Slashdot Mirror
British NHS May Soon No Longer Offer Free Care
An anonymous reader writes "Coinciding with challenges in the rollout of the U.S. Affordable Care Act are challenges for NHS. The Independent reports, 'A National Health Service free at the point of use will soon be "unsustainable," if the political parties do not come forward with radical plans for change before the 2015 election, top health officials have warned. Stagnant health spending combined with ever rising costs and demand mean the NHS is facing "the most challenging period in its 65-year existence," the NHS Confederation said ... In a frank assessment of the dangers faced by the health service, senior officials at the confederation say that the two years following the next general election will be pivotal in deciding whether the NHS can continue to provide free health care for all patients. "Treasury funding for the service will be at best level in real terms," they write. "Given that demand continues to rise, drugs cost more, and NHS inflation is higher than general inflation, the NHS is facing a funding gap estimated at up to £30bn by 2020."' From The Guardian: 'Our rose-tinted view of the NHS has to change.' More at the Independent, Mirror, and Telegraph."
Nah, that's just your allergies kicking in.
No surprise, really. Medical care is something hard to avoid - everyone will get sick / aged / infirm sooner or later and few will opt not to try and at least feel better, if not lengthen or improve their lives. Western medicine is simultaneously very powerful and pretty pathetic. We've gone after much of the low hanging fruit - the newer interventions are going to center on complex molecular biology and that stuff doesn't come cheap. On top of that the population is simultaneously increasing and aging. Not good for controlling medical costs.
We could limit costs. Remember the 80 / 20 rule (actually closer to 90 / 10) - a few patients consume most of the resources. Limit those folks and you've saved quite a bit of money. Of course, that's rather a large change in our social contract and I expect one that would not be palatable to the vast majority of people.
Barring that, there are still some options to reduce costs. Carefully evaluate the cost / benefit ratios of expensive therapies (bye bye dialysis). Basically freeze drug research (it's not like they have come up with any great new therapies) and essentially force generics. Get rid of Big Pharma's advertising budget (bigger than their research budget). Get rid of insurance companies and simplify the byzantine American medical system (one time savings, but a big one, basically kicks the can down the road). Limit reimbursement. Shoot the lawyers. Ration. Ration. Ration.
But people really want good health care which means somebody has to pay for it (preferably someone else). Now, IMHO, in the US at least, we could come up with all the money we needed if we restrained our military from trying to outspend the rest of the world by orders of magnitude. We don't need 11 carrier battle groups. We don't need the F-35. And so on - the money is there, we just have to figure out what our priorities are.
Unfortunately, given the partisan nature of US politics nothing substantive will happen. The ACA was likely the best political compromise available and it sucks big time (basically doesn't change the issues noted above). In the UK, obviously they have fewer levers to pull so they may, again, have to have that difficult 'social contract' conversation.
Just exactly what do you want society and government to do? (And don't give me any free market drivel, even the highly modified 'free market' in the US hasn't worked out so well in terms of patient safety. Just what do you think would happen if the government regulators went on permanent holiday. Do you think any consumer can rationally evaluate treatments? Who has the club in that scenario?)
Faster! Faster! Faster would be better!
Actually, if you follow international news at all, there has been a strong Conservative/Tory assault on the NHS for several years now. The assault comes in the form of privatization and the introduction of the 'free' market to the health care ecosystem. This system, if anything, is attempting to emulate the system put in place with the ACA, and the right in the UK has made it clear that they would like do what the right in America has been arguing for this whole time in terms of health care. Would the Dems have desired to emulate the original NHS, prior to its evisceration? Yes. Now? Not so much. Here's a bit of light reading on the topic, which is anything but hard to find. (Yes, they do tend to be from more leftwing sources, however, they have good information on what has been done to the NHS recently.) http://www.socialistreview.org.uk/article.php?articlenumber=11935 http://www.independent.co.uk/voices/farewell-to-the-nhs-19482013-a-dear-and-trusted-friend-finally-murdered-by-tory-ideologues-8555503.html http://www.medialens.org/index.php?option=com_content&view=article&id=676:people-will-die-the-end-of-the-nhs-part-1-the-corporate-assault-&catid=25:alerts-2012&Itemid=69
"And don't give me any free market drivel, even the highly modified 'free market' in the US hasn't worked out so well in terms of patient safety."
There's nothing even approaching a free market in the US. You can't negotiate a price (possibly on some elective things, but not much), you can't bring your own aspirin, hell, they can't/won't even tell you what they're charging for their aspirin until you get your bill.
You can't negotiate a price when you need an ambulance or emergency care. The mystical, magical, almighty free market that you worship won't work there.
That's pretty misleading. More people die in hospitals in the UK because they can go to the hospitals for free. In the US, they're more likely to die at home, because they can't afford to go to the hospital.
But dead is dead, and the UK's life expectancy is better than America's, while spending less per capita on health care. No amount of spin can change that.
European countries created socialized healthcare after they had been devastated bu WWII. They had no money for it but they had the political will. Now that they produce more wealth than ever (France GDP gown 700% since 1945, while population only doubled, for instance), European countries have the money but no political will to move it to socialized healthcare instead of shareholders profits.
You mean death panels? America already has them - they're called the Insurance Industry
The UK's NHS has, for most of its life, been neither a single-payer nor an insurance based system ... instead its costs came out of general taxation with no treatment-accounting. By that I mean there was no financial record-keeping related to individual treatments or doctor consultations ..... Family doctors (GP) receive a flat annual sum for each patient they have registered, regardless of how many or how few times the patient visits them. Likewise Hospitals were funded based on the medical needs of the area, with no financial records kept of individual's treatment episodes.
this approach resulted in admin costs of about 5% of expenditure only
Tony Blair started the rot when his Labour government introduced the "internal market", forcing every medical episode to be recorded and costed.. The excuse being that hospitals would compete for patient-referals from family doctors ... as the NHS had gone through a phase when it relocated most district's hospital services onto single sites, most areas of the country have only a single hospital competing against itself. There was no medical advantage to this change BUT it introduced the financial recording system needed for future privatisation
The result was an explosion of admin and financial staff ..... and admin costs that reached 11% of expenditure..
the current government's reforms are predicted to push admin costs over 20% of expenditure.
The other aspect that the Tories hate is that it is paid for out of general taxation not through an insurance premium ... so the rich contribute more than the poor and the unemployed and the less affluent pensioners still receive health-care. with the original funding method, most people paid far less in their taxes for healthcare than in insurance systems such as the US.
In general there are no medical co-pays as in the US ... Drugs are free BUT, unless are exempt (over 60, under 16, etc) you pay $10 for the prescription ... there are small co-pays for a few services such as dentistry and glasses .... things like hearing aids, breathing equipment etc, are provided free .... the NHS used to be the worlds biggest manufacturer of hearing-aids, false-teeth, glasses and artificial limbs ...
You clearly haven't been lying on an emergency ward bed on the verge of dying of respitory failure before. Trust me, at that point the negotiating powers are rather poor and frankly one isn't feeling much like a "rational agent".
Excuse the Unicode crap in my posts. That's an apostrophe, and slashdot is busted.
Why ever could that be?
What do you think that graph shows?
Here's what it seems to show. Between 1997 and 2008- the entire Labour term in office before the financial crash- debt dropped to 40% of GDP. This coincides with the highest increase in NHS spending in recent history. Now I'm not trying to argue a causal link- but it clearly wasn't NHS spending which caused our government debt. It spiked in 2008, which correlates with the huge government spending to nationalise and otherwise prop up financial service providers- not spending on a single other thing.
The chart goes on to show that since 2010, the debt to GDP ratio has continued to go up at a faster rate than at any time before the financial crisis. This coincides with the harshest cuts to NHS spending in recent history. So clearly cutting NHS funding hasn't made much of a difference to our government debt either.
Arguing that cutting spending on the NHS or welfare is going to make the blindest bit of difference either way is disingenuous. The only reason the Tories are cutting spending on the NHS is because they always want to cut spending on the NHS, in all circumstances. It's just their basic political modus operandi.
You hear wrongly.
http://euobserver.com/social/121778
http://www.telegraph.co.uk/news/worldnews/europe/eu/10361971/Britain-admits-it-has-no-figures-on-EU-welfare-tourist-numbers.html
Unproductive immigrants are largely a myth. People who can work themselves up enough to emigrate are not usually the sort of people to shy away from work. Statistically, an immigrant is more likely to be in work than a UK native, and is likely to make greater net payments to the state (paying taxes versus using government services) than a native.
Immigration is a knee-jerk right-wing bugbear. You can argue, if you like, that they're taking our jobs. But you can't also argue that they're all work-shy scroungers. Can't both be true.
The right-wing party hate the NHS because it represents a large slice of the economic pie that their buddies in industry want to get their fork into. They don't care that it's one of the most efficient healthcare systems in the world with excellent outcomes.
The left-wing party just fucked things up by being corrupt and not having the balls to bring the contracts started by the right-wing party to an end.
The biggest crisis facing the NHS is the Public Private Partnership scheme - in which big private companies get the contract to build hospitals and other medical facilities AND a sweetheart contract to run them for 30 years, which typically runs the total cost of ownership up to around 300% of what it actually would have cost.
That was probably the killer blow - you now have hospital trusts struggling to make their buildings payments and keep their clinical services functioning at the same time, which enables the politicians to step in and say "Look, this hospital is struggling! The only thing that can save it is the Invisible Hand of the Market!" ... with no actual coherent explanation of how a private company which by definition will take their cut off the top, can provide a better service than a public institution that has had years of practice at running an operation on a shoestring budget, having had their income cut to the bone so many times that their bones are now rather thin.
The Invisible Hand of the Market of course just wants to reach up the patient's backside and pull the gold fillings out of their back teeth. They don't care about the risky, expensive, uncommon, and difficult procedures, they care about the assembly-line procedures and services that have predictable consumption rates and costs, like hip replacements, haemorrhoids, etc, which they can monetize nicely, ignoring the fact that that surplus on these procedures is what paid for the difficult stuff, like open heart surgery that saves the lives of babies with congenital defects.
The destruction of the NHS is just outright evil, because it will result in less healthcare (because doing less and charging more makes more money), at a greater cost (when the NHS struggles, the private company is brought in. When the private company struggles, it will be bailed out), for less of the people that need it (the lower social demographics require NHS services disproportionately more and are less likely to be able to stump up the co-pay), all to line the pockets of a few Conservative party donors. Doing bad unto others for your own benefit or amusement being the definition of evil.