Be Excellent To Each Other

Wow, we're setting the bar really low these days.

Not sure of the point you're making. If it's "the tabloid press are twats", well, yeah.

Personally I'm totally appalled and mortified at 47% and feel the situation is beyond critical... What, so if Nick Griffin secured 47% of the national vote, you'd all be saying 'phew... crisis, what crisis, at least he was 3% shy of a majority everyone!' ..?

... A plague on all the houses of those who devised self evidently fatally flawed vanity projects such as the Euro, open and unfettered borders and political union. As ever, the end game will be the very opposite! Such irony, then... even as people like you guys refuse (still) to even believe it's happening at all.

I don't refuse to believe what is happening; I just don't see that there's a lot I can do to stop it.

If Murdoch prints "Muslims are my baby and the EU is to blame" and disseminates that viewpoint on a daily basis to millions and millions of people, there's not a lot I can do to stop the madness than ensues.

Look at the States. A website made up that a particular pizza restaurant was being used by Hillary as a child abuse den. One of Trump's cabinet endorsed the fake news and now a nutter with several guns went in and fired shots there, surrounded by families, because he believed it.

Not sure where all of this can lead, but it is unlikely to be a good place.

Well, regardless of the outcome of this week's hijinks at the Supreme Court, hopefully it'll remind people that not only do we have a constitution but that it matters.

I had an amble round the building last year when killing time in London. Not normally a fan of mock gothic but it was quite charming in its way (and kept me out of the rain for an hour or so). The gift shop wasn't very good, however.

Yeah, i know a bloke who wasn't very impressed with the shop. He showed his displeasure by nicking a calendar. He got twelve months.

Get out.

By the way, the nasty Austrian Nazi chap did get around 46.7%, but this was a re-run of the past election that was annulled. In the original he got 49.7%. So his vote share decreased, which is a good thing.

Interesting article in light of the Casey report.

See, this is the thing I just don't get.

On the one hand, people can get very hot under the collar at times over, say, very mildly inappropriate and even wholly inadvertent use of mere language here (say, some unintended mildly sexist faux pas or other; a 1980s anachronism perhaps), with all sorts of ensuing "twit-storms" or whatever....... yet some fucking Neo Nazi *just* misses being elected head of state, right on our doorstep in *Austria* of all places, and Italy's government falls on the same day, and the response is pretty much "meh"...?

I suppose it's an overload/this does not compute moment. Me? I can't see the first thing "good" about it, and just because I personally can't do much about it as an individual surely does not mean it's not even worth discussing? I pretty much can't influence anything at all in politics, but that doesn't mean we shouldn't talk about this stuff.

You reap what you sow. Note that I will never, ever, EVER excuse anyone for using their democratic, hard fought for and hard won vote to vote for an extreme Right (or Left) candidate, regardless of perceived or actual provocation. But it surely *is* clear that the terrible backlash is coming from years of quite ordinary people being force-fed bullshit - that they're damn well going to like things they never wanted or asked for like the Euro, full political union, open borders, unfettered immigration - and if they don't, well, they're somehow evil fascists or whatever. So yeah, under the circumstances, somewhat ironic, huh...

So in short, I very much blame the utterly perverse, clueless political vanity of the Europhile Left for this dangerous situation whose tipping point is surely now well exceeded. People are angry.

I think it's come about largely by people being force fed bullshit by the overwhelmingly right wing media. People are pissed off about a situation that is, in many respects, a work of fiction. Mainstream right wing parties spent decades playing up to that and then when the far right seized the initiative they lost control of what they had created. Reap what you sow indeed.

I care deeply about things like the Austrian election, but it's less in my control than trying to make language more inclusive etc. Obviously electing a fascist is worse, but I'm not sure what I'm supposed to be doing here to show that.

There are certainly structural issues of how we can ensure that less metropolitan areas of the country can retain jobs that pay well. The far right media barrage of the likes of the Sun, Express, Mail et al who continually lie and stoke fear and xenophobia though, they really exacerbate the problem and drive normal people into the arms of UKIP, Britain First, EDL, KKK and so on. People believe them, but the only press regulator is still the press themselves, since the government commissioned a massive report and ignored all the fucking findings.

No. I'm the first person to berate the press and journalists (in fact, far more so than most here, much to the chagrin of some I might add), but to blame the Daily Mail for the stuff that's demonstrably and inarguably happened in EU states, especially mainland Europe, for the last 5 years, is just plain daft.

Whether we like it or not, whether it's palatable or not, whether it fits one cosy world-view or another, or not.... people have grievances and they're not all the figment of the right wing gutter press' imagination. The sooner this basic, bitter home truth is faced up to the better, I'd say, although it's probably too late either way now.

What kind of things have happened due solely to the EU in the last five years? I think most of the things you say will end up being the choice of our govebrment.

Surely I don't actually have to trot out the various manifold failings of the EU these last few years, most notably those in specific connection to the aspirations of political and monetary union? Come on, surely this has to be a rhetorical question, and in the nicest possible way, Curio, I don't have the time mate.

Enough of the untruths. The EU isn't "Left". Try finding a mainstream centre-right party in a EU member state which doesn't support EU membership. (Or a centre-left party, for that matter.) European Union membership is a political centre, national consensus issue for most of Europe.

Anyway, for a diversion, let's have a look at the founding fathers of the EU…
https://europa.eu/european-union/about- ... fathers_en
* Konrad Adenauer (German Christian Democrat)
* Joseph Bech (Luxembourg Christian Democrat)
* Winston Churchill (British Conservative)
* Alcide De Gasperi (Italian Christian Democrat)
* Walter Hallstein (German Christian Democrat)
* Sicco Mansholt (Dutch Social Democrat)
* Jean Monnet (French economist)
* Robert Schuman (French Christian Democrat)
* Paul-Henri Spaak (Belgian Social Democrat)

Wow, what a load of dangerous lefties.

Are all those Christian Democrat parties related in some way?

They or their successors would all have been members of the European People's Party at some point.

Christian Democracy has generally been very successful in western Europe. Germany, Italy and the Netherlands in particular have been governed for long runs by Christian Democrat parties.

Thanks, I'll have a proper read in a bit.

It's interesting to note that, according to the OECD,

http://stats.oecd.org/Index.aspx?DataSetCode=SHA

... despite Spain having more beds per capita than we do, their healthcare system costs them 9% of GDP, significantly less than ours at 9.8% of GDP... which is also much more than Australia, Italy, Finland and loads of others besides... and actually comparable to the excellent Canadian system costs at 10.2% of GDP, despite vastly more disparate populations and harsh climate etc. Even Austria's is 10.1% comparable to our 9.8% - and with three times as many beds per capita being achieved. Oh dear.

I'm sure there's a lesson or two to be learned there. But hey, done to death previously. "Our grate NHS11! it's all evil Torees with their cuts!!!!!!!!!" etc.

No doubt the suggested, default solution of the Left is to throw yet more (borrowed) money at it as-is, eh. Same old, same old.
No wonder why this moribund, failed politics has gone the way of the dodo.

The NHS is broken, not poor.

Time to start again and emulate other vastly more successful, efficient systems, then, as I've been saying for 30 years, political vanity be damned. Throwing yet more money at it is utterly futile and, I would argue, morally wrong. Good money after bad etc.

It is, quite literally, a matter of life and death.

So what do we change? If we have a roughly even level of funding with these other countries, what do they do that we don't?

Just as long as it's not "Copy the USA", who spend vastly more than us, but have a similar level of beds per head and who's healthcare system appears to be a giant bureaucratic nightmare.

The USA has basically the worst healthcare system in the entire world, unless you're rich.

Bullfighting.

http://ec.europa.eu/economy_finance/gra ... ife_en.htm

If our system was consistently amongst the worst in these comparisons then I'd agree. But it isn't, it's usually up there amongst the best. And plenty of the ones that do worse are based on the sorts of systems people like cavey would want to see here.

I just don't see how that graph and countless others like it, set against a trajectory over recent years of increasing efficiency support the notion that totally dismantling the current system in the hope that it will be replaced magically by one of the few more efficient ones, themselves systems which evolved into being over many decades makes any kind of sense.

Unless we just keep picking out individual stats such as "beds per capita" or some shit, which bear little relation to outcomes.

The report by the British Social Attitudes survey (BBC summary) on leaving the EU (I'm tired of hearing 'brexit' now, although if the prime minister is taking requests, I'd like an itsy-bitsy teeny weeny yellow polka dot one please) is very much in line with Lord Ashcroft's work from a few months back.

What depresses me is the thought that I, and others, might be so out of touch with understanding the needs, concerns, and values of half the country, and that I currently can't see a way to bring them onside.

In a nutshell: Private Sector.

(Predictably, we're getting the USA cited as a false example, despite no-one - least of all me - EVER advocating it/them. Just the usual red herring BS, almost every one of those empirically and demonstrably cheaper, more efficient and better performing healthcare systems that I mention are Private Sector based systems. Almost no-one uses the NHS model... why would anyone want to emulate failed 1940s Socialist-centralised, top-down State controlled and run systems? No company has been run like this since the 70s).

I don't think the health service is helped by having massive overhauls every five years or so either. No sooner does a system bed in and start functioning the whole edifice is torn down and rebuilt again. See also: education.

The problem with private sector involvement in healthcare is that they're companies that are inherently driven by profit margins and shareholder value. Healthcare is somewhat the opposite. There are conditions that are extremely expensive to treat and the motivation is always going to be there for companies to find ways to not offer expensive treatments, or to find ways to avoid paying out at all. A national healthcare service has to be altruistic at it's heart, and that's a tough sell in the boardroom.

Surprisingly perhaps, but I agree. I wish people/Parties would have the political courage to just come out and baldly state the NHS, as a model, doesn't work (or is demonstrably much worse than the best of the rest), so instead of endlessly tinkering at the edges, bin the entire thing and start again with a Spanish, Austrian or Finnish mode (or whatever) from the ground up, in one giant hit. All we need to do is just copy what they do.

I don't think that's something you can state though. Yes, it's straining under pressure, but in terms of quality of care and survival rates it's consistently up near the top of the scoreboard.

I think the problem with people's perception of the NHS is that it is an attempt to get 60 gallons into a 55 gallon drum.

Seriously, how is it then that these private sector companies with shareholders and boardrooms ARE able to so successfully deliver in Austria, Spain, Finland or wherever? The answer lies in the frameworks upon which those systems require them to operate, and all we need to do is copy them.

It's not so much a case of whether the current structures and funding levels achieve the good outcomes now, but whether they will provide a similar or better standard in thirty years' time, especially against an ageing population, greater dependency ratios, and rising costs.

I probably need to spend a wet weekend reading papers from the Kings' Fund because I'm really not sure where to begin to attempt to answer these points.

Spain has the same model as us - fully funded state healthcare or private via insurance. It's pretty close to identical.

Wait, and so is the finnish model. I'm confused.

You did read that OECD table I linked to in my OP, right? It's one table, on one A4 piece of paper.

But seriously, I really should know better. You can never be told, end of.
As I've remarked before, it's the same syndrome as and his bust-up with GCSE Physics, and I've really no time for that kind of thing if I'm honest.

What "Private Sector based systems"? The countries you've mentioned, Austria, Italy, Finland, Spain, Canada all have universal public healthcare. You can't have universal healthcare without state intervention and involvement. (Note that even America has state-funded Medicare and Medicaid.)

The British NHS is historically one of the most influential healthcare systems. The Italian health system's name translates as national health service for a reason. The premier of Saskatchewan, Canada who introduced North America's first public healthcare system was deliberately influenced by the NHS. Just two examples. Yes the NHS is imperfect, but it is bollocks to claim that the NHS never influenced other countries.

If you want a reason why Austria has three times as many beds per capita, incidentally, it's because the system is funded by social insurance, therefore suppliers of healthcare (hospitals and clinics and so on) will have spare capacity. The supply and insurance/assurance elements of healthcare provision are de-coupled under that system, unlike the integrated NHS model.

London Underground was influential too, and that's lagging behind most other underground train networks.

Not that anyone mentioned influence, but still.

Privatising it will still only stand a chance of working if you either increase the money coming in (through people paying, or paying more) or decrease demand (and you want to do that by decreasing the number of people using it for things that will get better on their own, rather than sick people just being scared to go, but the latter will happen too).

The thing that's often missed by 'make it private, because private sector is skill' advocates is that demand is increasing by 4% per year, and money isn't. Doubtless there's some slack in any system, but healthcare is special, in that people will put more effort in more or less any time they can see that doing so saves lives/helps. In a pizza place? Less so.

Compare to that pizza place. Demand increases 4% each year. But no (or little) more money is received. First year, fine - you've got to make more pizzas, people have to work a bit harder. They get less downtime to chat, a little less happy perhaps, but you find a saving on tomatoes, and everything works. Next year, 4% more pizzas again. Still no more money, so no more staff. Maybe you find another way to save money, but keep the quality the same. Next year, 4% more demand again. By now, you're out of great ideas to save money. You're shipping out even more pizzas, your staff have no spare time, some of them quit, and are replaced by others - are they as good?

No business, long term, can cope with that - 4% increase in demand every year, with no extra revenue.

This graph (being the first one I found) suggests that spending is increasing by way more than 4% a year, though.

It is old! ignore it and I'll find a better one.

Ugh. They're nearly all as a % of GDP, which means nothing.

That was my replay to Cavey falsely claiming "Almost no-one uses the NHS model…". As Cras has noted in his posts above, Finland and Spain based their health systems on the NHS. It's a common claim by people in favour of privatising the NHS that no other country adopted or was influenced by the NHS model, which is very much untrue. Technically speaking, the NHS has been the most influential health system worldwide, along with the (West) German system, the latter inspiring nations as wide as Japan and Israel.

(No, of course that isn't me saying the NHS in 2016 is perfect or in a good state, or that other countries duplicated the NHS down to the last detail.)

I guess the comment I'd make here, JBR, is that if there is a '4% increase in demand' each year, presumably this will be down to factors like an ageing population (as well as an increasing one through net migration) - but these factors are surely little different to the other better 'competitor' systems of Europe or Canada costing similar amounts, for more bangs-per-buck? How come they can cope better, achieve more beds per capita (for similar outlay) than our creaking NHS, with its burgeoning deficits and so on?

The other point to note, of course, is that as Grim... says, it's not even the case that the NHS budget is static and unchanging, it's anything but. Real terms spending has very much increased these last 10 years, despite lean, post 'financial crisis', austerity-driven times.

My understanding is that NHS net expenditure (resource plus capital, minus depreciation) has increased from £75.822 billion in 2005/06 to £117.229 billion in 2015/16 (+55%). Planned expenditure for 2016/17 is £120.611bn (+3% on last year), and deficits (i.e. overspending beyond budgets, a 'business overdraft' if you will) are increasing to boot. So really, the pizza place analogy doesn't work mate.

According to that, the yellow line (i.e. actual cash spend, at 2010/11 prices) went from £60Bn in 1997 (end of the Tories' rule) to c.£110Bn in 2007 - that's not far off doubling in a mere decade. Bloody hell, that's a massive increase, and we're *still* bobbins..?.

By way of comparison, this health spend rose from c.£39Bn in 1980 to perhaps £42Bn in 1990 (i.e. over 10 years of Tory govt). That's a real terms increase of around +10% for the entire decade (not +100%)

You keep asserting this, but I don't know where you're getting it from.

http://www.nhsconfed.org/resources/key- ... on-the-nhs



If your only metric for a healthcare system is value for money, then I can see a valid source for concern. But it absolutely should not be the only, or most important metric.

Also, see the last couple of pages for further examples, Austria, Australia etc.

I don't mean to sound nasty, Cras, you're a nice guy and one of life's true gentlemen. I like you a lot. Frankly though mate (IMO) you will never see this, because for whatever reason, you too far vested in the beliefs and arguments you've been making for the last few years (albeit I cast my mind waaay back to 'the early years' and, IIRC at least, you used to think as I do).