Boris 2.0 Operating System

As I pointed out in my previous comment.

The underperformance persisted even when the funding was running at much higher levels, ergo, funding cannot be the only cause of the underperformance.

Which leaves us with the system itself.

Another advantage of moving to the German model would be the removal of politics from the equation. That alone would bring much needed stability and stop the large fluctuations in funding etc.

I am not against a conversation against about changing the system.   Whatever system we have we will need to invest in and pay for.

I don't believe the German system woulf be as good with UK spending per capita. 

It is dishonest to say that nothing could be imrpoved with within the NHS model or that other models wouldn't work.  It is also dishonest to say that spending less than other comparable countries will deliver their health care outcomes if we adopt their model.

The German system has been better than the UK system when spending was near equal.

It probably wouldn't be as good if Germany spent less but the NHS wouldn't be as good as the German system even if spending was increased to match German spending.

The principle benefit of the German model, as I've previously emphasised, is the removal of political interference.

The German 'spending' is a mixture of both state and private expenditure.

By encouraging and enabling greater private provision they increase health spending and make it far less vulnerable to political influence.

Rich_cb wrote:

The German system has been better than the UK system when spending was near equal.

I'd still like to see your evidence for that and your definition of better.  Waiting lists are/were virtually non-existent in Germany - but their better system doesnt show up in life expectancy (pre-Covid).

This seems fairly even handed on Pro's and Con's.   Certainly doesnt suggest major change is needed.

https://www.bbc.co.uk/news/health-38899811

I replied previously with several examples and a link to a detailed comparison.

Avoidable mortality is the best overall single measure. This is lower in Germany and IIRC Australia.

Survival rates from common cancers and serious illnesses is another good guide to the performance of a healthcare system.

Germany and Australia outperform the UK on these measures too although the UK does well on Diabetes.

Rich_cb wrote:

The NHS simply can't continue in its current form. The Australian and German models are both far more successful. The German model, crucially, almost completely removes politicians from the equation. It's time to abandon the NHS.

Justify your wild and sweeping statements with actual facts and figures please.  Including your definition of successful.

"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years .

It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).

It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."

https://www.kingsfund.org.uk/press/press-releases/nhs-receives-mixed-sco...

Compare the UK to Australia and Germany.

We do seem to do better at managing Diabetes and we're good at generic prescribing but survival from cancer, stroke and heart disease are worse.

New models would certainly be worth looking at.  However change would be very hard.  The NHS is our biggest employer and one of the few remaining popular touchstones.  So - a bit like cars or "the war on some drugs" but much more so - any attempt to change the status quo will sink you as a politician.  If you were surprised at how fast Kwarteng and then Truss disappeared that would be as nothing to someone who stood up in Parliament and declared "It's time to abandon the NHS."

That is unfortunately true.

We can move towards the German and Australian models relatively easily though.

Incentivise private health insurance and allow people on NHS waiting lists to access a voucher equivalent to 90% of the NHS cost of their treatment which can be put towards a private operation.

Once enough people have experienced an alternative to the NHS it will lose its quasi religious following and a proper debate can be had about its future.

Rich_cb wrote:

The NHS simply can't continue in its current form. The Australian and German models are both far more successful. The German model, crucially, almost completely removes politicians from the equation. It's time to abandon the NHS.

Except our Powers That Be don't want to come up with any social model to replace the NHS - their preferred model is the US model of paying $1million dollars for childbirth, $1thousand to be picked by an ambulance, that sort of thing...

brooksby wrote:

Except our Powers That Be don't want to come up with any social model to replace the NHS - their preferred model is the US model of paying $1million dollars for childbirth, $1thousand to be picked by an ambulance, that sort of thing...

There's a lot of money to be made from illness, especially with the Tories looking to rip out all the EU worker protection legislation and starving the NHS of money and workers (the NHS being an equal opportunities employer had a large percentage of immigrant workers back in the days of freedom of movement i.e. pre-Brexit).

It's not just that the Tories want poor people to suffer - they want to make big bucks doing so. Also remember, that with the right-wing, cruelty is its own reward.

Last paragraph is a bit disappointing.

The fact that people in many other countries get better healthcare than we do means it's cruel to want to emulate their systems?

If a greater involvement of the private sector leads to fewer people dying unavoidably, as demonstrated in Australia and Germany for example, then who cares if profit is being made?

Rich_cb wrote:

Last paragraph is a bit disappointing. The fact that people in many other countries get better healthcare than we do means it's cruel to want to emulate their systems? If a greater involvement of the private sector leads to fewer people dying unavoidably, as demonstrated in Australia and Germany for example, then who cares if profit is being made?

We can't even seem to be able to copy better cycle infrastructure, so I have exactly zero faith in trying to "improve" the NHS by allowing rich people to get good health care and the poor will get completely screwed over (most likely subsidising the wealthy).

Cruelty is the hallmark of the U.S. healthcare system and especially their health insurance. Also, compare with Sunak moving money from deprived areas to bolster up rich areas. I can personally guarantee that the Tories will sell as much of the NHS as possible over to U.S. companies for a quick buck and future generations will be paying the price forever.

Doesn't matter how you dress it up, the Tories are evil, blood-sucking parasites.

I do love the trope that the Tories are going to privatise the NHS.

It's wheeled out continuously but here we are 12 years in and they still haven't done it.

The same goes for the endless comparisons with the US system whilst comparisons with our European neighbours or Antipodean friends are almost never mentioned.

Why do you insist on backing a system that causes huge numbers of people to die needlessly?

Edit.
'Othering' people is never OK btw.

Rich_cb wrote:

I do love the trope that the Tories are going to privatise the NHS. It's wheeled out continuously but here we are 12 years in and they still haven't done it. The same goes for the endless comparisons with the US system whilst comparisons with our European neighbours or Antipodean friends are almost never mentioned. Why do you insist on backing a system that causes huge numbers of people to die needlessly? Edit. 'Othering' people is never OK btw.

They haven't been able to do it yet.

It's a classic from the right-wing playbook - intentionally cripple a service (e.g. remove 80% of available NHS workers by erecting barriers to travel) and then when people complain about the poor service, come up with "we've got a great plan to fix it - why don't we make money and get rid of the expensive bits by bringing in ACME Ltd to administer it?".

You may believe that we'd copy some good ideas from European neighbours, but that's not how it would play out at all - look at Jacob Rees-Mogg's plans to rip out the EU workers protections. We're heading fast for a U.S. style health bankruptcy where the rich can afford health services (despite the rich having much better health outcomes) and the poor will be thrown out on the streets (c.f. mental health services) or at least be one operation away from poverty.

As far as 'othering' goes - I'm just calling it as I see it. When politicians such as Braverman can get away with saying that their ultimate dream is to witness a flight sending refugees and asylum seekers to Rwanda, then how do you expect me to think that Tories have any empathy or decency? When Johnson partied whilst relatives were unable to visit dying relatives, just what do you really expect people to think - give him another go at the job?

As long as people are supporting the policies of "I've got mine, so screw everyone else", then they deserve to be called out for supporting inhumane, selfish monsters. I'm not 'othering' people because of what they are, but because of what they choose to do.

If they can't do it with an 80 seat majority then when can they do it?

It's just a Labour party 'boogeyman' threat.

Rich_cb wrote:

It's just a Labour party 'boogeyman' threat.

I hope you're correct, but my cynicism suggests otherwise

Rich_cb wrote:

If they can't do it with an 80 seat majority then when can they do it? It's just a Labour party 'boogeyman' threat.

You surely don't think that they'd do it by actually passing a law and voting on it, out in the open?  That might make the public think that they are the Baddies.

They will simply starve it of more and more funding until - well! - it just HAS to be put into the private sector.  For its own good.

(With no comment about the choice having been made by them to starve it of funding in the first place...).

So when is the master plan finally going to be put into action?

It's 12 years and counting...

Alternatively, it's nonsense.

If you put a frog into boiling water it will leap out. But if you put it in tepid water and then heat the water gradually...

The whole narrative and the political landscape have been changed around us over the last twelve years, rich, with everything being gradually shifted further and further right... (my god! Flying asylum seekers to central Africa as a mainstream policy?)

Its not nonsense or a Laaay-baaah bogeyman. It is a desire and a target of many Conservatives and it will happen.

If it's not happened yet then it simply won't happen. It was a believable lie in 2010. The Conservatives had been out of power for years, they could be planning anything! After 12 years in power it's lost any sense of credibility.

We'll find out soon enough, the Conservatives will almost certainly lose in 2024 so they've got 2 years to put the 'secret master plan' into action. I won't hold my breath.

The shift to the right narrative is similarly nonsensical.

Taxation is at its highest level since King George VI was on the throne. Is that right wing?

Government spending is even higher than that. Is that right wing?

The Dublin Convention allows asylum seekers to be removed to another country and to have their application for UK asylum summarily dismissed. We were signatories to that for years whilst we were members of the EU.

The Rwanda plan is simply a different version of the same idea.

Rich_cb wrote:

The shift to the right narrative is similarly nonsensical. Taxation is at its highest level since King George VI was on the throne. Is that right wing? Government spending is even higher than that. Is that right wing?

Tax and spending are at high levels because 2010s economic growth was anaemic and has gotten worse since covid (we're still not back to pre-covid GDP,). And covid required huge public spending, so public spending being a high share of GDP isn't surprising. Comparator countries are in a similar position, except that they've had better growth.

The rightward shift can be for some things and not others. Rising populism seems to be have brought a search for simplistic, dog-whistle solutions (perhaps more socially than economically to the right) more than a consistent ideological path.
 

Rich_cb wrote:

If they can't do it with an 80 seat majority then when can they do it? It's just a Labour party 'boogeyman' threat.

Tend to agree. Apart from the past 12.5 years, the Tories have been in power for most of the time since the NHS was created and yet its share of national public spending keeps on rising.  

No doubt there are some Tories who'd like a US-style system - but like those who favour much-increased immigration, abolishing the planning system or capital punishment, it just ain't gonna happen. "The NHS is the closest thing the English have to a religion", as Nigel Lawson said.

Labour have also have fringe beliefs/believers too (e.g. unilateral disarmament) - neither side's get their own way very often.

I wonder how much of the current problems are down to the weakness of the social care system? The NHS isn't great on its own, probably either in funding or structure - but it does seem to be hobbled by having to make up for social care's weaknesses.

I agree about the care side.  That may also have bearing on our results vis-a-vis other countries.  It's complex and very definitely political because governments have to show "successes" in this area.

In general (e.g. not just NHS now) I think being victims of our own success is one strand of it.  How we manage having more older people and a greater proportion of older people has lagged behind our ability to keep alive longer.

I'd agree that social care doesn't help the NHS but its problems extend far beyond that.

Personally I'd like to see council tax reformed and made more progressive and the proceeds put towards social care. A fixed percentage of your house value every year for example. Bands similar to stamp duty could make it progressive rather than the current horrifically regressive mess.

Housing wealth is disproportionately held by the older generations who, for obvious reasons, disproportionately require social care so it would directly benefit the group who ended up paying the most.

Taxing unearned wealth wouldn't be that controversial surely...

Two reasons.

Firstly the rates are not uniformly applied. A band D property in one area will pay a completely different rate to a band D property in another area. The effect of this is that in areas with lower house prices council tax is higher relative to house value so the 'rate' is effectively higher.

Secondly, the bands don't continue increasing infinitely. There is a maximum value, above with everybody pays the same rate. If you own a £20m property you pay the same rate as a £1m property giving the very wealthiest a much lower effective 'rate'.

Higher rates for the poorest, lower rates for the richest. Regressive.

A tax of x% of house value per year would be fairer. If the % increased with value or x% of first £200,000, x+1% of next £200,000, then x+2% for value above that (in a similar way to stamp duty) then it would be progressive.

What is RSG?

It can vary because of democratic differences but the vast majority of the difference in council tax is simply down to the difference in house prices.

People in deprived areas are essentially paying a higher rate of tax than those in rich areas for the same services which is regressive.

If people are asset rich but cash poor then they could forfeit part of their equity in lieu of the council tax to be redeemed on change of ownership.

The housing wealth in those situations is usually almost entirely unearned so taxing a small portion of that unearned wealth shouldn't really be controversial.