Wednesday, 30 May 2012

Readers' Letters Of The Day

Both from The Metro:

Wendy Keelan suggests Britain might as well leave the Eurovision Song Context because we haven't done well lately. Why are we such poor losers? France hasn't one since 1977 and Spain hasn't won since 1969. Stalwarts such as Malta, Iceland and Portugal have never won.

Do people think England should quite the World Cup simply because we haven't won since 1966?

Hazel Ford, Kent.


If the NHS was [sic] privatised, then Tax Freedom Day would come much earlier. However, would we really be free if, instead of working to pay taxes, we were working to pay vast private medical bills?

I feel more free knowing that, whatever happens, there is a health service free of charge.

M Huntbach, London.


Electro-Kevin said...

Letter A - We are krap at popular music and Azabaijan are the masters - everyone knows that, but do we have to come second from bottom nearly every time ?

Letter B - The insurance wouldn't cost nearly so much, especially as we wouldn't be footing the bill for breast augmentations, health tourism and IVF.

Anonymous said...

Private healthcare is cheaper than the alternative. I learned this categorically when in NHS and private hospitals with Crohn's Disease. The private option was both cheaper and the quality was 50 times better.

Mark Wadsworth said...

EK, a few things are known:
1. At least one-third of NHS budget disappears on crap.
2. Even including the crap, NHS spending is quite low as % of GDP by international standards, it's not bad value for money or anything.
3. Insurance companies are con artists, doctors are con artists.
4. It is not clear how much we would pay in insurance for same level of cover. Now, insurance is about risk spreading, the more people take part, the better the risk spreading and the provider gets better bulk discounts.
5. All in all, I'm in favour of taxpayer funding (mass inurance) and competing providers (competition drives up standards), that seems to be the least-bad option.
7. As a blokey sort of bloke, I think breast enhancement on the NHS is great value! Let's have more of it! Brighten up everybody's day!

RA, much nicer, certainly, but who was paying?

Sarton Bander said...

M Huntbach, Insane ward, Bedlam, London.

It goes private becuase it'll actually cure you. State treatment rationing is cheap because it does feck all.

Sarton Bander said...

> All in all, I'm in favour of taxpayer funding (mass inurance)

That's not insurance! That's moral hazard.

Insurance has.
Premiums based on risks.
MULTIPLE pools based on similar risks.
User can choose how much Excess/Deducatable (and thus modify the cost)

I trust insurers (in a competitive market) vastly more than I trust the state.

Best not to let the state get into treatment provision (same with education) and let the market sort it out.

In short pay people the citizens dividend and let them sort it out. It's better for them, and better for society.

Sarton Bander said...

WRT the first letter.

Eurovision is an example of how annoying, tacky, wasteful, disorganised and low quality Europe can be! As a EUSceptic I wish it had more prominence and thus influence.

Twice a year?

Anonymous said...

Who was paying? BUPA, who else? I'm not sure where you're going with this. Let's take it from a pure accounting perspective:

Payments made by me to the NHS: Parking, newspaper and internet charges.
Payments made by me to the State: National Insurance contributions.
Payments made by me to the private hospital: none.
Payments made by me to BUPA: smaller than NICs of someone earning minimum wage.

Sarton Bander said...

Eurovision targeted by Jihad against tuneless shite.,7340,L-4236041,00.html

Mark Wadsworth said...

SB, overall NHS outcomes aren't that bad. Clearly, allowing people to choose their own insurance provider out of their CD has a lot of advantages, provided the insurance companies are prevented from taking the piss. That's the tricky bit.

RA, yes, I did look it up once on Moneysupermaket, paying full BUPA for the whole country would cost about £60 billion, i.e. barely half what the NHS costs, and that's before we haggle for a bulk discount.

James James said...

Yes but BUPA is effectively subsidised by the NHS: they don't have to pay for everything you could need. Right?

mombers said...

Look to the US for what a private insurance market can develop into. They spend 17% of GDP on health but get no better outcomes than countries who spend half of this. An enormous amount of resources get eaten up in all the billing and insurance company admin.
Another huge problem is pre existing conditions. In the same way that you can't get car insurance only when you have a crash, no insurance company is going to cover you if you have a serious pre-existing condition. I for one would not have been able to start my own business when I lived there (I have epilepsy). Only because I worked for a big company did I manage to get insurance (no underwriting for group policies). The only solution is to force people to buy insurance so that the risk pool is evenly shared and you get no freeloaders. This requires people to buy services from a private company, which rankles both left and right. The NHS isn't perfect but it does a much better job than the private sector in many ways. Those who can afford private healthcare (I have Axa through work), good for them.
MW, Bupa/Axa don't cover most long term medical bills or maternity (or at least mine doesn't) so I don't think £60bn is a comparable figure

Mark Wadsworth said...

J, I have never been able to find out to what extent BUPA and their ilk are subsidised by the NHS, i.e. is it the case that the extra you pay for BUPA merely pays for the extra bit of service above and beyond that which is provided by BUPA but paid for out of the NHS budget?

I really don't know, which is why I am a tad hesitant on the whole issue and wouldn't just make a sweeping "BUPA is better" judgment, or even a sweeping "NHS is better" judgement.

A K Haart said...

Our views on NHS outcomes tend to be anecdotal. I've been critical of the NHS in the past, but recently had very good and timely treatment for a moderately serious condition. It changes your view.

My impression is that you are right, outcomes are on the whole satisfactory to large numbers of people in spite of the horror stories.

Sarton Bander said...

> SB, overall NHS outcomes aren't that bad.

I would disagree. It imposes massive unseen costs elsewhere via it's bureaucratic rationing and delay tactics. The cost not customer model also tries to minimise treatment, and leads to meddling in peoples health like banning smoking and fat taxes, to try and correct the failed NHS incentive structure.

The best way is to merely have a scheme whereby the cost of insuring the fittest x% is calculated is calculated, and the insurance subsidy is set at that level. Combined with a catastrophic insurance and treatment annuity scheme.

Lola said...

The US system is not 'free market'. It is wildly protectionist and insurers don't really compete and their Docs have an even stronger union than we do.

If you look back the UK prior to about 1914 had excellent basic health insurance by Friendly Societies who paid doctors and did transfers to another society if you were working away. This didn't doctors (low pay) or insurers (couldn't compete on price and value) so the FS were got stuffed by Parliament due to better lobbying by Docs/Insurers.

NHS has both tried to kill me (Failed NICE 'guidance') and fixed me - Papworth. The clinicians in the NHS still just about cling to professional responsibility and 'caring', but the vast bureaucracy couldn't give a shit. My heart fix (new valve) was very well done indeed.

But I also have a 'pre-existing condition' that has always made me uninsureable since no commercial outfit can assess the risk. This is where the State can operate as insurer of last resort.

But, as MW says best to privatise all the provision and give every CD or a voucher.

Kj said...

You have a couple of other health systems within the UK; Guernsey and Jersey has public/contracted hospitals and free market GPs, while Sark has a contracted GP that charges set fees, but no public insurane/hospital provision. I have no idea how this works out in £s and health outcomes, but I'm curious.
Personally I think GPs, dentists and opticians could be privately funded. The last two are close to entirely privately funded and operated over here already, and except for a few anti-competitive practices by dentists that needs to be ironed out, it works.

john b said...

Private healthcare is cheap and effective *where an adequate-ish state-funded healthcare system exists*. Where it doesn't, it's expensive.

(decent private healthcare insurance in India costs more than BUPA, because in India you're going to damn well use it for every medical situation, whereas in the UK the most expensive situations - say, sewing you back together after your bike gets hit by a truck - will invariably be dealt with by the NHS)

The point here is 'state-funded', rather than 'state-provided', of course.

Kj: private funding for GPs is a terrible idea. The expense of healthcare ranges roughly from "eat more fruit & veg" (very cheap) through to "heart transplant at 50" (very expensive). Getting rid of state-funded GPs will encourage poor people not to seek treatment until whatever they have is acute, which is inevitably vastly more expensive than treating it earlier on.

TheFatBigot said...

It's impossible to compare private and NHS healthcare in terms of cost and outcomes because the NHS has to deal with things the private sector doesn't cover and the NHS is burdened with the people whose financial situation means they could never pay-in more than the cost of what they receive.

To suggest that private doctors are better than NHS doctors is a straw man argument. With very very few exceptions, private doctors also work in the NHS and there is no reason to think they are more accurate in their diagnoses or more careful in their surgery when working privately.

The reason the NHS is a joy for socialists is that it can never be anything other than an under-funded disappointment about which they can make unattainable promises of improvement.

Of course everyone cannot be treated immediately and receive the best possible treatment. That will always be the case because there is only so much money. Only so many nurses and so many doctors can be employed, only so much can be spent on drugs and other treatments, only so many old hospitals can be upgraded or replaced by a new building, only so many CAT scan machines can be afforded and so on ad infinitum.

There are certainly valid questions about the amount of money the NHS spends on bureaucracy but almost all that is unnecessary for patient care is essential for the gathering of statistics the government of the day needs to use to feather its electoral bed.

"Sorry, we can't afford it" is the honest answer to most complaints about the NHS, the answer from the naive left is always "of course you can have it, it's your right". The latter garners votes from those who don't have to foot the bill.

Mark Wadsworth said...

AKH, I'm glad to hear you're feeling better.

SB: "[The NHS] imposes massive unseen costs elsewhere via it's bureaucratic rationing and delay tactics" I'll come back to that later.

L, agreed, the USA seems to be the worst of all possible worlds.

Kj, dentists and opticians are more or less private in the UK, that seems to work, because teeth and spectacles are cheaper and more manageable, it's not like heart transplants and so on which end up costing tens of thousands. And cosmetic surgery seems to be private and that works fine as well.

JB, yes, that's what I thought.

TFB: ""Sorry, we can't afford it" is the honest answer to most complaints about the NHS"

Exactly! If they - and we - just said that more often, maybe it would sink in that the NHS is not a bottomless well of money and magical free treatment.

But then people come up with expressions like "bureaucratic rationing" and "postcode lottery" and "it's my right" when clearly it's not a right. It is a privilege to be treated at other people's expense and other people are only willing and able to pay so much.

Kj said...

JB:private funding for GPs is a terrible idea. ...Getting rid of state-funded GPs will encourage poor people not to seek treatment until whatever they have is acute, which is inevitably vastly more expensive than treating it earlier on.

It's intuitive, but not necessarily true. The NHS is the only system in Europe as far as I know that doesn't charge anything for basic GP visits, some countries charge up to a significant share of the costs, also within the public health system, without any evidence of cost-shifting to hospital treatment in lower income groups. The worth of preventative care is overrated, but the value that is in preventative care offered by GPs, is not offered in patient mills with a couple of thousand on the list and 5 min. per patient. It's one of the fields of medicine that can be offered competitively, and differentiated much more (nurses can do a lot more, low cost walk-in-clinics for the small stuff etc.).

MW:dentists and opticians are more or less private in the UK, that seems to work, because teeth and spectacles are cheaper and more manageable, it's not like heart transplants and so on which end up costing tens of thousands. And cosmetic surgery seems to be private and that works fine as well.

Yes, it's also usually non-urgent, and people can make choices, as opposed to when having a stroke. Not all dentistry is cheap though, and dentist's I know tells me that people from all income groups purchase pretty expensive dental work when it's needed, and manage fine with a combo of savings, loans and help from family. That's not to say it's not difficult from some, but having private provision and funding of manageable health issues isn't draconian IMO. I was under the impression that dental and optics was mainly NHS provided, thanks for the correction.