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  1. #21

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    Quote Originally Posted by FatLazyContractor View Post
    Then they should be Scottish. Fecking haggis neepers!
    Could be worse. In Yorkshire they dispense with the whole cousin debate as it is usually too difficult to fathom. Marital prospects generally come down to a finger count.

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  2. #22

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    Quote Originally Posted by SueEllen View Post
    Children don't put into healthcare before they receive it. It's given to them on the promise that they will be future tax payers.

    Some will be but some will emigrate before they start contributing.

    Likewise some tax payers from other nations pay in more than the help they receive.
    Agreed.

    We have a pot of money paid into by taxpayers on the understanding that it will be used for the treatment of them, or their children should the need arise. This is the basic premise of the NHS.

    Are you intending to imply agreement or disagreement with my earlier stated premise that it is ethically more palatable to use said pot of money for the treatment of those who have contributed before those who have not?

    Put another way: if you spend money to take out insurance on your health and subsequently fall ill at the same time as another person who has not previously taken out said insurance; who should the insurance money be spent upon first, from an ethical perspective?

  3. #23

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    Quote Originally Posted by wonderboy View Post
    Agreed.

    We have a pot of money paid into by taxpayers on the understanding that it will be used for the treatment of them, or their children should the need arise. This is the basic premise of the NHS.

    Are you intending to imply agreement or disagreement with my earlier stated premise that it is ethically more palatable to use said pot of money for the treatment of those who have contributed before those who have not?

    Put another way: if you spend money to take out insurance on your health and subsequently fall ill at the same time as another person who has not previously taken out said insurance; who should the insurance money be spent upon first, from an ethical perspective?
    You didn't mention children in your initial post.

    Funnily enough I did a course covering the welfare state plus NHS and while there is a social contract between the UK government and the UK people it's not regarded as that. The initial welfare state did not include family structures and other things that are the norms today.

    So ethically your point isn't valid as the NHS is not like an insurance policy as it treats people who will never pay in, or will take out far more than they can/did ever pay in due to no fault of their own.

    If it was an insurance policy those with chronic diseases would not get treated as they cost too much. This is one of the issues with US healthcare insurance.

    If you are arguing about who should get treatment generally children who are likely to live a long fruitful life regardless of where their parents came/come from are given priority over those over 70. Even if those children are the sons/daughters of immigrant groups who statistically don't do well in the UK.
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  4. #24

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    Quote Originally Posted by SueEllen View Post
    You didn't mention children in your initial post.

    Funnily enough I did a course covering the welfare state plus NHS and while there is a social contract between the UK government and the UK people it's not regarded as that. The initial welfare state did not include family structures and other things that are the norms today.

    So ethically your point isn't valid as the NHS is not like an insurance policy as it treats people who will never pay in, or will take out far more than they can/did ever pay in due to no fault of their own.

    If it was an insurance policy those with chronic diseases would not get treated as they cost too much. This is one of the issues with US healthcare insurance.

    If you are arguing about who should get treatment generally children who are likely to live a long fruitful life regardless of where their parents came/come from are given priority over those over 70. Even if those children are the sons/daughters of immigrant groups who statistically don't do well in the UK.
    I made a statement that I believed it to be more ethically palatable for those that contribute to the National Health Service to be treated ahead of those that do not. You then made some statements of fact, mentioning children, with which I cannot disagree.

    I clarified my post, expanding it to respond to your mention of children and asked a specific question: "are you intending to imply agreement or disagreement with my earlier stated premise?"

    It may be true that the original formulation of the NHS differed from the current institution, and the precise definition of "insurance policy" is interesting; but your contention that I am making a point that is "ethically invalid" does not stand because I am not making a point. I am stating an opinion and asking a question.

    You mention correctly that there are confounding factors when it comes to deciding the ethicality of a decision - such as age. But can I get your opinion on a simpler premise?

    There is a finite amount of money in a pot to be spent on treating illness. Two adults fall ill through similar circumstances. One has contributed to the pot, the other has not. One has to be treated ahead of the other. What is the more ethical order of treatment?
    Last edited by wonderboy; 5th April 2015 at 21:15.

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    Quote Originally Posted by wonderboy View Post
    There is a finite amount of money in a pot to be spent on treating illness.
    And that is the nub of the issue. Within in any health care system there is limited resources and care is rationed. That's true whether it's the UK, the USA, Germany, France or anyone else.

    The issue with the UK NHS is that our system provides "Universal care, free at the point of use". We cover 100% of the population and pay for it out of general taxation.

    This worked fine in a world with low levels of migration but it's not sustainable in a world with high levels of migration, open borders and cheap transport.

    The funding model should be changed. I have no issue at all with someone being treated on the NHS regardless of where they come from but I do think that they ( or their government ) should contribute to the cost of treatment. Especially if they are not a long-term resident.

    Anyone know how the rest of Europe deals with this issue? Cannot be unique to the UK.

  6. #26

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    If the two adults are in the UK the one with greatest perceived clinical need for treatment is treated first. Payment is looked at second.

    Medicine isn't a precise science so the clinicians in the NHS will not refuse to treat someone who has collapsed in the street as they have no way of knowing whether they have yet paid tax in the UK.

    Also immigration officials must already refuse entry to anyone they see as too sick to be able to maintain themselves, anyone they think is coming to the UK as a health tourist and people who haven't paid previous NHS bills for their treatment.
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  7. #27

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    Quote Originally Posted by tomtomagain View Post
    This worked fine in a world with low levels of migration but it's not sustainable in a world with high levels of migration, open borders and cheap transport.

    The funding model should be changed. I have no issue at all with someone being treated on the NHS regardless of where they come from but I do think that they ( or their government ) should contribute to the cost of treatment. Especially if they are not a long-term resident.
    Agree. To me this seems common sense.

    To many, however, discussion of this results in outrage.

    From those same people there is, however, no outrage at the non-tourist patients being denied a decent level of care due to a funding situation caused in part by health tourism.

    The health service is a zero sum game. Pay one pound here, and you can't spend one pound there.

    Maybe someone on here can help me understand the thought processes of the sizeable portion of the population that is so quick to take offence at the discussion of health tourism thereby shutting down the debate? If there is an intellectual argument to be made for health tourism, I want to hear it!

    SueEllen's argument seems to be the rather laid back: "well, what with some people emigrating and some people staying healthy, it all balances out in the end". But where is the evidence to support such a laid back stance?

    Net immigration is now at a little under ten-times pre 2000 levels [Source]. There is no filter in place for those entering the country from the entire EU, so we are open to the risk (perhaps already realised) of those seeking to subvert or take more than they can give to the country [Source]. The right to freely move has been extended to ten formerly eastern block countries since 2004, resulting in some of the highest ever net migration figures into this country [Source]. Public services including healthcare, transport and education are in crisis due to unprecedented demand for their use. [Source, Source, Source].

    The answer seems so obvious, it leaves me wondering what the real reasons behind the strategic policy decisions are.
    Last edited by wonderboy; 5th April 2015 at 23:13.

  8. #28

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    Quote Originally Posted by SueEllen View Post
    If the two adults are in the UK the one with greatest perceived clinical need for treatment is treated first. Payment is looked at second.

    Medicine isn't a precise science so the clinicians in the NHS will not refuse to treat someone who has collapsed in the street as they have no way of knowing whether they have yet paid tax in the UK.

    Also immigration officials must already refuse entry to anyone they see as too sick to be able to maintain themselves, anyone they think is coming to the UK as a health tourist and people who haven't paid previous NHS bills for their treatment.
    Sorry, my question wasn't posed with enough precision. By similar circumstances, I meant they shared similar clinical diagnoses and shared similar back-stories leading to diagnosis.

    So what is your answer to the following question given that the clinical situation is the same?

    "Two adults fall ill through similar circumstances. One has contributed to the pot, the other has not. One has to be treated ahead of the other. What is the more ethical order of treatment?"

  9. #29

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    Quote Originally Posted by wonderboy View Post
    Sorry, my question wasn't posed with enough precision. By similar circumstances, I meant they shared similar clinical diagnoses and shared similar back-stories leading to diagnosis.

    So what is your answer to the following question given that the clinical situation is the same?

    "Two adults fall ill through similar circumstances. One has contributed to the pot, the other has not. One has to be treated ahead of the other. What is the more ethical order of treatment?"
    Your scenario never happens.

    Sorry I know plenty of people who have had the same clinical diagnosis as someone else. Due to the prejudices and skill level of individual NHS medical staff plus the postcode lottery people get diagnosed at different stages with the same condition. As a result some need more expensive treatment when they finally get treated, others are emergencies when they finally get treated or find its too late to be treated.

    Also if you are an emergency regardless of where you come from you get treated and questions get asked later, if you are not then you get refused treatment if you aren't from an eligible country. The only exception seems to be those who give birth who use deception to get out of paying.

    Finally I have to listen regularly to NHS medical staff complaining about people from certain EU countries travelling back to get treatment and tests there because they are unhappy with NHS treatment. They then return with the test results knowing exactly what the tests mean, and ask why has the NHS in that area has refused to do them.
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    Quote Originally Posted by wonderboy View Post

    The answer seems so obvious, it leaves me wondering what the real reasons behind the strategic policy decisions are.
    The reason why policy decisions aren't made is because parties only think how to get voted in at the next election or remain in government.

    It's easier for politicians to get us to blame each other and newcomers, who they want in to either increase the number of taxpayers, carers/ health workers or both, then engage in long term non-party political planning.

    If some policy areas were non-party political they wouldn't think they had to hide from the public the fact that due to demographic changes they need to change how things are structured in the UK.

    For example it was know decades ago that due to demographic changes that there would be a heavier burden on the welfare system in terms of pensions and associated payments due to an increase in the age of the population. No political party in government did anything until the last minute.

    This is why the pension age for women was suddenly increased when they should have been telling those women when they were in their 30s and 40s in the 1980s and 1990s they weren't retiring at 60. The sex discrimination act was law in 1975. There have been both Tory and Labour governments who could have said something but they didn't.

    In regards to transport policy I know within London there has been fluctuations in what transport is popular due to changes in working patterns and the economy. So it's not always easy to predict the amount of capacity you need. Most other cities around the world build their transport infrastructure with an eye to making it easily expandable, but the rail and tube network are ancient in the UK and this wasn't thought about when they were built.
    "You’re just a bad memory who doesn’t know when to go away" JR

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