Competition is not some great cure all that some capitalists maintain. See rural bus routes for example.

Actually, rural bus routes can be run by private companies – they are round here (Madrid). The buses run on time, are clean, and they’re not that expensive. Assuming well-set targets, and clear, impartial oversight – there’s no reason why a private provider couldn’t do the same in the UK.

Of course, this assumes a state-run, controlled NHS. Whether that’s what the current government has planned – long term – is another matter altogether.

Or it’s actually a sign of a very competitive market. Cartels are hard to maintain because of the high defection risk.

The supply of power generally being an excellent example of that fact. Lets pick at random someone representative. How about OPEC?

The supply of power generally being an excellent example of that fact. Lets pick at random someone representative. How about OPEC?

OPEC is actually a really good example of how difficult it is to maintain a cartel! Even though it’s all done in public, explicitly, with massive (!) barriers to entry and without any legal prohibition, members still defect. It really only functions at all because Saudi acts as a swing supplier and because the demand side is oligopsonistic.

OPEC is actually a really good example of how difficult it is to maintain a cartel!

It may be difficult, but they still manage it. And have been doing for decades. Because ultimately its in their interests to do so. And completely against the interest of ‘consumers’.

And there are loads of examples of cartels operating when they’re in a position to exploit the market dominance of a relatively small number of players

BA and Virgin (who apparently hated each other) fixing the price of Atlantic flights?

The ‘big four’ banks are always at it!

I simply don’t believe domestic power suppliers are not colluding with each other. Or are all their identical price rises purely co-incidental and have been since privatisation – with enormous resulting profits?

The point I was making about the whole process of privatisation, far from delivering ‘competition’, actually establishes private and very anti-competitive monopolies.

Looking at the ‘players’ presently eying up the NHS, I can’t see that being about to change

The whole thing is a con

The point I was making about the whole process of privatisation, far from delivering ‘competition’, actually establishes private and very anti-competitive monopolies.

It can do, but there’s no guarantee that it will. OK, telephone tariffs are massively overcomplicated (a sign of healthy competition to my mind) but the service levels are so much better than when BT was the only player.

But you’re still talking about complete privatisation, not using private-run companies to supply publicly offered services. Do you object to private companies competing to run hospital cleaning, for example?

Actually, rural bus routes can be run by private companies – they are round here (Madrid). The buses run on time, are clean, and they’re not that expensive. Assuming well-set targets, and clear, impartial oversight – there’s no reason why a private provider couldn’t do the same in the UK.

Well they have not done so far without subsidies – are the madrid buses sunbsidised as well? Regulated – ie they have to run them legally? Profitable for those rural routes?
TBH i doubt either of us knows so shall we resist arguing abut rural spanish buses on a NHS thread? OR
is it google high nooon 😯

I can’t think of any real examples of part-privatisaton. Once you start, then its all or nothing. That’s the rub with the health service too

The real crux of this is that once you open the supply of treatment up to ‘the market’ then competition law then applies. So them American Big Health PLC can mount a legal challenge to the NHS forcing them to compete for service

Do you think they’re going to want to take on long-term care or anything remotely challenging? Of course not! They’ll cherry-pick the quick and profitable bits, leaving the NHS with the expensive time-consuming and involved stuff.

The NHS is an example of part-privatisation! GPs are private businesspeople – not to mention the support and technical services which are provided by private contractors.

I simply don’t believe domestic power suppliers are not colluding with each other. Or are all their identical price rises purely co-incidental

The BA/Virgin example is an excellent one too: it’s a market in which there are significant barriers to entry (mostly to do with landing rights) and limited competition, and where the arrangement was unstable and discovered.

I don’t think anyone is suggesting the price rises are coincidental. The very instability of prices is suggestive of the absence of collusion between the players. Parallel behaviour may exist because there is no scope for unilateral price changes; or where there is dominant price leadership due to economies of scale; or where there is barometric price leadership.

(And I won’t even bother to point out that none of the examples of cartels that you have given are anti-competitive monopolies, what with it being impossible for a cartel of producers to exist simultaneously with monopoly…)

Wish they hadn’t privatised BP, licence to print money right there.

HMG gets a big chunk of oil money through PSAs and duty on oil and gas already, and without the hassle of actually having to develop it itself. Oil companies are already good at extracting oil. If the government wants to get more money from it, it just has to increase tax, it doesn’t have to own it itself.

I can’t think of any real examples of part-privatisaton. Once you start, then its all or nothing. That’s the rub with the health service too

So, in your world, the NHS does not buy products or services from any private sector companies?

Wish they hadn’t privatised BP, licence to print money right there.

That’s my concern, too.

The objective of a public company is to provide a service for customers/consumers. It might not always succeed, but the idea of service is rooted in its core being.

The primary objective of a private company is to make profit and to declare regular dividends to shareholders whilst providing the required service.

Philosophically, I’m of the opinion that the nation’s core service providers should all be public sector.

Didn’t say that flashy. Of course it does. But opening up clinical services to European competition law means that it has to open up any area to legal challenges to tender. Only, as I’ve stated, the private companies will only tender for the areas they can make the most profit at, while the NHS has a legal obligation to provide the lot!

Sound like a level playing field to you?

just a thought, the comment about MRSA in hospitals, aren’t PRIVATE companies now the norm for cleaning contracts? cut costs, cut quality, as i said just a thought

Can any of you privatisers please give one example of private healthcare being better than state funded.

CFH – you have raised two straw mem

1) no one is saying the the NHS is perfect and needs no alteration

2) – You state I want a monolithic supplier for political reasons – I don’t – I want a monolithic supplier because its cheapest and most efficient. I want the best healthcare for the money we have to spend – the NHS provides that.

Thats the fact you privateers (sic) forget – the NHS is one of the most efficient healthcare systems in the world. Not pie in the sky. Proven fact.

Privatisation of healthcare always produces worse outcomes at greater costs.

I have worked in NHS, PFI, Private and charity run healthcare. the NHS is not perfect but provides the best care at the least cost/,

As for competition / choice – its overwhelmingly proven that want people want is good local services – that is the choice they want – not a choice of this or that hospital.

The key thing here is evidence based practices – and the evidence is that for healthcare the NHS is the best solution. Most efficient, best outcomes, its what people want.

So I ask again – can any of you pro privatisation people show any evidence backed reason why private healthcare is better.

Well they have not done so far without subsidies – are the madrid buses sunbsidised as well? Regulated – ie they have to run them legally? Profitable for those rural routes?
TBH i doubt either of us knows so shall we resist arguing abut rural spanish buses on a NHS thread?

They’re certainly subsidised – they’re paid to run the service. They can’t raise rates on their own, and I’m sure they’re legally obliged to run them on what would otherwise be unprofitable routes. I’m just pointing out that using a private provider for a state service isn’t necessarily problematic.

TJ’s point is a very good one though – I certainly can’t provide any real example of using private healthcare providers to provide a public service, and while I’m sure their are some points of the NHS that need a shakeup, I’m no big fan of ideologically based wholesale changes.

Private healthcare is not always/usually better. But a monolithic health service doesn’t work in lots of areas because of the lack of incentive for poor services to change. And some kind of competition – and incentives to services to do well is necessary to get this. In some areas this may be provided by other NHS trusts – but not always. There is no reason why Community Diagnostics needs to be Hospital or NHS based, and on many things (MRIs, endoscopies etc etc) it would be good to get them out.

The issue is non-NHS providers paid for by NHS funds. These won’t always be evil scum sucking US conglomerates. And I give you the Horder Centre at Crowborough, as an example.

Looking at private services, some of the most successful IVF services dealing with the more difficult cases are private, with some of the NHS centre results having been rather embarrassing in the past.

The NHS is generally good, generally improving, generally better than it ever has been, but has huge areas of poor performance and complacency and is not really focused enough on the way it handles people.

so TJ now you are back – would you care to address my question about Labour’s relationship with private health care providers. The Conservatives may be in bed with management consultants, but Labour were in bed with United Health, Kaiser Permanente etc etc?

My experience of private healthcare including PFI is that it costs more for worse outcomes – and my understanding is that is the experience in the English NHS where private providers have been allowed in to do some work.

Interestingly the main benefit from private healthcare is improved hotel services in the institutions. You get a niche room but your nurse in inexperienced and there is no on call doctor

Private healthcare is not always/usually better. But a monolithic health service doesn’t work in lots of areas because of the lack of incentive for poor services to change. And some kind of competition – and incentives to services to do well is necessary to get this.

^^This^^

At issue here are a couple of things;
1 – It’s seen as herecy to posit the idea that there could be some benefit to change within the NHS
2 – Anyone who even considers such a change is an evil privateer (Nice use of the word, there!) and wants to rapaciously slash and burn their way to a profit by taking the state out of the NHS
3 – There is an incorrect assumption that somehow the this will be total NHS Privitisation (sic), when in fact it would be looking at ways of making improvement
4 – Looking at ways of making improvements is apparently evil
etc. etc. etc.

I rather like the NHS actually. Saved my father’s life. It’s ace. That’s not to say that I don’t think that it would be a good idea to constantly look for ways to improve it, no matter where or how they arise.

Stoatsbrother – labours links with private healthcare providers stinks. I am no labour supporter. Just cos I hate the tories does not make me a labour supporter.

And some kind of competition – and incentives to services to do well is necessary to get this.

Evidence based practice – find some evidence that thi is so. Its an oft repeated mantra but its false.

Find me some evidence of a for profit healthcare provider reducing costs without worse outcomes.

You will not be able to.

So give me some evidence of competition improving healthcare. is a total fallacy.

EVIDENCE BASED PRACTICE not ideologically led change

with buses one of the current failings is that cross subsidies don’t happen. This is also a failing with the post and probably a lot of other services. I wouldn’t be surprised if you could find examples in the NHS.

Some things will always cost more than the income they can generate, other things can make a profit. You can either use the profit to subsidise the loss making services, or you can cream it off give it to shareholders and then demand the state subsidise the loss making services.

Surely from a tax payers point of view, cross subsidises make more sense, but that wouldn’t do would it from a shareholders point of view.

My experience of private healthcare including PFI is that it costs more for worse outcomes – and my understanding is that is the experience in the English NHS where private providers have been allowed in to do some work.

What I can’t understand is why this should be the case: set out the conditions, including the maximum spend (based on current annual cost), and open it up to bidding. If it’s costing more with worse outcomes that says just as much about the incompetence of the people responsible for opening up the service as it does for the provider.

At issue here are a couple of things;
1 – It’s seen as herecy to posit the idea that there could be some benefit to change within the NHS
2 – Anyone who even considers such a change is evil

You keep claiming this but non of us have said it

3 – There is an incorrect assumption that somehow the this will be total NHS Privitisation (sic), when in fact it would be looking at ways of making improvement

That is the aim of this reform. Don’t be mislead. Its to allow American private for profit healthcare companies to take NHS contact

Surely from a tax payers point of view, cross subsidises make more sense, but that wouldn’t do would it from a shareholders point of view

The tax payer sets the conditions on the bid, if the shareholders don’t like the terms they won’t bid on it.

PFI is a totally separate issue. Conflating the two is daft.

PFI is a horrendously expensive and near fraudulent financial measure to get capital costs off the government books – largely occurring under… Labour!

This is a very different issue. It is quite important not to get the two confused in one’s hurry to demonise everything which smells of capitalism. 😉

So – Tony Blair and Simon Stevens Mr Jeremy? 😛

Loving your increasingly dogmatic statements btw…

PFI, another thought, consider healthcare 25years ago and consider it now? Things change, many of the PFI contracts not only are expensive but also are structured to work against the long term.

mogrim – Member

What I can’t understand is why this should be the case: ( private healthcare costs more)

I can tell you why – the profits made and the increased managerial costs are greater than the NHS innefficiences.

Teh NHS is one of the most efficient providers of healthcare anywhere – far more efficient than for profit firms

The tax payer sets the conditions on the bid, if the shareholders don’t like the terms they won’t bid on it.

But what if the requirements don’t appeal to bidders? does the ideologically driven government change the contract to make it more attractive or except it is a non starter and get on with life?

On a slight aside…

http://www.telegraph.co.uk/health/healthnews/8741134/Head-of-NHS-claimed-50000-a-year-for-flat.html

Very efficient….very cost effective. Dolphin Square is lovely, by the way. Very good gym.

Stoatrsbrother – and I find your inability to see beyond the end of your nose farcical. Capitalismn does not work in healthcare – proven many times over.

So come on – give me one piece of evidence to back your assertions?

Just one place where a for profit provider has produce better cheaper healthcare?

PFI is a horrendously expensive and near fraudulent financial measure to get capital costs off the government books – largely occurring under… Labour!

Um…. after criticising Labour for them when in opposition, the Tories have I believe gone absolutely bat-shit crazy for them once in power.

So is anyone going to point out the flaws in the study which showed the NHS is one of the most efficient healthcare systems in the world (I posted it above)?

edit: BTW CFH – it’s ‘heresy’ not ‘herecy’

But what if the requirements don’t appeal to bidders? does the ideologically driven government change the contract to make it more attractive or except it is a non starter and get on with life?

That’s not ideology, that’s dishonesty. In that case all bets are off.

So how do we fix broken services run by complacent clinicians and obstructive managers, where patients have their appointments cancelled 7 times in a row, and get no apology, where there is no other provider within 20-30 miles…

I have worked a lot in the “collaborative” movement, and seen excellence in cooperation in some areas. But it doesn’t always happen. And in the end – taking the patient and the money out of the system can be the only way to get a solution. I could give some very specific examples here, but it would bore the pants off everyone and probably really damage my professional relationships if I blew the gaff on them… but trust me, they are out there…

Anyway – TJ more examples of cheaper/same-cost faster or better services which are now in the private sector local to me – routine Glaucoma management and Direct Cataract referral by optometrists – private providers delivering NHS Hearing Aids (which has certainly made our local Hospital Hearing Aid service up its game) – DEXA scanning for osteoporosis (not available at an NHS hospital locally but provided by one Private and one GP provider under contract. Shifting Diabetes care out of hospitals into General Practice ( in line with DUK recommendations). And the Orthopaedic centre I have already mentioned.

And you might want to look at some of the stuff going on in Dorset.

But I suspect this will be met with repeated emphatic statements ignoring the facts… 😉

One thing we can agree on – a US Insurance-led system is stupid. Admin costs and profits come to about 30%, and the US Government through medicare and medicaid spends more per capita than the UK NHS, despite the US disavowal of “Socialized Medicine”

I can tell you why – the profits made and the increased managerial costs are greater than the NHS innefficiences.

Teh NHS is one of the most efficient providers of healthcare anywhere – far more efficient than for profit firms

So why do huge private companies outsource certain functions – catering, for example? Why should the NHS be any different? Or is there really nothing you could more efficiently provide with private contractors?

(Home time – I’m sure the thread will still be running when I next connect!)

But I suspect this will be met with repeated emphatic statements ignoring the facts…

Your personal experience is not ‘the facts’. Again, how about criticising the report I linked to above? Surely there musc be some basic flaws in the methodology?

It suggests the NHS is one of the most efficient healthcare systems in the developed world.

Saying ‘yeah but I had my appointment cancelled and my nan had to wait for an operation so that can’t be true’ isn’t a very convincing argument.

Tandem Jeremy

Since you ask: http://www.reform.co.uk/Portals/0/documents/itcanbedone.pdf

But frankly you are asking the wrong question. A lot of the opposition stated on this thread focuses on the perceived threat of creating private sector monopolies that would continue to stifle competition. But the logic of that argument is to argue against any monopoly provider whether private or public, not revert back to your conclusion.

You are becoming increasingly dogmatic in you posts which suggest that the line of your argument is failing. Really the onus is on you to:

1. Explain why the structure of the NHS failed right from its early days (please see my earlier post)
2. Explain how, against all theory and most practice, a monopoly supplier can be a more efficient supplier of scare resources that one that is subject to competition
3. Explain why most people who can afford to, will choose private versus public sector suppliers of health, education etc. Are they mad? Or do they recognise that they can pay for a better service (albeit probably not in the case of genuine emergencies)?

Are you going to let your (possibly well intended) dogma lead to a solution that means better access to health care will only ever be available to those who can afford to pay – because like it or not, that is where your logic will lead.

Anyway – I know my place – I’m not a big hitter so I’ll scurry back under my rock. 😉

TJ have you ever considered your posting style might be slightly counterproductive? Just a thought. And you do seem to get more angry and your argument more disorganised.

grum if it was the one I alluded to as support for my argument earlier in this thread – actually it was a bit of a methodological joke… 🙂 We could learn a lot from countries other than the US, Canada for instance.

That’s not ideology, that’s dishonesty. In that case all bets are off.

And i think we have reached the crux of the problem, Does anyone believe that politicians are working in the best interests of the population or are they working in the interests of businesses?

The NHS is not perfect but no one actually trusts anyone in power to fix it.

Does anyone believe that politicians are working in the best interests of the population or are they working in the interests of businesses?

Then why have them running the most important thing in our lives?