[HN Gopher] Collapse of emergency healthcare in England may be c...
___________________________________________________________________
Collapse of emergency healthcare in England may be costing 500
lives every week
Author : buro9
Score : 203 points
Date : 2022-08-23 09:48 UTC (13 hours ago)
(HTM) web link (twitter.com)
(TXT) w3m dump (twitter.com)
| simonswords82 wrote:
| For those not from the UK there's a wider narrative at play here.
|
| Any and all government bashing is almost a national sport and
| pastime at this stage. Throw in some numbers to try to prove your
| point and you're going to be well received.
|
| So there's a lot of misinformation out there. Perhaps this
| Twitter chap is talking rubbish too.
|
| For the record not saying our government is perfect but holy heck
| it's hard to keep up with the negativity
| pas wrote:
| the 12+ hour wait times, the hospital occupancy, the aging
| population and slashed social spending are all hard data. if
| you want just ignore everything about the excess mortality, and
| you'll still get the same picture, it's not gonna look nice
| anyway you dice it.
|
| healthcare (and education) are both incredibly big outliers in
| the last decades of technological progress (incredible
| diminishing returns, just look at US spending, brutal Baumol
| effect, since almost everything is still manual labor .. every
| MRI/CT requires more professional labor, every new drug
| requires more tests and consultations, and so on).
|
| no wonder it's looking worse and worse when compared to total
| GDP of aging populations.
| pjc50 wrote:
| > Any and all government bashing
|
| They're doing incredibly badly despite friendly press support,
| are leaderless after the misconduct got too much even for the
| Tory party, and are facing some really serious problems this
| winter if energy prices match projections. In the meantime they
| waste time on culture war nonsense. They're not being bashed
| _enough_.
| simonswords82 wrote:
| Well bashing doesn't appear to be changing anything so can we
| try something else perhaps?
| tailspin2019 wrote:
| I would suggest that the bashing contributed to Boris
| Johnson being forced (correctly in my opinion) to resign.
| Not to mention causing many of his former colleagues to
| read the writing on the wall and finally admit that his
| honesty was "questionable" (either on TV leadership debates
| and/or by way of resignation).
|
| If the general public was instead expressing _extreme
| satisfaction_ with the government, I find it unlikely that
| this would have happened.
| M2Ys4U wrote:
| "This Twitter chap" is a journalist at the Financial Times and
| is a senior fellow at the London School of Economics. He's not
| just some rando bashing government...
| jokethrowaway wrote:
| Logical Fallacy: Appeal to Authority
|
| I would trust a rando more than a journalist these days
| nobody9999 wrote:
| You might want to check this out:
|
| https://en.wikipedia.org/wiki/The_Death_of_Expertise
|
| https://www.c-span.org/video/?426290-1/tom-nichols-
| discusses...
|
| Unrelated, but the second link also provides the best
| definition of fake news I've ever heard.
| M2Ys4U wrote:
| > Logical Fallacy: Appeal to Authority
|
| It's putting the source in the proper context.
| ben_w wrote:
| Even though I frequently make note of the Gell-Mann amnesia
| effect, I'd still rate journalists higher than randos.
| simonswords82 wrote:
| So you're saying as a result of these two positions that he
| holds he cannot possibly be wrong and I should blindly trust
| anything he says so long as he shows some workings?
| M2Ys4U wrote:
| No, I am not saying that.
|
| I'm saying that you shouldn't dismiss what he's saying
| because he posted it on Twitter and/or because (you feel
| that) people are bashing the government.
|
| He's a journalist at a well-respected newspaper, who has
| practical and academic experience using and interpreting
| data for his journalism, communicating his story in
| accessible way (both accessible in a pedagogical way and
| because the FT has a paywall). Engage with _what_ he 's
| posted and evaluate it on its merits, not just dismissing
| it because it's a Twitter thread containing a viewpoint
| that you don't want to be true.
| dredmorbius wrote:
| Your initial comment strongly suggested _distrusting_ the
| information strictly based on the source, "this Twitter
| chap".
|
| Reputation isn't everything. But it's a useful guide.
| DanBC wrote:
| You don't have to blindly trust him, but so far he's
| provided a bunch of data to support his position and you've
| provided nothing.
|
| Show me the data.
| Havoc wrote:
| Meanwhile the prime minister is on perma vacation and the
| replacement candidates are focused on banning on shore renewables
| and squabbling among each other
| mhh__ wrote:
| Don't forget our prison camp in Rwanda!
| smcl wrote:
| The replacement candidates are also both sure that the main
| issues facing the UK public are "woke" politics and trans
| people[0], and seem entirely unphased about the pending crisis
| around energy bills and the price of food. And the opposition
| seem pretty uninterested in taking advantage of this _massive_
| open goal. Incredible.
|
| [0] no, not in a nice "let's all remember to treat LGBTQ+
| compassionately and with respect" way
| rsynnott wrote:
| > And the opposition seem pretty uninterested in taking
| advantage of this massive open goal.
|
| Never interrupt your opponent while they are making a
| mistake.
|
| Right now, Labour and the Lib Dems don't have a particularly
| credible method to cause an election. Given that, their best
| _political_ option is probably to allow the Tories to run
| themselves into the ground.
| smcl wrote:
| I'll believe that they have a response to these things when
| I see it. While I've seen polling putting Labour ahead of
| the Tories but no big movement on the problems I've
| mentioned (in addition to some worrying anti-worker
| sentiment @ party level relating to the rail strikes)
| buscoquadnary wrote:
| I don't think it is coincidental that there is also now a large
| push in England for State sanctioned suicide. Especially after
| reading how administrators in Canada are treating it.
| standardUser wrote:
| Decriminalization of physician-assisted suicide is becoming
| more popular in a lot of places because it is far more humane
| than the status quo.
| bambataa wrote:
| What are you talking about?
| c7DJTLrn wrote:
| My 80 year old grandfather was due for a knee operation and it
| was delayed twice. On the day after the second time it was
| delayed, his knee collapsed and he smacked his head on the
| concrete floor. His speech was slurred, his vision was affected,
| and he was in extreme pain. Bearing in mind in his younger years
| he's had eyes slashed open and fingers cut off, so he has a high
| pain threshold. The ambulance took six hours to arrive. If his
| brain was bleeding he would have died. When they arrived at the
| hospital they were waiting a further six hours to be seen.
|
| The NHS is a tragedy and I almost wish they'd just hurry up and
| privatise it so I don't have to pay with it with my taxes
| anymore, which means the Tories achieved their goal.
|
| If I didn't have private healthcare I'd have left the UK by now.
| I was born and raised here, so I think that says something.
| asdff wrote:
| As someone in the U.S., don't expect the timeliness to improve
| any with private healthcare.
| lkramer wrote:
| Anecdotal, but I have twice in the last year heard from the same
| friend of 2 instances where the waiting time for an ambulance was
| around an hour.
|
| The first was when he observed an accident where a car hit a guy
| on a scooter. The guy was hurt, but not in a life threatened
| manner.
|
| The other was a guy in a bar who probably overdosed on something
| and his heart stopped. If someone hadn't been around who knew
| CPR, he would have been dead.
|
| Both instances was in London.
| dmix wrote:
| Canada is having the same issue with 20hr waits in the emergency
| room and others being rejected outright
|
| https://globalnews.ca/news/9066662/emergency-rooms-canada-bi...
|
| I've heard a big part is all the doctors have been going on
| vacation all at once now that COVID is largely over, after not
| taking them for two years. They don't have enough staff to cover
| even partial shortages.
|
| That plus the elephant in the room of paying nurses/doctors more
| to keep them in Canada is always an issue.
| cmrdporcupine wrote:
| There's a public sector salary cap in many parts of Canada,
| despite roaring inflation.
|
| And a general vibe from the public and the government that
| generally despises public sector unions and would almost
| certainly backlash against nurses and teachers should they
| sensibly decide to go on strike.
|
| For two years they busted their asses for the public in tough
| straits and now COVID numbers in the hospital system are still
| crazy but the public is pretending they aren't, and basically
| expecting the health care system to "deal with it."
|
| A prov government here in Ontario that screwed the public
| health care system and nurses in particular all through the
| COVID crisis, and has every intent on doing more of that ...
| was just re-elected with a landslide majority.
|
| If you put foxes in charge the hen house, it's not a surprise
| when the nurses^H^H^H^H^Hhens start to disappear.
| dmix wrote:
| No comment on unions but I never understood the salary caps,
| especially that new one for nurses. That's the opposite of
| what we should be doing.
| shagie wrote:
| The business idea behind the salary cap is to make
| budgeting more predictable. If the budget is $X and you
| need a staff of Y, your salary cap of $X/Y makes it easier
| to manage... in theory.
|
| In reality, if $X/Y is low, then you can't find anyone who
| will work at that rate and you either have to cut back
| services or outsource (which is often in a different budget
| - see traveling nurses).
|
| It is the opposite of what _should_ be done, but if you 're
| trying to fit things into a fixed budget then it is what
| must be done. The way to fix it is to get the budget to
| expand up to what is needed to supply services. That is a
| difficult sell in the public sector.
| cmrdporcupine wrote:
| It's the opposite of what you'd be doing if you wanted the
| system to function correctly... But what if you didn't?
| Because you wanted to replace it, but it was dangerous to
| say that out loud?
|
| The Conservatives (and to some extent some Liberals as
| well) have been playing a long game -- since the 70s when
| it was introduced -- to get rid of medicare.
|
| It's incredibly popular with Canadians as a whole, but if
| you take conservative leadership aside, get them drunk, and
| get them to speak honestly ... they want it gone. Or at the
| very least, severely curtailed and a private option
| introduced.
|
| Klein tried to do it in Alberta in the 90s (bring in more
| extensive private services) and the feds (under Chretien)
| beat him back in the courts. But now they're getting quite
| open again about it in both Alberta and Ontario and
| pitching it as a solution to a crisis. A crisis they helped
| creat.
|
| EDIT: again, I think the system needs reforming. But likely
| not the way they want it reformed.
| fencepost wrote:
| Hey, if you object to privatizing healthcare, why do you
| hate the free market? Don't you think that private
| healthcare and insurance companies should be able to skim
| billions of dollars off the top of all health-related
| spending? Are you some kind of commie?
| raydev wrote:
| I'm still an outsider (recent immigrant to Canada) but my
| impression of right vs left politicians here reminds me
| very much of Dems vs Reps in the US.
|
| When the right obtains power, they incrementally and
| consistently put the pieces in place to ensure that the
| quality of gov-provided services decreases over time.
| Then when the left obtains power, they simply maintain
| status quo, never improving or fixing the problems
| created by the previous administration.
|
| And of course, we have issues where practically no one
| shows up to vote and a widely-disliked premier gets a
| majority government, a premier who will continue to
| ensure the gov-funded options get worse.
| Scoundreller wrote:
| > When the right obtains power, they incrementally and
| consistently put the pieces in place to ensure that the
| quality of gov-provided services decreases over time.
|
| My favourite was when one promised 'fiscal restraint' and
| no deficits, so they sold off a 99y lease on a tolled
| highway to plug their deficit. They promised prices
| wouldn't go up more than 30% in 15 years, but they went
| up 200%.
|
| https://www.thespec.com/news/canada/2019/09/03/birth-of-
| a-fi...
|
| While the public highways are gridlocked, there have been
| at least 2 aircraft landings on the tolled highway
| without injury:
|
| https://www.cbc.ca/news/canada/toronto/plane-makes-
| emergency...
|
| https://www.cbc.ca/news/canada/toronto/plane-
| highway-407-mar...
| nivenkos wrote:
| It's the same in the UK, junior doctors and nurses have had
| terrible compensation for years (the Conservatives even
| scrapped the student bursaries).
|
| And now they're surprised when they all leave for Australia
| and the USA where they can earn 3-4x as much...
| betaby wrote:
| At the same time there are plenty of medical specialists in
| the sunshine list making 400K+ CAD. Keeps me wondering why
| radiologists are paid that well, compared say with
| oncologists. Also do not forget 1) province caps on medial
| school admission and 2) administrative bloat. Nurses shortage
| is only one of the many issues with the healthcare in Canada.
| Scoundreller wrote:
| Only the small fraction of doctors that are
| government/hospital employees will show up on that list.
| The vast majority that are contractors or under non-
| governmental employee arrangements will not.
|
| I _think_ radiologists tend to be employees since they
| usually don 't physically see most of their patients, but
| not sure.
|
| And those showing up on that list as employees may still
| have other revenue from services they can bill for as
| contractors.
| cmrdporcupine wrote:
| Yes, I agree in general.
|
| _However_ when I was taking a $300k+ CAD comp package at
| Google for a (relatively low ladder) SWE position, it was
| really hard for me to sympathize with people griping about
| _anybody_ being overpaid in the public service.
|
| Pricing irrationality is one of the usual critiques that
| libertarian types have against state-run anything. Thing is
| that the US health care market also exhibits similar
| distortions. I think it's a constant struggle.
|
| I think the Canadian system (and probably UK NHS) is due
| for major reform. I just _do not trust_ the people in power
| to make the right kind of reforms. Again, foxes and
| henhouses.
| Cthulhu_ wrote:
| I'm happy for them that they made it to the point they can
| actually take time off. A big issue over here (NL) is that the
| doctors and nurses have fallen ill themselves, either from the
| 'rona or long covid, or from being overworked for so long. And
| because of the workload, a lot of people have quit as well.
| ilamont wrote:
| Family member recently received emergency care in northern NY.
| Several of the nurses were Canadian coming over the bridge for
| better pay.
| Scoundreller wrote:
| There's somewhere from 1000-2000 health care workers that
| work in the Detroit area, but live on the Canadian side.
|
| When the borders were sealed shut-ish, they were going back
| and forth regularly and not required to quarantine upon
| return at any point during COVID like most everyone else
| returning was.
|
| Kinda defeated the purpose of trying to keep a virus out of
| Canada when you literally have Canadians caring for the most
| afflicted people regularly with relatively few restrictions
| upon return.
| magicalist wrote:
| Nurses are leaving a ton of places in the US for better pay
| elsewhere, too.
| Scoundreller wrote:
| They're not leaving the US, they're re-allocating
| themselves internally.
| 11101010001100 wrote:
| As always, it very much depends. We just went to the emergency
| room and experienced less than 30 minutes of wait time.
| jeffh wrote:
| Certainly it does, but one can guarantee more than 30min wait
| time at some emergency rooms coming up as they are closing
| outright due to staffing issues.
| https://bc.ctvnews.ca/8-more-overnight-closures-on-the-
| way-f... It's a real problem, and not just in BC. Some have
| argued this is a politically manufactured issue to force more
| talk of private care ... regardless, people are suffering in
| the mean time.
| mattlondon wrote:
| As a UK tax payer, and as a UK tax payer that winces every time
| they see how much they lose to taxation in their P60 each year
| (six figures in tax), what are people's solutions to this?
|
| It seems like the NHS budget keeps on going up and up and up [1],
| as does the number of doctors and nurses (while "managers" has
| either declined or stayed relatively static) [2]. So NHS is
| getting more funding, and there are more doctors and nurses. Yet
| there is still outcry about how we need MOAR MOAR MOAR!
|
| We're spending ~10% of GDP on the NHS at the moment [3] - how
| much more do people want? 10% appears to be roughly comparable to
| other developed nations (except USA...) and the data says that
| nurses and doctors _are_ increasing in numbers while "managers"
| are not, so the usual cries about the money being spent on
| "management consultants" appears to be ill-founded, as does the
| complaints that it is the Tory party reducing funding.
|
| Throwing money at the problem appears not to be working because
| the budget keeps going up, the numbers of doctors and nurses
| keeps going up, yet people are still complaining about it being
| awful? What gives? What is the solution when just spending more
| money isn't working?
|
| 1 - https://www.bma.org.uk/advice-and-support/nhs-delivery-
| and-w...
|
| 2 - https://www.kingsfund.org.uk/audio-video/key-facts-
| figures-n...
|
| 3- https://www.kingsfund.org.uk/audio-video/key-facts-
| figures-n...
| vehementi wrote:
| > Yet there is still outcry about how we need MOAR MOAR MOAR!
|
| Was the budget increased enough in the first place to what the
| experts recommended? "I generously give my employees a raise
| every, single, year, of 0.5%, and yet all I hear is that they
| want MOAR MOAR MOAR"
| mhh__ wrote:
| Note that your bma source contains a graph titled "Regular
| healthcare expenditure if it had kept pace with the historical
| average over the last decade"
| Scoundreller wrote:
| > how much more do people want?
|
| I believe they voted for 350 million pounds a week to fund the
| NHS
|
| https://leftfootforward.org/2022/02/where-is-the-350-million...
| londons_explore wrote:
| Is it possible the NHS took on lots of 'bad deals' in the
| 2000's, and is now having to repay them? Things like a "Get
| this cheap building, but now you're locked into paying inflated
| rent and service charges on it every year for the next 50
| years"
| rdl wrote:
| The best thing about NHS (from my perspective as a US person,
| although I lived in the UK for a while) is the use of QALYS to
| allocate budget, rather than spending huge sums on a small
| number of interventions at extreme cost and limited benefit.
| Has that focus shifted?
|
| (My personal belief is there should be a level of universal
| medical care funded by some public entity, probably the nation
| state currently, but it should be capped at a relatively low
| level, probably closer to 1% of GDP and allocated on a QALYS
| and emergency or communicable biased, with private care in a
| relatively unregulated market outside of that. Probably would
| end up in the 5% range overall, but with universal access to
| basic and cost-optimized care and probably a wider variety of
| private, charity, experimental care.)
|
| We should not spend excessively on medical care vs. other
| interventions -- it's absurd that in the US we can have
| homeless people on the street with extremely limited assistance
| on housing or lifestyle interventions, but as soon as they
| develop some medical condition, they get essentially unlimited
| much higher cost intervention to remediate those things, but
| still nothing to address the underlying cause. There are a
| bunch of cases where we could shift $1k out of medical spend
| for $10 in other spend and achieve a better outcome for the
| person and for broader society.)
| simonh wrote:
| We still use QALYS. The problem is you don't get to choose
| how much a given level of health care costs, and I think 1%
| of GDP is woefully inadequate. You spend about 4% of GDP just
| on Medicare alone.
|
| As a US tax payer you pay about as much for Medicare,
| Medicaid and CHIP as tax payers in most developed countries
| do on health care in total. But then to actually get health
| care yourself you have to pay about the same again fir
| private health insurance.
|
| I get private health care here in the UK through my employer.
| I pay for the NHS through taxes, and that's actually how I
| and my family get most of our health care in practice. The
| private cover is basically a top up. If I use it I can get
| treatment more quickly, but at no cost to the NHS.
|
| I think this is the best of both worlds. As a nation we get
| health care comparable to the US at half the cost, it's truly
| universal so millions of people don't fall out of the system.
| So I fully support the NHS, as a beneficiary of private
| health care I still think I and my family have got excellent
| value for money from it throughout my life. Private health
| care expands health care capacity, and reduces demand in NHS
| services, so everyone benefits. It may not see, ideal, but in
| practice I think it works very well, and frankly it's how
| well it works that actually matters.
|
| Currently the NHS is in rough shape, but this is mostly down
| to the flat economy since the financial crisis and the
| pandemic. Spending levels at the peak of the boom in 2008
| were unsustainable whoever was in power.
| s1artibartfast wrote:
| >and I think 1% of GDP is woefully inadequate. You spend
| about 4% of GDP just on Medicare alone.
|
| That all depends on the spending ROI. If the first 1% of
| GDP gets you 90% of the benefit and is universal, it may be
| just fine.
| simonh wrote:
| The problem is I don't think it would. That logic just
| doesn't scale. If one tenth of spending gave 90 of the
| benefit, then one hundredth of the spending should give
| you 90% of that, or about 80% of the benefit. That's not
| how skilled labour intensive service costs work though.
| It's probably more like one tenth of the spending would
| get you about 20% of the benefits. That's certainly more
| efficient, but it's just not going to be acceptable.
| Scoundreller wrote:
| Is the NHS using QALYs beyond drug treatments?
|
| Is there a list somewhere of the QALYs for every
| intervention?
|
| It becomes enough of a hot potato to say "drug X works, but
| not enough so we're not paying for it" because it lets you
| complain that the drug companies are charging too much.
|
| But when you say "surgery X works, or 1:1 therapy works, but
| not enough so we're not paying for it", criticism now comes
| from both sides: the workers doing their job and the public.
| throwaway-blaze wrote:
| Agreed...the biggest failure of "Obamacare" was not
| separating out a basic level of care as a minimum that all
| citizens get and requiring those kinds of plans be made
| available in every state.
|
| Where I live I can only buy plans that include things like
| Chiropractic and Acupuncture and all kinds of other non-basic
| or catastrophic services. If I want a low-cost basic care +
| emergencies plan, I'm SOL.
| willyt wrote:
| From your first source; The combination of a mismanaged economy
| plus an aging population has meant that the NHS spend is 50BN
| less than projected but is a now a larger share of GDP compared
| to other EU economies because the UK economy has performed so
| badly compared to the rest of the EU. Productivity has
| flatlined while people bought more and more expensive houses of
| each other on credit. My theory is that the conservatives have
| fucked the economy by being too tight fisted with public sector
| pay causing a drop in disposable income for about 1/4 of UK
| workers leading to lower spend in small businesses like pubs
| and hairdressers etc which has caused 10 years of general
| stagnation.
| pharmakom wrote:
| Funding may go up but demand increases more because UK
| population is old and overweight... and getting more so. This
| is the reality of an aging population plus socialised health
| care.
| oliwarner wrote:
| It's because they're acting as an emergency care home.
|
| My local 450-bed DGH has over 150 medically fit patients
| waiting to be discharged into community care that isn't
| available.
|
| And this happened secondary to central government funding being
| withdrawn from social care.
|
| So hospitals like this one are actually running at 120% _in
| summer_. They do need "MOAR MOAR MOAR" but that more is a
| place to look after the patients that don't need to be in
| hospitals.
| twic wrote:
| Other countries spend more (10 - 20 % more) and get better
| outcomes, so it seems like the solution is indeed to spend
| more. The fact that it has been climbing slowly and we haven't
| seen radical improvement doesn't contradict that. Sorry.
| b1n wrote:
| The solution is for young people (tax payers) to form a "Youth
| Union" and start demanding that older people pay more towards
| their health care.
|
| When this doesn't work, the solution is for the members of this
| union to leave.
| jrochkind1 wrote:
| I hadn't (here in the USA) heard anything about "collapse of
| emergency healthcare in England" -- can anyone provide some links
| for some context? What is actually going on, and (to the extent
| people know/educated guess) why? Have wait times been gradually
| increasing, or has there been a sudden increase? ("collapse"
| sounds sudden?) Etc etc.
| DanBC wrote:
| For years people have been raising the warning about the
| pressures on healthcare system, and for years the conservative
| party have asked the NHS to do more with less.
|
| What does collapse look like?
|
| Well, in the early days, it looks very gentle. The four hour
| wait for ED treatment goes up a bit. Healthcare people say
| "Look! This is concerning!" and politicians say "eh, it's just
| winter pressure, we know things are rough in winter."
|
| Or you say "Look at the waiting list for community eating
| disorder treatment, this is concerning!" and politicians say
| "we're taking people out of mental health hospitals and giving
| them treatment in the community, so there's a transition
| period" (they cut beds for ed treatment, but didn't also fund
| community ed treatment, so wait lists have gone up a lot).
|
| It's like Buckaroo or kerplunk or jenga. You can load the
| donkey, pull the straws, pull the blocks, and stuff still sort
| of works (less safe, less effective, more harmful) but then
| something happens and blam you've tipped over into catastrophe.
| pjc50 wrote:
| As we've learned from COVID, it doesn't matter what
| casualties the system inflicts if the press aren't willing to
| see it like that.
| buro9 wrote:
| The Conservative Party have been in power for 12 years. When
| they gained power they pursued a policy of "austerity" to
| reduce the size of the govt and local govt, reduce the funding
| of nationally funded things, and to replace such govt owned
| things with "public private partnerships". This can be seen
| everywhere from social care (private care homes), schools
| (academy schools), transport (where area contracts are bid for
| by private companies), etc.
|
| With health specifically the goal is to have more privately
| owned profit making companies in the NHS. The NHS as it is
| constructed doesn't allow for this. But for the Conservatives
| this opportunity for them and their backers. For the public,
| there is a national pride in the NHS.
|
| So we entered the pandemic with an already under-funded and
| stretched health care system.
|
| Much to the chagrin of those in charge though... this has not
| led to any calls for privatisation. Nor has it led to a boom in
| people taking out private health care cover.
|
| It turns out that the British stiff upper lip response to
| something they're nationally proud of is that they'd rather die
| than embrace health privatisation. So we're in uncharted
| territory... the playbook that had allowed the privatisation of
| almost everything else isn't working now, it's just killing
| people.
| DanBC wrote:
| > the NHS as it is constructed doesn't allow for this.
|
| This is simply untrue. (What is Livewell South West?) We've
| had private provision of NHS services for years and the
| Lansley reforms explicitly embed privatisation (state funded
| private provision) in the NHS. Commissioners are forbidden by
| the 2012 law from preferring NHS providers over NHS
| providers.
|
| https://www.legislation.gov.uk/ukpga/2012/7/section/75/enact.
| ..
|
| We have a lot of private provision of NHS services (all GP
| practices are private providers!) and it just doesn't work.
| trappist wrote:
| NIH budget has increased over 40% since 2015.
| https://officeofbudget.od.nih.gov/pdfs/FY22/spending-
| hist/Me...
| pjc50 wrote:
| That set of figures is for the US and therefore completely
| irrelevant?
| dekhn wrote:
| also it's a research institution, not a medical care
| facility.
| nobodyandproud wrote:
| NIH is not NHS.
| nobodyandproud wrote:
| > It turns out that the British stiff upper lip response to
| something they're nationally proud of is that they'd rather
| die than embrace health privatisation. So we're in uncharted
| territory... the playbook
|
| Good for you guys.
|
| Basic healthcare should be a public service to maximize most
| coverage at a reasonable quality level.
|
| Not privatized to get the most money for the least amount of
| service, which is the practice of virtually every long-lived
| business.
| gadders wrote:
| >> The Conservative Party have been in power for 12 years.
| When they gained power they pursued a policy of "austerity"
| to reduce the size of the govt and local govt, reduce the
| funding of nationally funded things, and to replace such govt
| owned things with "public private partnerships".
|
| You seem to be missing a bit of context here - this was after
| the Global Financial Crisis when even the outgoing Labour
| Chancellor of the Exchequor admitted there was no money left
| https://www.theguardian.com/politics/2010/may/17/liam-
| byrne-...
|
| >> So we entered the pandemic with an already under-funded
| and stretched health care system.
|
| It's 12% of GDP currently, which isn't that out of step
| globally.
| [deleted]
| ben_w wrote:
| To riff off the Oscar Wilde quote, half a decade of no
| growth may be regarded as misfortune, one and a half
| decades looks like carelessness.
| baobob wrote:
| Folk talking about austerity as a tory thing are going to
| be in for a monster shock if energy prices persist through
| the next elections, and when they realize the size of the
| Covid bill vs the GFC bill. It may very well be Labour
| sitting as the final nails are driven into the NHS, just by
| sheer luck of timing
| gambiting wrote:
| Overtonwindow wrote:
| What if the government allowed private enterprise to open
| emergency clinics in times of great need? There are probably a
| lot of people who would be willing to pay out of pocket for
| medical care, especially in an emergency, if it meant getting
| seen sooner.
| Broken_Hippo wrote:
| Tell me, if you are having a heart attack or have had a stroke,
| how likely are you to have the mental fortitude required to
| realize that not only is there a for-profit emergency service,
| but you can pay to get seen now?
|
| Probably not very likely. If your emergency is urgent but not
| actually life threatening, then you might. You might - might -
| think of it if you have gall bladder or appendix types of pain,
| if you aren't in too much pain to think about it.
|
| And how, exactly, would this go into place? Would you call the
| emergency line, who proceeds to upsell you on a premium
| emergency room that will see you _right now_ if only you pay
| money upfront? Does this also mean that poor people 's lives
| are worth less since they cannot pay up? How about teenagers,
| who might be calling the emergency line yet don't actually have
| money to pay?
| xtracto wrote:
| I understand you pretty well. But see, the majority of people
| in this forum are from the USA so most of the scenarios that
| you draw like "freak cases" are normal day to day things that
| happen in the USA where most healthcare is for-profit.
|
| For someone that is used to social/universal healthcare (like
| UK, Norway, France, Germany) the prospect of having to deal
| with stupid for-profit situations during an emergency are
| laughable. But for someone living in that hell, it is
| something normal. Not for anything you read countless of
| anecdotes of people deciding to stay at home and use some
| superglue or rolled towels when they have an accident and
| bleed.
|
| I've had the opportunity of experience the two systems (UK'
| NHS, Germany's Gesetzliche Krankenversicherung, Mexico's IMSS
| for public, and Mexico's private system) and really makes me
| angry that society is moving toward for-profit privatized
| systems instead of looking to fix the issues in
| universal/public systems. (It's like if when we saw that the
| police or the firefighters were not working, we decided to
| make law enforcement private... throwing the baby out with
| the bathwater)
| 1234letshaveatw wrote:
| in the states, my experience has been that neighbors will
| frequently discuss the location of new urgent care clinics or
| share them in group chats. "hey do you guys know of any good
| urgent care places? I have a swollen arm from a bee sting"
| was a recent msg thread that popped up on my phone. Usually
| the patient is insured but you can (should) also ask for a
| cash price if needed.
| SketchySeaBeast wrote:
| That feels positively dystopian if you're dealing with a
| time sensitive, life threatening, emergency.
|
| "Hey y'all, anyone know a good place for heart stuff? My
| husband can't feel his left arm and keeps passing out!
| Preferably cheap!"
|
| <Your neighbour Tom is typing...>
| brutusborn wrote:
| Your strawmam is accurate, stroke survivors will need an
| ambulance. But you're forgetting that a lot of people get
| driven to emergency by friends or family. And if those
| bystanders pass a private hospital on the way to public
| emergency, they could decide their friend / family members
| life is worth the extra cost. Of course it wouldn't work for
| everyone, but it would ease the pressure on a failing system.
|
| Also your tone isn't conducive to a constructive discussion
| and is not appropriate when responding to someone who is
| suggesting ways to make the world a better place. Just
| because you can't imagine someone's idea working doesn't mean
| it's a bad one.
| Broken_Hippo wrote:
| I drove my father to the hospital when he was having a
| stroke. To be fair, I didn't know until he told the nurses.
| Just because someone is being driven by family doesn't mean
| that it isn't serious nor that there is realistically a
| chance to call around because of price.
|
| I don't care if you find my tone constructive, by the way.
| The issues I've raise are real issues, and if you can't
| explain how you'd get around these and still be sure to
| have the same quality of care for the poorest of people, it
| isn't a good plan. Unless, you know, the "separate but
| equal" (Which rarely works) is your goal.
| brutusborn wrote:
| I didn't suggest anything about seriousness of
| conditions, and the parent did not suggest having
| different quality of care for poor people. You are
| projecting your own politics onto our comments. The
| issues you have raised are real but irrelevant to the
| comment "What if the government allowed private
| enterprise to open emergency clinics in times of great
| need?" I addressed your first criticism (incapacitated
| patients) and you responded with a personal anecdote
| connected to a nonsensical sentence about price. I'm not
| going to go through the rest of them.
|
| I'm not sure why you are so belligerent, without
| engagement in each others arguments this is pointless so
| I'll stop here.
| neilwilson wrote:
| "What if the government allowed private enterprise to open
| emergency clinics in times of great need?"
|
| Using what for doctors?
|
| The problem is a supply side shortage of medical staff. Praying
| to the god of the private sector won't magically cause doctors
| to appear.
|
| I'll remind everybody again. Primary care in the UK has been in
| private hands since 1948. It's the lack of capacity in the
| _private_ part of the NHS that is driving people towards A &E
| for basic stuff.
| SketchySeaBeast wrote:
| Emergency care specific private enterprise seems incredibly
| predatory. I also wonder where the infrastructure and staff for
| these surge clinics would come from.
| bzxcvbn wrote:
| The USA have tried, it doesn't work. People still wait hours
| and hours in the ER. They just have to pay thousands for the
| privilege.
| 1234letshaveatw wrote:
| doesn't work? there are urgent care places everywhere
| SantalBlush wrote:
| The last time I was in an urgent care facility, the doctor
| tried to upsell us on a medical procedure. When he left the
| room, the nurse assured us the procedure was unnecessary
| and he just wanted to charge us more. I wish I were making
| this up.
| bzxcvbn wrote:
| Have you tried one? Last time my wife went in there for a
| broken back, she was told to sit in a chair at 10PM and to
| wait until 8AM for the doctor to come in.
| skeeter2020 wrote:
| This isn't exactly true, nor what the GP is suggesting.
| Supplementing public service with private is already
| happening in the UK and very common around the world in even
| the most socialized, public systems like Canada. Where the US
| shines is high-end ongoing treatment, for which you do pay
| big bucks.
| jimbob45 wrote:
| _People still wait hours and hours in the ER [in the US]_
|
| If you have a genuine emergency, you'll be seen immediately
| virtually anywhere in the US.
| Cthulhu_ wrote:
| Private enterprises are already running a significant chunk of
| UK health care at the moment; the Tory government is
| dismantling the socialized health care in favor of short-term
| profit. It's not about whether people are willing, it's whether
| they can afford it or if they have no choice but to go into
| debt.
|
| Anyway, the NHS has also paid private clinics already because
| their own facilities are at capacity.
| simonswords82 wrote:
| The nhs also has a shedload of funding.
|
| Let's not overlook the aging population in the UK please.
| There are many more factors than simply "the Tories are to
| blame"
| swores wrote:
| It would get a lot more value from that funding if the
| Tories (and to be fair, also the last Labour gov a decade
| and a half ago, though not as much) hadn't been pushing so
| much of it towards embedding privatisation through the NHS
| such that profits are pointlessly being taken out at all
| stages. (Well, obviously not pointless for the
| shareholders, who happen to often coincidentally be tory
| party donors.)
|
| A hospital having a 20% bigger budget for their janitorial
| staff isn't in a better position if it's also been required
| to move from hiring full time cleaners in-house to
| contracting an approved cleaning company that has 30%
| profit margin baked in. An NHS patient isn't helped knowing
| that 50% more funding goes into paying consultants for the
| problem they have, if gradually more and more of those
| consultants are moving to private health companies and
| having to be rented back to the NHS at a markup that pays
| both the doctor and the company's shareholders. Etc etc.
|
| Sure, the population demographics are related, but even if
| we had the exact same population as 20 years ago we'd be in
| a much worse situation; plus it's the government's job to
| pay attention to things like demo changes in their
| population, and to listen to the warnings that have been
| coming from the medical community for many years, and
| should have been proactively funding better social care
| (instead of completely abandoning it to local councils
| while also lowering their funding) AND making the NHS even
| better (rather than gradually turning it into an umbrella
| for private companies who eat up any budget increases).
| X0Refraction wrote:
| This is the actual issue, spending isn't keeping up with
| the demand. I'd agree that "the Tories are to blame"
| doesn't capture it, but I don't think they're equipped to
| deal with the problem. Real terms spending per age adjusted
| capita appears to have been on a downwards trend [0] since
| they took power. I think this has gone up since the
| pandemic, but I think it's likely too little too late and
| will probably be a short term increase.
|
| I'm also skeptical the IFS have managed to accurately
| estimate the required increase in funding. They don't go
| into their workings from what I can see, but I doubt
| they've accurately included the effect of the lifetime
| allowance on pensions causing doctors to avoid overtime or
| the PS100k tax bracket where you lose your personal
| allowance not moving since 2009 which more and more doctors
| will fall into. I'd imagine they've underestimated it, but
| would be happy to hear evidence to the contrary.
|
| That's not to say that I think any other party has a
| solution or is properly holding the Tories to account on
| this.
|
| I'll admit I haven't thought too hard about the problem,
| but I think the fairest solution would be to make
| pensioners pay national insurance on their income. It
| wouldn't affect the poorest pensioners and since national
| insurance is no longer ring fenced for pensions/healthcare
| I'm not sure what the justification for a tax break based
| on age even is anymore.
|
| As someone who intends to subsist on more in retirement
| that change would negatively affect me, but I still think
| it's fair. I know that this would be deeply unpopular
| though, so I don't hold out much hope of it happening
| anytime soon.
|
| Maybe that isn't the best solution, but I really wish we'd
| start to have real discourse on how we need to restructure
| our society as the demographic of the country continues to
| skew older.
|
| [0] https://ifs.org.uk/publications/9186 (figure 5)
| simonswords82 wrote:
| Interesting - nice to have a sensible debate on it. I
| think your idea is worth pursuing even if it's not
| perfect.
|
| Young people should not be subsidising old people who no
| longer work - especially those same young people who
| don't own house or have savings or a pension.
| hotpotamus wrote:
| Yep, your money or your life is a strong economic incentive
| indeed.
| selfhoster11 wrote:
| Hell no. NHS as a public service is currently fighting for its
| life. Opening up to private enterprise would accomplish the
| goal of killing and/or privatising it even quicker.
| cirrus-clouds wrote:
| This twitter thread is excellent. Here are selected tweets to
| highlight the crisis from hospital and ambulance waiting times.
|
| ---
|
| "England & Wales as the only part of Europe that has recorded
| sustained and rising excess mortality over the last few months
| with no obvious natural explanation."
|
| "Patients who waited 8-12 hours had a 16% higher chance of dying
| in the subsequent 30 days than average."
|
| "This was after adjusting for a huge range of possible
| confounders, i.e this was not due to those patients'
| characteristics, conditions etc, but due to the length of the
| wait."
|
| "You may have heard almost 30,000 people waited 12 hours in
| English A&Es in July, but that figure actually only refers to the
| wait _after_ initial assessment "
|
| "Thanks to @Rebeccasmt's reporting, we know that if you include
| all time spent waiting, 100,000 people waited 12+ hours!!"
|
| "Take ambulance delays, for example: for emergency situations
| including suspected strokes and heart attacks, the _average_ wait
| for an ambulance to arrive on the scene is now one hour, and
| 40,000 people with these sorts of emergencies waited 2 hours last
| month. "
|
| "As before, the peaks in ambulance-related harms broadly coincide
| with peaks in England's non-Covid excess mortality.
|
| "It's a grim picture, and an increasingly conclusive one."
| simonswords82 wrote:
| As somebody else in this thread pointed out the numbers don't
| stack up. This thread is subjective at best
| pas wrote:
| could you link to that pointing out? which parts don't stack
| up? the 12+ hour wait times, the hospital occupancy, the
| discharge rate, the aging population and the slashed spending
| are all seem to be hard numbers (dare I say facts?) ... what
| doesn't add up?
| dekhn wrote:
| If you can wait 12 hours, you didn't have an emergency.
| adolph wrote:
| And if you can't wait 12 hours you become excess
| mortality.
|
| Sometime before the 12 hour period, one must make a
| choice whether to seek care or not.
| dekhn wrote:
| the 12 hour wait is once the person enters the doors of
| the facility. In a hospital, if you walk into the ER,
| people are observing you closely and expediting people at
| immediate risk of death. A person who can sit in a chair
| for 12 hours waiting didn't have an emergency. Instead,
| they were using the ER for non-urgent care.
| Jtsummers wrote:
| > A person who can sit in a chair for 12 hours waiting
| didn't have an emergency. Instead, they were using the ER
| for non-urgent care.
|
| Or the ER was crap. Like the time I waited 12 hours
| (because I had no choice, I needed a surgeon) to have my
| foot put back together.
| LorenPechtel wrote:
| A few years back the doctor sent me over to the ER. Had I
| gone home instead there would have been zero (above
| background average) risk of dying in the next 12 hours.
| That doesn't say the doc was wrong in sending me there--I
| had a kidney stone, the risk was kidney damage and
| infection, not dropping dead.
| eikenberry wrote:
| What is the situation of urgent care establishments in
| the UK? Places you can go for non life threatening but
| life stopping events, like say a broken leg?
| gambiting wrote:
| It all goes through A&E, which unfortunately is meant for
| both the life threatening situations and urgent but not
| leathal ones yet. You have to go in, register and sit and
| wait - if it is "just" a broken leg yes you might wait a
| few hours before being seen.
| lkramer wrote:
| A few years ago I had an infected gallbladder. It was
| enormously painful, and I went to ER. It might not have
| been potentially fatal (I'm honestly not sure if you can
| die from it), but I didn't know that. I just knew I was
| in a ridiculously amount of pain.
|
| Anyway, so I went to the ER and to begin I did sit in a
| chair like you said, however I don't think anyone was
| keeping an eye on the patients, since by the time someone
| came to look at me, I had been writhing in pain on the
| floor for an hour or so, and it had taken another patient
| to call a nurse over.
|
| All and all it took 4 hours before I got to see a doctor,
| but this was pre-pandemic.
|
| Still, I think you're probably right and people do show
| up to A and E for non-urgent issues, however it's
| probably also tied to how difficult it is to see a GP
| these days.
| notahacker wrote:
| If the people triaged into 8-12 hour queues have a 16%
| higher chance of dying in the next month, that's a pretty
| obvious indication that many of them are, in fact, in
| critical condition.
| dekhn wrote:
| I wouldn't trust a stat like that without digging into
| the underlying causation. The whole twitter presentation
| is a nice narrative but I see many places where it could
| just be outright wrong, or saying misleading things (I
| work in medical biology and have plenty of familiarity
| with how hospitals run their ERs).
| notahacker wrote:
| I agree that this sort of thing needs a study.
|
| Fortunately the previous tweet linked to the original
| source, a published study of 5 million ER visits which
| appears to have a full set of controls and specifically
| measures time to inpatient transfer in excess of 5 hours
| as a mortality risk factor
| https://emj.bmj.com/content/emermed/39/3/168.full.pdf
| dekhn wrote:
| A retrospective, observational (IE, after the fact data
| analysis from a population without controls) study found
| a risk factor (association). That's not enough to make
| any real conclusions as to whether this is causal.
| notahacker wrote:
| It may not be conclusive on the subject of whether the
| 16% additional deaths were specifically influenced by the
| additional wait, but in light of that data point, you're
| going to need a whole lot _more_ evidence to justify your
| original claim that the cohort that dies 16% more than
| the baseline population in the days that follow were,
| without exception, not in any urgent need of medical
| care...
| [deleted]
| WithinReason wrote:
| They subtract COVID deaths from excess deaths to get the
| baseline, forgetting that COVID deaths were counted somewhat
| liberally, and some percentage of non-COVID deaths were counted
| as COVID deaths if someone was infected close to their time of
| death. This can be seen in the following chart:
| https://ourworldindata.org/explorers/coronavirus-data-explor...
| (You need to change the "Metric" dropdown)
|
| If you compare excess deaths in 2022 to COVID deaths in the same
| period: Peaks in COVID deaths don't produce peaks in excess
| deaths. So saying that excess deaths are higher now than they
| were in the past is likely due to the underestimation of con-
| COVID excess deaths during COVID, and not a real effect.
| armada651 wrote:
| > They subtract COVID deaths from excess deaths to get the
| baseline, forgetting that COVID deaths were counted somewhat
| liberally, and some percentage of non-COVID deaths were counted
| as COVID deaths if someone was infected close to their time of
| death.
|
| If COVID deaths were counted liberaly and even after
| subtracting those inflated numbers you still have excess
| deaths, then that only further underlines their point that
| these excess deaths are not COVID-related.
|
| Just because you think the criteria for counting COVID deaths
| were wrong doesn't make every conclusion based on those numbers
| incorrect.
| WithinReason wrote:
| No, they say that _current_ non-COVID excess deaths are
| higher than non-COVID excess deaths were _during COVID_. They
| underestimate non-COVID excess deaths during COVID because of
| the subtraction, which makes _current_ excess deaths higher
| than average. In reality, they underestimated the average
| that they compare to. Hope it 's clear now.
| armada651 wrote:
| I see what you mean, yes it does make it difficult to prove
| a trend between periods with high rates of COVID infection
| and low rates of COVID infection.
|
| But proving such a trend is problematic regardless of what
| the criteria for a COVID excess death is. Simply because
| during a period of high COVID infection a lot of people are
| dying from COVID before they have the chance to die from
| other causes.
| WithinReason wrote:
| Yes, that's another confounding factor.
| LorenPechtel wrote:
| However, Covid preys heavily on the already sick. We should
| see a *reduction* in deaths because Covid killed off a lot
| of people that didn't have a lot of time left. We don't
| even have an accurate baseline to compare to at this point.
| diogenescynic wrote:
| Boris Johnson really historically screwed over his country. Even
| as bad as some of our leaders have been, it seems like Boris
| significant eclipses their incompetence.
| adamredwoods wrote:
| The thread reminds me of the Guardian's podcast "Sewage Sleuths"
| which uncovered catastrophic sewage being dumped into England and
| Wales's rivers and streams. Very informative and enlightening how
| bad some government infrastructure can be (hint: in the podcast
| they also enlightened HOW the failure got bad).
|
| https://www.theguardian.com/news/audio/2022/aug/15/sewage-sl...
| WhyIsItGlowing wrote:
| It's worth clarifying that the issue with the government
| infrastructure is with the regulatory agencies, rather than the
| water infrastructure itself which is privatised.
|
| There's also a good text article version;
| https://www.theguardian.com/environment/2022/aug/04/sewage-s...
| jmfldn wrote:
| It's a failure of privitisation 30 years in the making since
| water and waste management was privatised in 1989 here in the
| UK. Of course you can lay some blame at the door of the
| regulator but let's not forget the tens of billions that have
| been siphoned off to shareholders and fatcat CEOs, some of whom
| are arguably criminally negligent and should be put on trial
| for the catastrophes that have become apparent in recent years.
| LatteLazy wrote:
| That is what people voted for...
| DethNinja wrote:
| I don't buy that explanation. Democracy turned out to be easily
| manipulatable with large sums of money and media control.
|
| At this point, an average person can't have much of an affect
| on how government is acting. Very few people can take a day off
| to protest, and even if they do, protests tend to be
| meaningless too.
|
| I'm not saying that average person is blameless but most of the
| fault lies with the ruling classes.
| Nokinside wrote:
| >Democracy turned out to be easily manipulatable with large
| sums of money and media control.
|
| People being easy to manipulate is feature of humanity, not
| evidence that democracy does not work.
|
| People are in charge for allowing that to happens, allowing
| to continue etc. If things go shit under heavy influencing
| and manipulation it's the failure of the people. "ruling
| classes" in democracy works is the fault of the non ruling
| majority.
| selfhoster11 wrote:
| > People being easy to manipulate is feature of humanity,
| not evidence that democracy does not work.
|
| Maybe it's both. Much like communism assumes altrustic
| spherical humans in a vacuum, so does democracy assume that
| each voter will both bother to vote, and that they are
| rational enough to vote close to what they actually want
| without being swayed.
|
| This could be evidence that democracy, much like communism,
| does not work very well.
| Nokinside wrote:
| I don't think so. Communism has an idea of what should
| happen next, democracy does not. Democracy is open to
| change, for whatever people choose, even quitting
| democracy.
|
| Democracy is always changing, always on move and
| dangerous. That's why I like democracy. Functioning
| democracy can even end democracy and choose tyranny.
| robertlagrant wrote:
| > At this point, an average person can't have much of an
| affect on how government is acting. Very few people can take
| a day off to protest, and even if they do, protests tend to
| be meaningless too.
|
| The older I get, the more I believe the only real voting
| someone can do is with their wallet.
| selfhoster11 wrote:
| And even that is mostly bullshit, if you don't happen to be
| flush with money so you can actually afford to throw the
| weight of your wallet's contents around.
| robertlagrant wrote:
| It's more fundamental than that. Prices and features of
| low-cost things and services are equally picked in this
| manner.
| treeman79 wrote:
| The founding fathers were heavily against democracy and did
| everything they could to limit the power of the government
| without being completely ineffective. Idea being that
| individuals create wealth. Government will always become
| tyrannical.
| ben_w wrote:
| > The founding fathers were heavily against democracy
|
| Well yes, but this is the UK so the founding fathers would
| be one of William the Conqueror, James VI and I (that's one
| person), or George III and his regent, depending on which
| argument you want to have.
| refurb wrote:
| Nahh... when people say "the vote was manipulated" what they
| mean is "the vote made no sense to me personally, and clearly
| the voters can't be blamed, so it must have been
| manipulated".
|
| There are plenty of examples of billions being thrown at
| campaigns and barely even moving the needle (e.g. Bloomberg's
| $1B fight for the Presidential race where he didn't even get
| 1% of the vote).
| pjc50 wrote:
| People aren't arguing that the _vote_ was manipulated in
| the UK, rather that the _voters_ were misled, especially by
| the partisan media.
| refurb wrote:
| I know.
|
| What I'm saying is that what people see as manipulation
| of voters (nobody could ever believe that!) is actually
| just another valid opinion that you so happen to disagree
| with.
|
| Nobody was deceived. Nobody was manipulated. The voters
| just don't agree with you on this issue.
| pjc50 wrote:
| This is silly: all kinds of promises were made for
| Brexit, and if they weren't delivered then those
| expecting them are at least disappointed, and if there
| was no reasonable way they could have been delivered and
| no real effort to deliver them, then they absolutely were
| deceived.
|
| How did the "PS350m for the NHS" bus work out?
|
| > actually just another valid opinion
|
| Some opinions - sky is green, earth is flat - aren't
| valid.
| ben_w wrote:
| If any vote results in voters regretting their vote, I
| think that counts as voters being deceived.
|
| I don't know (or care, given I left the UK as a direct
| result of the vote) if there was any significant regret
| in this case.
|
| (I caveat "significant" because 5-10% of the population
| will agree with almost any proposition in any opinion
| poll, no matter how nonsensical the question).
| treeman79 wrote:
| Or maybe a water main breaks during vote counting and
| everyone is sent home. Except one party that keeps working.
| But of course nothing suspicious about that.
| dkarl wrote:
| > Democracy turned out to be easily manipulatable with large
| sums of money and media control.
|
| Is it, though? Establishment interests spend huge sums of
| money and often lose. The Republican party was an elite
| country club party, but when evangelicals emerged as a
| political force, the party had to jump on that wave, no
| matter how distasteful the old party elites found it. Then
| Trump came along, giving blatantly shallow lip service to
| religion, and now the party is beholden to him. That wasn't
| in anybody's plan except Trump's, and his personal wealth was
| paltry next to the Republican Party's resources.
|
| But maybe the elites who do the manipulation are happy to
| pander on a few issues if they get what they want on the
| issues that are really important to them. Let's think about
| that. If there was one core tenet of the GHWB-era Republican
| Party that its elites would have wanted to protect above all
| else, what would it be? If there was one core tenet that
| united _all_ American economic elites, one thing above all
| others that they would want to instill in voters ' heads,
| wouldn't it be economical liberalism? More specifically, free
| trade? Well, they've failed at that. NAFTA was a banner
| achievement for the Republicans. Now Trump calls NAFTA a
| Clinton disaster and promotes trade war with China, and he
| runs the Republican Party, because it does matter what the
| voters want, and you can't outright buy their belief in
| anything.
|
| We blame voters for being bought and manipulated when someone
| speaks to them in a way they find compelling but "shouldn't"
| according to our worldview. We assume that the superiority of
| our worldview gives us a natural advantage, and we look for
| special reasons why our views don't prevail. "What's the
| matter with Kansas?" in other words. What's the matter is
| that Trump's voters really do care more about Trump licking
| their wounded egos more than they care about anything else.
| ben_w wrote:
| Wrong country. Despite the joke, the UK isn't an American
| state.
| dkarl wrote:
| Do you think it doesn't apply to the UK? I drew on a US
| example because it was something I could explain in
| enough detail. Maybe UK economic elites have mastered
| control of their voters in a way that US elites have not.
| Although, you'll have to explain which economic elites in
| the UK decided that Brexit would be to their advantage
| and how they stole a march on the UK finance industry.
| pjc50 wrote:
| > Although, you'll have to explain which economic elites
| in the UK decided that Brexit would be to their advantage
|
| The press.
|
| For a time, Johnson himself was both a minister and a
| "journalist" for the Times. He was paid more for writing
| one article a week than for being a minister. Eventually
| he was forced to give this up. But Brexit is to a great
| extent a media project, backed by sensational but
| misleading claims, and supported by the media/politics
| revolving door.
|
| The Sarah Vine/Michael Gove couple had quite an effect
| too.
| dkarl wrote:
| If that's the best answer, I think it tends to show that
| money didn't buy Brexit. The media doesn't care what
| circus they're covering, as long as there are plenty of
| clowns and dancing bears. The people who had the money
| and motivation to buy public opinion on the issue lost
| out, and it all happened because some politicians found a
| message that resonated with voters and kept on it as long
| as it kept working.
| Apocryphon wrote:
| Sounds like an explanation Adam Curtis would approve of.
| I wonder if he's made a film that's explored this in full
| yet? I know he's certainly mentioned Brexit.
| ben_w wrote:
| The UK "establishment" is approximately Oxbridge, the
| Conservative party, the Queen, and the Church of England.
| These groups are not quite the same thing as economic
| elites.
|
| The UK also has much stronger spending (and content)
| limits on electoral campaigns compared to the US.
| funnybeam wrote:
| No they didn't.
|
| More people voted against the conservatives than voted for
| them, but due to the first past the post system they got a
| massive majority in Parliament and can do whatever they want.
| plantain wrote:
| But they voted for first past the post!!
|
| In my opinion that was the defining moment that cemented the
| UK's decline.
|
| https://en.wikipedia.org/wiki/2011_United_Kingdom_Alternativ.
| ..
| rjsw wrote:
| I voted against an Alternative Vote, I do support
| Proportional Representation.
| pjc50 wrote:
| Well then we got neither. That was a once in a generation
| vote, holding out for a better option was a very bad
| idea.
| rsynnott wrote:
| Watching from next door (we've had STV PR in Ireland
| since independence), I never got this. PR _wasn't on
| offer_. Unless you actually preferred first past the post
| to AV (PR > FPTP > AV seems like a weird preference
| ranking, but I suppose it might be _someone's_), why on
| earth didn't you vote for AV?
| LatteLazy wrote:
| Welcome to England where people prefer Bojo to Kier
| because Kier isn't left wing enough...
| rjsw wrote:
| I live in a safe seat but feel that if I lived elsewhere
| then I could get the same effect as AV by just voting
| tactically.
| rsynnott wrote:
| You might very well _feel_ that, but unless everyone
| votes tactically (which would require coordination), it's
| not really true.
| simonswords82 wrote:
| Cthulhu_ wrote:
| This would only be true if democracy was fair, but it isn't.
| dontlaugh wrote:
| It's not just first past the post, but with capitalists
| controlling all media (even the BBC, which is mostly led by
| Tories).
|
| This is not what the majority voted for.
| grnmamba wrote:
| Yep it's the people's own fault that they died while waiting in
| the emergency room. The politicians are sacrosanct and must not
| be criticized under any circumstances. So, you see, all these
| excess deaths are really suicides.
| spywaregorilla wrote:
| I don't have time to go in depth on this but I'm a bit skeptical
| of the claims here
|
| After adjusting for age, the english excess death rate is 5%
| above. It is the highest. But it also just came from being the
| lowest several months ago. How much natural variance is in this
| data. Is this moment noteworthy? Is it possible we're not seeing
| more people die sooner but rather a large chunk of people putting
| off death a few months all kicking the bucket now for some
| reason?
|
| Twitter confuses me a bit but reading all the thread here seemed
| to hide some additional posts which were important. The rate of
| people going into the emergency room is normalish. The rate of
| people leaving it is slow but not clearly slower than normal.
| This does suggest the general problem is really that we don't
| know where to put all these incapable poor health old people.
|
| But... If we assume that people are leaving the system at the
| same rate as before (afaict no data here), and that the health
| system had large inflows of patients from covid earlier, it seems
| likely that this is just the system slowly returning to
| equilibrium and dealing with that excess bulge of patients who
| entered and are hard to get rid of. The problem is probably not
| that patient outflows have gotten worse. It's just that there are
| more patients in there now because there were a lot more new
| patients shortly before now.
|
| He's got one critical chart which shows that hospital occupancy %
| has been growing from 6% to 8% 2010-2020. It is now at 12%. But
| the data is missing for the pandemic period for some reason.
| So... that seems like an important bit. Is this problem
| correcting itself? Kind of depends on the rate of change we're
| seeing in this figure if the rest of the analysis is to be
| believed. But it's hidden and too short term to make a good
| forecast on just the recent months.
| pjc50 wrote:
| > This does suggest the general problem is really that we don't
| know where to put all these incapable poor health old people.
|
| This has been the case for years: there are plenty of people
| who should not be discharged home to fend entirely on their
| own, but there's no social care in place to look after them, so
| they aren't discharged. This is also technically the
| responsibility of the local council rather than central
| government.
|
| During the pandemic there was almost unlimited money available
| for Test and Trace, some for the entirely temporary
| "Nightingale" hospitals, .. and basically no effort to increase
| staffing levels or solve the social care issue.
| M2Ys4U wrote:
| >This has been the case for years: there are plenty of people
| who should not be discharged home to fend entirely on their
| own, but there's no social care in place to look after them,
| so they aren't discharged. This is also technically the
| responsibility of the local council rather than central
| government.
|
| Not to mention that local government had has its funding cut
| to the bone (and beyond, in many cases) over the last 12
| years of Conservative government.
| spywaregorilla wrote:
| But my point is that this seems to have been a gradually
| growing problem for some time, but the recent spike from
| covid is likely a temporary bump greatly exacerbating it.
| It'll drop down again. Then, gradually, climb back up to
| where it is now. If it reverts to the mean quickly, it still
| won't take that long to get to where it transiently is now
| based on a straight line trend so maybe it's just a point of
| pedantry.
|
| tl;dr at a glance it looks like lingering effects of covid
| have pushed the english health care system into a state a
| single digit number of years ahead of schedule. It will
| likely wear off, but getting back on track isn't much of a
| relief.
| ectopod wrote:
| When you have a system with no spare capacity a sudden
| spike in demand causes queue lengths to grow but _they
| never get shorter again_.
|
| That's the theory. In reality, the rising death rate will
| cause a drop in demand.
| spywaregorilla wrote:
| That could be true of some queueing systems, but its
| certainly not true of all queuing systems. It is
| certainly not true of this system because you cannot stay
| in the queue forever. Over the long term this will
| converge on a steady state determined by rate of arrival
| and rate of departure, treated or otherwise, and nothing
| else.
| pjc50 wrote:
| > It is certainly not true of this system because you
| cannot stay in the queue forever.
|
| This is true, and people can drop out of the queue by
| dying. The death rate will increase until the queue is
| balanced.
| xtracto wrote:
| Aaah, so this might only be a paid shill with a bait for the
| pro-privatization of healthcare looking to push for a for-
| profit health system.
| spywaregorilla wrote:
| Not at all. The data presented here is very informative and
| generally hits on a very important problem. I just disagree
| with the short term takeaways.
| simonswords82 wrote:
| Here's the thread roll out for those of you like me that find
| this hard to read:
| https://threadreaderapp.com/thread/1562004612172873728.html
| JustSomeNobody wrote:
| Sooo... are they trying to destroy HC so they can rebuild it as
| the monstrosity we have here in the USA?
| pid_0 wrote:
| badcppdev wrote:
| Yes there are significant and multiple areas where private
| healthcare companies are being paid to 'provide' services to
| the NHS in a classic outsourcing process similar to what you
| would see in IT.
|
| Private company charge a lot more, pay their staff a bit more
| to attract workers from the NHS, extend their contracts to
| provide more services where there are NHS staff shortages.
| Taxpayer money turns into company profits. I wouldn't object if
| it provided more efficient care but it doesn't seem to.
| DanBC wrote:
| It's a bit complicated. Private providers can have different
| staff mixes, so you might have more healthcare assistants and
| fewer nurses. You might have more unregistered nurses and
| fewer registered nurses. You might find more staff are on
| zero-hour contracts, or things like "hotel services" (food,
| cleaning) are contracted out to companies that are low pay
| poor condition companies.
| pkaye wrote:
| Don't most countries in the EU have a mix of public and
| private health care providers? How do they manage it?
| cpr wrote:
| swores wrote:
| Not much groupthink needed to downvote somebody who feels a
| single short sentence, with no citations or.. anything really,
| yet one that goes against current mainstream medical and
| scientific opinions, is worth writing.
|
| If you actually wanted to try to convince anyone that you might
| be even somewhere in the vicinity of having a point, you've
| given up before even trying and opted for pre-complaining about
| downvotes (something which, on HN, almost guarantees you
| downvotes even if you're saying something people agree with,
| btw) rather than suggesting a single piece of data that would
| lead to any reasonable person thinking "hmm, yeah maybe worth
| investigating further this theory that vaccines are the cause
| of UK's current high excess mortality rates".
|
| But I suspect you didn't have much choice, if there actually
| were a compelling argument to make in support of your claim
| then, well, you'd be making it.
| cpr wrote:
| You're right in that I'm being lazy and shouldn't have
| commented without backup data. There's plenty of data out
| there, but why try to collect if the HN readership's thinking
| is so mainstream that they'll reject any such attempts out of
| hand?
| bananapear wrote:
| But what has caused the collapse of emergency healthcare in the
| UK? A lack of supply or an increase in demand?
| iam-TJ wrote:
| Increase in demand - much of which is attributed (by the NHS
| itself) for people having poor life-styles (meaning tending to
| obesity [0] and not maintaining physical and mental fitness),
| and the tendency for people to be kept alive longer existing
| with chronic conditions that a few decades ago would have
| naturally expired (dead!).
|
| There's been an endemic problem for the last 30+ years where-by
| a large proportion of the population has a sense of entitlement
| to NHS care without at the same time bearing responsibility to
| keep themselves reasonably fit and healthy.
|
| @ [0]: "Nearly two-thirds of adults in England are overweight
| or obese. In 2016/17, 617,000 admissions to NHS hospitals
| recorded obesity as a primary or secondary diagnosis"
|
| [0] https://www.longtermplan.nhs.uk/online-
| version/chapter-2-mor...
| cjrp wrote:
| 617k is roughly 11% of admissions for that year. That alone
| doesn't explain the situation.
| nosianu wrote:
| > _Nearly two-thirds of adults in England are overweight or
| obese._
|
| That means the issue is systemic and one needs to look at
| things outside of individual control. Yes, often systemic
| issue can be overcome by individuals - by the top quartile
| kind of individuals with more luck, better genes, better
| education (including what they picked up at home while
| growing up), more money, more suitable lives than the
| majority, or with outliers in levels of personal discipline.
| But systems should work for the people that actually live, if
| you need to blame two thirds of the population(!) it's most
| likely your system that is wrong.
|
| Yes you can look at most of the individuals that are part of
| those two thirds and find what _seems_ to be personal choices
| - but you miss the environment and the pressures from it that
| lead people into making those choices.
|
| For example, that a lot fewer people know how to cook today
| than several decades ago (example link:
| https://www.bonappetit.com/entertaining-style/trends-
| news/ar...), do yo want to blame each individual? To me this
| very much looks like a bigger societal issue. It's not like
| people make such choices after careful consideration, it
| "just happens" and they "slip" into those behaviors without
| much deliberation, based on their living situations.
| AuryGlenz wrote:
| You can both blame people and society. Modern living makes
| it easy to be fat, but plenty of us don't succumb to the
| temptation of easy meals and overeating.
|
| I'm not sure how you'd even change modern life to get
| around this, save maybe for incredibly large sin taxes on
| everything from soda to every restaurant. I'm sure we'll
| just end up with a pill sometime soon. Semaglutide comes
| close.
| AuryGlenz wrote:
| Meanwhile in the US there's been a push to limit the copays
| for insulin, pushing the cost of all of those almost entirely
| preventable type 2 diabetics on to everyone else.
| the_why_of_y wrote:
| This would only be a problem due to how incredibly,
| absurdly expensive insulin is in the USA.
|
| https://www.bbc.com/news/world-us-canada-47491964
| [deleted]
| badcppdev wrote:
| The UK has an ageing population. A higher percentage of older
| people and fewer younger people. Saying that those old people
| should have died earlier would be disgusting so I'm sure
| that's not what you meant.
|
| So to be clear there's an increase in demand because British
| people are living longer. That's a good thing and should
| result in increased funding.
| iam-TJ wrote:
| It's exactly what I mean. There is absolutely no value in
| hanging on to the last possible moment due to ever
| increasing levels of interventions.
|
| Living longer is not "a good thing" if that life is costing
| (not just in financial terms) society and the country so
| much more and the person can not sustain an independent
| quality of life.
|
| In 1946-47, when the NHS, National Insurance (state
| pensions), and related programmes were created the average
| survival after retirement (60 for women, 65 for men) was 10
| years or so (average mortality was 75 for men and little
| later for women).
|
| So pension funding only needed to last on average 10 years
| and there was no comprehensive costly life-sustaining
| interventions to keep people alive that would otherwise
| have popped their clogs.
|
| Now the average age of mortality in men is 85 and 89 for
| women, and these are rising. And as these are averages
| there are a lot of people lasting a lot longer - many spend
| years sitting in a chair effectively waiting for Death to
| show up.
|
| So now the same pension funding has to provide for 20 or
| more years AND there are many costly and life-sustaining
| health interventions and "social care" that add cost and
| load on a dwindling number of tax payers.
|
| I'm a farm-boy born n bred, as is my father, who is now 86.
| He's been amazingly fit his entire life but the last two
| years he's going rapidly downhill due to onset of mild
| dementia, but also due to not accepting doctors advice on
| treatments and medicines (this he's been doing for 40
| years!) and subsequently hitting crisis where there have to
| be expensive emergency interventions.
|
| As far as I am concerned he is abusing the NHS - like those
| who are obese or mistreating themselves in other ways - and
| if it were up to me I'd refuse to treat his emergencies if
| he is not prepared to look after himself by simply taking
| medicines that would prevent the emergencies.
|
| Personally, I'll kill myself when I can no longer be
| useful.
|
| Humans need to learn from how the rest of the planet's
| breathing life-forms treat life... and death, and lose the
| sentimentality. The planet already has twice as many humans
| on it as it can naturally sustain.
| DanBC wrote:
| It's complicated.
|
| In England social care (care homes) are funded by local
| authorities, not the NHS, and are overwhelmingly provided by
| private providers. We've had decades of under-funding of local
| authorities, and the Conservative government has made it very
| difficult for LAs to raise funds via taxation.
|
| So, during a time where we have an ageing population we do not
| have nearly enough beds for these people to be cared for.
|
| When people go into hospital, either as a planned (elective)
| admission or as an emergency, and they get treatment, and
| they're ready to leave hospital they have to have somewhere to
| go to. Lots of people will go back to their own home, but some
| people will be unable to do this because it's not safe to do
| so. These people need a care or nursing home. Because there
| aren't any available beds, and because there aren't any
| available suitable home care packages, these people stay in
| hospital on the wards.
|
| Those beds are now not available to be used.
|
| So, now you have a problem of flow of patients through
| hospitals. You can't discharge patients from the ward, which
| means that ward can't now accept patients from elsewhere
| (surgery, ED) in the hospital. This means that elective care
| reduces, and emergency care slows down. People wait in Ed for
| very long times. And because ED is full people can't get in to
| ED, so ambos queue outside ED for hours. This means many ambos
| are queued outside ED waiting to transfer a patient, and not
| available to travel to people. So now people in life-
| threatening emergency or with _severe_ injury are waiting far
| too long for an ambo.
|
| Fixing care homes and nursing homes would do a lot to fix
| patient flow, but it's not going to happen because we have a
| government that hates the NHS and hates LAs and hates taxation.
|
| On top of all of this we have an incoherent approach to
| staffing. The English NHS is full of staff who've come to
| England to work. We _need_ these people - they improve the
| quality of care and they increase the amount of care we can
| deliver. We should be making it easier for people to come here,
| but we don 't, we put up a load of weird bureaucratic blocks.
| (Because we have a government that hates immigration.)
|
| We need to train very many more staff (there is something like
| 100,000 staff shortage, at least 10,000 doctors and 50,000
| nurses) but we've made it more expensive to train to become a
| nurse, or a doctor; we've cut pay for all staff (for junior
| doctors to achieve pay restoration they'd need something like a
| 25%-30% pay increase).
|
| We need to retain the staff we already have, but there are a
| range of things that make working for an English NHS trust
| pretty terrible. It's not just pay, but poor pay doesn't help.
| There's a weird thing around pensions that means many doctors
| can either retire early or face a _massive_ increase in their
| taxes. Lots of staff have trouble getting paid on time when
| they start work at a new organisation. People have to pay for
| car parking, and they 're fined if they overstay even if that
| overstay was caused by saving the life of a very ill patient.
| (These can be over-turned but why should it happen at all?).
| Rest areas are generally _awful_ and expensive. Hot food is
| generally not available 24 hours a day. Rotas are chaotic.
| Doctors can apply for leave a year in advance and then have
| that denied with very short notice. Some NHS trusts have toxic
| work cultures and problems with racism, sexism, and bullying.
| And these are just the things I can remember, the real list is
| very much longer.
|
| About demand: there has been an increase in demand for
| healthcare. GPs are seeing more people than they were before
| pandemic, but there's a perception that it's quite hard to see
| a GP. (I don't have much trouble, but I have cancer and my GP
| is pretty good, but I recognise other people have difficulty
| with weird access restrictions). This trickles through to ED -
| a few people turn up to ED needlessly. Before pandemic we had
| clear evidence that it wasn't really enough to make much
| difference to the overall ED demand. The picture is less clear
| during pandemic - certainly people going to GP not ED if they
| need GP is a good thing because they get better care, but it's
| hard to know if it's making the ED problem much worse.
| rich_sasha wrote:
| NHS has been underfunded for years. These issues are, in a way,
| not new. But it just kept getting worse and worse, COVID added
| burnout and a huge backlog of treatments and missed diagnoses.
|
| It probably doesn't help that a lot of the medical staff were
| from the EU and just before COVID were PTFO.
|
| I'm still waiting for those hospitals to be built by all the
| money saved by Brexit.
| missedthecue wrote:
| How do you know the problem is in fact underfunding? The UK
| seems to spend as much on healthcare as many other first
| world countries, but with worse results.
| willyt wrote:
| Lack of qualified staff willing to work at the current pay
| rates. There are shortages in plenty of sectors at the moment
| so medical personnel who have had enough are leaving or
| retiring early and they can't be replaced because pay rises are
| not keeping up with inflation. I'm going to look for my source
| just now but I read that there are 100,000 vacancies in the
| care professions currently. Postal workers, train drivers, bus
| drivers, dockers and barristers(!) are all planning to strike
| in the next month or two because of inflation effectively
| causing large pay cuts.
| badcppdev wrote:
| The British Medical Association quotes a shortage of 50,000
| doctors: https://www.bma.org.uk/bma-media-centre/nhs-short-
| of-50-000-...
|
| There's an amazing chart here: https://www.bma.org.uk/advice-
| and-support/nhs-delivery-and-w... which shows the "Practising
| doctors per 1,000 inhabitants: England, UK and OECD EU
| nations". The UK is 16th out of 19.
| tailspin2019 wrote:
| The first one, and now the second one on top.
| ben_w wrote:
| Both. Demand has increased faster than expected because of
| covid, and supply has been hampered by covid, but even in the
| counterfactual world that has not faced this pandemic the UK
| has not funded enough nursing places to meet the previously
| forecast demand (the ageing population told us demand was going
| to go up, but the government cut funding in 2017 that reduced
| nursing degree applications in England and Wales by 23%), and
| Brexit reduced the number of nurse applications from the EU.
| dominotw wrote:
| Its always the same answer. People stuffing their faces with
| garbage food and chilling on the couch all day. Apparently
| there was an explosion of obesity in UK during covid. These
| people clog up all the available supply leaving very little for
| the rest. Its the same story everywhere. Ppl whine about
| funding, shortages ect but no one cares about if we can do
| something about the demand.
|
| Govt pushed covid vaccine on young healthy people saying its
| good for the community if we all get it and its our duty to
| society. So why isn't getting off the couch and going for a
| walk considered duty to society.
| hadrien01 wrote:
| They did: https://www.nhs.uk/live-well/exercise/running-and-
| aerobic-ex...
| dominotw wrote:
| lol. i don't see how this being marketed as duty to society
| like covid vaccine. No denunciation or shaming of
| voluntarily obese as a strain on society. No "COVID is a
| disease of unvaccinated" by the presidents.
| pjc50 wrote:
| The effects of obesity are _wildly_ overstated, not to
| mention how many medical conditions it 's irrelevant for.
| Especially in accident&emergency.
| dominotw wrote:
| > The effects of obesity are wildly overstated
|
| 90% of health care costs are attributable to chronic
| disease in usa per cdc. [1]
|
| Americans with five or more chronic conditions make up 12
| percent of the population but account for 41 percent of
| total health care spending.
|
| Hypertension, high cholesterol, diabetes are top chronic
| conditions. Course of treatment for all those is "lifestyle
| changes" ( along with meds for managment). [2]
|
| 1. https://www.cdc.gov/chronicdisease/about/costs/index.htm
|
| 2. https://www.rand.org/content/dam/rand/pubs/tools/TL200/T
| L221...
| WhyIsItGlowing wrote:
| There's a big problem where social care got moved from the
| department of health to local government a few years ago.
|
| Then, shortly after, the government cut local government
| funding massively. It used to be funded by a mix of local taxes
| and funding from central government that was about 50/50. This
| was part of a strategy to insulate richer areas from the impact
| of cuts, while poorer ones (which relied more on central
| funding) took the hit.
|
| This means there's a huge problem with elderly patients who
| need to be discharged into social care not having the support
| they would need to go home or a spot in an old people's home to
| go into.
|
| Which, combined with covid still being around and the fact that
| even before covid government obsession with efficiency meant
| that there were a relatively low number of beds which already
| had a high occupancy rate.
|
| So there was no spare supply to begin with, increasing demand
| due to a growing and aging population and covid, and lots of
| people who are stuck in hospital because they need support to
| leave which doesn't exist.
| vfclists wrote:
| Someone should ask the guy to publish on a blog and link his
| twitter to it.
| nindalf wrote:
| Blogs don't make sense for the most prolific creators. Here's
| something I saw recently
|
| > I gave up blogging after decades because the ROI simply
| wasn't there any more. Why spend hours on a post that will get
| hundreds of views when a tweet composed in minutes gets tens of
| thousands to millions?
|
| https://twitter.com/carnage4life/status/1559852146601799683
|
| And it's the same with Scott Hanselman, who's quoted in that
| tweet. Hasn't blogged since last year, stopped after 20 years.
| He's big on YouTube and Tiktok now.
| vfclists wrote:
| If you are serious about communicating then you MUST blog in
| addition to tweet. Twitter is for soundbites, not lengthy
| articles. You can't expect people to read tweet after tweet
| when they would rather read a long continuous article.
|
| The dude probably has the software that breaks down lengthy
| articles and tweets them in reverse order but that shouldn't
| be abused.
|
| And what happens when you fall foul of twitter's rules and
| get banned?
| robotnikman wrote:
| Not sure why you were downvoted, as those are valid points.
| Twitter is the best medium when it comes to talking about
| subjects in depth. It is good when it comes to making a
| quick hot take, but not in depth articles or explanations.
|
| Unfortunately, a lot of people don't engage much in long
| form discussion as much as they would a tweet. Tweets are
| much easier to discover, find, and view compared to a blog
| post. It's much easier to click like on a tweet or retweet
| something, and bigger engagement numbers == better. So
| people instead will write out tweets instead of blog posts.
| I don't care for it much myself, but such is the modern
| internet I guess.
| skeeter2020 wrote:
| Scott Hanselman states he stopped because he was tired, not
| that he's switched mediums. The Tiktok / YT comment was a
| joke; he still does lots of media for his job though.
| boffinism wrote:
| Sure, here you go: https://www.ft.com/john-burn-murdoch
| pacifika wrote:
| It's an article on the Financial Times
| drumhead wrote:
| Emergency care hasn't "collapsed". It's under strain from a
| backlog cases unseen during the pandemic. But collapsed? No.
| DanBC wrote:
| What would collapse look like?
|
| If people are queueing in an ambo for 12 hours why isn't that a
| sign of collapse?
|
| If people are dying of stroke or heart attack at greater rates,
| because they can't get ED care, why isn't that a sign of
| collapse?
| DanBC wrote:
| So, for example: https://twitter.com/mattdiscombe/status/1562
| 108007407919104?...
|
| > Almost 333,000 hours were lost by ambulance crews because
| of handover delays in the 12 months to July 2022 - 18 TIMES
| higher than the 17,600 hours lost during the same period in
| 2019 to 2020.
|
| What's this if it's not collapse?
| cas14655 wrote:
| johnday wrote:
| What exactly is the point you are trying to make?
|
| Yes, under a pro-spending, forward-looking government (such as
| the one we had from roughly 1997 to 2010), staffed public
| services improved and a trajectory was laid down for future
| improvements.
|
| Under pro-austerity, myopic governments (such as the one we had
| from 2010 until now), public services have been rotting from
| the inside.
|
| It's not difficult to draw a straight line from one to the
| other. Pouring money into "diversity" is certainly nothing to
| do with it, and that goes double for our current reigning
| party.
|
| For what it's worth, it's a testament to the overall resilience
| of the NHS as a service that it has broadly managed to weather
| the storm of long-term underfunding and is likely going to
| continue on track until a forward-looking government is able to
| come back and breathe life back into it again. Roll on 2024.
| CamperBob2 wrote:
| Conservatives: "Government doesn't work. Elect us and we'll
| prove it."
| nobodyandproud wrote:
| Compared to the cesspool that is the US system? The NHS was
| amazing.
|
| We don't talk about it, but people still die for non-COVID
| emergencies because hospitals in the Us are routinely full in
| 2022.
|
| Privatization of hospital systems in the US have lead to very
| warped incentives, where C sections are the norm because it's
| faster and more money for the hospital and Drs.
| pookha wrote:
| Here in the US I had stage III cancer. I was receiving full
| blown cancer treatment(s) less than a week after I went to
| the ER with symptoms (chest port + three types of chemo
| drugs). And that's routine. The US health care failures are
| mostly the fault of administrators and insurance companies
| gaming the public. The care is fast + extensive and it's not
| a cesspool.
|
| And the "full hospital" meme isn't entirely accurate. The US
| hospital wards are -- by design -- supposed to be full. If
| 100 beds are allocated for severe flu cases (example) but
| there's only 25 patients they'll shift the flu ward to 35.
| Thus they achieve a 75% capacity for the flu beds and
| allocate the additional beds to other sections. Sometimes the
| American media (sensationalist by design) will report this as
| "OH MY GOD THE FLU WARD IS NEAR CAPACITY. 75% FULL!!" without
| reporting total beds vs flu beds.
| selectodude wrote:
| It's laughable to call the US healthcare system bad, but I
| feel like that sort of treatment should be commonplace and
| universal for what we pay here. The UK has spent about 10
| percent of GDP over the last ten years. The US spends 20
| percent. It's going somewhere, but I don't think it's going
| towards care at quite the same rate as over healthcare
| systems. Even 15 percent of US GDP would be $3 trillion, or
| more than the entirety of UK _total_ GDP.
| erichocean wrote:
| > _Even 15 percent of US GDP would be $3 trillion, or
| more than the entirety of UK total GDP._
|
| It's almost like the two countries might not be
| meaningfully comparable.
| pkaye wrote:
| Its 16.77% of GDP for the US currently. Germany is at
| 11.70%. I think Germany is probably the most reasonably
| run health care system to compare against since Germany
| doesn't have the collapse of healthcare issues of UK or
| Canada we keep hearing about.
|
| https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?mo
| st_...
| MisterBastahrd wrote:
| While it's nice that you were able to get quick treatment,
| there are tons of people who never receive any or adequate
| treatment because they are absolutely terrified of what the
| cost will mean for themselves and their families.
|
| Hospital capacity depends on the number of staff capable of
| supporting it. You could have a room with a thousand beds,
| but if you've got two nurses, your capacity is a tiny
| fraction of that.
| adventured wrote:
| > Privatization of hospital systems in the US have lead to
| very warped incentives, where C sections are the norm because
| it's faster and more money for the hospital and Drs.
|
| The US rate of c-sections was 32% in 2017 (and roughly the
| same for 2020), the same as Switzerland. It's 27.7% in
| Canada, 33.7% in Australia and 27.4% in the UK.
|
| 28% across the OECD, 30% in Germany, 45% in South Korea, 34%
| in Italy.
|
| So much for that.
|
| https://www.oecd-
| ilibrary.org/sites/fa1f7281-en/index.html?i...
| nobodyandproud wrote:
| Your own source disagrees.
|
| Per your own link: " Variations in caesarean section rates
| across countries have been attributed to a number of
| factors, including financial incentives, malpractice
| liability concerns, differences in the availability and
| training of midwives and nurses, and the proportion of
| women who access private maternity care. For example, there
| is evidence that private hospitals tend to perform more
| caesarean sections than public hospitals. In Switzerland,
| caesarean sections were found to be substantially higher in
| private clinics (41%) than in public hospitals (30.5%)
| (OFSP, 2013[1])."
|
| Privatization correlates to more C-Sections.
| oliwarner wrote:
| This isn't a collapse of emergency healthcare, it's a very
| predicted collapse of community social care: hospitals can't
| discharge if they need a care home place that doesn't exist.
|
| Without inpatient bed availability, ERs and AMUs can't admit to
| specialties and everything gums up at the front door.
|
| Let's be clear: we do need many more doctors and nurses, but the
| existing ones can't do their jobs because their wards have turned
| into medically-fit nursing homes. They spend half their days
| trying to send people (who don't have care requirements) home
| faster than they'd like.
|
| Why? Because central government withdrew funding. Social care is
| now on the council to fund and many councils have squashed social
| care, along with libraries and early years provisions. The trap
| of outsourcing caught many councils out.
|
| Turns out the whole endeavour was yet more myopic, Tory penny-
| pinching.
| cjrp wrote:
| > libraries and early years provisions
|
| Seen exactly this in my local area. Libraries closing or
| cutting hours/resources. The number of children's centres
| (where you go for check-ups/weigh-ins of young kids, to get
| feeding advice, etc.) reduced by 80+% in some counties. It's
| dire.
|
| Some relevant graphs here:
| https://www.instituteforgovernment.org.uk/explainers/local-g...
| usrusrusrusr wrote:
| >Social care is now on the council to fund and many councils
| have squashed social care, along with libraries and early years
| provisions. The trap of outsourcing caught many councils out.
|
| It could be phrased as - social care was a way to paper over
| cultural and societal cracks, by paying peanuts to people with
| limited job choices.
|
| As in most things, our response to Covid has just exposed the
| endgame much quicker than expected.
| prof-dr-ir wrote:
| This certainly makes a lot of sense, and although I am happy to
| believe you I am having a hard time convincing my grandma that
| you are right.
|
| Do you maybe have a source for your claims that would convince
| her? A simple news article from a reputable source would
| probably suffice.
| xtracto wrote:
| It is too bad that corrupt government officials keep
| systemically defunding Social Health programs with the
| objective of pushing private for-profit healthcare (which just
| doesn't make sense). Then they point to the deficient
| healthcare and blame the "socialized" aspect of it for the
| issues.
|
| Here in Mexico we've seen it all play out: We had an amazing
| social healthcare system (in the form of the IMSS) in the 70s
| and 80s. But the corrupt government officials kept dismantling
| it and allowing corruption to run rampant within the system.
| All to get a piece of the private for-profit health system
| including Health Insurance.
|
| Back in 2004 when I lived in the UK, the NHS was really good.
| And I remember hearing at that time that it was nothing
| compared to the NHS in the 80s and 90s. I seriously hope it
| doesn't have the same outcome as our system had in Mexico. For-
| profit health is inhumane.
| oliwarner wrote:
| 2004 was the peak of Blair-Brown Labour party investment.
|
| They didn't get it all right. They used PFI and outsourcing
| to fudge the sums on major investments, and I dare say they
| didn't invest in mental and social health care in the amount
| required. But nobody ever has.
|
| The job of fixing this is _so_ expensive and requires so much
| political force. We 're still worried French immigrants are
| going to eat our dingos, or something. I'm fairly certain now
| we're destined to limp into an American insurance model; eat
| the poor.
| [deleted]
| jfk13 wrote:
| > Back in 2004 when I lived in the UK, the NHS was really
| good. And I remember hearing at that time that it was nothing
| compared to the NHS in the 80s and 90s.
|
| That sounds like some seriously rose-tinted nostalgia to me.
| Yes, the NHS certainly has its problems. But within the past
| decade, my wife has been through several fairly major health
| issues, including cancer, and our overall experience of UK
| healthcare has been quite positive.
|
| She is from the US (and had "good" insurance there), but
| feels that the UK system has served her far better than the
| American ever did.
| ChuckNorris89 wrote:
| _> with the objective of pushing private for-profit
| healthcare (which just doesn't make sense)_
|
| Maybe it doesn't make sense for you, but it makes their
| buddies in the private sector a lot of money. And that's the
| game in capitalism, making a lot of money.
|
| The government competing with affordable options for everyone
| against the private sector is "bad for business".
| cjbgkagh wrote:
| Let's not pretend corruption is unique to capitalism.
| ChuckNorris89 wrote:
| That's not what I said.
| WalterBright wrote:
| The game in socialism is also making a lot of money.
| Jensson wrote:
| Problem: Politicians are corrupt!
|
| Solution: Give more power to politicians! Lack of power
| corrupts, need to give them more until they stop being
| corrupt!
|
| Not sure why anyone thinks that would work.
| asdff wrote:
| I really don't understand how people can simultaneously
| believe that governments are corrupt and the private
| sector would support the public's interests. Guess who is
| corrupting government: the private sector who only
| support their own interests.
| WalterBright wrote:
| I know this is difficult to understand how it works, but
| the beauty of the free market is everyone benefits while
| selfishly working for their own self-interest.
|
| Socialism, however, requires altruistic behavior, and
| very few people are consistently altruistic and self-
| sacrificing for the common good.
| asdff wrote:
| How can people benefit when in the free market system
| consumers are seen as a resource to be exploited?
| WalterBright wrote:
| Because the seller, in a free market, has to please is
| customer. The way to please the customer is to have the
| customer benefit from the transaction.
|
| For example, how long do you think McDonald's would last
| if its McBurgers tasted bad? McDonald's success is
| extremely tied to customer satisfaction.
|
| Tossing the ball back to you, under socialism, why would
| the socialist service care if you're pleased with the
| service or not?
| asdff wrote:
| Because a socialist system is ran by the public. It is
| beholden to the public as its shareholders. Mcdonalds
| needs to taste tasty, but only to get you hooked enough
| to choose mcdonalds over other foods. You think the
| shareholders would rather their customers actually eat
| healthy which means limiting consumption of Mcdonalds?
| No, they are practically in the business of selling
| cigarettes but in the form of fats and sugars. They want
| you addicted. The goal of the capitalist isn't to make
| their customer happy, its to extract as much of their
| available disposable income as possible.
| WalterBright wrote:
| > It is beholden to the public as its shareholders.
|
| Every country that tried having the government run food
| production produced starvation.
|
| Every one.
|
| > The goal of the capitalist isn't to make their customer
| happy, its to extract as much of their available
| disposable income as possible.
|
| True, but the way to get that money is to please the
| customer, because the company cannot force them to buy.
| kingkawn wrote:
| Too much koolaid
| pessimizer wrote:
| > I know this is difficult to understand how it works
|
| Are we going to pretend that free market capitalism and
| its magical benefits haven't been pounded into all of our
| heads from every angle from the moment we were being
| taught anything about how the world works? It's not
| difficult to understand, it's difficult to _see_ in a
| world where companies commit crimes and collapse in
| mountains of debt, but no one goes to jail. Not a
| situation that Adam Smith would approve of.
|
| The reason the benefits capitalism are spread out to any
| degree is because there are riots when they aren't, so
| you need to at least reward the people responsible for
| putting those riots down through violence, technology,
| and bureaucracy. Hence, the middle class.
|
| > Socialism, however, requires altruistic behavior, and
| very few people are consistently altruistic and self-
| sacrificing for the common good.
|
| "Socialism" requires cooperation, and people do it just
| fine. Even capitalists are socialist amongst themselves
| when it comes to keeping out competition.
| Jensson wrote:
| The politicians you vote for can regulate those
| companies, that is how the system is intended to work. If
| those politicians takes bribes to not regulate those
| companies, then the problem is corrupt politicians taking
| bribes, you don't fix that by giving those politicians
| more power you fix it by voting them out and voting in
| politicians who does what you want.
|
| > Guess who is corrupting government
|
| How are they corrupting the government? Is the private
| sector deciding who gets power in the government somehow?
| Sounds like your democracy doesn't work then. Giving all
| the power to politicians when the democracy doesn't work
| just leads to the same scenario as in Soviet.
|
| Bribing the government isn't "corrupting" them, a
| politician who accepts bribes or tit for tat deals is
| already corrupt.
| pydry wrote:
| Because politicians are accountable to voters and unless
| the monopolies are nationalized the monopolies are
| accountable to no one.
| WalterBright wrote:
| > politicians are accountable to voters
|
| And then what happens to minority interests?
|
| How about we have a national vote on what phone you get?
| Which car you get? Whether carrots or tomatoes get
| produced? What movies get produced? What clothes are
| produced? Which diseases get funding? What apartment you
| get? How many ounces of meat you get per week? What music
| you get to listen to?
|
| What could go wrong with that?
| imtringued wrote:
| Just do Sortition, give more power to a representative
| sample of the population.
| isk517 wrote:
| The game of any ecological/political system is to acquire
| power, the exact system is merely the set of rules you
| play by to get it.
| imtringued wrote:
| The Soviet Union seems to have failed that game by
| collapsing through external debt.
| MichaelCollins wrote:
| The Soviet Union accrued massive debt due to internal
| production inefficiencies caused by corruption and
| mismanagement. Russia has extraordinary natural
| resources, by all rights they should be one of the most
| wealthy countries on earth.
| WalterBright wrote:
| The same goes for South America. Yet they remain mired in
| poverty thanks to their predilection for socialism.
| trs8080 wrote:
| Actually they remain mired in poverty largely because the
| US keeps meddling in their affairs: https://en.wikipedia.
| org/wiki/United_States_involvement_in_r...
|
| So it's more like "they remain mired in poverty because
| of the United States' predilection for predatory
| capitalism."
| 6t6t6t6 wrote:
| Exactly. They should know better and vote for governments
| that are aligned with the US government's interests, so
| they don't need to go through a CIA-sponsored coup.
|
| https://en.wikipedia.org/wiki/Operation_Condor
| groby_b wrote:
| The game has never been to make money for the country, or
| the government.
|
| And IIRC, a lot of people in power in the USSR made a lot
| of money out of the collapse of the USSR.
|
| Heck, there's some mid-level KGB dude who made $200
| billion off it.
| ericmay wrote:
| It definitely came across that way to me in your comment
| as well. You associated corruption with capitalism via
| "and that's the name of the game" as though the objective
| of capitalism is to destroy public institutions, when
| what's actually the case is that the objective of corrupt
| people is to destroy or co-opt public institutions for
| their own benefit. The economic system is largely
| immaterial in that effort. Actually, you could argue the
| opposite in that capitalism helps prop up public
| institutions versus other economic systems because there
| are minimum levels of regulation, rule of law, and
| security that are required for capitalistic economies
| (ranging from the US, to Sweden, to Singapore) to
| function and for capital owners to profit.
| xupybd wrote:
| You're correct that the game is to make a lot of money but
| the key to making that work is ensuring transactions are
| beneficial to all parties.
|
| It doesn't matter how you structure things you end up with
| some way to climb the hierarchy. The problem with pure
| communist systems is they try to prevent all hierarchies.
| Human nature attempts to circumvent this, the only way to
| do so is via corruption and political power. Corruption and
| political power exist in abundance in free markets as well,
| but there is another outlet for personal ambition. People
| can get rich. The hope is that you can build a system that
| incentivizes people to get rich by providing value for
| everyone. You can have private for-profit healthcare but
| you have to make sure that people get a good deal out of
| that. Normally we rely on competition to ensure customers
| always get a good deal. I don't think that works in this
| setting. Healthcare is tricky, I don't think we've found a
| good way to setup incentives for heath systems to have the
| best outcomes. We will need strong government regulation no
| matter what we do. Competition will not provide
| sufficiently good outcomes.
|
| In the US you have great hospitals but at astronomical
| costs, the entire system is distorted by insurance
| companies and massive bureaucracies. Here in NZ the
| hospitals are terrible underfunded socialist messes. We
| can't hold on to staff because we don't pay enough.
| Emergency waits are hours. My friends wife just spent 3
| days before getting emergency surgery to reattach nerves
| and tendons in her hand. She had to travel 3 hours to
| another city to get that care. The last two times I
| required emergency care the wait was over 8 hours. I can't
| pay for better service and there is no private emergency
| option.
| eikenberry wrote:
| When you put politicians in charge of healthcare they will
| play politics with it. Politicians playing politics doesn't
| make sense to you? Remember most don't really care that much
| about the healthcare itself, only how it can be used to
| further their agenda and be spun for their constituency. It's
| the tradeoff from private where the money rules.
| throwaway049 wrote:
| In 2004 when I worked in NHS emergency care we had such a
| problem with no space in ED to unload ambulances that the
| ambulance service threatened to put a mass casualty tent in
| the hospital car park.
| [deleted]
| WhyIsItGlowing wrote:
| > Back in 2004 when I lived in the UK, the NHS was really
| good. And I remember hearing at that time that it was nothing
| compared to the NHS in the 80s and 90s.
|
| In a lot of respects, this isn't very accurate. It got pretty
| bad in the early '90s, anything that needed to go beyond the
| GP had really bad wait times, people stuck on trolleys in
| A&E, etc. By 2004 it was much better, so that anything which
| required a hospital visit would be dealt with much more
| quickly and effectively but the GPs were coming under more
| pressure from a growing and aging population so the first
| point of contact had a less personal touch.
| buscoquadnary wrote:
| I have to wonder how much of the current "crises" we are
| seeing right now are simply because of a massive aging
| population. Of course the medical system is going to have
| issues, no matter if it is public or private, if you
| suddenly increase the demand, as the older you get the more
| health care you need, while at the same time all your most
| capable and experienced doctors are retiring.
|
| Another is housing, right now we have one generation coming
| up right as the most populous generation is towards the end
| of their life, resulting in an increased demand and price,
| in 20 years as more and more the later generations start
| passing on they'll be leaving behind houses and properties,
| it's not like those disappear when the people do.
|
| I've noticed that the media seems very engaged in making
| everything the crises of the moment and the focus on
| looking at things over the course of years or decades is
| often ignored in favor of sensationalism.
| vorpalhex wrote:
| It appears NHS funding has increased year over year:
| https://fullfact.org/health/spending-english-nhs/
| oliwarner wrote:
| Cash doesn't help bedflow if it's not going towards the
| places required for getting people out of hospital... which
| I've already said is now a local issue.
|
| Job deterioration, Brexit and the pension cap have all lead
| to an increase in more expensive locum cover. Few people want
| to be locked into a job where you have a daily meeting to be
| shouted at by your site team for not discharging people who
| have nowhere to go.
| Peanuts99 wrote:
| Still not in line with what is required. An aging population
| which is also living longer couple with poor staff retention
| and management has left it in a much worse state that 12
| years ago.
| Ferrotin wrote:
| It's almost as if centralized control of resources doesn't
| allocate them optimally.
| owisd wrote:
| Seems to work better in this case, as essentially the only
| buyer of pharmaceuticals in the country the NHS are in a
| better position to negotiate deals in bulk than if hospitals
| had to negotiate individually. The UK has higher life
| expectancy than the USA for 2.5x less per capita healthcare
| spending.
| oliwarner wrote:
| No, you've learned the wrong lesson.
|
| It's almost as if a locally allocated choice between
| collecting the bins and homing grandma will always go with
| what inconveniences voters least.
|
| Areas with poor, old populations can never pay their way. The
| excess gets dumped on the centrally funded NHS.
|
| It's a bad model that is a massive disservice to us all.
| lotsofpulp wrote:
| >Areas with poor, old populations can never pay their way.
|
| The root of the issue is that this area is now the country.
| Giving all old people the labor necessary to support them
| in old age was easier when the ratio of working people to
| non working people was much higher, in conjunction with old
| people not living as long.
|
| Turn that population pyramid upside down due to drastically
| reduced birthrates and medical technology allowing people
| to live longer, and you get the current situation.
| oliwarner wrote:
| You say that like it's an imperative but it's not. This
| is a choice.
|
| Through the government we elected, we choose to starve
| social care. We choose to starve education.
|
| Yes, our age profile made it more expensive, but so what?
| We choose to underfund it.
| MichaelCollins wrote:
| > _This isn 't a collapse of emergency healthcare, it's a very
| predicted collapse of community social care: hospitals can't
| discharge if they need a care home place that doesn't exist.
| Without inpatient bed availability, ERs and AMUs can't admit to
| specialties and everything gums up at the front door._
|
| How does that manifest as ambulance wait times? Do you think
| ambulance drivers are sitting around for an hour before
| responding to calls for help because... the hospital is full?
| That's like saying my train to the airport was late because the
| airport was full, it doesn't make much sense. How does one back
| up into the other?
| oliwarner wrote:
| If you come to our local DGH's A&E in an ambulance and you're
| not a trauma or cardiac or stroke, you face seven to _twenty_
| hour wait in the carpark.
|
| You will see multiple paramedics as they change shifts in
| situ.
|
| In fairness the ambulance service has scaled amazingly well
| given most of their staff are now pegged in hospital
| carparks, but yes, waiting times for critical calls are
| extended, people _are_ dying because ambulances aren 't
| available.
|
| All because they can't hand over to A&E. Because A&E can't
| ingest patients. Because wards can't discharge. Because care
| homes don't exist.
|
| It's that simple. If you doubled the number of community care
| placements, staff, etc, you'd buy the NHS another ten years.
| dia80 wrote:
| Yes, The ambulances are waiting outside the hospitals with
| the last patient so they can't go to get the next one.
| Source: Family members have recently waited some hours
| outside A&E in an ambulance.
| MichaelCollins wrote:
| This is hard to believe. Just wheel the patient through the
| front door and let the hospital do the babysitting. There
| is no sense in using an ambulance as a waiting room.
| pessimizer wrote:
| The patients are waiting in the ambulance because the
| waiting room is full, but I see your point. Why not just
| tip the patient onto the pavement outside the waiting
| room? I'm sure a full hospital with a full waiting room
| won't be to busy to sort that out.
| MichaelCollins wrote:
| > _Why not just tip the patient onto the pavement outside
| the waiting room? I 'm sure a full hospital with a full
| waiting room won't be to busy to sort that out._
|
| Literally yes. Keeping them in an ambulance instead of
| the sidewalk won't get them into the ER any faster. And
| keeping the ambulance tied up at the hospital won't do
| any good for the next guy who has an emergency and is
| sitting on the sidewalk at the site of the accident
| either. At least if you move the injured people to the
| sidewalk at the hospital, the nurses can look outside and
| prioritize the worst. And the problem will be highly
| visible to the public, instead of papered over by using
| ambulances as waiting rooms.
|
| What they're doing now is obviously prioritizing for
| appearances, not patient outcome.
| Peanuts99 wrote:
| Then you only rush to another patient who you can't treat
| either. Paramedics also need to hand off their treatment
| to hospital staff, if that doesn't happen then hospitals
| won't know what treatments were administered.
| roywiggins wrote:
| The emergency department fills up because they can't find
| beds to admit people to. When the emergency department is
| full, there's nowhere for the ambulance patients to be
| put.
|
| Just one of many, many stories on this:
|
| https://www.bbc.com/news/uk-scotland-61395685
| captainredbeard wrote:
| An ambulance is a portable "mini" ER room...
| MichaelCollins wrote:
| Using a parked ambulance as an ER room is gross
| mismanagement because the 'waiting room' for an ambulance
| 'ER room' is casualties spread across the entire city,
| such that the worst cannot be prioritized.
|
| Even if the hospital's ER room has saturated capacity,
| moving all the casualties to the hospital waiting room as
| rapidly as possible still has utility because that allows
| the hospital to prioritize the worst, which they can't do
| if the worst is laying on the street a mile away with the
| ambulances all parked at the hospital.
| cameronh90 wrote:
| I can promise you that the many smart people working in
| hospitals have considered this issue.
|
| If someone is walking-wounded, they WILL be unloaded to
| sit and wait for 6 hours in a corridor.
|
| The people who the ambulances are holding for long
| periods are those who are too sick to be left without
| attention. The paramedic staff continue to monitor them
| in order to escalate further if their condition
| deteriorates, and depending on the situation, medical
| staff from the hospital will be involved in this.
|
| The ambulance staff obviously have a moral and legal duty
| of care, and can't just leave a seriously unwell patient
| on the floor outside the hospital entrance to get to the
| next call, which would likely be a patient no more ill
| than the one they just abandoned.
| oliwarner wrote:
| Babysitting? These are patients deemed medically unfit
| enough to bring in. Who's looking after them after
| they're turfed out the ambulance? Every bed in every bay
| in A&E is occupied, each with an allocated nursing
| provision.
|
| Oh we just double the number of nurses? Yeah, but no.
| They don't grow on trees. The current ones don't stretch
| (we asked). You can't just absorb 20-40 patients into
| your acute departments without space and staff. The
| paramedics are acting as those staff, their ambulances
| the space. Yes it's far from optimal.
| elif wrote:
| t3rabytes wrote:
| (Not) Luckily the US healthcare system is already collapsing
| without social medicine, so it's not a great talking point.
| Staffing and supply shortages paint a bleak picture over the
| next few years.
| Overtonwindow wrote:
| "the US healthcare system is already collapsing" What do you
| mean by this, specifically? People not having insurance?
| Increasing deaths inside the hospital? Large numbers of
| people turned away from emergency rooms?
|
| I'm questioning this because with the exception of
| malpractice, the U.S. healthcare system seems to be working
| quite well, despite the large numbers of uninsured and those
| who cannot pay.
|
| I just don't buy this argument that the U.S. healthcare
| system is "collapsing" because if you call an ambulance they
| will take you to the hospital, and if your life is in danger
| regardless of your ability to pay, there's a higher chance of
| surviving in an American medical facility than most places on
| earth.
| nradov wrote:
| About 10% of Americans don't have medical insurance. That
| number has been fairly stable for several years, so it's
| not great but also not a sign of collapse.
|
| https://www.aha.org/news/headline/2021-11-17-cdc-reports-
| uni...
| SketchySeaBeast wrote:
| Isn't that 10% stat potentially hiding issues of co-pay,
| deductibles, network range, and actual level of coverage?
| nradov wrote:
| Nothing is being hidden. High deductible health plans
| have been popular, especially among younger consumers.
| The federal government has specifically promoted those as
| a way to hold down healthcare expenses, and enrollees
| receive income tax benefits.
|
| https://www.cdc.gov/nchs/products/databriefs/db317.htm
|
| Health plans are required to meet network adequacy
| requirements.
|
| https://www.kff.org/health-reform/issue-brief/network-
| adequa...
| LorenPechtel wrote:
| Observation: There's adverse selection at work. People do
| the economics and look at their expected medical spending
| with both low and high deductible plans--those not
| expecting substantial bills generally choose the high
| deductible plans. Insurance companies observe the results
| of this--those who choose low deductible plans end up
| costing more.
|
| I've done the math most years and I have yet to find more
| than a narrow window where you're better off with the low
| deductible plan than with a high deductible plan and
| putting aside the savings. Typically there's no window at
| all, the high deductible plan is always superior. (Note
| that this generally changes in situations where you pay a
| *percentage* of your premium, such as subsidized ACA
| plans.)
|
| If we want to move away from high deductible plans the
| only way is for Congress to impose it, market forces will
| always drive it as high as it can legally go.
| SketchySeaBeast wrote:
| My point with the "hidden" comment was that even though
| people have coverage they may not be able to use it due
| to having an unaffordably high deductible, and your first
| link is showing that there is a rise in high deductible
| plans and that lower income people don't usually have an
| HSA to offset the cost. It also points out that 60% of
| people get their insurance through their company, and
| that companies are increasingly moving towards the
| cheapest plans with the highest cost to the individual
| user.
|
| Is an insurance plan an insurance plan if you can't pay
| the deductible?
| wincy wrote:
| People just love to talk about how horrible the US
| healthcare system is but my disabled daughter has never
| paid a dime for care in her life (in Kansas, of all
| places!) via Medicaid. Even her birth was free due to
| retroactive Medicaid. Her 9 months in the NICU was billed
| at over $2 million. Thanks taxpayers.
|
| I was having chest pains last week and got triaged within
| minutes at the ER. I'm pretty sure I "owe" them $500 for a
| previous ER visit which nobody mentioned during my stay.
|
| My 65 year old uncle hasn't had insurance in 20 years but
| when he got cancer three ago the social worker helped him
| sign up for disability and they got him on Medicare so fast
| your head would spin. He started chemo basically
| immediately and while his cancer is terminal the treatment
| has kept him alive for a long time, even longer than the
| doctors predicted.
|
| My wife got billed $200,000+ for a visit in the hospital
| when she had a critical illness and almost died. She ended
| up paying $2000. This was more than ten years ago and it
| didn't ruin her credit and nobody ever came after her for
| it.
|
| And One more. The hospital messed up the billing for our
| first daughter's birth and called us two years later saying
| we didn't have insurance (we did). My wife said that was
| their problem. We never heard from them again or got a
| bill. I guess they just ate the cost? No idea. But it was
| over seven years ago and there were zero consequences and
| we never paid a dime.
| czzr wrote:
| So socialised medicine works?
| [deleted]
| sickofparadox wrote:
| If by "socialized medicine" you mean public option health
| insurance, then yes it does work. I'm willing to bet,
| though, that the poster you're replying to only received
| care from privately run hospitals/clinics, so calling it
| socialized medicine seems misleading.
| triceratops wrote:
| > public option health insurance
|
| > calling it socialized medicine seems misleading.
|
| Outside of the UK, that is how health care in developed
| countries is organized. It's either that or some version
| of Obamacare (regulated, private, with price caps and
| subsidies) or a combination.
|
| American conservatives call them all, without exception,
| "socialized medicine".
| spywaregorilla wrote:
| US health is socialized in that the public will pay for
| it if you're willing to game the system like the uncle in
| this story, plus spin the wheel of chance to see how much
| you'll how privately anyway. I don't think the uncle here
| acted maliciously or TRIED to game the system, but that
| is what happened and that is what will continue to happen
| with this shitty half implemented system.
| wincy wrote:
| Hah, the world is complicated. I feel like me and my
| family are the worst case scenario in the health care
| system and it worked... pretty well aside from them
| wanting to give my daughter too much care she didn't
| need.
|
| The US basically has socialized medicine that scares
| naive/"honest"/conscientious middle class people into
| paying up to subsidize it. I suspect if we passed
| legislation tomorrow to make the US a single payer system
| it'd all fall apart. But I suppose we've managed to trick
| the US taxpayers into socializing medicine while letting
| them pretend we haven't.
| analog31 wrote:
| >>> I guess they just ate the cost?
|
| We did, through our taxes and insurance premiums and
| opportunity costs. We paid for average care plus the
| greatest medical rentier system in the galaxy.
| Mechanical9 wrote:
| Man it just seems insane to me that you are acting like
| being billed $2 million, $200,000, and having unknown
| other bills, is somehow a good system.
|
| Let's be honest, overbilling and non-accountability is a
| huge disaster here. While people like you slip through
| the cracks in terms of not needing to pay, others slip
| through the cracks in terms of not getting care at all.
| jrochkind1 wrote:
| I think there are a variety of ways the US healthcare
| system is collapsing.
|
| One way I experience, relevant to OP, is that even with
| "good" health insurance, I can't manage to get an
| appointment with most specialists faster than 3 months, and
| I can't even see my primary care physician faster than 3
| weeks (at best) -- in case of something "urgent", maybe in
| 2 or 3 days.
|
| This may be especially bad in the region I live in, I'm not
| sure. When I ask around, many of my friends in other
| regions have similar experiences. It is not in fact true
| that those in the US can generally see physicians without
| long waits for appointments, currently.
| Mountain_Skies wrote:
| Can't wait for an ideologue to use the situation to push their
| partisanship into an unrelated conversation by projecting their
| actions onto their ideological foes.
| FpUser wrote:
| I think Canada can match England in this area. It is borderline
| criminal what happens here in some cases.
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