Tory Tax Cut Proposals

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A fair point, Venusian. The system here in Belgium is one of the best in the world and is surely better than the NHS or the Irish health service.

The main difference seems to be that you don't have this gulf in standard between public and private care. Everybody has medical insurance and the same access to consultants and to treatment. Those who want to can pay extra in order to get a room sharing with fewer people or on their own.

The system is a lot less elitist and medical fees are a lot lower. My local GP charges 25 euro per appointment and consultants normally charge about EUR 60, which most patients get to recoup.
 
I admit to being half aslump last night, but there was a tv programme discussing the enormous sums of money - running into the billions - which the 'reforms' in the NHS have cost and lost the country over the past several years. It discussed the decisions to hive off hospitals to private investment enterprises (Brian, you'll know what I'm on about - something like 'PPIs'), which is now leading to as many new hospitals being built as there are closing and being sold off for 'redevelopment' (er, not as hospitals, of course). Apparently the deal is also that the privately-managed hospitals which close can only be sold back to the PPI? As I said, I was dozing afast on the sofa, so only half the ears heard this, but the sums lost are absolutely, incredibly, enormously appalling. Why, we could fund a whole other war with the money, if we had it!

So I'd suggest that the 21bn in cuts would be eminently achievable if the NHS reverted to a system whereby it wasn't exploited for private profit - and like Headstrong indicates, a few hundred hospital managers wouldn't be a bad place to start. Since they've clearly been marked rather low in Book-keeping I and II, I don't know how the hell they continue to hang onto their jobs and pensions, while hospitals around them dwindle into disuse.

Amazing to think that Haslar Naval Hospital (Hants.) is supposed to close, with the Navy's hors-de-combatants being treated in what are reportedly overcrowded and understaffed NHS hospitals. Wherever you look, people are being advised that their local hospitals are closing, while new ones are being built elsewhere. It appears to be as shambolic as Ascot's refurbishment, but I don't see those responsible falling on their swords as Edifice-Crumbly has gallantly done.
 
Cheers, bets - the very same! Sounds like a licence to print your own money - although I have to admit to being only half-awake at the time of the programme.
 
Originally posted by Venusian@Oct 22 2006, 06:36 PM
Why is it that whenever the NHS is criticised, the only other system that gets considered is the American one, as though their model was the only conceivable alternative to ours?
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For the purposes of this thread I'm delighted to compare it with the health care services available in, say, France, Germany, The Netherlands and the Scandinavian countries, from all of which we could learn a lot.

It makes the same point that I have been making all along - you can't expect to have a low taxation economy and the public services that everyone wants. there are those who seem to think that it's possible though.
 
Now that we have denationalized the railways, I can't think of another public service - apart from Health - that we still have in toto, Brian. And if the health services is now semi-skimmed by the PFIs, it's not even a fully-government funded operation. So why is it still lurching around in a state of permanent financial crisis, in debt to the tune of billions?
 
Originally posted by krizon@Oct 22 2006, 08:14 PM
Now that we have denationalized the railways,
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I will be kind and not comment on your Americanisation of the spelling - but are you aware that the railways now receive more in government subsidy (ie our money) now tan they did prior to privatisation?
 
Originally posted by BrianH@Oct 22 2006, 08:10 PM
you can't expect to have a low taxation economy and the public services that everyone wants. there are those who seem to think that it's possible though.
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But after the ineptitude that governments regardless of flavour have shown for so long in administering our public services it amazes me why so many people are still clamouring for them to do so - and worse are prepared to give them even more money to do it.

Introduce market forces - introduce efficiency. Will it be perfect? Almost certainly not. Will it be better? Well can it be worse?
 
No need for kindness, old bean, either on my AmericaniZation of certain words (and I'll let your overlooked aitch lie, too) or my ignorance, but NO, I did not realize or realise that. How vair interesting. It sounds like another complete balls-up, just like the NHS. Tell us more, tell us more...

Perhaps we should know all of the areas in which the government is still handing out subsidies, and why, and then perhaps a bit of serious pruning could be undertaken, rather than tax cuts? Would it not make more sense to prune the deadwood as ruthlessly as possible, to induce real competition, or do away with the pretence that railways can be profitable in this country, and just make effective A and B roads and bypasses?

Ah, Grey - one and a half minds with but a single thought... :D
 
Originally posted by betsmate@Oct 22 2006, 08:25 PM
Introduce market forces - introduce efficiency. Will it be perfect? Almost certainly not. Will it be better? Well can it be worse?
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Yes it bloody can! I was going to say to krizon not to get me started on PFI, which was introduced by the Tory government and condemned by Labour - who embraced it lovingly once they came to power.

My own view is that a private/public partnership ideally run would be the best way of providing services. But ideally run is the operative phrase. I have a little experience of working within an industry that touched on dealing with PFI contractors. We have rampant PFI initiatives in, among other areas, health, education and the prison service.

I was away when Liam Halligan exposed in a Channel 4 Dispatches programme last August some of the results of PFI. He had carried out a six month investigation and I know that many were scandalised by his report. The headline writers were attracted by the cost of changing a light switch in an NHS hospital locked into a PFI contract - £333!

Another of Halligan’s revelations was that one local authority is paying thousands of pounds a month under a PFI contract for meals and cleaning services in a school that closed a year ago.


PFI initiatives are increasing the costs of the services provided to an amazing degree - but governments like them as it keeps capital items off the balance sheet and gives a rosier picture of government borrowing.

The government recently announced a new PFI programme worth £1.5 billion.

The programme will build six new hospitals. The most efficient and economical way to build these would be for the government to provide funding directly. Governments are able to borrow at extremely low rates of interest.

Instead, under PFI, private companies will raise the capital needed to build the hospitals at commercial rates of interest. The hospitals - along with non-
clinical services such as cleaning and catering - will then be leased back to the NHS, locking it into an inflexible contract extending 25 or 30 years into the future.

The multinationals view PFI as a reliable source of profit for their shareholders - the government guarantees their income.

PFI costs have soared under Labour. In a briefing on PFI, John Lister of pressure group Health Emergency, wrote, “Annual payments on a £420 million scheme in central Manchester came out at £51 million per year, index linked, over 38 years, £30 million of which was the ‘availability charge’ for the building itself.”

The total cost of PFI and related payments reached almost 20 percent of the trust’s total revenue.

At Norfolk and Norwich University Hospital, private investors a profit of £80 million when they “refinanced” a PFI deal, but the hospital only saw £34 million of this money, and that only after a great deal of hassle. That was one of the cases that Ian Hislop referred to on last week's Have I Got News For You.

Queen Elizabeth Hospital in south east London is facing insolvency due to a PFI scheme that has cost the trust £9 million a year.

Labour’s plans to extend PFI. This is certainly good news for shareholders in the companies that provide it, butbad news for NHS users and staff.

The drain on resources is likely to add to the financial deficits across the health service, which are currently driving job cuts, ward closures and other cutbacks.
 
Then don't PFI it. Privatise it and stimulate competition. No private company is going to waste their own money.

The government's role should be limited to providing the correct regulatory and incentivised (word?) environment for an efficient and comprehensive healthcare system to flourish.

They have proved they cannot run the whole she-bang themselves and you have proved (and I was fully aware) that PFI is not the correct environment to breed the much-needed efficiency. There is however a third way (no pun intended).

I accept that unmanaged privatisation will almost certainly result in the cherry-picking of the most lucrative segments of healthcare provision. But you cannot get away from the basic supply and demand principle that will always exist. Exactly how privatisation is managed and whether something can be done to ensure that healthcare provisions remain (sic) comprehensive is an argument for someone with a better understanding of these things than me - but pouring more taxpayers money into a government run NHS is not, can not and will not be the solution.
 
Originally posted by betsmate@Oct 22 2006, 09:10 PM
Then don't PFI it. Privatise it and stimulate competition. No private company is going to waste their own money.

The government's role should be limited to providing the correct regulatory and incentivised (word?) environment for an efficient and comprehensive healthcare system to flourish.

They have proved they cannot run the whole she-bang themselves and you have proved (and I was fully aware) that PFI is not the correct environment to breed the much-needed efficiency. There is however a third way (no pun intended).

I accept that unmanaged privatisation will almost certainly result in the cherry-picking of the most lucrative segments of healthcare provision. But you cannot get away from the basic supply and demand principle that will always exist. Exactly how privatisation is managed and whether something can be done to ensure that healthcare provisions remain (sic) comprehensive is an argument for someone with a better understanding of these things than me - but pouring more taxpayers money into a government run NHS is not, can not and will not be the solution.
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So, please explain how you privatise, say, the health service and the education systems so that they can provide for the needs of the entire population while still creating an adequate return for shareholders.
 
Top of my head only (and grossly simplified as I do not have all night)…

Healthcare is basically like any service industry. There is demand i.e. sick people and supply (currently NHS and a handful of others) but for this argument a range of competing private healthcare providers. These healthcare providers will target the different market segments (of sick people) with their services. These services will be provided to the public at a charge greater than the cost to the provider (averaged) thus ensuring a return for shareholders. Private healthcare companies will use economies of scale, cost-benefit analysis and above all their competence to provide these services at a lower cost to the public and themselves than the inefficient NHS can currently do so.

However like all service sectors many of the general public will choose not wait until healthcare is needed to pay for it – instead they will take out private healthcare insurance (paid for with their increased disposable income due to the reduced tax levied by a government no longer needing to prop up the NHS). These insurance brokers will be able to negotiate tie-ins with the healthcare providers to guarantee a certain market share. This will increase economies of scale but more importantly competition further and thus lower prices.

Now I am aware that not everyone will save enough in tax to afford private medical insurance – therefore the Government may wish to provide a compulsory basic-care package that is funded through social security/NI. The beauty about this is that rather than try to rule the show and run it – the government here is only acting as an intermediary in the same way as the insurance brokers above and are able to contract out this huge market share to the most competitive provider. Thus while not eradicating social security/NI charges reducing them.

The oft-put forward argument is that ruthless competitiveness will reduce the standard of care provided. I would argue that conversely by reducing costs and passing savings on the end-user the increased disposable income opens the door for premium services to be readily affordable to more people.

One argument that I do not have an answer to is what happens to those people who require expensive care that is not catered for either within their healthcare insurance or some form of basic-care package. These are the problem cases. However before anyone uses this as a stick to beat down the idea of privatised healthcare, I would suggest that they consider that these are also the forms of treatment that disproportionately affect the government’s existing ability to provide healthcare within budget on top of the inefficiency that privatisation would hope to address.


Now for Education. Again a service industry, but one that I suggest – for good reason - there is a fair amount of reluctance just to hand over to the private sector. Therefore what I would be looking for would be a compromise.

Now I appreciate that this is controversial, to the extent that the US have passed legislation precisely to make this sort of thing impossible, but it is certainly not without its merits.

I would look to “brand” education. By this I mean that I would encourage private industry to tender for the right to assist (influence?) education provision. For example if Microsoft were to win a competitive tender, not only to ensure that their software was installed as standard throughout schools, but to ensure that one of their MCP or MCSE qualifications made it on to the curriculum – and further to incentivise (my made up word again) the best students to graduate to their Microsoft Academy. What are the downsides? We have private funding replacing the drain on taxpayers. We have students being educated in real-world tools rather than theory (backing up the government’s move to vocational education). How about a sportswear manufacturer tendering for the right to not only provide games equipment, but to nurture students on to the excellence programmes in a bid to launch the next generation of athletes. The possibilities are endless.


Of course, we are talking about two hugely important issues here: The health of our nation and the education of future generations. Therefore it is imperative that both of the above are managed correctly, the correct decisions made, the correct tenders accepted and rigid control measures put in place. But that is exactly what a government should do. They should govern, manage, foster an environment – call it what you like. One thing they have proven that they cannot do is run the whole lot themselves. My argument is they don’t need to and they shouldn’t.
 
OK, now please give me an example of any country in the world where the health, education or transport service works well for the benefit of its users without state funding, totally or partially (ie money collected from tax-payers by the state and reallocated to the services.)

In case you are one of those people who have been abducted by aliens and returned after the usual rectal probe etc I must ask you to stick to this lanet.
 
Originally posted by BrianH@Oct 23 2006, 06:55 PM
I must ask you to stick to this lanet.
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:what: Don't do it, Betsmate however nicely he asks you. I have heard that sticking to a lanet is very painful, so please ensure you can get to A&E within 20 minutes or you may well need the assistance of a fireman and his cutting equipment. :blink:
 
I googled... and if I googled correctly Australia has a predominantly private health-care system that is operating successfully with just a small government-funded system (Medicare Australia) for the less well off (in a similar vein to my basic care package above).

Now I've got to eat, because if I left it to you to organise a memorial race it would be over jumps... :)
 
I'm not convinced. Under Medicare Australia the residance of Summer Bay whether pregnant, knocked down by a car or suffering with testicular cancer have been using the same hospital room.
 
Originally posted by Gearoid@Oct 23 2006, 08:13 PM
I'm not convinced. Under Medicare Australia the residance of Summer Bay whether pregnant, knocked down by a car or suffering with testicular cancer have been using the same hospital room.
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Yeah but over at Yabbee Creek they have the fully private facilities.
 
Australia has Medicare - same name but works better than the US system. Read about it here: Medicare - Australia

The webpage starts:

Welcome to Medicare - Australia’s universal health care system.

Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special circumstances allied health services.

If you look you'll also find these comments:

Medicare and the Pharmaceutical Benefits Scheme cover all Australians and subsidise their payments for private medical services and for a high proportion of prescription medicines. Under Medicare, the Australian and State governments also jointly fund public hospital services so they are provided free of charge to people who choose to be treated as public patients. Australian Government funding of the 30% Rebate and other key incentives support people’s choice to take up and retain private health insurance.

People make their contribution to the health care system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.

The aim of the national health care funding system is to give all Australians, regardless of their personal circumstances, access to health care at an affordable cost or at no cost, while allowing choice for individuals through substantial private sector involvement in delivery and financing.

Not dissimilar to what we have here, but probably easier to adminster for 20 million people than for 60 million.
 
Ok to save me from further googling:

“The United States is the only OECD country where voluntary health insurance represents the main health financing and coverage system for most of the population.”

...and I am sure you won't find it hard to contest your "works well" criteria against that one.

However, I am not sure that "because no-one else does it" is a particularly strong argument in the face of the crisis that our health system is facing?
 
Originally posted by betsmate@Oct 23 2006, 09:20 PM
“The United States is the only OECD country where voluntary health insurance represents the main health financing and coverage system for most of the population.”
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My point precisely
 
Which I was making for you. But surely you aren't suggesting that just because private healthcare has been less than a total success in the states that it is not a viable alternative at all?

The same logic when applied to British implementation of a publicly administered system hardly bears thinking about.
 
The problem with private anything is that a large percentage of the population can't participate. Which seems, where it exists, of little concern to some members of the remaining portion but fortunately not for most.
 
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