Future of the NHS

Old Dec 11th 2014, 11:05 am
  #256  
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Default Re: Future of the NHS

Originally Posted by Shard View Post
It does seem to me that singling out specific disease causes and penalising such patients through fees is a sure route to an eventual carving up of the NHS and making healthcare insurance-based. It should be free to all eligible, with perhaps some provisions to discourage abuse (such as chronic drunks, inappropriate 999, etc).
Why? The NHS never has coverered everything. Selecting which group/s they spend their budget on, isn't new either. I don't know why some people think that the NHS covers everything for free. Common sense should tell these people that the NHS can't finance everything. Why do people think there are all these fundraising events?

All this is nothing new. I recall someone in our village in the early 90s, raising funds to pay for their childs operation and the therapy following the operation. About the same time, my family all clubbed together to finance treatment for a child in our family too, in a UK hospital (but not free); and a group of us paid for an electric wheelchair for another friend, who lost his legs due to smoking and couldn't manage the manual wheelchair from the NHS.

Just wait to when the 'free for all' treatment in A&E ends and people find they are billed if they can't prove are allowed free NHS treatment. I'm sure we will see lots of stories on that too because people 'forgot' to get travel insurance. Just as we see stories in the paper now when people find out their UK EHIC card used in other EU countries, didn't pay for everything and how they are now trying to raise funds to pay their medical bill.

Last edited by formula; Dec 11th 2014 at 11:22 am.
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Old Dec 11th 2014, 11:21 am
  #257  
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Default Re: Future of the NHS

Originally Posted by formula View Post
The NHS never has coverered everything. Selecting which group/s they spend their budget on, isn't new either. I don't know why some people think that the NHS covers everything for free. Common sense should tell these people that it can't finance everything
Looking back, I'd agree with that. My concern is whether the amount of procedures/treatments it can't or won't provide is going to increase, who decides ( plays God ) and what public awareness there will be of what is or isn't provided in order for them to accommodate these shortfalls should they wish to do so.

Like a previous poster said, it's a slippery slope.

Interestingly in the article, it stated that the health authority had a legal obligation to meet the financial requirements, which made me wonder if they also had a legal requirement to meet patient needs.
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Old Dec 11th 2014, 11:31 am
  #258  
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Default Re: Future of the NHS

Originally Posted by Bud the Wiser View Post
Looking back, I'd agree with that. My concern is whether the amount of procedures/treatments it can't or won't provide is going to increase, who decides ( plays God )
Doctors, consultants, the health authorities prioritise, each NHS department for that area ect.

Originally Posted by Bud the Wiser View Post
and what public awareness there will be of what is or isn't provided in order for them to accommodate these shortfalls should they wish to do so.
I think most Brits (who live in the UK) know that the NHS doesn't fund everything. We have fundraising events going on all the time, in local areas, on TV and always have done. We also know that there are waiting lists for operations, hence the massive kick-back at the different governments in allowing immigrants to have free operations as soon as they move to the UK. Hence the start of 'immigrants to pay an annual NHS levy until they get ILR', I assume, as oppose to what other countries do (making them pass a medical to get a visa).

I noticed on the uk-yankee forum, that some have said that they got a shock when they moved to the UK and discovered that the the operation they always wanted, or dentistry they always needed, wasn't funded by the NHS. One even said that a consultant said to them something along the lines of 'why do Americans always think everything is free on the NHS'. To be fair, I don't think it is just americans who think that.

So where does this "the NHS will pay for everything" belief, from people outside the UK, come from?

Last edited by formula; Dec 11th 2014 at 11:51 am.
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Old Dec 11th 2014, 11:43 am
  #259  
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Default Re: Future of the NHS

I would definitely be in favour of smokers and obese people being a lesser priority. Not those who are obese because of another health issue but the majority that are obese because they eat too much. Those people who don't have a self inflicted problem should be prioritised.
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Old Dec 11th 2014, 12:07 pm
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Default Re: Future of the NHS

Originally Posted by chris955 View Post
I would definitely be in favour of smokers and obese people being a lesser priority. Not those who are obese because of another health issue but the majority that are obese because they eat too much. Those people who don't have a self inflicted problem should be prioritised.
Oh great idea. So anybody with type 2 diabetes, like me, should just have to pay for their 14 different medications or go without and go blind, have kidney failure etc. Wonder how much it would cost to fund dialysis for me or how much I'd get in benefits if I go blind or have my legs amputated? I certainly won't be able to carry on working and paying my way like I do now. Or maybe I should just be left on the streets to beg or die of kidney failure? A lot of health problems like high chlosterol and high blood pressure are genetic too. Maybe people who try to commit suicide should not be treated because afterall, it was self-inflicted! And who gets to decide who has themselves to blame and who is blameless? A panel? How much do these panels cost to set-up and administer? Who pays for all the extra staff needed for billing and accounting for these payments? In the US it is a whole industry, medical billing.

Sheesh, you people who say these things are obviously 100% healthy and know you always will be. Ivory towers.
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Old Dec 11th 2014, 1:48 pm
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Default Re: Future of the NHS

Originally Posted by Bud the Wiser View Post
Interestingly in the article, it stated that the health authority had a legal obligation to meet the financial requirements, which made me wonder if they also had a legal requirement to meet patient needs.
Not sure, but the law can always be altered to fit. If you look at the way the NHS is going, they now seem to be linking free use to those who have contributed to the UK during their working life i.e. in receipt of a UK state pension; contributed to the UK for (7 or 10?) years.

For those wanting to retire to another EEA country, they cannot use their UK EHIC to pay for healthcare and they have to buy insurance if they don't work in that EEA country. However, if they receive a UK state pension, then the UK will pay for their healthcare in that EEA country. But from 2016, UK state pensions will only be given out on your own contributions, of at least 10 years. There will be no more piggy backing a UK state pension off a spouses contributions.

Last edited by formula; Dec 11th 2014 at 2:04 pm.
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Old Dec 11th 2014, 1:51 pm
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Default Re: Future of the NHS

Originally Posted by formula View Post
Why? The NHS never has coverered everything. Selecting which group/s they spend their budget on, isn't new either. I don't know why some people think that the NHS covers everything for free. Common sense should tell these people that the NHS can't finance everything. Why do people think there are all these fundraising events?

All this is nothing new. I recall someone in our village in the early 90s, raising funds to pay for their childs operation and the therapy following the operation. About the same time, my family all clubbed together to finance treatment for a child in our family too, in a UK hospital (but not free); and a group of us paid for an electric wheelchair for another friend, who lost his legs due to smoking and couldn't manage the manual wheelchair from the NHS.

Just wait to when the 'free for all' treatment in A&E ends and people find they are billed if they can't prove are allowed free NHS treatment. I'm sure we will see lots of stories on that too because people 'forgot' to get travel insurance. Just as we see stories in the paper now when people find out their UK EHIC card used in other EU countries, didn't pay for everything and how they are now trying to raise funds to pay their medical bill.
I suppose it's a question of degree. As you say, there are certainly treatments for which the NHS does not pay, and ultimately its resources are finite. But thankfully, these are special cases and relatively few people are afflicted. What we should be doing is finding ways for the NHS to pay for these rare cases too, not using anomalies as justification for carving up the health service. Once people start suggesting denying access to people who smoke or are obese, that covers huge numbers of people and will undermine the system.
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Old Dec 11th 2014, 1:51 pm
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Default Re: Future of the NHS

Originally Posted by LondonSquirrel View Post
Oh great idea. So anybody with type 2 diabetes, like me, should just have to pay for their 14 different medications or go without and go blind, have kidney failure etc. Wonder how much it would cost to fund dialysis for me or how much I'd get in benefits if I go blind or have my legs amputated? I certainly won't be able to carry on working and paying my way like I do now. Or maybe I should just be left on the streets to beg or die of kidney failure? A lot of health problems like high chlosterol and high blood pressure are genetic too. Maybe people who try to commit suicide should not be treated because afterall, it was self-inflicted! And who gets to decide who has themselves to blame and who is blameless? A panel? How much do these panels cost to set-up and administer? Who pays for all the extra staff needed for billing and accounting for these payments? In the US it is a whole industry, medical billing.

Sheesh, you people who say these things are obviously 100% healthy and know you always will be. Ivory towers.
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Old Dec 11th 2014, 4:07 pm
  #264  
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Default Re: Future of the NHS

Originally Posted by Editha View Post
Smokers lose an average of ten years of life. Average life expectancy of whole population is 81 years, so average life expectancy of smoker is 71 years. How much productivity is lost from people between ages 71 and 81?

Like I said, a nonsense figure.
Poor logic. The fact that smokers have an average life expectancy of 71 does not mean that all smokers die at 71. It inevitably means that more die when they are of working age than non-smokers and, just as inevitably, will cause more productivity to be lost through smoking-related ailments when of working age. They don't all magically drop dead at 71 having been in good health until that point. A cousin of mine is a case in point:- smoked all his life, had a minor stroke at 60, suffered from progressive emphysema for at least the last decade of his life, and died at... 72.

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Old Dec 11th 2014, 5:02 pm
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Default Re: Future of the NHS

Not poor logic. It is the average that matters. On average the years of life lost by a smoker are unproductive years during which they would have been a cost to the state, not a contributor to the GDP. That is just a fact.

Any attempt to assess the financial cost (or benefit) to society of smoking should take into account the savings caused by a shortened lifespan as well as the loss caused by low productivity.

I also have some difficulty with the notion that someone's death, even during their productive years, results in lowered productivity (GDP) for society as a whole. That could only be true if there were full employment and no workers to take the place of the deceased. I grant you that the Black Death in the fourteenth century probably resulted in lowered productivity, but I'm not convinced smoking ever has.
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Old Dec 11th 2014, 5:06 pm
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Default Re: Future of the NHS

Originally Posted by Editha View Post
Not poor logic. It is the average that matters. On average the years of life lost by a smoker are unproductive years during which they would have been a cost to the state, not a contributor to the GDP. That is just a fact.
No, it is not a fact. In fact you haven't addressed my point... at all, namely that the closer life expectancy is reduced to retirement age, the more productivity will be lost through death or disability in years that otherwise would be productive and tax-paying.

Originally Posted by Editha View Post
Any attempt to assess the financial cost (or benefit) to society of smoking should take into account the savings caused by a shortened lifespan as well as the loss caused by low productivity.
I agree. However, studies of Medicare have shown that a disproportionate share of healthcare costs are expended in the last few months of life. Those costs will be expended in those few months whether the person dies at 71 or... 81.

Originally Posted by Editha View Post
I also have some difficulty with the notion that someone's death, even during their productive years, results in lowered productivity (GDP) for society as a whole. That could only be true if there were full employment and no workers to take the place of the deceased. I grant you that the Black Death in the fourteenth century probably resulted in lowered productivity, but I'm not convinced smoking ever has.
You are falling for the "lump of labour fallacy".

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Old Dec 11th 2014, 5:13 pm
  #267  
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Default Re: Future of the NHS

Originally Posted by Shard View Post
What we should be doing is finding ways for the NHS to pay for these rare cases too, not using anomalies as justification for carving up the health service.
They are not "carving up the health service"; because "everything" has never been covered for free by our NHS. We pay for stuff that isn't covered. We always have done.

Last edited by formula; Dec 11th 2014 at 5:45 pm.
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Old Dec 11th 2014, 5:26 pm
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Default Re: Future of the NHS

The lump of labour fallacy, as I understand it, is the idea that there is just x number of jobs, or to put it another way, x amount of labour, when in fact the amount of labour is not static.

So, for example, the contention that 'immigrants are stealing our jobs' is an example of the fallacy, because immigration also creates jobs, or immigrants do jobs the native population can't do, etc.

'Steady state economy' theory, which suggests that we could achieve a no-growth economy, desirable for environmental reasons, is also criticised for the lump of labour fallacy.

But, actually, I don't see that it applies to my argument. Perhaps you can explain?

I think I have answered the first point you make already. Your second point is in error for the obvious reason that medical costs are not the only call elderly people make on the public purse.
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Old Dec 11th 2014, 5:37 pm
  #269  
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Default Re: Future of the NHS

Originally Posted by Editha View Post
The lump of labour fallacy, as I understand it, is the idea that there is just x number of jobs, or to put it another way, x amount of labour, when in fact the amount of labour is not static.

So, for example, the contention that 'immigrants are stealing our jobs' is an example of the fallacy, because immigration also creates jobs, or immigrants do jobs the native population can't do, etc.

'Steady state economy' theory, which suggests that we could achieve a no-growth economy, desirable for environmental reasons, is also criticised for the lump of labour fallacy.

But, actually, I don't see that it applies to my argument. Perhaps you can explain?
Healthy workers create demand and pay taxes. Those that are disabled (or die) create less demand. The more unhealthy workers we have (for example, due to premature death or disability due to smoking) the less demand there will be in the economy. Your claim was that smoking would only cause a decrease in GDP if there were full employment. That is clearly erroneous. Demand in an economy is not a static thing and an unheathly population will tend to reduce it due to lost productivity.

Originally Posted by Editha View Post
I think I have answered the first point you make already.
No, you really haven't. So I will state again "the closer life expectancy is reduced to retirement age, the more productivity will be lost through death or disability in years that otherwise would be productive and tax-paying."

In what way is that an inaccurate statement?

Originally Posted by Editha View Post
Your second point is in error for the obvious reason that medical costs are not the only call elderly people make on the public purse.
I guess you missed the "I agree" part of my reply

Also note that people who are prematurely disabled due to smoking ailments will have a larger call on public resources such as disability payments in earlier years. So whilst it is true that those that die early will make less demand on the public purse for things such as pensions, you have to factor in their earlier calls on said purse.

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Old Dec 11th 2014, 6:00 pm
  #270  
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Default Re: Future of the NHS

Lot of talk about the burden smokers and obese people put on the NHS.

If it's cutting or refusing services to people who are 'to blame' for their condition we're talking about, then please include:

People who have had a few too many drinks, and subsequently do something stupid and injure themselves. They should have known better.

People who don't take the full course of antibiotics prescribed by their GP, and subsequently require further medical care. They should have known better.

People who develop high cholesterol due to eating too much of the wrong thing, although they're not obese. They should have known better.

People who don't maintain good oral hygiene and subsequently require dental treatment. They should have known better.

People who have an increased genetic risk of having a child with a disability, and subsequently give birth to a child with a disability. They should have known better.

People who have acquired the HIV virus, by whatever method of transmission. They should have known better.

Every bloody person who doesn't rigidly obey every bloody 'rule' about what they should and shouldn't do, and instead just live their lives as best they can, according to their level of intelligence, education and experience. Because, of course, all those people should have known better.

By all means explore ways to reduce NHS spending (although you pay people a hell of a lot of money to do just that). For my money, demonizing particular groups isn't the way to do it.
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