ChezGiven

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too. Having a Nobel Prize doesn't make someone right. Friedman won it in the past and Paul Krugman won it most recently with his neo-Keynesian views. If you have such contempt for the notion that someones employment shapes their opinion, I'm suprised you brought it up as some sort of proof that you alone are privvy to the incontrovertible truth of the matter or berate others for refusing to do so. You what mate? If employment is irrelevant why do you bring it up? Anyway, despite all the slurs against me I'll not get bogged down in an argument about how we argue. I was listening to five live this morning and they were talking about the chief executive and the trouble he's going to have balancing the Premier League interests with those of the grass roots game. To me it seemed perfectly analogous to the private healthcare debate. The top 4 teams in the league hold most of the power, they buy the best players, win most of the trophies and collect most of the TV money. The idea of the premier league was that it would benefit the English game as a whole, that money would 'trickle down', but all that's happened is the strong get stronger and every season more and more clubs are threatened with closure as they can't afford to exist in the modern game. I can't see how that is even vaguely analogous to the discussion in this thread. You don't think the insurance companies and pharmaceutical companies are getting rich while poor people die or go bankrupt trying to pay for healthcare in the US? Or you don't think Premier League Chairman, players, managers, agents are getting rich while lower league clubs are docked points for going into administration? Wrong about pharma, universal coverage brings another 50 million people into our market. Thats a good thing commercially by the way Also, those who are getting richer in the US whilst others go bankrupt are taxpayers, no one else. I mean that categorically too.

Yeah but the Secretary of State for Health and Joseph Stiglitz are on mine.

I didnt, Parky did. I then spent pages ignoring it and then decided to address it properly. The debate on the economics of Singapore's system etc is backed up by academics, not by someone's profession.

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too. Having a Nobel Prize doesn't make someone right. Friedman won it in the past and Paul Krugman won it most recently with his neo-Keynesian views. If you have such contempt for the notion that someones employment shapes their opinion, I'm suprised you brought it up as some sort of proof that you alone are privvy to the incontrovertible truth of the matter or berate others for refusing to do so. I don't think Chez has been banging that particular drum tbf. I'm probably more guilty of that but its canny frustrating arguing against someone who is clearing trawling Google as the source of their knowledge. All I've heard from HF in this thread is whining about the health service becoming a two tier system. Fair enough maybe, but no alternatives have been offered. I'd genuinely like an alternative 'real world' point of view on what we should do in the future. If one isn't forthcoming then that speaks volumes. We've had a nationalised health service since after the war, only a small percentage choose private treatment. We are living the real world alternative but it's being pushed slowly and surely towards an American model where forty odd million don't have any health care. As has been pointed out before, the world has changed so dramatically since then that the model is no longer working. Evidence for this is the change in policy that prompted this thread.

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too. Having a Nobel Prize doesn't make someone right. Friedman won it in the past and Paul Krugman won it most recently with his neo-Keynesian views. If you have such contempt for the notion that someones employment shapes their opinion, I'm suprised you brought it up as some sort of proof that you alone are privvy to the incontrovertible truth of the matter or berate others for refusing to do so. You what mate?

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too. Perhaps we need a 'Conflict of interest' disclaimer on Toontastic so people like you can be barred from these types of threads, you evil-pharma bastard. I think you got the order wrong mind, pathetic would be at the start of my list. True but i'm offended by Parky/fop/Happy Face's insinuation that i'm incapable of independent thought and the frankly absurd notion that i'd spend my time on here posting some sort of 'party line' on this debate. If you step back and think about it, its a really fucking stupid perspective to have regarding an online debate on toontastic. Pharma Palmer tbh. Face Palm tbh.

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too. Perhaps we need a 'Conflict of interest' disclaimer on Toontastic so people like you can be barred from these types of threads, you evil-pharma bastard. I think you got the order wrong mind, pathetic would be at the start of my list. True but i'm offended by Parky/fop/Happy Face's insinuation that i'm incapable of independent thought and the frankly absurd notion that i'd spend my time on here posting some sort of 'party line' on this debate. If you step back and think about it, its a really fucking stupid perspective to have regarding an online debate on toontastic.

Fop believes that the economy, social welfare, GDP have some sort of impact on the ability of an economy to introduce private resource allocation mechanisms into healthcare, without explaining the macro- or more importantly micro-economic dynamics that support this. I've highlighted nobel prize winning economists that have outlined the key factors in determining how this all works. Thats the authority i would use in a debate with someone uninformed. How i earn my salary is irrelevant. Its thanks to Parky that it has become an issue as he pointed it out in this thread. I find the notion that i would post something on a football forum that merely reflected the commercial interests of my employers offensive, stupid, crass and pathetic. In that order too.

Stade Rennais and Blyth Spartans. Rennes cos our lass was born there and some of the lads i watch football with support them. The Bretons were our basque forefathers too. 4th and nae idea.

My mate swears down that during that cup-final, the camera cut to Cole sitting on the bench just at the moment a peanut stotted off his head. Apparently funny because his head is shaped like a peanut. Funny lad my mate. Was he on the bench for that match?

Change the file extension?

Spot on. It was deliberately left as an 'open letter', but you can add Fop to the list too. Hilarious how they profess some of the strongest opinions on here but time and again fold under cross examination from someone with any actual expertise in a subject. No coincidence either that these are all too scared to admit what they do in their professional life. Yes actually "expertise" that didn't even know about a universal flu vaccine being developed. Like I said before I've probably got more experience in the field than he has, or at least if he has more than me he should be very ashamed. Mate, Chez has effectively made you look like a know-nowt gobshite in this very thread, so i'm simply saying that whatever you say now in here you look like a tool by default anyway. My point is, your dignity should tell you to leave well alone but you clearly can’t help yourself. He has some expertise at pulling figures out of his ass, I agree (when you look at them, like his Singapore example he runs away ). But that's not what we're talking about. You of all people cannot criticise posters for being selective about what questions they answer. Coming from you that is utterly embarrassing. Again this proves my point though, to have the brass neck to come out with that in this very thread! Basically after a while it doesn’t matter what point you’re making, you pass a threshold where it’s fair game for people to respond to you with insults and derision. I for one certainly reserve that right. Much like Renton he brought it up, I pointed out the reasons it wasn't the same, he couldn't counter them and ran away. It'll be time for you to run soon (again). You said Singapore's size allowed it to use private insurance more easily than the UK. I pointed out the painfully (and i mean really painful for me) obvious fact that small size is a disadvantage in insurance markets that rely on large numbers to 'pool' risk efficiently. In fact, it was the opposite of what you claimed. Singapore's success in utilising a blend of market and public sector resource allocation mechanisms was all the more admirable due to their size. This point was ignored by you as you have never studied the subject. Spence, Akerlof and Stiglitz (who you may have heard of) won the nobel prize in 2001 for their work in this area and it is influencing the policy debate all over the world. I think you then just said, well their size will make it easier anyway. This ignores the OP in this thread that shows that all it takes to introduce more market orientated allocation mechanisms in the UK is a single decision to allow top-up fees. Now, carefully explain how that is running away since 1, i'm repeating myself and 2, you've not countered this or any other point?

Alfred Marshall captured it best when he said that "they are separated by degrees and one shades imperceptibly into the next".

Did you read about the bumper harvest in the Lebanon this year? Unfortunately about 95% stays within the country. That's some quality resin as well man Edit: Missed the rather obvious Pol Pot gag Its a classic.

Speaking of dictators, i was smoking some killer cambodian at the weekend.

http://www.liveleak.com/view?i=9c5_1226241931

Why do you keep saying you've been 'proved right' and others 'proved wrong' fop? It makes you look like a cunt.

Back on track, this is the main thrust of the thread. As soccermom said, it would be great if the NHS didnt waste so much money (but does it? it had a £1.7bn surplus this year). The issue is all about getting the balance right between equity (fairness, social justice, equal access to treatment for all) and efficiency. It needs to be a public and private system. One that works very well is the Singapore system. http://healthcare-economist.com/2008/01/14...th-care-system/ That's big bonus achieving!! but I fully agree, I don't see why anyone should have a problem with a top up system. Pay private if you can afford it, more and more NHS hospitals have private wards offering numerous services. Like wise if you want to pay for meds, whats the issue here? They should be happy not condemning the prospect, less for them to shell out it gives some people a hope, and if it works it will improve the hospitals morbidity and mortality rates!! Ofc the drug companes will see this as a good way to make a quick buck praying on the foolhardy and desperate. It takes medics to be honest with these people about their situation but ultimately their decision to purchase is theirs alone. Fortunately, drug companies are not allowed to communicate directly with patients in the EU. There are risks in this though, the top-up thing needs to be carefully regulated.

Good post argued passionately, not sure I agree though. You seem to be advocating trained clinicians should be used as managers, I would have thought this was actually a huge waste or resources if anything. Like it or not, its vital that a huge organisation like the NHS (the second largest in the world iirc, after the Indian railways) has effective management. I've also heard that the NHS has a very lean management structure compared with an equivalent private-sector company, it'd be interesting to see if anyone has any figures that might back this up or disprove it. I don't think we can go back to a bygone age when only a handful of treatments was available though. As for the implication that managers don't care about people as much as clinicians, well, I think that's a bit insulting. I also work for the Department of Health although I'm not a clinician or a manager. I am, however, a user of the NHS and I value it greatly, I'm sure the vast majority of people do, managers included. Well said and I hear and understand your statements, but I work up close with these 'caring' managers on a daily basis and all they are interested in are the latest government targets. I'm not suggesting that we go back to the 60's and offer less of a service, On the contrary I'm suggesting we offer more of a service, trained clinicians and senior nurses do alot of their managers work loads now and forfeit the praise. What I am suggesting is the system needs a major overhaul. The right people put in charge of the right specialities. People who understand that area specifically instead of those coming forward to place they have no knowlegde of cutting staff ratios, witholding budget so they come in under and gaining thair bonus for saving that trust money, whilst depriving staff and patients of needed facilities and equipment. Ofc not all managers fall under this umbrella but i'm saddened to say many of them do, they take these positions and hold on to them just long enough to improve their CV and often leave a mess of what was originally a well run fully funtioning department in their wake. I am not anti-change, you can not be in this modern day NHS, it wouldn't work, we have new abilities and technologies developing everyday, we need to use these opportunities to learn and improve our practice not stifle professional development as a managerial exercise to gain individuals advancement. There is so much history, pride and potential in our system, it seems a shame to watch it fall into the hands of those who abuse it and work purely for self gain. I am no angel, I go to work for money, everyone does, but working in health is a vocation, you see people born and you see them die, you need to care in the NHS. Thats the whole point of it. Very nicely put. I worked in Great Ormond St at the Institute of Child Health for nearly 2 years, amazing experience.

Back on track, this is the main thrust of the thread. As soccermom said, it would be great if the NHS didnt waste so much money (but does it? it had a £1.7bn surplus this year). The issue is all about getting the balance right between equity (fairness, social justice, equal access to treatment for all) and efficiency. It needs to be a public and private system. One that works very well is the Singapore system. http://healthcare-economist.com/2008/01/14...th-care-system/

Couldnt you also argue however that something such as HIV vaccine will not reach anything like a global coverage? What I mean is that out of that 6 billion the majority will not take it up for instance anyone happily married (so scratch 50% off?, catholics (who believe its a gay curse), so another 15-20%? Nuns? children (although I guess at some stage they become potential customers). Finally though theres a big big proportion of people who dont feel they need it because it will "never happen to them". To be fair the very people at high risk are those that wouldnt pay the $100 fee (drug addicts, street prostitutes etc). Finally, I think theres another element and that is the moral crusaders who would argue that a vaccine against HIV would be taking out the fear factor and make the world more immoral, that in itself could reduce a companies stock. Just point out now I havent got a fucking clue on the validity of any of the above statistics or even thoughts Im confident though that the customer base isnt anything like 6 billion because of those facts but am playing devils advocaat for the hell of it. Oh you're quite right pud, i was just stretching the point as far as possible to make flopsy look as big a tit as possible. No, the $600bn figure was perhaps a 'little high' but it was to show the potential of a vaccine market and therefore dismiss any notion that there was less commercial interest. I get asked the question quite a lot "Does your company have a cure for cancer and just doesnt let anyone know about it?". I work through a few figures with them and its clear that anyone who discovered something like this would rake it in. The global market for HIV treatments is probably about $6-8bn, if you had a cure, you'd want to sell it.

Fop, "Still a long way to go" and the basic machinations of the executive bonus incentive system (time-horizon 5 years for decision-making) means that everyone wants to find the winner. You'd retire worth millions more if it happened on your watch. You know nothing of business so am not surprised this passed you by. HF, the NIH is a superb organisation, research it properly and even if there are examples conflicts of interest, dont dismiss it because of that.

According to that report commercial investment in an AIDS vaccine has all but dried up either way. What's shocking or even surprising about it? If its not possible to make an HIV vaccine why waste money trying? There would obviously be no money in it. Think about the vaccine that would make the most money - one against the common cold. If this nut was cracked the profits of the pharmaceutical company holding the patent would go through the roof, they'd be worth more than Google to the power of Microsoft. But it hasn't and won't because it's impossible, not because GSK want to retain profits on Lemsip. The common cold is caused by rhinoviruses, coronaviruses, adenoviruses, influenza viruses etc, all of which have dozens of subtypes constantly mutating, which is why vaccination is not feasible. Iirc the HIV virus mutates even more rapidly, and of course affects the immune system itself, so its not surprising vaccination is likely to be next to impossible and frankly not worth wasting money on. Why have the US thrown almost a billion at avian flu in a couple of years then? http://www.state.gov/r/pa/prs/ps/2008/oct/111241.htm Isn't that a rapidly mutating virus. But it's only killed a couple of hundred people. Because they are really communists?

According to that report commercial investment in an AIDS vaccine has all but dried up either way. What's shocking or even surprising about it? If its not possible to make an HIV vaccine why waste money trying? There would obviously be no money in it. Think about the vaccine that would make the most money - one against the common cold. If this nut was cracked the profits of the pharmaceutical company holding the patent would go through the roof, they'd be worth more than Google to the power of Microsoft. But it hasn't and won't because it's impossible, not because GSK want to retain profits on Lemsip. The common cold is caused by rhinoviruses, coronaviruses, adenoviruses, influenza viruses etc, all of which have dozens of subtypes constantly mutating, which is why vaccination is not feasible. Iirc the HIV virus mutates even more rapidly, and of course affects the immune system itself, so its not surprising vaccination is likely to be next to impossible and frankly not worth wasting money on. That's made my day, i think i'll use that one.

Yep, I already agreed with that above. But when they invest such a small proportion of funds into research, it's rotten to the core that they take all the profits. The tax payers subsidise discovery of a cure, at the expense of other social programs for the less well off, and when a cure is found neither of these groups have access to the cure that they sacrificed most to create. The only research that counts is productive research. Over the period covered by the IAVI doc, nothing was interesting, there was little worth testing. The people who make the money will be the people who own the patent. If that ends up being a pharma company, that will tell you a lot about the productivity of private research compared to public research. It might not be (although the only one in phase 3 is a phama company candidate). http://avac.org/trials_table.htm The money spent is higher now than it was 4 years ago but still is limited by the probability that the candidates will work at a high enough level. One of my mates from GSK now works at IAVI in NYC, i can ask him for his opinion on this. But isn't the majority of public sector funding paid directly to the private companies to assist their research, rather than actual government scientist looking into it. Is their even such a thing as an American government scientest these days? As a result, it will inevitably be a private sector company that claims the patent if it's ever found. Yes, the NIH. Good question, there only are a few examples of this, coincidentally in HIV, lamivudine and Ziovudine were NIH-related discoveries (US funded research). The patents were sold for 14% royalty. Of course when that was sold, it hadnt proved to be effective and the NIH didnt have the money to develop it. This was in the 80s though. Not sure how it would happen today but thats because thats not how things happen. Today, its all about small biotechs taking all the risk and the big co's buying them if it looks good. Public sector research has found nothing of note recently.