Reply to: Should Contractors pay their fair share of tax?

[seanraaron]

That's what the Hippocratic oath is for isn't it?

You'd think so, but given the privately run hospitals in the States that charge outrageous fees for the most basic services and have a history of denying care to poor people are administered by doctors, it doesn't seem to be enough.

That's assuming you weren't being snarky of course ;-)

[seanraaron]

The problem is that people like you and the left in general are polarised "out of principle" in how you think the health service should be run.

Of course. That's because most of the time basic services aren't in and of themselves money-making enterprises so you end up with either having the state subsidising private companies (public transport) or allowing prices to spiral in the pursuit of profit without any enhanced services (utilities). Ultimately the only thing the lawmakers get out of it is not having to take any responsibility for problems in those formerly public-owned industries.

Looking at the NHS a lot of the problems are down to poor managment at the trust level: failure to plan long-term and relying upon too few staff to provision service. Emphasis on lower costs versus quality of care and work environment probably doesn't help either.

I think the private sector can help pick up the slack, but given the past record of privatisation which ended up having the primary effect of enriching a few businesspeople without enhancing services, I'm sure you can understand why there would be a strong resistance to anything that smacks of privatising the NHS.

[NigelJK]

well-being of patients as the first priority

That's what the Hippocratic oath is for isn't it?

[DodgyAgent]

If you happen to have care which is regarded as cost-effective (oddly enough this isn't substantially different from the NHS, just that the motive is ensuring greater profits rather than limiting costs) and you can afford your policy. But hey, don't take my word for it, I'm just an American expat who lived with the system for most of my life.

Universal coverage in the private sector is unlikely to provide better coverage or be cheaper. In most privatisation exercises, the people who benefit most are unlikely to be service users - you have your pick in the UK if you want an example. Of course I suspect the people who push for it the most are in the "I've got mine" camp.

@fullyautomatix I've been wondering the same thing. Unless I'm getting shafted by an umbrella I really can't see the value-add of an LLC outside of tax-dodging...

The point is the debate should be about implementing the best possible solution to healthcare for everyone - whether private or public or a combination of the two. I happen to agree that running the NHS in a profit motivated environment would be a disaster just as operating it as public service would also be a disaster. The problem is that people like you and the left in general are polarised "out of principle" in how you think the health service should be run.
The dynamics that make institutions run efficiently should be introduced where they are appropriate. Dynamics that create negative outcomes for patients - restrictive practices, profit motivated processes should be weaned out. For example nurses, paramedics and other clinical skills are in short supply. Pay for these jobs is less than £30 k per year yet hospitals are constrained by National pay scales that prevent trusts from paying market rates to workers. What happens? these people leave the NHS and work as locums/banks earning more than twice as much and costing even more (thanks to huge agency margins ) thus creating a vicious spiral of escalating costs. if any trust tried to break free and pay more for clinical staff the wailing Unions and left would start crying "not fair" "everyone should get the same"

[seanraaron]

That will be never then as the whole point is you talk to an actual (UK) based GP who have their own 'brain based' database. For minor ailments this is OK for me, if they clock anything more serious they tell you it's worth making an appt with your GP.

Recent history of the 101 line does not bode well, but given the infant that died as a result of the less than accurate diagnosis via the number had presented at the GP's a number of times and a chest infection was missed multiple times after a physical examination then that does not bode well for the normal service either.

None of it is going to be perfect, but I think having a state-run non-profit-driven service is going to be more trustworthy about having the well-being of patients as the first priority.

Some kind of computer-based live chat service in addition to being able to escalate to a GP over the phone would probably be a good idea. I'm not as big a fan of the pay-to-play model, but some kind of means-tested co-pay may end up being necessary for the NHS.

[NigelJK]

I'd wonder how long it would be before the private GP helpline was offshored to people using a medical database myself

That will be never then as the whole point is you talk to an actual (UK) based GP who have their own 'brain based' database. For minor ailments this is OK for me, if they clock anything more serious they tell you it's worth making an appt with your GP.

Recent history of the 101 line does not bode well, but given the infant that died as a result of the less than accurate diagnosis via the number had presented at the GP's a number of times and a chest infection was missed multiple times after a physical examination then that does not bode well for the normal service either.

[seanraaron]

There was an interesting discussion on R4 yesterday evening. One the one hand there as a 'private' group of GP's who'd hit on the idea of a 24/7 telephone consultancy for minor ailments. It was £5 for a 5 mins consolation which would mean that you wouldn't have to take any time off work for a 15 min (maximum) consultation with your GP. I felt sorry for the GP on the opposing team who ended up justifying their position by saying that some of their customers liked to 'chat'.

That is what NHS24 is supposed to be, but it didn't exactly get executed well and then there's the lack of inspiration behind getting told for anything that sounds remotely like it could be something serious "better talk to your GP - especially if children are involved."

I'd wonder how long it would be before the private GP helpline was offshored to people using a medical database myself...

The fact that I can actually get an appointment with a GP is something of a novelty. When I was with Kaiser Permanente in the States (one of the largest and better regarded HMOs) and tried to get an appointment I was told that wasn't possible and I should just go to the first-come-first-served drop-in clinic instead, which basically meant taking the entire day off since I had no idea when (or if) I'd end up seeing anyone. When I did see the doc I basically had what I'd told them parroted back at me and was given an ineffective prescription.

The NHS has issues, but the grass isn't necessarily greener on the other side.

[NigelJK]

There was an interesting discussion on R4 yesterday evening. One the one hand there as a 'private' group of GP's who'd hit on the idea of a 24/7 telephone consultancy for minor ailments. It was £5 for a 5 mins consolation which would mean that you wouldn't have to take any time off work for a 15 min (maximum) consultation with your GP. I felt sorry for the GP on the opposing team who ended up justifying their position by saying that some of their customers liked to 'chat'.

[d000hg]

Why are we talking about the NHS anyway, this is a thread about contractors. Who are all BUPA members, right?

[seanraaron]

At least these are efficient and work

If you happen to have care which is regarded as cost-effective (oddly enough this isn't substantially different from the NHS, just that the motive is ensuring greater profits rather than limiting costs) and you can afford your policy. But hey, don't take my word for it, I'm just an American expat who lived with the system for most of my life.

Universal coverage in the private sector is unlikely to provide better coverage or be cheaper. In most privatisation exercises, the people who benefit most are unlikely to be service users - you have your pick in the UK if you want an example. Of course I suspect the people who push for it the most are in the "I've got mine" camp.

@fullyautomatix I've been wondering the same thing. Unless I'm getting shafted by an umbrella I really can't see the value-add of an LLC outside of tax-dodging...

[fullyautomatix]

What amazes me is that when contractors go permie they will willingly pay the max tax rate and don't moan about it but when they go contracting and earn twice they suddenly want to pay 0% tax. What changed ?

[d000hg]

At least these are efficient and work

They work in the sense they deliver profit to shareholders. Not necessarily in the sense they provide effective, efficient, affordable health-care to everyone who needs it.

[DodgyAgent]

As opposed to profit-driven entities whose first order of business is delivering dividends to shareholders? Yes.

At least these are efficient and work

[d000hg]

I assume you meant to quote the other post. But I don't buy any of that. In an environment that isn't so horrendously regulated and licensed, that the scenarios you describe will follow just doesn't make any logical sense from an economics perspective.

Really? Companies don't cut corners at the expense of customer satisfaction for short-term /short-sighted reasons? Even in the NHS we see this happening because they still have budgets.

[seanraaron]

So a state run business run on trust as a monopoly is the answer to delivering healthcare is it?

As opposed to profit-driven entities whose first order of business is delivering dividends to shareholders? Yes.