The Politics Thread

[Prufrock]

There is an article somewhere (perhaps a chapter in Freakonomics) studying the 'common wisdom' that the candidate who spends the most in a Presidential election wins. They reckoned it was cause and effect backwards, that people don't spend money on candidates unlikely to win (John Kerry!) and so the better candidate gets more money spent on them. Spending money must make some difference though, I'd imagine in a close one like this spending the money might stop you losing it, rather than winning it for you, if that makes sense.

$2b is luuuuuuuuuuudicrous though.

[Verbal]

Ends up being a bit of an arms race, innit. They can't exactly sit around and scratch their arses while their (de facto) only competitor is glad handing everyone (in Ohio, Virginia, North Carolina and Florida, anyway).

Barry will get Ohio early on and that's pretty much it, for me.

Also, Pru: when are you moving down here?

[Prufrock]

Dunno, still no start date. Within the next two weeks I'd hope/pray/imagine.

[BWFC_Insane]

We don't like it already - it's called postcode lottery. You can get some treatments and certain medicines in one health trust but not in another adjacent one, and it all depends on the luck of the draw as to where you live. For a National health service it is a ridiculous concept.

Because the budgets have been managed at regional and local level. And because in some areas, there are very costly health issues that mean they can't always afford to buy all the other treatments that in other areas they can.

Fact is if you nationalised the budget the majority of those expensive treatments would be pulled for EVERYONE because there isn't enough money to fund those EVERYWHERE alongside all the other standard treatments.

Some trusts can choose to spend money on those treatments because the general health may be better in their area and they may be spending less on say cardiac or lung disease than in other areas.

[Montreal Wanderer]

I guess I didn't realize the National Health Service was in fact a Regional one. Are you allowed to go to a different region to get a particular treatment not offered in your region?

[thebish]

people want a system that responds to local needs and isn't all run centrally by people who don't understand their local area - but then cry "postcode lottery" when a local area decides to prioritize something that is perceived to be a local need at the inevitable expense of something else that is deemed a priority somewhere else...

it's always a delicate balance between the crude one-size-fits-all
and the post-code-lottery

[Verbal]

Cool American election infographics!

http://www.facebookstories.com/vote" onclick="window.open(this.href);return false;

and a graphic novel of the campaign :S

http://www.guardian.co.uk/world/interac ... phic-novel" onclick="window.open(this.href);return false;

[Prufrock]

We don't like it already - it's called postcode lottery. You can get some treatments and certain medicines in one health trust but not in another adjacent one, and it all depends on the luck of the draw as to where you live. For a National health service it is a ridiculous concept.

Because the budgets have been managed at regional and local level. And because in some areas, there are very costly health issues that mean they can't always afford to buy all the other treatments that in other areas they can.

Fact is if you nationalised the budget the majority of those expensive treatments would be pulled for EVERYONE because there isn't enough money to fund those EVERYWHERE alongside all the other standard treatments.

Some trusts can choose to spend money on those treatments because the general health may be better in their area and they may be spending less on say cardiac or lung disease than in other areas.

It's isn't affordable for everyone, so some can have access to it and others can't? That doesn't sound like the sort of thing you are normally quick to justify...

[thebish]

We don't like it already - it's called postcode lottery. You can get some treatments and certain medicines in one health trust but not in another adjacent one, and it all depends on the luck of the draw as to where you live. For a National health service it is a ridiculous concept.

Because the budgets have been managed at regional and local level. And because in some areas, there are very costly health issues that mean they can't always afford to buy all the other treatments that in other areas they can.

Fact is if you nationalised the budget the majority of those expensive treatments would be pulled for EVERYONE because there isn't enough money to fund those EVERYWHERE alongside all the other standard treatments.

Some trusts can choose to spend money on those treatments because the general health may be better in their area and they may be spending less on say cardiac or lung disease than in other areas.

It's isn't affordable for everyone, so some can have access to it and others can't? That doesn't sound like the sort of thing you are normally quick to justify...

to be fair - i don't think that's even close to what BWFCi just wrote!!! give yourself a slap!!

[Prufrock]

We don't like it already - it's called postcode lottery. You can get some treatments and certain medicines in one health trust but not in another adjacent one, and it all depends on the luck of the draw as to where you live. For a National health service it is a ridiculous concept.

Because the budgets have been managed at regional and local level. And because in some areas, there are very costly health issues that mean they can't always afford to buy all the other treatments that in other areas they can.

Fact is if you nationalised the budget the majority of those expensive treatments would be pulled for EVERYONE because there isn't enough money to fund those EVERYWHERE alongside all the other standard treatments.

Some trusts can choose to spend money on those treatments because the general health may be better in their area and they may be spending less on say cardiac or lung disease than in other areas.

It's isn't affordable for everyone, so some can have access to it and others can't? That doesn't sound like the sort of thing you are normally quick to justify...

to be fair - i don't think that's even close to what BWFCi just wrote!!! give yourself a slap!!

[thebish]

he is simply describing how the system works for the benefit of those who live overseas and so might not know...

there is SOME regional autonomy for choosing how to spend budgets locally - what priorities to set.

so - for the sake of argument - you might find a bigger expenditure on coronary care in one area and in other places a bigger expenditure on asthma care

if you were to replicate the highest levels of spending for each local area nationally - in other words - if you were to make EVERY branch of medicine (regardless of local need) a top rated priority across the board and spend everywhere the amount spent in the highest-spending region, then the NHS would be bankrupt

BWFCi is not advocating better health care for those who can afford it - he is explaining regional variations in priorities.

I'm SURE you understand this!

[Prufrock]

I didn't say he was advocating better healthcare for those who can afford it.

BWFCi said that the NHS couldn't afford to provide all the expensive treatments to everyone and so there are two choices: provide it to nobody, or only provide it to those whose local area's NHS can afford it. The current choice is option two. This means it is available to some, and not to others. This is not the sort of thing we normally hear BWFCi in support of.

IIRC he has history working for the NHS, and what he said reads to me like a justification. It may be I'm wrong and he is just explaining the system. If so, I'll happily slap myself .

As it happens, I think in real terms, often indirectly what the current system does is give better healthcare to those who can afford it - for free.

I don't have any figures for this, and so it could just be common-sense giving a false conclusion, but it seems to me the areas which can't afford the expensive treatments are likely to be those which spend their budgets fighting problems caused by poor diet, poor lifestyle, smoking, and an even unhealthier approach to drinking, and these tend to be problems affecting the less affluent. The more affluent areas spend less on this and so have more for the expensive cancer fighting treatments.

We then get a very difficult argument. On the one hand, if the more wealthy are going to get better treatment, surely they could at least be expected to pay for it? The uncomfortable truth is the NHS cannot afford to give every potentially helpful treatment to every patient. If the NHS can't afford to give it to everyone who needs it, then the NHS cannot afford it. Otherwise it is no longer 'universal healthcare'. The problem then is the only people with access to that treatment are the wealthy, and people who cannot afford it are all screwed whereas before they might have got treatment due to their fortune in living in a local area which could afford it.

So either some people get the treatment because they can afford it, and others don't, because they can't; or, some people get the treatment because they happen to live in a certain area, and others don't because they don't. I'm not sure either option is particularly palatable, but the advantage of the former is that at least the people who can afford to pay for it, do, and so that money is available for everybody based on what the NHS CAN afford.

I cannot see a viable future for the NHS that doesn't involve at least private insurance top-ups.

[BWFC_Insane]

To be clear Pru I have never worked for the NHS. I have in the past worked for a company who supplies it services.

Not justifying the system just explaining it. And whilst you may be correct about people in more affluent areas benefitting, that is actually in many cases not the true picture. Often elderly care which costs the NHS a huge chunk is far greater in more affluent areas leaving less budget for other things. And then you are more likely to have a good walk in centre service in a poorer urban area than a rich suburban dominated place, for example.

Ideally you want everyone to get everything. It's not possible and the system at present to tailor health to local needs may not be ideal, but I'm not sure what you'd replace it with?

[thebish]

i think it's much simpler...

(and I am ALWAYS backing BWFCi up)

Monty was sounding like he thought there was no regional variation (or budget-priority-setting) in our system - making it wholly and unthinkably different to the U.S. Monty seemed to think we have a simple one-size-fits-all nationally-measured NHS.

BWFCi was just explaining that there IS some regional choice-making over priorities - thus making an opening for people to cry "post code lottery" - and a (perhaps legitimate) claim that someone might get better cancer treatment in one area than another (whilst ignoring the possibility that they'd get better coronary care in their area.)

of course you are only really interested in the quality of treatment of the particular ailment you (or those close to you) are suffering from - so if you have prostate cancer and your PCT doesn't proiritise that - but spends more on a leprosy screening service - then you probably think they should cut the leprosy screening service and spend more on prostate cancer... etc...

[Prufrock]

To be clear Pru I have never worked for the NHS. I have in the past worked for a company who supplies it services.

Not justifying the system just explaining it. And whilst you may be correct about people in more affluent areas benefitting, that is actually in many cases not the true picture. Often elderly care which costs the NHS a huge chunk is far greater in more affluent areas leaving less budget for other things. And then you are more likely to have a good walk in centre service in a poorer urban area than a rich suburban dominated place, for example.

Ideally you want everyone to get everything. It's not possible and the system at present to tailor health to local needs may not be ideal, but I'm not sure what you'd replace it with?

OK. I can't find an emoticon for self-slapping!

As for which system is better. Making sure every treatment which is available on the NHS is available to everyone who needs it seems much fairer and more in keeping with the ethos of the NHS. It may well be that the way it is divided at the moment saves and prolongs more lives for the same money, in which case fair enough.

Deciding what care is and is not available is certainly not a job I'd want, and one which is surely only to get more difficult!

[thebish]

As for which system is better. Making sure every treatment which is available on the NHS is available to everyone who needs it seems much fairer and more in keeping with the ethos of the NHS.

indeed - i doubt many would disagree with that...

but - if the pot is limited (as it is)

then is it better to provide a basic no-frills (ie. - no swanky expensive treatments) service that is set nationally and applies to everyone... a national one-size-fits-all service

or

to divide the budget up regionally and allow each region to make some decisions about what health-care priorities there should be locally - using essentially the same amount of money - but not using it in the same way in every place.

with the first option - you get the fairness that you crave
with the second option - you get some recognition that health care needs are not uniform across the UK

of course - it's not really as simple as that!!

[Athers]

Given everything which has gone on in the last 4 years I'm just about for giving Obama another term but I still feel disappointed on the way he's acted regards a credible deficit reduction plan. Ignoring his own commissions' findings etc.

More depressing is the inability of many politicians over there to accept any compromise when it comes to getting a decent ratio of spending cuts to tax increases into a plan (something like 75:25 to 80:20). The deadlock and fiscal cliffs stuff is one giant game of chicken that I find distasteful when it's dictating economic policy.

I much prefer our system of democracy where the Chancellor can simply read out the budget and that's that*. Gets stuff done.. but there you go.


* except for sausage roll tax

The European system of electing governments with the power to govern does seem more logical, but its important to remember that the US is a democratic republic as opposed to a true democracy. The idea is that each of the states governs themselves, and the federal government only gets involved where there is common interest such as defence, foreign relations, major crime etc. Thus the system is wholly intended to make it as hard as possible for the federal government to make much of an impact, the system is in effect acting as limiting agent against overreach by the federal government, thus protecting states rights, and "freedom".

The concept of freedom, or loss of it, is one of the main ideals behind the TEA Party, who perceive Obamacare as wealth distribution, and thus the whole Obama agenda as marxist/communist. When you add in the natural hate towards Obama in the confederacy states, and the dominating influence of the TEA party in the GOP, then you have a completely polarized political scene that has so far only come together when the outcome of not doing so would mean the country would start to be unable to operate.

My preference from the outside would be for a more federal US in order for them to govern more effectively, I can't handle in my mind how the world's most important economy can let their debt ceiling be played about with by a stubborn House using it as a threat.

This is probably also true when certain states make decisions around social issues which are rather wacky, out of step or seemingly stupid by global standard - for example the teaching of creationism.

I also don't like the politicisation of judges to the Supreme Court. What are we at now, 4 of each and 1 independent who could determine judgement calls all by himself, but that's for another day probably.

My view is undoubtedly influenced by growing up in a relatively small and United Kingdom though.

The thing I think is often forgotten is the redistribution which already happens -

http://www.economist.com/blogs/dailycha ... scal-union" onclick="window.open(this.href);return false;

[Montreal Wanderer]

i think it's much simpler...

(and I am ALWAYS backing BWFCi up)

Monty was sounding like he thought there was no regional variation (or budget-priority-setting) in our system - making it wholly and unthinkably different to the U.S. Monty seemed to think we have a simple one-size-fits-all nationally-measured NHS.

BWFCi was just explaining that there IS some regional choice-making over priorities - thus making an opening for people to cry "post code lottery" - and a (perhaps legitimate) claim that someone might get better cancer treatment in one area than another (whilst ignoring the possibility that they'd get better coronary care in their area.)

of course you are only really interested in the quality of treatment of the particular ailment you (or those close to you) are suffering from - so if you have prostate cancer and your PCT doesn't proiritise that - but spends more on a leprosy screening service - then you probably think they should cut the leprosy screening service and spend more on prostate cancer... etc...

Right, we know who to blame but my question, once I realized there are regional differences, has not been answered. If you need something not given in your region, can you get it in another region where it is offered. Yes or No.

[thebish]

Right, we know who to blame but my question, once I realized there are regional differences, has not been answered. If you need something not given in your region, can you get it in another region where it is offered. Yes or No.

sometimes yes - sometimes no.

[mummywhycantieatcrayons]

I think the radicalizing effect of Obama is as much to do with who he is, rather than any judgement on his political skills.

So?