To ask what should be being done about the economy and the country generally

[AlertCat]

I’m fairly Keynesian in my economics (I’m not an economist) but there are so many problems in society at the moment that I’m not sure even a massive programme of work like in the 1950s would really help.
There’s another thread where people are expressing unhappiness at the levels of tax they’re being asked to pay and it’s easy to find lots of threads about benefit claimants and immigration.

If we take as given that (a) our birthrate means we need immigration; (b) we have a benefits system that’s both overly punitive and (apparently) overly lenient if you say the right things (I’m not sure I personally believe the second part, but it’s an opinion I see a lot); (c) climate change means more and more people from the global south moving north; (d) the days of good state services, free at the point of use may be over-

what would you do differently to the government? Could we get back to the kind of services provision we had in the post-war consensus era (up until the Thatcher government)? Is that a pipe dream? Is it even desirable?

I.e. we’re losing 20 to 25 times as much growth and tax revenue from Brexit per year, and compounding annually, than we could hope to gain from a best-case scenario of a trade deal with the US even if we capitulate and let them feed us chlorinated chicken to get rid of the bacteria and maggots, and let them take over our GP practices.

Anybody want to petition the Government to rejoin the single market and customs union yet?

The new 1997 contract enabled GPs to be directly contracted to the NHS. And GPs are also part of the NHS pension scheme. Quasi private businesses at best.

So, compare the amount spent per capita with life expectancy. Again, the idea that the UK healthcare system is inefficient isn't borne out by the data. No doubt it could do better with more investment, but the figures don't suggest that the system is at fault. Do you know which country has the most efficient system based on this comparison? Cuba, which has nationalised (some would say socialist) healthcare.

I'd like to suggest an experiment. Let's try funding the NHS to the same per capita level as France, Australia or even Ireland. Give it at least ten years, but preferably 20. If, after that time, our health outcomes are worse than theirs, then we can change systems.

Just part of the whole dysfunction of the NHS in general. When it was first set up in 1948 Bevan boasted about how he’d get the doctors to go along with it by “stuffing their mouthes with gold”.

That was about allowing consultants to work in the NHS and have private practice, not GP practice.

Which indeed I said in my post . GPs however work in very close partnership with the NHS in providing Primary healthcare in this country & coming under American ownership has been extremely detrimental to the way in which they are allowed to operate regarding both mandated medical investigations and drug prescription.
I am very happy to post links to the many documented discussions between American healthcare companies regarding the NHS ‘proper ‘ . I have been following , generally with great dismay , the political shenanigans that have been the true source of major damage to the NHS over the last 30 years . Marcus Chown succinctly summarised the worst of this in the following article.
www.opendemocracy.net/en/ournhs/great-nhs-robbery/

@InPraiseOfIdleness I think you will find they were nhs employees but were contracted to do the GP work. The doctors were and are state employees with large pensions paid for by all of us. Andrew Lansley changed the system to a different set of contracts which we know today. In 1948, a majority of GPs had come into the newly formed NHS as contractors. However they swiftly found they didn’t have much autonomy. Each doctor was personally responsible for their patients. If they were an autonomous business they would need to find their own customers, borrow commercially and, crucially, pay fully for their pensions. They don’t do any of these things.

No, you can’t just compare it with life expectancy, obviously.

I could set up a fantastic hospital with the best world class equipment and cream of the crop doctors in a war zone (if I paid the doctors enough). The life expectancy of the patients would still be significantly lower than a much lower quality health service in another country where people weren’t having limbs blown off daily or being hit by shrapnel.

In some countries people have healthier lifestyles, diets. It’s very difficult to compare but you cannot compare based on just life expectancy, or PPP cost, obviously, because that is really just a reflection of different currency values and salary levels primarily (as salaries make up far more of the cost of healthcare than equipment or facilities).

To reach a sensible comparison you have to do a detailed comparison between survival rates for different conditions, treatment times, quality of patient care, and then compare this against cost. Obviously there’s subjectivity in which ones you weight as more important but primarily the focus of robust comparisons is mainly looking at survival rates/ recovery rates and patient outcomes per condition plus timely treatment and then looking at a ratio of this against percentage of GDP spent on healthcare to ascertain value for money.

The NHS scores extremely low on such measures, despite variation in how they are calculated, given that this is a developed country, it takes MONTHS or sometimes years for people to receive treatment when in most developed countries this happens in days or weeks for serious conditions, our patient care and outcomes are far lower, cancer survival rates are lower, outcomes for most serious diseases are lower, maternity care and infant mortality are far worse than in comparable countries, etc. And yet our system is not costing us a much lower percentage of GDP than most other comparator countries at our level of development. It’s perfectly clear that our system is useless.

It always used to make me laugh when - before Brexit and they were made to feel so unwelcome that most went home for good - without exception my lovely friends here from the EU used to go back to their own countries whenever they needed medical care or even dentistry because they knew they could book two weeks of holiday, go to see family, fix their medical/ dental issues to a much higher standard than would happen here even if they waited for a year, then come home again. And yet people were constantly going on about “health tourism”. You’d have to have a death wish to come to the UK on purpose to get health treatment.

They are part of the NHS pension scheme, but GP practices are private practices owned as partnerships by the senior doctors. They are paid a fixed amount per patient on their books per year. They have never been part of the NHS as such, they contract with the NHS.

I do think that we fanny around the issue but we just need to tax wealth more and sort the tax system out.

The question is then what to spend that on- health care, housing, and investment in defense and Pharmaceuticals. That's my 5 step plan 😂

Not any more.

You’re wrong, I’m afraid. They are. In fact, by chance my lovely GP wrote me a letter in which she mentioned this precise issue, just a couple of weeks ago. Random, and I won’t go into the context of why she did so, but I have it right here next to me in my study.

Although there's merit to discussions about how our healthcare system may be improved, and lessons that can be learned from other countries, it all feels a bit like moving deckchairs around on the titanic.

All of the countries cited as having better healthcare systems have the same, central economic crisis that we do - low fertility rates. We are barreling towards economic collapse, and high immigration, is a sticking plaster at best.

Without radical solutions to that, everything will continue to trend negative.

A good explanation, with South Korea as a case study:

I suppose as a partner in her GP practice she was just making it up, though, just to annoy @Blossomtoes on the off chance Blossomtoes might be writing nonsense on the internet again a couple of weeks later.

Not to mention the basic contractual terms between the practices and the NHS which are publicly accessible if you care to look.

🤔

The Conservative government also introduced a new locally negotiated personal services contract for general practitioners, which became law in 1997.6 This expanded under Labour in 2003, when more general practitioners opted for the greater working flexibility the contract allowed. Doctors could choose to be salaried, paid by the session, or work as locums as well as remaining self employed.

Comparing disease survival rates is tricky. People who are diagnosed early will inevitably survive longer post-diagnosis than someone who is diagnosed later even if there is no effective treatment for their condition.

I agree that NHS cancer care is in trouble, but I think it's due to patient backlogs, as a result of years of under-investment. My DM was diagnosed more than ten years ago and waiting times for investigations and treatment have slipped significantly since then. In our area, the two-week pathway is now a four-week pathway in all but name. We need to find the money, staff the service fully and sustainably and reduce reliance on expensive staffing agencies. Complaining that the NHS is an "inefficient black hole" won't help.

Immigration will not fix it. There won’t be any immigration available because birth rates are falling off a cliff everywhere outside sub-Saharan Africa. I mentioned this earlier in the thread regarding population collapse and how the effect is exponential and irreversible. At least some countries have Governments that are trying to slow the effect through family-friendly policies and tax breaks like South Korea, Hungary and others in Europe, whereas ours makes life ever less family friendly because they’re so stupid.

But it won’t stop it, and the effect is going to be catastrophic. Particularly if we don’t fix the state pension and public sector pension ponzi scheme problems rather quickly now because they will literally not be payable, and will not be paid.

Less than 3% of immigration is irregular and of people seeking asylum. The other 97% are inter company transfers, points based skilled visas, short term skills gap or agricultural workers or sectors that are in need such as the NHS or the care sector as well as students who prop up the education sector. Where did you get the majority are not net contributors? Even asylum seekers would work if they had the right to do so, rather than live on £9/week subsistence.

in actual fact an immigrant is more likely to be working than a young person in this country who are invariably a NEET.

https://www.ted.com/talks/jennifer_d_sciubba_the_truth_about_human_population_decline?language=en

Yes, this is why I said immigration is a sticking plaster solution at best. It has, in the UK and various other European countries, delayed the worst effects of population decline but does not solve it, and we are still approaching the abyss.

Unfortunately, high immigration is causing politics to lurch to the right, and I don't think that's where the solution will be found.

Agreed. People are so stupid they don’t seem to be able to understand the basic maths that the ageing population has meant population size has continued to go up despite the birth rate falling, masking the effect to some extent - so far. But it makes current irresponsible and fiscally unsustainable public sector structures completely unviable and they have to be changed. The options are change them (which people wont’ like), or simply wait for them to collapse (which will be far, far worse). But people are stupid and politicians are cowards so the ostrich syndrome will continue…

So depressing, that almost all of the problems on this thread could be addressed and made significantly better if people weren’t so selfish and short-sighted. But they are, so they’ll keep voting for morons and focusing on irrelevant nonsense issues that will pale into insignificance compared to what’s to come if we’re unprepared for it, which we will be if we continue as we are.

Shouting into the vacuum is a waste of time though, isn’t it? I think my best hope is to grab a towel, put my thumb out and take my chances with the Vogons.

That’s exactly what I said! GP practices are run as partnerships. The doctors own them as a business and are paid a fee per patient per year that they have on their books. Some of the other GPs in the practice who are not partners are employed as salaried employees, and when they have shortages the practice can contact in locums of course as well like any other business can hire temping staff. What part of it didn’t you understand??

@QuaintShaker it’s definitely a case of follow the lead of the dolphins at this point, isn’t it? This thread has made me face palm too many times now.

So long and thanks for all the fish! 🐬

Silly internet duplicating posts, so deleted.

Time for bed, and a lift to another galaxy, ideally!

Absolutely. There are despairingly few politicians who are even willing to speak about the problem, and it's alarming.

I appreciate that it is currently nigh-on-impossible to get elected from anything other than a marginally-left-of-centre position but I feel like this is where Labour and others should be making hay.

We should be talking about addressing wealth inequality, reducing the incentive for people to spend most of their 20s and 30s working long hours and, through fiscal incentives, encouraging people to have larger families. At the moment, you cannot "get ahead" and have 3 or 4 kids, too.

You could (justifiably) leverage the electorate's concerns as to high immigration by explaining that it is a stop gap, acknowledging that it cannot go on forever, and explain to people that a more equitable society is the most likely way by which we can realistically reduce immigration over the coming decades.

The harder bit will be selling the much-needed changes to the state pension...