Privatisation of the NHS discussion

Bletchleyite said:

The prescription charge is silly too.

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I've heard from somewhere, not sure how true it is though, that the costs of prescriptions are higher for the NHS since the prescription charge came into being due to the extra admin it requires.

klambert said:

I've heard from somewhere, not sure how true it is though, that the costs of prescriptions are higher for the NHS since the prescription charge came into being due to the extra admin it requires.

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That would seem reasonable, but I doubt it exceeds the price charged per prescription. Living west of Offa's Dyke, I was surprised to find that you're now being charged £9 per item of medicine in England.

Butts said:

Probably why Scotland and Wales got rid of them ?

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Quite possibly. It's completely bizarre and arbitrary that if the thing that's wrong with you requires medicine you have to pay an arbitrary sum (not in any way connected with its cost) for it, but if it requires personal attention (something much more expensive than a lot of medications) such as physio, or even a sophisticated operation costing ten grand with months of followup care, you don't have to pay for that.

A fee per course of treatment (as per dental work) probably makes more sense than that, though I would rather no fee at all and it being funded by general taxation or mandatory health insurance priced based on your ability to pay as per many European countries.

433N said:

It seems the height of irony that the greed of American corporations and their demand for access to overseas markets in the pursuit of growth which they can't find in the US, has left so many behind that they vote for Brexit against the Bogeyman EU, only for American corporations to demand more access to British markets.

As somone once said American corporations ARE the American government.

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Yes - for example, the Arms industry = opposition to gun control.
Oil & Coal industries = opposition to anti-global warming measures.
Insurance & "Medical" industries = opposition to affordable health care.

Belperpete said:

The main thing the USA wants is for the UK to pay American prices for drugs. As I understand it, the NHS uses its buying power to negotiate low prices on many drugs, and many other countries use these prices as a template for what they are prepared to pay. The American drug companies are very unhappy at the loss of profits this causes.

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Exactamondo.

In the US, drug companies lobbied so that under Medicare Part D, the federal government cannot negotiate drug prices. This has been estimated to be worth $205 billion to the drug companies over a 10 year period [ https://pdfs.semanticscholar.org/c546/293f7bde0bc8b7606ec20ffa401bb3d44175.pdf ]

klambert said:

I've heard from somewhere, not sure how true it is though, that the costs of prescriptions are higher for the NHS since the prescription charge came into being due to the extra admin it requires.

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May have been in the past but now with computerisation and internet, the admin should be cheap - but then again, it is the nhs so probably still do loads by hand for job creation.

underbank said:

May have been in the past but now with computerisation and internet, the admin should be cheap - but then again, it is the nhs so probably still do loads by hand for job creation.

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They probably fax them. The NHS is bureaucratic beyond belief.

What the US wants from the UK in regard to the NHS is spelt out in its trade negotiating position as follows.

“ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are non-discriminatory, and provide full market access for US products.”

Trump has stated that he wants the NHS to pay higher prices for US sourced drugs as due to the NHS purchasing power the UK pays less for them than US citizens do. For the last 12 months we imported around £26bn worth of Medicinal & pharmaceutical products of which £2.3bn came from the US. No idea what proportion of those products can only be sourced from the US.

TTIP by the back door.

Howardh said:

One thing that should be charged are patients who fail to turn up for appointments without good reason. How you would get the money off them in "fines" I don't know, but maybe they should provide their credit card number on their details at the surgery/hospital?

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If they don't pay the fine then refuse them any future appointments till they do pay it.

Dave1987 said:

I don’t believe the current favourite for the Tory leadership, Boris Johnson, can be trusted not to offer the NHS on a plate to the US in return for a trade deal.

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Seconded (despite the bus).

Dave1987 said:

I don’t believe the current favourite for the Tory leadership, Boris Johnson, can be trusted not to offer the NHS on a plate to the US in return for a trade deal.

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Typhoon said:

Seconded (despite the bus).

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Maybe that "bus message" was meant to read "let's give £350m to the NHS instead, so it can pay US prices for things".

greyman42 said:

If they don't pay the fine then refuse them any future appointments till they do pay it.

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Not sure how you're going to fine the young & old who are exempt, the disabled, the unemployed, and those with MH issues. So it basically leaves workers who are the ones paying the most into the system anyway. It'd take a brave politician to try to charge/fine the most vulnerable! I'd love to see statistics of which groups of society are the ones most likely to miss appointments - the information must be there within the NHS systems, just ready to be mined - I suspect it's the ones who'd be exempt who are the ones causing most of the missed appointments.

deltic said:

What the US wants from the UK in regard to the NHS is spelt out in its trade negotiating position as follows.

“ensure that government regulatory reimbursement regimes are transparent, provide procedural fairness, are non-discriminatory, and provide full market access for US products.”

Trump has stated that he wants the NHS to pay higher prices for US sourced drugs as due to the NHS purchasing power the UK pays less for them than US citizens do. For the last 12 months we imported around £26bn worth of Medicinal & pharmaceutical products of which £2.3bn came from the US. No idea what proportion of those products can only be sourced from the US.

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Late reply (sorry) but I'd like to put the potential cost of paying more for US-sourced drugs in perspective.

The total NHS budget is around £150 billion and we might pay an additional £1 billion if they charged about 40% more.

Dai Corner said:

Late reply (sorry) but I'd like to put the potential cost of paying more for US-sourced drugs in perspective.

The total NHS budget is around £150 billion and we might pay an additional £1 billion if they charged about 40% more.

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Great number ... you should put it on the side of a bus.

Without arguing numbers, do you really think if it was just worth £1 billion to the US that they would be even mentioning it as a part of a trade deal ?

Perhaps the US are more desperate for money than I thought. You can believe that figure if you want but I think in the grand scheme of things that is chump change to them that wouldn't merit a mention.

433N said:

Great number ... you should put it on the side of a bus.

Without arguing numbers, do you really think if it was just worth £1 billion to the US that they would be even mentioning it as a part of a trade deal ?

Perhaps the US are more desperate for money than I thought. You can believe that figure if you want but I think in the grand scheme of things that is chump change to them that wouldn't merit a mention.

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I was just putting the figures given in perspective. Happy to do the same with any other figures people care to quote.

I really don't see why we (ie NHS) should pay more for prescription medicines. We get a low price because we buy in bulk which, in turn, guarantees the US pharma companies large orders every month. This practice is rife in retail. Surely it is just an example of market economics?

Typhoon said:

I really don't see why we (ie NHS) should pay more for prescription medicines. We get a low price because we buy in bulk which, in turn, guarantees the US pharma companies large orders every month. This practice is rife in retail. Surely it is just an example of market economics?

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Indeed. If what Trump is quoted above as saying about Americans paying more than us is true, then American buyers should be asking why that is and refusing to pay more than the NHS do.

Dai Corner said:

Indeed. If what Trump is quoted above as saying about Americans paying more than us is true, then American buyers should be asking why that is and refusing to pay more than the NHS do.

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I have no experience of buying prescription medicines in the US so this is supposition. Within the NHS cost is the driver, so if you take, say Aspirin, we presumably get the brand which is cheapest; in the US do buyers purchase on the strength of advertising, promotions, reputations? Are buyers buying for smaller markets? Is there a reluctance to interfere with the pricing structure?
There is also the matter of Trump's record on truth to consider.

If it is right then we need to get NHS buyers in to sort out our trade deals PDQ!

Typhoon said:

I have no experience of buying prescription medicines in the US so this is supposition. Within the NHS cost is the driver, so if you take, say Aspirin, we presumably get the brand which is cheapest; in the US do buyers purchase on the strength of advertising, promotions, reputations? Are buyers buying for smaller markets? Is there a reluctance to interfere with the pricing structure?
There is also the matter of Trump's record on truth to consider.

If it is right then we need to get NHS buyers in to sort out our trade deals PDQ!

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I don't know anything about the American pharmaceutical
marketplace either, but I do know that when we (the public) buy non-prescription drugs for ourselves we are swayed by advertising and pay premium prices for branded ones over generics.

underbank said:

Not sure how you're going to fine the young & old who are exempt, the disabled, the unemployed, and those with MH issues. So it basically leaves workers who are the ones paying the most into the system anyway. It'd take a brave politician to try to charge/fine the most vulnerable! I'd love to see statistics of which groups of society are the ones most likely to miss appointments - the information must be there within the NHS systems, just ready to be mined - I suspect it's the ones who'd be exempt who are the ones causing most of the missed appointments.

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Why would they be exempt?

Dai Corner said:

I don't know anything about the American pharmaceutical
marketplace either, but I do know that when we (the public) buy non-prescription drugs for ourselves we are swayed by advertising and pay premium prices for branded ones over generics.

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I was once in a pharmacy where a customer was asking an assistant for advice about which of three (similar) products to buy. The suggestion was that a particular one was advertised on TV. With logic like that I will stick to going to discounters and checking the PL number.

Dai Corner said:

I don't know anything about the American pharmaceutical
marketplace either, but I do know that when we (the public) buy non-prescription drugs for ourselves we are swayed by advertising and pay premium prices for branded ones over generics.

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Looks like you are right:- “Anyone who watches television knows these ads are pervasive, and anyone who studies them knows they are contributing to the cost of prescription drugs by encouraging patients to request physicians to prescribe more costly branded medications where cheaper alternatives are available,” said Michelle Mello, professor of law and professor of health research and policy at Stanford University.
https://www.drugwatch.com/featured/us-drug-prices-higher-vs-world/
Supporting information https://www.verdict.co.uk/trump-drug-prices-pressure-uk-regulations/

Trump has accused the NHS of freeloading off of American pharma, it seems to me like we are doing no such thing, we are buying the own brand goods rather than the expensively advertised ones. The only difference is that in the case of medicines, the items are not just similar but identical.

Typhoon said:

Looks like you are right:- “Anyone who watches television knows these ads are pervasive, and anyone who studies them knows they are contributing to the cost of prescription drugs by encouraging patients to request physicians to prescribe more costly branded medications where cheaper alternatives are available,” said Michelle Mello, professor of law and professor of health research and policy at Stanford University.
https://www.drugwatch.com/featured/us-drug-prices-higher-vs-world/
Supporting information https://www.verdict.co.uk/trump-drug-prices-pressure-uk-regulations/

Trump has accused the NHS of freeloading off of American pharma, it seems to me like we are doing no such thing, we are buying the own brand goods rather than the expensively advertised ones. The only difference is that in the case of medicines, the items are not just similar but identical.

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That's interesting. Thanks.

Also, NHS patients don't get to request particular brands. The doctors prescribe purely on medical grounds. At least I hope they do!

Dai Corner said:

Indeed. If what Trump is quoted above as saying about Americans paying more than us is true, then American buyers should be asking why that is and refusing to pay more than the NHS do.

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The thing is, the "buyers" in the US system are the insurance companies.

They choose how much of a deductible (excess) needs to be paid by the patient, and then the rest of the cost is pooled between everyone's premiums. Nothing's really coming out of their pocket, provided that they set their premiums high enough (or choose who to offer insurance to) so that they end up with a profit for their shareholders.

You might think that the ability to offer lower premiums than their competition would be good for business for insurers. But with many individuals getting healthcare as part of their employment package, they don't really shop around. And the large companies buying healthcare policies for their workforce are prone to accepting kickbacks.

Hospitals and healthcare providers aren't funded centrally so their source of revenue is the invoices they issue to their patients and their insurance companies. So it's in their interest to invoice for everything they can. And the manufacturers of pharmaceuticals, equipment, etc, will charge as high a price as they can, especially for any product which is protected by patent, licensing, or some other exclusivity. Add on a whole load of lobbying and bureaucracy, by those that are currently making money from the system, and want to keep it that way. (e.g. manufacturers like to be able to advertise their prescription drugs directly to patients, so lobby to keep the right to do so.)

The trouble is, when you get down to the individual, refusing to pay (for insurance) just leaves you with the danger of a huge medical bill that you have to pay for yourself. And that's not an option anymore, you have to buy healthcare. The recent reforms to US healthcare (Affordable Care Act of 2010) aimed to make insurers offer healthcare premiums to all, and also required everyone to obtain insurance. But with all the vested interests involved (see lobbying), it's not been a panacea by any stretch of the imagination. And the current US president is quite adamant that the Act needs to be revoked.

(Note, the above is an outsider's understanding of the situation. I can't claim any personal experience of the system, and I wouldn't particularly want to either.)

Donald Trump has always hated the NHS for the brilliant deals it gets as a result of economies of scale. This is something that the USA, a 'leading' world economy really struggles in achieving and thus loses a lot of money, time and efficiency that he wished America had.

Trump is the sort of person to only like ideas if it has his name on it. Even if he did like the way the NHS runs, he wouldn't publicly owe to it unless he had some part to play in making it happen.

Stupid thing to bring something not for sale and try to buy it out when that's not what we are asking for in a trade deal. Also seriously damaging enough for UK to willingly cancel Brexit if need be to save the NHS.

The NHS is one of those beautiful things that regardless of who you support or where you stand on the political spectrum, you will always adore, appreciate and defend at all costs.

700007 said:

Donald Trump has always hated the NHS for the brilliant deals it gets as a result of economies of scale. This is something that the USA, a 'leading' world economy really struggles in achieving and thus loses a lot of money, time and efficiency that he wished America had.

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Has he? I don't know if he has or not, but at the press conference that kicked off this whole debate, I got the impression that when he was questioned by the reporter, he didn't recognise what "N-H-S" is (hence May's attempt to clue him in), and that he was bluffing an answer in his usual style of "everything's negociable".

Either way, Trump tends to say what's on his mind at the time. That may or may not correspond to what he's said previously, or will say later.

greyman42 said:

Why would they be exempt?

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Can you imagine the social media outrage when an OAP with dementia or a woman with inoperable cancer gets a fine or struck off a GP list for missing appointments? It's just not going to happen.

krus_aragon said:

And to throw out another scare story, there's the caravan of people who travelled north to Canada to buy affordable insulin, as reported a month ago

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Which is the sub- plot in the film Love & Other Drugs, starring the very easy on the eye Anne Hathaway.

yorksrob said:

but de-coupling the funding aspect of it from Government. Perhaps we could start by ring-fencing the existing chunk of taxation for health spending

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Healthcare and the NHS should not be a political football kicked about by any politician

SteveP29 said:

Healthcare and the NHS should not be a political football kicked about by any politician

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Any service funded or subsided by the taxpayer will inevitably become a political football.