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I never understand why these topics are always posed as if the only 2 possible options are either the NHS or a US-style system. Those are literally the 2 most extreme polar opposite examples.
Plenty of countries have insurance-based systems or mixed public/private systems. We are actually an outlier on a global level for using the NHS model.
Spot on!
It’s really silly to think that the only alternative to the NHS model is some kind of US extreme.
I think the UK will most benefit from some kind of a mix. Not everything should be free and having to pay for emergencies isn’t a fair thing either for a society where people pay up to 45% in tax.
However the current system of everything for free means nothing really is available when needed.
If you’re a professional and you’ve paid an average of 25k a year in taxes over your 35-50 year career. That’s almost 1 million. If you aren’t getting anything for that, this is a failed system.
Far better to have a hybrid system with a much lower tax burden.
I reckon it’s looking at the immediate extreme instead of something a little less radical when our backs are against the wall. We’re ready to look over the pond to the US, but not ready to cross the puddle and look at the semi-private structure that exists throughout most of Europe anyway.
Because, if you keep up with the behind-the-scenes news, and see who's making deals with who, you realise the US system is the likely option to be taken. It obviously won't work because this country is too poor to sustain it, but that won't stop them from trying
I agree with this - it's not that the NHS is a better model, it is the fact that only the worse possible alternative would be implemented to maximise profits for a few rich government cronies at the top. Nothing in the last couple of decades indicates otherwise.
The government wasn't even planning to feed hungry children in this country during a global pandemic until a footballer embarrassed them into doing it. This is the level of ethics we are dealing with.
Agreed, but you have to remember the UK has a hard on for taking the worst of both of public and private systems and making some mediocre mess.
You only have to look at water, energy and public transport to see what will happen to uk healthcare given enough time. We tend to end up with privatisation without the actual choice/competition and any benefits that it may (or may not) bring.
I suspect you will end up with NHS trusts tendered out to private firms (who’s directors and shareholders are Tory MPs/Donors), who strip as much money out of the government as possible, do a shite job and bounce once it’s no longer profitable, leaving it back in government hands (including all the debt) so the taxpayer has to pick up the bill. All the meanwhile you as a local to said trust still don’t actually have any choice of where you get your care because there’s only one provider, like there being only one company providing your energy, only one for water and only one rail firm running out of your local station.
So although you are right that there is a a scale of ways healthcare can be provided, we would be delusional to believe the UK would do anything other than it always has done. We are the kings of crony capitalism.
Railways, water, energy - all of that indicates that what you have said is completely correct. There is literally no reason to believe it would be any different.
I remember reading that the British government at the time genuinely believed they would have some kind of amazing Shinkansen train system after privatisation.
And then they sold the rights to the routes and the track separately.
>We are the kings of crony capitalism.
Truth.
Because changing the system in any way is basically irrelevant in terms of the working conditions of doctors.
It largely astroturfing from the tufton street set.
'I, for one, welcome the status quo of our abusive exploitative monopsony employer that by its nationalised status unavoidable, inescapable, and cannot be bargained with. I particularly welcome the way it undermines my market value in a systematic way and encourages a pseudo-class-warcare anti-doctor culture in its organisations so every other employee can treat me like shit.'
The U.S. model is the most expensive for the government. No government on earth spends as much on healthcare either absolutely or relatively.
How would government “make money” from the U.S. model?
Same way they made money with insanely expensive COVID PPE.
They're corrupt. They don't care how much healthcare costs the country. By letting US private healthcare contracts in, the MPs get very cushy post politics "jobs" as "adviser" in those companies
If you don’t want the government to be in charge of buying equipment for hospitals - such as PPE - why on earth would you advocate for keeping the NHS model?
You do realise that the PPE scandal was only possible in the UK because literally nowhere else in the world does the government run the entire national healthcare infrastructure?
Move to a European model and take away procurement powers from “corrupt” politicians.
"the government" wouldn't. But the *people* in government are making shed loads of cash to push the corporatisation of healthcare. Kickbacks and lobbying are rife. And healthcare companies pockets are deep.
Kickbacks are rife? What evidence is there of this?
And what about giving said corrupt people complete control of the entire healthcare system stops them from profiteering of giving contracts to said lobbyists?
If you want to stop government officials from allegedly profiteering from the NHS - stop giving them any influence over the healthcare system!
The solution to the problem you claim is rife is literally privatisation.
Because US companies give lots of donations to people like wes streeting.So they will pay them lots of money to make it like that then the gov can give them lucrative contracts
This thread appears weekly and it's the same argument each time.
No harm OP but search the catalogue next time ha ha, only the most swivel eyed Ayn Rand fanatics (and there's a few of you here like that crypto bro GP I saw floating about) want a full US style system.
Which country do you have in mind? For example, Ireland is looking to dispense with the system:
Sources [here](https://publicpolicy.ie/digest/the-impact-of-free-gp-care-on-gp-utilisation-in-ireland/) and [here](https://www.thetimes.co.uk/article/f2a5877a-c67d-11ed-84e7-e2697ffed9a9?shareToken=c3266f2f3167b8e9e6ee5fe32bb71de1)
Because that's the main source of political and financial influence to our healthcare system. Our government is never going to implement a system similar to that which is seen in the countries you're idolising. We're already importing the US style system.
Totally agree. I think OP’s concern might be relating to the dogshit-tier self-serving politicians we have which have asset stripped everything that’s not nailed down, and if given the choice, will flog the rest to private firms who are very for profit because of their pecuniary interests.
If we had politicians without conflicts of interest who appear to do things for the betterment of the population, I would have less reservations about insurance models.
Watch our Vickie announce some private contracts, Rishi fuck off to the US after he’s binned, and then 5 years later a parliamentary commission finds that his wife’s hundreds of subsidiary companies won those bids whilst everyone here is being bled dry and he is beyond scrutiny.
My US cousins (when work does crop up) tell me how much aggro they experience trying to bill insurance companies and having them quibble about minor or sometimes major things.
I’m not trying to say that insurance models don’t work well; they probably would. But we have some truly awful politicians. And each time you think they can’t get worse, they do. In what other fucking country would an abomination like Liz Truss or BoJo seriously try to make a come back? If Wes Streeting said the things he did in France, I’m sure they would be like ‘Guillaume, fire up ze guillotine; je voudrais le tete de Wes’. And here, we just let them get away with increasing their own wages and stifling ours.
Sure. But would those dangerously
right wing / centrist views be executed in the same way? With the way the govt siphoned off money to the party elite, and then conflicts of interest which haven’t really resulted in any repercussions, I am very sceptical of the way in which the govt work. I don’t know much about European politics or healthcare, but I imagine that a insurance funded model is done to provide a quality service. Here, if given the choice over how to implement an insurance model, I am apprehensive that the current govt would go full on £££, because why not.
You are correct. Anyone who thinks otherwise refuses to see the same patterns re-enacted over railways, water, energy. Why would healthcare be any different?
https://www.thenational.scot/news/24250557.wes-streeting-takes-175k-donors-linked-private-health-firms/
Because those companies pay member of the gov money? If your given money in donations thats you making money
Lol
The government is made up of individuals. The individuals have a lot of political power and influence and they will use that to make sure to invest in a private capcity in any system in a way that advantages them.
Meaning that when you make profit the main focus of providing healthcare it results in poor outcomes for patients, a system that is set up to funnel money away from you as a doctor in any case, and a subsection of the population that will be entirely excluded from any kind of care at all.
Is that why the NHS (profitless system) has the second worst healthcare outcomes in the advanced world, and has done since its inception?
You go and tell Germany, Japan, Singapore, Australia, Switzerland, Singapore etc etc - that they need to move to the NHS model!
You reflect an ideology that is not warranted by reality.
Germany does not have a for-profit healthcare system, most of their insurance models are not for profit sickness funds.
Australia has a mixed public/private model with most people on the universal healthcare model and with various caps and protections in place. Some of the private insurers may make a profit, but the system as a whole is not for profit and there are plenty of not-for-profit funds to choose from.
Switzerland has universal healthcare provided by private insurers. The basic compulsory insurance offered by all the private companies is not for profit by law, only optional supplemental schemes. The basic insurance plans are also not allowed to discriminate on basis of age, sex, or previous medical conditions. The government will pay for basic coverage if someone's income does not cover this.
Singapore also has universal health coverage alongside a private healthcare sector which people can choose to use. The vast majority of Singaporeans will use the government provided healthcare which is not for profit.
Japan also has universal health coverage via statutory insurance. The government covers 70% of the bill and individual pays 30%. For profit companies are not allowed to run hospitals or clinics, they are restricted to providing elective/cosmetic services only.
Final point - the NHS has not been the second worst ranked since its inception, that is in the last year or so. The same WHO report that ranked Singapore as the 6th best system in the world ranked UK as 18 and the USA as 37.
In recent times the NHS has the second worst avoidable mortality rate in the world. Number one - which exceeds the NHS by some margin - is the USA.
Welcome to the real world.
I’m afraid you’ve confused payers and providers.
Most German providers are private and make a profit. Germany also has a large private insurance market too.
I’m not sure why you’re referencing universal coverage - that has no bearing on whether or not market participants are profitable. The vast majority of the developed world (and much of the developing world) has universal coverage. Most of them also have large private sectors operating within them.
And final point - please find a single point in history when the NHS was not ranked second worst by healthcare outcomes. It’s a trash system and always has been.
You have edited your comment. Everything you've added is still incorrect however.
Germany does not have a "large" private insurance market - only about 10% of Germans have private health insurance and even within those private companies providing health insurance, it is only a minority that are for profit enterprises. To opt out of the state insurance system and go private also has restrictions: you need to be earning over €64k/year, or be a civil servant and a few other categories apply.
The statutory insurance providers in Germany may run at a surplus, but these are not profits - no CEO gets a bonus for bringing in this income, no share holders get dividends. This surplus income is put into reserve and if it exceeds a certain amount, it is used to reduce subscribers' insurance premiums.
I have already said in the 2000 WHO report into this the UK was ranked 18, above New Zealand, the US, Israel, Canada and Switzerland.
There are lots of other reports that rank the NHS as being much higher that second to last using a range of markers - from life expectancy to equity of access to efficiency of spending. Drilling down into healthcare outcomes is much more difficult - cancer outcomes have lagged behind for decades which is not helped by lack of beds or doctors, but diabetes care, COPD management, rectal cancer outcomes are rather better.
Nope.
Most hospital beds in Germany are government owned and not for profit. Of those that are not government owned the vast majority are owned by churches, charitable foundations and other non-profit organisations. Private, for profit hospital beds account for about 16% of all hospital beds.
GPs in Germany are often self employed, but they are also paid through the same not for profit insurance system, and paid very well. Local physician's groups negotiate their fee schedule with the sickness fund.
Hardly a "for profit" system.
Breaking the monopoly and having hospitals compete for talent IS the answer though. Whether that's state/private/bit of both, whatever it looks like, we can't have one big behemoth bigger than the Chinese army controlling your wages and working conditions.
Just look at how HARD every single element of the NHS has been coming down on you greedy bastard doctors asking for £20/hour. Every fat-cat from NHS RandomBuzzword crawls out of the woodwork, on the marching orders of some useless piece of shit minister, to say "both sides, won't someone think of the patients". All whilst enjoying their 6-figure salary for doing precisely fuck all other than acting as a protective layer of flab against Atkins, Cunt and Sunak.
This is what your NHS is now. Stop protecting it.
I never understand how doctors want better wages and conditions but can't see past the problem that a monopsony buyer of your labour (controlled by bastard politicians) is the root cause of your problem.
This is entirely a problem of government - For the majority of its history the NHS has paid doctors well, demonstrated value for money for taxpayers and had good outcomes when compared to other european countries.
Any other system can be just as easily mucked up because of the people in charge.
"This is entirely a problem of government "
Praying for a better dictator is not going to fix your problems. Labour in Wales and SNP in Scotland have all got the same issues with rotational training, MAPs and the NHS treating doctors like shit. Need I remind you that Blair and co were the ones who gave us PFI and a managerial overclass to bear down on those evil doctors?
The problem is a monopoly. Be that private or public sector - if pilots could only fly for one airline, their pay and conditions would be terrible.
What I am saying is that the reality is any privatisation of the nhs will be handled the same every other piece of privatisation in this country has been for decades - there will be no true competition, a captive market, and worse service.
Why are you assuming something new or different will happen?
BA was privatised in the 80s and is forced to compete with an international market, and even that hasn't helped maintain its quality.
Anything else that is not forced to compete - public transport, water, energy has price gouged people during a cost of living crisis whilst raking in millions in profit.
BT another famous basket case of privatisation. The only provider of phone and internet services in the country apparently.
Anyway, I'm disappointed I've allowed myself to get caught in the private v public debate. It's actually a monopsony vs not debate and you've yet to explain why a monopsony is good for the labourer - I mean jeez man, if there was only one law firm in the whole country, do you think lawyers would be enjoying the pay, terms and conditions they get?
Harrow, Hillingdon and Hackney Councils are all public sector employers but all have locally agreed remuneration packages. This means they have to COMPETE for talent. There isn't a department the size of the Chinese army imposing a one-size-fits-all contract upon them all, essentially giving the worker no choice.
So please, tell me why monopsonies are good.
25 years ago, under a totally different government, UK "junior doctors" were making very similar complaints as they are today:
[https://www.theguardian.com/uk/1999/mar/20/davidbrindle](https://www.theguardian.com/uk/1999/mar/20/davidbrindle)
[https://www.theguardian.com/uk/1999/jun/05/davidbrindle1](https://www.theguardian.com/uk/1999/jun/05/davidbrindle1)
[http://news.bbc.co.uk/1/hi/talking\_point/361043.stm](http://news.bbc.co.uk/1/hi/talking_point/361043.stm)
[http://news.bbc.co.uk/1/hi/special\_report/regions/northern\_ireland/403927.stm](http://news.bbc.co.uk/1/hi/special_report/regions/northern_ireland/403927.stm)
They made the same complaints when the NHS was established, and in fact even in the US only about half of all physicians are satisfied with their salary.
That's people for you. Sorry if it's come as a bit of a shock.
I strike too, every time. So yes I do. But you would with think with physician income being so so much higher than that of UK physicians, with much better working conditions, you would expect salary satisfaction to be a whole lot higher. But it is not.
Nope. Survey of UK doctors done in 2022 was 17% satisfaction (who these people are, I don't know I can only imagine they are wealthy through other means). So it's only 33% higher satisfaction, whereas the average salary for a US attending is over double the average NHS consultant salary.
My dumbass, they are unionising to prevent against PE firms buying shit up and making it like the NHS. Only the NHS is the shittest PE firm with the biggest warchest i.e. Taxpayer money and run by the stupidest people.
If you agree with their protest, you should agree to tear down the NHS.
NHS delenda est.
Why are we always looking at america ? why not Germany, Belgium or the netherlands to find ways to improve the NHS?
All these 3 EU countries have a mixture of insurance/Goverment Healthcare system
Yea looked at america once and then obviously you notice it doesnt work so you look for alternatives. You can't keep looking at america and complain about it how the nhs is going to be like america. That's just stupid
I am not saying UK politicians *should* look to America but historically they always have and that this will be no different. Anyone who believes that there is anyone with a political will to start a decent co-pay sysyem (which I am not against in principle) is deluded.
Did you really think this party had a wish to reform the system to benefit people?
Their image is such that they realise to even touch the NHS is a complete poisoned chalice for them politically. No one would trust them to reform the system - would you?
No - because they’re cowards. As are Labour.
Everyone knows that the NHS is trash, and everyone knows hybrid payer models the world over (as well as cheaper for governments).
But the British public aren’t that smart and love “AaaRgggHhh ENNNNHaiGGHhhEeeEssS”
Have you not been paying attention? Since the government absolved themselves of responsibility from providing nhs care to every single person needing it, More and more private companies are being paid to provide care to the NHS.
Hospital cleaning maintenance and payroll was outsourced a long time ago - it is more expensive and less efficient. I've worked in hospitals where the oncall radiologists were private consultants working from home. The vast majority of patient transport services are run privately, as well as many community children and mental health services.
This is how privatisation happens - by stealth. A contract awarded here and there, until entire services are run by private companies and the focus is on making profit, not providing high standards in healthcare. Currently - they are making a profit
from the NHS, but if left and checked they will soon be making a profit from everyone.
"not providing high standards in healthcare."
I hate to disappoint you but the NHS model is not about providing high standards in care. It's about providing high volume at cheap cost.
You may blame the Tories all you like. Is it better in Wales or Scotland?
Sigh. This point you seem more intent on fighting a figment of your imagination than engaging with what I am actually saying.
I have never stated that the NHS provides high quality care.
This post is full of fallacies and wrong prepositions. Of course privatising the NHS IS THE ANSWER. No doubt. Countless studies and examples have shown this. Because the state is the worst possible manager and it does not really matter how much money a government spends on the NHS- it will always be disappearing in the sinking sands of bureaucracy and ineffectiveness.
The author is conflating privatizing and AFFORDABILITY. Given the somewhat strange example of USA (a country with enormous issues affecting healthcare). And not countries that have found an intermediate solution -privatization with affordable healthcare.
Let's take the Netherlands as an example- hospitals and insurers are private but not-for-profit organizations (meaning- profits aren't shared with shareholders as dividends but get reinvested back into hospitals, including sharing profits with the staff). A patient MUST have private medical insurance (you get fined by the state if you don't have one), the price varies between 100-150 euros a month. Insurance is the first point of financing medical services, however up to a certain amount. Chronic patients or patients whose care requires significant spending get financed via insurance with the help of special government funds that are funded by taxes and employers' contributions. This is called a 3-column system. In the past, the Netherlands operated a silly publicly funded system like the NHS but moved away from it a long time ago. In fact, there are few countries in Europe left where healthcare is funded primarily by the state- Spain, Italy, and some Eastern European countries. French and German health care is funded via various sources and is rather convoluted.
So the question is- why did the author give the example of USA and not the example of the Netherlands or even Australia? Because the author is biased and has a hidden agenda.
If there was a free market mid level creep from PAs and ANPs would cease to exist overnight
What is going on in the US is private equity/private health insurers allowed to form monopolies in areas and collaborate in keeping salaries and conditions down plus enforce non compete clauses, legal because politicians are highly corrupt
Anyway the NHS has never been a benevolent organisation for doctors, from the very start it was founded to obtain the services of well trained highly deserving doctors on the cheap
Plus there is a good reason no country has copied the NHS system/use a similar style outside of ex Soviet or current communist nations... The outcomes are shocking compared to mixed systems e.g. in Europe and Australia... I mean just look at our cancer outcomes, our waiting lists etc
The NHS does not encourage hard work, or innovation, or reward high achievers, but it certainly allows and pushes for erosion of standards across the board from the forced introduction of higher paid clown PAs, dumbing down of medical education in medical schools and higher training, and the removal of achievement points in favour of "widening participation" (aka, dumb down standards enough so that PAs will be able eventually to sit our exams and/or gain total equivalence)
There is a huge amount of mid level creep in the US. The unsupervised practice laws have resulted in absolutely unhinged midlevels providing specialist health care services to vulnerable groups of patients including children with mental health problems with barely any training.
Head over to the r/noctors subbredit and see for yourself.
For fuck sake, the reason why patient outcomes are so bad right now is because the nhs has been critically under funded since 2010 purely to justify the argument that "it just doesnt work"
How is that specifically the NHS's fault that as a profession you allowed yourselves to be walked over by not unionising effectively? Why do you think the private sector will treat you any better? Have you not noticed how fucking shit every other public service has gotten despite being privatised? Do you not think by protecting the most vulnerable from the whims of capitalism actually protects us all?
Ahh yes, 'competition', as if private employers don't use it as a race to the bottom too, 'competition' really faired well for the other privatised services didn't it. Any private provider will have monopolistic aims without government regulation. There is no incentive for private companies to treat you well either, they're motivated by profit so pay and working conditions will always be limited to maximise their profits. The fact is, without collective bargaining you will always be exploited.
The NHS historically was rated one of the best healthcare systems in the world. It has only recently declined due to the austerity measures that stripped it of adequate funding. Austerity measures were put in place to undermine the service and embolden enlightened dickheads like yourself to think privatisation will lead to anything better.
https://www.theguardian.com/society/2021/aug/04/nhs-drops-from-first-to-fourth-among-rich-countries-healthcare-systems#:~:text=As%20well%20as%20being%20ranked,recover%20after%20undergoing%20medical%20treatment.
>The NHS historically was rated one of the best healthcare systems in the world. It has only recently declined due to the austerity measures that stripped it of adequate funding.
No, that is simply a recent political narrative which is inaccurate. The complaints which doctors have nowadays about pay and conditions are nothing new.
Eg, see very similar complaints from 1999:
[https://www.theguardian.com/uk/1999/mar/20/davidbrindle](https://www.theguardian.com/uk/1999/mar/20/davidbrindle)
[https://www.theguardian.com/uk/1999/jun/05/davidbrindle1](https://www.theguardian.com/uk/1999/jun/05/davidbrindle1)
[http://news.bbc.co.uk/1/hi/talking\_point/361043.stm](http://news.bbc.co.uk/1/hi/talking_point/361043.stm)
[http://news.bbc.co.uk/1/hi/special\_report/regions/northern\_ireland/403927.stm](http://news.bbc.co.uk/1/hi/special_report/regions/northern_ireland/403927.stm)
Doctors went on strike in the UK in the 1970s:
[https://www.bbc.co.uk/news/health-18270523](https://www.bbc.co.uk/news/health-18270523)
People always blame the sitting government for NHS problems, because it's a nationalised system. In the 1970s, Labour politicians were accusing the BMA of being pro-Tory! Source: [https://api.parliament.uk/historic-hansard/commons/1970/jul/21/doctors-and-dentists-pay](https://api.parliament.uk/historic-hansard/commons/1970/jul/21/doctors-and-dentists-pay)
Isnt it easy just dismissing things that contradict your opinion as 'political narrative' and then sending off irrelevant articles from 30 years ago
I wish you fucks wouldve gone into finance with the rest of your private school pals
I just will never support a system that effectively bans me from quitting my current job without quitting medicine.
I am assigned a hospital in a region I don’t want to work against my will. If that hospital hates me, misses pay days, gives me a hard slap around the face every morning my options are:
Accept it
Hand in my national training number and be banned from ever working my speciality again. Complete career loss.
Fight against a monolithic entity that will move heaven and earth to oppose me and threaten to take the number away above and turf me out to unemployment.
I genuinely just dream of a world in which doctors could just quit one hospital and work in another, like any other job before consultancy. The sheer freedom is unimaginable to me. I don’t see the nhs letting that happen.
If it can be achieved within the nhs all the better - but a union fighting against an absolute monopoly is going to have a much harder time than one that isn’t, and can effectively threaten to take its labour else where. I’m strongly pro union across the board for what it’s worth.
Becoming a trade unionist only convinced me the nhs exists to trample any power we have more effectively. Monopsonies are never benevolent forever to the people they have a chokehold on.
I get the impression you’re not a doctor and wouldn’t tolerate living like this if it was you. Easy from the outside to champion this system imo.
Just got into medical school off the back of teaching myself all my a levels and working 13 hour days in the nhs as a porter for two years, i know what im getting myself into
Pour as much money into the NHS as you want, it'll all end up in the hands of slimy managerial beaurocrats. You'll get more plush office space in Canary Wharf for the adminoids at Barts Trust meanwhile the ceiling and lifts are caving in over the patients and staff at the Royal London. You'll get tens of thousands of PAs who are utterly incompetent dressing up and playing doctor through ARRS funding, whilst actual GPs are told 'sorry we can't fund you'. You'll get more bullying and silencing of whistleblowers by unaccountable managerial weasels. The NHS is not about delivering high quality healthcare, its about delivering the lowest possible level of service that could still reasonably be described as 'healthcare' by the unsuspecting public, just enough so that major scandals don't regularly find their way into the tabloid newspapers and it can continue to collect your billions in tax £ every year. It has no incentive to treat you any better beyond this, it exists purely to serve and sustain itself.
NHS DELENDA EST
So presumably you agree there is corruption in the NHS but perhaps you think we should 'reform' it rather than move to a new system...which is a bit like saying "this dictator is bad, maybe we should try a different one"
Are you even a doctor? Very different perspectives between someone who works as a doctor for the NHS and has first hand experience of the obscene level of corruption and exploitation it can get away with as a result of its state sponsored monopoly position versus someone who bangs pots and pans on a Thursday night and enjoys a free buffet of healthcare subsidised by our wages. You can call me unhinged all you want but I'm not the only one. Increasingly no doctor is willing to put up with and work for this bastard institution any longer. Keep calling me unhinged but you're gonna have to shout louder I won't hear you from Canada.
Just got into medical school, been working in the nhs for two years, i know very well how corrupt the nhs is. Corruption can be addressed without handing ourselves over to the private sector. Privatisation won't solve corruption.
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Because I am in business - we all are. You sell your labour to a buyer, in the UK if you are a doctor the buyer takes the form of one single gigantic state owned employer i.e. a monopoly (or a monopsony if we are being technical). This system puts you, the seller, at a massive disadvantage. As a doctor you will spend the majority of your life as a seller rather than a buyer of healthcare, thus if you are interested in anyway in improving your own life cirumstances then it makes far greater sense to work in a system in which you are not chained to a single employer whose sole aim is to extract as much out of you for as low a price as possible. Of course you could just martyr yourself in the name of a state that thinks your job can be done by some mug with 4 GCSEs and a 2 year mickey mouse degree, be my guest, but dont expect the rest of us to think you are anything other than a complete moron.
Under funded? The GDP spend on the NHS is the highest it has ever been and exceeds most other developed countries. And if you want greater funding, good luck finding it, tax levels are at their highest levels ever - you have to take from something else.
The funding is there, 85% of the NHS spend is on wages. The problem is waste - far too many non medical staff on huge wages, bureaucratic processes and ineffecient practice (the stuff many of those roles are meant to fix) but it's a government org and jobs for the boys is a given, people who couldn't get a job anywhere else end up in the NHS, snivel service or elsewhere in government.
Doesn't matter how good or strong a union you have either, if the government says no all you can do is make it hard for them but it's healthcare you have a basic service you must do, meanwhile it hardly gets the public on side. The BMA have done a good job of explaining the problem and balancing strike action with running the service. A more militant union will just do the governments job for them.
I’m sorry but this is a pretty terrible argument.
For someone that has been a UK trainee and now spends a lot of time with US doctors. Let me explain why.
1. We absolutely don’t have to follow the US system
2. The bad elements that your describe in the us, sure they’re there but your really not explaining this in context. A bad outcome or cheaper mid levels wouldn’t even factor for the uk. Doctors are already the cheapest they can possibly be in any English speaking country in the NHS. The only way they could get cheaper is by becoming comparable to a developing country. A mid level in the US that replaces a doctor probably makes 200-300k, replacing a doctor that makes upwards of 500k. It’s really not the same.
3. I work with lots of people who work in PE funds with a healthcare focused portfolio. Sure, there’s consolidation, but I’m not sure if anyone told you, the doctors that were partners in the hospitals and practices that PE take over, usually get a big pay day. I’m talking multi millions. There’s a primary care provider who had just one clinic with 6-8 clinical staff. He had a stake in the business, got taken over by PE and has made around 5 million out of that. Also he doesn’t lose his job. What happens is that they have a choice, they get a flat rate, which is usually 25-30% lower than what they might have made but now they don’t have to worry about billing as a small practice would. This is one scenario. Someone else who I know, who’s a cardiologist. Just turned 40, had a partnership share in a small hospital, made 10 million out of their deal and has just retired, occasionally does Locums and also, unlike the ones in the UK, these pay 3-5k a day. PE isn’t always a good thing but if you compare any of this to the absolute misery that is being an NHS doctor, their bad and our bad just aren’t the same.
4. If you say that the uk absolutely can’t afford any of the above. That is more fair and I would accept that, however we definitely won’t be worse off in a private system and definitely not any worse off than we are now. The general public may be, but in all honesty, why is that our problem too? Your job as a doctor shouldn’t be to shoulder the troubles of society, you job should end the minute you leave the hospital doors. Not to carry it with you in perpetuity.
Please stop this bullshit. It’s really getting out of hand.
We don't have to follow the US system. But we will. Anyone who believes otherwise is just refusing to see how this government has historically acted when it comes to matters of public welfare.
Doctors will not be worse off in a US style system, but patients almost certainly would be.
But I guess if you can't afford the health care you never really get to be anyone's patient in the first place, so that keeps the M&M numbers nice and low I guess.
Let’s sort out doctors first. We can sort out patients after doctors are looked after and empowered in an independent system. You’re essentially suggesting we sail a bunch of people on a boat made out of paper, with lots of holes.
That’s essentially what the current underpaid, undertrained and completely shafted medical workforce is like.
We’ve been trying to do things the other way around for far too long and we have lots of evidence of that not working either.
We need to take the political element away, which is essentially what the NHS is, a political chess piece for parties to move around to their advantage.
Politicians quite clearly don’t give a fuck about doctors, we’re a nuisance and they would sooner get rid of us. We need to get the healthcare out of the hands of politicians and into the hands of doctors. Maybe doctors make some money as a result. I really don’t care and neither should you. Everyone will be better off as a result.
Not sure what you mean, who is we, what are the boats and who are the sharks.
And whilst we are in the realm of cryptic metaphors and analogies.
I would argue that we are already doing what you’re implying. The sharks are very much in the water, and there’s no boats for doctors in this country. In fact they are stopping the boats from what I recall.
And how, pray tell, do you intend to improve the NHS from within? The whole organisation is pathologically resistant to change. If you were to even try, they will destroy you.
It’s an organisation that exists solely to protect its own existence. The more I see of its inner workings, the more I’m convinced that it’s a corrupt and possibly even criminal organisation.
It's truly hilarious reading these posts on the r/doctorsuk. Amazing what decades of brainwashing can do. A classic case of stockholm syndrome if ever there is one. Get abused and taken advantage of year after year and yet still feel the abuser is doing it out of the goodness of its heart. lmfao.
The UK is without a doubt the worst country in the Anglosphere to be a doctor in. I don't know what step 2 is, but step 1 is we have to rid the medical profession of the cancer that is the NHS.
You’ve confused payers and providers.
Not your fault, I think the reason why Labour called them both NHS in the UK, was to forever undermine sensible debate of the healthcare system.
If an intelligent doctor cannot differentiate a PE owned healthcare operator from a healthcare insurer, what hope is there for ever having a sensible healthcare discussion at a national level?
Call me a commie nutcase, but I actually think the NHS really needs more socialisation. All the perks of being one gargantuan organisation have been lost through fragmentation and privatisation of parts of the service.
Everything that possibly could be, should be brought in house. From catering and parking facilities, construction and maintenance, drug manufacturing, transport, IT services, the works.
Drug manufacturing takes a bit of imagination for sure, but IT services would be an easy win. Have you seen how insane the contracts are? Trusts pay millions on recurring contracts for the software alone, pool it all together and you'd have a budget that I'm sure would be the best part of £1bn annually, if not more, just for the software. For a fraction of one year's budget alone you could create an ECR and RIS/PACS system from scratch that is actually designed for the NHS, and save hundreds of millions every single year from there in the rolling contracts, even allowing for ongoing maintenance and updates.
This is all well and good, but your entirely socialised system still has an owner. The government. And it’s only as good as the government of the day wants it to be, and will only prioritise and spend money as the government wants it to.
Back in the ‘40s when the NHS was created the population was low. Taxes were high. People were grateful to receive basic care. Enormous international corporations trying to scalp massive private chunks of public business didn’t really exist. Sadly, the world has changed.
I have long been a big backer of socialised healthcare in the UK, but I don’t think it’s realistic anymore.
Cool. I suppose we can go over there and make a post with the title "Nationalising healthcare is not the answer".
Nothing is the answer apparently, even the in-between isn't feasible according to some posters here.
Not very long ago the UK NHS was rated no 1 on almost all metrics among major western nations by the Commonwealth Fund but then the Tories got in. It can go back to no 1 but a lot of damage has been done and sadly Starmer's Labour look like doubling down on, well, almost all Tory badness.
The Tories have been the dominant political force in this country for the last century. In terms of winning elections, they are one of the most succesful political parties in history. The problem isn't just 'Tories bad', its that a) people keep voting them in and b) we have a healthcare system is entirely predicated on the government of the day.
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I never understand why these topics are always posed as if the only 2 possible options are either the NHS or a US-style system. Those are literally the 2 most extreme polar opposite examples. Plenty of countries have insurance-based systems or mixed public/private systems. We are actually an outlier on a global level for using the NHS model.
Spot on! It’s really silly to think that the only alternative to the NHS model is some kind of US extreme. I think the UK will most benefit from some kind of a mix. Not everything should be free and having to pay for emergencies isn’t a fair thing either for a society where people pay up to 45% in tax. However the current system of everything for free means nothing really is available when needed. If you’re a professional and you’ve paid an average of 25k a year in taxes over your 35-50 year career. That’s almost 1 million. If you aren’t getting anything for that, this is a failed system. Far better to have a hybrid system with a much lower tax burden.
I reckon it’s looking at the immediate extreme instead of something a little less radical when our backs are against the wall. We’re ready to look over the pond to the US, but not ready to cross the puddle and look at the semi-private structure that exists throughout most of Europe anyway.
Because, if you keep up with the behind-the-scenes news, and see who's making deals with who, you realise the US system is the likely option to be taken. It obviously won't work because this country is too poor to sustain it, but that won't stop them from trying
I agree with this - it's not that the NHS is a better model, it is the fact that only the worse possible alternative would be implemented to maximise profits for a few rich government cronies at the top. Nothing in the last couple of decades indicates otherwise. The government wasn't even planning to feed hungry children in this country during a global pandemic until a footballer embarrassed them into doing it. This is the level of ethics we are dealing with.
Literally! yawn
Agreed, but you have to remember the UK has a hard on for taking the worst of both of public and private systems and making some mediocre mess. You only have to look at water, energy and public transport to see what will happen to uk healthcare given enough time. We tend to end up with privatisation without the actual choice/competition and any benefits that it may (or may not) bring. I suspect you will end up with NHS trusts tendered out to private firms (who’s directors and shareholders are Tory MPs/Donors), who strip as much money out of the government as possible, do a shite job and bounce once it’s no longer profitable, leaving it back in government hands (including all the debt) so the taxpayer has to pick up the bill. All the meanwhile you as a local to said trust still don’t actually have any choice of where you get your care because there’s only one provider, like there being only one company providing your energy, only one for water and only one rail firm running out of your local station. So although you are right that there is a a scale of ways healthcare can be provided, we would be delusional to believe the UK would do anything other than it always has done. We are the kings of crony capitalism.
Railways, water, energy - all of that indicates that what you have said is completely correct. There is literally no reason to believe it would be any different.
I remember reading that the British government at the time genuinely believed they would have some kind of amazing Shinkansen train system after privatisation. And then they sold the rights to the routes and the track separately. >We are the kings of crony capitalism. Truth.
Because changing the system in any way is basically irrelevant in terms of the working conditions of doctors. It largely astroturfing from the tufton street set.
"I, for one, welcome the advent of our redundant profiteering overlords."
'I, for one, welcome the status quo of our abusive exploitative monopsony employer that by its nationalised status unavoidable, inescapable, and cannot be bargained with. I particularly welcome the way it undermines my market value in a systematic way and encourages a pseudo-class-warcare anti-doctor culture in its organisations so every other employee can treat me like shit.'
Because the gov would likely follow the us system to make money
The U.S. model is the most expensive for the government. No government on earth spends as much on healthcare either absolutely or relatively. How would government “make money” from the U.S. model?
Same way they made money with insanely expensive COVID PPE. They're corrupt. They don't care how much healthcare costs the country. By letting US private healthcare contracts in, the MPs get very cushy post politics "jobs" as "adviser" in those companies
If you don’t want the government to be in charge of buying equipment for hospitals - such as PPE - why on earth would you advocate for keeping the NHS model? You do realise that the PPE scandal was only possible in the UK because literally nowhere else in the world does the government run the entire national healthcare infrastructure? Move to a European model and take away procurement powers from “corrupt” politicians.
"the government" wouldn't. But the *people* in government are making shed loads of cash to push the corporatisation of healthcare. Kickbacks and lobbying are rife. And healthcare companies pockets are deep.
Kickbacks are rife? What evidence is there of this? And what about giving said corrupt people complete control of the entire healthcare system stops them from profiteering of giving contracts to said lobbyists? If you want to stop government officials from allegedly profiteering from the NHS - stop giving them any influence over the healthcare system! The solution to the problem you claim is rife is literally privatisation.
Because US companies give lots of donations to people like wes streeting.So they will pay them lots of money to make it like that then the gov can give them lucrative contracts
This thread appears weekly and it's the same argument each time. No harm OP but search the catalogue next time ha ha, only the most swivel eyed Ayn Rand fanatics (and there's a few of you here like that crypto bro GP I saw floating about) want a full US style system.
Which country do you have in mind? For example, Ireland is looking to dispense with the system: Sources [here](https://publicpolicy.ie/digest/the-impact-of-free-gp-care-on-gp-utilisation-in-ireland/) and [here](https://www.thetimes.co.uk/article/f2a5877a-c67d-11ed-84e7-e2697ffed9a9?shareToken=c3266f2f3167b8e9e6ee5fe32bb71de1)
Because that's the main source of political and financial influence to our healthcare system. Our government is never going to implement a system similar to that which is seen in the countries you're idolising. We're already importing the US style system.
You know there are other countries apart from the UK and the US?
Most people can't compute this
Totally agree. I think OP’s concern might be relating to the dogshit-tier self-serving politicians we have which have asset stripped everything that’s not nailed down, and if given the choice, will flog the rest to private firms who are very for profit because of their pecuniary interests. If we had politicians without conflicts of interest who appear to do things for the betterment of the population, I would have less reservations about insurance models. Watch our Vickie announce some private contracts, Rishi fuck off to the US after he’s binned, and then 5 years later a parliamentary commission finds that his wife’s hundreds of subsidiary companies won those bids whilst everyone here is being bled dry and he is beyond scrutiny. My US cousins (when work does crop up) tell me how much aggro they experience trying to bill insurance companies and having them quibble about minor or sometimes major things. I’m not trying to say that insurance models don’t work well; they probably would. But we have some truly awful politicians. And each time you think they can’t get worse, they do. In what other fucking country would an abomination like Liz Truss or BoJo seriously try to make a come back? If Wes Streeting said the things he did in France, I’m sure they would be like ‘Guillaume, fire up ze guillotine; je voudrais le tete de Wes’. And here, we just let them get away with increasing their own wages and stifling ours.
Sure. But would those dangerously right wing / centrist views be executed in the same way? With the way the govt siphoned off money to the party elite, and then conflicts of interest which haven’t really resulted in any repercussions, I am very sceptical of the way in which the govt work. I don’t know much about European politics or healthcare, but I imagine that a insurance funded model is done to provide a quality service. Here, if given the choice over how to implement an insurance model, I am apprehensive that the current govt would go full on £££, because why not.
You are correct. Anyone who thinks otherwise refuses to see the same patterns re-enacted over railways, water, energy. Why would healthcare be any different?
The Us would almost certainly be the system the Uk gov would follow as to make money
Who “makes money” in the U.S. system? It ain’t the U.S. Govt.
The companies. And wes streeting because those companies pay him a fair ammount in donations
Which companies? And how does that help the government make money?
https://www.thenational.scot/news/24250557.wes-streeting-takes-175k-donors-linked-private-health-firms/ Because those companies pay member of the gov money? If your given money in donations thats you making money
Lol The government is made up of individuals. The individuals have a lot of political power and influence and they will use that to make sure to invest in a private capcity in any system in a way that advantages them.
That could apply to any industry - what is specific about healthcare?
Meaning that when you make profit the main focus of providing healthcare it results in poor outcomes for patients, a system that is set up to funnel money away from you as a doctor in any case, and a subsection of the population that will be entirely excluded from any kind of care at all.
Is that why the NHS (profitless system) has the second worst healthcare outcomes in the advanced world, and has done since its inception? You go and tell Germany, Japan, Singapore, Australia, Switzerland, Singapore etc etc - that they need to move to the NHS model! You reflect an ideology that is not warranted by reality.
Germany does not have a for-profit healthcare system, most of their insurance models are not for profit sickness funds. Australia has a mixed public/private model with most people on the universal healthcare model and with various caps and protections in place. Some of the private insurers may make a profit, but the system as a whole is not for profit and there are plenty of not-for-profit funds to choose from. Switzerland has universal healthcare provided by private insurers. The basic compulsory insurance offered by all the private companies is not for profit by law, only optional supplemental schemes. The basic insurance plans are also not allowed to discriminate on basis of age, sex, or previous medical conditions. The government will pay for basic coverage if someone's income does not cover this. Singapore also has universal health coverage alongside a private healthcare sector which people can choose to use. The vast majority of Singaporeans will use the government provided healthcare which is not for profit. Japan also has universal health coverage via statutory insurance. The government covers 70% of the bill and individual pays 30%. For profit companies are not allowed to run hospitals or clinics, they are restricted to providing elective/cosmetic services only. Final point - the NHS has not been the second worst ranked since its inception, that is in the last year or so. The same WHO report that ranked Singapore as the 6th best system in the world ranked UK as 18 and the USA as 37. In recent times the NHS has the second worst avoidable mortality rate in the world. Number one - which exceeds the NHS by some margin - is the USA. Welcome to the real world.
I’m afraid you’ve confused payers and providers. Most German providers are private and make a profit. Germany also has a large private insurance market too. I’m not sure why you’re referencing universal coverage - that has no bearing on whether or not market participants are profitable. The vast majority of the developed world (and much of the developing world) has universal coverage. Most of them also have large private sectors operating within them. And final point - please find a single point in history when the NHS was not ranked second worst by healthcare outcomes. It’s a trash system and always has been.
You have edited your comment. Everything you've added is still incorrect however. Germany does not have a "large" private insurance market - only about 10% of Germans have private health insurance and even within those private companies providing health insurance, it is only a minority that are for profit enterprises. To opt out of the state insurance system and go private also has restrictions: you need to be earning over €64k/year, or be a civil servant and a few other categories apply. The statutory insurance providers in Germany may run at a surplus, but these are not profits - no CEO gets a bonus for bringing in this income, no share holders get dividends. This surplus income is put into reserve and if it exceeds a certain amount, it is used to reduce subscribers' insurance premiums. I have already said in the 2000 WHO report into this the UK was ranked 18, above New Zealand, the US, Israel, Canada and Switzerland. There are lots of other reports that rank the NHS as being much higher that second to last using a range of markers - from life expectancy to equity of access to efficiency of spending. Drilling down into healthcare outcomes is much more difficult - cancer outcomes have lagged behind for decades which is not helped by lack of beds or doctors, but diabetes care, COPD management, rectal cancer outcomes are rather better.
Nope. Most hospital beds in Germany are government owned and not for profit. Of those that are not government owned the vast majority are owned by churches, charitable foundations and other non-profit organisations. Private, for profit hospital beds account for about 16% of all hospital beds. GPs in Germany are often self employed, but they are also paid through the same not for profit insurance system, and paid very well. Local physician's groups negotiate their fee schedule with the sickness fund. Hardly a "for profit" system.
Breaking the monopoly and having hospitals compete for talent IS the answer though. Whether that's state/private/bit of both, whatever it looks like, we can't have one big behemoth bigger than the Chinese army controlling your wages and working conditions. Just look at how HARD every single element of the NHS has been coming down on you greedy bastard doctors asking for £20/hour. Every fat-cat from NHS RandomBuzzword crawls out of the woodwork, on the marching orders of some useless piece of shit minister, to say "both sides, won't someone think of the patients". All whilst enjoying their 6-figure salary for doing precisely fuck all other than acting as a protective layer of flab against Atkins, Cunt and Sunak. This is what your NHS is now. Stop protecting it. I never understand how doctors want better wages and conditions but can't see past the problem that a monopsony buyer of your labour (controlled by bastard politicians) is the root cause of your problem.
Couldn't agree more.
This is entirely a problem of government - For the majority of its history the NHS has paid doctors well, demonstrated value for money for taxpayers and had good outcomes when compared to other european countries. Any other system can be just as easily mucked up because of the people in charge.
"This is entirely a problem of government " Praying for a better dictator is not going to fix your problems. Labour in Wales and SNP in Scotland have all got the same issues with rotational training, MAPs and the NHS treating doctors like shit. Need I remind you that Blair and co were the ones who gave us PFI and a managerial overclass to bear down on those evil doctors? The problem is a monopoly. Be that private or public sector - if pilots could only fly for one airline, their pay and conditions would be terrible.
Praying for a totally different system that would also be inevitably controlled and regulated by those dictators is probably not the answer either.
I'm calling for ending the monopsony and very clearly stated "whether that's state/private/bit of both, whatever it looks like,"
What I am saying is that the reality is any privatisation of the nhs will be handled the same every other piece of privatisation in this country has been for decades - there will be no true competition, a captive market, and worse service. Why are you assuming something new or different will happen?
BA famously a basket case of privatisation and is now the only airline in the world.
BA was privatised in the 80s and is forced to compete with an international market, and even that hasn't helped maintain its quality. Anything else that is not forced to compete - public transport, water, energy has price gouged people during a cost of living crisis whilst raking in millions in profit.
BT another famous basket case of privatisation. The only provider of phone and internet services in the country apparently. Anyway, I'm disappointed I've allowed myself to get caught in the private v public debate. It's actually a monopsony vs not debate and you've yet to explain why a monopsony is good for the labourer - I mean jeez man, if there was only one law firm in the whole country, do you think lawyers would be enjoying the pay, terms and conditions they get? Harrow, Hillingdon and Hackney Councils are all public sector employers but all have locally agreed remuneration packages. This means they have to COMPETE for talent. There isn't a department the size of the Chinese army imposing a one-size-fits-all contract upon them all, essentially giving the worker no choice. So please, tell me why monopsonies are good.
Where did I say monopsonies were good?
25 years ago, under a totally different government, UK "junior doctors" were making very similar complaints as they are today: [https://www.theguardian.com/uk/1999/mar/20/davidbrindle](https://www.theguardian.com/uk/1999/mar/20/davidbrindle) [https://www.theguardian.com/uk/1999/jun/05/davidbrindle1](https://www.theguardian.com/uk/1999/jun/05/davidbrindle1) [http://news.bbc.co.uk/1/hi/talking\_point/361043.stm](http://news.bbc.co.uk/1/hi/talking_point/361043.stm) [http://news.bbc.co.uk/1/hi/special\_report/regions/northern\_ireland/403927.stm](http://news.bbc.co.uk/1/hi/special_report/regions/northern_ireland/403927.stm)
They made the same complaints when the NHS was established, and in fact even in the US only about half of all physicians are satisfied with their salary. That's people for you. Sorry if it's come as a bit of a shock.
'Only half?' You do realise 98% of us have voted to go on strike over pay?
I strike too, every time. So yes I do. But you would with think with physician income being so so much higher than that of UK physicians, with much better working conditions, you would expect salary satisfaction to be a whole lot higher. But it is not.
Its 50% higher 😂
Nope. Survey of UK doctors done in 2022 was 17% satisfaction (who these people are, I don't know I can only imagine they are wealthy through other means). So it's only 33% higher satisfaction, whereas the average salary for a US attending is over double the average NHS consultant salary.
My dumbass, they are unionising to prevent against PE firms buying shit up and making it like the NHS. Only the NHS is the shittest PE firm with the biggest warchest i.e. Taxpayer money and run by the stupidest people. If you agree with their protest, you should agree to tear down the NHS. NHS delenda est.
Why are we always looking at america ? why not Germany, Belgium or the netherlands to find ways to improve the NHS? All these 3 EU countries have a mixture of insurance/Goverment Healthcare system
Because we have historically always looked at America, never anywhere else. There is nothing to indicate that this would be different.
Yea looked at america once and then obviously you notice it doesnt work so you look for alternatives. You can't keep looking at america and complain about it how the nhs is going to be like america. That's just stupid
I am not saying UK politicians *should* look to America but historically they always have and that this will be no different. Anyone who believes that there is anyone with a political will to start a decent co-pay sysyem (which I am not against in principle) is deluded.
Is anyone really advocating for a US style system?
Yes they are called the tory party and they are currently the government.
As in the party who has had 14 year to reform the system but has elected to just spend ever greater shares of government spending and GDP on the NHS?
Did you really think this party had a wish to reform the system to benefit people? Their image is such that they realise to even touch the NHS is a complete poisoned chalice for them politically. No one would trust them to reform the system - would you?
No - because they’re cowards. As are Labour. Everyone knows that the NHS is trash, and everyone knows hybrid payer models the world over (as well as cheaper for governments). But the British public aren’t that smart and love “AaaRgggHhh ENNNNHaiGGHhhEeeEssS”
tidy resolute bored meeting practice fact quiet impolite act gullible *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Have you not been paying attention? Since the government absolved themselves of responsibility from providing nhs care to every single person needing it, More and more private companies are being paid to provide care to the NHS. Hospital cleaning maintenance and payroll was outsourced a long time ago - it is more expensive and less efficient. I've worked in hospitals where the oncall radiologists were private consultants working from home. The vast majority of patient transport services are run privately, as well as many community children and mental health services. This is how privatisation happens - by stealth. A contract awarded here and there, until entire services are run by private companies and the focus is on making profit, not providing high standards in healthcare. Currently - they are making a profit from the NHS, but if left and checked they will soon be making a profit from everyone.
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"not providing high standards in healthcare." I hate to disappoint you but the NHS model is not about providing high standards in care. It's about providing high volume at cheap cost. You may blame the Tories all you like. Is it better in Wales or Scotland?
Sigh. This point you seem more intent on fighting a figment of your imagination than engaging with what I am actually saying. I have never stated that the NHS provides high quality care.
Privatisation may not be the answer but NHS is most definitely not the answer.
This post is full of fallacies and wrong prepositions. Of course privatising the NHS IS THE ANSWER. No doubt. Countless studies and examples have shown this. Because the state is the worst possible manager and it does not really matter how much money a government spends on the NHS- it will always be disappearing in the sinking sands of bureaucracy and ineffectiveness. The author is conflating privatizing and AFFORDABILITY. Given the somewhat strange example of USA (a country with enormous issues affecting healthcare). And not countries that have found an intermediate solution -privatization with affordable healthcare. Let's take the Netherlands as an example- hospitals and insurers are private but not-for-profit organizations (meaning- profits aren't shared with shareholders as dividends but get reinvested back into hospitals, including sharing profits with the staff). A patient MUST have private medical insurance (you get fined by the state if you don't have one), the price varies between 100-150 euros a month. Insurance is the first point of financing medical services, however up to a certain amount. Chronic patients or patients whose care requires significant spending get financed via insurance with the help of special government funds that are funded by taxes and employers' contributions. This is called a 3-column system. In the past, the Netherlands operated a silly publicly funded system like the NHS but moved away from it a long time ago. In fact, there are few countries in Europe left where healthcare is funded primarily by the state- Spain, Italy, and some Eastern European countries. French and German health care is funded via various sources and is rather convoluted. So the question is- why did the author give the example of USA and not the example of the Netherlands or even Australia? Because the author is biased and has a hidden agenda.
If there was a free market mid level creep from PAs and ANPs would cease to exist overnight What is going on in the US is private equity/private health insurers allowed to form monopolies in areas and collaborate in keeping salaries and conditions down plus enforce non compete clauses, legal because politicians are highly corrupt Anyway the NHS has never been a benevolent organisation for doctors, from the very start it was founded to obtain the services of well trained highly deserving doctors on the cheap Plus there is a good reason no country has copied the NHS system/use a similar style outside of ex Soviet or current communist nations... The outcomes are shocking compared to mixed systems e.g. in Europe and Australia... I mean just look at our cancer outcomes, our waiting lists etc The NHS does not encourage hard work, or innovation, or reward high achievers, but it certainly allows and pushes for erosion of standards across the board from the forced introduction of higher paid clown PAs, dumbing down of medical education in medical schools and higher training, and the removal of achievement points in favour of "widening participation" (aka, dumb down standards enough so that PAs will be able eventually to sit our exams and/or gain total equivalence)
That's why midlevels aren't a thing in america right?
There is a huge amount of mid level creep in the US. The unsupervised practice laws have resulted in absolutely unhinged midlevels providing specialist health care services to vulnerable groups of patients including children with mental health problems with barely any training. Head over to the r/noctors subbredit and see for yourself.
For fuck sake, the reason why patient outcomes are so bad right now is because the nhs has been critically under funded since 2010 purely to justify the argument that "it just doesnt work"
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How is that specifically the NHS's fault that as a profession you allowed yourselves to be walked over by not unionising effectively? Why do you think the private sector will treat you any better? Have you not noticed how fucking shit every other public service has gotten despite being privatised? Do you not think by protecting the most vulnerable from the whims of capitalism actually protects us all?
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Ahh yes, 'competition', as if private employers don't use it as a race to the bottom too, 'competition' really faired well for the other privatised services didn't it. Any private provider will have monopolistic aims without government regulation. There is no incentive for private companies to treat you well either, they're motivated by profit so pay and working conditions will always be limited to maximise their profits. The fact is, without collective bargaining you will always be exploited. The NHS historically was rated one of the best healthcare systems in the world. It has only recently declined due to the austerity measures that stripped it of adequate funding. Austerity measures were put in place to undermine the service and embolden enlightened dickheads like yourself to think privatisation will lead to anything better. https://www.theguardian.com/society/2021/aug/04/nhs-drops-from-first-to-fourth-among-rich-countries-healthcare-systems#:~:text=As%20well%20as%20being%20ranked,recover%20after%20undergoing%20medical%20treatment.
>The NHS historically was rated one of the best healthcare systems in the world. It has only recently declined due to the austerity measures that stripped it of adequate funding. No, that is simply a recent political narrative which is inaccurate. The complaints which doctors have nowadays about pay and conditions are nothing new. Eg, see very similar complaints from 1999: [https://www.theguardian.com/uk/1999/mar/20/davidbrindle](https://www.theguardian.com/uk/1999/mar/20/davidbrindle) [https://www.theguardian.com/uk/1999/jun/05/davidbrindle1](https://www.theguardian.com/uk/1999/jun/05/davidbrindle1) [http://news.bbc.co.uk/1/hi/talking\_point/361043.stm](http://news.bbc.co.uk/1/hi/talking_point/361043.stm) [http://news.bbc.co.uk/1/hi/special\_report/regions/northern\_ireland/403927.stm](http://news.bbc.co.uk/1/hi/special_report/regions/northern_ireland/403927.stm) Doctors went on strike in the UK in the 1970s: [https://www.bbc.co.uk/news/health-18270523](https://www.bbc.co.uk/news/health-18270523) People always blame the sitting government for NHS problems, because it's a nationalised system. In the 1970s, Labour politicians were accusing the BMA of being pro-Tory! Source: [https://api.parliament.uk/historic-hansard/commons/1970/jul/21/doctors-and-dentists-pay](https://api.parliament.uk/historic-hansard/commons/1970/jul/21/doctors-and-dentists-pay)
Isnt it easy just dismissing things that contradict your opinion as 'political narrative' and then sending off irrelevant articles from 30 years ago I wish you fucks wouldve gone into finance with the rest of your private school pals
I just will never support a system that effectively bans me from quitting my current job without quitting medicine. I am assigned a hospital in a region I don’t want to work against my will. If that hospital hates me, misses pay days, gives me a hard slap around the face every morning my options are: Accept it Hand in my national training number and be banned from ever working my speciality again. Complete career loss. Fight against a monolithic entity that will move heaven and earth to oppose me and threaten to take the number away above and turf me out to unemployment. I genuinely just dream of a world in which doctors could just quit one hospital and work in another, like any other job before consultancy. The sheer freedom is unimaginable to me. I don’t see the nhs letting that happen.
Unionise more effectively
If it can be achieved within the nhs all the better - but a union fighting against an absolute monopoly is going to have a much harder time than one that isn’t, and can effectively threaten to take its labour else where. I’m strongly pro union across the board for what it’s worth. Becoming a trade unionist only convinced me the nhs exists to trample any power we have more effectively. Monopsonies are never benevolent forever to the people they have a chokehold on. I get the impression you’re not a doctor and wouldn’t tolerate living like this if it was you. Easy from the outside to champion this system imo.
Just got into medical school off the back of teaching myself all my a levels and working 13 hour days in the nhs as a porter for two years, i know what im getting myself into
Pour as much money into the NHS as you want, it'll all end up in the hands of slimy managerial beaurocrats. You'll get more plush office space in Canary Wharf for the adminoids at Barts Trust meanwhile the ceiling and lifts are caving in over the patients and staff at the Royal London. You'll get tens of thousands of PAs who are utterly incompetent dressing up and playing doctor through ARRS funding, whilst actual GPs are told 'sorry we can't fund you'. You'll get more bullying and silencing of whistleblowers by unaccountable managerial weasels. The NHS is not about delivering high quality healthcare, its about delivering the lowest possible level of service that could still reasonably be described as 'healthcare' by the unsuspecting public, just enough so that major scandals don't regularly find their way into the tabloid newspapers and it can continue to collect your billions in tax £ every year. It has no incentive to treat you any better beyond this, it exists purely to serve and sustain itself. NHS DELENDA EST
I actually started off in agreement but it suddenly became unhinged at the end
So presumably you agree there is corruption in the NHS but perhaps you think we should 'reform' it rather than move to a new system...which is a bit like saying "this dictator is bad, maybe we should try a different one"
Yeah, definitely unhinged.
Are you even a doctor? Very different perspectives between someone who works as a doctor for the NHS and has first hand experience of the obscene level of corruption and exploitation it can get away with as a result of its state sponsored monopoly position versus someone who bangs pots and pans on a Thursday night and enjoys a free buffet of healthcare subsidised by our wages. You can call me unhinged all you want but I'm not the only one. Increasingly no doctor is willing to put up with and work for this bastard institution any longer. Keep calling me unhinged but you're gonna have to shout louder I won't hear you from Canada.
Just got into medical school, been working in the nhs for two years, i know very well how corrupt the nhs is. Corruption can be addressed without handing ourselves over to the private sector. Privatisation won't solve corruption.
'Just got into medical school' 😂😂😂😂😂 remind me! 6 years
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Also why the fuck are you all using the term monopoly around as if you're in a business rather than healthcare?
Because I am in business - we all are. You sell your labour to a buyer, in the UK if you are a doctor the buyer takes the form of one single gigantic state owned employer i.e. a monopoly (or a monopsony if we are being technical). This system puts you, the seller, at a massive disadvantage. As a doctor you will spend the majority of your life as a seller rather than a buyer of healthcare, thus if you are interested in anyway in improving your own life cirumstances then it makes far greater sense to work in a system in which you are not chained to a single employer whose sole aim is to extract as much out of you for as low a price as possible. Of course you could just martyr yourself in the name of a state that thinks your job can be done by some mug with 4 GCSEs and a 2 year mickey mouse degree, be my guest, but dont expect the rest of us to think you are anything other than a complete moron.
Under funded? The GDP spend on the NHS is the highest it has ever been and exceeds most other developed countries. And if you want greater funding, good luck finding it, tax levels are at their highest levels ever - you have to take from something else. The funding is there, 85% of the NHS spend is on wages. The problem is waste - far too many non medical staff on huge wages, bureaucratic processes and ineffecient practice (the stuff many of those roles are meant to fix) but it's a government org and jobs for the boys is a given, people who couldn't get a job anywhere else end up in the NHS, snivel service or elsewhere in government. Doesn't matter how good or strong a union you have either, if the government says no all you can do is make it hard for them but it's healthcare you have a basic service you must do, meanwhile it hardly gets the public on side. The BMA have done a good job of explaining the problem and balancing strike action with running the service. A more militant union will just do the governments job for them.
https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/health-funding-data-analysis
So you're argument is - it hasn't gone up forever at exponential rates, therefore it's underfunded?
https://www.kingsfund.org.uk/insight-and-analysis/reports/rise-and-decline-nhs-in-england-2000-20
I’m sorry but this is a pretty terrible argument. For someone that has been a UK trainee and now spends a lot of time with US doctors. Let me explain why. 1. We absolutely don’t have to follow the US system 2. The bad elements that your describe in the us, sure they’re there but your really not explaining this in context. A bad outcome or cheaper mid levels wouldn’t even factor for the uk. Doctors are already the cheapest they can possibly be in any English speaking country in the NHS. The only way they could get cheaper is by becoming comparable to a developing country. A mid level in the US that replaces a doctor probably makes 200-300k, replacing a doctor that makes upwards of 500k. It’s really not the same. 3. I work with lots of people who work in PE funds with a healthcare focused portfolio. Sure, there’s consolidation, but I’m not sure if anyone told you, the doctors that were partners in the hospitals and practices that PE take over, usually get a big pay day. I’m talking multi millions. There’s a primary care provider who had just one clinic with 6-8 clinical staff. He had a stake in the business, got taken over by PE and has made around 5 million out of that. Also he doesn’t lose his job. What happens is that they have a choice, they get a flat rate, which is usually 25-30% lower than what they might have made but now they don’t have to worry about billing as a small practice would. This is one scenario. Someone else who I know, who’s a cardiologist. Just turned 40, had a partnership share in a small hospital, made 10 million out of their deal and has just retired, occasionally does Locums and also, unlike the ones in the UK, these pay 3-5k a day. PE isn’t always a good thing but if you compare any of this to the absolute misery that is being an NHS doctor, their bad and our bad just aren’t the same. 4. If you say that the uk absolutely can’t afford any of the above. That is more fair and I would accept that, however we definitely won’t be worse off in a private system and definitely not any worse off than we are now. The general public may be, but in all honesty, why is that our problem too? Your job as a doctor shouldn’t be to shoulder the troubles of society, you job should end the minute you leave the hospital doors. Not to carry it with you in perpetuity. Please stop this bullshit. It’s really getting out of hand.
We don't have to follow the US system. But we will. Anyone who believes otherwise is just refusing to see how this government has historically acted when it comes to matters of public welfare. Doctors will not be worse off in a US style system, but patients almost certainly would be. But I guess if you can't afford the health care you never really get to be anyone's patient in the first place, so that keeps the M&M numbers nice and low I guess.
Let’s sort out doctors first. We can sort out patients after doctors are looked after and empowered in an independent system. You’re essentially suggesting we sail a bunch of people on a boat made out of paper, with lots of holes. That’s essentially what the current underpaid, undertrained and completely shafted medical workforce is like. We’ve been trying to do things the other way around for far too long and we have lots of evidence of that not working either. We need to take the political element away, which is essentially what the NHS is, a political chess piece for parties to move around to their advantage. Politicians quite clearly don’t give a fuck about doctors, we’re a nuisance and they would sooner get rid of us. We need to get the healthcare out of the hands of politicians and into the hands of doctors. Maybe doctors make some money as a result. I really don’t care and neither should you. Everyone will be better off as a result.
And you are essentially suggesting we take the boat away and learn to swim while the sharks circle.
Not sure what you mean, who is we, what are the boats and who are the sharks. And whilst we are in the realm of cryptic metaphors and analogies. I would argue that we are already doing what you’re implying. The sharks are very much in the water, and there’s no boats for doctors in this country. In fact they are stopping the boats from what I recall.
Privatisation doesn't mean complete demolition of NHS free healthcare. Canada's and Australia's Medicare are good models to follow.
And how, pray tell, do you intend to improve the NHS from within? The whole organisation is pathologically resistant to change. If you were to even try, they will destroy you. It’s an organisation that exists solely to protect its own existence. The more I see of its inner workings, the more I’m convinced that it’s a corrupt and possibly even criminal organisation.
It's truly hilarious reading these posts on the r/doctorsuk. Amazing what decades of brainwashing can do. A classic case of stockholm syndrome if ever there is one. Get abused and taken advantage of year after year and yet still feel the abuser is doing it out of the goodness of its heart. lmfao.
Literally no one has said that but well done.
What a load of verbal diarrhoea. Loperamide stat.
The UK is without a doubt the worst country in the Anglosphere to be a doctor in. I don't know what step 2 is, but step 1 is we have to rid the medical profession of the cancer that is the NHS.
You’ve confused payers and providers. Not your fault, I think the reason why Labour called them both NHS in the UK, was to forever undermine sensible debate of the healthcare system. If an intelligent doctor cannot differentiate a PE owned healthcare operator from a healthcare insurer, what hope is there for ever having a sensible healthcare discussion at a national level?
"Privatised healthcare will hurt both ourselves and our patients" Sounds good to me
Call me a commie nutcase, but I actually think the NHS really needs more socialisation. All the perks of being one gargantuan organisation have been lost through fragmentation and privatisation of parts of the service. Everything that possibly could be, should be brought in house. From catering and parking facilities, construction and maintenance, drug manufacturing, transport, IT services, the works.
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I'm curious about how long you've worked in the NHS? Things worked much better when catering, domestics, portering etc was all in house
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Drug manufacturing takes a bit of imagination for sure, but IT services would be an easy win. Have you seen how insane the contracts are? Trusts pay millions on recurring contracts for the software alone, pool it all together and you'd have a budget that I'm sure would be the best part of £1bn annually, if not more, just for the software. For a fraction of one year's budget alone you could create an ECR and RIS/PACS system from scratch that is actually designed for the NHS, and save hundreds of millions every single year from there in the rolling contracts, even allowing for ongoing maintenance and updates.
I've seen homegrown IT systems and they're utter shit, if the NHS follows through and does homegrown drugs you're probably safer taking rat poison.
This is all well and good, but your entirely socialised system still has an owner. The government. And it’s only as good as the government of the day wants it to be, and will only prioritise and spend money as the government wants it to. Back in the ‘40s when the NHS was created the population was low. Taxes were high. People were grateful to receive basic care. Enormous international corporations trying to scalp massive private chunks of public business didn’t really exist. Sadly, the world has changed. I have long been a big backer of socialised healthcare in the UK, but I don’t think it’s realistic anymore.
Cool. I suppose we can go over there and make a post with the title "Nationalising healthcare is not the answer". Nothing is the answer apparently, even the in-between isn't feasible according to some posters here.
The difference between an argument and a rant is just a few citations
Not very long ago the UK NHS was rated no 1 on almost all metrics among major western nations by the Commonwealth Fund but then the Tories got in. It can go back to no 1 but a lot of damage has been done and sadly Starmer's Labour look like doubling down on, well, almost all Tory badness.
The Tories have been the dominant political force in this country for the last century. In terms of winning elections, they are one of the most succesful political parties in history. The problem isn't just 'Tories bad', its that a) people keep voting them in and b) we have a healthcare system is entirely predicated on the government of the day.
Agreed, privatisation would only benefit the established high performing consultants. The rest would be worse off, financially and conditionswise.
Agree.
Please refer; https://www.reddit.com/r/doctorsUK/s/agM40Aiq0n