?</blockquote>
Everyone who pays into the NHS. Without someone saying what should, or shouldn't be what direction is there for the NHS to take? As a UK tax payer, should I not have say in how the NHS (funded by my taxes) should be?
The NHS, like all tax funded organisations, is never going to be economically viable. The very idea that it has to worry about survival in today's economic climate is what I meant by seduced by the American model. The founders of the NHS provided it at a time when disease in the UK was rampant. Yes life expectancy was less, but then the care required for every single illness was more time and cost consuming.
Fifty years ago a new-mother would stay in hospital for 10 days, today they are out in the same day. Diseases such as TB, measles, chickenpox etc would see people in a hospital bed for weeks on end - often followed up by years of out-patient treatment.
These are all things which are no where near the burden on the NHS as they were a few decades ago so to say the cost burden of "non-infections chronic diseases" is causing a problem is not strictly true. If the NHS management (and government direction) had the will to survive disease epidemics in the sixties, why can they not cope with the trivial costs of non-infectious diseases today?
The best way to deal with any disease, infectious or otherwise, is to prevent it happening. The fact is that no one would ever suggest the same sort of measure to prevent infectious diseases as they would for "lifestyle" illnesses.
On the subject of taxation, for decades the UK has taxed cigarettes way beyond the rates of inflation and it has had barely perceptible impact on people smoking - if anything the rates at which young people take up smoking has increased in the last ten years - so why on Earth do people think that a taxation increase on alcohol will be successful?]]>On the subject of agreement, I think we even disagree over how we disagree. My observations are equally factual, in that I am stating things which are factually correct. As for the raising questions that is only a good thing because without it there would be no progress.
The circumstances I describe are equally “what is” – tax increases themselves are based less on a “what is” than a “what should be” so it seems strange to argue against that.
However who is to say what ’should be’?
Everyone who pays into the NHS. Without someone saying what should, or shouldn’t be what direction is there for the NHS to take? As a UK tax payer, should I not have say in how the NHS (funded by my taxes) should be?
The NHS, like all tax funded organisations, is never going to be economically viable. The very idea that it has to worry about survival in today’s economic climate is what I meant by seduced by the American model. The founders of the NHS provided it at a time when disease in the UK was rampant. Yes life expectancy was less, but then the care required for every single illness was more time and cost consuming.
Fifty years ago a new-mother would stay in hospital for 10 days, today they are out in the same day. Diseases such as TB, measles, chickenpox etc would see people in a hospital bed for weeks on end – often followed up by years of out-patient treatment.
These are all things which are no where near the burden on the NHS as they were a few decades ago so to say the cost burden of “non-infections chronic diseases” is causing a problem is not strictly true. If the NHS management (and government direction) had the will to survive disease epidemics in the sixties, why can they not cope with the trivial costs of non-infectious diseases today?
The best way to deal with any disease, infectious or otherwise, is to prevent it happening. The fact is that no one would ever suggest the same sort of measure to prevent infectious diseases as they would for “lifestyle” illnesses.
On the subject of taxation, for decades the UK has taxed cigarettes way beyond the rates of inflation and it has had barely perceptible impact on people smoking – if anything the rates at which young people take up smoking has increased in the last ten years – so why on Earth do people think that a taxation increase on alcohol will be successful?
]]>Your observations are normative and raise questions. Mine are factual and do not raise questions, just say what is going on. If ‘what should be’ is not the same as ‘what is’, we will appear not to agree.
However who is to say what ‘should be’?
I do not think it is about the UK being seduced by the American model; it is about the economics of keeping a free-at-the-point-of-delivery health service running using assumptions from 60 years ago when the reality is very different now. The burden of non-infectious chronic diseases is growing worldwide and we cannot really hide from it. The best way to deal with them is to prevent them from happening. That shift is also universal. It is up to us to determine what the best way is.
]]>The problem with introducing a value based decision system as to who you treat and who you don’t treat lies in the way the NHS works.
For example, if I went out drinking every night and then found out the NHS would no longer treat any disorder that could be linked to alcohol would I then be able to reduce my tax contributions on the basis that one of the services I paid for was no longer available?
The link between behaviour “X” and symptom “Y”, while sometimes apparent is not always so. For example someone gets their face smashed in by a drunk while they are out drinking. Does that person then forgo the right to treatment because they were drunk at the time?
The reductio comes in the form that every communicable disease and every accident is the result of people’s social behaviours. Some one who is careless and falls down stairs – should they be treated or should they be punished for failure to show due care? What about someone who goes into work with a cold – should they be prosecuted for spreading an illness which the NHS will then have to treat?
The only shift is that people have become enamoured with isolated aspects of foreign cultures. We are being seduced by a despicable American healthcare model and, as such, the NHS is heading slowly towards a pay-service.
]]>Thanks for your note. I do not mind my comments being in moderation 🙂
You say: “One of the big problems with alcohol, more so than tobacco, is that after a few drinks people lose their rationality..”. In my view there lies the rub. The government appears to do something through raising prices (keeps public health lobby happy) and the drinks industry can always rely on this truism about rationality-loss. Everyone is happy. The Queen is in the parlour eating bread and honety, the Chancellor is in the counting house counting out the money. No?
As for the NHS being there to treat people, that is the ideal. But in the recent years, NHS is moving away from being a ‘sickness’ service to a ‘wellness’ service where the primary ethos is prevention. Is that not also the point of the patient charter announced at the 60th anniversary of the NHS this year? So if drink-related injuries are avoidable, they may refuse to treat; if people are obese, they may not get knee replacements. Rationing has been around, now it is more prominent.
The logic may be reductio ad absurdum but at the risk of sounding pompous, I would still say we are in the midst of a shift, a twister – those outside can see it more clearly, all we see is leaves going round and round at a great speed. No?
]]>A lot of the point Heather was trying to make, I think, is that the idea people are binge drinking more today than an arbitrary date in the past is a false one. From my limited personal experience I can certainly agree with this – I encountered as many instances of drunken, loutish, behaviour when I was a teenager as I do today. The recent arguments about tax increases use the information that the “real” cost of alcohol has gone down in the last 15 years, however my personal experience is that when alcohol was more expensive there were just as many drunken, yobbish, incidents.
From this, assuming my personal experience wasn’t massively different from the national situation, it would seem that even a significant increase in the cost of alcohol wont dramatically affect people on nights out.
One of the big problems with alcohol, more so than tobacco, is that after a few drinks people lose their rationality – the extra cost is not a deterrent to someone who is drunk. All that happens is the person wakes up with a hangover and a load of credit card / cash point receipts in their wallet. For the younger generation this is not going to stop them drinking to excess, only hamper the things they can do (which cost money) when they are sober.
For example, will the increased taxes see less students off their faces drunk or will they simply eat even less beans on toast?
It may well be true that the NHS is burdened by the costs of treating people with injuries that are related to someone being drunk, but surely the idea behind the NHS is that it treats people. If we drew up a list of things where a persons life-choices resulted in something that made them sick or injured – then taxed them on it – we would soon hit a reductio ad absurdum.
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]]>The putting up of the tax on alcohol is slow to come, I’d day. A friend of mine wrote an evidence paper on Binge Drinking for our parliamentarians (you can find the paper on the website of Parliamentary Office of Science and Technology). The drinks industry and I suspect the DH have known for years about a price-demand graph, which shows a distinct relationship which suggests price may be the only thing to make a real impact on drinking. Why bother? A good half or more of emergency maxillo-facial surgeries being conducted are due to people falling over when drunk. Liver problems in women are up 30% in the last 3 or 5 (not sure, but can check) years. So its cost to the NHS is real and rising.
The government however did not touch the drinks industry for several reasons – the Portman Group works very closely with the DH (did during the launch of 2004’s Choosing Health report); the government makes a lot of money from alcohol and wouldn’t want to piss the industry or electorate off and cynically, it is easier to ramroad a drunk electorate than a sober one.
Why now? I think the government is out of options to raise more taxes. If they were committed to health, they would remove some taxes such as from smoothies to make them cheaper, or add taxes to high fat/ sugar/ salt foods (since they were feeling like intervening). One might argue those would be regressive taxes but think about it – isnt the one on alcohol regressive? Who will be affected more? Rich kids in Oxbridge or poor people anywhere else?
It may be a tradition, but NHS did not exist then nor did several statisticians. So data were hard to come by, so a case was never made. Now, have data, will regulate (put up taxes)…
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