or point of flaws, causing massive amounts of feature creep and confusion, affecting budgets, delivery time lines, and ultimately the quality of the end product.

As a final anecdote, as a small web agency we once were involved in the build of a website for a London borough. We were in competition with some much bigger agencies, but we went back with a good proposal, some great design concepts, and what we felt was a fair budget. The decision maker loved our whole proposal except for the cost - he actually made us double the cost of the build, simply because that then matched his budget so that it wouldn't be cut the next year (spend it or lose it!) and because it brought it in to line with the bigger agencies (so his managers wouldn't think our offering was less feature rich because it was cheaper). This way of thinking is not unique to the the public sector but is endemic throughout it, and the big suppliers prey upon this.

Re:related?

[TheRaven64]

(scalability and reliability of an NHS sized system is not trivial)

Depends on what you're doing. I have a friend who works in the medical records department at the local hospital. A lot of her job involves running from one end of the hospital to the other because the doctor needs a specific file in 10 minutes and only just realised. A system where every doctor had a tablet PC of some kind and could call up all of the records in a hospital would be really simple to design and deploy. It wouldn't have to cover the entire NHS, just the one hospital. That's only a few TB of data with a few hundred users. Once the records are in electronic form, the next step is defining formats and protocols for exchanging them between hospitals, GPs surgeries, and so on.

If one hospital had paid for the development of such a system and specified that they own the copyright on the resulting code, they could have released it under an open license and other hospitals could have used it easily.

Re:related?

[Anonymous Coward]

that would not meet confidentiality guidelines anywhere. A doctor only has permission to access his own patients' records, not everyones. Administrators should not have access to patient records either. If the ipad is stolen, or borrowed, does the new user get access to all patient records, or does the doctor end up entering password 70 times a day? etc... etc...

It's non-trivial, but there are lots of such systems out there, It's hard to see why they could not work with some of these efforts and bring in systems incrementally, for a lot less money:

http://en.wikipedia.org/wiki/List_of_open_source_healthcare_software

Re:related?

[Richard_at_work]

If one hospital had paid for the development of such a system and specified that they own the copyright on the resulting code, they could have released it under an open license and other hospitals could have used it easily.

Fraid not for so many reasons - each hospital has its own budget, out of which comes everything from drugs purchases to theatre time to IT systems, so you would end up with one hospital spending the money.

Which means that they would want to use it as a profit centre with regard to other hospitals, so they would sell it to other hospitals. Unfortunately, working practices between hospitals (hell, between departments within hospitals) are very different, so the package would have to be heavily customised for each hospital (.... department) so if you are spending the money making the purchase and then the customisation, why not just do a custom build.

And we arrive at the actual situation within the NHS currently - everyone has gone computerised, they've just done their own thing.

Re:related?

[Richard_at_work]

In current systems, a doctor in a hospital can access basically any patient entered into that hospitals system - but when the audits bring that access up, and it will within the week, you have to be able to justify the access pretty damn well or you will face a disciplinary.

Actually, now would be a damn good time to explain how most UK hospitals work...

During the day, all departments are staffed, with consultants, registrars, Foundation Year 1 and 2's.

At night, most hospitals run "Hospital at Night", where everyone buggers off home aside from half a dozen or so junior grade doctors (consultants and permanent registrars stay on call, but you literally have to call them, training scheme registrars and FY2s get to run the hospital) - who have to cover the entire hospital (aside from A&E and a few very specialist departments).

So, while the hospital may take 400 or more doctors to run during the day, thats reduced to a handful at night - and what that means is that while you may get a doctor who has trained (or is training in) in the department you were admitted to, at night its pot luck.

So that night doctor needs full access to your patient record to treat you, even though they may only ever see you once.

Re:related?

[Anonymous Coward]

I'm not sure it'd be that easy: there's a lot more to it than just giving doctors access to records. Off the top of my head, even a basic system would have to account for the following things:
1) Data protection: aside from the various UK/EU laws on data protection (e.g. expiry of data, etc), patients may have confidential data (e.g. mental health issues) or be classed as needing protection (e.g. celebrities/politicians/etc). You'd therefore need some way to authenticate the person viewing the data, as well as a way to ensure that they only see the patient's confidential data if it's relevant to the current case. You also need a robust logging system - and even when the person has full permission to access the data, you need some way of ensuring that the tablet can't be accessed by non-authorised people (e.g. a rogue journalist): simply putting a password on the tablet won't cut it. You'd also need some way to disable/lock access to data if the tablet is stolen or if someone attempts to hack into it.

2) Hardware: you'd have to pick a tablet which has good battery life and is highly robust: it's likely to be dropped, thrown about and may well end up covered in various body fluids and/or medical chemicals. It may also need some form of card-reader for the authentication system and it also needs to be small and light if it's going to be carried out for an entire shift; realistically, something like the iPad 2 is too large, heavy and expensive for this sort of use-case - and whatever is picked, if it's based on commodity hardware, there will be a risk that the tablets will be stolen simply for their perceived physical value, even if the hardware/OS is fully locked down to make it useless outside the hospital.

3) Software: an app will need to be written for the tablet; as the data needs to be protected - and there may be some form of physical authentication system - you can't simply serve out HTML from a web-server. The tablet will also need to be locked down, to stop people installing their own software on it; at best, it wastes resources and at worst, it could be a data-stealing trojan horse or virus.

3) Network: you'll need to set up a hospital-wide wifi network; aside from the risk that the wifi signal could interfere with some medical hardware (or vice-versa), there's also the fact that many hospitals are in victorian (or older) buildings, so there may well be issues with getting cabling installed and/or punching signals through the walls.

4) Training: the doctors will probably need training on how to use the tablet, the app and authentication systems, so there's the cost of writing the training documents and the costs associated with the training sessions.

5) Ongoing support: tablet repairs, new tablet builds, software upgrades, etc.

To be fair, none of these are insurmountable - and many may have already been completely or partially solved (e.g. wifi in hospitals, training to use authentication systems), but a solution needs to be found for each which all the interested parties can agree to - the government, the data-protection regulators, the doctors, the hospital management team, the hospital support team, and so on.

And I'd suggest that navigating all of these legal, logistical, technical and process minefields is going to take a lot more than a small team, a few months and a few hundred-thousand pounds...

Re:related?

[Sad Loser]

I am a senior doctor in the NHS and am one of many trying to unravel some of this unholy mess to work out which bits are workable.

The obvious stuff - own a basic infrastructure, use open standards, manage contracts tightly and locally, encourage a diverse IT culture within and outside hospitals and use competition to drive down price and drive up performance - this just didn't happen. As the parent says - a centralised system specified by obsessive compulsive people who don't touch patients and with an irresistible urge to gold plate everything.

The NHS doesn't even own the N3 network - it rents it off BT.

We are tied down with a vast number of closed systems that will cause untold unhappiness, waste and frustration in years to come - my hospital is about to go live with CERNER, which has a Windows 3.1/ 'visual basic by a first year programmer' look and feel. It takes >30 seconds to authenticate every time you want to do anything (often)! this alone will steal many hours of medical and nursing time waiting.

They as the parent says, the contracts were poorly specified, carved up by the usual management consultancy clowns and their mates, and then just left to fester.

Unfortunately, the people running the whole thing were not equipped with the mental or managerial experience to make it work. There was one head of IT, Richard Grainger, who might have had a chance at doing it properly from the off, but was brought in too late when the carve up had taken place, and ran away as fast as he could. The rest is history.

What they could have done differently?
1. read ' the mythical man month'
2. pay someone to re-engineer VISTA in c++/ c# / java
3. get some people in who are successful doctors, not just the nearest beardy muppet who doesn't want to touch patients any more.

COI: IAANHSD

Re:related?

[Shuntros]

It's a shame these big contracts are being allowed to tarnish all the achievements which have been made. Digital x-rays, scans etc enjoy 100% coverage across the UK; consultants can get a second opinion from someone 100 miles away in minutes, instead of sending x-rays in the back of a taxi to another city.

Electronic referrals from GPs (family doctors) for hospital treatment are in the tens of thousands per day and GP2GP record transfers for people changing doctors are becoming widespread. All NHS sites are connected by the N3 network.

The big sticking points are the large hospital trusts and their systems; in London and the south the system of choice was Cerner Millennium (a bastardised billing system from the US market not particularly well suited to the NHS), and in the North it was iSOFT's Lorenzo (a web-based system built specifically for the NHS, but built by coders in India who have no idea how the NHS works). In all fairness, despite its lack of suitability Millennium is up and running at quite a number of big hospitals. Lorenzo has been delayed for many years and is only just becoming usable, although it's hardly what one could describe as feature rich at this point in time.

Aside from software issues, one of the major issues the suppliers had was trying to be too helpful; every hospital will insist they are somehow unique and by pandering to every possible requirement the scope of the software build simply exploded.

Trivialising the scale of the task shows considerable naivety in the working of the NHS, but it definitely could have been done at a fraction of the cost. The national-level architecture (NHS Spine) whilst showing its age a little now, is still valid in its construction; a national interchange which any software complying to the relevant messaging standards can interact with.

As you've probably guessed, I'm involved in this particular industry. The intentions from a patient care and modernisation perspective were honourable, but the huge contracts for specific things from specific suppliers were a mistake.

Re:related?

[LizardKing]

Instead, the government specifies a system with an insane list of requirements for a huge number of unusual use cases, and then wonders why the project fails.

The contractors are at fault - they bought into a project that was obviously going to fail. They could have done the decent thing, and told government that the requirements needed scaling back, but all it takes is one of the competing contractors to say it was doable and they would all fall in line. Of course, the contracts are so badly written that the contractors can get out part way through, having already made enough profit that any penalties for non-delivery are insignificant.

Then there's the implementation. A former colleague went to work on the NHS system for BT - one of the contractors despite no track record in this kind of system. This colleague was a notoriously sloppy coder, to the point of incompetence, and as a result he had been shunted off of my C++ and Java based project to do trivial PHP work. BT employed him in a fairly senior coding position to do PHP on the NHS IT contract. Shudder.

Re:related?

[Captain Hook]

Most of that could be handled by have something like a Citrix Server and the clients just being cheap access terminals.

No need to worry about the tablet being stolen because the tablet is never given the data (outside of screen scrap from the server).

Re:related?

[Anonymous Coward]

There's also another side to the budget process. A project budget usually goes something like 1. define need; 2. define what's need to fit the need; 3. get proposals for budget amount; 4. Submit and then wait. 5. Budget committee meets and funds are budgeted for the project. 6. Wait some more until the new budget cycle (when funds are released) begins. 7. Now that you're free to proceed, you nail down the true amount needed and pick a vendor.
And that's where if you're really good at funding a deal, you get a better price than what you budgeted. You save the company money and your boss asks you why you did such a poor job in coming up with an amount for the budget request. Do it enough times and they start just cutting your budget requests figuring you're over-estimating anyway.

Re:related?

[Anonymous Coward]

However that's not how the government thinks. They want to go all encompassing from day one, speccing out a bloated and unworkable unholy mess that the end user doesn't want or need, and certainly doesn't understand, that takes a budget several orders of magnitude more than is required. Then throughout the project more and more people will hear about it and give their input or point of flaws, causing massive amounts of feature creep and confusion, affecting budgets, delivery time lines, and ultimately the quality of the end product.

The government don't *want* to go all encompassing from day one - they generally have little choice. A broad objective, broken down into small, iterative steps (which expect and react to failure) doesn't work when you have a hostile opposition party and hyper-critical media that jump on every problem as a sign of total incompetence. A practice ultimately endorsed by the voters.

Until the public's, media's and government's mindset changes, to get any initiative out of the starting blocks, you sadly need the bloated, unworkable over-detail behemoth of a specification.

And yes, I am quite happy to vote for someone I broadly trust and who's principles I am broadly aligned with. "We'll figure it out as we go along" works as a policy for me.

Re:related?

[Just Some Guy]

he actually made us double the cost of the build, simply because that then matched his budget so that it wouldn't be cut the next year (spend it or lose it!)

I genuinely feel sorry for anyone having to work within those constraints, and hope the policies contribute to the (relatively) quick death of their organizations. Here's how my company's budgeting works:

1. Once a year, the boss asks what purchases we've planned for the next year or so. He uses that to estimate our budget needs.
2. When we need to make those expenditures, we tell him. If it's a good day in the budget cycle (e.g. we didn't just host a convention a few days earlier), he authorizes the purchase. If not, he asks us to wait a week or so first.
3. If we need something extra and unforeseen, we tell him what we need and why it will benefit the company. We buy it.

If I show him how I saved money by using our current resources more efficiently, he remembers it come annual evaluation day. His long-term response is to become even more receptive to purchase requests because he trusts me to spend his money wisely.

I understand that managing a large corporation is a lot different from running a small company, but the basic principals stand. If you punish departments for efficiency, you deserve bankruptcy.

Re:related?

[Anonymous Coward]

The answer is really simple the government tells the unwanted contractors to go frell them selfs and just change the law so they have ZERO comeback their stupid ideas are not working so they have failed so they have forefitted any rights to payment after all that is the sort of stunt they pull on the public so let them have a taste of their own medicine for once see how they like it they wont but all together now You Know What TOUGH suck it in

Re:related?

[Anonymous Coward]

Are you sure? I thought I remembered that it was Grainger's idea to hav ethe big contracts? And he certainly had no enthusiasm for clin user input The q that was always on my mind was why they didn't build off the ethos of pry care computing, which by and large works quite well. Emis systm1 etc all do the basics sort of fine and are clinically focused as much as mgmt focused.

Anyhoo the next challenge will be getting some level of integration between pry comm and acute and la and mhts. As that's likely to be clin-driven, at least consent may get sorted this time!

Re:related?

[Duncan J Murray]

I'd be interested it getting involved, as a Haematology SpR and an interest in open-source and open-standards. I imagined the NHS would be the perfect poster-child for an open-source project funded by the government to create a hospital system, possibly running on linux (if not the terminals, then at least the backend), which could then be used possibly by others in developing countries. It would then be modular, and updateable, and wouldn't result in the NHS relying on one piece of proprietary software, the owner of which would have a monopoly on future service contracts.

Do get in touch!

Duncan.

Re:related?

[mikael]

The Register had a discussion on this some time ago. Basically, every health board patient record system had evolved to completely different formats for ranging from basic details like names and addresses to additional information pages on medical conditions. Imagine trying to merge 200+ separate and constantly evolving online job application webpages into a single unified webpage format including portfolios and show-reels, then you'd understand what they have to do. Add to that, the standard need for consultancy style specifications, reviews, and you could see they were trying to hit a moving target.

A guide to the crisis in the NHS national IT programme

Re:related?

[Rich0]

Aside from software issues, one of the major issues the suppliers had was trying to be too helpful; every hospital will insist they are somehow unique and by pandering to every possible requirement the scope of the software build simply exploded.

Vendors do this all the time - since usually it is in their interests to do so. Most contracts are time-and-materials, so the more you shoot yourself in the foot, the more money the vendor makes.

Why would an analyst for the vendor fight some bigwig doctor over the feature they want which will add six months and six million dollars to the project? First, they tick off a stakeholder who is used to getting what they want. Second, they make six million dollars less. Third, they make the project get six months closer to the day when they all lose their jobs. Finally, if the project never gets done nobody will ever be able to prove that the vendor couldn't have done it in the first place.

If you're a contractor paid by the hour, the best thing you can do is accept every scope change you can - the more disastrous the better. The only people who will complain are the twits in IT who actually are supposed to deliver the project on time, but you can usually convince the users of the system to use their clout to override the IT objections.

Re:related?

[Shuntros]

Not the case for CSC though. They're on pay-per-deployment. When trying to deploy a single-instance system shared between many organisations with minimal tiered config scope creep is bad. Very bad.

Re:related?

[Chris Mattern]

Welcome to the wonderful world of government. While I won't pretend that such things don't happen in corporations, eventually it catches it up to them, as you say. In government, you never have to worry about that. It's a wonderful thing when you don't have to depend on people voluntarily giving you money.

Re:related?

[RockDoctor]

It would be trivial to deploy a database system to store the more relevant information

Who decides what is relevant or not?

Everything would be recorded anyway, because most doctors are realistic enough to know that they don't (generally) know what is wrong with a patient, but are working to a working hypothesis. So, if that working hypothesis turns out to be wrong and they've discarded the data that didn't conform to their working hypothesis ... then they've got to do it all again. Plus there's serious risk of confirmation bias.

That's the doctors having reasonable scientific caution. If the lawyers get involved ("if"? "if"?! can't you tell that I'm joking?), then everything will be recorded, in triplicate, on video. Then audited to fuck. (It was actually some of the auditing data that would have proved that Harold Shipman was a premeditated murderer. His case notes described a patient's death before he made the house call when he killed the patient, and the auditing software recorded when he made the note, and when he corrected the time-stamp on the note.)

[SNIP]in a way that's easy for doctors to access.

Which doctors get which access? There are aspects of my medical history from decades ago that I don't want a doctor at work to read when he's treating my sprained ankle. OTOH, there are aspects of my work (e.g. a month of malaria prophylaxis) that I might want my doctor at home to know about when they're treating my "influenza". I think that I will make that choice, thank you. Not some programmer knocking up a system in his mum's basement.

You tirvialize it as much as you want. I've instructed my doctor to remove my records from the system (as we have the right to do in my country, but I don't know if they have in the other countries of the UK) and to only maintain them as paper copies.
Oh, sorry, have I just added another non-trivial complication : that they're trying to generate one system to cover at least 3 different legal systems (possibly 5 if they're covering the IOM and CI too).

"Trebles and sky-rocketing specifications all round" as the Private Eye cartoon has probably said already. Repeatedly.

Re:related?

[Anonymous Coward]

If VistA (the VA's Hospital Information System) had been deployed it would have done the job for a fraction of what the NHS spent.
It already works, and it is Public Domain Software. It would be even less effort if the existing MUMPS code simply was used.

There was a time when...

[Richard_at_work]

Summaries actually summarised the article, and not just reposted the first two paragraphs of it...

(The below is my opinion, not a summary of the article)

Basically, what has happened is that the Great And Wonderful NHS Computerised Records System has been in the doldrums for so long that we have ended up with a situation where every GP (community doctor for those not in the UK, they run their own clinics outside of hospitals) and every hospital has implemented their own computer records system, with the large majority of them incompatible with each other.

The only semblance of the NHS wide system to come to light in a customer facing manner has been the emergency care records, which is a computerised subset of your entire record meant to be accessible to every A&E (ER) department in the country - but they still haven't rolled it out to everyone, and it won't be rolled out to everyone it would seem.

It has gotten to the point where the NHS requirements have changed so much that the contracting companies are now walking away from their contracts because they are being asked to do so much more work under the original commitments.

This whole thing has been collossally mismanaged from the start, the current government just gets the blame for the result...

Re:There was a time when...

[Spad]

The whole NCRS project was doomed from the start; they made the assumption that the best way to make clinical records available across the country was by way of a gigantic central database and the proceeded to design it without consulting any of the users, using smartcards that were obsolete before the project started (so they can't be used for anything else like SSO because nobody supports them anymore) and changing the requirements every couple of weeks. Oh, and there's no fine-grained access control so they can't put any Mental or Sexual Health records on it since anyone with access to part of your record has access to all of it.

What they should have done is to define a standard data exchange format, mandated that all local systems supported it and then have a central lookup table for locating where any given record is located, but then they wouldn't have been able to award massive contacts to the usual suspects.

Re:There was a time when...

[Anonymous Coward]

Interestingly I have a bit of insight into this as I have a family member who has worked for the NHS for 20+ years in various administrative roles.

It's not only that the technologies being used are incompatible between hospitals, they are often incompatible between different departments of the same hospital! And that is not the worst, the people in the hospitals responsible for technology projects have no idea what they are doing and as such buy stupidly outdated systems which require constant upkeep just to work, the classic example being the hospital where said family member works their 'new' patient records system (called PMS, Patient Management System) which was put in within the last 5 years or so runs under DOS, there isn't a windows client, you have to run it in a command window and as far as they know there are no plans to deploy a windows client.

I'm not surprised the recommendation is ditch it all as a bad idea.

For the amount of money wasted they could have had a bespoke system designed and deployed by now.

Re:There was a time when...

[Kalriath]

HL7, CDA, and a national private network. Problem solved. Yes, it'll be expensive - but you don't need to "define" anything because everything you need is defined already.

In case you're wondering, I just described New Zealand's entire health system. The central government holds the demographic record, and your GP holds the medical record. Obtaining that record is a simple matter of requesting it from the GP that holds it, who will then deliver it to you via the national health network and it's received in minutes. Not exactly a stretch to change that into YOU holding your record on some sort of card (preferably not RFID).

That's all how it's meant to work of course. Since people are involved, it's not failsafe.

Re:There was a time when...

[Spad]

There's already a national private network (N3) so we're halfway there.

Re:There was a time when...

[Richard_at_work]

Don't get me started on SSO, my wife changed rotation yesterday, and despite not going outside of the deanery, she still had to submit all the same paperwork yet again, and pick up no less than four usernames and passwords for hospital systems...

Four.

Four, for crying out loud. Without ever having to leave the one building to use them all.

Re:There was a time when...

[Anonymous Coward]

GP (community doctor for those not in the UK, they run their own clinics outside of hospitals)

GP stands for General Practitioner. It's used outside the UK, such as the US. It's a non-specialized doctor. The opposite of a heart surgeon, a brain surgeon, a back/spine specialist, etc. That last I read about it (admittedly it was a while ago), in the US GP's are the hardest doctors to fill due to the lower pay (specialists make much more money) with the equally high cost of malpractice insurance and the continued culture of suing over every possible thing to make a quick buck. A position where a GP can easily find themselves in as they handle a much wider variety of cases and despite how minor the health need is.

Coupled this with the fact that said GP's, having been bit themselves or knows someone who has, has lead to simple doctor visits costing extreme amounts of money, ie.causing health care prices to skyrocket. "Oh, you have a swollen ankle because you said you twisted it in a hole? Ok. Well, it's probably a sprain. But I'll request you to get an MRI and x-rays just to make sure nothing else is wrong and you better also go see this ankle specialist to get a second opinion and sign up for 30 hours or rehab." It use to be "elevate it and put ice on it, you'll be fine."

If not because the doctor orders you to get a bunch of unnecessary tests, but because the hospital is spreading the costs over many more people and charging you $150 for 5 mins with a doctor for acne creme because it helps off-set the costs elsewhere.

And the sad part is all we keep having this continuing debate that the government should pay for it and not about how we can stop this runaway train of costs. After all politicians won't look at tort reform. Almost all of them are lawyers themselves! (Another major issue in US politics, wealthy lawyers are the political class. Having a discussion about $150 haircuts and flying private jets around the country every week is normal to them.)

*sigh* and people are surprised when grass root movements like the Tea Party pop up. A party supported by both conservative and liberal politically leaning citizens to fight back against the wealthy political elite, but has since been successfully supported by the Republican party, which has made it the enemy of the Democratic party and now it's nothing more than another politically polarized talking point.

but I degrees.

Re:There was a time when...

[Richard_at_work]

In the UK a GP is a specialisation - a non-specialised doctor remains a Senior House Officer, or FY2, and can be employed by a hospital as such (they can make great money doing locum work as an FY2). To become a GP after your FY2 year, you have to go through a 3 year training course to specialise in that area, and GPs get paid quite well in the UK, all things considered.

Re:There was a time when...

[mcmonkey]

HL7, CDA, and a national private network. Problem solved. Yes, it'll be expensive - but you don't need to "define" anything because everything you need is defined already.

I was just thinking the same thing, particularly in response to the posters writing that GPs and hospitals have gone forward with their own computerized system that are now not interoperable.

For those who don't know, HL7 includes, among other things, an XML schema for health care information. Let each office or organization build their own system--with a list of 'best practices' from the NHS to reduce reinventing the wheel--and use the existing standard for inter-org communications.

Re:There was a time when...

[__aarzwb9394]

They also get good hours. Another reason why it appeals

The real question is...

[ArsenneLupin]

... whose palms were greased to secure the signature of those dodgy contracts in the first place?

Re:The real question is...

[Anonymous Coward]

That would be Tony Blair and Gordon Brown (a.ka. the Iron Chancellor) who left this shite fest in place.

BT get shafted? What a shame.

[Anonymous Coward]

BT get shafted? What a shame. Couldn't happen to a nicer company.

Disaster that was predicted years ago...

[FRAKK2]

As someone who worked on the program from nearly its beginning I can tell you, people coould see this road crash coming for years. They tried to do too much in on go. Of course you can blame the Labour party and the suppliers for that. What with the end of Boom and Bust its always easy to pish other peoples money i.e the taxpayers up the wall!

And the amount of ex IT consultants working for the government means that that this kind of debacle happened time and time again , just the same as defence.

As for the contract costing as much to cancel as to complete thats the same trick Gordon Brown used to make sure the new brtiish carriers were built in scotland. Bent as a nine bob note!

Getting paid for things that don't work.

[tebee]

Maybe governments should start writing contracts that only pay up if a usable systems s delivered at the end of it ?

OK know this is a gross oversimplification but at least it would give the people doing the work some decent motivation to make sure it did actually work in the end.

I was brought in as a capacity planner on a former NHS computerization contract about 30 years ago. After 3 months there s was obvious to me that what the were doing, the very silly way they were doing it was not going to ft on the IBM mainframe they had specified to do this.

On pointing this out to them I was told that some very highly paid consultants had said it was going to work and who was I, a lowly contractor, to question their wisdom even though this was the job they brought me in to do.

I was asked to produce some pretty pictures and my contract was not renewed.

Re:Getting paid for things that don't work.

[Anonymous Coward]

Nobody in their right mind would agree to that sort of contract. Because any cock-up here is as much a result of shifting requirements as it is incompetence on the part of the suppliers, and that's always the problem with massive government IT projects.

Re:Getting paid for things that don't work.

[shortscruffydave]

I was involved with a UK government contract years ago which followed that sort of model. It was for a system which would interconnect offices across the whole of the UK, and there was a clause that payment wasn't released until at least ninety-odd percent of the user base had access to the system. As it happens, the job got canned part-way through, leaving the prime contractor in the position that they'd spent a lot of money, but not received any payment.

Re:Getting paid for things that don't work.

[Paradise Pete]

Maybe governments should start writing contracts that only pay up if a usable systems s delivered at the end of it ?

Sure, you can do that if you're willing to pay ten times as much for the work. And write a complete spec that never changes during the course of development.

Re:Getting paid for things that don't work.

[nedlohs]

Maybe governments should start writing contracts that only pay up if a usable systems s delivered at the end of it ?

For which they'd have to pay an order of magnitude more for, possibly more than just trying multiple times and ditching the failures.

And of course no one is going to sign up for it unless the requirement are written in stone at the start. Good luck with getting that to happen.

Re:Getting paid for things that don't work.

[Anonymous Coward]

Erm...this was on eof the ideas behind npfit. It has not been a roaring success

the usual pork barrel mess

[Anonymous Coward]

If you'd seen the design... shudder...
A mass of microsoft systems and sharepoint clusters, it just has MS stamped right through it. On a project which screamed foss, it was effectively locked out from participating by the contracts and design chosen.
Now x years later, the ms stuff has turned into the mess we all predicted when the pitches were happening. Plus its been so slow in delivering that meanwhile the world has changed around it and introduced new requirements...

Re:the usual pork barrel mess

[phonewebcam]

s/health/defence

The UK is once again in the ludicrous situation it was in of having actual government ministers go on TV and tell the country it's cheaper to go ahead and build pointless aircraft carriers than stop the projects right now. We see once again the level of courage they had with the banks - who just announced *bonuses*, not investments or redundancy payments, freaking *bonuses*, of £14bn - paid for by the real workers. Announced co-incidentally the day the Murdochs were publicly grilled, so it got little coverage. Thank goodness it's not their money.

I, Pencil: My Family Tree

[Coolhand2120]

Once again, this proves anything that needs to get done, gets done, privately (doctors implementing their own electronic database) without the need of government. The government's version is more costly, inadequate, corrupt, full of nepotism and fraud. The private system does what needs to be done without the heavy hand of government, better, cheaper, faster. And all without the threat of force.

This reminds me a lot of the essay I, Pencil: My Family Tree. Anything that needs to be done can be done better in the hands of private free individuals.

Re:I, Pencil: My Family Tree

[digitig]

Once again, this proves anything that needs to get done, gets done, privately (doctors implementing their own electronic database) without the need of government.

Except it doesn't do what needs to be done, only the easy part of what needs to be done. It's fine as long as I only fall ill close to home, but if I need to see a doctor when I'm at the other end of the country, well fine, I can see a doctor, but they won't have access to my medical records.

Re:I, Pencil: My Family Tree

[Coolhand2120]

You're missing the point. When it becomes necessary to have your records moved around like that, and the need outweighs the cost, it will happen naturally by private hands. It is the path of least resistance. Anything else is going to be fulfilling needs that are not needed (unnatural), like the government providing an education to people who are starving to death.

Nobody is going to know the needs of a system like this better than the people who are running and implementing the system not some government bureaucrat with ulterior motives (nepotism, fraud, corruption) which so often occurs in government. Also, this costly venture by the government has taken away from the people (private industry) who had the best chance to make a usable portable format.

Re:I, Pencil: My Family Tree

[Anonymous Coward]

You know, except that after years and years, the private actors have ... an unholy useless mess.
Nice libertarian dreaming, but nope - letting the free (and wildly uninformed) market define standards is not the way to go either.

Re:I, Pencil: My Family Tree

[Spad]

Anything else is going to be fulfilling needs that are not needed (unnatural), like the government providing an education to people who are starving to death.

Yeah, fuck those guys!

Re:I, Pencil: My Family Tree

[digitig]

You're missing the point. When it becomes necessary to have your records moved around like that, and the need outweighs the cost, it will happen naturally by private hands.

And what would the driver for that be? I have the need, the doctor bears the cost. Sure, the the people who are running and implementing the system know the needs of the system better than some government bureaucrat, but they have no incentive to meet them. Your sort of free-market libertarianism doesn't seem to have an effective mechanism for dealing with negative externalities.

Re:I, Pencil: My Family Tree

[Coolhand2120]

And what would the driver for that be?

I'm glad you asked!

Your need is the driver . Believe it or not, your doctor is trying to serve please you. Adding value added services like portable records do this. And draw your business away from doctors who don't implement this technology. If a doctor not implementing the technology loses too many patients they either a) implement the technology or b) go out of business. Both courses are totally natural and not compelled through the use of force.

How many countless times have you heard private industry boasting technological improvements to ease your life? Do you deny this constant drone of technological improvements being advertised by service providers vying for your business?

Your need is the driver . That same thing that causes all private industry to improve! Read the (very short) essay I, Pencil: My Family Tree I posted earlier, it explains these interactions in detail.

What sort of strange world do you live in where you trust your life with someone who you don't trust with the money you pay them?

Re:I, Pencil: My Family Tree

[Coolhand2120]

The private industry is bad to the extent that the government has fettered the free market. For instance in the U.S., the government prevents the sale of health insurance across state lines. It causes much less competition and drives up prices.

In the healthcare industry the government regulates everything making it difficult to business at all, because of all the bureaucratic red tape a roll of micro-porous tape that you can get at CVS for $1.50 ends up costing $25.00, and who pays for that? Certainly not the government.

Now lets add the lack of tort reform, allowing for fraudulent lawsuits and ambulance chasing lawyers (the democrat party base) to sue doctors for things like "My child had autism and I blame the doctor for not performing a cesarean section" further driving up costs of private health care.

Next lets add the way the government 'fixes' the medicare price of procedures and does not allow the doctor to charge what he thinks is a reasonable rate for the procedure. Of course 99% of the time the government's rate is much lower than you would charge a private individual, and that's mostly because the loss on government medicare patients is recouped in the cost on privately insured individuals. The end result of this is doctors charging more, and providing less because they are being paid less by the government.

The government takes money from everyone to provide health care for a minority of the people (medicare, medicate, medical) who cannot afford this care- that money, for the most part, would be better off in private individual's pockets some of which would go to pay for better healthcare. I know way too many medicare recipients with $4000 computers.

I could go on and on about how the government fetters the free market system and drives costs up, but I think you get the point. For a 'free market' there is quite a lot of government in there!

Re:I, Pencil: My Family Tree

[digitig]

Your need is the driver . Believe it or not, your doctor is trying to serve please you.

I'm sure my doctor is -- she seems to be a nice person. But I'm not sure I would be her choice of charity donation.

Adding value added services like portable records do this. And draw your business away from doctors who don't implement this technology.

My doctor has pretty much all the business she can cope with, and so has no incentive to draw more business. Besides, I would need to know when choosing a GP everywhere that I might visit in the future, to check that they had data sharing with doctors there. Doesn't work.

What sort of strange world do you live in where you trust your life with someone who you don't trust with the money you pay them?

Perhaps you should read the original article, and learn that it relates to the UK, and that I don't (directly) pay my doctor. The good news for me is that I only pay (through taxation) a small fraction of what folks in the USA pay, for comparable health outcomes (or have the costs gone down significantly with Obamacare?). You see, your system only works if there is an oversupply -- the good doctors have significant spare capacity -- which is inherently inefficient. And, as I said earlier, it doesn't deal with negative externalities.

Re:I, Pencil: My Family Tree

[Arivia]

I can make words bold too. Fuck off, troll.

Re:I, Pencil: My Family Tree

[CrimsonAvenger]

(or have the costs gone down significantly with Obamacare?)

Latest I've seen show indicate that costs are going to go UP significantly with Obamacare.

Of course, part of that is that Obamacare included Medicare cuts as part of the cost-balancing, and the Medicare cuts are unlikely to actually happen (in general, contrary to popular rumour, Medicare cuts in the budget don't happen, because Medicare payouts are low enough now that many doctors won't take Medicare patients) since that would cause even more doctors to refuse to take Medicare patients (slightly misleading: they cannot, by law, ditch an existing Medicare patient, but they can (and do) refuse to take NEW Medicare patients).

Re:I, Pencil: My Family Tree

[tazan]

It hasn't happened yet and it's not likely to on its on. I just had records from my doctor sent to a specialist. It took 6 weeks. There's no incentive for my doctor's office to speed this up. If anything the incentive is to make it more difficult so you won't change doctors.

Stupid start to it anyway

[Anonymous Coward]

They SHOULD have started with defining an electronic format that all the records could be stored in.

THEN pay for a project to convert the documents into that format. And while that's underway, work on letting each trust work out who would do the work to get a product reading that format.

But no, they wanted the whole lot done in one go.

Because a project that big looks important and can ONLY be solved by a vast corporation.

Re:Stupid start to it anyway

[Kalriath]

Actually, the worst part is that healthcare IT has very good specifications already. In fact, all the standards needed to implement a system like this with maybe half a million pounds (initial buildout - scaling would of course cost more) exist. HL7, CDA, and multitudes of other specs already solve all the problems with storing EMRs, and there's several solutions already from some big name vendors already to solve the problem (where I work, we use Agfa).

Re:Stupid start to it anyway

[Anonymous Coward]

Agreed - the specifications are already there and that's where the government should have left it. They should have mandated that any medical company which wished to join the NHS programme must implement those specifications (perhaps even specified UI guidelines so that doctors could use different systems without having to re-learn those systems) and then left it to the medical companies to slug it out and compete for contracts on a local level. This would have promoted competition amongst the existing suppliers as they would have to ensure their system complied in order to continue to make sales.

Instead of this they became convinced that to do it right the whole software infrastructure had to be homogenised and this job could only be managed by big companies (BT, Accenture, Fujitsu etc) who were brought in and paid billions to do what the smaller companies were already doing.

Instead of GP's and hospitals being allowed to purchase their own system (as happened previously), they were forced to use whatever system the Health Authority for their area had chosen to use (i.e. whichever big company had been awarded the contract for that area). Some of these systems hadn't even been written yet, yet established systems which GP's were happy with were being thrown out to make room them!

And now several years down the line people are finally waking up to the fact that this whole idea was rotten from the start, yet the big companies are still able to walk away from the mess and take a whole load of money with them.

The architects of this farce should be lined up and shot and the Government should never ever award contracts to BT, CSC, Accenture or Fujitus ever again.

Socialism Sucks

[Coolhand2120]

This reminds me of what Frederick Bastiat (1801-1850) said of the subject Socialism. Below is a link to his complete book "The Law" (in HTML format) and the specific part it this article reminded me of. The UK government in this situation is (attempting) to fulfill a need of society by commissioning the construction of a piece of 'public infrastructure' that the government deemed the society needed. A rather costly venture to be sure. But from whom did the government take this money? It takes it from the people who would have otherwise been implementing what was really needed, and who eventually did with what little the government left them.

The natural course of things, what Leonard E. Read called "the invisible hand", would have created the fully digital medical system that the government legislators commanded through the threat of violence (pay your taxes or else!) that an unnatural (Sc. useless, uncalled for) system be created. The end result, as so many other government ventures end, was a mess so epic that only the forceful hand of government could compel otherwise intelligent individuals to such total folly.

From The Law by Frederick Bastiat.

The Vicious Circle of Socialism

We shall never escape from this circle: the idea of passive mankind, and the power of the law being used by a great man to propel the people.

Once on this incline, will society enjoy some liberty? (Certainly.) And what is liberty, Mr. Louis Blanc?

Once and for all, liberty is not only a mere granted right; it is also the power granted to a person to use and to develop his faculties under a reign of justice and under the protection of the law.

And this is no pointless distinction; its meaning is deep and its consequences are difficult to estimate. For once it is agreed that a person, to be truly free, must have the power to use and develop his faculties, then it follows that every person has a claim on society for such education as will permit him to develop himself. It also follows that every person has a claim on society for tools of production, without which human activity cannot be fully effective. Now by what action can society give to every person the necessary education and the necessary tools of production, if not by the action of the state?

Thus, again, liberty is power. Of what does this power consist? (Of being educated and of being given the tools of production.) Who is to give the education and the tools of production? (Society, which owes them to everyone.) By what action is society to give tools of production to those who do not own them? (Why, by the action of the state.) And from whom will the state take them?

Let the reader answer that question. Let him also notice the direction in which this is taking us.

Re:Socialism Sucks

[splutty]

I'm sorry, but you particular view of the world breaks when people need to work together that have no reason to work together other than that 'The People' would like them to.

Localized private companies don't want to invest money in being able to exchange data with other localized private companies (possibly in a completely different country), since they don't have any use for such a system.

And if you get hit somewhere where the local company doesn't have coverage, and you unfortunately die because you're hyper allergic to penicilline.. Well. That's not their problem, now is it?

That's what you have government for, to have some sort of control over all the little fiefdoms. Although I agree with you that what government tends to do nowadays is far overreaching.

Re:Socialism Sucks

[itsdapead]

The UK government in this situation is (attempting) to fulfill a need of society by commissioning the construction of a piece of 'public infrastructure' that the government deemed the society needed.

Actually, the real problem in the UK is that, because, since WW2, we have alternated between socialist and capitalist governments, we have ended up with an infrastructure that sometimes combines the social conscience of capitalism with the freedom and efficiency of socialism. We have socialist structures that conservative governments hate and want to fail, but can't openly abolish because the voters actually rather like them (and know damned well that even if they were abolished, we'd only see token tax cuts). We get public money used to engage private contractors, and "commercial confidentiality" use by the government to avoid public scrutiny. We get road and rail transport nationalized by a socialist government, then the profitable bit (road) privatized by the next while rail goes to hell, finally we get rail semi-sold off in a bizarre kludge where one company owns the rails and other companies run the trains on ridiculously short franchises that deter any investment. We get nonsensical "internal markets" set up in the NHS whereby public bodies are supposed to compete like private companies...

Probably the best solution to the NHS would have been to set up a quango which employed its own development team to produce its own system based on an open data exchange standard. A socialist solution to a socialist problem: put taxpayers money in, get a bit of public infrastructure out. Instead, we get a half-baked mix of government bureaucracy and private contracts with "for profit" companies.

Re:Socialism Sucks

[Coolhand2120]

Name a single example where private individuals failed to step up to the plate and deal with a real problem?

Today, if I change doctors, and I have numerous times, they request information from my last doctor, this system, that has been around for as long as doctors have been around, has yet to fail me. As far as allergies are concerned, people with unusual or extreme allergies carry around a medical bracelet or necklace that describes the allergies. Furthermore, if you cannot be identified because you are without ID and unconscious, the bracelet would be far more valuable than a unfetchable medical record.

The Electronic health record has been around for a long time, with numerous private sponsors and a half dozen viable standards for use. And now the government wants to "revolutionize medicine" by giving us "electronic health records" as if the private industry hasn't been doing this for decades. Oh and by the way, we're paying for the government to invent "electronic health records" as if it didn't exist. Do you really think that govenrment buricrats are going to contrubute to this system? I think they will decimate it as they do with everything else they touch.

But if you still think the "government way" is better, check out the number of private companies offering:

• 1) standardized medical record exchange between different vendors.
• 2) portable medical record devices.
• 2) electronic medical record keeping systems.

Now, compare this to the number of government's anywhere offering any of this. Draw your own conclusions.

Re:Socialism Sucks

[Coolhand2120]

Rather than experiment with individuals, why not let the natural course of things take place? You seem to agree that the government can only bungle things, so wouldn't it be better if they were to just step back? Government interference in any industry turns that industry from natural order to chaos by substituting the laws of nature with their own versions, causing uncertainty and inefficiency.

I fail to see the value added by having the government do things that the private individual is perfectly capable of doing himself and better. Is everyone so stupid that they cannot do anything without the forceful hand of government and the infinitely intelligent legislators? And if the people are so inept, how can they be trusted to elect intelligent legislators? That's vicious circular logic of socialism.

I also cannot think of a single example, national defense and courts not withstanding, where the government can do a better job than private industry. In fact, I challenge you to find me a single example..

I patiently await your reply.

Re:Socialism Sucks

[Dog-Cow]

Pollution.

Re:Socialism Sucks

[__aarzwb9394]

Name a single example where private individuals failed to step up to the plate and deal with a real problem?

I presume you are American.
Your country has large numbers of people who cannot quit jobs they hate because they need health insurance from a large employer. They cannot consider working for a small business. (This is the experience of someone I know directly.)
Large numbers of your population have no insurance at all.
Your country won't have decent public transport because it's for teh commies. You would rather fund the arabs more than use more efficient transport.
Let me guess - these are not "real problems" ?

Roads in areas without dense population in my country won't be paid for without taxpayers, people who live in rural areas of my country benefit from subsidy from the more densely populated and "profitable" areas.

Interestingly, here in civilisation people did stand on the crease and solve the problem like the brave individuals they are - they elected successive non-libertarian governments.

The Sacred Market (Blessings and Peace be upon its Holy Name and Works) is part of the mental framework that you use to justify your utter selfishness.

Re:Socialism Sucks

[Anonymous Coward]

I live in the UK and i am no fan of the NHS, its outcomes are some of the worst in the western world and the staff in my experience are rude, unsympathetic and terminal jobsworths.

I now have private medical insurance for my family due to the utter incompetence of the NHS, if I or someone i loved were ill i would genuinely be frightened for their safety being treated in an NHS hospital.

Re:Socialism Sucks

[__aarzwb9394]

Roads.
Public transport.
Water supply.
Government built the telephone networks originally in this country, then handed the network to a private monopoly in the late 80s. BT was very profitable at that time.
Not sure if any advanced country has an entirely laissez faire education system? (Private primary and secondary schools have a much easier job - they cherry pick clever children and can discipline and eject the real troublemakers.)

Public service broadcasting provides much better news than conglomerates.
BBC radio is vastly superior to anything on commercial radio. (It does come from an unfair charge - licence fee paid by anyone who owns a TV, regardless of how much bbc they watch or listen to.)
Public libraries (now becoming less used because of the internet, of course.)
Police - I think most people wouldn't want that to be a for profit enterprise.

Some people can understand that the profit motive will not lead to providing all services to all people. Talking to a libertarian is like talking to a religious fundamentalist.

Re:Socialism Sucks

[Anonymous Coward]

Anecdotes aren't data, but to provide a counterpoint, I live in the UK, and without the intervention of the NHS, I wouldn't live anywhere.

Re:Socialism Sucks

[Coolhand2120]

99% all solutions for pollution in existence today have come from the labor of private individuals, without being forced to do so by the government. How can you government is superior? Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using? A car that runs on air? What is this thing that the government has that you think private industry is incapable of possessing?

The strictest socialist government in the world is also the world's worst polluter, while most free market companies promote their 'green initiatives' without force from the government. Why? Because they think it will help promote their public image which will result in more profit. Because their customers demand it. The solution to smog did not jettison as a projectile from a government gun, but though talented engineers in private companies. Do private companies pollute? Yes. Does the government pollute? Yes. Is the pollution of one somehow inherently less toxic than the other? At least with private industry polluting there is recourse if their actions have harmed you. Can you say the same about the government?

Re:Socialism Sucks

[Coolhand2120]

You present a false choice though. You imply that if NSH wasn't there that doctors would not exist for some reason. I contend that doctors practice in spite of NHS.

Re:Socialism Sucks

[Anonymous Coward]

Not quite - what I mean to imply was that if my life-sustaining neonatal incubation wasn't provided by the NHS, it wouldn't have been provided by any doctors due to lack of payment etc.

Not entirely evidenced, of course - which puts it on equal par with your own contention,

Re:Socialism Sucks

[NeutronCowboy]

99% all solutions for pollution in existence today have come from the labor of private individuals,

Citation needed.

Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using?

Strawman.

What is this thing that the government has that you think private industry is incapable of possessing?

Rhetorical question, based on complete ignorance of the reason behind government.

The strictest socialist government

Citation needed that that is China (on multiple levels).

in the world is also the world's worst polluter,

Citation needed.

while most free market companies promote their 'green initiatives' without force from the government.

Citation needed.

Because they think it will help promote their public image which will result in more profit.

Citation needed.

The solution to smog did not jettison as a projectile from a government gun, but though talented engineers in private companies.

Citation needed.

At least with private industry polluting there is recourse if their actions have harmed you.

Citation needed.

Can you say the same about the government?

Rhetorical question, based on complete ignorance of how government works.

Wow, that was fun. You made every factual statement up out of whole cloth, and are ignorant of the most basic premises behind government AND private enterprise.

I'm sad to say, but you're a shining example of what passes for a Libertarian in the US: Ignorant and full of strawmen and rhetoric based on ignorance.

Re:Socialism Sucks

[NeutronCowboy]

You present a false dichotomy AND a strawman. In one sentence. Clever. To spell it out for you: Doctors existing does not imply access to doctors. NHS doctors existing does imply access.

Re:Socialism Sucks

[Anonymous Coward]

And, even given all it's faults, the NHS itself is massively more cost-efficient than the American system.

Re:Socialism Sucks

[Coolhand2120]

Your country has large numbers of people who cannot quit jobs they hate because they need health insurance from a large employer. They cannot consider working for a small business.

The same can be said in reverse. Some leave their jobs to go to a job that has better health care. At least we have a choice. Tell me what your plans are when you find that your health care is poor? And BTW when was the last time you visited a dentist? I pay $150.00/yr for dental insurance through Delta Dental, I pay $20 for a visit, $10 per filling $80 for a crown. I have a cavity so I made an appointment two days ago for today, I could have gone yesterday. I'm just wondering, how long does it take for you to get an appointment with a dentist? The insurer with most denied claims in the U.S. is Medicare, not a private insurer. I already know who is the largest denier of claims in the U.K. and it dwarfs the number in Medicare. I guess there's something to this whole "pay for goods and services" thing. It sort of gives people an incentive to do things. Meanwhile in the socialist countries you rely upon what? The goodness of the doctor? What exactly makes people want to become doctors in the UK? The 8 years of school? The cost of the schooling? It's certainly not the big payout when they get a job like here in the U.S.. But I guess that's why the U.K. has severe shortages of doctors.

Large numbers of your population have no insurance at all.

Anyone who wants health care in this country gets it. Period. Everyone in the U.S. pays into medicare and medicaid. These are for retired/injured and poor respectively. The percentage of people with healthcare in this country is around 97%. That's if you don't count 1) people who have never applied to medicaid/medicare 2) people between providers 3) illegal aliens. These three groups account for about 15% of the uninsured. Another 3% truly cannot obtain insurance for some reason or another. A lot of the time however that reason is often the government preventing them from obtaining insurance, for instance by preventing the sale of insurance across state lines.

Your country won't have decent public transport because it's for teh commies. You would rather fund the arabs more than use more efficient transport. Let me guess - these are not "real problems" ?

There's more socialist logic. Presenting a false choice. So if the government runs things they don't "fund the arabs"? In fact, government tampering with the right to drill for oil domestically is what makes us resort to "the arabs" as you call them in the first place. The enviro-socialist logic being: even with looser environmental controls, that's the "arab's" earth, not ours so our earth isn't harmed.

We are free do do what we want, some people want public transportation and some people want to drive a car. It's called freedom. And how little you know about where I come from. I live in California, the state with the least public transportation among the 50 states. It is said we enjoy driving, and indeed I do. I have a very fast sports car that gets really bad gas mileage, but it makes me happy to drive it, and I happily pay more for that right. But in spite of this and the fact that California has half the population of the UK, we have massive public transportation systems that dwarf the UKs. These systems not only can take you from anywhere to anywhere in this state but from anywhere in this state to anywhere in the union. Here in Long Beach, CA we have the Long Beach Transit, we have the Orange Country Transit and about three or four other independent transit companies operating public bus lines. And that's not counting private companies like grayhound or yellow cabs. We have so many damn bus lines in Long Beach someone thought it clever to even have a UK style double bus line, just for fun. There's also th

Re:Socialism Sucks

[Coolhand2120]

Where did you get that I implied access to doctors? Or didn't? I made no inference in either direction. I stated that the lack of NHS does not mean that doctors cease to exist. And what's the straw man argument I presented? That doctors operate in spite of the NHS? I think that's a pretty widely held position among doctors in the NHS, not that I've taken a poll or anything, but it's hardly a straw man argument, mostly because it isn't even an argument! But if you need proof of this non-argument, look at the severe shortage of doctors in the UK as proof of a less than desirable environment for doctors.

Re:Socialism Sucks

[mikechant]

I also cannot think of a single example, national defense and courts not withstanding, where the government can do a better job than private industry. In fact, I challenge you to find me a single example..

The NHS provides a reasonable level of healthcare to the *entire* population at a cost per head of about 60% of the US system.
I realize you will not accept this because of your ideology, but it commands a *very* high level of support from the UK population which is why right-wing parties who wish to get elected in this country *have* to pledge to defend the NHS (at least the basic principle - free to all at the point of use, paid for from general taxation).
In many countries in Europe even with most of them having right-wing governments, healthcare *is* regarded as a basic government service as important as the police or the army.

I assert that in the UK, the government does a better job of healthcare than the private sector would. I can't prove it of course (as the alternative is obviously untried in the UK in modern times) and you will no doubt rubbish it. But a large enough majority of the UK population agree with me to ensure its future indefinitely, including many of those who wholeheartedly supported the privatization of nearly every previously state owned industry in the 80's/90's.

Re:Socialism Sucks

[itsdapead]

I also cannot think of a single example, national defense and courts not withstanding, where the government can do a better job than private industry. In fact, I challenge you to find me a single example..

I patiently await your reply.

Well, according to the WHO the USA spends more per capita on its nice capitalist healthcare system (that the right wing parties are fighting so hard to defend) than any other country, including all the free healthcare systems.

Of course, because that money isn't taxes that's fine and dandy, and everybody has the Gawd-given freedom to cross their fingers and hope they don't get ill.

But I guess middle-class Americans do have good teeth.

Oh, and a few years ago, most of the world listened to the ultracapitalists and removed lots of regulation from the financial industries.

That went well.

What with all the bail-outs needed to keep the credit flowing, is there any truly private industry left any more?

Re:Socialism Sucks

[NeutronCowboy]

Ignorant AND stupid. Libertarian indeed.

The point that you keep missing - I still don't know if that's deliberate ignorance or not - is that the AC was referring to the fact that without the NHS, he wouldn't have ACCESS to doctors. Something that is very different from doctors not existing, but that has the same impact for him.

I'm sure the next thing you're going to trot out is that it's his own fault that without the NHS, he wouldn't have had the money for a doctor. I mean, infants should be personally responsible for their health care, right? And if they aren't, they should definitely pay for the sins of their clearly worthless parents.

Libertarians, I swear.

Re:Socialism Sucks

[Coolhand2120]

Since the government in the U.S. does not control or own any industry, it follows that all innovations for any industry come from private industry. I was being kind when I gave the government %1, but I would say the burden of proof is on you to prove the 1%, the 99% is self evident. The DOE does not make anything the EPA does not make anything. If you still need a citation, I'll need to know how you want me to quantify it. I assure you, no matter how you count it, innovation belongs to private industry.

Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using? Strawman.

No, this is not a straw man, this is in fact the core of the argument. I need to know why you think the government can do "it" better than private individuals. What does government posses that private individuals do not?

Rhetorical question, based on complete ignorance of the reason behind government.

I have read more volumes about government than I even care to list here. From Plato to Hobbes to Locke and just about everything in between. Literally dozens of books including ones that I disagree with like Bossuet, Blanc and Marx. That you declare my ignorance on the subject based on that statement speaks volumes about you.

in the world is also the world's worst polluter Citation needed that that is China. The strictest socialist government Citation needed that that is China (on multiple levels).

I guess you've never been to China.

China is the world's worst polluter nation with the highest overall annual emission of greenhouse gases (6,018 million tonne).

And it really does suck: Environment in the People's Republic of China. Did you know, that in China, they use what's called night soil? That is, they use human fecal material to feed their crops. Now, I'm not sure how you quantify "strict'. So here's a try Highest number of people annually executed, massive Religious intolerance the adoption of the Communist form of socialism, the strictest form of socialism, dictating the eradication of all other political thought. I can go on if you require more citations. Ever hear of Tibet?

while most free market companies promote their 'green initiatives' without force from the government. Citation needed.

Here's about 25.7 million You can go though them. But I'm telling you now, it would be more difficult to find a company that doesn't have some sort of "green initiative"

Because they think it will help promote their public image which will result in more profit. Citation needed.

All of the results from the link above were about companies trying to promote their public image through green initiatives. And they do speak for themselves.

The solution to s

Re:Socialism Sucks

[Coolhand2120]

I cannot argue with fact, other than to say, we spend more money and get a better product. We have more MRI machines per patient, shorter wait times to see a GP or a specialist. Really a better quality of service all around. And the best part is if you don't like the health care system you're in you can switch. It is not a coincidence those with money go to the U.S. to get treatment. The U.S. creates more innovate drugs and procedures than any other country. More progress has been made in the U.S. to cure disease than any other health care system anytime in history. If requested I can provide citations for each statement. It even sounds like the most expensive too . On the other hand, a week doesn't pass without reading about some horror story out of the NHS, the same cannot be said for the U.S. system. And not only do the middle class have good teeth, with insurance as low as $150/yr everyone has good teeth, that is if they care to go to the dentist that is. (more doctors = more competition = better service and lower prices) And if you don't have enough money, you've just qualified for medicaid! Now your healthcare is free! I'm going to guess you're from the U.K. So it may be strange to you to find out that we have TV commercials made by dentists (and of course other doctors) vying for your business.

Oh, and a few years ago, most of the world listened to the ultracapitalists and removed lots of regulation from the financial industries.

What regulations were removed? There were no loosening of regulations. If there was show me the citation. There isn't a more regulated system than the ones in place for financial institutions. The reason for the collapse, if you care to go back and find out, is largely due to people defaulting on home loans to GSA's (government entities) that the government forced down private banks throats. Because they were GSAs they were not subject to the regulation of the FTC, but to congress, under the stewardship of Chris Dodd and Barney Frank. They first encouraged giving loans to minorities who otherwise would have been turned down (due to poor credit rating) and discouraged any sort of audit of Fannie or Freddie who eventually admitted to "cooking the books". But don't take my word for it, do a little reading.. Increasing regulation in an already over-regulated industry to combat government agencies that were not even subject to the regulation in the first place is just wrong. The reason this is 'so secret' is that the main stream media is overwhelmingly liberal and the idea that the GSAs can fuck something so bad doesn't fit their ideology so they report on it as sparingly as possible.

Re:Socialism Sucks

[NeutronCowboy]

Since the government in the U.S. does not control or own any industry, it follows that all innovations for any industry come from private industry.

Only by a very narrow definition of industry and control. What do you call SEC and EPA regulations?

Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using?

Do you know what a strawman is? It's an argument that no is making, created for the sole sake of knocking it down. The quote is a strawman, because no one is making the argument you're making.

What does government posses that private individuals do not?

Really? You're asking that question? I'll just put out a really, really obvious example: what's more effective, a private individual shooting at trespassers, or the US Army shooting at trespassers?

I have read more volumes about government than I even care to list here.

Notice I didn't say anything about your reading habits. Merely about your knowledge. The two are not identical. Quite obviously so, in your case. And for the record, I probably read more than you.

Stuff about China

I'm shocked that you actually have citations. Too bad you didn't read them. Your rediff link, for example, points out that there are multiple definitions of polluters, and under one of them, Australia is actually ranked #1, and China #44. Things are never as easy as they look. This is no clearer demonstrated than with capital punishment and imprisonment. Did you know that the US has more prisoners per capita than China? I'll just point at Wikipedia, since you seem to be fine using that as a source (I'm sure you know it really isn't). China is so big that a lot of national numbers are misleading. Finally, you clearly didn't read the Wikipedia entry for Communism, because China isn't communist. It very much is its own form of government, rooted in a few thousand years of government and philosophical traditions.
Again, it goes to show that reading is not the same as understanding.

Here's one for you to get started "mesothelioma lawyer"

And why is that effective? Because of government laws. Find me something that shows you have guaranteed recourse outside of getting any government agency involved - recourse being made whole.

Google link

Google is not a source. Don't be lazy.

Ever hear of the right of citizens to redress grievances [wikipedia.org] with the government?

So you're saying, it kinda works like lawsuits or anything else? Shocking. Furthermore, I was looking for something much simpler. Look up the concept of voting.

I've backed up 100% of my assertions with facts.

Yeah... about that. Your sources didn't even support the assertions you were trying to back up with them, if they didn't flat out contradict them. Good job.

And to that end, I suggest you honestly sit down and read The Law [constitution.org] It's not even 50 pages long if you double space them, and in the time it takes to argue with me, you can read one of the books I draw my arguments from and sort of "skip the middleman".

I find Proudhon more convincing than Bastiat, which isn't saying much. Bastiat, while certainly able to see the fallacies of socialism taken too far, is unable to follow his own arguments to their logical conclusion. Furthermore, he commits the sin of building a great theoretical construct of the law that completely ignores the realities of human nature. You can argue that we should all aspire to be great people, but the reality is that most of us aren't, and will never be. As a result, his basic premise that government non-intervention will always lead to the optimal human development is a complete non-starter, and renders his entire concept unworkable. In that sense, I find him actually worse than Rousseau. At least Rousseau's Candide has a certain poetic and literary charm.

Re:Socialism Sucks

[ColdWetDog]

Now, compare this to the number of government's anywhere offering any of this. Draw your own conclusions.

The conclusion I draw is that your insane libertarian fantasy is just that. For all of these wonderful little demonstrations you've quoted, I don't see EHRs rolled out in a standardized fashion anywhere. If you are correct, there should be some evidence of interoperable EHR adoption by now. Got any takers?

The VA (standards based) doesn't talk to Kiaser nor Giesinger nor Mayo nor even the military system. In your wonderful fantasy land I would expect the VA (US Veteran's Administration, government run) to interoperate with the US Military medical system at the very least. Currently, if you are the local US Coast Guard Clinic and you ask the local VA hospital for a patient's medical record you do get them in a more or less electronic fashion - they're faxed over. Not even plain text computer to computer capture like secure e-mail. Faxed. A presumably dead technology.

There are small demonstration projects. There are NOT large scale build outs. EHRs are (relatively) easy to create for individual hospital / clinic systems. They are very hard to do nation wide. It should not be as hard as it is, but that mostly has to do with the inefficiency of the government in dealing with complex problems. However, your solution of letting the market sort it out has led to no attempt at a solution because there isn't any money in it. And no, claiming to offer an interoperable EHR as an additional 'service' won't cut it - certainly hasn't yet.

Leave the magic wand waving to Harry Potter films.

Re:Socialism Sucks

[Coolhand2120]

Ignorant AND stupid. Libertarian indeed.

You sound to me like a 14 year old. Now you may not be 14, but that is how a 14 year old sounds, not a civilized adult. I will respond to you only in an effort to educate you, but really, there is no reason to be so childish.

The point that you keep missing - I still don't know if that's deliberate ignorance or not - is that the AC was referring to the fact that without the NHS, he wouldn't have ACCESS to doctors. Something that is very different from doctors not existing, but that has the same impact for him.

And the point that you keep missing is that he would have seen a doctor in the absence of NHS. NHS does not have a monopoly on doctors. NHS does not have a monopoly on "free" health care. Using your logic, if NHS didn't exist, everyone in the UK would suffer and die if they required a doctor because only the NHS can provide ACCESS to doctors. Using the same logic a tyrannical dictatorship is good because they provided ACCESS to the fire department that put the fire in your house out (fire departments exists in non-dictatorships also so the dictatorship deserves no special praise). NHS and doctors are not inseparable. For instance, in the U.S. we don't have NHS but people in need can ACCESS a doctor free of charge. As far as infants go, in the U.S. we have a safety net called medicaid for people who cannot afford insurance. There isn't a child in the U.S. that goes without medical care. My whole argument is this: NHS didn't save anyone's life, a doctor did. If NHS never existed, a doctor would still save his life And because this is totally hypothetical, I theorize they would have done a better job.

You seem to argue "only NHS can provide ACCESS to doctors", but you must admit that were the NHS to have never existed, something else would be there instead, and no matter what's there, the doctor is the important part, not the government. The government can only hamper and confuse this relationship as they have absolutely nothing to do with it.

Doctor: Your tooth is toast, you need a root canal.
Patient: When can I come in to get that?
Doctor: I don't know, I have to ask the government.


That may sound stupid, but that's NHS. Now in the U.S. the conversation goes like this:

Doctor: Your tooth is toast, you need a root canal.
Patient: When can I come in to get that?
Doctor: Tuesday.

So what exactly is the value added by the government? Ya, I know, you'll say straw man, but that shit happens every day so it's hardly a logical falicy. British are down right famous for their poor dental care, and that is a direct cause of the NHS. When the government takes responsibility for healthcare, they must also take the risk of failing at it, as they have in the case of the NHS. (isn't this article yet one more example of their failure?)

I can't speak for the UK but in OZ they will refuse medical treatment to foreigners who cannot produce a credit card. My close friend was stung by a deadly insect called a "stinging tree" on a trip to OZ, and they refused him treatment for a life threatening ailment until he could produce a credit card, he almost lost his leg. In the end his mother was able to provide a CC over the phone to the hospital. In the U.S. if you're a doctor and refuse treatment to someone who is in dire need, you're going to jail. You cannot be refused service at an emergency room in the U.S. unlike OZ.

Also, non-citizens of this country have the same access and quality of care as any citizen has. Quality so good that people flock from all over the world to come to U.S. hospitals. It may be more costly than what you get in the U.K. but you really get what you pay for.

I hope this now totally refutes the idea that NHS saved him. Here in the U.S. he would have been saved even if he was a non-citizen in spite of our lack of an NHS style system. He's not being saved by the system, but rather in spite of the system. A good doctor, believe it or not, wants to cure disease.

Re:Socialism Sucks

[ColdWetDog]

we spend more money and get a better product.

You really did drink the Kool-Aid didn't you? Too much by far. "A better product"? By what metric? So you can get the MRI that you don't need faster? So you live longer (oopsie), so you have better prenatal outcomes (oopsie again), so you have better mental health coverage (damn, lots of oopsies).

The US health care system is an incredible, expensive, inefficient mess. Yes, part of this is the government's fault. Quite a bit of government intervention has come directly from attempting to reign in illegal (and extraordinarily immoral) practices by the 'capitalists' attempting to game the system.

But I suppose I'm just doing this to practice typing. You're so far over the deep edge on this, so completely off base that I think it would be best if you just switched channels and communed with Ms. Bachman or just went out target shooting with your Sarah Palin blow up doll.

Re:Socialism Sucks

[Coolhand2120]

Since the government in the U.S. does not control or own any industry, it follows that all innovations for any industry come from private industry. Only by a very narrow definition of industry and control. What do you call SEC and EPA regulations?

Useless. Just to give an example. One of my customers is a ceramics manufacture, the EPA requires that he have all sorts of licensees to do what he does, among those are two gems that I'll never forget. 1) Silica dust from ceramic manufacture (aka sand) is a nuisance dust and therefore the EPA needs $x.xx each year yet his factory is 2 blocks from the beach and sand regularly accumulates on the curbs around the neighborhood from the beach. What's the EPA doing to stop this "beach nuisance" and how does taking money from him help? and 2) the lead content in the glaze (there's lead in just about everything) has be to 1/1000th the amount of lead that is allowed in our drinking water. That's just personal experience, but look at what the EPA wants to do next. Regulate CO2. Hey you produce that! I wonder what great ideas the EPA has for that gas. But typically they just run amok doing things like this:

After 35 years of hemming and hawing over how to fix the largest estuary in the Western Hemisphere – the sprawl of canals, levees, and flood plains that join the Golden State's two river systems – the state has been told by a federal judge that business-as-usual is now illegal.

A new ruling to stop pumping up to 37 percent of the water that flows through the delta to protect endangered fish species has sent shock waves of concern into the three main sectors that have long competed for it: cities, farms, environment.

we may starve to death, but thanks to the EPA, the mud guppy will have a pristine habitat. That's right, the EPA sided with a tiny fish and threw 23 million people and 5 million acres of farm land to the wind. Why the fuck would they care? After all, they're the government!

Do you know what a strawman is? It's an argument that no is making, created for the sole sake of knocking it down. The quote is a strawman, because no one is making the argument you're making.

Yes, I know what a straw man is. And it's two words not one. The argument is made by government proponents all the time that the government can run certain industries better than the private sector, I included the word "magic" to try and drive home the point that the government has no additional capabilities beyond that possessed by individuals. But without explanation, people talk the "government is better" line. Therefore it is not a straw man argument.

Stuff about China

Yes, I did read the link, it says without equivocation that china is the #1 polluter that's why I gave you the link, it backs up what I said 100%. You talk about OZ is but the often cited study is talking about CO2, a gas without which all plant life on the planet would die, and not a pollutant in any way shape or form of the word pollutant ( you can breath it, it is not harmful to anything ). And you have the nerve to say it didn't support my arguments. Now, and after you finish reading this and tomorrow and the next day, China, will still be the #1 polluter and you cannot claim I was wrong when that was what I said no matter how much you want me to be wrong, I'll still be right. You can try and rationalize your assertion that OZ is polluting more than China, but you're going to look like a total fool doing it.

And why is that effective? Because of government laws. Find me something that shows you have guaranteed recourse outside of getting any government agency involved - recourse being made whole.

This is the only reason we resort to law i

Re:Socialism Sucks

[Coolhand2120]

You can't understand the usefulness of additional MRIs or the need to use them quickly? You know it's used to diagnose cancer, as well as numerous other diseases, which we in the U.S. survive at a much higher rates than anywhere else in the world. A lot of these diseases are time sensitive, so being put on a 4 month waiting list for an MRI can mean the difference between life and death. I know, I had cancer, the day I found my lump I was in an MRI.

I'm not sure what the cause of some of the statistics you point out are, but "government inaction" cannot be the reason, government cannot perform any medical procedures, they must coerce a doctor to do it. More likely government caused the poor statistics, almost half of our country uses "public health care" via medicaid/medicare/VA and the number one denier of procedures per capita is medicare.

Statistics are like a bikini, what they reveal is interesting, but what they hide is essential. It is a matter of fact that the best medical schools and university hospitals are in the U.S.. It is also a matter of fact that the U.S. spends magnitudes more in research and development than any other country. When a country wants a new doctor they send them to the U.S. to be educated. When a foreign head of state or a extravagantly rich person needs treatment they come to the U.S.. My question is: do you think they[super-rich] do that because of poor mental health coverage? Lower life expectancy? Inferior prenatal care? Or maybe it's because they are highly informed and were seeking the best care possible.

Re:Socialism Sucks

[NeutronCowboy]

Since you clearly can't make coherent arguments on your own, I'll just respond to your valid points.

Voltaire wrote Candide, not Rousseau, my apologies. What you missed though was that Candide is all about the human condition, albeit written in a form a bit less dry than Bastiat. And since the human condition is at the root of ANY discussion about government, it actually is a useful text.

You're also right that Bastiat demonstrates the logical fallacies in Proudhon's ideas. I just happen to agree with some of Proudhon's axioms more than with Bastiat's. Both though have significant problems in their argumentation. If you want to discuss them, feel free to actually read what I wrote.

As for the rest.....

Maybe if there wasn't so many instances were it appeared to me that you were lying I would take you more seriously.

I thought you were above insults? I actually directly referred to terminology used by Bastiat in his argumentation. How did you miss that? Maybe you're not as familiar with his arguments as you'd like to think?

All in all, this is about what I've come to expect in any argument with a self avowed socialist, so I guess I shouldn't be too disappointed with your deceit.

Self-avowed socialist? I guess I know where your ignorance comes from: you just make shit up.

Re:Socialism Sucks

[NeutronCowboy]

Just because it's kinda funny at this point...

If NHS never existed, a doctor would still save his life

Since the AC was an infant, he couldn't have paid the doctor. Assume for a second that his parents weren't able to pay, either. How does the doctor get paid, in the absence of a government or a corporation subsidizing individual health care? Do doctors work for free? If not enough doctors volunteer to work for free, do you require charity work them to perform charity work?

"only NHS can provide ACCESS to doctors"

Your use of quotes is incorrect. I said " he wouldn't have ACCESS to doctors". I know this is difficult, but stay with me: there's no indication in there that because someone's in set A (people with no access to doctors), set A is identical to set B (all people).

Now in the U.S. the conversation goes like this:

Doctor: Your tooth is toast, you need a root canal.
Patient: When can I come in to get that?
Doctor: Tuesday.

And this is the how the discussion goes on Tuesday:
Doctor: You owe me $2500. Your insurance covers half. You owe me $1250.
Patient: Here's my credit card.
Now picture for a second the situation (I know, difficult, but just try) where the patient doesn't have a credit card, or the bank account is overdrawn, or any other reason why the patient doesn't have the cash. The doctor just performed the operation for free. How often will he provide a free root canal? Never again. As a matter of fact, the patient won't be able to schedule an appointment with him until they clear their debt (exact time of cut-off of healthcare varies with doctor. but it will happen).

And just because this REALLY cracks me up...

As far as infants go, in the U.S. we have a safety net called medicaid for people who cannot afford insurance.

Wait. No. Way. You didn't just promote a government run safety net that takes from some to pay for the needs others, did you? Bastiat is spinning in his grave.

There are some truly hardcore Libertarians out there. I can respect their integrity. I might think they're loony, but they at least buy into every last consequence of Bastiat's theory of government. You, on the other hand....

Re:Socialism Sucks

[Coolhand2120]

Since you clearly can't make coherent arguments on your own, I'll just respond to your valid points.

My arguments are perfectly coherent, you just choose to ignore them. If you're bored and have more time I'd love it if you went back and argued some of them, I do enjoy it.

I thought you were above insults? I actually directly referred to terminology used by Bastiat in his argumentation. How did you miss that? Maybe you're not as familiar with his arguments as you'd like to think?

I apologize if you were not lying, I didn't mean to insult, I just found the inconsistencies piling up. I listed why I was skeptical of what you were saying and think it was sound reasoning. I don't want to drive you away with insults.

Self-avowed socialist?

Now, you did just say "I just happen to agree with some of Proudhon's axioms" who is a major league socialist. I thought that you were a socialist was understood. I didn't think you would take that as a pejorative. I certainly didn't make anything up. I'm basing my conclusions on a) your support of the NHS and the general line of argument you offer and b) your support of a guy who's famous saying is "Property is Theft!". I mean, what else can I take from that? What axiom of Proudhon's do you agree with that isn't overtly socialist? I estimate that he is the polar opposite of Bastiat (and sort of crazy). If you're not a socialist, than I can see how you might view that as in insult, but you must reconcile your support for Proudhon if you're not. Like Bastiat, I'm not a big fan of his.

What you missed though was that Candide is all about the human condition

My guess is you just read the wikipeda description of Candide that describes it as about the "human condition", but I will suspend my disbelief for the sake of argument. That's pretty general, I can argue pretty strongly that most all fiction is about the human condition, some more directly than others. I could just as easily say "Star Wars" is about government, it certainly examines the human condition in a much more articulate way than Candide. Candide was just chaotic, evil things happening for no reason, Candide abandoning El Dorado because he just wants to. His friend having her ass eaten by starving men, that's just gross. Then Candide abandons hope. And the great theme of the novel was "abandon all hope, existence is folly".

Now, how you draw any conflict or even a comment from Candide about Bastiat's work is puzzling. Bastiat is writen as a technical a priori argument, as if argued to a jury, about government, sort of like Locke's 2nd treatises on government or Hobbes' Leviathan. Candide doesn't support any form of government, except maybe the made-up-cracy in the fictitious city El Dorado, but Voltaire doesn't go into any detail about what form of government that is anyway. And I'm not sure what sort of government you can base "abandon all hope" on.

I actually directly referred to terminology used by Bastiat in his argumentation.

What do you mean? Can you cite an example from the book? I linked to the entire text.

As for the rest..

China
That's sort of a cop out. I'm certain you're wrong about China even though you're trying to weasel out of it. But you claim this point "an incoherent argument". It's a link, pointing to a source, where the first sentence confirms what I said. I can provide 1000 more links that say the same thing. You change the argument to per capita and then say "oh you're wrong". No, you changed the argument to say something I never said. Furthermore I really don't think per capita is important at all, China has millions of mud farmers that don't have electricity so of course their per capita is going to be low, that doesn't somehow make them pollute less, and that's

Re:Socialism Sucks

[Coolhand2120]

How does the doctor get paid, in the absence of a government or a corporation subsidizing individual health care?

Ya, that's right, the cooperation most of the time pays the doctor, but the cooperation is the hospital, not even the insurer, and maybe the hospital has to charge more to offer this 'free' service, so be it. I don't think the government needs to get involved though, they can only cause problems.

Your use of quotes is incorrect. I said " he wouldn't have ACCESS to doctors". I know this is difficult, but stay with me: there's no indication in there that because someone's in set A (people with no access to doctors), set A is identical to set B (all people).

In my quote I was assuming the subject was "him" and not all people. What I should have said was "only NHS can provide [him] ACCESS to doctors" I understood what you said. My point still stands. Even without NHS he would have had access to doctors, but this is purely theoretical, and the AC even confirmed that because "no NHS" is purely theoretical, both arguments for and against are equally sound. From the AC:

Not quite - what I mean to imply was that if my life-sustaining neonatal incubation wasn't provided by the NHS, it wouldn't have been provided by any doctors due to lack of payment etc. Not entirely evidenced, of course - which puts it on equal par with your own contention,

And this is the how the discussion goes on Tuesday:
Doctor: You owe me $2500. Your insurance covers half. You owe me $1250.
Patient: Here's my credit card.

Ya, but the costs there need to have their decimal points moved to the left one. And that's even if you can't afford the $150/yr dental insurance which would take it down to an even more trivial amount. Also, every doctor I've ever been too will take payments.

patient won't be able to schedule an appointment with him until they clear their debt

Which of course is better than never going at all the way the NHS does it. In the view of the NHS if a procedure is to costly, you just can't have it no matter what you say about it, or how bad it will kill you if you don't have it. I can provide multiple citations, but I'm sure you've heard the horror stories.

Wait. No. Way. You didn't just promote a government run safety net that takes from some to pay for the needs others, did you? Bastiat is spinning in his grave.

I was pointing out that even without a NHS, there are still other ways to get free healthcare. And I don't think Bastiat would throw a sick baby into the wilderness. You can't think for me or Bastiat. Just because we don't think that the government should provide services to the poor, does not mean we don't think services should be provided to the poor. And to that end there are literally hundreds of reputable private charities that are way more efficient in how they spend their money than the government is. So who is the compassionate one now? I would rather give all my tax money to the poor than a single cent to bail out GM, or pay for the health care of someone who has a $4000 computer and a 50" LCD. Government doesn't really give a rats ass what it does with your money, maybe some might make it to the poor, but it's sure as hell going to line the pockets of every politician and politician's friend before it makes it there.

Re:Socialism Sucks

[NeutronCowboy]

Mmh. Clear arguments. I can actually live with this. Onward...

On Proudhon

While there are certainly socialist tendencies in some of his writings, he is actually closer to a Libertarian or an Anarchist than a Socialist. He explicitly disavows communism and generally rails against against any power source that can cause someone to control someone else. The reason that I find him more coherent than Bastiat is that he correctly understands that the entire concept of property is completely arbitrary. He furthermore understands that property, as an exclusionary concept applied to limited resources, by definition creates inequality, and thereby leverage, of one person over another. This leverage is opposed to the concept of liberty and equality. Mind you that it isn't better or worse, but the concept of property destroys the concept that people are born equal in liberty and opportunities. Instead, their birth places them in a social and economic context. And since it takes arguably more to escape your social and economic context than it does to preserve it, a persons position in life has only marginally something to do with their abilities.

Proudhon vs Bastiat

Bastiat's main drawback is that he idealizes The Law, and completely fails to apply his idealized concept of it to any real world situation. Because in even the most basic application - that of group self-defense - his law fails to provide Justice in anything but the most convenient set up. At the most basic, imagine the following situation: a widget was posessed by A, but now is in the hands of B. Further assume that the event was only witnessed by person A and B. A cries theft, and invokes group self-defense. What is the proper course of action of the rest of the group? String up B? String up A? Why? You want more detail? Of course you do, as you should. Because suddenly, we get into contract law (did A give widget to B for service C?), judicial process (is A lying? is B lying?) and even that of feasibility (can B beat off the self-defense group on his own?). Compared to Bastiat's idealism, Proudhon is a downright cold calculator. Hence my preference for his line of reasoning.

Candide

Your guess is wrong. I actually have Candide on my smartphone (along with Descartes, Rousseau, the federalist papers and other free classics), and had to study it fairly extensively in High School. The phrase "human condition" is fairly common in French philosophical studies, and is a far more common term in colloquial French than it is in English. Wikipedia merely got common terminology right. For some reason, I always get Rousseau and Voltaire mixed up. *shrug*
Furthermore, just like "A modest proposal", it was explicitly designed to explore specific aspects of the human condition through satire - in this case, Optimism and its impact on life.
The comparison to Bastiat was a bit of a throw-away. I find Bastiat uninteresting, rehashing thoughts that had been better expressed by others before him, with little redeeming quality anywhere. While Candide has its own issues as a discussion of the human condition, it at least is entertaining. If a text can't be insightful, it better be entertaining. And the government they lead to is very similar: as small as possible, with individuals responsible for tending to their own small patch of influence. The difference is that Voltaire presents that life as hoping for minimal interference, while Bastiat prescribes minimal interference in the affairs of others.

On The Law

You were looking for where I got that terminology from. His phrase is: "If a nation were founded on this basis, it seems to me that order would prevail among the people, in thought as well as in deed." I'm pretty sure that "government non-intervention will always lead to the optimal human development" is a reasonable paraphrase of that. While it sounds nice in theory, practice disproves his conjecture. Furthermore his

Re:Socialism Sucks

[NeutronCowboy]

Just a few things, since it is getting late:

Ya, but the costs there need to have their decimal points moved to the left one.

Beats me - I based that on the cost of my crown, which was about $800 total, with me paying %50. And that's with Delta Dental. Maybe I need to talk to your employer about a job.

And I don't think Bastiat would throw a sick baby into the wilderness.

Again, I think you don't recall Bastiat as well as you think you do. To wit:
"This question of legal plunder must be settled once and for all, and there are only three ways to settle it:

1. The few plunder the many.

2. Everybody plunders everybody.

3. Nobody plunders anybody."

His conclusion is that the only acceptable position is 3., with 1. being given a pass if it is used to fight socialism. And I'm sure you are aware that legal plunder is his wording for protections, subsidies, tariffs, etc - anything that takes from one to give to another. He specifically calls out that the legal plunder is often enacted under the guise of philanthropy, but that it really is false philanthropy.

I'm glad you're not a complete hardass - but then you're looking for guidance from the wrong person.

Re:Socialism Sucks

[Coolhand2120]

I don't have an insurance plan from my work, I'm an independent contractor so I sort of own my own business (which really sucks). Delta Dental or something like that is all I can get, unless I want to shell out $250/mo for real insurance, and I would just rather spend that money elsewhere.

Again, I think you don't recall Bastiat as well as you think you do...

A the end of my blathering there are two quotes from The Law. Bastiat addresses philanthropy specifically in the second quote, and indirectly in the first. In the first example here he talks about how just because we feel that government isn't the answer, doesn't mean that philanthropy shouldn't exist, just that these institutions should not be controlled by the government. And you must readily admit that private aid organizations are a lot more focused on where there money is being spent because they had to earn it, meaning they didn't take it at the point of a gun. Aid organization are held to a very high standard, and are regularly audited and required to show how many cents on the dollar go to actual aid (vs. administrative overhead).

Compare this to the government's philanthropy. In my own life I know a person who owns several $4000 computers, multiple big screen TVs, has 3 kids, no job, and lives life 100% off the government tit. He pays no taxes. He pays no rent (the government pays that). He actually is paid money, by the government, simply because he has kids. So $0 in tax and they still give him money. This person is perfectly healthy and capable of working, but chooses not to. I went to high school with the guy and this was actually his plan way back then. Have more kids => get more money. And do you think the kids have a good quality of life with a dad like that? Do you think maybe if the government didn't encourage him to have children he wouldn't? I mean, they cost a lot more when you pay for them. IMHO an aid organization would never have given him a dime, they would see his devious nature (because, remember, they have to earn their money) and kick him to the curb, saving more money for people who are truly in need. And to show this problem is endemic and not just my own observation understand that almost half of all american's pay no federal income tax.

How much more money would philanthropic people have to give were the government to not take so much? How much wasted money goes to line the pockets of corrupt politicians (and friends) in the name of philanthropy? How many people could have been saved? If this is true then this is a really big deal.

Aid organizations are also more focused on a specific task. AIDS in Africa, give here, cancer research, give here. There's even organizations based on your religion or political ideology ensuring that your money would never go to support a cause that you find repugnant. I could continue and list all of the corruption and nepotism inherent in the socialist style of philanthropy, but I'm sure you're already familiar with them. The recourse for poorly spent funds within the government usually results in nothing, at best, a legislator might be sacked. On the other hand when a private aid organization is found to be spending poorly they simply cease to exist, the natural course of things.

In the socialist system, who gets to define who should and should not have money? What happens when the government cannot afford to give health care to everyone? Does it start rationing? Who do you give to first? Who do you take from? And when this transfer of wealth occurs, don't you think the people whom you've robbed to pay for another person will be pleased with the situation? More likely they will want to take over the controls of the government and bend them to their own will, and what vengeance they would seek if they seized power.

The chaos increases and questions only become more di

Re:Socialism Sucks

[Coolhand2120]

It appears I may have replied to the parent of your post. But I'm not sure, /.'s freaky ass system is always doing something ... freaky. It would be rather difficult to copy and paste all I wrote (formatting will disappear) so here's a link to my misplaced post: Re: Socialism Sucks

Re:Socialism Sucks

[itsdapead]

I know, I had cancer, the day I found my lump I was in an MRI.

If we're doing anecdotal evidence, last time I had a MRI (invented at my local University, by the way) on the NHS I waited a whole week - and that was non-urgent (plus I had other scans and tests while I was waiting). If it was suspected cancer it would have been quicker. A relative had bowel cancer and it was successfully removed within a few days. Another relative has a rather neat home kidney machine and truckloads of supplies delivered to their door every fortnight - all without them worrying about where the money is coming from (sure, they've paid their tax in the past, when they had an income to pay it from). Unfortunately we have one or two ultracapitalist press barons (you may have heard of them recently) who love to scour the country for dirt on the NHS, BBC or any other organization that is a bit too left for their liking, and rarely report the good bits.

By the way, thanks very much for the extensive research you did in your earlier post (you know, the link to a google search for "NHS Horror" [27 hits]). I now realize that rather than bothering to find the actual report from the WHO on per-capita healthcare costs I should have taken a leaf from your book and Googled "USA health care horror" - that gives me 296 hits so, quite frankly, QED.

Re:Socialism Sucks

[NeutronCowboy]

Interesting insurance experience. I never had anything remotely resembling that kind of dental plan when I was a contractor. Prices were pretty eyewatering then, and one reason I was happy to switch to salaried.

Government philanthropy.

Very true that Bastiat only talks about government run programs being bad. However, we were talking about Medicaid, a government run philanthropy. Bastiat would have been apoplectic about its existence.

People on welfare

I'm sure you are aware of the argument from anecdote. I personally know one person who is a productive member of society, but would not have made it without government welfare. Finally, ALL organizations are at risk of deceit and waste. Just one real quick example, but many abound with a bit more serious digging. ahref=http://shanghaiist.com/2011/06/24/showing_off.phprel=url2html-28102http://shanghaiist.com/2011/06/24/showing_off.php> NGOs in Africa and Afghanistan are notoriously ineffecient, largely because the local government structure requires it. The real question is, what's the ROI on the investment? Positive, or negative? Again, to cut a long argument short: there is a place for both GOs and NGOs in the welfare space. Sometimes, efficiencies of scale do make things possible that otherwise aren't.
Lastly, I don't understand the relationship between who pays taxes and whether the government should provide philanthropy. To some extent, it counters your main thrust: that people would have more money to give to charity if they wouldn't be taxed. Well, half the people don't pay taxes, and give very little to charity. The other half does, and gives more to charity. Does this mean that taxes lead to charity? Of course not, but statistics are fun. It does mean, however, that taxes and charity are not related in the way you argue that they are.

Personal philanthropy

Note that I never said you're not philanthropic. As a matter of fact, I did imply that you did have a heart. Regarding your link of conservatives vs liberals, remember your quote about statistics. It's handy. The article itself says the correlation isn't so much conservative vs liberal as religious vs non-religious - which makes sense. Christianity, after all, is founded around the precept of helping the weaker, and Catholic and Protestant churches are big on church donations. It's also interesting that the statistics switch from % of income to total numbers when it comes to supporters of welfare vs not. My experience is that the overwhelming majority of people against government welfare are hanging out in the top 15% of incomes. That skews total numbers. What I would be interested in is what the donations are for. My suspicion is that once you take out religious organizations as targets of the donations, the numbers would be a lot closer. No proof, of course, that they will be even, but they will be closer. Unfortunately, I don't have access to the actual study, so I can't back that claim up. I realize that Brooks claims that Christians give more "in every measurable way", but I can't verify that statement.
From what I've seen of that study, it is interesting, but I find that its statistics are designed to show the greatest gap possible. Just doing back of the envelope calculations of his comparison of South Dakotan giving vs San Franciscan giving, I know that the relationship would be reversed if he had used raw numbers, rather than %s. As a result, I strongly suspect that the math might be valid, but he chose numbers based on effect, rather than abstract study. To me, this makes the study not worth quoting.

Re:Socialism Sucks

[Stuarticus]

If you have a bad tooth you'd probably be better off seeing a dentist. NHS dentists are far cheaper than private, they generally consult a calender to find a free time for an appointment, maybe it's a special government calender though, I don't really know what I'm talking about. Luckily neither do you by the sound of it.

Re:Socialism Sucks

[Coolhand2120]

So you must agree that MRIs are important, and the more you have per capita the better. This goes for the availability of all equipment and personnel. If you don't have enough, that means rationing.

I went ahead and did the news search "USA health care horror" and it did result in some hits, but not a single one talked about a horror story in a US hospital, maybe I missed it and you can point that one out. Even after trying Obama can't seem to find any horror stories about the US health care system so I wouldn't spend too much time scouring. Almost without exception the articles talked about Obamacare and related issues. Unlike when you substitute NHS for USA, there are a lot of hard news articles detailing incompetence and abuse in the NHS. You also gave no answer to the question: why do so many well off people choose the US to get their health care and not another country if it's so crappy?

Re:Socialism Sucks

[Coolhand2120]

If you have a bad tooth you'd probably be better off seeing a dentist.

I'm not sure if you knew this, but dentists are doctors.

NHS dentists are far cheaper than private

Yes I'm guessing unless the private doctors pay you, free will be cheaper. And that's why they have to consult the government. There's a finite number of dentists to fix teeth and whole lot of teeth, so some people need to come before others, old people should go after young people, healthy people are more viable so they should come before sick people, unless the sickness is related to the visit, and even then only if there's a chance of survival.

In the US. You come in on Tuesday. There is no rationing of care. The same cannot be said of the NHS.

Re:Socialism Sucks

[__aarzwb9394]

You are labouring under the delusion that no private healthcare is available to UK citizens.
Guess what? It is.
In the same way that your country has govenrnment funded education and private education.

Thankyou for bringing up slavery. Abolished in Britain before the United States.

"The entire state of California is easily navigable via public transpiration."
False. I have direct personal experience of this. A half hour walk to a bus stop with one bus per hour is not usable public transport. NB This is *not* from rural california but 40 min drive from Riverside. Southern California would be hell to live in without a car, more likely 2 cars if you are a family.

You appear not to know the difference between absolute monarchies and constitutional ones.

As it happens I would count myself as a republican (note the lower case r).
They do function as walking tourist attractions, and also a lightning rod for nationalist zeal. It is harder to attack political opponents by wrapping yourself in the flag. The head of govt is not the head of state, so no-one can ask "why do you hate Britain?" when you criticise the government. This occurred to me in 2003 when America seemed to go a bit mad.

Re:Socialism Sucks

[Coolhand2120]

The U.S. fought a civil war to throw off the democrats who were a) propagating slavery, b) propagating the law of succession, c) wanted a monarchy in the U.S.. Your current government does not believe that "all men are created equal". You have the law of succession which was abolished at the founding of the U.S. along with slavery. And maybe you forget that slavery was tomb stoned in the Constitution of 1778 nearly 100 year before the idea even occurred to the British the founders set a date for slavery to cease to exist. Indeed, by the time the British outlawed slavery the abolitionist movement was already in full force, all of the union states had already outlawed slavery and were in pitched battles to wipe it out.

Your government, today, believes that people of royal birth are inherently better than everyone else. You pay for their expensive cars and homes because why? Their blood is better than your blood? God favors the king? This sort of subjugation is almost as bad as slavery, you are still a slave and you don't even know it, and there's nothing you can do about it because your form of government considers this righteous behavior. At least someone must explain to me where and why my tax dollars are being spent, maybe I don't agree with the purpose, but we have universal suffrage, a recourse, something your country only plays lip service to, meaning: good luck firing the queen. Once your country throws off the monarchy, and only then, can call yourself civilized, "God save the queen" will never be an acceptable answer to an free person. I hope you feel the same way.

You are labouring under the delusion that no private healthcare is available to UK citizens. Guess what? It is. In the same way that your country has govenrnment funded education and private education.

The big difference is that the government doesn't take a portion of our pay and say it is for our medical care. Becuase of this our medical intitutions are much better financed, we don't have 50 year old EKGs etc. Consider this quote from wikipedia:

All Canadians have access to similar care at a considerably lower cost." There is "no question" that the lower cost has come at the cost of "restriction of supply with sub-optimal access to services," said Bell [President and CEO of University Health Network, Toronto].

Did it ever occur to you that "you get what you pay for"? We have a better health care system here in the U.S. because we pay a lot more for it. More new procedures and medical technology is developed in the U.S. than in any other country (Ask yourself why! Don't just ignore the fact! ) We keep our money and are able to spend it any way we like, on private medicine, or on a new computer, its called freedom, I hope it comes your way some day.

Thankyou for bringing up slavery. Abolished in Britain before the United States.

The abolitionist movement started in the U.S. long before it reached the U.K..

One of the first protests against the enslavement of Africans came from German and Dutch Quakers in Pennsylvania in 1688.

It wasn't until 100 years later that the British government even considered the question, and by that time slavery had been tomb stoned in the Constitution. Some people didn't like that, there was a war, the rest is history.

False. I have direct personal experience of this. A half hour walk to a bus stop...

A) Riverside is extremely rural B) There is tons of public transportati

Re:Socialism Sucks

[__aarzwb9394]

A) Riverside is extremely rural

Rural means farms to people who speak English of any dialect. I have been to Riverside, it is not rural. It has poor public transport. I have seen it myself. Go to any suburb in California and you are stuck on island it is nearly impossible to leave safely without a private car.

What do you mean? Than who is? I'm pretty sure the head of government is the head of state since state and government mean the same thing.

Is it true that you need a link to tell you what Head of Governemnt and Head of State mean?
Not giving you the link, look up the government of Ireland, Germany, Japan, United Kingdom, Netherlands. Commonwealth countries are interesting in that their nominal head of state is from somewhere else. France is also an interesting mix.
You are suffering from the problems of growing up in a very insular country. You cannot compare countries' systems of government without realising that the frameworks may or may not be the same.

Spend a little of your commie-fighting time learning about other countries and how they operate. It could be quite profitable for you.

Re:Socialism Sucks

[Coolhand2120]

I don't know why I'm arguing with you about Riverside being rural or having a mass transit. You can read it yourself they are the largest exporter of oranges in all of CA, I've been there dozens of times. There is a city but it is surrounded by farms. You are not "suck on an island" in CA, mass transit will take you anywhere and you don't have to wait for more than 10 minutes for a bus to arrive, I don't know what you experienced but that is not the norm.

Is it true that you need a link to tell you what Head of Governemnt and Head of State mean?

Since it is so elementary why don't you explain it to me or provide a link.

Wait, I'll provide one for you: From Dictionary.com

Main Entry: state Function: noun often attrib 1 a : a politically organized body of people usually occupying a definite territory; especially : one that is sovereign b : the political organization that has supreme civil authority and political power and serves as the basis of government —see also compelling state interest at INTEREST 3a, SEPARATION OF CHURCH AND STATE c : a government or politically organized society having a particular character state> 2 : the operations or concerns of the government of a country : the sphere of administration and supreme political power of a country (as in international relations) state> state> 3 a : one of the constituent units of a nation having a federal government; specifically : one of the fifty such units comprising the great part of the U.S. —see also STATE LAW b : the territory of a state

I added the emphasis. So perhaps you are wrong? Maybe you can find an example somewhere on the internet that proves dictionary.com wrong?

And of course by biggest argument you ignore all together again. You are the subject of a king/queen in a monarchy and therefore not a free man. Why don't you feel like you have reconcile that? This will be the third time you ignored it so I have to assume I've hit a nerve.

Minimum Viable Product

[Anonymous Coward]

I guess no one in the NHS has heard of the term "Minimum Viable Product". Build the simplest thing that works and provides some value to someone, then iterate and improve from there. As the saying goes, "A complex system that works is invariably found to have evolved from a simple system that worked. A complex system designed from scratch never works and cannot be patched up to make it work. You have to start over, beginning with a working simple system."

Re:Minimum Viable Product

[Anonymous Coward]

That's crazy talk. Start thinking like that, and it could apply to the NHS as a whole - madness!

Needs an Act of Parliament

[maroberts]

Forbidding the Government to make any contract which it cannot terminate within 3 months of announcing its intention to do so.

Re:Needs an Act of Parliament

[Richard_at_work]

No, you just need to set realistic contracts - here are some restrictions that I have been discussing with others around the military contracts debacle, where entire programmes can go through development only to be cancelled prior to the purchasing phase, meaning the development is wasted money that has still been spent.

1. Set a fixed ceiling for contractor-driven budget overruns, something like 115% of original budget. Anything else after that must be covered by the contractor.

2. Require every change to the original contract to be set under its own budget, with no change to the original contract. This budget has the same cost ceilings as set out in point 1, with the budget being that of how much it would cost over the original budget to implement.

3. Require every contract entered into to have a multi-year operating budget included, with that operating budget ring fenced and planned for in each fiscal year. Any operating cost overruns are subject to the same ceiling as set out in point 1. This stops projects going to term during development, only to be cancelled to save operating costs.

4. Require any contract cancellation to be confirmed by a vote in parliament. This stops partisan cancellations.

How does that sound?

MedXML and P2P protocols

[Anonymous Coward]

You just need to define a file format and exchange protocol (including security), the rest can get get done on an ad-hoc basis by each individual healthcare institution. Cryptographically sign the file (and if you want, the trail) to ensure a single up-to-date copy and you're done, no centralisation needed - we could call it.....MedBitcoin?

Re:MedXML and P2P protocols

[Coolhand2120]

Done!
Electronic health record

Governments do IT very inefficiently

[Stonefish]

Governments do IT very inefficiently, they are also clueless when outsourcing but they think that they're good at it. Vendors have teams who manage deals all the time and a government agency thinks that it can draw a team together every few years and not get skinned by the vendors. It a bit like the hometown team going up against a bunch of pros.
Internal government IT departments make these vendors attractive because they're monopolies, if the business want to wind down costs that means cutting services, there are no creative cost effective solutions. For example every innovative IT company over the past decade is using local storage not SANs as they figured out that doing storage the classic tier 1 .. teir n way that vendors said to do it was not economically feasible. But Government and the dinosaurs of the business world are still investing in these technologies.
Government buy software solution that only have a single supplier such are Microsoft, Oracle etc. You will never get a decent price or decent service when there is only one supplier, this is a market principle which governments choose to ignore. Hardware has become cheap because there's multiple supplier but the price of software has increased.
The bottom line is seek commoditisation, make markets work for you rather than against you and finally run software development like a lottery. Small teams of developers can actually out-compete most large organisations if the solution is chunked in the right way.

Uh huh...

[tkrotchko]

"t would be trivial to deploy a..."

Almost every time someone says this about an IT problem, that usually means they don't understand the complexity of requirements, and you'll end up spending 10x as much as you think you will.

I'm not defending the integrators in this case (we don't know enough about this project to say who is at fault), but there is rarely a large IT project that can be solved as simply as "throw up a data base and...".

Re:Uh huh...

[TheRaven64]

The point is that a trivial system would address 70% of the needs. A massively complex system would address 100% of the needs. We could cheaply have had the trivial system deployed over a year ago. The complex system is millions of pounds over budget and still not finished.

Which is the better solution?

Re:Uh huh...

[Anonymous Coward]

I dunno. When Accenture takes a 300m hit to back away from the project, hands it to a competitor, then they walk away from the project, and all anyone at NHS can say is, "well the project is a problem because of our evolving needs"... I think we can cut to the chase on what's going on.

The customer is a fucking mess. The job has changed 5,000 times in far fewer days. Nobody thinks it can be "finished" in any satisfactory way, at any price. If they did, they would be happy to do it for contracts that large. This is not the first example of this that we've seen.

Re:Uh huh...

[mcmonkey]

Given that these are healthcare-related data with personal identification information, if the 70% covered by the trivial system does not include security, then there's good reason to hold out for the 99.99% solution (no complex system is ever 100%) rather than use the 70% solution in the interim.

NHS didn't know what it wanted.

[Anonymous Coward]

As someone who was involved with the project from early on...

The NHS really didn't know what it wanted, it just knew that it kinda wanted some sort of joined up system, and that it had a massive wodge of cash to spend.
Result? Even when the project was years late, the NHS was STILL delivering requirements.
Add to that entrenched company's refusing to be a part of the project and working against it from the outside (One of the biggest GP software suppliers did this), good old fashioned stupidity, and a reporting structure that was classically backwards, everyone could see it would have issues.

The big suppliers are far more astute than government is. They could see several years down the line that the project would get canned, especially if the Tories got in, so they started building to that conclusion to the project (and turned it into a self-fulfilling prophecy).

One last kick at everyone involved... the GPs themselves. Under the ideas of "privacy", they fought the system wholesale. Despite the system having adequate safeguards in place. The reality is that the system would make it easier to expose bad practice among HCPs, and harder to bury evidence when needed by FOI requests. You can't sell that system to the people who are using it... it would be like making politicians vote for making themselves more transparent. Never going to happen.

And the paper is encrypted???

[Anonymous Coward]

Because the admin who is running across the hospital with the paper records is holding the plaintext version. They can read it. Someone can intercept the records and read it and when stored, someone can break into the records room and read it.

Or the transfer could be done wirelessly. Enctrypt to the public key of the doctor who wants it, sent it over the air. Sorted.

You didn't get a termination clause?!?!?!

[Anonymous Coward]

I smell bullshit. A termination clause is normal even when there isn't a "you don't get paid until it works" clause.

So let me get this straight...

[Anonymous Coward]

See if I have this right.

IF you're correct and you need 10x the money to agree to getting the work done, then the following options are the only ones on the table

1) You actually NEED 10x the money to do what you said you could do for the contracted price

2) You only have a 10% chance of doing the work you said you'd do

3) You're just making figures up because you DO NOT WANT to have to actually produce the work you said you could

Re:So let me get this straight...

[Paradise Pete]

You want a guaranteed result, with perfect prediction. Huge, complex projects are impossible to predict. They're also impossible to completely spec, so the whole proposition is a fantasy. But if you want someone else to take all the risk that doesn't come for free and it doesn't come cheap. This is true throughout life, not just in your scenario.

Insanely Over Priced

[Anonymous Coward]

It's been said already but at the end of the day any database system for archiving records can be put together by a small team of developers in the space of a few months.

The tricky part is scaling but then it's only a matter of scaling the back end database system and any modern database server (even the free ones) is easily scalable these days, the rest is network and connectivity and thats a doddle.

As far as cost goes, I seriously think someone cooked up a price and then added several zero's to the end of it, I cannot fathom how they can achieve a price of several billion GBP for a database project, I imagine several small Caribbean islands were purchased when the monies were handed over...

Agreed

[Sad Loser]

digital radiology works, but is generally a standalone system and poorly integrated.

GP to GP transfers - well that would have happened anyway.

Lorenzo is totally dead in the water. Involved in product testing of modules in last 3/12 - doesn't even get to first base. hopelessly broken.

Yes CERNER Millennium works, but is a maladapted dinosaur, with the same evolutionary potential.

A lowly NHS service desk worker

[Anonymous Coward]

I am a lowly service desk worker at a NHS trust implementing a new system contracted from BT and I can't believe how the system is implemented.

The new initiative to move from an old CLI based piece of software to a 'new' (not really new) GUI proprietary software all has seemed very unorganised.
Trainers have had to force people to use the piece of software in a certain way before it has been rolled out as it is buggy and breaks if you don't follow the exact set of direction. (this does not work, I don't think cerner has heard of HCI). With the issues involving american-english/british-english terminologies and buggy user un-friendly interface, the NHS probably would have done better putting the project on rent-a-coder.
Like others have mentioned, management don't seem to grasp the fact that 10 minutes of extra time in a system will lead to hundreds of thousands of pounds worth of man power. (silver bullet, mythical man month anyone?)

(also.. I was told Fujitsu walked out because they were in a contract where they were going to lose money due to their delays/failings...)

consultant analogy

[Anonymous Coward]

consultants are like taxi drivers *: they can help you ge tto your destination, but if you don't know where you want to go, they'll be glad to run up the meter by driving all over the place.
* so this analogy sort of involves cars.