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The Big Scottish Independence Debate


Laurence

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If you had ever used the US healthcare system, I doubt you would be holding it up as an example of good practice, and certainly not of efficiency and value for money.

 

It is absurd to say that the drive for profits cuts out inefficiency; everyone wants and gets their cut, so that costs are sky high, as are profits. 

 

The great irony in this and in the broader referendum debate is that it is the Scots who are holding to traditional "British" values, and that it is the erosion of those values by the market-driven ideas espoused here that has created the chasm that may well lead to a definitive parting of the ways.

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Let's be clear, nobody is advocating introducing the American system here in the sense that Healthcare be funded through insurance.  It is that aspects that brings inefficiencies into the american system.  But if you read what I said above, you will see it is not me that is holding up American services as examples of good practice, it is the SNP Government that is doing that.  It is they who have sent managers from here over there and invited their managers and clinicians over here so that we can learn from them.

 

It is far from absurd to say that the drive for profits cuts out inefficiiency.  It is what market forces are all about and all capitalist economies are based on the truth of that.  Of course everyone wants their cut - that's what incentivises the system - but if providers get too greedy about profit margins or dont drive inefficiencies out of their systems then costs will be higher than people are prepared to pay.  If they don't provide the quality the customer requires then the customer won't buy the product.  The end result is that customers get the products they want and prices they can afford whilst the supplier makes a fair profit and everyone is happy.

 

There is no irony in the situation.  Traditional "British" values are of embracing a market economy.  The market may drive the economy but it is important that the market does not drive policy.  It is some on the "YES" side who seem to want to do away with the market economy altogether and have visions of a separate socialist state.  That is simply not going to happen even if there is a Yes vote.  If that is what you want then a one way ticket to Cuba is what you need.  I am certainly no Thatcherite but you are increasingly sounding like a Marxist.

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You have a very naive view of the US healthcare system, as I say everyone gets their cut, and it is completely inefficient.

 

What is clear is that your views of traditional British values are quite different to those of many Scots, and you are sounding increasingly like a desperate Tory if you think that having an unshakable belief in social healthcare equates to being a big bad "Marxist."

 

But anyway, you just keep on telling us what is right and what we should be thinking.

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You have a very naive view of the US healthcare system, as I say everyone gets their cut, and it is completely inefficient.

 

What is clear is that your views of traditional British values are quite different to those of many Scots, and you are sounding increasingly like a desperate Tory if you think that having an unshakable belief in social healthcare equates to being a big bad "Marxist."

 

But anyway, you just keep on telling us what is right and what we should be thinking.

 

...whilst you just keep on completely ignoring the arguments of others and making assertions based on no facts or rational argument at all.  Without repeating the arguments you chose to ignore, let me just say that I too have an unshakable belief in social healthcare.  The difference in our views appears to be that I acknowledge the fact that significant parts of our publicly funded health service are delivered by the private sector whilst you appear to be unwilling to acknowledge that fact.

 

I am not telling anyone what is right.  I am simply offering a few facts and giving a few opinions of my own.  I am not telling anyone what they should be thinking but I am asking you what you are thinking and you are not rising to the challenge.  Let me put it simply; do you think that current private sector service delivery in the NHS should be phased out and replaced with public sector provision?

 

My view is that where private sector service delivery allows public money to be spent more efficiently then the government should make use of the private sector.  That is because where the private sector can deliver services more efficiently it releases public money to spend either on other public services or tax cuts.  That is a view shared by all the major political parties and, I suspect, by about 99% of the population.  Where the parties disgree is whether savings made in this way should be reinvested into other public services or used to cut taxes.  What is your view?  Do you share the view of the SNP or do you take the view that poorer public services or higher taxes are an acceptable consequence of keeping the private sector out of publicly funded healthcare provision?

 

It's a simple question and I really would appreciate a straight answer.

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You have a very naive view of the US healthcare system, as I say everyone gets their cut, and it is completely inefficient.

 

What is clear is that your views of traditional British values are quite different to those of many Scots, and you are sounding increasingly like a desperate Tory if you think that having an unshakable belief in social healthcare equates to being a big bad "Marxist."

 

But anyway, you just keep on telling us what is right and what we should be thinking.

 

...whilst you just keep on completely ignoring the arguments of others and making assertions based on no facts or rational argument at all.  Without repeating the arguments you chose to ignore, let me just say that I too have an unshakable belief in social healthcare.  The difference in our views appears to be that I acknowledge the fact that significant parts of our publicly funded health service are delivered by the private sector whilst you appear to be unwilling to acknowledge that fact.

 

I am not telling anyone what is right.  I am simply offering a few facts and giving a few opinions of my own.  I am not telling anyone what they should be thinking but I am asking you what you are thinking and you are not rising to the challenge.  Let me put it simply; do you think that current private sector service delivery in the NHS should be phased out and replaced with public sector provision?

 

My view is that where private sector service delivery allows public money to be spent more efficiently then the government should make use of the private sector.  That is because where the private sector can deliver services more efficiently it releases public money to spend either on other public services or tax cuts.  That is a view shared by all the major political parties and, I suspect, by about 99% of the population.  Where the parties disgree is whether savings made in this way should be reinvested into other public services or used to cut taxes.  What is your view?  Do you share the view of the SNP or do you take the view that poorer public services or higher taxes are an acceptable consequence of keeping the private sector out of publicly funded healthcare provision?

 

It's a simple question and I really would appreciate a straight answer.

 

 

I won't respond to your original response to me, bar to say  I am shamelessly using the Fear Factor? I am?  :rotflmao:  Don't you read the guff from No Better Together Thanks and the MSM?

 

I agree that the NHS needs to be made more affordable, but before starting to privatise it wholesale, as is happening in England, putting everything  from cancer treatment to old age care out to tender to make profit for the healthcare businesses with which so many of our legislators are financially involved, we should be rethinking what we are actually funding and whether the treatment offered is is to maintain health and/or prolong life....or enhance lifestyles.

 

However, the point I was trying to make was the probable consequences of reductions in the Barnett Consequentials, due to firstly the austerity budgets which are ongoing, regardless of who wins the next election in UK, and the creeping privatisation of the NHS in England, which started with the horrendously expensive PFI, (which we also have in Scotland, thanks to the Scottish Unionist Governments after 1999), but which does not exist for Barnett purposes.......and which is now heading into delegating acute/chronic health care to private health companies by competitive tender......and with the best will in the world, while most expensive is not necessarily the best, as we see with many brand name goods, the cheapest is not necessarily the best either. 

 

In Scotland, we already spend £200 a head more than is theoretically spent in England on health care (if you don't, as Westminster doesn't, count the ongoing long term costs of PFI) out of the block grant, but as long as Westminster introduces welfare cuts as they have been doing, and will continue to do, Scotland's reducing income will have to cover more outlay and something has to give..and that probably will be our NHS, as it is expected that by 2020, 50% of the English NHS will be "privatised" and therefore is, theoretically, not spent in England on the NHS..therefore Scotland gets no share, although they will still pay. 

 

And into the bargain, if, as we will be, sooner or later, we are forced to privatise as England is doing to maintain the NHS, that then will leave us open to attack by American healthcare companies through the TTIP being instituted by the EU.  We are already in a situation in which repaying the money owed on PFI contracts takes precedence over the money going into Clinical Health Services, so that a struggling Health Board has to cut beds/staff etc in order to ensure repayment of PFI contracts, rather than being able to suspend maintenance work and cut ancillary services until the crisis has passed.

 

From http://www.patients4nhs.org.uk/eu-us-free-trade-agreement-or-ttip/

 

The prospect of being unable to intervene and regulate healthcare in the interests of public health, or to ensure quality services, has led some governments (e.g. Canada) to seek the exemption of health services from FTAs. Not so our current government. Some of those who are promoting TTIP say that health will be exempt from the treaty because it is a public service. This is highly misleading. In the context of FTAs, the term ‘public service’ refers only to those services that are not supplied on a commercial basis, or are not in competition with other service providers. Since the passing of the Health and Social Care Act (2012), the NHS does not conform with this description.

In addition, TTIP negotiations are based on what is called ‘negative listing’ – if negotiators don’t specifically list a sector like health as exempt, it will count as being included the treaty.  Despite evasive answers to the question of whether the NHS is exempt from TTIP (for example, David Cameron has answered this question in the House of Commons by saying “I am not aware of a specific exemption for any particular area”), the fact is that the UK has listed no exemptions.

 

And that is the biggest threat to the Scottish NHS from remaining in the Union. Outside the Union, we can exempt our NHS from TTIP........inside the Union, as our income reduces, as we know it will, we will be unable to keep it as a public service.

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A lot of what Doofersdad says is correct. NHS Scotland does use the private sector for some services. It will use private hospitals if these can provide a service not available, or available with long waiting times, in NHS hospitals. My wife had an operation in a private hospital in Dundee simply because Perth and Dundee NHS hospitals did not have the bed or theatre space at the time. The consultant who carried out the operation worked for both entities.

GP's and hospitals will also use private laboratories where there is a backlog in NHS provision. All of those services, however, are paid for from the NHS Scotland budget. If Virgin Medical come along annd offer to treat cancer patients how is this going to be paid for? From the NHS budget.

The NHS is free at the point of service to all and thats how it should remain. Its not privatisation or the use of private sector services that is needed. Its a total revamp of what is provided from within. That revamp must start with getting rid of the high salaried people running our service. Many of whom have absolutely no background in the healthcare profession. We need specialists who are employed by and committed to the NHS. Not people who give half there time for high salaries whilst devoting most effort into their private healthcare provision. If a private health provider is able to provide a service whilst still able to make profit for its shareholders then NHS Scotland should be able to do exactly the same. The people, the expertise, the technology. They are all in place. Its how they are used that needs to change.

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You have a very naive view of the US healthcare system, as I say everyone gets their cut, and it is completely inefficient.

 

What is clear is that your views of traditional British values are quite different to those of many Scots, and you are sounding increasingly like a desperate Tory if you think that having an unshakable belief in social healthcare equates to being a big bad "Marxist."

 

But anyway, you just keep on telling us what is right and what we should be thinking.

 

...whilst you just keep on completely ignoring the arguments of others and making assertions based on no facts or rational argument at all.  Without repeating the arguments you chose to ignore, let me just say that I too have an unshakable belief in social healthcare.  The difference in our views appears to be that I acknowledge the fact that significant parts of our publicly funded health service are delivered by the private sector whilst you appear to be unwilling to acknowledge that fact.

 

I am not telling anyone what is right.  I am simply offering a few facts and giving a few opinions of my own.  I am not telling anyone what they should be thinking but I am asking you what you are thinking and you are not rising to the challenge.  Let me put it simply; do you think that current private sector service delivery in the NHS should be phased out and replaced with public sector provision?

 

My view is that where private sector service delivery allows public money to be spent more efficiently then the government should make use of the private sector.  That is because where the private sector can deliver services more efficiently it releases public money to spend either on other public services or tax cuts.  That is a view shared by all the major political parties and, I suspect, by about 99% of the population.  Where the parties disgree is whether savings made in this way should be reinvested into other public services or used to cut taxes.  What is your view?  Do you share the view of the SNP or do you take the view that poorer public services or higher taxes are an acceptable consequence of keeping the private sector out of publicly funded healthcare provision?

 

It's a simple question and I really would appreciate a straight answer.

 

 

Well you seem to have moved the goalposts somewhat, from promoting a US style healthcare system to now posing a rhetorical question on a common sense policy.

 

Anyway, great to see you backing SNP policies. :smile:

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A lot of what Doofersdad says is correct. NHS Scotland does use the private sector for some services. It will use private hospitals if these can provide a service not available, or available with long waiting times, in NHS hospitals. My wife had an operation in a private hospital in Dundee simply because Perth and Dundee NHS hospitals did not have the bed or theatre space at the time. The consultant who carried out the operation worked for both entities.

GP's and hospitals will also use private laboratories where there is a backlog in NHS provision. All of those services, however, are paid for from the NHS Scotland budget. If Virgin Medical come along annd offer to treat cancer patients how is this going to be paid for? From the NHS budget.

The NHS is free at the point of service to all and thats how it should remain. Its not privatisation or the use of private sector services that is needed. Its a total revamp of what is provided from within. That revamp must start with getting rid of the high salaried people running our service. Many of whom have absolutely no background in the healthcare profession. We need specialists who are employed by and committed to the NHS. Not people who give half there time for high salaries whilst devoting most effort into their private healthcare provision. If a private health provider is able to provide a service whilst still able to make profit for its shareholders then NHS Scotland should be able to do exactly the same. The people, the expertise, the technology. They are all in place. Its how they are used that needs to change.

You must be onto something - both Oddquine and I like your post!

 

I think the point you make about the need for the current structures to change is the key thing.  I would like service provision to be public sector run if at all possible.  There are a number of reasons but a key one is because specific services don't work in isolation and the linkages between the different strands of the NHS will be harder if a range of different service providers are contracted to deliver very specific bits of service delivery in line with a contract.  But if public sector delivered services are run well then they should be able to delivered for less money than the private sector can do because the public sector does not need to factor in a profit element to its costings.  It is a sad reflection on the way the public service manages it's affairs that it is increasingly neccessary to contract with the private sector either to get a service delivered within available budget or simply to get the service delivered at all.  The big question is how do you completely overhaul the NHS management structure to allow service delivery to be more efficient?  It will be extraordinarily difficult to do and would require the shedding of thousands of posts with redundancies on a large scale and the retraining of many other staff back into clinical roles.

 

I don't think this type of radical overhaul will be entered into easily.  Ironically, what might provide the trigger is the TIPP intiative that Oddquine is so worked up about.  If the private sector is allowed to bid for certain aspects of service provision which are currently blocked to them then the current managed service will face the prospect of major job losses in any case.  The iniative may force them to get their act together to ensure they can compete with the private sector.  If they don't rise to the challenge and improve and contracts go to the private sector then whilst public money would not be being spent as well as it could be, it would at least be spent better than if we do nothing.

 

But to be honest, I don't see that addressing these issues will be any different whether we are independent or not.  NHS costs are threatening to spiral out of control and radical action is required.  I don't see anything in what either the YES or NO camps are saying that leads me to think that this crucial issue is more or less likely to be tackled whether we become independent or not.

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You have a very naive view of the US healthcare system, as I say everyone gets their cut, and it is completely inefficient.

 

What is clear is that your views of traditional British values are quite different to those of many Scots, and you are sounding increasingly like a desperate Tory if you think that having an unshakable belief in social healthcare equates to being a big bad "Marxist."

 

But anyway, you just keep on telling us what is right and what we should be thinking.

 

...whilst you just keep on completely ignoring the arguments of others and making assertions based on no facts or rational argument at all.  Without repeating the arguments you chose to ignore, let me just say that I too have an unshakable belief in social healthcare.  The difference in our views appears to be that I acknowledge the fact that significant parts of our publicly funded health service are delivered by the private sector whilst you appear to be unwilling to acknowledge that fact.

 

I am not telling anyone what is right.  I am simply offering a few facts and giving a few opinions of my own.  I am not telling anyone what they should be thinking but I am asking you what you are thinking and you are not rising to the challenge.  Let me put it simply; do you think that current private sector service delivery in the NHS should be phased out and replaced with public sector provision?

 

My view is that where private sector service delivery allows public money to be spent more efficiently then the government should make use of the private sector.  That is because where the private sector can deliver services more efficiently it releases public money to spend either on other public services or tax cuts.  That is a view shared by all the major political parties and, I suspect, by about 99% of the population.  Where the parties disgree is whether savings made in this way should be reinvested into other public services or used to cut taxes.  What is your view?  Do you share the view of the SNP or do you take the view that poorer public services or higher taxes are an acceptable consequence of keeping the private sector out of publicly funded healthcare provision?

 

It's a simple question and I really would appreciate a straight answer.

 

 

Well you seem to have moved the goalposts somewhat, from promoting a US style healthcare system to now posing a rhetorical question on a common sense policy.

 

Anyway, great to see you backing SNP policies. :smile:

 

 

I haven't changed the goal posts at all.  I never for a moment gave any support for the American Healthcare system - I stated agreement with the SNP Government's strategy of learning from certain American service providers about how to run a service more efficiently.  Glad to see we appear now to be in broad agreement and you too are backing SNP policy which embraces private sector service provision when necessary. :smile:

 

Rather than do yet another post, let me give a brief response to PMF's posting of Phillipa Whitford's speech.  She talks very eloquently and I very much share her concerns about what is happening in the NHS down South.  But what she fails to do is to explain why that threatens the health service here.  The fact is that what is happening there is not happening here.  In Scotland Healthcare is a devolved function and the fact that health care policy is going in a different direction North of the Border  is an example of how well devolution is actually working. 

 

It is good to have two very different approaches.  I know which one I prefer but the proof of the pudding is in the eating so to speak.  What will the patient outcomes be of the two different systems and t what cost to the public purse?  Evidence about that in a few years time may result in changed opinions either North of the Border.

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Yep! Exactly!

 

http://bellacaledonia.org.uk/2014/07/17/dinner-with-no-voters-or-what-i-wanted-to-say-before-the-pudding-hit-the-fan/

 

It's long......and this is a long quote from it

 

In any case, despite the devout wish of many in the BBC and the Labour Party, to name but two, that this whole question had never been raised,, the status quo, as I’ve said before, may well be on the ballot paper. But it is not on the cards. A wish for a return to normal is a wish for a stability that is already in the past.

 

You can’t go home when it’s not there any more. Indeed, I would argue that a No vote will change the terms of that “stability” quite as radically as a Yes vote. A No vote is just as much of a vote for change. It is not only Yes voters who should be called on to look into a crystal ball and imagine a future that is radically “not the same”

 

Before my No voting friends dismiss that as a paradox, may I ask them to consider the following.

 

Every vile piece of Westminster legislation that has attacked the poor and dismantled the Welfare State, every policy that has ensured that it is only the poor who have paid the price of the recession caused by the greed of the rich, every act of economic and social vandalism – it has been the comfortable posture of the well meaning voters of Scotland that none of these things have been your fault. That you didn’t vote for them.

 

Well, you won’t be able to say that any more.

 

Up until September the 18th, we have all been able to hide behind all that being someone else’s fault. Either way the vote goes, Yes or No, that comfortable position has already been shattered. Either we vote to take responsibility for our own economics , our own wealth distribution, our own decisions to make war or peace…or we are voting to mandate away control over all of these matters to Westminster forever.

 

Either way, we will be responsible.

 

If a Yes voter has to take on board the moral hazard of whatever happens for good or ill in an independent Scotland, a No voter must equally accept moral responsibility for having given Westminster permanent permission to do whatever it likes forever. No questions asked.

 

Moral Hazard works both ways.

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Don't forget that the attitude of the current administration in Westminster, and that of all their predecessors, is cynical, self-serving and not only devoid of rationality when it comes to being fair to the pensioners who live overseas and who do NOT live outwith an ex-commonwealth country but it's also devoid of any kind of morality.

 

Why should  refusing an annual inflation-related  pension increase to an ex-Pat who happens to live in an ex-Commonwealth country,  whilst at the very same time giving this increase right across the board to an ex -pat who happens to live elsewhere, have any fairness attached to it whatsoever?

Why do they do it. SIMPLE! The can get away with it and they admit this freely. And they don't care!

 

Meaning that, so far , after having been on the DSS pension for only 11 years,  which was based on my past contributions when I was employed in Britain just like all the others retired folks, I have lost over 20% in real value because of their policy.

 

So if the Scottish people ever think they will get a fair shake after a "NO" vote  obliges them to be continue  be subservient to the current set of politicians flush with new power, they are terribly mistaken. And from that point on this will be forever, as has been pointed out succinctly above.

 

This is a once-in -a-lifetime chance to break the cycle of power, which will not return , especially when the oil revenues diminish, and forge a new path with riches on tap. Don't blow it folks, please.

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Absolutely.

 

The resentment built up from being subjected to the unfair, self-serving and hypocritical acts of these politicians on a long term basis affects mood, your pocketbook and your happiness. This ultimately can lead to depression and stress which leads to chemical changes within the body and thus a deterioration in health....and higher medical premiums.

 

For the more robust individuals in society , those who are sound of body and mind and usually have more interests and outlets for their energy, it can all be shrugged shrug off for time periods which allow them to counter these degenerative changes.

But the disabled can't do this due to the fact that they are much more moribund and inactive AND unable to exercise. The latter being the best antidote to the poison generated in uncaring bucketfuls by these parasitic political panderers whom you can usually trust only if they say something that you know will definitely lead to something else that will line their pockets with filthy lucre.

 

So, for those who are still contemplating voting "No", I rest my case. Good luck with that one.

But while you ruminate again this evening on the words of the sage Confucious,  who sayeth unto thee :    ''The river, if taken at the flood, leads on to greatness."  do remember also that "He who hesitates is lost".

 

Or, to put it bluntly, chums..."Faint heart ne'er won fair lady."

You have got only ONE chance to break the  yoke of the new English Hammer of the Scots ..and his name aint Eddy the 1.

It's ..."You can Trust Me" Cammy the Cute, who now thinks he's the modern successor to King ****

 

You'll be in fine fettle if you grasp the nettle

And dinna run away

'But if you don't, your Master Cameron will make you pay

And, even if you enter the fray, youse will never have a say

No matter what you do or what you think

Your boat willnae float for long but will surely sink.

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I see in January, I posted that I couldn't see anything other than a No victory but I don't feel that way anymore.  The sense I'm starting to get is that there's a good chance Yes will pull this out the bag.  Even if they don't, I can't see a landslide for No and I reckon in the long run, independence could well be inevitable.

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Here's a link to the FT story from earlier in the year providing proof that the finances are stronger when we take control for ourselves. Some nice infographic slides there.

 

http://www.ft.com/cms/s/2/5b5ec2ca-8a67-11e3-ba54-00144feab7de.html#slide6

 

Here's a link to IndyPosterBoy's web based infographic slideshow.

 

http://www.indyposterboy.info/screen/

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proof that the finances are stronger when we take control for ourselves.

 

I wouldn't go that far. Without dismissing it altogether, I would point out that:

 

1) The data was a snapshot 3 years ago, at the height of the recession, debt crisis and Eurozone crisis, and since which time oil revenues have continued their fall. 

2) What it shows is that even when oil revenues were higher than they are now, Scotland couldn't remotely balance its books.

3) All this is also before taking into account the massive additional costs that Scotland would instantly face as an independent country, and also before taking into account all the spending plans and promises.

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