Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 80s. But the corrupt government officials kept dismantling it and allowing corruption to run rampant within the system. All to get a piece of the private for-profit health system including Health Insurance.
Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s. I seriously hope it doesn't have the same outcome as our system had in Mexico. For-profit health is inhumane.
Maybe it doesn't make sense for you, but it makes their buddies in the private sector a lot of money. And that's the game in capitalism, making a lot of money.
The government competing with affordable options for everyone against the private sector is "bad for business".
It doesn't matter how you structure things you end up with some way to climb the hierarchy. The problem with pure communist systems is they try to prevent all hierarchies. Human nature attempts to circumvent this, the only way to do so is via corruption and political power. Corruption and political power exist in abundance in free markets as well, but there is another outlet for personal ambition. People can get rich. The hope is that you can build a system that incentivizes people to get rich by providing value for everyone. You can have private for-profit healthcare but you have to make sure that people get a good deal out of that. Normally we rely on competition to ensure customers always get a good deal. I don't think that works in this setting. Healthcare is tricky, I don't think we've found a good way to setup incentives for heath systems to have the best outcomes. We will need strong government regulation no matter what we do. Competition will not provide sufficiently good outcomes.
In the US you have great hospitals but at astronomical costs, the entire system is distorted by insurance companies and massive bureaucracies. Here in NZ the hospitals are terrible underfunded socialist messes. We can't hold on to staff because we don't pay enough. Emergency waits are hours. My friends wife just spent 3 days before getting emergency surgery to reattach nerves and tendons in her hand. She had to travel 3 hours to another city to get that care. The last two times I required emergency care the wait was over 8 hours. I can't pay for better service and there is no private emergency option.
That is a massive non-sequiter though, nobody is suggesting that factory workers rise up and sieze control of the hospitals. Or even that nurses do so. The proposals for healthcare usually involve the oligarchs being in control and the public enforcing standards. Which typically turns out to be unsustainable because the middle class is where the people who know how to run things come from and they just got cut out.
The problem here is excessive centralisation where if (more practically, when) the government becomes corrupt or makes a bad decision it becomes illegal to do something different to the regulatory standard.
Politics by people with communist leanings isn't helping the situation, but the fundamental issue here is people keep proposing 'solutions' that don't work and effectively block people from actually solving the problems. Eg, I bet someone with a good idea of how to organise an independent emergency healthcare service wouldn't be allowed to do it in England.
I agree that centralization causes huge problems.
My main point was that I don't think we've found a good system for providing hospital care and whatever that solution is I don't think it lies at either extremes of the left - right political spectrum.
Unbelieavable wealth and seeking power is gene survival. More wealth more survival resources. More power more survival and reproductive resources.
Genes drive everything that is "wrong" with the way things are.
So it's more like "they remain mired in poverty because of the United States' predilection for predatory capitalism."
This is regime change /that we know about/. Intelligence agencies haven't made a huge habit of discussing their covert successes.
> Venezuela has been hostile to the US, yet they are still there.
Yes, because the international response would be quite severe if the US decided to what - destroy Venezuela?
Foreign occupations and coups decimate countries who then have to deal with the effects for generations. The new regime is usually beholden to the powers that put it there (or the old one has to abide by the occupier's demands), permanently crippling the government or the economy or both. Many countries continue to suffer under the conditions created by their overthrowers, so maybe they share some blame but it's largely the longlasting effects of foreign incursions.
> You have to try harder if you want to blame their issues on the US.
It's really not that difficult to understand cause and effect here. If you destroy a country's economy, divide its people, cripple it's infrastructure, and install an authoritarian government, it's going to take a long time to recover.
I.e. there's no evidence.
It's not like the CIA likes to document its dark-ops in Latin Am. on wikipedia as proof for you.
This is still not proof of anything happening, just because someone wants something to be true doesn't make it so.
"Argentina’s Long Road to Ruin A century’s worth of corruption and leftist politics devastated this once-rich nation."
https://www.wsj.com/articles/argentinas-long-road-to-ruin-hy...
Also, your article is unfortunately paywalled, but an op-ed from someone at the WSJ isn't going to change my mind.
ended 40 years ago. The article I cited is today.
> but an op-ed from someone at the WSJ isn't going to change my mind
Not very open-minded to close your mind to something you haven't read. Do you know what is happening to Argentina today?
I'm no liberal. And I used to read the Wall Street Journal every day before Murdoch.
Now it's a pack of lies all the time.
The descendants of those families still have huge wealth and influence in South America.
And IIRC, a lot of people in power in the USSR made a lot of money out of the collapse of the USSR.
Heck, there's some mid-level KGB dude who made $200 billion off it.
Solution: Give more power to politicians! Lack of power corrupts, need to give them more until they stop being corrupt!
Not sure why anyone thinks that would work.
Socialism, however, requires altruistic behavior, and very few people are consistently altruistic and self-sacrificing for the common good.
Are we going to pretend that free market capitalism and its magical benefits haven't been pounded into all of our heads from every angle from the moment we were being taught anything about how the world works? It's not difficult to understand, it's difficult to see in a world where companies commit crimes and collapse in mountains of debt, but no one goes to jail. Not a situation that Adam Smith would approve of.
The reason the benefits capitalism are spread out to any degree is because there are riots when they aren't, so you need to at least reward the people responsible for putting those riots down through violence, technology, and bureaucracy. Hence, the middle class.
> Socialism, however, requires altruistic behavior, and very few people are consistently altruistic and self-sacrificing for the common good.
"Socialism" requires cooperation, and people do it just fine. Even capitalists are socialist amongst themselves when it comes to keeping out competition.
Progressivism conquered America a century ago. Antitrust law. Central bank. Income tax. Universal suffrage. Old age pensions. Public education, research grants. National parks. Interstate highways. Welfare, public housing. Equal opportunity employment. Disaster relief. Socialized medicine for the poor and elderly. Workplace safety. Automobile safety and emissions standards. Space shuttle.
Recently, a flirtation with Universal Basic Income.
You're concerned about what? Free Prime delivery?
https://ourworldindata.org/grapher/world-population-in-extre...
My dad was a professor of finance in a midwestern college. He'd have students coming up to him saying "I didn't know there even was a case for free markets!"
> "Socialism" requires cooperation, and people do it just fine.
Both socialism and free markets require cooperation. The difference is that socialism requires forcible cooperation, and in free markets the cooperation is voluntary.
People innately like to compete and will do so over the dumbest things, like who can get the little puck in the net with sticks the most, or who can correctly guess the sum of a pair of dice.
Market capitalism coopts this most basic of human instincts,not greed, and selfish greed is actually the root of many failures of capitalism endeavors, and human endeavors in general.
For example, how long do you think McDonald's would last if its McBurgers tasted bad? McDonald's success is extremely tied to customer satisfaction.
Tossing the ball back to you, under socialism, why would the socialist service care if you're pleased with the service or not?
Every country that tried having the government run food production produced starvation.
Every one.
> The goal of the capitalist isn't to make their customer happy, its to extract as much of their available disposable income as possible.
True, but the way to get that money is to please the customer, because the company cannot force them to buy.
Those goalposts were just fine where they were, put them back and address the actual argument. Nobody was advocating for 'government run food production'.
That's why it's the poster boy for socialism's failures.
Plus your quip is a little bit dated honestly. The soviets had famines because they literally didn't support evolution for quite some time. They believed Lysenko and allowed him to execute his critics. Meanwhile today, look at China the past few decades when modern agricultural practices were finally well established around the world. Another 600 million people in 50 years. Huge population growth doesn't happen because of starvation.
Ah, the arrogance of knowing what is best for others. (Of course, I know what's best for everyone else, too, but my arrogance stops at taking the next step of being entitled to force it on them.)
> The soviets
You can make excuses for the Soviets. But you gotta explain the starvation from every other communist country. The starvation in Jamestown when they tried communist agriculture. The starvation in the Pilgrims' first year when they tried communist food production. The failure of the Kibbutzen in Israel to feed themselves without government subsidy.
It goes on and on.
P.S. China stopped starving when the stopped collectivist agriculture.
Now for the flip side. Which was the first country to eliminate famine? The US, around 1800, with free market agriculture. Next, which free market agricultural system has suffered from a famine?
lol you misspelled "ran by corrupt authoritarian governments that don't give 2 shits about the public unless they can exploit them"
You can ding corporations... but the real world socialist examples are worse.
Corporations aren't perfect (and we don't live in pure capitalism anyways. Common sense controls exist for good reason). But they are better than socialist governments.
Industrial democracy, where workers own and control the company, backed by a robust welfare state, is socialism.
Besides, the US under free market agriculture produced the tallest people in the world up until WW2. It's kinda hard to believe that Americans grew that tall from eating garbage.
Capitalism, like democracy, is the worst form of government, except for all the others. To believe that the US brand of capitalism can do no wrong is to be as deluded as the communists were. If the free market were perfectly efficient, there would be no such thing as conmen or MLM scams, and every consumer would be 100% informed and perfectly rational. That's ridiculous, so the government needs to step in at times, to promote a freer market than one without regulation.
Go eat at a restaurant in Times Square. They exist only because of their location, and the fact that tourists don't stay long. So their food is bad AND they don't need to try and harder because it doesn't hurt their business. They're a total ripoff and a tourist trap and that's with capitalism's vaunted free market backing the enterprise.
> They're a total ripoff and a tourist trap and that's with capitalism's vaunted free market backing the enterprise.
If you think they're a ripoff, don't patronize them. Nobody is making you.
That seemed obvious to most observers, up to the Cold War.
It can't account for international trade, which functions on mutual self-interest.
There’s a reason why Five Guys, etc are everywhere. People who want a good burger go there.
Imagine if that co-worker that doesn’t contribute or might even drag the team down can just quit and play PS5. Glorious.
How do I know people don’t need coercion or even pay to produce great products? Open source software. Windows is capitalism and Linux is socialism. Which do you prefer?
Consider not being rude next time. Flagged.
> Guess who is corrupting government
How are they corrupting the government? Is the private sector deciding who gets power in the government somehow? Sounds like your democracy doesn't work then. Giving all the power to politicians when the democracy doesn't work just leads to the same scenario as in Soviet.
Bribing the government isn't "corrupting" them, a politician who accepts bribes or tit for tat deals is already corrupt.
And then what happens to minority interests?
How about we have a national vote on what phone you get? Which car you get? Whether carrots or tomatoes get produced? What movies get produced? What clothes are produced? Which diseases get funding? What apartment you get? How many ounces of meat you get per week? What music you get to listen to?
What could go wrong with that?
Not sure if giving the corrupt government more money and power is a good idea in that case.
yeah, but in real capitalism, this is done by consumers voluntarily choosing a product. What we are seeing here is crony capitalism play out.
They didn't get it all right. They used PFI and outsourcing to fudge the sums on major investments, and I dare say they didn't invest in mental and social health care in the amount required. But nobody ever has.
The job of fixing this is so expensive and requires so much political force. We're still worried French immigrants are going to eat our dingos, or something. I'm fairly certain now we're destined to limp into an American insurance model; eat the poor.
https://www.google.com/amp/s/amp.theguardian.com/politics/20...
PFI was used because it was a way to get "free money" for the NHS by pushing the real costs into the future.
The core problem for the socialized model is that nobody can assemble a voter coalition that agrees to raise taxes. The poorer Labour voters say no, the rich should pay, or alternatively, the money already exists it's just the evil Tories refusing to fund the system. The more affluent conservative voters say no, because either, the NHS is wasting money and should fix that first e.g. the massive spend on diversity officers, or, the NHS is always overloaded due to uncontrolled immigration, so fix that first. The NHS doesn't have enough admin support as a result. Then the woke middle classes say no, reducing immigration is awful and we will fight it all the way and of course we won't pay higher taxes because if we allowed unlimited immigration the new taxes from all the highly skilled doctor/engineer immigrants would fix the problems.
In the UK there's also the issue that the social care workforce was one of the only professions forced to take vaccines. Lots quit and the rest learned that they have fewer human rights than other people. So having treated the social care workforce like shit, which was already overstretched, the system is now in total collapse for lack of workers.
State run systems always have problems like this. It's one size fits all, so the different groups with their different priorities can never agree and the result is deadlock and collapse. The people who run it are too far removed from the front line and the "too big to fail" problem rears its ugly head. The NHS could never survive as is, it's just a pity that it had to end like this.
In a lot of respects, this isn't very accurate. It got pretty bad in the early '90s, anything that needed to go beyond the GP had really bad wait times, people stuck on trolleys in A&E, etc. By 2004 it was much better, so that anything which required a hospital visit would be dealt with much more quickly and effectively but the GPs were coming under more pressure from a growing and aging population so the first point of contact had a less personal touch.
Another is housing, right now we have one generation coming up right as the most populous generation is towards the end of their life, resulting in an increased demand and price, in 20 years as more and more the later generations start passing on they'll be leaving behind houses and properties, it's not like those disappear when the people do.
I've noticed that the media seems very engaged in making everything the crises of the moment and the focus on looking at things over the course of years or decades is often ignored in favor of sensationalism.
That sounds like some seriously rose-tinted nostalgia to me. Yes, the NHS certainly has its problems. But within the past decade, my wife has been through several fairly major health issues, including cancer, and our overall experience of UK healthcare has been quite positive.
She is from the US (and had "good" insurance there), but feels that the UK system has served her far better than the American ever did.
Seen exactly this in my local area. Libraries closing or cutting hours/resources. The number of children's centres (where you go for check-ups/weigh-ins of young kids, to get feeding advice, etc.) reduced by 80+% in some counties. It's dire.
Some relevant graphs here: https://www.instituteforgovernment.org.uk/explainers/local-g...
This is all due to 2008 can kicking. The needed to cut, didn't want to get blamed for cutting so just massively cut central funding for councils who were left to make the hard decisions. Year on year the cuts increased the drive for "efficiencies" grew. There is no slack left and nothing left to cut that isn't obvious.
I hope that someone learns that just because you've taken the cost of the balance sheet doesn't mean the problem it was solving goes away, it just ends up as an inefficiency somewhere else, in this case in the NHS where staff cannot discharge perfectly healthy patients.
Job deterioration, Brexit and the pension cap have all lead to an increase in more expensive locum cover. Few people want to be locked into a job where you have a daily meeting to be shouted at by your site team for not discharging people who have nowhere to go.
It could be phrased as - social care was a way to paper over cultural and societal cracks, by paying peanuts to people with limited job choices.
As in most things, our response to Covid has just exposed the endgame much quicker than expected.
Do you maybe have a source for your claims that would convince her? A simple news article from a reputable source would probably suffice.
12-16% drop in community care bed availability https://www.nuffieldtrust.org.uk/resource/care-home-bed-avai...
https://ourworldindata.org/grapher/social-spending-oecd-long...
And this is amidst rising inflation adjusted per capita GDP, meaning even more rapid rise in real per capita social welfare spending.
Where is this "Tory penny-pinching" happening?
How does that manifest as ambulance wait times? Do you think ambulance drivers are sitting around for an hour before responding to calls for help because... the hospital is full? That's like saying my train to the airport was late because the airport was full, it doesn't make much sense. How does one back up into the other?
You will see multiple paramedics as they change shifts in situ.
In fairness the ambulance service has scaled amazingly well given most of their staff are now pegged in hospital carparks, but yes, waiting times for critical calls are extended, people are dying because ambulances aren't available.
All because they can't hand over to A&E. Because A&E can't ingest patients. Because wards can't discharge. Because care homes don't exist.
It's that simple. If you doubled the number of community care placements, staff, etc, you'd buy the NHS another ten years.
Oh we just double the number of nurses? Yeah, but no. They don't grow on trees. The current ones don't stretch (we asked). You can't just absorb 20-40 patients into your acute departments without space and staff. The paramedics are acting as those staff, their ambulances the space. Yes it's far from optimal.
Until they go, A&E can't admit people through to the beds they're currently in.
Even if you lie to the population and claim you'll add 7000 beds this winter, those beds aren't staffed. We can't surge 5000 nurses and 2000 support staff out of nowhere. They're all busy.
It's all about throughput. You're only looking at the front while the problem is in the back.
Just one of many, many stories on this:
This is such a stellar use of the handwavey "just" that I feel we should have it bronzed.
Literally yes. Keeping them in an ambulance instead of the sidewalk won't get them into the ER any faster. And keeping the ambulance tied up at the hospital won't do any good for the next guy who has an emergency and is sitting on the sidewalk at the site of the accident either. At least if you move the injured people to the sidewalk at the hospital, the nurses can look outside and prioritize the worst. And the problem will be highly visible to the public, instead of papered over by using ambulances as waiting rooms.
What they're doing now is obviously prioritizing for appearances, not patient outcome.
Even if the hospital's ER room has saturated capacity, moving all the casualties to the hospital waiting room as rapidly as possible still has utility because that allows the hospital to prioritize the worst, which they can't do if the worst is laying on the street a mile away with the ambulances all parked at the hospital.
If someone is walking-wounded, they WILL be unloaded to sit and wait for 6 hours in a corridor.
The people who the ambulances are holding for long periods are those who are too sick to be left without attention. The paramedic staff continue to monitor them in order to escalate further if their condition deteriorates, and depending on the situation, medical staff from the hospital will be involved in this.
The ambulance staff obviously have a moral and legal duty of care, and can't just leave a seriously unwell patient on the floor outside the hospital entrance to get to the next call, which would likely be a patient no more ill than the one they just abandoned.
Yes, this happens - my grandfather attended with a head injury, and we were stuck in a side room with the ambulance crew (along with another patient and a second ambulance crew) waiting to do a handover.
It's almost as if a locally allocated choice between collecting the bins and homing grandma will always go with what inconveniences voters least.
Areas with poor, old populations can never pay their way. The excess gets dumped on the centrally funded NHS.
It's a bad model that is a massive disservice to us all.
The root of the issue is that this area is now the country. Giving all old people the labor necessary to support them in old age was easier when the ratio of working people to non working people was much higher, in conjunction with old people not living as long.
Turn that population pyramid upside down due to drastically reduced birthrates and medical technology allowing people to live longer, and you get the current situation.
Through the government we elected, we choose to starve social care. We choose to starve education and so many other public services.
Yes, our age profile made it more expensive, but so what? We choose to underfund it.
Root cause: the law says to raise local taxes beyond a certain amount councils must hold a referendum. They systematically refuse to do this because they know they will lose.
Voters by and large think local councils are wasteful and don't really need more money. There's also another issue: some local councils especially in the North have a history of deliberately cutting front line services whilst e.g. expanding the central bureaucracy, because they know they can blame the Tories for not giving them "enough" money and the voters will fall for it. The councils could raise taxes, or rebalance spending, but that wouldn't energize their base.
Save the odd blip, Norfolk is as blue as it gets. Interestingly they also blame central government.
And local tax raising is pretty blunt. How much your house would have been worth in April 1991, if you're working. High-retirement or high-unemployment areas usually have lower rates, and much lower incomes, while needing more than rich areas.
https://ourworldindata.org/grapher/social-spending-oecd-long...
The burden of providing social care has increasingly been transferred from individual families, to the centralized state.
Social care is 12-16% less available now than it was a decade ago. https://www.nuffieldtrust.org.uk/resource/care-home-bed-avai...
On your second part, this study also shows a significant 25y fall in the number of 85yo+ who are in homes. We aren't increasingly relying on the state.
If those social welfare programs are mismanaging those funds, that's an entirely different argument than arguing it's "starved".
If we pretend there's been steady investment, and imagine stable demand, the same thing can cost more than it did before.
But irl, budgets have collapsed, demand is soaring and costs have already risen and are about to explode due to fuel-driven inflation.
So no, starved on three counts. The baseline cost is deviating from the investment. And yes, there are many, many elements to why.
From 22.79% of GDP in 2010, to 21.49% in 2016 (the last year provided). This is after an increase from 10.44% to 1964 to 22.79% in 2010. The big picture is a massive multi-generational increase in social welfare spending, interspersed with tiny downward fluctuations over a small proportion of the years covered.
>>It's worse than that because the true picture needs to factor in local government spending now.
This is aggregate public spending, so it should already be factoring in local government spending.
>>If we pretend there's been steady investment, and imagine stable demand, the same thing can cost more than it did before.
Per capita GDP has increased in inflation-adjusted terms, so when social welfare spending as a percentage of GDP increases, that means a real (inflation-adjusted) increase in per capita social welfare spending.
The only possible way this leads to less support for citizens in need is growing mismanagement of the funds by the social welfare programmes.
It's important to note that social welfare also covers housing, unemployment and other things not care in the same sense as being discussed. Housing costs have exploded in price so even more of that stagnant budget has been diverted away from care.
Once you allow for inflation, there is a growing underspend in care. A starvation. Yes, generations of growth, but not finding it appropriately now (and for a decade) means it's being starved.
https://www.health.org.uk/publications/long-reads/health-and...
I'm leaving it with the Health Foundation, there. I'd suggest you read that if you really want an appreciation of how budgets and inflation work together but if you just want to tell me "they have more money, so it's being wasted more" you don't understand how money works; I can't help you.
And if you're reading around, be wary of COVID era numbers as they include boosts for testing and extraordinary measures. Nothing that increases provisionable service.
And if you call the Tories reducing spending by 1.3 percent of GDP, what do you call a doubling of spending as a share of GDP? The Big Picture here is massive spending growth over the long run, that totally eclipses this minute drop.
>>Once you allow for inflation, there is a growing underspend in care
Wrong. The UK has seen significant per capita GDP growth, after accounting for inflation.
So rising social spending as a percentage of GDP means rapidly rising inflation-adjusted spending per capita.
But neither are happening. Old people are abandoned to healthcare providers. This, in turn impacts on the life expectancy of much younger people requiring emergency care who won't get it because the hospital and ambulances are full. It's not sustainable for patients or providers.
There are two ways out. Choose to do this properly, or choose a much uglier withdrawal of care for the old and infirm.
Before you choose, remember that these are people who worked for 45 years being told that their National Insurance payments were paying it forward for this kind of care. If you're going to change the rules —and especially if you're going to start incinerating grandmas when they get "too costly"— you have to expect the next generation probably isn't going to stick around. Many of that exodus will be doctors.
Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door.
Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards have turned into medically-fit nursing homes. They spend half their days trying to send people (who don't have care requirements) home faster than they'd like.
Why? Because central government withdrew funding. Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out.
Turns out the whole endeavour was yet more myopic, Tory penny-pinching.