surely the relatively low proportion of GDP devoted to health in UK has a simple more Darwininian explanation, almost a Selfish Gene story. I am simply far more ready to put my hand in my pocket to cover the cost of healthcare for myself and my family than I am for my neighbours, colleagues or anonymous members of the UK population as a whole. Hence it is always going to be hard to sell high taxes to fund healthcare, whereas private funding - whether via insurance, co-payments or prescription charges, as in most other rich countries - is bound to be more politically acceptable. Add a dash of British hypocrisy in here. Many middle-class folk of ostensibly left-wing persuasion profess to believe that they and most other people are "decent" (i.e. altruistic), but of course when the NHS lets them down, they pay for private care,
BTW, you might ask those who argue that the NHS has been sytematically underfunded by the wicked Tories how this could have come about in a democracy? After so many decades (and a good many years of Labour Governments), how have the Tories managed to keep the NHS in poverty while winning elections?
Hi Laurence! Can u reply to your comment? If I may say so, that position assumes you can continue to pay for yours and your family’s healthcare. What if you couldn’t? What then?? The assumption that private is best and you can jump the NHS queues tells on the two systems being available. It also Telstra on your ability to maintain income. Illness can strike in a flash. Job security can change in a sixpence. Just ask the investors of Bernie Madoff or Northern Rock, RBS and Woolworths! Nothing is too big to fail even a government can default and a run on a bank can wipe out savings and pensions anywhere in the world now we are global! Divorce or any unthinkable thing can affect yours or anyone’s position to take that view. Do for your sake and mine I hope there is always an NHS and a Benefits system to maintain our needs in any event! A position of ‘I’m alright jack’ is common but in my experience misplaced. So much better NOT to limit your horizon for yourself your family and all of us! Why not have a fully working fit for purpose NHS? Why not have a wonderful state pension or state benefits? What is stopping us having fantastic wages double or treble if even those greatly increased benefits and pensions? And why not bring the mega rich and mega poor to the centre of the balance scales instead of an out of balance set? Cuts are no good for health and wealth. It’s limiting. Money is a funny thing. It’s a worthless piece of paper. But it means we can exchange your work for mine. But how much are you really worth? Are you worth more than a surgeon? Is Wayne Rooney worth more than a special forces soldier? And is Gary linekar worth more than a scientist or a firefighter? Who knows but, if 70.000 people want to pay Wayne to kick a ball who am I to argue? But Wayne had a contract and a duty moral or civil to spend that back to allow the cycle to rotate and do it again? The problem we face, as you say in a democracy, is that why go we allow the very few mega rich hold on to all of our money? Making us on a daily basis devoid of it, do we don’t earn enough tax? Because the pot is unfunded without its input? No tax is triggered on unspent money, none! So not spending contributes no return of the money and no tax revenue either! So why do we allow it? The answer is we shouldn’t! If we did, everyone would earn more. Tax would outpace government spending and ironically tax can be reduced with a tsunami of spending. Why the Tory’s or the Labour haven’t is because they are dimwits! Two dimensional household budgets is not four dimensional thinking! The NHS costs what it costs! You can’t cut snd expect it to do the same! It’s only because of duty of care from its workers it’s managed this far. But like the NHS it will collapse just like our economy as we have long since run out of money! It’s a debt ridden household budget that the government are in charge of. So they or we better start thinking and looking at the position dead in the eye! Or all of us will need resuscitation!
Very informative piece. Well thought through. However we can’t keep our politicians out of it! We just need better politicians! … but that’s a whole different story! ….of course when they do get involved, basically there are never out of involved! …they stick their ore in and hold the conveyor belt up!…this has now meant that we have more and more queues for each treatment or investigation that the problem never gets sorted out in an holistic way! It’s also true that the more patients on those waiting lists need more and more managers and paper pushers to not only manage those ever increasing queues but to deal with the ores that the government keep putting in!… furthermore, the NHS now employ not private hospitals so much as accountants and bean counters to disperse the ever decreasing pot of money needed to avoid spending it, increasing the waiting lists further. They actively avoid spending it! And spend more on managers and civil law payouts than on the nurses doctors and surgeons we really need. The low wages of whom means we can’t retain their skills! It’s truly an utter shambles of biblical size!…it all starts at the GPs or A&E. You either can’t get an appointment and have to negotiate past lady’s who’s job it is NOT to allow you past their gate as gatekeepers to the service that day or any day soon any more or you queue in the ambulances outside as another queue in an emergency for hours on end! Either way it’s a queue! From the beginning! You queue for bloods, for basic BP checks, for prescriptions and for x rays, scans, treatments and care! You name it we wait for it! Even beds!…. Now that’s said, the service has been underfunded for decades. In a dirty attempt to undermine it so it can be privatised! Thatcher started this sell off but the public just wouldn’t allow our NHS to be sold off! So now we are trying to play catch up on a decreasing real terms revenue tax take. It’s a total shambles. Thatcher thought it best to get rid of all their problems by selling off water electric gas and anything else to first get money but second to get of the responsibility of all those utilities. The less headache to worry and be in charge of the better for their lazy way of governing! Plus I can imagine some kick backs along the way as individual incentives to sell off! Someone was going to gain from it! A bit like the PPE scandal! …. But running down the NHS was never good and we are where we are! More managers and support staff than nurses doctors and surgeons! Managing more queues than ever never getting treated in the round and always lacking in funds. I remember local health centres that closed to get treated at larger hospitals! Now they are failing Streating wants to go back to local hubs! With no extra staff and no money and no equipment! It’s a shambles! He had no clue. His best idea is AI…. AI! Yes, an app on our phone do we can treat ourselves! Ridiculous!!!! Just like 111 and 999 it’s never going to work better than proper GPs. Will they just stop! Have one ministry of health to oversee supplies and have doctors in the desks if surgery’s not staff! Do all tests immediately that day! Get the job done! Not delay it! But we must have doctors and nurses paid properly for their service so we get retention! Not do it on the cheap! Get the best equipment locally! And stop training people and letting them go! Make those who they go to pay back their investment snd loss, a bit like a football transfer fee! So we are not out of pocket! Stop these accountant led managers run things! We don’t need assisted dying as it’s already happening! Treatment isn’t being given now! People are dying needlessly because the system and attitudes are shot to bits! They are not treating and by so they are dying early! DNR are on everyone it seems to me! Poor decisions everywhere! Cuts after cuts after cuts on an increasing population. But it can all be paid for properly. We need a SPENDING POLICY!!!!!! Make all money move so tax is triggered because at the moment only a small proportion of our money is in our working pot triggering taxes! Too much money is unspent, unused and idle each month incurring no tax! None!! Nada!!!… if that was to be spent the tax revenue can cope with the needs of us including NHS. I’d put a spend by date on money and make the rich spend it back. Vat will cover the needs. The cost is the cost! Cuts can never work. But we are spending too much in one direction and nowhere near enough in doing the task in hand! Don’t cut make rules that make sure our money flows through our economy to increase tax take! Make all our money flow like a raging river not a trickle! One will produce tax the other won’t!
Kristian, are you saying that labour productivity is poor but because the NHS is 'capital-light' its total factor productivity is not at all bad. Thus mix of resources is inefficient.
That apart could we not garner productivity insights by making comparisons with private hospitals that exist in the UK (and look at how they balance of their resources)?
surely the relatively low proportion of GDP devoted to health in UK has a simple more Darwininian explanation, almost a Selfish Gene story. I am simply far more ready to put my hand in my pocket to cover the cost of healthcare for myself and my family than I am for my neighbours, colleagues or anonymous members of the UK population as a whole. Hence it is always going to be hard to sell high taxes to fund healthcare, whereas private funding - whether via insurance, co-payments or prescription charges, as in most other rich countries - is bound to be more politically acceptable. Add a dash of British hypocrisy in here. Many middle-class folk of ostensibly left-wing persuasion profess to believe that they and most other people are "decent" (i.e. altruistic), but of course when the NHS lets them down, they pay for private care,
BTW, you might ask those who argue that the NHS has been sytematically underfunded by the wicked Tories how this could have come about in a democracy? After so many decades (and a good many years of Labour Governments), how have the Tories managed to keep the NHS in poverty while winning elections?
Hi Laurence! Can u reply to your comment? If I may say so, that position assumes you can continue to pay for yours and your family’s healthcare. What if you couldn’t? What then?? The assumption that private is best and you can jump the NHS queues tells on the two systems being available. It also Telstra on your ability to maintain income. Illness can strike in a flash. Job security can change in a sixpence. Just ask the investors of Bernie Madoff or Northern Rock, RBS and Woolworths! Nothing is too big to fail even a government can default and a run on a bank can wipe out savings and pensions anywhere in the world now we are global! Divorce or any unthinkable thing can affect yours or anyone’s position to take that view. Do for your sake and mine I hope there is always an NHS and a Benefits system to maintain our needs in any event! A position of ‘I’m alright jack’ is common but in my experience misplaced. So much better NOT to limit your horizon for yourself your family and all of us! Why not have a fully working fit for purpose NHS? Why not have a wonderful state pension or state benefits? What is stopping us having fantastic wages double or treble if even those greatly increased benefits and pensions? And why not bring the mega rich and mega poor to the centre of the balance scales instead of an out of balance set? Cuts are no good for health and wealth. It’s limiting. Money is a funny thing. It’s a worthless piece of paper. But it means we can exchange your work for mine. But how much are you really worth? Are you worth more than a surgeon? Is Wayne Rooney worth more than a special forces soldier? And is Gary linekar worth more than a scientist or a firefighter? Who knows but, if 70.000 people want to pay Wayne to kick a ball who am I to argue? But Wayne had a contract and a duty moral or civil to spend that back to allow the cycle to rotate and do it again? The problem we face, as you say in a democracy, is that why go we allow the very few mega rich hold on to all of our money? Making us on a daily basis devoid of it, do we don’t earn enough tax? Because the pot is unfunded without its input? No tax is triggered on unspent money, none! So not spending contributes no return of the money and no tax revenue either! So why do we allow it? The answer is we shouldn’t! If we did, everyone would earn more. Tax would outpace government spending and ironically tax can be reduced with a tsunami of spending. Why the Tory’s or the Labour haven’t is because they are dimwits! Two dimensional household budgets is not four dimensional thinking! The NHS costs what it costs! You can’t cut snd expect it to do the same! It’s only because of duty of care from its workers it’s managed this far. But like the NHS it will collapse just like our economy as we have long since run out of money! It’s a debt ridden household budget that the government are in charge of. So they or we better start thinking and looking at the position dead in the eye! Or all of us will need resuscitation!
Very informative piece. Well thought through. However we can’t keep our politicians out of it! We just need better politicians! … but that’s a whole different story! ….of course when they do get involved, basically there are never out of involved! …they stick their ore in and hold the conveyor belt up!…this has now meant that we have more and more queues for each treatment or investigation that the problem never gets sorted out in an holistic way! It’s also true that the more patients on those waiting lists need more and more managers and paper pushers to not only manage those ever increasing queues but to deal with the ores that the government keep putting in!… furthermore, the NHS now employ not private hospitals so much as accountants and bean counters to disperse the ever decreasing pot of money needed to avoid spending it, increasing the waiting lists further. They actively avoid spending it! And spend more on managers and civil law payouts than on the nurses doctors and surgeons we really need. The low wages of whom means we can’t retain their skills! It’s truly an utter shambles of biblical size!…it all starts at the GPs or A&E. You either can’t get an appointment and have to negotiate past lady’s who’s job it is NOT to allow you past their gate as gatekeepers to the service that day or any day soon any more or you queue in the ambulances outside as another queue in an emergency for hours on end! Either way it’s a queue! From the beginning! You queue for bloods, for basic BP checks, for prescriptions and for x rays, scans, treatments and care! You name it we wait for it! Even beds!…. Now that’s said, the service has been underfunded for decades. In a dirty attempt to undermine it so it can be privatised! Thatcher started this sell off but the public just wouldn’t allow our NHS to be sold off! So now we are trying to play catch up on a decreasing real terms revenue tax take. It’s a total shambles. Thatcher thought it best to get rid of all their problems by selling off water electric gas and anything else to first get money but second to get of the responsibility of all those utilities. The less headache to worry and be in charge of the better for their lazy way of governing! Plus I can imagine some kick backs along the way as individual incentives to sell off! Someone was going to gain from it! A bit like the PPE scandal! …. But running down the NHS was never good and we are where we are! More managers and support staff than nurses doctors and surgeons! Managing more queues than ever never getting treated in the round and always lacking in funds. I remember local health centres that closed to get treated at larger hospitals! Now they are failing Streating wants to go back to local hubs! With no extra staff and no money and no equipment! It’s a shambles! He had no clue. His best idea is AI…. AI! Yes, an app on our phone do we can treat ourselves! Ridiculous!!!! Just like 111 and 999 it’s never going to work better than proper GPs. Will they just stop! Have one ministry of health to oversee supplies and have doctors in the desks if surgery’s not staff! Do all tests immediately that day! Get the job done! Not delay it! But we must have doctors and nurses paid properly for their service so we get retention! Not do it on the cheap! Get the best equipment locally! And stop training people and letting them go! Make those who they go to pay back their investment snd loss, a bit like a football transfer fee! So we are not out of pocket! Stop these accountant led managers run things! We don’t need assisted dying as it’s already happening! Treatment isn’t being given now! People are dying needlessly because the system and attitudes are shot to bits! They are not treating and by so they are dying early! DNR are on everyone it seems to me! Poor decisions everywhere! Cuts after cuts after cuts on an increasing population. But it can all be paid for properly. We need a SPENDING POLICY!!!!!! Make all money move so tax is triggered because at the moment only a small proportion of our money is in our working pot triggering taxes! Too much money is unspent, unused and idle each month incurring no tax! None!! Nada!!!… if that was to be spent the tax revenue can cope with the needs of us including NHS. I’d put a spend by date on money and make the rich spend it back. Vat will cover the needs. The cost is the cost! Cuts can never work. But we are spending too much in one direction and nowhere near enough in doing the task in hand! Don’t cut make rules that make sure our money flows through our economy to increase tax take! Make all our money flow like a raging river not a trickle! One will produce tax the other won’t!
Kristian, are you saying that labour productivity is poor but because the NHS is 'capital-light' its total factor productivity is not at all bad. Thus mix of resources is inefficient.
That apart could we not garner productivity insights by making comparisons with private hospitals that exist in the UK (and look at how they balance of their resources)?