Politics of provision

[*Bob*]

I haven't got a bloody clue what you're all going on about. Is it too early to go to the pub?

[mockney piers]

never bob, never, mine's a Landlord please. oops better make that a pint of Collectivised Land Reform lest I upset CWALD ;-P

Or a pint of Get Orff My Land lest I annoy JonBoy.

[Jonboy]

This sounds suspiciously like someone who was never on the receiving end of the care in question. To reverse it - would I rather be a poor person needing medical care in the US or in the UK?

Ok if you have money and are used to certain levels of comfort then the rough and tumble of the NHS might be an affront to your senses - but considering what it is providing to everyone it's a small price to pay IMO

____________________________________________________________________________________________________________________________

Sean, I would far rather be in the UK on the grounds that someone like me will pay for my care. The NHS this financial year has a budget of ?104 billion. That works out to be around a ?1700 contribution for every man, woman and child in the UK. ON the grounds that they dont all pay tax and that i pay quite a bit, my share is probably closer to twice that sum.

The US have no free at point of entry care, but once you're in, the system is superb. My argument with the NHS has always been that for ?3400 I could buy an absolutely bloody brilliant private health policy - and whilst I'm not expecting quite the same level of treatment I do expect a system that works.

The NHS is far from free for many of us and quite simply doesn't work terribly well.

[SeanMacGabhann]

Marmora Man started the thread by expressing the expectation that a lively debate would ensue and it has (yay!)

I like anyone with political views to (whether they chime with mine or not) be able to articulate them and support them, which MM has done since (yay!)

DaveR and I even share the same taste in bars according to his recent post (yay!)

But we seem to now be at a stage where, by even questioning the status quo, we get labelled as Trotskyites ( a very obvious.. Booooo!)

[SeanMacGabhann]

I hear you jonboy - either way you are sorted, but you have an obvious preference. Great.

Now what would you suggest someone who earns below the level of taxation does (and hasn't made a contribution and can't afford the private care)

And don't say get a better job - our relevant comfort-levels depends on those people earning below the taxation level*

*Notwithstandng any recent tax-level changes which swooped a whole bunch of poor people into it's grasp

[Marmora Man]

SeanMacGabhann Wrote:

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> DaveR - the debate has been going so well - no

> need to degenerate into yah boo sucks type

> language

> "The poorest people in a market-based democracy

> are invariably richer than the poorest in an

> equivalent authitarian state, and they know it.

> Slagging off market economics is a luxury

> availalbe only to developed world whingers"

>

> If we DO have the luxury of "slagging off market

> economics" - or as I would prefer to describe it

> "addressing the obvious problems affecting even

> the best run economy", then that doesn't mean we

> should ignore it.

>

> To address a specific point of MM's - namely:

> "I have worked in public and private healthcare

> sectors here and abroad and it is these

> experiences that have led to my absolute

> conviction that business does it better than

> government. I will admit that I make an assumption

> that what I have seen in healthcare translates

> across to education, but what I've learnt is that

> the 1960s / 1970s state education level of

> service, quality, ethos and expectation that I was

> fortunate enough to enjoy was not easily found for

> my two children over the last 10 years."

>

> This sounds suspiciously like someone who was

> never on the receiving end of the care in

> question. To reverse it - would I rather be a poor

> person needing medical care in the US or in the

> UK?

> Ok if you have money and are used to certain

> levels of comfort then the rough and tumble of the

> NHS might be an affront to your senses - but

> considering what it is providing to everyone it's

> a small price to pay IMO

>

> As for the 60s/70s ethos found in your education

> but not in your children's - is it not possible

> that the higher levels of taxation in that period

> meant a bigger fund for education, thus nurturing

> the staff and ethos you describe? I'm not saying

> that's the only factor but if the state ran a

> pretty good education system then, what's to stop

> it now?

Sean,

Healthcare first: I was born in the 50's - statistically I'm about to start costing the NHS money and have already been on the receiving end (orthopaedics / cardiac / haematology) and also been responsible for the delivery in the NHS. I wanted to receive the best and I certainly wanted my team to deliver the best. Both desires were thwarted by the inherent tendency toward mediocrity that bloated organisations create. Trying to persuade staff that turning up on time was a good idea, that not booking all appointments for the same 2.00pm slot could lead to greater efficiency and service to patients (never clients - please), that the Patient Transport System did not exist to take tired and emotional porters and nurses back to their home or that tea / meal breaks were not more important than a patient were all problems I spent time working on in the NHS. I had some wins and persuaded some staff to change, eventually sacked (tho' it took nearly 18 months) two obvious time wasters but there are scars on my back. Moving to private healthcare I discovered nurses that enjoyed caring for patients and didn't need a committee meeting every other day or run off for a fag just when a patient arrived, doctors who really wanted to make people better and were content they didn't have to battle the system to get things done - that the unit had just one manager (me), an accountant and three clerks. Everyone else was either clinical or service orientated (cooking, cleaning & maintaining). If a doc came to me with an idea for a new service we could get it up and running in weeks - not years. I was able to recruit new staff when required at salaries that attracted them immediately and not wait for the HR department to approve the new vacancy. I was able to performance manage staff with an appropriate mix of incentives (bonus / promotion / additional responsbility) and disincentives (no bonus / demotion / dismissal) without unnecessary HR hassle. The big difference was response to, and speed of, change when required to satisfy patients.

Recent changes toward market forces in the NHS have seen some of the patient service initiatives I tried to develop in the early 90's become almost standard - but the mediocrity tendency remains.

Education: Education in the 60s / 70s wasn't awash with money - it was awash with more dedicated staff and a much simpler ethos. Today there's far more money spent (real terms) than ever before for less positive results. Mny staff are demoralised - affecting the ethos and driving standards and expectations down.

On both points I don't think either system is in total meltdown - heroic efforts by those that stay inside the system keep it running. Their job and the output would just be som much easier / better if business ran the system rather than government. Governments are better at raising taxes and spending - they are, in general, b***** awful at managing.

[mockney piers]

Don't tell me, they get on their bike (the 300 miles to the nearest hospital whose relevant services haven't been hamstrung by Pat Hewitt's underhanded attempts to get rid of the NHS)

*gosh this is a confusing thread as our posts step over each other*

[Marmora Man]

Jonboy Wrote:

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> MM, I am fearful for your long term safety, both

> in this virtual world and also in the real ED

> world. The expression of interest in such

> loony-right ideals as smaller government, a

> privately managed NHS and a market ecomomy will

> upset many of the militant Trots who hang out in

> here.

>

> Try to bear in mind always when in this forum that

> market forces are evil. They allow people to

> freely choose what to buy, and where to buy it

> from. As an example, the evil emporium White Stuff

> will offer a range of clothes. If they are not

> what people want to buy, the shop will close. This

> is morally wrong. The shop should be prevented

> from opening in the first place, to protect us all

> from the evil intentions of its owners, viz, an

> interest in offering us a place to buy clothes.

>

> Your crazy high-Tory spoutings will endanger all

> of us who have so far managed to be more discreet.

> Please, stop now as you put all of us in danger.

>

> For the love of God MM, go back to Fulham. If you

> must stay here, then contact me. A bunch of us

> crazy neo-cons meet in secret at the top of One

> Tree Hill each week to read the Spectator - you're

> more than welcome to join us if you can be

> trusted.

Great - can I bring my copy of Wealth of Nations ot quote from and a New Statesman to burn for warmth?

[Marmora Man]

JoeChuff Wrote:

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> haha i'm in a minority in that I openly welcome

> more nannying from the state - I need it!

>

> That's an interesting point about libertarians,

> though. I've met a few committed libertarians, and

> without exception (so far) they are well educated,

> sensible, self-disciplined and responsible people.

> Two have been former US marines. If everyone was

> like them, then minimal state intervention would

> probably work. But unfortunately, most people are

> not.

My aim in life is to persuade more people to think libertarian and become like the exemplars you mention. You know it makes sense!

[Jonboy]

Sean, I am actually in favour of the NHS. I think the rich have a moral (and practical) duty to subsidise the care of those less well off. No argument there.

The point I'm making is that the State also has a moral duty. That duty is to spend my money wisely, and to ensure that the system works.

Bear in mind that I have no choice here. I can't choose whether or not to pay for the NHS, so in return I do expect a working system that will fix me.

[mockney piers]

So MM, you're happy to at least acknowledge that many of the problems are to do with implementation of public service rather than the ethos full stop.

Definitely true of education. I had some fantastic teachers who were mostly laid off (early retirement) toward the end of the eighties in order to pay for a load of kids who had little or no idea and were soon to be immersed in the spirit sapping culture of targets and 'choice' of this shagsack of a government.

Money is one thing and you're right it's the commitment and culture of teaching full stop which has suffered. I'm sure in time and treading a different path education for all can be the wonderful thing that I was lucky enough to experience a couple of decades ago.

[Jonboy]

Yes please MM, bring them along. You can do the first reading next week.

[Marmora Man]

Mockney - it's all to do with implementation.

Governments can't we (the individual) can.

This discussion is getting so lively I can't post quickly enough to respond to all the points - but I detect a swing toward some individualism - and to reply to an earlier comment by someone - I want everyone to have the same freedom fro nannying / direction / government decision making as I want.

[SeanMacGabhann]

Good comebacks jonboy and MM

As ever most people want the same thing but disagree on how best it can be achieved.

I can only imagine the pain involved Marmora, trying to turn around a culture as deeply entrenched. Such attitudes are not unknown even inthe most private of private sectors either it should be noted and I have my own scars from trying to improve working practices there. That said, healthcare doesn't lend itself so neatly to efficiency as does, say, banking and even there we can see a two tier structure

If we take the high street banks versus the private banks as a parallel example. Private Banks offer tailored service to the clients (who obviously pay the premium) and would have pretty high satisfaction levels. High Street banking customers however (often of the same organisation as the private banks) have to make to with a much more generic template and as we all know, satisfaction levels are pretty low amongst customers

The point I'm making is that the organisations in question already know about efficiencies, market-forces, customer-service etc - it's just not in their interest to spend enough on it to improve the levels of service for the average punter

I'm not advocating nationalising them, or introducing legislation to change their ways - just illustrating that equipped with the full might and wealth of these brand-leaders doesn't really instill a customer-centric approach. Just enough is done to maintain (give or take) satisfactory levels of customers but the priority is shareholders

[Jonboy]

Take your point on banking Sean, but I am a shareholder in the NHS. The entire country is. We can't not be!

[SeanMacGabhann]

Indeed Jonboy - both shareholders and customers ;-)

Of course if we DID have the choice, it simply wouldn't exist. Enough people (ie those with the money that enables it to exist) would choose summat else. Game Over. Not for those people who chose to withdraw but those left behind. So even though you and I might not get anything out of it (I've paid in for 20 years and never once been for so much as a check-up) the knowledge that it exists, however imperfectly, for all those who need it, is... enough

[Jonboy]

I'm going to offer a very lowbrow book as an example of things working! Tom Clancy's Executive Orders of all things.

Jack Ryan (who else) is now President after a plane crash kills all the Executive. He knows nothing about politics per se and has no interest in its machinations.

He does however believe in things that work. DOesn't matter who works them, as long as they work, because the country needs things that work. ( I can practically feel the forum losing the will to live by thsi point)

He appoints a cabinet of staff who have no political experience at all but are experts in their field. ie as Treasure Sec he appoints a famous trader - not the alternative guy who has all the political experience yet has no experience of making things work in the real world.

I guess thats MMs point (although he makes it better then me). Politicians and goverments have no experience in building things, managing things or running things. They're straight out of uni to be someones PS, then up the ranks to Under Sec etc etc.

Never built or managed a thing. Never should either.

Hope you enjoyed the plug for the book - actually one of his better ones.

[Jonboy]

Also, at nearly 900 pages its a good one for the beach.

Or picket line, or DSS office.

Wherever you spend your holidays really.

[SeanMacGabhann]

"Jack Ryan (who else) is now President after a plane crash kills all the Executive. He knows nothing about politics per se and has no interest in its machinations." (unlike Tom Clancy ;-) )

Good to see humour creeping back in here as well.. right, pint anyone? A selection of bars are available in The Lounge to suit everyone's taste although there is room for a neo-con bunker on the market ;-)

[mockney piers]

A pint sounds good. I'd go for a glass of wine but Tom Clancy, oh he of such knowledge, reliably informed me in one of his novels, that Australian wine is substandard.

I never read another novel and left him to enjoy his Ernst & Julio Gallo!!

[Marmora Man]

Jonboy Wrote:

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> Also, at nearly 900 pages its a good one for the

> beach.

>

> Or picket line, or DSS office.

>

> Wherever you spend your holidays really.

But as with almost all author's his first was his best. Hunt for the Red October was firstlty a great techno thriller (probably the first, secondly it revealed a signifcant number US Navy secrets in the first five pages and finallly was. loosely, based on a real incident in the Gulf of Finland.

[mockney piers]

Yep, really enjoyed that book but they went rapidly down hill, and the aforementioned incident was in The Sum of all Fears. It wasn't so much the wine ignorance as the fact that the book was s**t, he'd stretched reality to the utterly absurd, his story telling powers we weak and frankly life's too short.

[JoeChuff]

Marmora Man Wrote:

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> JoeChuff Wrote:

> My aim in life is to persuade more people to

> think libertarian and become like the exemplars

> you mention. You know it makes sense!

I disagree, I think it just ends up in feudalism, with the strong exploiting the weak. And some of the exemplars I mentioned are also absolute lunatics. Libertarianism is, like communism, a lovely idea on paper but a nonsense in reality.

Also I have a basic philosophical issue with you basing your political philosophy on the premise "I am an individual". I find it difficult to separate "thinking libertarian" with "thinking selfishly".

[Marmora Man]

I woudl argue that my "selfish" needs (shelter, warmth, food) are met by particpating in society and helping others. I don't need to be legislated into doing this. My Goose Green example was an illustration of my personal plan

[ChavWivaLawDegree]

Jonboy - "That duty is to spend my money wisely, and to ensure that the system works" - well join a political party (preferably the Green Party) and fight to decide where it should and shouldn't be spent.

I actually want to punch myself because I'm finding myself in agreement with JB. This and previous governments use the tax system to fleece us all, and line the pockets of their business friends who in turn line theirs. I agree totally with redistribution of wealth, but not from the bottom up to the top as it is now!

Kick the corrupt greedy b@st@rds out and take back the power we gave them!!

Viva la Revolution, yeh I know I said this already today!