Women shrieking In the Sport of Tennis Compared to other Sports.

by Guest Thu 31 Mar 2016, 9:00 am

First topic message reminder :

It is well recognised that in recent years the sport of women's tennis has become characterised by certain players and the various noises emanating from their mouths when striking a tennis ball. Sometimes that noise starts before the ball is hit, sometimes the noise starts after the ball is hit. Sometimes the noise extends into the opponents play. The shrieks emanating from Victoria Sharapova and Venus Williams has sometimes caused the crowd to laugh and to make sensitive children cry. Azarenka has a strange extended shriek that extends into the opponents play. Some people have compared the Azarenka shriek to Chinese water drip torture. Some people have compared the Sharapova and Venus Williams shriek to a Jumbo Jet taking off.

Anyway my question is - is this just a women's tennis thing or does it extend to other sports? In squash and badminton and singles volleyball there are no such shrieks. There may be the occasional cry and the occasional audible exhalation of breath, but it seems to me there is nothing to compare with the women shriekers that populate the sport of tennis. [I think the shrieks are "voiced" rather than "unvoiced" - requiring resonance of the vocal chords].

In the sporting arena there is the occasional cry from the field athletes, shot putters, javelin, discus - but it is not repetitive and it is diluted in the enormous arena of the athletics stadium.

Personally I am physically unable to watch women's tennis which contains a shrieker - I just can't stand the noise, I find it irritating, it stops me from thinking about the match, it breaks my concentration, I get a headache, I have to leave or switch off. Not all women's tennis players shriek. The WTA don't seem to do anything about it.

From all the recent discussion about "WTA being a parasitic organisation", "prize money equality", "market value" ... it makes me wonder whether the WTA are really being responsive to its market, the spectators, the viewers. I suspect it is being shielded from its market by the success in the Men's Game (with or without Federer and Nadal) and the way it attaches itself to the Men's Game.. I won't go as far as saying the WTA has a parasitic relationship to the ATP but I remain open minded about that label.

by bogbrush Thu 31 Mar 2016, 5:33 pm

It Must Be Love wrote:
bogbrush wrote:
If AmritHealth set up as a health retailer, and you as CEO wanted to establish your brand, you're only going to 'stock' treatments with brilliant providers, right? You'll audit the providers, negotiate great prices, delist uncompetitive / secondary providers and charge a margin for the service. You'll defend your reputation to the death because it's all you have.
That's NOT insurance, which is rubbish because it carries all the hazards you describe.
Interesting you're against the insurance system, glad you agree on that.
But that doesn't mean you get a pass on all my concerns:

a) Public would not really know if they're getting a good service; companies can pressure cost saving measures which are not in the best interest of and can harm the patient, without patients having a clue. That's a fundamental problem. There's no real way to avoid it. Many patients complain when they've read something on yahoo answers or google, and demand medication when it's not necessary. On the other hand doctors can sometimes do everything right, but there's no way of saving the patient. Numerical league tables will always be unreliable, as they can't accurately standardise for all the factors such as genetics, patient history, lifestyle.

b) If we had a private healthcare system, I think it's quite likely doctors will be paid more than they are now. Now we have a system which basically bans doctors from going into just private healthcare right after they qualify. That allows NHS to as a monopoly employer to depress wages. So that would increase overall costs

c) What happens if someone is poor, and has a chronic disease which is expensive to treat, or has recurrence of cancer. Even if the cost is brought as low as possible, a chronic or recurrent disease will still have a significant cost. If that person is unemployed and doesn't have savings, surely we can't just leave them to die ?

a) you think "Which" or any of the other consumer interested publications will leave you alone? You provide this health retail service and they're going to write about you. They write bad things, your customers go elsewhere. Just because they read a bad thing. Did you see that Mars recalled many, many millions of pounds worth of sweets from 54 countries because of ONE consumer complaint about plastic in a bar?? I mean, how protective of reputation could you want people to be?
Armed with your reputation you can gently defend your service from idiots. After all, you're not really interested in getting their business again are you?

Meanwhile, these guys kill them by the hundred and write reports.

https://en.m.wikipedia.org/wiki/Stafford_Hospital_scandal

b) Oh so paying Doctors less is a good thing? Why not let Doctors earn the rate based on their skills? Engineers don't all get paid the same - the best get 3, 4, 5 or more times others. Just as it should be. In any case, Doctors would be competing for their wages based in reputation and delivery, driving results up again.

As for efficiency, the private side competing on price as well as service will always murderca public organisation. I can't tell you too much but my business now sells product for far less in nominal terms that many years ago, does it better, and makes more money.

c) if the nation wants to subsidise healthcare for poorer people then it's easy enough to provide vouchers. The retail industry already price segments based on consumers willingness / ability to pay more, so that would play a part too.

By the way, the law loves to prosecute private firms who breach legal obligations. It's never quite do good at doing it on itself (partly because fining yourself doesn't work and it hadn't got the ability to shut down crap units). You'd have a far more strictly enforced legal environment.

by bogbrush Thu 31 Mar 2016, 5:36 pm

Jahu wrote:I'm not a fan of State ownership, but neither of favoured private monopolies, which in the end is just swapping money from incompetent State to Private pocket.

I am all pro business but with good clean state oversight, but we saw that with Banks, in the end we always pay either way, and does not guaranty a better service, neither did the privatised Rail.

100% agree. Banks are just an arm of the State, and they showed it when they

- reimbursed investors when their businesses went broke
- held Directors immune from prosecution for recklessly managing their businesses.

The issue isn't public v private, its monopoly v competition. The State is always rubbish because it's always a monopoly, but it's not the only one.

by socal1976 Thu 31 Mar 2016, 5:45 pm

Jahu wrote:
socal1976 wrote:If I was a woman I would never visit a gynecologist at Jahuhealth services, just saying.

Would still be better than some places that do female genital mutilation, me is good doc.

Don't be scared.

Lesser of two evils I suppose

by It Must Be Love Thu 31 Mar 2016, 5:46 pm

bogbrush wrote:

a) you think "Which" or any of the other consumer interested publications will leave you alone? You provide this health retail service and they're going to write about you. They write bad things, your customers go elsewhere. Just because they read a bad thing. Did you see that Mars recalled many, many millions of pounds worth of sweets from 54 countries because of ONE consumer complaint about plastic in a bar?? I mean, how protective of reputation could you want people to be?

Lol, as if Which magazine would have a clue. You have to know a patient's exact circumstances such as history and genetics to know whether scans are suitable or what medication is best. You're waiting for Which magazine to save you, you're living in a dreamland.
Complaints ? Complaints will come in that the doctor isn't listening to them about something they've read on Yahoo answers, or that they aren't getting enough antibiotics for a cold. I've already explained why numerical league tables would be totally unreliable.

b) Oh so paying Doctors less is a good thing? Why not let Doctors earn the rate based on their skills? Engineers don't all get paid the same - the best get 3, 4, 5 or more times others. Just as it should be. In any case, Doctors would be competing for their wages based in reputation and delivery, driving results up again.

We already have doctors getting paid more than other doctors. You have to pass very tough exams and interviews to be promoted. If doctors make mistakes, they can be brought in front of the GMC and have their license taken away. But the overall costs will be more if they are paid more, as they would in your system.

c) if the nation wants to subsidise healthcare for poorer people then it's easy enough to provide vouchers.

OK, so you agree with state subsidies for the poorest, that's good.

by bogbrush Thu 31 Mar 2016, 5:50 pm

I see you missed out the really important bits, like why the Hell Mars took the action they did, while those b@$tards at South Staffs left people in their own p1ss, killed loads more, and covered it up. Good old State sector, really trustworthy aren't they?

You are soooooo wrong on pay. I pay well over the odds for engineers because a clever businessman knows one top man is worth 5 ordinary. Paying well for the best is good, efficient business.

I expressed no opinion, either way, I just explained how it's an easy problem to address.

by It Must Be Love Thu 31 Mar 2016, 5:59 pm

bogbrush wrote:I see you missed out the really important bits,

Because as I said it's irrelevant. Healthcare when the companies main incentive is to make a profit can be bad without being as obvious as plastic in a mars bar.

bogbrush wrote:
You are soooooo wrong on pay. I pay well over the odds for engineers because a clever businessman knows one top man is worth 5 ordinary. Paying well for the best is good, efficient business.

There's no huge difference between doctors in general who are at a similar level of training. Some obviously are exceptional I suppose, and they get pretty rich anyway, and the poorest wouldn't be able to afford them.
If doctors make mistakes, and a complaint is launched, the GMC can take away their license.
Go to hospitals, most doctors and hospitals have the incentive of trying to help patients and make them better, that is better than the profit incentive. The NHS on general does provide good healthcare, obviously there will be a few exceptions, but the main problem with NHS is lack of funding for the rising demand, not that the incentive of healthcare providers isn't focused enough on money.

by It Must Be Love Thu 31 Mar 2016, 6:17 pm

bogbrush wrote:
It Must Be Love wrote:
bogbrush wrote:c) if the nation wants to subsidise healthcare for poorer people then it's easy enough to provide vouchers.
OK, so you agree with state subsidies for the poorest, that's good.
I expressed no opinion, either way, I just explained how it's an easy problem to address.

So do you personally believe we should subsidise healthcare for those in poverty with vouchers or not ?

by Jahu Thu 31 Mar 2016, 6:49 pm

First you must take forcibly if needed people off support (most of them), get them to work ( but not zero hour contract crap), that will lessen poverty and subsidy.

I see no reason tourists claiming benefits, let alone local people scratching their balls all day and survivng on income/housing benefit.

While I'm pro business, I like a little tough hand from the state too.

by Jahu Thu 31 Mar 2016, 6:52 pm

socal1976 wrote:
Jahu wrote:
socal1976 wrote:If I was a woman I would never visit a gynecologist at Jahuhealth services, just saying.

Would still be better than some places that do female genital mutilation, me is good doc.

Don't be scared.

Lesser of two evils I suppose

Are we friends now, you California big mouth? Laugh

by bogbrush Thu 31 Mar 2016, 7:02 pm

It Must Be Love wrote:
bogbrush wrote:I see you missed out the really important bits,
Because as I said it's irrelevant. Healthcare when the companies main incentive is to make a profit can be bad without being as obvious as plastic in a mars bar.

bogbrush wrote:
You are soooooo wrong on pay. I pay well over the odds for engineers because a clever businessman knows one top man is worth 5 ordinary. Paying well for the best is good, efficient business.
There's no huge difference between doctors in general who are at a similar level of training. Some obviously are exceptional I suppose, and they get pretty rich anyway, and the poorest wouldn't be able to afford them.
If doctors make mistakes, and a complaint is launched, the GMC can take away their license.
Go to hospitals, most doctors and hospitals have the incentive of trying to help patients and make them better, that is better than the profit incentive. The NHS on general does provide good healthcare, obviously there will be a few exceptions, but the main problem with NHS is lack of funding for the rising demand, not that the incentive of healthcare providers isn't focused enough on money.

Oh come on, what was obvious about one privately communicated complaint? Their reaction was staggering, and the beauty of it is that they did it because in the long run it increases profits!

"There's no difference between doctors in general who are at a similar level of training"

Ridiculous. So there's no difference between teachers, accountants, bricklayers, engineers, etc who are similarly trained? I wonder why they get paid so differently? Odd, eh?

by socal1976 Thu 31 Mar 2016, 7:09 pm

Jahu wrote:
socal1976 wrote:
Jahu wrote:
socal1976 wrote:If I was a woman I would never visit a gynecologist at Jahuhealth services, just saying.

Would still be better than some places that do female genital mutilation, me is good doc.

Don't be scared.

Lesser of two evils I suppose

Are we friends now, you California big mouth?

No. but we are not enemies either as long as you don't urine me off

by It Must Be Love Thu 31 Mar 2016, 7:14 pm

bogbrush wrote:
Oh come on, what was obvious about one privately communicated complaint?

I meant it's obvious if there's plastic in your mars bar. And I've explained at length how it's not so obvious for patients if they're getting good care. This is getting slightly silly, I'm not sure if you're missing my point on purpose or just accidentally forget to address it.

bogbrush wrote:
"There's no difference between doctors in general who are at a similar level of training"
Ridiculous. So there's no difference between teachers, accountants, bricklayers, engineers, etc who are similarly trained? I wonder why they get paid so differently? Odd, eh?

Well the doctors generally follow the same guidelines, so care is standardised to an extent, so in general I don't think doctors at the same level of training will have huge differences; but ok I'm sure some doctors are better than others.
Go to hospitals, talk to doctors, what motivates them is helping people. And if you make a mistake and a patient suffers, doctors are human, that can be very emotionally stressful. We have the GMC as well who are tough and have taken away licenses.
Most mistakes if they are made by doctors, is because of exhaustion or lack of resources; certainly not due to bad intent or something that can be solved by money.

by Jahu Thu 31 Mar 2016, 7:37 pm

socal1976 wrote:

Are we friends now, you California big mouth?

No. but we are not enemies either as long as you don't urine me off[/quote]

But when you get off into liquids, thats so priceless Smile

Done.

by bogbrush Thu 31 Mar 2016, 7:46 pm

It Must Be Love wrote:
bogbrush wrote:
Oh come on, what was obvious about one privately communicated complaint?
I meant it's obvious if there's plastic in your mars bar. And I've explained at length how it's not so obvious for patients if they're getting good care. This is getting slightly silly, I'm not sure if you're missing my point on purpose or just accidentally forget to address it.

bogbrush wrote:
"There's no difference between doctors in general who are at a similar level of training"
Ridiculous. So there's no difference between teachers, accountants, bricklayers, engineers, etc who are similarly trained? I wonder why they get paid so differently? Odd, eh?
Well the doctors generally follow the same guidelines, so care is standardised to an extent, so in general I don't think doctors at the same level of training will have huge differences; but ok I'm sure some doctors are better than others.
Go to hospitals, talk to doctors, what motivates them is helping people. And if you make a mistake and a patient suffers, doctors are human, that can be very emotionally stressful. We have the GMC as well who are tough and have taken away licenses.
Most mistakes if they are made by doctors, is because of exhaustion or lack of resources; certainly not due to bad intent or something that can be solved by money.

Did you actually read the link to the South Staffordshire scandal? Were they all "tired". Was their obscene treatment not "obvious".

Ridiculous comments about standards if doctors, just daft. Try replacing "doctor" with any other job title, read again, and then wonder why doctors would be different. Clue: they're humans with differing IQ's, interest levels and values.

Honestly, I wonder about you sometimes.

by Jahu Thu 31 Mar 2016, 7:54 pm

Easy easy bb, LoverBoy is a Medic student I think Smile

by It Must Be Love Thu 31 Mar 2016, 8:00 pm

bogbrush wrote:
Did you actually read the link to the South Staffordshire scandal? Were they all "tired". Was their obscene treatment not "obvious".

Ah BB, did I read about it? Firstly it's Mid Staffs, not South. And secondly yes, I've not just read up on it, I've had to study it in great detail.
The biggest problem was a chronic shortage of staff, and particularly nursing staff. The board in 2006-2007 also cut spending quite dramatically, which made problems even worse. There were issues with culture as well, but the hospital has improved and we can't extrapolate from one time period in one hospital and say it represents the NHS.
The NHS does have an overall problem with staff shortages, but the vast vast majority of hospital do not have issues to the same extent as Mid Staffs did.
We can both list ways the NHS is imperfect, or talk about anomalies, the difference is I believe it can be helped by greater resources and more staff, you think having it totally privatised is the solution.

But the issue with having a profit incentive is a systemic problem, it wouldn't just be an anomaly... you haven't addressed my main point on that. You keep accidentally ignoring it.

bogbrush wrote:
Ridiculous comments about standards if doctors, just daft. Try replacing "doctor" with any other job title, read again, and then wonder why doctors would be different. Clue: they're humans with differing IQ's, interest levels and values.

Honestly, I wonder about you sometimes.

The differing IQs, and interests levels are represented in progress up the medical field (i.e. some do get promoted, some don't); it's not easy to pass exams for consultancy, you'll have to go through a pretty rigorous process. I'm saying at the same levels of progress through training there won't be huge differences in general, as doctors tend to follow the guidelines set by NICE and the boards.
But under your system the richest will get the better doctors, while now it's more of an equal distribution. If doctors really want to get rich, they can when more senior work for a private company, as I said the vast majority of mistakes doctors make are due to exhaustion, wanting to make more money won't make a difference to that.

by bogbrush Thu 31 Mar 2016, 8:30 pm

Jahu wrote:Easy easy bb, LoverBoy is a Medic student I think

It wouldn't surprise me. Thankfully we're not debating medicine.

by bogbrush Thu 31 Mar 2016, 8:42 pm

It Must Be Love wrote:
bogbrush wrote:
Did you actually read the link to the South Staffordshire scandal? Were they all "tired". Was their obscene treatment not "obvious".
Ah BB, did I read about it? Firstly it's Mid Staffs, not South. And secondly yes, I've not just read up on it, I've had to study it in great detail.
The biggest problem was a chronic shortage of staff, and particularly nursing staff. The board in 2006-2007 also cut spending quite dramatically, which made problems even worse. There were issues with culture as well, but the hospital has improved and we can't extrapolate from one time period in one hospital and say it represents the NHS.
The NHS does have an overall problem with staff shortages, but the vast vast majority of hospital do not have issues to the same extent as Mid Staffs did.
We can both list ways the NHS is imperfect, or talk about anomalies, the difference is I believe it can be helped by greater resources and more staff, you think having it totally privatised is the solution.

But the issue with having a profit incentive is a systemic problem, it wouldn't just be an anomaly... you haven't addressed my main point on that. You keep accidentally ignoring it.

bogbrush wrote:
Ridiculous comments about standards if doctors, just daft. Try replacing "doctor" with any other job title, read again, and then wonder why doctors would be different. Clue: they're humans with differing IQ's, interest levels and values.

Honestly, I wonder about you sometimes.
The differing IQs, and interests levels are represented in progress up the medical field (i.e. some do get promoted, some don't); it's not easy to pass exams for consultancy, you'll have to go through a pretty rigorous process. I'm saying at the same levels of progress through training there won't be huge differences in general, as doctors tend to follow the guidelines set by NICE and the boards.
But under your system the richest will get the better doctors, while now it's more of an equal distribution. If doctors really want to get rich, they can when more senior work for a private company, as I said the vast majority of mistakes doctors make are due to exhaustion, wanting to make more money won't make a difference to that.

Yes, it was Mid Staffs. After that you went badly wrong as the litany of neglect and mismanagement went far beyond resources. It is a story of poor quality, incompetent management and institutionalised corruption. I have seen good businesses with no money and they don't behave as this lot.

I'm delighted to hear of a system that differentiates people skill and interest so precisely. It doesn't exist of course.

I have told you - repeatedly - how the profit motive in a competitive environment drives change and improvement. Credit me with extensive knowledge of what I speak, having run a successful, growing business in a massively competitive environment, by offering better quality and innovation at lower prices while investing at very high levels.

Look, I'm sure you are good at medical techniques and are enthusiastic for to your profession; forgive me for coming over as patronising but when it comes to understanding the behaviour of institutions you sound very young.

by Guest Thu 31 Mar 2016, 8:59 pm

socal1976 wrote:
It Must Be Love wrote:
HM Murdock wrote:^It's a monopoly that costs £115bn per year (and rising) but remains exempt from critical scrutiny because it's a left wing shibboleth.

The big shock to me is that BB got through that post without a single mention of the BBC!
That cost is not that much though if you see it in perspective, I believe actually that as a proportion of GDP, the NHS is actually lower than most advanced countries.

I know the US for example has more doctors per head of population; and their whole population isn't even medically insured unlike the UK. Obviously I go to hospitals, and the situation is very sad. The doctors I shadow are working 14 hour shifts without a break, and due to gaps in number of doctors, I've even seen quite a few instances of doctors having to work 24+ hours in a row to cover. Obviously you have to be tough, but I think most humans would feel it's frankly exhausting, and it's pretty scary to see. You work 23 hours without any sleep, and one mistake and someone dies.
Also I can absolutely guarantee you that vast majority of junior doctors work already above the hours they are paid for. Atleast 2 hours extra, I've never seen someone leave the hospital when they're meant to. To be fair if they did, patients would literally suffer, so they would have to be amoral to say 'ok times up it's 5pm, ready to go, oh sorry about the patients I haven't covered yet, hope you get reincarnated as something good next time'.
NHS needs to manage to curb the demand. Prevention methods to stop obesity related issues, as well as tobacco and alcohol. Also I'm pro-EU, but I think it's unfair that if a Brit goes to France we have to pay for healthcare, but if a French person comes here they get it for free. A fair system, in or out of the EU, could be that you get the healthcare in UK that you would get in your home country (cost-wise). Current high demand just not sustainable.

The problems with your socialized healthcare system are laughable compared to the American system which is by far the most privatized in the developed world. My mother had a cyst removed and the hospital billed her insurance (not the surgery) for just one night in a hospital where all they did was observe her with a nurse walking in every couple of hours and they billed her insurance 50, 000 dollars. One non-cancerous cyst being removed and one basic surgery cost more than 100k. If she didn't have insurance and poor she would have to wait till a cyst turned cancerous, declare bankruptcy and then throw herself on the mercy of the government again who would then end up paying 20 times the figure I discussed to solve a problem that could have been solved with a routine surgery. The unchecked free market doesn't lead to perfect competition over and over again it has shown that it leads to monopoly and oligarchy. The American healthcare system prior to Obamacare, outside of caring for those on assistance or the very old was by far the most expensive in the world. Why it is controlled by a few regional powerhouses that have conspired to push prices to ever more profitable highs because they can. No one is saying that government is the solution to every problem but the idea that the free market is perfect and with good competition you get the best of everything all the time I think is pretty silly. What we have seen is that without government regulation that most supposedly free markets really end up through consolidation (to raise prices not to reduce them) being run by cartels and monopolies. At some point the biggest competitors succeed in wiping out the choice and price competition that they claim is the lifeblood of pure capitalism.

This is not supposition, this is actually what happened when we had the libertarian utopia of small neutered national government that kept its nose out of business. It was called the 19th century, those selling you the utopia of doing away with the government should study that period. In that period every major huge industry, with some excepetions was controlled by a monopoly or a cartel that would set prices completely devoid of competition. Not to mention the biggest problem of that period the fact that the so-called perfect unregulated free market crashed in massive deflationary depressions like clockwork every 20 years. They weren't called Depressions in that period they were much more truthful with their lingo they were called panics. And if you think a neutered government (in 1900 US nationl government accounted for 2 percent of GDP now its like in the mid 30s) small government that stays out of business is the way to go I invite you to research the panics of 1817,1837,1857,1873, 1893, and 1906. We are talking about massive deflationary events that ruined millions over night, not your typical inflationary recession we experienced in the modern age prior to 2007. By the way Alan Greenspan, noted limited government conservative admitted that doing away with government regulation of the financial sector was the reason for the crash as it gave rise to the shadow banking world we still live in to some extent.

Excellent post and reflective of the reality of capitalism vs the 'utopian' principles of the free market.

There's no such thing as a free market in the real world - rigged market, yes - free? never

Every major industry is run by oligarchs, cartels, small groups of politically entwined multinationals.

by It Must Be Love Thu 31 Mar 2016, 9:05 pm

bogbrush wrote:
Yes, it was Mid Staffs. After that you went badly wrong as the litany of neglect and mismanagement went far beyond resources. It is a story of poor quality, incompetent management and institutionalised corruption. I have seen good businesses with no money and they don't behave as this lot.

The main issue was lack of nursing staff actually; but yes there were problems beyond that, as I said I did study that case in great detail. But the hospital has improved, and we can't extrapolate the performance of one hospital in one time period and claim it represents the NHS.

Bogbrush wrote:I'm delighted to hear of a system that differentiates people skill and interest so precisely. It doesn't exist of course.

No system, can do so precisely. But we do have a system now where some doctors get promoted, and others don't, many doctors will never become a consultant. It is a merit based system, and the best doctors in the UK do have the opportunity to make money in the private sector. (btw I am not a doctor, but am a student)

Bogbrush wrote:
I have told you - repeatedly - how the profit motive in a competitive environment drives change and improvement. Credit me with extensive knowledge of what I speak, having run a successful, growing business in a massively competitive environment, by offering better quality and innovation at lower prices while investing at very high levels.

Look, I'm sure you are good at medical techniques and are enthusiastic for to your profession; forgive me for coming over as patronising but when it comes to understanding the behaviour of institutions you sound very young.

Look, I'm pretty certain that I understand both macro-economics and medicine better than you, you're very idealistic and not interested in nuance, but that's ok, let's not turn this into a Trump-style 'who's got bigger hands' debate.
I do agree that most industries are best in the hands of private firms; and I don't campaign for the nationalisation of Lidl.
But I do think, as many others do, that when it comes to healthcare there is a real issue with having the profit motive driving everything.
You keep ignoring this point: when you receive a product from Lidl you can tell more or less whether you like it, unless you have extensive medical knowledge it is very difficult to tell whether companies and doctors are working in your best interests or trying to save themselves money. You laughably talk about Which? magazine, as if that's going to be the saving grace. It's almost delusion... the magazine would probably be filled with complaints about how 'doctor didn't prescribe antibiotics for my cold' or how the doctor didn't listen about something read up on Yahoo answers (I've seen tonnes of these examples with my own eyes)- in reality unless it's a specialist in the field and they have all the details such as genetics and patient history it's very tough to make a judgement; heck even GPs or doctors of other specialties would struggle, forget the general public/ Which? magazine.

I think I've made all the points that are needed to be made here, we're going to have to 'agree to disagree', I'm sure you have had a great experience with the private sector, but you don't really seem to grasp why the profit motive may not be so effective or efficient in the particular example of healthcare. Until next time

by socal1976 Thu 31 Mar 2016, 9:40 pm

emancipator wrote:
socal1976 wrote:
It Must Be Love wrote:
HM Murdock wrote:^It's a monopoly that costs £115bn per year (and rising) but remains exempt from critical scrutiny because it's a left wing shibboleth.

The big shock to me is that BB got through that post without a single mention of the BBC!
That cost is not that much though if you see it in perspective, I believe actually that as a proportion of GDP, the NHS is actually lower than most advanced countries.

I know the US for example has more doctors per head of population; and their whole population isn't even medically insured unlike the UK. Obviously I go to hospitals, and the situation is very sad. The doctors I shadow are working 14 hour shifts without a break, and due to gaps in number of doctors, I've even seen quite a few instances of doctors having to work 24+ hours in a row to cover. Obviously you have to be tough, but I think most humans would feel it's frankly exhausting, and it's pretty scary to see. You work 23 hours without any sleep, and one mistake and someone dies.
Also I can absolutely guarantee you that vast majority of junior doctors work already above the hours they are paid for. Atleast 2 hours extra, I've never seen someone leave the hospital when they're meant to. To be fair if they did, patients would literally suffer, so they would have to be amoral to say 'ok times up it's 5pm, ready to go, oh sorry about the patients I haven't covered yet, hope you get reincarnated as something good next time'.
NHS needs to manage to curb the demand. Prevention methods to stop obesity related issues, as well as tobacco and alcohol. Also I'm pro-EU, but I think it's unfair that if a Brit goes to France we have to pay for healthcare, but if a French person comes here they get it for free. A fair system, in or out of the EU, could be that you get the healthcare in UK that you would get in your home country (cost-wise). Current high demand just not sustainable.

The problems with your socialized healthcare system are laughable compared to the American system which is by far the most privatized in the developed world. My mother had a cyst removed and the hospital billed her insurance (not the surgery) for just one night in a hospital where all they did was observe her with a nurse walking in every couple of hours and they billed her insurance 50, 000 dollars. One non-cancerous cyst being removed and one basic surgery cost more than 100k. If she didn't have insurance and poor she would have to wait till a cyst turned cancerous, declare bankruptcy and then throw herself on the mercy of the government again who would then end up paying 20 times the figure I discussed to solve a problem that could have been solved with a routine surgery. The unchecked free market doesn't lead to perfect competition over and over again it has shown that it leads to monopoly and oligarchy. The American healthcare system prior to Obamacare, outside of caring for those on assistance or the very old was by far the most expensive in the world. Why it is controlled by a few regional powerhouses that have conspired to push prices to ever more profitable highs because they can. No one is saying that government is the solution to every problem but the idea that the free market is perfect and with good competition you get the best of everything all the time I think is pretty silly. What we have seen is that without government regulation that most supposedly free markets really end up through consolidation (to raise prices not to reduce them) being run by cartels and monopolies. At some point the biggest competitors succeed in wiping out the choice and price competition that they claim is the lifeblood of pure capitalism.

This is not supposition, this is actually what happened when we had the libertarian utopia of small neutered national government that kept its nose out of business. It was called the 19th century, those selling you the utopia of doing away with the government should study that period. In that period every major huge industry, with some excepetions was controlled by a monopoly or a cartel that would set prices completely devoid of competition. Not to mention the biggest problem of that period the fact that the so-called perfect unregulated free market crashed in massive deflationary depressions like clockwork every 20 years. They weren't called Depressions in that period they were much more truthful with their lingo they were called panics. And if you think a neutered government (in 1900 US nationl government accounted for 2 percent of GDP now its like in the mid 30s) small government that stays out of business is the way to go I invite you to research the panics of 1817,1837,1857,1873, 1893, and 1906. We are talking about massive deflationary events that ruined millions over night, not your typical inflationary recession we experienced in the modern age prior to 2007. By the way Alan Greenspan, noted limited government conservative admitted that doing away with government regulation of the financial sector was the reason for the crash as it gave rise to the shadow banking world we still live in to some extent.

Excellent post and reflective of the reality of capitalism vs the 'utopian' principles of the free market.

There's no such thing as a free market in the real world - rigged market, yes - free? never

Every major industry is run by oligarchs, cartels, small groups of politically entwined multinationals.

Yes and if you think that in a world with megabillion and even soon trillion dollar multinationals that the little guy can just stand up for himself without having a large and functioning state policing the rules of the game and looking out for the common good then in my opinion you are dangerously naïve. The world is rarely black and white, ie market is always good and perfect and government is always bad. Rarely are extremist and absolutist positions workable in the real world. Thanks for the vote of confidence, nice you are back.

by HM Murdock Fri 01 Apr 2016, 8:59 am

It Must Be Love wrote:But I do think, as many others do, that when it comes to healthcare there is a real issue with having the profit motive driving everything.

This is a huge flaw in your argument. Profit already saturates healthcare and with good effect.

It costs pharmaceutical companies hundreds of millions of dollars to get a drug to market. They only do this because they have the chance to make a profit. If drug development were left to non-profit state organisation, medicine would be light years behind where it is now.

NHS consultant doctors earn between £75k and £100k per year. They are earning a 'profit' on this salary i.e. it does more than meet their costs. What do you think the size and motivation of the work force would be if people with the talent and intelligence to be consultant doctors only got paid minimum wage?

Consider also that every bed, thermometer, X-ray machine, light bulb and toilet roll used by the NHS was sold to it at a profit. The need to make a profit forced the manufacturer to make the best product they could at the best price.

The profit motive has benefited health care enormously. As far as I can tell, the problems facing the NHS stem more from the functions that government controls.

As I stated earlier, there are certain aspects of the nature of the private sector that give me pause as to whether it is ideal for administering health care.

But the motive of turning a profit is not one of them.

I think too often objections to the profit motive are based on the idea that for someone to make a profit, someone else has to make a loss. This is a pervasive meme but completely inaccurate.

by bogbrush Fri 01 Apr 2016, 10:48 am

I do find it odd that people aren't arguing for State management of the food production industry (which is making better, safer, cheaper food every year) or the automobile industry (which is making better, cleaner, safer and cheaper cars every year), the IT industry (which is making faster, better, more convenient, more useful and cheaper equipment every week) or the entertainment industry (which is making better, broader and more accessible entertainment than ever), but somehow thinks the answer to better, cheaper and safer health is the State.

Too may people can't raise their head from the nonsense they get fed every day and understand the fundamental principles. Profit under competition creates everything good you use, every day. The answer to brilliant healthcare is competed profit. Focus on creating that and you get everything you want; give up on creating that (and crony systems don't come close) and you have to settle for something that has no interest in the needs of consumers and instead becomes captured by the producers or their political allies.

I'm shocked at how naive some people are.

by bogbrush Fri 01 Apr 2016, 11:11 am

It Must Be Love wrote:
bogbrush wrote:
Yes, it was Mid Staffs. After that you went badly wrong as the litany of neglect and mismanagement went far beyond resources. It is a story of poor quality, incompetent management and institutionalised corruption. I have seen good businesses with no money and they don't behave as this lot.
The main issue was lack of nursing staff actually; but yes there were problems beyond that, as I said I did study that case in great detail. But the hospital has improved, and we can't extrapolate the performance of one hospital in one time period and claim it represents the NHS.

This is the problem; you don't understand the principles. An organisation that can get itself into the position where it runs like this is the problem, not the superficial, triggering issue.

Unless you've actually run a business you're going to find this tougher to grasp.

It Must Be Love wrote:
Bogbrush wrote:I'm delighted to hear of a system that differentiates people skill and interest so precisely. It doesn't exist of course.
No system, can do so precisely. But we do have a system now where some doctors get promoted, and others don't, many doctors will never become a consultant. It is a merit based system, and the best doctors in the UK do have the opportunity to make money in the private sector. (btw I am not a doctor, but am a student)

With zero experience of how people move into differentiated jobs in the real World, as evidenced by this staggeringly limited idea of graduated capability and rewards. Honestly, you're just so wrong here it's untrue.

It Must Be Love wrote:
Bogbrush wrote:
I have told you - repeatedly - how the profit motive in a competitive environment drives change and improvement. Credit me with extensive knowledge of what I speak, having run a successful, growing business in a massively competitive environment, by offering better quality and innovation at lower prices while investing at very high levels.

Look, I'm sure you are good at medical techniques and are enthusiastic for to your profession; forgive me for coming over as patronising but when it comes to understanding the behaviour of institutions you sound very young.
Look, I'm pretty certain that I understand both macro-economics and medicine better than you, you're very idealistic and not interested in nuance, but that's ok, let's not turn this into a Trump-style 'who's got bigger hands' debate.
I do agree that most industries are best in the hands of private firms; and I don't campaign for the nationalisation of Lidl.
But I do think, as many others do, that when it comes to healthcare there is a real issue with having the profit motive driving everything.
You keep ignoring this point: when you receive a product from Lidl you can tell more or less whether you like it, unless you have extensive medical knowledge it is very difficult to tell whether companies and doctors are working in your best interests or trying to save themselves money. You laughably talk about Which? magazine, as if that's going to be the saving grace. It's almost delusion... the magazine would probably be filled with complaints about how 'doctor didn't prescribe antibiotics for my cold' or how the doctor didn't listen about something read up on Yahoo answers (I've seen tonnes of these examples with my own eyes)- in reality unless it's a specialist in the field and they have all the details such as genetics and patient history it's very tough to make a judgement; heck even GPs or doctors of other specialties would struggle, forget the general public/ Which? magazine.

I think I've made all the points that are needed to be made here, we're going to have to 'agree to disagree', I'm sure you have had a great experience with the private sector, but you don't really seem to grasp why the profit motive may not be so effective or efficient in the particular example of healthcare. Until next time

I doubt you understand macro-economics if you think it applies to this subject - this is about organisational behaviour and incentives.

Next time I'll have to be tediously literal with you if you couldn't grasp that the throwaway "Which?" comment was representation of all the plethora of consumer-orientated information that pervades private sector supply.
In the World of medicine you could tell fairly quickly if the service is up to scratch; whether your Doctor gives enough of a crap to see you, or to come to a call-out out of hours, or maintains appointments accurately; or if you catch a disease during treatments, or get fed properly while under treatment, or if your relatives are kept informed; or whether the outcome of your treatment was good, or whether the cost of that treatment was competitive, or .... shall I leave it there or do you want a full page of literal examples where it is obvious whether your treatment was good or bad?

by It Must Be Love Fri 01 Apr 2016, 12:59 pm

HM Murdock wrote:
It Must Be Love wrote:But I do think, as many others do, that when it comes to healthcare there is a real issue with having the profit motive driving everything.
This is a huge flaw in your argument. Profit already saturates healthcare and with good effect.

I said 'everything', not 'anything'. I have specific concerns that I've raised, the points you made are indeed true, I'm not calling for the nationalisation of thermometer companies.

by It Must Be Love Fri 01 Apr 2016, 1:15 pm

bogbrush wrote:
Next time I'll have to be tediously literal with you if you couldn't grasp that the throwaway "Which?" comment was representation of all the plethora of consumer-orientated information that pervades private sector supply.
In the World of medicine you could tell fairly quickly if the service is up to scratch; whether your Doctor gives enough of a crap to see you, or to come to a call-out out of hours, or maintains appointments accurately; or if you catch a disease during treatments, or get fed properly while under treatment, or if your relatives are kept informed; or whether the outcome of your treatment was good, or whether the cost of that treatment was competitive, or .... shall I leave it there or do you want a full page of literal examples where it is obvious whether your treatment was good or bad?

Bogbrush, I don't think you actually read my posts, I may as well be talking about Cinderella in Ancient Greek and you probably wouldn't notice.
I explained yesterday in quite a lot of detail and with some examples as to why it's not actually so easy for the public to tell if the doctors are working in their best interests. Sometimes it can appear the doctors and healthcare company are doing a great job, when the reality is different.

by It Must Be Love Fri 01 Apr 2016, 1:37 pm

HM Murdoch-yesterday I gave a few examples as to how private hospitals can be pretty sneaky when it comes to bringing in more revenue from either the patients or insurance companies.

I'll give another example I just remembered, my uncle in India had problems with his kidney so was admitted urgently to hospital. During his recovery, he had quite a few procedures, which kept him in hospital for a while, but after a few weeks he was released from hospital.
Now we have doctors in the family here in UK, and because my dad has seen private healthcare in India, and the NHS in UK, we tend to be sceptical of what private hospitals do in India. The hospital my uncle went to in Kolkata was the most famous and most expensive, Belle Vue.
After he was released, we asked for scans of what exactly he/ his insurance company was being billed for. We looked up the procedures; and talked to other specialists in the field- and it turns out that the procedures he had were basically unnecessary and the complications he were having could have been solved by regular dose of medication and a very un-invasive procedure (unlike what he had- which in turn meant he naturally had to stay in hospital for longer and pay more as there is a charge per day).
So he had been fleeced of money, and he didn't have a clue. When we told him his reaction was not really shock, he did not really trust the hospitals in the first place and knew things like this could happen. He would not have found out if we hadn't researched it, and we only knew because we have contacts in the medical field. This was the best and most expensive hospital in Kolkata- but his underlying trust in healthcare itself was so poor anyway, it's a sad state.

by HM Murdock Fri 01 Apr 2016, 1:45 pm

It Must Be Love wrote:
HM Murdock wrote:
It Must Be Love wrote:But I do think, as many others do, that when it comes to healthcare there is a real issue with having the profit motive driving everything.
This is a huge flaw in your argument. Profit already saturates healthcare and with good effect.
I said 'everything', not 'anything'. I have specific concerns that I've raised, the points you made are indeed true, I'm not calling for the nationalisation of thermometer companies.

I know you weren't proposing mass nationalisation.

I was questioning why you can accept that the profit motive benefits health care in so many ways but see it as such a danger in administering the service?

I understand your point that a customer can go to Lidl and make a judgement on quality but they cannot make an informed judgement on healthcare. They therefore don't know if the service they are being offered is good or bad. I broadly accept this point.

But they still have the same lack of knowledge when health care is provided by the State. They are still not equipped to make a judgement on the service being offered.

So your conclusion is based on the premise that the State can be trusted more than than the private sector to provide the best service.

But this is in conflict with what we actually see. Private health care is generally seen as better than the NHS. That's why many employers offer private healthcare as a perk. We can see that the private sector can and does administer good health care.

We must also recognise that anything, not just healthcare, run the State tends to be unwieldy, bureaucratic and not innovative. The NHS also has an exceptionally poor record with regards to whistle blowers (its behaviour here really is scandalous).

I'm therefore questioning where this premise of trusting the state over a private company comes from.

by It Must Be Love Fri 01 Apr 2016, 2:01 pm

HM Murdock wrote:
I know you weren't proposing mass nationalisation.

I was questioning why you can accept that the profit motive benefits health care in so many ways but see it as such a danger in administering the service?

I understand your point that a customer can go to Lidl and make a judgement on quality but they cannot make an informed judgement on healthcare. They therefore don't know if the service they are being offered is good or bad. I broadly accept this point.

But they still have the same lack of knowledge when health care is provided by the State. They are still not equipped to make a judgement on the service being offered.

So your conclusion is based on the premise that the State can be trusted more than than the private sector to provide the best service.

But this is in conflict with what we actually see. Private health care is generally seen as better than the NHS. That's why many employers offer private healthcare as a perk. We can see that the private sector can and does administer good health care.

Reasonable points HM, I see where you are coming from, but:

a) The average money spent per person in private is more than NHS, because generally richer people (or richer private companies) fund private healthcare. If everyone had private healthcare, that average cost would definitely have to go down.

b) I trust most doctors and nurses are there to do the best job they can. If they make a mistake it's not only that they may lose their license (or be hugely set back in their career if they want to become a consultant), but it's also very emotionally stressful to see patients suffer because of something you did. Most mistakes are made because wards are understaffed with nurses/junior doctors, or because doctors are tired after working 13, sometimes 24, hours in a row.
My dad works as I said in NHS mainly but some private. I've seen the emails the private companies send out to doctors, they have data on the doctors which are costing them the most money, and then they send 'recommendations' and subtle threats to become more profitable (one of my dad's colleague as I said was removed from the list of advertised doctors for a year)- it's pretty unethical.

c) This is an quote from a GP Gavin Francis writing in your favourite newspaper- the Guardian:

GP writing for The Guardian wrote:In my work as an NHS GP the corrupting effect of private practice is less immediately obvious, but through my correspondence with specialists I know it still goes on: scans, arthroscopies and follow-up appointments are all more lavishly recommended when the patient is paying, which makes one wonder about the criteria used to recommend them. Recently an angry father insisted I refer his son for consideration of a tonsillectomy after a couple of episodes of tonsillitis. If I want to refer someone to have their tonsils out on the NHS, my local surgeons won’t countenance seeing them unless they meet certain criteria: seven episodes of tonsillitis in the last year, or 10 over the last two years, or three a year for the last three consecutive years. There are good reasons for this: tonsillectomy risks haemorrhage, infection and leaving you more prone to throat problems in the future. Though we all pay for NHS care through taxation, no doctor in the NHS will now remove your tonsils just because you’ve asked them to – that would be considered a grave abandonment of professional standards, and a flouting of evidence-based practice. But the private healthcare market specialises in treatment on demand, and the rules are different over there. When the father repeated his demand at a private clinic the surgeon’s professional reservations melted away and the operation was scheduled within days.

d) There's also a problem with Bogbrush's plan for a total 'free market'. Bogbrush somehow assumes that all barriers to entry are caused by the state, so in a free market you have perfect competition.
But this isn't true, in a total free market, the companies that initially are more successful would grow in size. They would then start to take advantage of economies of scale. (Basically they can start getting equipment, medicines etc. for cheaper as they're bulk buying). This would drive many smaller healthcare companies that don't have economies have scale out of business. Bogbrush's example of 'if you don't like AmritCare start up Jahu care' is very naive and doesn't take into account the barriers to entry.
It would probably end up with a few huge healthcare providers, taking advantage of economies of scale to provide lower cost than others but still make profit. So Bogbrush's main dream of prefect competition, would not manifest in real life.

by HM Murdock Fri 01 Apr 2016, 2:07 pm

IMBL - our posts overlapped.

Your last message give some good reason for distrust of the private sector.

I still think your conclusion is to sweeping though.

If I've understood the account correctly, it was doctors who were ripping your uncle off. They were doing more than necessary in order to claim more money.

My question would be why would these doctors suddenly start putting the patient first if they worked for the NHS? They are clearly unethical doctors. These would blight any service, private or public.

Using these doctors as being representative of private care is as sweeping as using an over-tired, rushed doctor missing something vital because he needs to free up some beds as being representative of the NHS.

The question is which can produce a better "normal" standard - private or public.

My reservation about the private sector is nothing to do with the service they can offer. I'm sure it could offer a great service.

My reservation is about how the poorest people get good healthcare. If you don't have much money, you can buy cheap clothes, a cheap second hand car or you can even choose to go without certain things. I can't think how such an approach would work with health care.

by HM Murdock Fri 01 Apr 2016, 2:07 pm

We overlapped again! ^This is a response to your last-but-one message!

by bogbrush Fri 01 Apr 2016, 2:20 pm

It Must Be Love wrote:
d) There's also a problem with Bogbrush's plan for a total 'free market'. Bogbrush somehow assumes that all barriers to entry are caused by the state, so in a free market you have perfect competition.
But this isn't true, in a total free market, the companies that initially are more successful would grow in size. They would then start to take advantage of economies of scale. (Basically they can start getting equipment, medicines etc. for cheaper as they're bulk buying). This would drive many smaller healthcare companies that don't have economies have scale out of business. Bogbrush's example of 'if you don't like AmritCare start up Jahu care' is very naive and doesn't take into account the barriers to entry.
It would probably end up with a few huge healthcare providers, taking advantage of economies of scale to provide lower cost than others but still make profit. So Bogbrush's main dream of prefect competition, would not manifest in real life.

That's because you don't understand competition.

Answer me this, how does a small car manufacturer survive against Ford and Porsche?

Please, medical students shouldn't suggest businessmen of 25 years experience running a £80m company are naive about the workings of a market. It's reckless to say the least.

by It Must Be Love Fri 01 Apr 2016, 2:21 pm

HM Murdock wrote:
My question would be why would these doctors suddenly start putting the patient first if they worked for the NHS? They are clearly unethical doctors. These would blight any service, private or public.

No, I don't think that's the case at all, it's not black and white like that. Do read my point on the emails the private companies send doctors behind the scenes. We speak to these doctors, they do what they think is right for NHS patients, but have to take into account other pressures in private healthcare.
And remember the invasive procedure my uncle had was still suitable, it was just as suitable as another procedure which would have cost less and been less invasive. It's a systemic problem all across the private sector in every country you go to.

HM Murdoch wrote:Using these doctors as being representative of private care is as sweeping as using an over-tired, rushed doctor missing something vital because he needs to free up some beds as being representative of the NHS.

NHS resources not going up with demand is a huge problem for the NHS though. For that we need to either increase resources, or try and control the demand. I'm typically pro-EU, but I have to acknowledge immigration and better medicine are both increasing demand on NHS. Just because I disagree with BB's solution, doesn't mean I think NHS is perfect.

HM Murdoch wrote:
My reservation is about how the poorest people get good healthcare. If you don't have much money, you can buy cheap clothes, a cheap second hand car or you can even choose to go without certain things. I can't think how such an approach would work with health care.

Indeed, just compare the medical treatment of someone in poverty in the US, compared to someone in poverty in the UK. I'm proud I live in a country where if you are too poor and struggling with rents, getting cancer won't kill you of financially/literally.

by bogbrush Fri 01 Apr 2016, 2:30 pm

HM Murdock wrote:
My reservation is about how the poorest people get good healthcare. If you don't have much money, you can buy cheap clothes, a cheap second hand car or you can even choose to go without certain things. I can't think how such an approach would work with health care.

It already happens. You think Roman Abramovic would sit in A&E?

Cheap doesn't mean inadequate, nor does however the thing is supplied mean people can't be helped (as you acknowledged).

by It Must Be Love Fri 01 Apr 2016, 2:48 pm

bogbrush wrote:
Please, medical students shouldn't suggest businessmen of 25 years experience running a £80m company are naive about the workings of a market. It's reckless to say the least.

Oh sorry Mr. Trump, I nearly forgot that successful businessmen knew everything about anything.
https://www.youtube.com/watch?v=j3ULSN70tuo 'replace it with.. something great, just great'

Address my point about why economies of scale wouldn't create a barrier to entry in healthcare, and then we can talk about cars.
Your problem is you have a idealistic vision where every industry can go have perfect competition, and if Jahu doesn't like AmritiaCare, he can set up JahuCare; the problem is many markets give natural advantages cost wise to bigger companies; so we do end up with a few big companies dominating instead of your unrealistic dream.

by bogbrush Fri 01 Apr 2016, 3:03 pm

Because economies of scale operate to the point where they support superior service at lower cost - which is really good for customers, right? - and as soon as they result in inferior product, or slowness to adapt, they become diseconomies if scale. That's where they get run around by a better offer. Happens all the time, but the effects are usually countered by the State imposing the type of barriers that big, slow entities love.

I'm glad you're asking questions, I just hope you understand the answer. And don't bother with the cheap insults, they're water off a ducks back - you only show off what you don't understand by using them.

Now, think about other examples where smaller entities compete quite successfully with vast businesses. How do you think they do that?

by HM Murdock Fri 01 Apr 2016, 3:04 pm

bogbrush wrote:
HM Murdock wrote:
My reservation is about how the poorest people get good healthcare. If you don't have much money, you can buy cheap clothes, a cheap second hand car or you can even choose to go without certain things. I can't think how such an approach would work with health care.
It already happens. You think Roman Abramovic would sit in A&E?

Cheap doesn't mean inadequate, nor does however the thing is supplied mean people can't be helped (as you acknowledged).

My reservation is not inequality but ensuring that everyone gets something.

The free market creates variety and choice which I can fit to my budget. I can buy a Ferrari or I can buy a Dacia Sandero.

But certain medical conditions are incredibly expensive to treat. I'm not sure there could be a 'Dacia Sandero' when it comes to treating, say, HIV or some forms of Tuberculosis.

The free market is based upon willing transactions. By definition though, one person in a health care transaction is effectively forced into it. If I get a serious case of tuberculosis, I haven't 'chosen' a more expensive illness in the way that I might choose a more expensive consumer product. What if I can't afford the illness I've developed?

How does the free market model address this?

by bogbrush Fri 01 Apr 2016, 3:10 pm

HM Murdock wrote:
bogbrush wrote:
HM Murdock wrote:
My reservation is about how the poorest people get good healthcare. If you don't have much money, you can buy cheap clothes, a cheap second hand car or you can even choose to go without certain things. I can't think how such an approach would work with health care.
It already happens. You think Roman Abramovic would sit in A&E?

Cheap doesn't mean inadequate, nor does however the thing is supplied mean people can't be helped (as you acknowledged).
My reservation is not inequality but ensuring that everyone gets something.

The free market creates variety and choice which I can fit to my budget. I can buy a Ferrari or I can buy a Dacia Sandero.

But certain medical conditions are incredibly expensive to treat. I'm not sure there could be a 'Dacia Sandero' when it comes to treating, say, HIV or some forms of Tuberculosis.

The free market is based upon willing transactions. By definition though, one person in a health care transaction is effectively forced into it. If I get a serious case of tuberculosis, I haven't 'chosen' a more expensive illness in the way that I might choose a more expensive consumer product.

How does the free market model address this?

In the end there is always difference in options, the question could be misread as suggesting the current model doesn't have that. Some treatments are already not available on the NHS because of cost / benefit analyses and people die because of that, and there's always private healthcare. This will only continue.

The issue isn't offering identical treatments to all because that has never existed, it's about ensuring a sensible floor (an entirely different debate from 'production' of the service). That can be done through collective direct support to the ill person if we want but it sure as Hell would be easier if the service was cheaper and better, which brings us back to the role of competed profit

by It Must Be Love Fri 01 Apr 2016, 3:35 pm

bogbrush wrote:Because economies of scale operate to the point where they support superior service at lower cost - which is really good for customers, right? - and as soon as they result in inferior product, or slowness to adapt, they become diseconomies if scale.

But even if their service is slightly inferior, I myself can't set up a business and compete with their economies of scale unless I bulk buy. There is a share of the market where businesses can find the best balance between economies of scale and diseconomies of scale; and it's not necessary that it results in perfect competition.
And I've made so many points in detail about how they hospitals can actually not work in the best interests of the patient, without the patient realising, and I've given many examples. But you haven't even addressed that, HM did actually acknowledge it, but you only reply to things where you can give your stock response of a one sided view of the free market.

We are going to have to agree to disagree and move on, I think you're too idealistic to see any flaws in your belief

by HM Murdock Fri 01 Apr 2016, 3:46 pm

bogbrush wrote:The issue isn't offering identical treatments to all because that has never existed, it's about ensuring a sensible floor (an entirely different debate from 'production' of the service). That can be done through collective direct support to the ill person if we want but it sure as Hell would be easier if the service was cheaper and better, which brings us back to the role of competed profit

Which is why I think the State will ultimately have to play some kind of role in the process.

Which of course is not the same as saying it should be what delivers the service.

I think my general wish for the State to basically get out of the way but to be there in times of emergency would fit pretty well when applied to health care too.

by bogbrush Fri 01 Apr 2016, 4:38 pm

It Must Be Love wrote:
bogbrush wrote:Because economies of scale operate to the point where they support superior service at lower cost - which is really good for customers, right? - and as soon as they result in inferior product, or slowness to adapt, they become diseconomies if scale.
But even if their service is slightly inferior, I myself can't set up a business and compete with their economies of scale unless I bulk buy. There is a share of the market where businesses can find the best balance between economies of scale and diseconomies of scale; and it's not necessary that it results in perfect competition.
And I've made so many points in detail about how they hospitals can actually not work in the best interests of the patient, without the patient realising, and I've given many examples. But you haven't even addressed that, HM did actually acknowledge it, but you only reply to things where you can give your stock response of a one sided view of the free market.

We are going to have to agree to disagree and move on, I think you're too idealistic to see any flaws in your belief

It really isn't me who's idealistic, I believe in systems that turn people's selfish instncts to useful outcomes. Profit is selfish, use it, but don't ever insulate those who chase it from the implications of the contracts they enter into. Make sure they could lose everything, that'll make them direct their selfish urges where you want them,

You seem to think it's all about the cuddly State employing kind people who dream of days when we all love each other and no puppies ever die.

by temporary21 Fri 01 Apr 2016, 4:41 pm

There is such a thing as the left wing, there isnt just one way to do business. Not that that means I endorse Mr Pidgeon but I respect different points of view

by bogbrush Fri 01 Apr 2016, 4:55 pm

You should have gone to SpecSavers.

by Johnyjeep Fri 01 Apr 2016, 5:02 pm

It Must Be Love wrote:
bogbrush wrote:Because economies of scale operate to the point where they support superior service at lower cost - which is really good for customers, right? - and as soon as they result in inferior product, or slowness to adapt, they become diseconomies if scale.
But even if their service is slightly inferior, I myself can't set up a business and compete with their economies of scale unless I bulk buy. There is a share of the market where businesses can find the best balance between economies of scale and diseconomies of scale; and it's not necessary that it results in perfect competition.
And I've made so many points in detail about how they hospitals can actually not work in the best interests of the patient, without the patient realising, and I've given many examples. But you haven't even addressed that, HM did actually acknowledge it, but you only reply to things where you can give your stock response of a one sided view of the free market.

We are going to have to agree to disagree and move on, I think you're too idealistic to see any flaws in your belief

You are assuming that every product bought is determined by price. Of course you can enter a market without buying in bulk. Just don't compete on price. Differentiate your product in another way. Your textbooks will tell you that.

But the reason I posted is your notion that BB is too idealistic when your stance earlier is that anyone with a doctorate in any of the medicinal sciences suddenly reaches a state of enlightenment that they cannot possibly act in any kind of selfish manner or even make a mistake unless they have been working for 10 straight days. A look at the recent Junior Doctors strike will tell you anything but. Yeah, we accept the proposals..thanks for the pay rise on basic, we're still happy to work on Saturdays....but pay us more for Saturday's.

Having worked in the private sector for 10 years and now the public sector for 5, I would much much rather see as much control of important services taken away from public sector entities. For so very many seasons. Both financial and quality reasons.

For e.g. and fairly obviously, employee costs are by some distance, the biggest expenditure item for local government. Yet anywhere between 1/5th and 1/4 of these costs are going on employee pensions. A fairly hefty portion of that percentage, is to cover the vast deficit most LGPS schemes currently operate at. So a large portion of expenditure on employees is to pay for individuals who don't even work in delivering public sector services. It's a dire state. But the solution is not "just give us more money".

by Johnyjeep Fri 01 Apr 2016, 5:05 pm

HM Murdock wrote:
bogbrush wrote:The issue isn't offering identical treatments to all because that has never existed, it's about ensuring a sensible floor (an entirely different debate from 'production' of the service). That can be done through collective direct support to the ill person if we want but it sure as Hell would be easier if the service was cheaper and better, which brings us back to the role of competed profit
Which is why I think the State will ultimately have to play some kind of role in the process.

Which of course is not the same as saying it should be what delivers the service.

I think my general wish for the State to basically get out of the way but to be there in times of emergency would fit pretty well when applied to health care too.

I'd agree with this.

by bogbrush Fri 01 Apr 2016, 5:30 pm

bogbrush wrote:You should have gone to SpecSavers.

Or Vision Express.

by It Must Be Love Fri 01 Apr 2016, 6:22 pm

Johnyjeep, I think I've said all I've had to say on the private v state issue; you are right that it's not impossible to get round economies of scale, but it is still a significant advantage and it's very possible that a few providers will dominate the market.
If you want, read my points and examples at the top of the page and page 1 of the thread on why I think private healthcare may have real systemic problems. If you still totally disagree, then that's ok, we can move on.

Johnyjeep wrote:But the reason I posted is your notion that BB is too idealistic when your stance earlier is that anyone with a doctorate in any of the medicinal sciences suddenly reaches a state of enlightenment that they cannot possibly act in any kind of selfish manner or even make a mistake unless they have been working for 10 straight days. A look at the recent Junior Doctors strike will tell you anything but. Yeah, we accept the proposals..thanks for the pay rise on basic, we're still happy to work on Saturdays....but pay us more for Saturday's.

No I didn't say that, what I said is that I think most mistakes made by doctors aren't due to mal-intent (honest errors); and I think exhaustion is a big factor as well.
As for the junior doctor contracts, it's actually beyond belief. The more you look into the detail, the more disastrous it is, not just for the doctors but for the NHS. Do you want even more exhausted doctors treating you in an emergency ?
Most junior doctors I've spoken to would not accept the contract even if Saturday pay was increased- the problem is the BMA are compromising much more than they should be. If you believe everything you read in the media, and still want to demonise the whole workforce, that's fine, but consider this-

Most junior doctors actually already work far beyond the hours they are paid for. This I can bet my life on, as I've spent huge amounts of time shadowing them already, and not even once has a junior doctor actually left when the time is up. Technically it would be allowed, but then it's also negligent as patients would suffer. I'd say around 2-3 hours more on average than what they get paid for. Go to any hospital, and just ask anyone who's involved in the medical team. If the junior doctors worked the hours they were meant to, you could say bye bye to your NHS, it would all collapse in a week. It's being kept afloat on a sea of free labour.
Already we have many cases of total exhaustion, I have a few older friends who are barely getting time to eat and sleep and one has lost 7 kilos in 2 months- with the gaps in staffing and lack of locum recently I have with my own eyes seen a few instances of doctors having to work 25 hours in a row- the new contracts will see doctors leave and that will become a lot more frequent. There's also a hidden mental health crisis among junior doctors which total exhaustion plays a part in.

by bogbrush Fri 01 Apr 2016, 6:32 pm

I see you have the party line well settled.

Funny how the BMA is quite happy to endanger all the patients with exhausted doctors, so long as the pay is right for Saturdays. Laugh

by bogbrush Fri 01 Apr 2016, 6:34 pm

bogbrush wrote:
bogbrush wrote:You should have gone to SpecSavers.
Or Vision Express.

Oh how would I choose? I mean, it's medical, right?

by It Must Be Love Fri 01 Apr 2016, 6:46 pm

bogbrush wrote:I see you have the party line well settled.

Funny how the BMA is quite happy to endanger all the patients with exhausted doctors, so long as the pay is right for Saturdays.

It's not the party line, I'm talking about problems that are happening now, even without the new contracts.
This is from 2013, talking about the problem of exhaustion long before any change in contract:
http://www.dailymail.co.uk/health/article-2278685/Exhausted-junior-doctors-working-100-hours-week-putting-patients-lives-risk.html

The new contracts will make the problem even worse... talking about BMA arguing for Saturday pay is like them trying to quickly go into the kitchen and save the microwave before a hurricane smashes the whole house; the new contracts will make it less likely people will go into specialities such as emergency medicine which are already suffering from a recruitment problem, which means doctors in A&E will be have to be working even longer to make up for the lack of staffing and gaps in rotas.

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