The US National debt in context

[Rxke]

Yes, refreshing.

[Disembodied]

Some very good points. Honestly, in my opinion, when one goes to one extreme or another between capitalism and socialism, things get pretty ugly. I personally think that a capitalist system with the government serving as an impartial mediator (while enforcing only a handful of controls, such as the U.S. anti-trust and labor laws...which they haven't done much with in a while.) Tho, in reality, I know this is more of a fantasy than a reality. Government is rarely capable of being impartial. Too many personal benefits to taking sides.

For me, I don't actually think "capitalism" exists, really – or rather, it's as much a system of economics as "the law of the jungle" is a system of justice. All societies, if they aspire to the name, try to limit the activities of capital and trade, for a variety of different reasons, and with varying degrees of success.

I think the mistake people often make is to become partisan cheerleaders for one type of economic theory over another – a bit like OS wars, but with more bloodshed and human suffering. Capitalism, because it allows for failure, is a good (but not always great) way of producing consumer goods. If you make better, cheaper toasters than I do, then pretty soon I'll go out of business. Unless of course I already have a stranglehold on the toaster market – then I just slash prices, run at a loss for a couple of years and live off my accumulated fat, and wait for you to go bust. Or I tie up your company in years of vexatious litigation over the patent for "toaster spring grommet 117B", until your stock price drops so low I can buy you up. And so on (this is the "not always great" part ).

What I've always found confusing, though, is why some people insist that "a great way to make toasters" is also "a great way to run a health service", or "a great way to produce and distribute electricity across a national network" (capitalism seems to be particularly bad at networks: look at the mess the UK electricity industry was in, for example, before the state stepped in and created the national grid). It's equally as stupid to take "a great way to create a co-ordinated, national electrical system" and use it to try to manufacture toasters. These seem to me to be obvious category errors. It's a bit like saying "a splint is ideal for a broken leg, so let's attach a splint to your fear of heights."

I suspect the problem comes down to accumulations of power. While some fanboys, left and right, might genuinely believe that their favourite economic theory really is a universal panacea, most pressure will come from those who have acquired a lot of wealth and influence through their advantageous position under whichever economic theory happens to prevail. It works to their personal advantage, therefore they are keen to apply it as widely as possible. If all you have is a hammer, then every problem gets treated like a nail. Especially if you get paid for using the hammer.

[DaddyHoggy]

My wife, over qualified to stay "front-line" has been driven into Middle-management of the NHS and is fighting a losing battle against what is clearly, from her point of view, part privatisation. She's currently trying to go "up the food chain" in an effort to try and get herself in a position of potential sailing the boat rather than bailing it out with buckets down in the bilges, however, if that fails, and even though we can't afford it, for her sanity, she'd go back to being a front-line radiographer.

As I hear her whisper over and over again "the NHS is not a business, its an Organisation, they're not customers or clients, they're patients, and just because a GP can tell mumps from measles doesn't mean he can tell good business practice from bad." Then she whimpers and screams silently while staring into the middle distance.

[Dragonfire]

I suspect the problem comes down to accumulations of power. While some fanboys, left and right, might genuinely believe that their favourite economic theory really is a universal panacea, most pressure will come from those who have acquired a lot of wealth and influence through their advantageous position under whichever economic theory happens to prevail. It works to their personal advantage, therefore they are keen to apply it as widely as possible. If all you have is a hammer, then every problem gets treated like a nail. Especially if you get paid for using the hammer.

Very well put! Both systems are vulnerable to corruption. I guess it comes down to human nature in the end.

My wife, over qualified to stay "front-line" has been driven into Middle-management of the NHS and is fighting a losing battle against what is clearly, from her point of view, part privatisation. She's currently trying to go "up the food chain" in an effort to try and get herself in a position of potential sailing the boat rather than bailing it out with buckets down in the bilges, however, if that fails, and even though we can't afford it, for her sanity, she'd go back to being a front-line radiographer.

As I hear her whisper over and over again "the NHS is not a business, its an Organisation, they're not customers or clients, they're patients, and just because a GP can tell mumps from measles doesn't mean he can tell good business practice from bad." Then she whimpers and screams silently while staring into the middle distance.

Feelin' you. The medical field is not a business. I wish those charge would stop seeing it as such.

[Rxke]

lots of things are not business.

I work as a public servant, and my take on things is that it is *not* okay to sit on your ass because you're not in a business (the cliché image people have of public servants.)

But that we are in a unique position to do things that would not be possible in a purely commercial setting. That we should do our utter best, though doing that.



Example: I digitize stuff with abhorrently expensive camera's and scanners, I digitize manuscripts, old maps, old doctoral research papers, stuff like that. It takes a lot of time and hence money to do it right.

And sure we charge money for the results (digital images) but the prices are kept very sensible, because we are a research institute, not a commercial outfit.

Do I work my ass off? Definitely. Will we ever break even? No way.

Should we increase the price to reflect commercial reality?

Nope. Our primary public is composed of scholars, not commercial outfits.

Is the job I do counter-productive or an abomination in the eyes of commerce?

I don't think so. The stuff I do helps countless people. Who go on to do other stuff in real life that is of value.

[DaddyHoggy]

Nice one Rxke - sounds amazing.

Some things the Public Service/Government should do, some things they must do, I'm not adverse to "best practice", but I am adverse to "developing a commercial mindset" - but a commercial mindset is "make money" (at the end of the day)

[Cmd. Cheyd]

Feelin' you. The medical field is not a business. I wish those charge would stop seeing it as such.

Incorrect. Health care IS an industry. What his wife said is "the NHS is not a business". And it's not. It's a branch of the government that controls that industry in that country. Common logical fallacy.

[Dragonfire]

Correction to my wording, the medical field is not --supposed-- to be a business. As soon as it is considered one, the patients take low priority. Unfortunately, government run or privatized, money is the main goal. The wellbeing of the patients? Not so much.

[Cmd. Cheyd]

Correction to my wording, the medical field is not --supposed-- to be a business.

Says who? Monetization of health care has advanced the field of medicine greatly. It is why we now treat mental illness rather than locking its sufferers in prisons. Nearly the entire field of pharmacology exists thanks to health care being a business. Likewise for radiology, and a whole host of other branches.

The wellbeing of the patients? Not so much.

My wife, a great many of my former colleagues, and I would take no small amount of offense at that.

[DaddyHoggy]

Cmdr Cheyd - My wife who started as a lowly newly-qualified Radiographer back in 1994 and since then has worked her way up into NHS management tells me that at the front-line patient care is always top priority often despite rather than because of Department of Health Directives.

It is no joke that NICE (National Institute of Clinical Excellence) which decides how the NHS pot of cash is divided up is known by doctors and nurses as National Institute of Capping Expenditure.

The UK Government is currently hacking about with Public Service Pensions, including the NHS one, claiming that Public Service Pensions are costing too much because civil servants are now living too long after they retire (damn!). However, pension income collected by the State in the UK has never gone into a pension pot, it goes to the Treasury who spends it like any other income and then pays current pensioners out of the current tax revenue. However, the NHS scheme, if it was run as per a private pension scheme would be in the black and would paying out less in pensions than it currently collects from its members. The Government has denied the NHS the opportunity to break away and run its own private pension scheme and why, because it would cost the Government (Treasury) money to do so. Everybody in the Public Service (I'm no longer a public servant, my MOD pension contributions of 13 years are locked down as they were when I left) knows that the Government's claims that Public Service Pensions are costing too much and therefore they will pay another £2.3Bn in contributions this year has been done purely to make a small additional offset the (current) deficit, not one penny will go towards pay the pensions of longer living pensions of the future.

That's what's making current UK public servants angry. Do more, contribute more, get paid less and be grateful you've got a job while the Government stokes up resentment towards your final salary pensions to anger the rest of the private sector, most of whom don't have any pension at all, never mind a final salary one.

It's all very sad really. Consumer's have be bullied over the years into buying stuff they didn't really need based on easy credit and the fallacy that they were supporting the "booming" economy, and then of course somebody noticed the emperor didn't have any clothes on...

[Cmd. Cheyd]

DaddyHoggy - I think you may have misunderstood my intentions in my statements. Or I am misunderstanding your response.

My wife worked for the US Veterans Affairs dept for several years as a Nurse's Aide. I worked for around 6 years for the Health Divisions of two American Indian tribes* (who receive their funding from the Bureau of Indian Affairs, a sub-dept of US Dept. of Health and Human Services). I offer this info only so you understand that, like your wife, my wife and I both have experience in the Health Care industry.

I understand the UK health care situation is massively different than that here in the US. I have no doubt about the views held by the front-line folks regarding NICE. My wife and I both had similar depts here that we despised since both of the places we worked were public sector. And I'm sorry to hear how the NHS pension has been mishandled and subsequently mismanaged.

All that said, I was objecting to the broad painting of the Health Care industry as being more concerned with profit than the patient. Our wives are living proof the to the contrary. Similarly, I object to the notion that health care shouldn't be a private-sector operation. As your wife's experience and my own can attest, public-sector health care is as bad if not worse. As you implied, the NICE isn't concerned with the best treatment, but in managing the cost.


* - In interest of full disclosure, I now work for an insurance company. Business causality, not health care insurance.

[DaddyHoggy]

I think we're singing from the same hymn sheet, just slightly different versions of the same tune.

To qualify the UK state of affairs - we have several big name Private Health Care companies (BUPA for example). There is a constant claim both by BUPA itself and my UK government ministers how brilliantly efficient BUPA hospitals are, how clean they are, how well paid the staff, how little BUPA members pay for their treatments by comparison to the cost per head the UK tax-payer the NHS costs and all that is true, sort of, but here's the problem...

BUPA doesn't train any staff, it recruits them from abroad or the NHS. It doesn't fund University places, whereas the NHS is mandated that it must. BUPA doesn't set any exams or run any governing bodies, the NHS must because it is legally required to do so, the NHS must therefore fund all this additional infrastructure.

If you're a BUPA member and you're in an RTA you'll go to an NHS A&E department, you'll be fixed and when you're almost better, you'll be moved to your BUPA hotel. If you need brain/heart surgery or a transplant it'll be done by the NHS (it might be done in your BUPA hotel but all the staff will be NHS staff drafted in to perform the op - and if it all goes wrong - you'll be moved back to the NHS for ITU and then shipped back to BUPA when you're a bit better).

I have friends that have BUPA/private health care and they say it's unfair that they should have to pay their National Insurance Contributions because they're effectively paying twice. And all I can say to them, is that if BUPA had to pay for its own University courses, set up all the proper Operating theatres, train all of its own staff then NOBODY could afford their health care. So their business case looks great, but only because it parasites off the NHS. There's not a private health care company in the UK that can stand on it's own two feet, but they'll all tell you they can, and the scary thing is, I think they believe it and they've got NHS Senior Management and UK Government Ministers believing it too...

[Dragonfire]

To clarify once again, I'm not by any means referring to the wonderful doctors, nurses, and technicians that work in the medical field - my goal is to become one of them (neurologist). Most of them genuinely care about their patients (though, as with any field, there are always a handful of morons )

My statements are in referral to those that run the hospitals and doctors offices, the insurance companies, and the like. While I cannot speak definitively about Great Britain or any other European nation, I know that in America, profit is the top priority of a majority of hospital administrators, insurance companies, and other medical offices. And the patients suffer for it.

I wish more of the people in charge would think more about the patient, rather than business expediency and profit. The medical field obviously needs income to run, but as soon as profit becomes priority #1? Watch out...

[greenseng]

My statements are in referral to those that run the hospitals and doctors offices, the insurance companies, and the like. While I cannot speak definitively about Great Britain or any other European nation, I know that in America, profit is the top priority of a majority of hospital administrators, insurance companies, and other medical offices. And the patients suffer for it.

I wish more of the people in charge would think more about the patient, rather than business expediency and profit. The medical field obviously needs income to run, but as soon as profit becomes priority #1? Watch out...

I am impressed.

It is always nice to read such a comment, specially from a young person, as my hope for the world is again returning.

[drew]

The UK Government is currently hacking about with Public Service Pensions, including the NHS one, claiming that Public Service Pensions are costing too much because civil servants are now living too long after they retire (damn!). However, pension income collected by the State in the UK has never gone into a pension pot, it goes to the Treasury who spends it like any other income and then pays current pensioners out of the current tax revenue. However, the NHS scheme, if it was run as per a private pension scheme would be in the black and would paying out less in pensions than it currently collects from its members. The Government has denied the NHS the opportunity to break away and run its own private pension scheme and why, because it would cost the Government (Treasury) money to do so. Everybody in the Public Service (I'm no longer a public servant, my MOD pension contributions of 13 years are locked down as they were when I left) knows that the Government's claims that Public Service Pensions are costing too much and therefore they will pay another £2.3Bn in contributions this year has been done purely to make a small additional offset the (current) deficit, not one penny will go towards pay the pensions of longer living pensions of the future.

You should write that in to the Evening Standard, sir! It's obvious the government (uk) is trying to turn public opinion against the public sector with their constant reference to 'Gold-plated pensions'. I'm not clever enough to work out the answers to all this, but it seems to me that a ring-fenced levelled playing field for all folks with respect to pension would be fairer to all. Not sure about the practicalities of that of course.

In the last two years I've been contributing to a CARE (Career Average Related Earnings) pension. It's a defined benefit scheme, rather than a defined contribution scheme. It's not as a generous as a final salary pension, but it seems fairer to both me as the pensionee (I know what I'm going to get and I can make predictions based on it) and it's cheaper to run than a final salary scheme, which is clearly open to be skewed by promotions late in your career. If we had a state run version of that - mandatory for all, with appropriate legislation to ringfence it, that would seem a sensible answer.

Cheers,

Drew.