But this is absolutely ridiculous. Of course there is a price on it. The surgeon and doctor has to be paid. The nurses have to be paid. The medicine has to be researched and created. The machines, tools, buildings have to be maintained. There are countless administration costs and beds keep filled. It’s insanely expensive. You are advocating for the state coercing and using violence to steal people’s money to use on others basically. That’s what socialism is. And I think we have the right to question this when the systems are so terrible and getting worse. There has to be a better way. But Like it or not, there is a price for every medical procedure (and classroom). That isn’t even the question. The question is how do we make it as cheap and available as possible. The answer to that is more accountability on where the money is spent, more key performance indicators that focus on customer wellbeing and savings.. basically running the country like Microsoft instead of… a circus
Honestly, did you read what I wrote? I have said in many posts over the last two pages HEALTHCARE IS EXPENSIVE. You think caring about our society is coercion and violence? Why live in a society at all. Go dig a bunker on an island and live there. When did anybody say we should hide where the money goes? When did anybody say system couldn’t be more efficient? But you are asking - asking for all those checks - for more bureaucracy and greater costs. Yes. I am advocating for taxation that is inescapable and APPRECIATED. Tax and social responsibility are key to a proper society. If you feel like contributing to society is a burden, maybe community isn’t for you. You talk like a radical American rather than a Brit, to be honest.
After experiencing relatively serious illness in living in England and dealing with the aftercare in both England with the NHS and Ireland's largely private system, I can not speak highly enough about the NHS. It has flaws and is sadly being neglected but in Ireland my experience of the health system is a lot worse and that is even with private insurance...Waiting times and people on trolleys are at record levels here and people are dying as a result that shouldn't need to. Despite an ever growing population our bed numbers are lower than 20/30 years ago. You pay extortionate amounts basically to get moved up the waiting list a bit and go to a slightly fancier hospital. You need to pay though as you are in big trouble otherwise if something happens. I thoroughly despise our system after experiencing England's. It's not perfect but be careful what you wish for. When health is concerned it shouldn't matter how much money you have, people should be treated equally
Not sure why you’re getting annoyed? I am a fan of the NHS. Im just having a discussion about the alternatives. You are being quite emotional here and letting it cloud your logic. I am saying that ALL taxation is violent coercion. It is the state saying “give us your money or you will go to prison”. That is violent coercion. It’s unarguable. (I am also happy to pay taxes to live in a good society though. Both can be true.) If you are forced to work for someone else and give up 100% of your time you are a slave. We are now at the point in the UK where taxes are 40-70% of every £. At some point people need to realise that the government has a spending problem, not a taxation problem. They are over promising and under delivering and one of the biggest reasons is lack of accountability. This is the main reason by many of these institutions are failing. One good example to illustrate my point: I won’t say which site; but at one governing place I worked at, there was an upper manager in an office on one of the top floors of the building. NO ONE knew what he actually did. (Even people that you would expect to know as they were in roles directly related to him). He was probably on 100k or more per year, for over a decade. And no one knew what he did. There are genuinely thousands - perhaps tens of thousands of similar job roles in the current system. (In the Ministry of defence and NHS). Not to mention the wasted empty buildings and materials. All I am trying to say is there has to be a better way to negate waste and streamline these services. Easiest way to do this is by changing the incentives
I’m intentionally only going to comment on a few aspects of your post : Tax as violent coercion - this is strong wording but if we take this principle as given then it is a trade off / social contract with the alternative being an even more violent one where the resources of the state offer less / no protection. No healthcare when sick, no police (or fear of police) to reduce lawlessness etc. And this is why the reactions to things like police killings (and indeed massive underfunding of services) are so strong. Because to some the social contract isn’t being delivered on. Like or hate them that is the argument at least some supporters of BLM were making (note: not the organisation itself as that is problematic to say the least) I’m intrigued as to how private providers of things like health, railways and the like are more accountable than public ones. The latter can be voted on. The former cannot - and as explained, you can’t just easily shop elsewhere for some of these things that people are arguing to be state run. That is the point. The US has shown that private companies have no incentives to keep costs down. And our railways prove it to be a nonsense as well - only so many trains can be on the line so you can’t have “proper” competition As to the job thing - it is a leap to take an anecdotal example and the claim tens of thousands of similar ones. And private companies aren’t immune. I know they are jokes on tv shows but there are recurring bits about characters where people don’t know what they do (most obvious is Chandler from Friends). But I’ve seen anonymous posts from people in finance careers where people don’t really know what the others do. Stories of people going on secondment and turning up putting their coat on their chair going off and not doing any work. And no one asked until one day the coat wasn’t on the chair anymore. Or someone back in the days of paper files going down to collect a box of files leaving the office with it and their laptop and disappearing for the day. And that’s before I get to personal experience of middle management types who seem to spend a whole day taking credit for work others have done but passing the blame when it isn’t. Because the former is in theory just very good project management - as long as you accept the buck stops with you if it falls apart. So you aren’t describing things unique to the public sector. I guess the complain it more in the public sector these people are paid from public money
I am not getting emotional. A little perplexed that I keep saying things are expensive and you reply by saying that that is crazy because these things are… expensive. It feels like you totally ignored what I am saying. My brother works in industry. He is very high up. The people above him are the ones making the huge money. He says it works like this: Person A went to Oxford with person B. Person B hires person A to run programming at the firm. Person A knows nothing about programming and sits on his hands for a year while profits are good. Second year profits are bad. Person A is given the job of firing a load of people. Person A gets a huge payoff and leaves. Luckily, person B knows Person C… from Oxbridge. Person A uses the references from the job he couldn’t do to do the same job elsewhere. Repeat ad infinitum.
I am not claiming that I know any better than anyone. Just offering my experience. That was one story. I can tell you more about billions wasted on projects which never even happened, hundreds of millions spent on projects & contracts which achieve nothing. Meetings about meetings about meetings with no productivity. This still happens in private companies but MUCH less if they are well run. In general you have performance indicators which must be hit to keep you on target. You also have the ultimate key performance indicator which is “is the business making any money?” It is this which guides every decision and leads to better outcomes. This is what we need in these public institutions. “How does this benefit the patient? How does this benefit the general public?” Are questions which are rarely asked. The problem is the government and the way it structures and regulates these public services. I agree that the social contracts are broken, which is a big problem. They charge us insane taxes and yet everything is getting worse. Tax is violent coercion as I have no choice but to pay it, no choice in how it is spent and no accountability on where it goes.
I get what you're saying, and there's certainly some validity to it, but it's worth noting that some of the best run countries in terms of the social contract are the Scandinavian ones, which have a far higher rate of tax than we do.
I agree. It seems like privatising/nationalising institutions isn’t the only solution. It seems like knowledgable and experienced people making good decisions for the benefit of the nation is the answer. But those seem in short supply at the top of these organisations. I just hope some big things change soon, as things are really bad. I couldn’t believe the NHS waiting room when I took my little one there a few weeks ago. The queues are horrendous. We have to do more to help the nurses, teachers and staff instead of wasting so much time and money.
With regards to many of these things you have more choice and more ability to hold those to account (via voting) than if they were private companies. Because as explained - privatising certain things isn’t going to mean you can always shop around for the best deal The voting system is broken though. But it is still more say than any of us currently have over, say, the railways. If we need to take a train somewhere we basically have no choice. Other than to maybe go at inconvenient times or routes to make it slightly cheaper. But someone commuting to london at the same time every day buys a season ticket and that’s it. It goes up every year and they can do nothing about it. No choice. No accountability. Other than switching jobs which isn’t always viable.
Os totally ignoring large parts of what people say in replies? Surely not? I’m shocked I tell you. Shocked
The problem is that this presumes that privatization institutions is a solution at all, though. The track record of public-to-private services is extraordinarily grim, with the only benefit typically being the short-term influx of cash after the service has been sold...a benefit that accrues solely for the state and not at all for customers. Certain utilities naturally lend themselves to monopoly/monopsony positions, and that is never good for consumers. Privately-held utilities either necessitate heavy government regulation (where they are forced to operate in ways that avoid their natural anti-competitive tendencies, such as allowing other companies to use their infrastructure), or it falls into a consolidation --> monopoly --> government intervention --> consolidation --> monopoly pattern that is also hideously anti-consumer (see: the breakup and reconsolidation of the Bell telephony system over the past five decades).
What? I didn’t ignore it? I tried to address it when I said I am unsure to the way forward. To answer it directly; loadings point of a few friends giving each other jobs is actually ****ing minor compared to the cataclysmic waste produced by government-run institutions. We are talking about tens of millions (maybe more) daily. I can’t really provide evidence for this without doxxing where I have worked, so it’s a “trust me, bro”. But I promise to you if you saw the truth of how much money gets poured down the drain in the ministry of defence & public health system you would be horrified. Also I actually disagree with Greg’s post above. I don’t think we have any chance at all to hold people to account. We vote for MPs who then do whatever the **** they like. We have the technology now to easily audit and have more of a say in how things are run and where our money goes. Private corporations get held to account more by people refusing to purchase their products. It is actually quite easy to successfully boycott products. Although I agree with your point that in the case of trains & utilities it becomes impossible. This is why the government needs to step in and ensure the public isn’t price gouged & monopolised. Unfortunately at the moment they seem to get paid off and it’s all one big orgy of guzzling tax payers funds. The government has a huge spending problem. It is unsustainable, unsolvable and it makes me sick. Accountability of taxpayer funds is near zero and it’s a huge problem.
I don’t disagree with a lot of this, but you still haven’t given an example of a successful move from public into private where things have improved for the consumer. Your whole point of view has been that the private sector incentivises improvement and reform through profit, but you readily admit that when the consumer has no choice this incentive goes as we enter the murky world of monopoly. You say you aren’t worried about private sector corruption - ignoring how this is just a reflection of the same corruption that so worries you in the public sphere- and say you have seen millions and millions wasted in government (trust me bro)… but fail to see this a failing that exists also in private industry. How many companies each year are closed down and restarted under new names at enormous cost to ripped off customers? Your vision of a privatised public sector, closely monitored by government to offer a great public service is only two steps away from mine. One. The closest way for government to monitor public sector services is to directly control them. Two. To offer a great service we need to invest in the best people and spend. This is what private industry does. If Microsoft want the best techs they throw lavish money and bonuses at them. Stop taking nurses and teachers and all the rest for granted and throw money and bonuses at the best ones. **** off with clapping and start paying. The difference between us is that I understand money is a fiction created to solder society together- so we we might as well share it - and you see society as a contract constructed through shared taxation as theft. How do we reconcile those views? And see how I referred directly to what you had said? That helps in a debate.
Also, if you're concerned that there are people making high five/low six figures and having no societal benefit, wait until you discover executive compensation. I do not trust modern corporations to manage their own affairs, never mind critical infrastructure or services. Because fifty years of management culture has led to a widespread belief that the ideal corporation is one that makes nothing, employs no one, and exists solely to inflate the stock price and award enormous sums of money to corporate leadership and shareholders...over the short term. The sheer number of previously stable (and extremely profitable) companies that used to do something and gradually moved toward the platonic ideal described above only to implode is astonishing. Or at least it would be astonishing, if not for the fact that they people who instituted those changes generally make exorbitant sums before the implosion occurs. Running their own company into the ground can be enormously beneficial, so long as their stock options vest first. Does that perhaps seem problematic if they are given the reins to essential services? If capitalism ever collapses, it will not be because of socialism, and it will not be because of big government. It will be because of the sheer nihilistic avarice of the modern publicly-traded corporation. And I do not want that nihilistic avarice controlling my roads or trains or electricity or -- god forbid -- health care, certainly if paired with the sort of zealotic deregulation that Os favours. That way lies a certain kind of madness.
I did not say I am unconcerned about private corruption. I am hugely concerned about it. I think the influence that the rich & powerful have over society and governments is utterly outrageous. I said I was less concerned about your one specific point. (Jobs for the boys). But I would argue that in a well run, streamlined company this wouldn’t happen. Within the private sector there are smaller, more agile companies and there are huge behemoths that almost become like government-run entities. You’re right, we probably do agree on a lot; it’s just we have different ways of trying to achieve the same goal. Perhaps the real problem is an issue of centralisation and massive organisations. I would certainly say that it doesn’t matter how an organisation is set up (public/private) as long as you have leaders which are honest & have integrity. The question is how do we incentivise honest, competent behaviour. For your last point about money being a fiction, that’s an interesting point. I actually agree that it is a useful fiction. But I see it as a way of measuring human time & effort. ‘Capital’ is the way we allocate resources and solve problems. I think that if more capital ends up in the hands of hard working, intelligent, honest people and less in that hands of corrupt, inept, thieving officials/oligarchs, society will flourish. For all the problems of American privatised health care, their nurses and doctors are on great money. They get rewarded for helping people, which simply doesn’t happen here. I don’t understand how people can look at everything going on today and say “the government is doing such a good job.. you know what we need to do? Give them MORE wealth and MORE power”.
The things we're talking about invariably involve behemoths, though. You aren't going to have 150 different plucky startups each with their own electrical grid or railroad tracks or hospitals in Southampton, that would be madness. Those public utilities will invariably trend toward regional monopolies at best and national monopolies at worse, because they depend heavily on economies of scale which in turn involve the creation and maintenance of (obscenely expensive) infrastructure.
