US calls NHS "evil" Page 12

  • gang_of_bitches 14 Aug 2009 18:41:54 5,707 posts
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    Khanivor wrote:
    I think the best system would be one run by private companies which send the bill to the government's health department. This would obviously have to be heavily regulated and inspected, but then you get the benefits of both systems while reducing the negatives of both systems.

    Still not going to be perfect, but it would at least make for a worthwhile experiment.

    That's never (well nearly never) how it works when businesses and govt mix, you don't get the best of both, you get the worst. Beaurocracy and greed combined into one massive, expensive nightmare.
  • FWB 14 Aug 2009 18:42:00 56,337 posts
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    They have pools in Canada, ya know. :)
  • Deleted user 14 August 2009 18:51:11
    Khanivor wrote:
    I meant regulated as in controlling costs and the like, not as in fucking with the system for the sole purpose of trying to generate vote-winning headlines.
    Which one do you think in a utilitarian manner causes more harm, health being treated as a for profit business or some occasional vote-chasing? Which one on a day to day basis is a constant source of discomfort to people under the health care systems? And I have no idea how to visualise what you propose would be the best way, (the middle way I suppose you'd term it) because it just conjures up more problems in my mind than any solution, and really just seems to be the NHS the more I think about it, only, like an idealised idea of it, which would never be able to exist.
  • Nasty 14 Aug 2009 18:52:59 4,833 posts
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    gang_of_bitches wrote:
    Khanivor wrote:
    I think the best system would be one run by private companies which send the bill to the government's health department. This would obviously have to be heavily regulated and inspected, but then you get the benefits of both systems while reducing the negatives of both systems.

    Still not going to be perfect, but it would at least make for a worthwhile experiment.

    That's never (well nearly never) how it works when businesses and govt mix, you don't get the best of both, you get the worst. Beaurocracy and greed combined into one massive, expensive nightmare.

    A quick read on some PFI/PPP 'initiatives' will show you how much this can fail.
  • RetardStrong 14 Aug 2009 18:57:53 3,229 posts
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    Khanivor wrote:
    I think the best system would be one run by private companies which send the bill to the government's health department. This would obviously have to be heavily regulated and inspected, but then you get the benefits of both systems while reducing the negatives of both systems.

    That's more or less the system we have in Belgium. You have to become a member of a 'health fund' which costs something like 20 euros a year. These 'Health funds' are in turn sponsored by the government. So when you go to the doctor you pay say 20 euros for a standard visit, you get a note, which you have to send to the 'health fund' which in turn pay you back 18 euros or so. So all in all you pay 2 euros for a visit to the doctor. Like the NHS the system isn't perfect though.
  • Khanivor 14 Aug 2009 19:01:24 44,403 posts
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    gang_of_bitches wrote:
    That's never (well nearly never) how it works when businesses and govt mix, you don't get the best of both, you get the worst. Beaurocracy and greed combined into one massive, expensive nightmare.

    Hey, I never said I knew what I was talking about! I do think, however, a different approach to marrying the private and the public would be worth a shot in a small scale experiment. It seems pretty obvious to me that both systems are fairly broken, if in their own individual way.

    I think if you could use government to regulate the profit the private companies could make, while giving tax breaks which help to offset that, you could approach a system where you can attempt to minimise and maximise the relative plus and minus points.

    For this system to work you would need a new oversight body that had the power to fully delve into the finances of both parties, something which is not present in PFI/PPI programs and something which I feel would reveal the basis of the terms these things are run under.
  • chopsen 14 Aug 2009 19:04:47 20,926 posts
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    cubbymoore wrote:
    Khanivor wrote:
    I meant regulated as in controlling costs and the like, not as in fucking with the system for the sole purpose of trying to generate vote-winning headlines.
    Which one do you think in a utilitarian manner causes more harm, health being treated as a for profit business or some occasional vote-chasing? Which one on a day to day basis is a constant source of discomfort to people under the health care systems? And I have no idea how to visualise what you propose would be the best way, (the middle way I suppose you'd term it) because it just conjures up more problems in my mind than any solution, and really just seems to be the NHS the more I think about it, only, like an idealised idea of it, which would never be able to exist.

    Why?

    You seem to think something can't be state funded without being government run.
  • ChronoTravis 14 Aug 2009 19:04:56 155 posts
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    blizeH wrote:
    Have we done these yet?

    http://www.flickr.com/photos/granitepics/3812645821/
    http://www.flickr.com/photos/granitepics/3812674353/sizes/o/

    :D

    Are those signs real or are they photo shopped? Maybe we should just have term limits!
  • Deleted user 14 August 2009 19:04:59
    I like the placard the girl in pink is holding in the second one. "Oh I'm sorry we thought reading the bill was ur job". Such condescension from such a teenager voice.


    Definitely fucking can't fault the first pic though, OBAMA MAKE IT HAPPEN! IF YOU SUCCEED YOU WILL GET AN APPROVAL RATING OF 150 FROM ME.
  • chopsen 14 Aug 2009 19:05:48 20,926 posts
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    gang_of_bitches wrote:
    Khanivor wrote:
    I think the best system would be one run by private companies which send the bill to the government's health department. This would obviously have to be heavily regulated and inspected, but then you get the benefits of both systems while reducing the negatives of both systems.

    Still not going to be perfect, but it would at least make for a worthwhile experiment.

    That's never (well nearly never) how it works when businesses and govt mix, you don't get the best of both, you get the worst. Beaurocracy and greed combined into one massive, expensive nightmare.

    That is exactly how general practice has been funded since the NHS was founded. Hasn't worked out too badly there.
  • Deleted user 14 August 2009 19:07:45
    Chopsen wrote:
    cubbymoore wrote:
    Khanivor wrote:
    I meant regulated as in controlling costs and the like, not as in fucking with the system for the sole purpose of trying to generate vote-winning headlines.
    Which one do you think in a utilitarian manner causes more harm, health being treated as a for profit business or some occasional vote-chasing? Which one on a day to day basis is a constant source of discomfort to people under the health care systems? And I have no idea how to visualise what you propose would be the best way, (the middle way I suppose you'd term it) because it just conjures up more problems in my mind than any solution, and really just seems to be the NHS the more I think about it, only, like an idealised idea of it, which would never be able to exist.

    Why?

    You seem to think something can't be state funded without being government run.
    I can, I just think the end result would be almost exactly the same. If not slightly worse, see outsourcing that is already going on in NHS in terms of cleaning etc.
  • Khanivor 14 Aug 2009 19:14:58 44,403 posts
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    cubbymoore wrote:
    I can, I just think the end result would be almost exactly the same. If not slightly worse, see outsourcing that is already going on in NHS in terms of cleaning etc.

    But this would be different. A private hospital would obviously try to keep costs down but if you have unclean wards or raging infections people will not go to your hospital and people will lose their jobs, unlike in the NHS, where unless you live somewhere large there's only going to be one hospital and the manager is going to get a pay raise.

    Competition between hospitals doesn't just have to lead to cost cutting. Again, the city I live in has less than 200k people living in it and there are two main hospitals along with a half dozen or so more smaller and specialised hospitals. Shit man, we got a fucking robot hospital here!

    I do not think the answer is simple but I do think both the US and the UK need to seriously work on their health care. Maintaining the status quo is not an option.
  • Deleted user 14 August 2009 19:21:56
    Khanivor wrote:
    A private hospital would obviously try to keep costs down but if you have unclean wards or raging infections people will not go to your hospital.
    I don't see it personally - I don't really think that people, especially potentially seriously ill people can pick and choose their hospital. It's not like there's two in ever town or anything. It's be like the trains where people have to use what's there and the private companies can take their custom for granted (which kind fucks with the point of the free market really).
  • chopsen 14 Aug 2009 19:22:36 20,926 posts
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    @khani Exactly. The reason "free market" experiments haven't worked in the NHS is that there was never any competition. See the "connecting for health" fiasco for the ultimate example of this - huge contracts being given to massive companies for loads of money....but no incentive to actually be any good at it.

    Outsourcing cleaning contracts not working? The solution is to get another company in to compete against the one you have. Divide it up by floors. Those with the cleanest floors get given more of them - the ones that don't have the number of floors for them to clean reduced. Income based on number of floors. Easy. Instant incentive to be good at cleaning.

    The way it's done at the moment is contracts get granted, and it doesn't matter how well you do, you get paid. There is no competition. So of course profiteering in the face of poor service results.

    @dg

    Not everything would be amenable to improvement by competition, obviously. But a lot could be.
  • Khanivor 14 Aug 2009 19:28:24 44,403 posts
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    disussedgenius wrote:
    Khanivor wrote:
    A private hospital would obviously try to keep costs down but if you have unclean wards or raging infections people will not go to your hospital.
    I don't see it personally - I don't really think that people, especially potentially seriously ill people can pick and choose their hospital. It's not like there's two in ever town or anything. It's be like the trains where people have to use what's there and the private companies can take their custom for granted (which kind fucks with the point of the free market really).

    Exactly my point. Change the system and then all this government BS about choice might have some merit to it.

    The city I used to live in had one A&E. To serve around 400k people. This city has at least two that I know of and the one chance I've had to visit it when my mum got sick made me less feared then if she had been bundled off to ARI, (long regarded one of the best hospitals in the country). I've been to a number of hospitals here in the states and while I personally couldn't afford the bills they've been in much better shape then ones I've been to in the UK. A middle ground must be found.

    Right now in the UK you're getting fed a line of crap about patient choice when you have next to none. It's just a smokescreen to fuck with the NHS in ways that benefit everyone but the patient.
  • Deleted user 14 August 2009 19:30:30
    Chopsen wrote:
    Not everything would be amenable to improvement by competition, obviously. But a lot could be.
    Sure, it's not like I don't see the logic in it and I agree completely with your first paragraph. If you can get genuine competition then it's all well and good. Unfortunately all too often people (well, the government) seems to equate privatisation with competition, though I suspect that has more to do with worrying about the cost than the outcome.

    ...

    Man, that was a boring post, would you like me to edit it so I can disagree with you to liven things up a bit?
  • chopsen 14 Aug 2009 19:32:50 20,926 posts
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    Yeah, go on. Make a little stawman arugment or something. They're good for keeping things going.
  • Deleted user 14 August 2009 19:32:51
    Christ, I barely even disagree with Khani. :/

    Though I still don't think that you can have competition between different hospitals, not outside of a (UK) city at least. There needs to be something a bit more elegant me feels.
  • Khanivor 14 Aug 2009 19:39:36 44,403 posts
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    Well you can have competition between hospitals. It seems to work pretty well, at least as far as the kind of care on offer. Of course, in the UK you would have a long wait for more hospitals to be built, but in the meantime it might be possible to generate some of the benefits of competition by building more smaller, specialist units.

    You're totally right that the government equates privatisation with competition, at least in the BS they spout. Unfortunately, all you're getting is the downsides of privatisation with none of the benefits that competition would bring, if it existed. Lowest bid contracts are not competition.

    Having BK, KFC, McD and Subway bid on a contract to feed me may seem like competition, but the end result is totally different from me being able to choose which one of those places I'd like to eat at on a particular day.
  • Lutz 14 Aug 2009 19:46:37 48,870 posts
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    Khanivor wrote:
    Right now in the UK you're getting fed a line of crap about patient choice when you have next to none.
    Eh?
  • NBZ 14 Aug 2009 19:52:59 2,424 posts
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    disussedgenius wrote:
    Though I still don't think that you can have competition between different hospitals, not outside of a (UK) city at least. There needs to be something a bit more elegant me feels.

    Do you really need a choice in such things?

    When getting ill I would think the wanted outcome is getting well, not choosing between different quality linen in the hospital...
  • Deleted user 14 August 2009 19:58:34
    NBZ wrote:
    Do you really need a choice in such things?
    If it raises standards it would be helpful for the service in general. It might also reduce the old Postcode Lottery problem we have at the moment. I just can't see how it could happen, not without building two competing hospitals next to each other.

    The other problem with it is that, taking where I used to live on the edge of London as an example, although we had 3 hospitals nearbyish they all had different specialities and the one you went to depended on that (only one had an A and E, for example, whereas another one was pretty good for cancer treatment). It's not like any of them were big enough to offer a 'complete' service. Having them compete against each other would be just as ineffective.

    Might be a bit different in the US though, seeing as they always have more and bigger everything than we do!
  • ChronoTravis 14 Aug 2009 20:03:32 155 posts
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    A health care town hall meeting in Montana is starting now. I wonder if anyone will discuss the death panels or the plan to turn old people into a food and call it soylent green.
  • chopsen 14 Aug 2009 20:15:04 20,926 posts
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    Yeah, I'm not sold on the "competing hospitals" idea. What people really want when they're unwell is a local hospital which is good, not a choice of hospitals offering a variable service and having to choose.

    There's also an economy of scale issue. Having two large A/E service for a given population will result in duplication in a lot of services on a huge scale. There's a lot of "minimum requirement" service that would be more efficiently delivered by merging the two. In fact, the Tories, champions of the free market, did a lot of merging of hospitals when they were in power.
  • NBZ 14 Aug 2009 20:18:42 2,424 posts
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    A problem with competition is that it is only an option in places where failure is an option. This is not the case in healthcare as failure will generally mean death and/or ruined lives.

    I had a relative die recently because members of staff in the hospital (and the GP before then) confused a brain haemorrhage to be swine flu and were unwilling to reconsider until it was too late. I can also mention two other cases from different hospitals which resulted in death due to incompetence. In each of those cases, the incompetence needs to be solved and I cannot see how competition will not solve that.

    There is a similar problem with pure capitalism for healthcare - it only works when simply walking away from the product is a viable option, and this is rarely the case for health.
  • Khanivor 14 Aug 2009 20:18:46 44,403 posts
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    The idea is that the competing hospitals drive each other to provide better service, so regardless of which one you wind up in you stand a good chance of getting better care than from the one hospital who only has to make sure their doors are open to get your patronage.

    You wouldn't want to create inefficiencies just for the sake of having choice, so some common sense would need to be applied. If you have a smaller population then you wouldn't have giant A&Es in each one. Saying that, having two A&Es in one place would be nice, as it should reduce the chance of you sitting around for hours and hours until someone has the time to quickly glance you over.
  • chopsen 14 Aug 2009 20:33:15 20,926 posts
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    ...or you could have one large A/E which uses economies of scale to create efficiencies (redeploying staff from majors to minors according to demand, for example), so you don't wait around for too long to be seen.

    Also, if you really need A/E, you're not really in the mood to pick and choose one from a brochure. You want your fucking head stitched!
  • Khanivor 14 Aug 2009 20:50:17 44,403 posts
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    Aye, but if the ambulance driver is able to call ahead and see if one is full while the other is not then you're set.

    One large A&E could be the better option but I think competition would be good in this department, as the A&E which is able to see and process patients the quickest and with the best results will get the most business. At the moment, as with most things in the NHS, people will get paid regardless of how long it takes them to do their job and how well they actually do it.

    Of course there will always be a continuous stream of reasons why one system will not work or will have faults but I like this conversation - we're agreeing things need to be done and - gasp - debating the merits of various possibilities towards repair, rather than just bitching.

    /group hug

    /gets swine flu from dirty Brits

    /breaks out arsenal

    /of guns

    /not gunners
  • NBZ 14 Aug 2009 21:38:29 2,424 posts
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    Khanivor wrote:
    ...I think competition would be good in this department...

    This presupposes that you are willing to have a lower quality service in one of the two hospitals.

    Why would *anyone* choose the lower quality service if both have the same availabilty and costs?

    The answer here is to fix the lower quality one, not to provide it with competition.

    As I said before, IMO competition only works if failure is allowed. multiple brands or products are allowed to compete because failure of one to succeed in the market is not generally a life and death decision.
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