Laughable.

If this is how the Left see “mainstream Tories”, it’s no wonder Labour’s going to get thrashed at the next election.

How Cameron can stand by and say nothing about the Hannan – Beck – Limbaugh – Palin clusterf*** that is vilifying the NHS is beyond me.

According to Palin, socialized health-care would not have treated the late Ivan Cameron but rather left him to die (I’m assuming that’s what a ‘death panel’ does).

We all now that it was precisely the care Ivan got from the NHS that has so shaped the leader of the oppositions views on the service.

“We know at least where this stems from: Obama is trying to extend healthcare coverage to everyone in the United States (a key promise he campaigned and won the election on!), and wingnut Republicans there are using Tories here to bolster their case.”

What an odd remark. The stance of the four Tories you have pictured has been consistent.

And the wonderful people who gave us two wars, identity cards, e-borders, cameras on every corner and any number of despicable things have cleared the way for this bunch of loons to get into power. The left’s done a wonderful job. Not.

Presumably Cameron won’t step in because that would just draw attention to the problem. And he’s just spent the last several years trying to persuade the country that his party are committed to the NHS. So it’s up to the left to publicise it.

As I’ve said on my own incipient blog, I think one of the most seriously worrying things about this new assault on the NHS by the British right is that they’ve shown themselves to have been influenced by the strategies that their US counterparts have used to stoke up the culture wars. That is, try to rally people round an extreme right agenda that very few would adopt on the basis of reasoned argument by scaring people shitless with misinformation about what the left has planned, and what the liberal alternative means for you and yours…

http://sohopolitico.blogspot.com/2009/08/culture-wars-are-coming-this-way.html

And yet this sort of wing-nuttery has become mainstream within the Conservative party here. Why doesn’t Cameron say anything about it? Why don’t the media hold him to account for his own people’s views?

Probably for the same reason that Tony Blair wasn’t asked, or expected to denounce every crackpot comment that came from the remnants of the far-left within the Labour party.

I know you are just playing petty politics, but do you really want a Parliament where every single MP slavishly obeys their Leader and never expresses a personal opinion?

That would just take us back to the old horrid days of Nu Labour, spin and pagers.

I’d rather live in a democracy where MPs are allowed to have some vestige of independence of thought and opinion.

After all, if every MP said the same thing – you wouldn’t be able to write another of your generic OMG THE TORIES ARE EVIL rants.

On second thoughts, hmmm…..

As has been pointed out above, Cameron doesn’t need to explain what other MPs and commentators think. Do you honestly believe that any party can show perfect unity on the NHS, education, welfare etc? Honestly, this is a truly limp attack on people who don’t matter as far as David Cameron’s leadership goes.

That said, these sorts of comments can still be dangerous.

Our Tory fiends can defend Hannan’s comments as ‘crackpot’ or ‘far’ right all they like, but what troubles people is that they rather suspect his views are more representative of the Tory party then Cameron’s.

@LFAT – Could it be, in an inversion of that famous Monty Python phrase, he’s not a very naughty boy,he’s the Messiah?

Actually, according to that Fabian poll 42% of Conservative voters think that the NHS is past its sell-by date (or think even worse of it). Given that the party’s support is currently boosted by people who want to turf this lot out, it’s reasonable to suppose that its core support – people who voted for it 1997 and 2001, say – is actually opposed to the NHS as we know it.

And it is poorer value for money now than it was in the 1990s, when it was recognised as a “cheap but cheerful” service. NuLab has poured a shedload of money into it, but people, ever ungrateful no doubt, don’t feel they have seen all that much for it. It’s probably also worth remembering that if NuLab had a clue how to get from the NHS as we have it to a European-style insurance-based system they’d be the on the case like the proverbial rat down the drainpipe.

And whoever forms the next government (and the ones after that) will have to deal with the realities of an ageing (and therefore sicker) population and health-care cost-plus inflation – new drugs and new surgical procedures mean that year on year the cost of the NHS (or indeed any alternative) increases in real terms and consumes a larger slice of the cake.

“Note that the US spends at least twice as much as we do on health as a percentage of GDP, and even then does not cover nearly 40 million people.”

Talking about being good on reality. Could we at least make contact with it here?

47 million is the usual number bandied about for the number of Americans who do not have “health care insurance”. That is very much not the same thing as the number of Americans who do not have “health care”.

1) Within that 47 million the real number of people without the ability to get health care insurance is around 9 million. To get up to the 47 million you need to add those who are eligible for Medicare (for the old) and Medicaid (for the poor) but who do not take it up, add all of those who were without health care insurance for any period of the previous year (ie, those who change jobs and see an interruption for even a few weeks in their insurance as a result) plus those who have the necessary income but, thinking that they are hale and hearty, decide not to purchase health care insurance.

2) Everyone in the US gets health care. If you don’t have insurance you will be treated in an emergency room. Every single county across the country has a contract with a local health care supplier to treat “the indigent”.

Please note that I’m not above trying to defend (or oppose) the current US system. Just trying to inject a bit of that reality that Sunny appears not so good on.

As to what they should do about reform that’s a very different matter and would be far too long for a blog comment. All I really want to get across here is that everything that is being talked about at the moment is “health care insurance”, not “health care”.

“Why doesn’t Cameron say anything about it? Why don’t the media hold him to account for his own people’s views?”

Because they’re relatively minor figures not at Shadow Cabinet level and Cameron doesn’t want to give them the oxygen of publicity?

Traditionally the Tory Right has tended to favour a more European healthcare system.

Goodness. Some people have dared to air a view that the NHS might not be the best way to run a health service. What is the world coming to? Call Ingsoc. They must be made to conform.

I especially like the link to the Fabian poll. They couldn’t have provided a more loaded question if they tried. Even I would agree with the statement “Whatever problems the NHS may have, its commitment to free treatment for everyone means it is still one of our great national symbols” but it doesn’t meant I don’t want it replaced with a more modern system.

Open your eyes. Do you really think there isn’t even a slight possibility that there is a better system of healthcare, either implemented or theoretical, than the NHS?

2) Everyone in the US gets health care. If you don’t have insurance you will be treated in an emergency room.

Being able to access ER treatment in extremis is not actually what most people would regard as a reasonable standard of health care. It may be OK for acute or emergency treatment, but sod all use for managing chronic conditions.

What a toadying arse Hannan is – am I the only one who thought he was going to start sucking the Fox News presenter’s nipple?

I think we all agree the NHS is not perfect and needs reform at the edges, but come on it is far better than the unfair, corruption soaked arsewit of a service they have in the states. This is a system where insurance companies take huge chunks out of employee’s salaries (never properly communicated to Americans) and do their best to push expensive, pointless drugs/treatments on patients that are only beneficial in the sense that they allow the CEO to buy that extra lap dance at the Xmas party.

Of course I realise that this isn’t what David “hug me quick” Cameron wants to introduce – but the Tories are being ambiguous in the extreme as to what they want to do.

Given the furnace of lies in the US at moment, maybe its a good time for the CONs to articulate their vision of the future?

Oh and here is Hannan’s email addy should anyone want to complain about his performance on Fecks News: daniel.hannan@europarl.europa.eu

“This is a system where insurance companies take huge chunks out of employee’s salaries (never properly communicated to Americans)”

They do? So you mean that if an employer pays something as a cost of employing someone then that cost is bourne by the employee? That if, say, health insurance is part of total remuneration then that reduces the employee’s wages?

Two things flow from this then.

1) US employee total remuneration has been rising stringly in recent years. For the cost of that health insurance has, increasing total compensation while not moving wages all that much.

2) Employers’ national insurance taxes are, on the same basis, thus paid by the employee in lower wages.

Why, we could even go on and talk about tax incidence….the idea that taxes aren’t necessarily paid by those who hand over the cheque. You know, like it’s the workers that pay the majority of corporation tax in the form of lower wages. Wouldn’t that be an exciting thing to think about?

[16] I would’ve expected you to agree with the second of those propositions, at least, Tim.

17) I agree with all three of them. It’s just that around here it’s rather difficult to get anyone to agree with any of them.

[18] Let me see if I can enlighten you, Tim.

Presumably you believe that if employers’ NI was abolished this would increase the demand for labour and thus lead to a wage rise.

If you believe this, you must also believe that the abolition of the business rate would lead to an increase in the demand for land and thus to commercial rent increases.

If you believe these things, you are in effect saying that tax changes have no effect on profitability – the entrepreneur’s costs and hence profits are fixed, it’s just a question of who (s)he pays those costs to. Hence business is indifferent to the amount of tax it pays.

“Presumably you believe that if employers’ NI was abolished this would increase the demand for labour and thus lead to a wage rise.”

True.

“If you believe this, you must also believe that the abolition of the business rate would lead to an increase in the demand for land and thus to commercial rent increases.”

Not all that sure. Depends upon the relative elasticities of demand and supply (as does the first example).

“If you believe these things, you are in effect saying that tax changes have no effect on profitability – the entrepreneur’s costs and hence profits are fixed, it’s just a question of who (s)he pays those costs to. Hence business is indifferent to the amount of tax it pays.”

Yes: but you’ve left out the important bit. We’re in an open economy. Thus the return to capital (no, not the entrepreneur, but to capital) is the global return to capital. Thus if in one locality we raise the tax on returns to capital it isn’t capital that’s going to be paying it. It’s the workers who will (or possibly the consumers) because capital is still going to get that global after tax return to capital.

That’s the purist position in a world of completely mobile capital. The only way this doesn’t work at all is in a world of completely immobile capital (ie, a complete autarky). We of course do not have perfectly mobile capital but it is still pretty mobile, thus the Congressional Budget Office estimates that 70% of the burden of corporate income taxes is carried by the workers and only 30% by the returns to capital (that’s for the US of course).

So in a sense you’re correct, capital doesn’t care what the tax rates to capital are: for capital ain’t paying those tax rates.

Oh no, the horror! Rich people aren’t allowed to buy their way to the front of the queue on the NHS. They have to wait their turn like everyone else. The unimaginable horror of having to wait like the plebs. Hannan is a twat.

He makes it sound like such things as private healthcare don’t exist in the UK. And then they use 5 year old statistics to back up the fantasy horror story they are creating about the NHS. They don’t even bother to credit the sources of the 100% cancer survival rate.

Of course there are always going to be ways to make things run better and more effieciently, thats the way things evolve, and the NHS is no excetion to this. But the fact is it is getting better and just to portray NHS hospitals as some kind of hellish morgue where the elderly go to die is nothing more than a empty soundbite.

But then that just about sums Daniel Hannan up – empty soundbites.

Try these output measures from OECD Factbook 2009 to assess the quality of healthcare in America:

Life expectancy
http://titania.sourceoecd.org/vl=3137588/cl=14/nw=1/rpsv/factbook2009/11/01/01/index.htm

Life expectancy at birth in America is lower than in Britain.

Infant mortality
http://titania.sourceoecd.org/vl=3137588/cl=14/nw=1/rpsv/factbook2009/11/01/02/index.htm

Among the countries shown, the US infant mortality rate is exceeded only in Russia, Mexico, Turkey, China, and Brazil.

So much for the excellence of healthcare in America from the perspective of the average citizen. In fact, 47 million Americans have no insurance cover for healthcare costs:

“The leading cause of personal bankruptcy in the United States is unpaid medical bills.”
http://www.newyorker.com/archive/2005/08/29/050829fa_fact

Never mind comparisons with Britain’s NHS. What Obama can lean from European healthcare, by Steven Hill
http://www.huffingtonpost.com/steven-hill/what-obama-can-learn-from_b_173154.html

The French Health Care System
http://www.medicalnewstoday.com/articles/9994.php

[20]

Capital doesn’t care what the tax rates to capital are: for capital ain’t paying those tax rates

So why does business whine about the tax burden if it just offloads it onto someone else?

“why does business whine”

I cannot speak for others, only myself. I whine about corporate and capital taxation because I want to raise the worker’s wages. For it is the workers who pay it.

“I whine about corporate and capital taxation because I want to raise the worker’s wages.”

Because that’s exactly what would happen if you suddenly only needed to pay a fraction of their current gross pay to leave their take home pay unchanged, isn’t it?

Cough*bullshit*cough.

“Because that’s exactly what would happen if you suddenly only needed to pay a fraction of their current gross pay to leave their take home pay unchanged, isn’t it?”

As above, it depends upon the elasticities of supply and demand but, in a competitive market for labour, yes.

Hey, even Marx got this point, why can’t you?

You did not put up the other Tory picture of Brown….

Good grief, even ignoring the idiotic comments here AGAIN, I find it hard to believe that Hannan thought that appearing on the mentalist that is Glenn Beck’s show could EVER be a good idea, I mean the man is mental, but clearly so is Hannan.

I’m with comment 2, rather like the silly alliance with a racist part in Europe, this is bad leadership letting an MEP wade in on such a dire show, has Cameron lost his mind? Comment 4 has it down, have we left the door open for these cretins to stroll in?

IanVisits and LFAT are wonderful examples of excuse making and LOOK OVER THERE rather than actually dealing with the issue, if it was a Labour MEP they’d be all over it and it is this failure to accept when they’re wrong that is a serious cause for concern, you’ve not won the election yet.

Mike Killingworth:

Your maths are so bad in the way you hop, skip and jump to the idea that most of the UK doesn’t want an NHS is made me laugh but then it made me cross at you being such a nob.

In fact it’s full of nobs, with Mark M making a strawman to tear down, to Tim Worstall ACTUALLY defending the terrible US healthcare system with in-accurate generalisations about how it works and how it doesn’t leave that many people out at all…glad I’m not one of those few million people left out then…

“in a competitive market for labour, yes”

Another euphemism for ‘it’s an empty truism’.

this is bad leadership letting an MEP wade in on such a dire show, has Cameron lost his mind?

You know, David Cameron probably doesn’t have the time or the inclination to vet the diaries of all his MPs, MEPs and (looking at Sunny’s list of ‘top Tories’) unaffiliated supporters.

“Tim Worstall ACTUALLY defending the terrible US healthcare system with in-accurate generalisations about how it works and how it doesn’t leave that many people out at all”

If I’ve made an error of fact then please do correct me. As I was attempting to do to Sunny….

[27] Thank God you didn’t put any words in my mouth, Danny-boy…

Tim J:

EXCELLENT passing of the buck/excuse making, lovely stuff, really top notch that and a sure fire way to dismiss all accusations of the Tories being a bit shit.

Tim W:

Plenty of factual errors and bad maths, you’ve hypothosised the amount of people without healthcare very badly indeed, you’ve also mis-judged that even those with private healthcare cannot afford either the premiums or get the treatment they deserve due to it being run by the private sector and selective insurance verdicts.

To be clear, the US is without universal healthcare, it is up to the individual only and this reform is not just about those without, it is about those with but who cannot meet the deductibles, never mind the premiums or those with previous conditions.

Good grief, defending the terrible American healthcare system is not a good way to look smart.

Mike:

My pleasure, avoid bad maths at all costs.

Hannan claims (1:54 in the interview) that his friend fractured his ankle and attended an NHS A&E on a Friday night.

A&E was full of fighting drunks according to the follically challenged MEP.
He was denied analgesia by psychopathic health care workers and told to get to the back of the queue (we get no information as to whether A&E staff were tied up with very sick patients, or legion of swine-flu neurotics, but I digress).
The greatest outrage however, seems to be reserved for the fact his poor mate couldn’t PURCHASE pain killer from an NHS facility (we will leave aside the fact that any petrol station, news agent or supermarket is literally groaning with all sorts of analgesics) – why didn’t Danny slip out to obtain neurofen + paracetamol if he is such an admirer of the market?
Unfortunately, we can only speculate as to why the MEP and his injured mate regressed to such a childlike, and incompetent state.

Does Hannan’s story ring true ……….. maybe.

But if I broke my ankle and had a choice between an NHS A&E department and an American ER I would take the NHS every time.

Waits are far shorter (98% of ALL patients seen in less than 4hrs – according to the slightly massaged figures) while waits in American ERs are measured in days (that’s just the wait, mind).
http://www.blnz.com/news/2008/07/03/Some_psych_patients_wait_days_8619.html
Immediate emergency orthopaedic back up is available on the NHS if metalwork, etc is needed (which is not means tested).

The system as I understand it is far less straight forward in the States exemplified by the amputated finger anecdote that starts Michael Moore’s “Sicko”.

Just look at the sinister faces highlighted by Sunny (in the main post) – now put your hand up if you would trust any of them with your health ……… thought not.

@34:

Indeed, the idea that we would lose or have to swap our system with the American one would fill any right-minded person with a deep sense of dread and terror and I’d be surprised if anyone here would do as you say and swap for the American system.

Let’s wait and see shall we?

#29 Given that Cameron seems to exercise more control over message even than early New Labour did, and he must be aware of Hannan’s multiple appearances on US TV, I can only assume that Cameron doesn’t want to take Hannan on. Which makes sense.

I find these “Defend the NHS” articles that Sunny occasionally puts up rather distasteful. It is unthinking and bordering on the demagogic (“these people want to steal your health care!”).

In truth, the NHS overpays doctors and underpays nurses, is often quite a racist employer (because it has no market competition – http://nhsblogdoc.blogspot.com/2009/01/racist-abuse-sooty-paki-and-staff-grade.html ), and its outcomes are neither especially good nor the most equitable in the Western world. It is especially unresponsive to people on lower income because, in the absence of monetary incentives, rationing is controlled by patient “voice”.

Of course, no one wants the American-style system of cartellised insurance companies and massive disincentives to allow people to control their own healthcare, and there is a very good argument that full-scale reform of the NHS would be too much to bare for a Government. That is a reasonable argument. But to claim that we have a wonderful system right now is balls. It allows more people to die than otherwise would under either the Dutch or Swiss systems, or, indeed, Singapore.

[37] The Swiss may do better, Nick but they are a much wealthier (and smaller) country who spend the highest % of GDP on health in Europe.

In fact the Swiss have ALWAYS spent more than the UK – although admittedly the gap has closed a bit in recent years.
Perhaps we should be thanking the NHS for doing reasonably well on certain things despite the cash shortfall – for example we have the best service in the world for those who suffer with a heart attack.
http://www.bmj.com/cgi/content/extract/333/7557/11-b

We have to credit Labour for injecting more cash into the NHS – for example, A&E is a far better service (on balance) than it was 10 years ago, despite Hannon’s haunting ankle debacle.

But I agree it could certainly be improved – look at the dosh blown on tamiflu and the swine flu hotline, or the growing number of managers. And don’t get me started on privatisation-by-stealth scheme’s (ISTCs, PFIs, etc) or out-sourcing of services such as cleaning that have brought very few patient benefits.

EXCELLENT passing of the buck/excuse making, lovely stuff, really top notch that and a sure fire way to dismiss all accusations of the Tories being a bit shit.

Tiresome. It is fatuous to suggest that David Cameron is or should be personally responsible for every statement made by every MP, MEP or Tory activist. If Dan Hannan’s policy on the NHS, which he has been making for years and years, should become official Conservative policy, then it will be David Cameron’s responsibility. Until then, it isn’t.

#29 Given that Cameron seems to exercise more control over message even than early New Labour did, and he must be aware of Hannan’s multiple appearances on US TV, I can only assume that Cameron doesn’t want to take Hannan on. Which makes sense.

Because God forbid there should be a range of intellectual positions within a party. What we really need is a party where all ideological positions are determined centrally, and then rigidly enforced by the leadership.

Investment has gone up but productivity has gone down, suggesting it is not just about money, it is also about incentive structure (and Switzerland is substantially marketised). Of course, the most successful services benefit from being small, which would seem to count (in this country) against a national health service, and in favour of more local provision.

Nick:

You find it distasteful? Here’s a thought: don’t read the bastard thing. And where you get demagogic from…good grief, have you not seen the nonsense coming from across the water about the NHS?

And then you wade in with the wild generalisations that the NHS is racist and that it pays people too much or too little and that it is unresponsive to lower income people? How an earth do yuo figure all that out?

How about some actual facts? Per capita spending by the UK on healthcare is 5th highest in the world, it’s 7th highest in terms of doctor-patient ratio, the best in terms of nurses-patients ratio and 6th in terms of number of beds in relation to population.

Add to that the 6th best global life expectancy and that sounds like a fair healthcare service to me.

Tim J:

You’re tiresome pal, with the endless defence of your beloved party.

Is it fatuous to expect the leader of a party to take responsibility for his MP’s behaviour and actions? What PR they are involved in? Esp. on a show with such a dire reputation?

I’m sure if it was a Labour MP you’d be all over it but your blind partizan nature does not enable you to see what a gaff this is, or maybe it isn’t maybe the Tory party is that backward and myopic…here’s hoping.

No one has a problem with a range of intellectual positions in a party but as always you give too much credit to the party close to your heart and you confuse such ‘intellectual’ positions (not that I’d give that credit to this Hannan twat) with associations that damage a party, Glenn Beck being such an association but as I’ve said, as the Tories have been cosying up with far-right parties in Europe, why not cosy up with a far-right bigot in the US?

Poor selection of allies methinks.

“Investment has gone up but productivity has gone down, suggesting it is not just about money”

Why would you even expect the money-vs-outcomes graph to be a straight line?

Is it fatuous to expect the leader of a party to take responsibility for his MP’s behaviour and actions? What PR they are involved in? Esp. on a show with such a dire reputation?

I’m sure if it was a Labour MP you’d be all over it but your blind partizan nature does not enable you to see what a gaff this is, or maybe it isn’t maybe the Tory party is that backward and myopic…here’s hoping.

Yes of course it is, even for the most extreme behaviour and actions, provided they’re not a member of the Government or Shadow Cabinet. Should Gordon Brown specifically apologise for/rebut Michael Meacher’s stated belief that 9/11 was an inside job? Should Nick Clegg deal with Norman Lamb’s belief that David Kelly was murdered? The contention is ridiculous.

Party leaders are responsible for the official positions of their parties, not the private opinions of all members of the party.

“Why would you even expect the money-vs-outcomes graph to be a straight line?”

We don’t. We describe variations from that straight line as variations in productivity.

Tim J:

We’ll you’ve made it pretty clear what you think makes for an acceptable running of a political party and that appearing on a notoriously right-wing TV show is private opinion, thankfully, I don’t at all agree with you.

Probably for the same reason that Tony Blair wasn’t asked, or expected to denounce every crackpot comment that came from the remnants of the far-left within the Labour party..

Except these people aren’t on the fringes of the party – they are on the mainstream. The Plan is widely touted as the book that the Tory high command has stolen ideas from liberally.

“We don’t. We describe variations from that straight line as variations in productivity.”

FFS Tim, are you having a competition with yourself to make the most trite comment possible today, or what?

If ‘we’ don’t expect money-vs-outcomes to be a straight line, why do ‘we’ hitch up our skirts and squeal when it turns out it is not one?

“If ‘we’ don’t expect money-vs-outcomes to be a straight line, why do ‘we’ hitch up our skirts and squeal when it turns out it is not one?”

Because what we want is increases in productivity. That’s how civilisation advances, being able to get more outcomes for less inputs.

We don’t want straight line, more inputs equals more outputs and we most certainly do not want more inputs equals less outputs.

What we’d really like of course is less inputs leading to more outputs….fortunately thats the one thing, innovation, which the capitalist/free market economy is extraordinarily good at. In fact, it’s unique amongst economic systems for precisely that trait.

(Note, I said innovation there, not ivention.Look up William Baumol for the difference).

Tim has one the trite comment competition. Well done that man.

Tim, you missed out: “…and a pony.”

The biggest iron of all of this is as follows:

The American right is claiming that the NHS leaves people to die because it is not “cost effective” to save them.

This is a lie.

It is, however, an accurate description of the way US insurance companies find loopholes to avoid paying for the care of individuals who contract expensive illnesses.

“How about some actual facts? Per capita spending by the UK on healthcare is 5th highest in the world, it’s 7th highest in terms of doctor-patient ratio, the best in terms of nurses-patients ratio and 6th in terms of number of beds in relation to population.”

That don’t mean much. What we are interested in is patient outcomes and on that, we aren’t bad, but a lot of countries do a lot better and are more equitable too. Take this study for example, which uses avoidable mortality as an indicator of health care effectiveness (better than taking life expectancy which has loads of other factors involved): http://www.civitas.org.uk/nhs/download/avoidable_mortality.pdf

I am not saying we are disastrous, just that it is clear that some systems are working rather better.

We’ll you’ve made it pretty clear what you think makes for an acceptable running of a political party and that appearing on a notoriously right-wing TV show is private opinion, thankfully, I don’t at all agree with you

So you think that every television appearance by all MPs, MEPs and activists should be cleared with the leader of the party first? Remarkable.

And of course Dan Hannan’s appearance on Fox was about his personal opinions on healthcare. What on earth do you think it was?

[50] – all this talk and about inputs and outputs puts me in mind of a sound mixing desk.

Can complex health phenomena really be reduced to such simplistic and market orientated mechanisms without introducing either perverse incentives or the law of unintended consequences?

Anyway, how do ‘inputs’ and ‘outputs’ work amongst the growing population of those with dementia, say.

Or what about mental illness – what measurements should we apply to schizophrenia?

Isn’t the American insurance system largely based on so called ‘pre-approved’ health conditions (with an entire infra-structure set up to deny 10% of applicants some of the services they would benefit from) – presumably because enabling access to what is really needed results in a (financial) disparity between ‘inputs and outputs’?

“And of course Dan Hannan’s appearance on Fox was about his personal opinions on healthcare.”

Yeah, because of course he’d have still got the gig even if he wasn’t a Tory MEP.

Spot on Mr. Sagar, spot on!

Nick, you’ve changed your turn when presetned with facts and then did a lovely job of making out those facts don’t mean much, that’s a fail in my book.

Tim J, Neil has you down pat, you fail to take the hint from my last comment to you, you can believe whatever you want, just don’t expect everyone else to believe your silly bias-ridden approaches as well.

Dan Hannan shouldn’t bother coming back to the UK. I hope, if by some freak chance he gets run over on our streets, that NHS doctors and nurses let him die. They can say he has a “pre-existing condition” – he’s a twat.

Yeah, because of course he’d have still got the gig even if he wasn’t a Tory MEP.

Tim J, Neil has you down pat, you fail to take the hint from my last comment to you, you can believe whatever you want, just don’t expect everyone else to believe your silly bias-ridden approaches as well.

I’d have thought that Hannan has attracted the attention of the right wing media in the US as a result of his YouTube takedown of Gordon Brown. Which he was able to do, of course, in his capacity as an MEP. But so what? He has made it clear (again and again) that his views on the NHS are not those of the Conservative Party but his own personal opinions.

So it’s not really a question of what I believe, except insofar that I believe that requiring party leaders to give his permission before any MP, MEP or activist does an interview is fatuous – is this honestly what you think should happen Daniel?

It’s not a matter of bias either incidentally. I wouldn’t expect Brown or Clegg to have to take responsibility for what their back benchers, MEPs or activists say.

Tim J:

This getting thin and desperate from you, goodness sake.

You’d have thought wrong Tim, pure hypothesis!

“except insofar that I believe that requiring party leaders to give his permission before any MP, MEP or activist does an interview is fatuous”

If I could just weigh in here as someone who has actually worked as a press officer for a political party? Booking people onto radio and TV shows, into newspapers?

You most certainly do not ask permission of the party leader to put someone on a show. You take the booking and assign someone to it and move onto the next opportunity.

Now that’s within the party structure. If someone manages to get a booking without you then you most certainly don’t complain……Cameron wouldn’t even have been aware that Hannan had been offered a slot let along had to either approve or not.

“Nick, you’ve changed your turn when presetned with facts and then did a lovely job of making out those facts don’t mean much, that’s a fail in my book.”

I haven’t changed my tune at all. In terms of measurable health outcomes, we are less effective and less equitable than various other systems, and they tend to be more market based and more localised. The facts you presented are not especially relevant to what we are want a heath system to do, that is treat people effectively.

Apologies if I can’t offer you a whole fresh dissertation on this but it is only because this debate gets to a ground hog day level of tiresome. It is always the same, an ad hominem attack on Dan Hannan, as if only evil people could possibly have a problem with the NHS. Then a few of us try to actually discuss the issues of health care in the UK compared to other countries. On previous rounds, when we actually get down to the specifics, the left don’t really have that much to offer in terms of substantial reforms or answers to why classical liberal reforms wouldn’t work:

http://www.liberalconspiracy.org/2009/04/06/make-dan-hannan-tory-spokesman/

http://www.liberalconspiracy.org/2009/04/10/is-this-the-least-credible-think-tank-in-britain/

These sort of posts love to spout off about personalities, but when it comes to policy, there is very little willingness to engage.

Look, Daniel, MEPs do not exactly have a high profile within the EU do they? Their profile in the US is rather lower. Dan Hannan is not being feted on Fox News because he represents the South East constituency in the European Parliament.

After the clip of his speech to Brown hit the 2 million views on YouTube, there was a lot of buzz on sites like The Corner, and so forth, along the lines of ‘isn’t it a pity that the Republicans don’t have anyone to stand up to Obama like that’. When it was also discovered that he strongly believes that a single-payer healthcare system is a Bad Thing (and given that he’s British, and therefore has experience of one in action) it made him an obvious choice to put that point of view in the context of the American debate. I really don’t know what about this you are finding hard to understand.

While, obviously, if the Tory leadership are asked about Hannan’s views on the NHS they should disown them (‘we know what Daniel thinks about the NHS, and his views are not shared by the party leadership. The Conservatives value the NHS etc etc etc), that is not the same as saying that they should try to prevent him from stating them, nor that they have any degree of ownership over those views.

If there is anything specfic there with which you disagree, please say.

I wish this debate (both in the US but especially here) was not couched in “UK versus US” terms – an unattractive prospect in both cases.

If the NHS is the 8th wonder of the world, why has no other country in the world copied us?

Could it be that the European model – state funded but not state run – might just be better than both the US and the UK??

And how dare Carswell and Hannan draw our attention to the success of Singapore’s approach…how very dare they!

Tim W:

Glenn Beck isn’t some interview with BBC Radio Lincolnshire, it is a show loaded with meaning, mostly negative and comes with much danger for the party, as the interview itself proves. It also comes with a condoning of the daft racist that runs the show. A serious media error however you look at it. Unless that’s the demographic Tories are appealing to?

Nick:

Sorry, you retreated and now you’re saying you’ve not and that still doesn’t take away the dismissive air when faced with the data. Simply put, you are defending the US healthcare system even though you don’t actually want an American healthcare system here and if you had to choose between the NHS and the American system you’d choose the NHS?

Am I wrong?

Thus, you only seem to be defending the US healthcare system because of a softspot for the twat Hannan?

Cool.

Tim J:

Is this still going on? You can justify all you want, that’s your right but as I’ve said TIME and TIME and TIME again, I don’t buy your interpretation.

Dig?

Cool.

cjcjcjcjcjc:

*sigh*

“And how dare Carswell and Hannan draw our attention to the success of Singapore’s approach…how very dare they!”

Who said that? No one. Bye.

PS: just because something isn’t copied doesn’t mean it isn’t any good.

“Glenn Beck isn’t some interview with BBC Radio Lincolnshire”

You’re really not quite getting what I mean. I’ve written 1,000 word pieces for national newspapers and told the politician what he said after they were printed. Blimey, I’ve done Five Live myself simply because I haven’t got anyone around.

It really won’t have been even discussed in Central Office.

OK, nothing specific, you just don’t ‘buy’ it. Cracking analysis there I must say.

Tim W:

Nah, you don’t seem to get it sweetheart, the point is, if Cameron didn’t know then he’s a bit of a nob considering the implications of going on a show like that and if he did then he let the twat go on a show with the implications it had.

Smashing.

Tim J:

You give too much creedence to the idea that your ideas need analysis duck.

70 – It’s OK, I rather prefer my political critiques to come from someone literate.

A&E charge nurse
“now put your hand up if you would trust any of them with your health ……… thought not.”

No, and I also wouldn’t put my hand up if you had photos of Obama Beach, Darling, Balls or any other politician for that matter. I trust myself, in much the same way as I trust myself to buy food, clothing etc. If you give me a real choice in healthcare (a selection private systems and a state run system for those who can’t afford anything else), I will choose the one most appropriate for me. Why is so wrong with that?

I have had laser-eye surgery with Ultralase, and I was confident in the service. They were friendly, organised and timely. I have also visited and NHS A&E when I dislocated my finger playing rugby. It was the quietest I’ve ever seen an A&E department (there was myself, a girl who’d broken her collarbone falling off a horse and a footballer with a broken ankle – compared to 4 nurses, 2 radiologists and 2 doctors that I saw) and it took a good 2 hours to see a doctor, get an x-ray, have an injection and pop it back into place and they were seriously troubled when I asked if I could have follow up checks at my local hospital (it was an away game).

The doctors and nurses of the NHS are hard working people we should be proud of. The system, however, is awful.

Tim J:

I’m very literate Tim, it’s just your ideas are shit, can’t make a silk purse out of a sow’s ear darling.

Bye bye now!

cjcjc – if you like Singapore so much, why don’t you go live there?

DHG, no I think the American health care system should be reformed in a different direction, with tax free health savings accounts, individuals being able to buy health insurance on the same terms as employers, and the ability to buy health insurance across state borders. Ideally, I woud also want to see the abolition or careful reform of drug patent laws so that health care costs don’t spiral for new treatment as they have.

As for whether I would rather have an American-style health care system or the NHS as an individual. It really depends on whether I am going to suffer a car accident (then NHS, please) or get prostate cancer (American-me-up). Of course, the US varies from state to state so really the comparison isn’t very reasonable anyway. Different systems achieve different results.

73 – It’s quite impressive really. I’m not sure I’ve seen the ‘la la la, I can’t hear you’ argument written down before.

Neil:

Heh, steady on, if I squint and tilt-my-head you’ll end up looking like one of those inferanl bigots that infests this place whenever the BNP get’s mentioned.

Nick:

I’m not convinced by your solution to the problem, I prefer what the Obama adminstration is cooking up:

1. End Discrimination for Pre-Existing Conditions
2: End Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
3. Ends Cost-Sharing for Preventive Care
4. End Dropping of Coverage for Seriously Ill
5. End Gender Discrimination
6. End Annual or Lifetime Caps on Coverage
7. Extend Coverage for Young Adults
8. Guaranteed Insurance Renewal

Tim J:

I can hear you but you give too much creedance to your own thoughts, which is fine but don’t foist them on me.

Ta Ta!

DHG, ok well the difference between my suggestions and yours is that mine don’t cost anything, and money is meant to be a bit tight right now. With that in mind, why wouldn’t you include my free market reforms along with your new regulations? It is not as if they are mutually inconsistent.

78 – ‘credence’, it’s ‘credence’. If you’re going to attempt the de haut en bas approach please at least try to spell it right.

Dan Hannan shouldn’t bother coming back to the UK. I hope, if by some freak chance he gets run over on our streets, that NHS doctors and nurses let him die. They can say he has a “pre-existing condition” – he’s a twat.

Though I don’t agree that some nasty thing should befall him – he is a twat.

Why shut Hannan up?

I think that it is good that his airings on US TV should be shown – and shown a lot with the obvious commentary that goes with it – “Would you want this man running the NHS?”

Then add to that all the right-wing shit that Hannan comes out with – I will hazard a guess that Dave-boy would shut him down in, about 3 hours and would actually denounce what Hannan has to say.

If Cameron allows the Tories to be painted with the same brush as the Republicans – who will be the winner there then – do you think?

…and to add to that; in the video of Hannan he says that the NHS isn’t free because it is paid for through taxes – then, slightly later on he says that you can only expect these inefficiencies from a free system because people look at it that way.

There is another the so-called left could pick up on.

Let the people of the UK know that their health system isn’t free and stop allowing the waste of millions of pounds by actually turning up for appointments. A&E said it above – why have an idiot system whereby people are scared to death over flu? An advertising, public information film would be cheaper, no?

The Spanish flu pandemic killed so many because of lack of good quality healthcare – something I can only think the Tories want to bring back because of their adherence to Hannan’s pinny ties.

If you want more privatisation of the NHS – vote for Hannan/Cameron.

You could also do a lot by way of getting rid of the stupid management system the NHS has – that would save a few quid methinks. When you have saved that money – put it directly into patient care.

“The Spanish flu pandemic killed so many because of lack of good quality healthcare”

Umm, no. We *still* don’t know how to cure *any* viral diseases. We know how to not get some of them (vaccines) but not how to cure. We’ve got Tamiflu and Relenza now for flu but they’re not all that good and they’re not a cure. They alleviate some symptoms, yes, but they ain’t a cure.

Basic treatment for flu now is same as it was in the 20s. Bed rest, liquids and hope.

Still kills 1-2% of those that get it each year.

Nick:

Yours won’t work, Obama’s will I fancy and when it comes to such matters, you won’t mind if I defer to him.

Also, on the issue of costing money, the US can afford reform, it’s a myth that reform will bust the budget. Obama and pals have identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; “ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.”

Tim J:

Bitch, is that the best you’ve got? Spelling? HA HA HA! You sad, sorry bastard.

Tim W:

I see the only come back to Will is on Spainish flu although how you can disagree that better healthcare then would have stopped it killing so many I’ve no idea. Bless you.

Basic treatment for flu now is same as it was in the 20s. Bed rest, liquids and hope.

Still kills 1-2% of those that get it each year.

Thanks for adding the obvious, Tim, much appreciated. Yet, I would have to suggest that if there had been a good, quality healthcare system around at the time – for all – there wouldn’t have been as many deaths.

As you like the old statistics line – how many of those who died during that pandemic were poor and how many could pay for good healthcare?

That said – I am sure the servants brought the infernal virus into the big house because they would have to stave if they didn’t work, eh? But they could have saved some of the meagre pence to provide themselves with healthcare – I’m sure of that.

Somehow.

This is quite simply pathetic!!

This is the same ” Lefties are benign loving good guys Vs Tories are ruthless heartless capitalist b@stards ” World View which informs most of the immature analysis of those on the Left; and stunts their understanding of the real causes of the social and economic problems of Britain.

I suppose though if you can swallow a crock like this, it allows you to think “Well Labour are a shambles but the Tories are the real heatless bastards”.

This is the type of mindless, utterly immature myopia, that drives the Damian McBride / Dolly Draper’s of this world to believe that smearing a Tories wife and planting unsubstantiated slurs is eminently justified by their own deluded sense of righteousness.

Doubtless caring comrade, you will remove this comment, though Lefties are never good at having their delusions challenged are they?

Hey by all means push the “Tories are Bogeymen” (Bogey-persons!!) greatest hits theme tunes out to the wider world, while listening to that great 1997 hit “Things can only get better*” on your I-Pod.

The idea that the Tories would dick with the NHS is just utter tosh, have you seen the gerontocracy that attends a Conservative Party Conference, it is a veritable NHS inpatients waiting room!

Keep on smiling comrade! This comment by the way is from a highly social active Conservative, who believes compassion is not a value that can be attached to any political party, nor a label one can stick on themselves (unless you are a Leftie!!).

DHJ – well there’s clearly no point in engaging in any sort of argument with you is there? You lack either the ability to understand them or the capacity to listen to them. Or both, possibly.

In the probably vain hope that you might possibly engage with this argument:

Also, on the issue of costing money, the US can afford reform, it’s a myth that reform will bust the budget. Obama and pals have identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; “ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.”

Whenever the Tories have argued that cuts to waste, fraud and abuse in Government programs will reduce spending on such programs without affecting frontline services, the left have universally derided them. What makes this different?

As you like the old statistics line – how many of those who died during that pandemic were poor and how many could pay for good healthcare?

The Spanish flu epidemic was pretty much an equal opportunities killer. The Prime Minister of South Africa and the Queen of Tonga presumably weren’t struggling to pay for their healthcare. Though I hadn’t realised that Max Weber also succumbed.

Mark M [72] – 2hrs for a finger dislocation, not great but not too bad either. Lets break the A&E visit down.

Registration – generation of hospital number, identification of next of kin, copy of A&E attendance card, etc.

Triage – initial assessment of injury, determine urgency of complaint.

Medical examination (identify if any nerve injury, or any other complications such as open wound, etc are present).

Pre-reduction x/ray (to identify if the digit is fractured as well as dislocated – thus avoiding anysubsequent medicol-legal complications such as a complaint that the reduction itself caused a fracture).

Reduction of dislocation – usually under local anaesthesia such asa digit block, injection – or with gas (entonox).

Strapping of injured finger post-reduction – hand elevation/hi-arm sling.
Provide oral analgesia to minimise the inevitable joint inflammation after the ligaments/tendons have been stretched or even ruptured.

Post reduction x/ray to exclude any joint subluxation.

Documentation of all processes – then arranging a follow up appointment with the local fracture clinic or burning a CD to hand to the patient to take to an alternative service.

This is assuming that the patient does not suffer a vasovagal episode (as men are prone to during these kinds of hospital procedures) so we sometimes have to factor in a recovery period as well.

As I say 2 hours can soon pass and while I accept that the department you visited may not have been busy at the time of your treatment the pattern typically is one of increased A&E attendance (33% increase at our place over the the last 10 years – 19 million A&E visits nationally).

This type of attrition may result in staff winding down slightly when A&E does not resemble a war zone as it did during the height of the swine flu hysteria.

“Yet, I would have to suggest that if there had been a good, quality healthcare system around at the time – for all – there wouldn’t have been as many deaths.

As you like the old statistics line – how many of those who died during that pandemic were poor and how many could pay for good healthcare? ”

Well, facts are wonderful things really:

“Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain’s extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body’s immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.”

Wikipedia of course…..

Given that the poor would have had weaker immune systems at the time we actually had a pandemic which, strangely, selectively attacked those who were hale, hearty, well fed and not suffering from other diseases…..those not poor in other words.

Geordie-Tory Doubtless caring comrade, you will remove this comment, though Lefties are never good at having their delusions challenged are they?

No reason to – you didn’t challenge anything, but just ranted away.

Love the “bET YOU WON’T PRINT THIS COMMIES!!!!!!1111″ line – pure spEak You’re bRanes green-inker.

Tim (90)

Well bugger me! Let’s use a wiki entry to off-set the statistics, and while we’re at it say, though not substantiated, that it was the rich who were hit worse than the poor.

Stats, Tim, stats!

How many poor died in comparison to the rich.

Tim J –

I am sure if Her Maj got a cold and then went on to croak it we would have a 4 trillion pound investment in how the royals should be protected from a virus.

Shall we go and look at Tongo and South Africa at the time of that pandemic?

The Prime Minister of South Africa and the Queen of Tonga presumably weren’t struggling to pay for their healthcare.

Fuck me – pass that one onto Hannan, I am sure he can share that with Hannity. Of course – it could be that SA and Tongo were a part of the British Empire – so we can conclude that it was the Empires fault.

Tim J –

I am sure if Her Maj got a cold and then went on to croak it we would have a 4 trillion pound investment in how the royals should be protected from a virus.

Shall we go and look at Tongo and South Africa at the time of that pandemic?

The Prime Minister of South Africa and the Queen of Tonga presumably weren’t struggling to pay for their healthcare.

Fuck me – pass that one onto Hannan, I am sure he can share that with Hannity. Of course – it could be that SA and Tongo were a part of the British Empire – so we can conclude that it was the Empires fault.

Er… what? The point was that the group most affected by the Spanish flu was young adults. And that since there was and is no cure for viral diseases, the quality of healthcare that you could afford didn’t make much of a difference to your survival chances. As can be seen by the deaths of prominent individuals.

Incidentally, Tonga was never formally a part of the British Empire. There was a Treaty of Friendship but no more. Fun fact…

Oh dear, it’s got grim here with Geordie Tory joining his pals. Speaking of which, Tim J are you still here duck?

I understand your nonsense I just don’t buy it, shocking as it my sound your opinion and theories are just that, yours, not shared, well not by me anyroad or anyone else here so you’re on your own.

And then you drag out an old chestnut/strawman, where you invent an argument to have with me about something I don’t even believe in or care about.

Great move that. Quite frankly, unlike the Tories who never outline their methods of cutting and speak in vageries, Obama’s actually outlined the details of the plan, more accurately Congress has. Why you’re drawing in your own bugbear for the terrible mis-treatment of the Tories I’ve no idea.

Play victim much?

Oh and Tim, Tonga was part of the Empire, under the British Western Pacific Territory, you weird pedent.

95 – Mate, I was quoting from your own post. That you wrote. Chestnut strawmen (which is a lovely image btw) have nothing to do with it.

96 – It was never a colony, nor formally a member of the Empire. It was under British defense protection, and party to a Friendship Treaty. They’re jolly proud of the fact that they’re the only Pacific island never to have lost their independence. Oh, and I’m not biting on the pedent front…

Tim, 97 as a comment makes no sense, as an indicator to your mental strength right now it speaks volumes, deal with 95 or move on.

Tim J -

Seen as wif come darn to talking ‘istory, guv – are many of doze yung adouwts were puwr like, ah mean, real puwr?

My point, obviously lost, was that if there had been a fully funded quality healthcare system at the time of the said, and repeated, pandemic there would not have been as many lives lost.

Whether Tinkerbell and Peter Pan died of it is of no consequence. I am sure that the people you name did have a bit of dosh – yet, because healthcare was not as it should be – lots died.

“My point, obviously lost, was that if there had been a fully funded quality healthcare system at the time of the said, and repeated, pandemic there would not have been as many lives lost.”

And if he motor industry had been up to modern standards then fewer people would have died in train crashes.

If farming had been up to modern standards then fewer people would have had ricketts.

And?

Technology does move on….what we’d really like to know is which economic and political system does that best …..

[100] Best for who, Tim?

The best or biggest payers?

Or those with the greatest clinical need?

100 – I can’t see the stats, Tim, are you going to bring them to the table or no?

And if he motor industry had been up to modern standards then fewer people would have died in train crashes.

Quite – and if economists used something other than Adam Smith people would be indoctrinated in another set patten as well. But that is all a part of discourse and debate.

I take it then, Tim that you will accept that a nationally run system that has helped in the welfare of millions of people for 60 years should be helped to become better with the objective of, cradle to grave care and a free at the point of use, etched in granite? No pre-condition bollox ad infinitum.

That a total twat willingly used as a propaganda tool for the US right who are simply lying to feather their own nests to the detriment of their own people should be condemned for his views?

Though I do like Hannan utilising the speak of the market in a right-wing ethos. Just makes people see what will become if fucking idiots like he were to actually take power – more arm to them I say.

If he and his ilk wake people up – oh joy I say.

97: you modded your comment to include the Tonga thing, I don’t know how to say this to you but on any list of British Empire nations, Tonga is on it and what they are proud of is being “the only Pacific nation never to have given up its monarchial government”.

Here is a map: http://en.wikipedia.org/wiki/File:The_British_Empire.png and one of many lists of those nations within the British Empire: http://www.britishempire.co.uk/timeline/colonies.htm

Good grief you’re wrong.

“cradle to grave care and a free at the point of use, etched in granite? ”

No, certainly not.

Health insurance, sure, all in favour of it. Health assurance, no, not so much.

The one part of a national system which I really do like (and I can’t think of any other reasonable way to get it either) is catastrophic treatment. Cancer, getting hit by a car, motor neurone etc.

However, I think that we’d probably do better if for routine care (that’s the assurance part) there was at least some out of pocket expense. More than just prescription charges.

Health insurance, yes, not assurance (and that’s what I do suggest that the US gets as well, along the lines of Arnold Kling and the like.)

“Best for who, Tim?”

For everyone. 100 years ago a diagnosis of diabetes was a death sentence which might be delayed as much as 12 months, no more. Now it’s a chronic and treatable disease (I’ve a cousin with Type I for 25 odd years, Mother has Type II).

What we want is whatever method of organisation that drives forward technology so that ever more diseases can be, if not conquered, at least made not life ending.

There’s a huge amount of evidence (Willaim Baumol is good on this subject) that this is the one unique advantage of the capitalism/free market melange. The one thing that it does better than any other system, innovate.

However, I think that we’d probably do better if for routine care (that’s the assurance part) there was at least some out of pocket expense. More than just prescription charges.

Odd that you advocate people pay twice, Tim.

Or, if we are to look at it further that people will pay, not only for their insurance, but that of others – which you intimated correctly earlier.

The bug bare, as I see it, in the US is not simply with the insurance companies losing their cash cow, but the fact that business will turn to the national, government run system because it takes costs out of their pockets and hands it to the tax payer/wage earner.

If you can, through a government run system do such a thing – I would have thought that business would welcome it with open arms, with the exception of the insurers.

How do you pay, in your system, Tim, pay for those who cannot afford to pay the insurance premiums? Are you therefore advocating a system where the more wealthy in society get better care because they can afford more?

The Lords and Ladies dress well at the expense of the peasant, Tim – still like that today.

This is the main point, that like any sector, the best way to improve outcomes is to grow it, make it more productive, and allow for innovation. Although the outcomes in a market are not shared using a formal equality metric, they substantially allow everyone to experience better quality of life. The main problem in the US right now is that those on lower incomes are excluded from the market by a cartelised insurance industry which, by statute, prefers to deal with employers rather than individuals.

I’d still be fascinated to know who the ‘we’ Tim Worstall keeps referring to are.

[89] A&E charge nurse

Actually, if anything it was the doctor who put my finger back in that was in danger of fainting.

And I do appreciate that it isn’t an easy job to organise A&E when it gets busy, but it was the sheer amount of waiting around when it was clearly very quiet that showed why the system needs altering. I don’t believe that the nurses and doctors would want me to sit around any longer than necessary, so when I’m sat waiting at the radiology department and I’m the only patient in sight it shows to me that our NHS staff is overburdened with paperwork. In terms of ‘action’ that took place, it took (let’s say) a minute to register at the front desk, about 5 minutes in triage, a few minutes for the doctor to do a touch-test, a minute for the x-ray, 5 minutes for the anasthetic to take effect, 3 minutes to put my finger back in, a minute for the second x-ray and a few minutes to burn a cd and write a note to another hospital. So how can all that add up to 2 hours if the staff are working in an efficient system?

That is my main point about the NHS. We do have some of the best health staff in the world, I have no doubt, and it seems a shame to me that we cannot provide a health framework for them that allows them to do their job to the best of their ability.

Mark M: there is a tremendous example of allowing staff to work more efficiently here, all quite common innovations in other parts of Europe: http://www.civitas.org.uk/blog/2007/07/were_doing_everything_that_is.html

I like what I hear…this is good news for employers and also employees

103 – FFS. Tonga was a protectorate, and signed a Treaty of Friendship with the British Empire, but was never a formal colony. It’s not a particularly important point, but it means that Tonga was the only Pacific Island nation never to formally cede its independence. As in “While exposed to colonial forces, Tonga has never lost indigenous governance, a fact that makes Tonga unique in the Pacific and gives Tongans much pride, as well as confidence in their monarchical system.”

It’s just a little historical anomaly. Like the other one regarding Tonga, which is that they are one of only three members of the Commonwealth with a monarch other than the Queen.

And as for a response to 95. What’s the use of continuing this ludicrous charade of a conversation? You argued that the US healthcare reforms could be funded through a cutting of waste in the current healthcare system. I said that every time this method of reducing costs was mentioned here, it was ridiculed as never providing enough savings to fulfil its intentions. Beyond that, there’s nothing in your comment at 95 with which to engage.

Tim J:

Tonga was part of the British Empire, a protectorate is “a territory which is not formally annexed but in which, by treaty, grant or other lawful means, the Crown has power and jurisdiction.” and any list of nations that were part of the British Empire includes Tonga.

Any list of these nations will show you Tonga’s membership from 1900-1970.

Silly boy.

What I wrote:

Incidentally, Tonga was never formally a part of the British Empire. There was a Treaty of Friendship but no more. Fun fact…

Your definition:

a protectorate is “a territory which is not formally annexed but in which, by treaty, grant or other lawful means, the Crown has power and jurisdiction.”

Reading isn’t your strong point I assume.

For instance, at various points, Tibet and Afghanistan were subject to a degree of British imperial control – Tibet indeed was a protectorate. Were they members of the British Empire? Not formally no.

I glad you quoted yourself because Tonga was a formal part of the British Empire, every map and list of British Empire nations includes Tonga.

One thing you do have right is that Afghanistan and Tibet were never part of the British Empire but Tonga was, why are you in denial Tim?

Every source clearly marks out Tonga as a member of the British Empire, do you want me to link to more maps?

http://op-for.com/British%20Empire.png

http://safalra.com/other/british-empire-map/british-empire-map.png

http://www.british-israel.us/israel/British-Empire-(color)-(cap.jpg

Oh, for God’s sake. It was a de facto member of the Empire and treated as such. But only a Friendship Treaty was ever signed, making it de jure not a formal member. It’s a little historical anomaly, worthy of a quick throwaway point. Nothing more.

And, in precisely the same technical way, Tibet was briefly a de facto part of the British Empire following the Younghusband expedition to Lhasa. The peace treaty signed over foreign relations to Britain, making Tibet a British protectorate. As was Afghanistan for rather longer, given that its foreign policy was also subject to British control. Nothing in history is entirely clear cut.

None of this is especially important, or indeed interesting, but there we are.

So you agree that Tonga was a memeber of the British Empire and you were wrong or do I need to link to yet more lists of Empire nations with Tonga on?

Aargh! I never said it wasn’t a member of the British Empire! I said, as a matter of pure historical anomaly, that it never signed a formal Treaty of Protectorate status, nor was it a colony, and that thus, in a technical legal sense, it was never formally a member of the British Empire. Yassus. Just read what people post, it saves time.

No, you said it was never formally part of the British Empire in comment 114, 97 and 94 when it was, from 1900-1970.

As I’ve said, in Tonga’s Wikipedia entry it is referred to as an ex-member of the British Empire and I quote: “Within the British Empire, which posted no higher permanent representative on Tonga than a British Consul (1901-1970), it was part of the British Western Pacific Territories (under a colonial High Commissioner, then residing on Fiji) from 1901 until 1952″ and a re-link to the map that clearly points out it was part of the British Empire… http://en.wikipedia.org/wiki/File:The_British_Empire.png

OK, last word from me on this, because we’re stating and restating the same position.

Tonga’s legal links with the British Empire were limited to a Treaty of Friendship signed between the monarchies that, de jure, left the Tongan monarch as sovereign ruler of Tonga. De facto, the British Empire took control first of foreign policy, and then later administrative policy, making it de facto a member of the British Empire, though no further treaties were signed.

Therefore ‘formally’, as in, in accordance with strict formal and legal requirements, Tonga was never a member of the British Empire, although in practical terms it was considered as such. This isn’t an especially interesting point, although Tonga remains proud of the fact that it, alone among the Pacific Islands, retained its indigenous government through the colonial era.

However, it is perfectly reconcilable for Tonga to appear on the list of members of the British Empire even though it was only ever subject to a Treaty of Friendship. In the same way, in lists of the British Empire forces in WWI, Southern Rhodesia appears, even though it was not then formally a member of the British Empire.

Tonga was a part of the British Empire, which is kind of what you’ve said above but your refusal to just go, “Yeah, I’m wrong” is very odd but thankfully everyone can see the links and facts themselves about Tonga being a part of the British Empire.

Cool.

Hopefully everyone can read and see the point I was making. Tonga was in practical terms a full member of the British Empire, but formally it was only ever a ‘Friendly nation’. Which isn’t particularly significant, or worthy of the level of attention you’ve given it.

Get a room you two.

You are inching step by step, to conceading that Tonga was a part of the British Empire.

Good on you, you’ll get there by next Wednesday!

124 – You’re right. Sorry, and enough.

That should’ve been to 125 Tim but you’ll get there.

I wonder if the sometimes over-zealous defenders of the NHS would, if given the opportunity, design a new healthcare system to match the NHS in every way.

Assuming for the sake of argument that they are not that silly, perhaps we can find some common ground on which to build, instead of having a bitching session about who said and thinks what and how evil they are.

Over zealous?

Where?

You making stuff up again?

Smashing.

ukliberty [128]

That’s the point most anti-NHS commenters make. If we were starting up a new healthcare model tomorrow, would we really design the NHS? Imagine going to the Treasury and saying “OK, we’ve got the details sorted. Now we want a £100bn a year budget”

The problem lots of the the pro NHS campaigners have is that they treat the NHS as a religion, and that to even question it slightly is a crime. You can’t have a sensible debate when one side isn’t even prepared to listen to the suggestion that there might be ways to improve the service for the patient.

Obama has said that if he were to start from scratch tomorrow, he would prefer a single-payer universal system, like the NHS.

Go figure.

Thing is, he hasn’t got the cajones to push through even a public health insurance option.

[128][130] No, that is not the way to find common ground.

In the first place, none of us know whether £100bn (actually I think it’s more like £96bn but let’s not quibble) is what we need to spend, or how to get best value for money. Let alone how to compare the value of health-care spending with, say, spending on rerar-admirals and submarines on the one hand or welfare benefits on the other.

Some of us think that economics can help us here, others are, to put it mildly sceptical of that notion.

In any case, the only way to move to a European-type system – since no one here is a wingnut advocating the American nonsense – would be to create a huge insurance fund for all those (like me, I’m 60) too old to build their own. And that would create a huge pile of public debt which I doubt we want right now. So in practice we either provide healthcare for the entire population through the NHS or not at all.

This is not to say that some “marketisation” couldn’t be introduced. But I have yet to see any intelligent suggestions around this. For example, charging people for GP visits creates transactions costs (and bureaucracy to manage the exemptions). And, just as the poll tax led people to disappear, so such charges would lead people to bail out of the GP service and rely on A&E departments.

In any case, acute conditions make up only a very small part of the NHS’s business. The majority of its work is the management (by drugs or surgery) of (mostly) lifestyle-related conditions in older people – chronic cases. Yes, the NHS represents a massive transfer payment from people of my kids’ generation to me and others my age.

If this transfer were on the basis of class, race or gender we’d be doing our pieces about it, but of course age isn’t, has never been, can’t be a source of political cleavage.

Mark M:

You’re repeating old arguments that have been dealth with elsewhere in this thread, myths so to speak.

And it is wise to never argue hypotheticals, such as your silly ‘build healthcare from scratch’ scenario. And the reason many, many people do not take well to unfiar attacks on the NHS is that the NHS is actualyl pretty good and it all seems a little odd to attack it, best to target summat else.

F Klug:

That was a while ago, considering the battle to get the current plan through you can only imagine the out and out war to secure that but to be clear, he never outlined and NHS style system.

It’s not about cajones, it’s about it actually being possible.

Not to be a smug bastard but all those saying that Cameron wouldn’t care or get involved you have been OWND!

HURRAH!

134 – You mean like this?

While, obviously, if the Tory leadership are asked about Hannan’s views on the NHS they should disown them (’we know what Daniel thinks about the NHS, and his views are not shared by the party leadership. The Conservatives value the NHS etc etc etc), that is not the same as saying that they should try to prevent him from stating them, nor that they have any degree of ownership over those views.

Aren’t you the bloke that denied Tonga was in the British Empire?

And I had to argue the point long enough for you lot to cede it, I’m just celebrating.

Woot!

No, you appear still to be labouring under a delusion caused by your lack of reading comprehension skills. Try going back and reading the posts again, slower. I’m sure eventually you’ll catch up.

Tim J:

Don’t be a douche mate, just cuz you fucked up on Tonga…

No, still not there yet. Keep going, perseverance can be its own reward.

here’s the link again to a LIST OF NATIONS THAT WERE PART OF THE BRITISH EMPIRE:

http://www.britishempire.co.uk/timeline/colonies.htm

And a link to TONGA ON A MAP OF EMPIRE NATIONS:

http://www.britishempire.co.uk/maproom/pacific.htm

Tim J:

You’re thick lad and your failure to just accept you’re wrong is painful to watch, you’re in denial.

HA!

[109] – I still say 2hrs is just about an acceptable time frame.

The legal profession seem to take much longer on simple stuff like buying a house.

Such activities are not (usually) measured in hours, or days – no, it takes months or even years.

Tim J:

#30 this is bad leadership letting an MEP wade in on such a dire show, has Cameron lost his mind?

You know, David Cameron probably doesn’t have the time or the inclination to vet the diaries of all his MPs, MEPs and (looking at Sunny’s list of ‘top Tories’) unaffiliated supporters.

DOH!

Tim J:

#40 Tiresome. It is fatuous to suggest that David Cameron is or should be personally responsible for every statement made by every MP, MEP or Tory activist. If Dan Hannan’s policy on the NHS, which he has been making for years and years, should become official Conservative policy, then it will be David Cameron’s responsibility. Until then, it isn’t.

OH YOUR PAIN!

Just read comment 121 again, there’s a dear. If it helps, try tracing a forefinger along the words. Or maybe ask a grown-up to read it out loud to you. If you still find it a struggle, try looking up ‘de facto’ and ‘de jure’. Or, possibly, ‘formally’, though I did try and provide you with a definition in 121.

Maybe next time I SHOULD WRITE IN CAPITALS.

Tim J:

#55 And of course Dan Hannan’s appearance on Fox was about his personal opinions on healthcare. What on earth do you think it was?

Well he got BOLLOCKED FOR ‘EM!

HA HA HA!

Tim J:

#60: It’s not a matter of bias either incidentally. I wouldn’t expect Brown or Clegg to have to take responsibility for what their back benchers, MEPs or activists say.

Well Cameron has had to take responsibility hasn’t he?

HA HA HA!

Man, you’re failing, you should’ve kept your head down clart instead of rearing back up in your EPIC TONGA FAIL moment.

#60: It’s not a matter of bias either incidentally. I wouldn’t expect Brown or Clegg to have to take responsibility for what their back benchers, MEPs or activists say.

Well Cameron has had to take responsibility hasn’t he?

No, he hasn’t. He has specifically disowned them. Rather like I said he would:

While, obviously, if the Tory leadership are asked about Hannan’s views on the NHS they should disown them (’we know what Daniel thinks about the NHS, and his views are not shared by the party leadership. The Conservatives value the NHS etc etc etc), that is not the same as saying that they should try to prevent him from stating them, nor that they have any degree of ownership over those views.

As a matter of interest, do you actually read what anyone else writes?

Tim J:

It took you until #64 to even concede that Hannan is a dickwad and that he will be disowned, after you started from the lofty tower of LOOK OVER THERE and then moved to distance him from his own party before eventually getting with the program.

HA HA!

Great stuff, really top notch. The shifting sands of Tim J’s Tory defense mechanisms…

As I’ve already pointed out, it took you until #64 to go that far, up until then you’d been engaging in LOOK OVER THERE and then defending the twat, before you had to concede that he is twat and he’ll get a bollocking, which he has.

And how you can say Cameron has not had to take responsibility…You are delusional rudeboy, the poor bastard has had to give a wee speech to the Hannan fool and send out an email.

Oh and don’t forget that Tonga was in the British Empire.

HA HA HA!

This is actually very stupid of them. The Tories pretty much have/had the election in the bag, but if they continue dissing the NHS, they won’t have.

150 – Not quite. My first point was simply that it was ridiculous to blame Cameron for ‘letting’ Hannan go on US TV when he would neither have known about it in advance nor been able to prevent it in any case. Something which Tim Worstall, who has been a party press officer, confirmed.

My second point was that, since Hannan was not speaking in any official Conservative capacity, his comments were not Conservative policy and were in fact contrary to it. As a result, if Cameron was asked about Hannan’s comments, he should say that he disagreed with them, and that they weren’t Conservative policy. Which he has now done.

What, precisely, about this do you disagree with?

Mr. Hunt:

I think due to how badly Labour is doing it will take far more than a twat MEP running his thick mouth off to lose the election but it is a start.

Tim J:

You still here? I hate repeating myself, BUT, to begin with, being a Tory you didn’t negage with the topic, you just did some lovely LOOK OVER THERE comments, then when that didn’t work you fudged on Hannan’s connections to the Tories, then when that failed to conceaded that he said a stupid thing and that he will be bollocked for it, which he has, which is great.

The rest is just flannel as after the Tonga incident your credibility is low.

I hate repeating myself

Hmm. The evidence is against you on this one. But this has been a bit too much like getting into an argument with a drunken bore in a pub. I’m going to take this opportunity to back away slowly, and talk to someone with rather better anger management.

I only do it because you really hate to admit you’re wrong and I like prodding bruised egos.

Tonga Tim is my new name for you.

YEAH!

Shhh… Remember what you said on your site: “Having the last word doesn’t mean you’ve won an argument, it just means you’ve had the last word.”

Tonga Tim:

Thanks for reading my blog, I love you to

“I’m going to take this opportunity to back away slowly, and talk to someone with rather better anger management.”

When did pop psychology become popular with tories?

The same time it became OK to say that Tonga was not part of the British Empire.

The same time it became OK to say that Tonga was not part of the British Empire.

Jebus. He said it wasn’t formally part of the Empire. You are arguing with something you’ve imagined. Will you not take your monomania elsewhere?

Bitch, it WAS formally a part of teh British Empire.

Now you drop it.

One factor which is always missed when debating the NHS, is the enormous number of people who volunteer their services free-of-charge. Up and down the country people are donating bone-marrow, women are donating eggs and drivers are giving their time to taxi elderly people to their destinations and,of course, the WI continue to provide retail services. The ‘jewel in the crown’ is The Blood Donor Service, in which people form a queue (some in their lunch hour) to freely give blood for no payment except a hot drink and biscuit.
Any political party which disregards the financial savings (I doubt if people would volunteer to do this for healthcare PLC), and the altruistic actions based on citizenship, would be foolish indeed.

Neil: “Love the “bET YOU WON’T PRINT THIS COMMIES!!!!!!1111? line – pure spEak You’re bRanes green-inker.”

OK perhaps my comments were a little bit of a rant, but you think that this comment was “Green-Ink” material compared with the nerd-fest over whether or not Tonga was a member of the British Empire.

But as a good leftie, your first instinct was to smear and denigrate me for making a comment in opposition to your views, at least you are all consistent.

Keep the Red Flag flyin’ bro’.

Well said, jb – but can I add to the list?

What about staff time?

60% of nurses work an average of an additional six hours per week …. gratis
(J Ball, RCN ‘Managing to Work Differently’, 2005).
http://www.rcn.org.uk/newsevents/government/briefings/nurse_staffing_and_workforce_planning

Mind you, the extra hours worked by junior doctors soon puts this unpaid work by nurses in the shade – even the EWTD will not stop some of them working TWICE the normal working week.

Staff support the aspirations of the NHS, you see.

a&e charge nurse @ 165, in relation to your last two paragraphs, did you see this by John Crippen?

Thanks, ukliberty – yes, I never miss my daily dose of Dr Crippen.

There’s no doubt junior doctors are working fewer hours nowadays and on balance its a good thing, at least for them.

Not that long ago the health of junior doctors suffered because of such demanding conditions while a certain percentage of errors were attributed to exhaustion.
http://www.independent.co.uk/news/uk/doctors-death-fuels-row-on-hours-1369224.html
http://www.dailymail.co.uk/news/article-401670/Exhausted-junior-doctor-kills-patient-massive-overdose.html

Junior docs do definitely work less but still far longer than their contracted hours.

Geordie-Tory:

Is that the best you’ve got?