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Posts Tagged ‘nhs’

I mean, the science is pretty clearly in, so we know the social and economic benefits of providing everyone with a basic income would be vast. Apparently another bonus is that it makes people “more entrepreneurial“, whatever that means and whatever’s so great about it. Sounds less exciting than escaping the constant anxiety of being homeless and starving if the intrinsically fragile capitalist economy has a bit of a bad day and decides to fuck you up, but sure.

But another thing that’s actually interesting about it, is that a basic income makes sense of a bunch of other policies many economists have recommended, but which often make bleeding-heart lefty types like me bristle.

F’rinstance: charging people a flat fee to see their GP or attend A&E. All the articles I’m finding about it seem to be at least a year old, but I’m sure this cropped up again somewhere just recently.

Basic economics tells us that an increase in something’s price will reduce the volume of its consumption; an increase from free, to a nominal fee of £10 a visit, would ease the burden faced by the NHS and reduce the volume of people using its services, but only those people whose problems are worth less than a tenner would be foregoing any medical attention. Care is still available to anyone who’d really benefit from it, but those who don’t really need it won’t go along anyway on the grounds that “might as well, it’s all free”.

The point of having money, after all, is to allow people to express preferences in a meaningful, concrete way. People who wouldn’t “prefer” to see a doctor than whatever else that small nominal fee could provide – coffee with a friend in Starbucks, say – probably aren’t going to die or deteriorate abruptly based on that decision, since it can’t be bothering them that much.

The problem, as things currently stand, is that the people who’d end up “preferring” to do something else with their nominal fee wouldn’t be choosing between a hospital visit and some overpriced caffeine; they’d be choosing between a hospital visit and the gas bill for keeping their home warm. Or the food they were planning to buy for their children this week. Or the bus fare to get to the Jobcentre so the bastards don’t fucking sanction them again.

Some people are so rich they can have basically all the things they want, and the use of money as a way to express preference becomes meaningless on this scale, while some people are so screwed over by the system already that they don’t get to make choices between preferences in a way that’s remotely fair. Even if you try and means-test it, it’s another hurdle requiring poor people to prove their neediness once again before granting them access to basic medical care.

If only there was some way to make sure people didn’t face that kind of harsh, brutal, unjust, life-or-death dichotomy, and were free to make genuinely economically rational choices about how to allocate the resources available to them.

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As I was saying, healthcare staff went on strike today, and in case I hadn’t been clear, I strongly support their actions and their goals.

I left off somewhere around here a few days ago: In a poll of RCM members, 94% of respondents supported, if not a strike, then taking some form of industrial action regarding their forthcoming real-terms pay-cut. I was a little perturbed by the remaining 6%. In a room full of 16 midwives, statistically one of them thinks they should all keep working without being paid, because to do otherwise would be to cause an unnecessary fuss over the steady decline in remuneration for the work they do get paid for.

This highlights the odd role which “work to rule” plays in the lives of many public sector workers. That continuing to do the job agreed with your employer, and going no further beyond what you’re being compensated for, can constitute a form of protest, is itself slightly bewildering, and notably one-sided. If my bosses regularly paid me to take extra-long lunch-breaks, and only withdrew this privilege when they wanted something from me, then… well, then I don’t know what. But it’d be weird. Though maybe I’d be a bit less down on this whole capitalism thing.

(Maybe I’ve figured out why the Guardian didn’t want to commission me to write about this. Actual journalists need to be able to finish a sentence. Also they’ve kinda got it covered.)

When a serious objection to working conditions needs to be raised, however, it may eventually come time to down-forceps entirely, which might get a little more attention. Even then, they’ll do their best to make sure that nobody will suffer serious harm from want of their services, but whatever measure they take, the backlash is inevitable from certain quarters, castigating and condemning them for the arrogance with which they put the public at risk for their own gain.

Some of our general national wariness over public sector strikes is reasonable and worth considering, notwithstanding the extent to which it’s drummed up and over-hyped by certain self-interested tabloids – and bearing in mind that a stronger majority of everyday folk support the 1% pay rise in contention than have provided a mandate for any government in the last I’d have to do some actual research to find out how many years. Healthcare workers have a unique power over us when we’re at our most vulnerable and in need of help; if they chose to wield this power irresponsibly or selfishly, we could all find ourselves held to ransom by a surgeon who charges extra to sew us back up again, or hostage to a paramedic whose defibrillator doesn’t seem to be working right now but might just power back up and be able to get granddad’s heart beating again with the right amount of “persuasion”.

But although this is theoretically conceivable, back in the real world a far more likely danger of social blackmail is faced by healthcare workers themselves, who are expected by many to continue working constantly and tirelessly, regardless of the conditions of their remuneration, with threats of being held responsible for whatever happens to those who need their services in their absence, if they ever dare let up their efforts for a moment. (I saw someone on Twitter earlier ask what would happen to “the lives that would have been in the hands” of a particular nurse who was on the picket lines today if she’d been working. That’s not the half of it – I hear some of them forego work to sleep and have social lives too, you know. The nerve of it! People could be dying!)

Of course, implicit in any complaints about the terrible peril that we all face if NHS staff stop doing their jobs, even for a few hours with several weeks’ notice, is the acknowledgment that the jobs they’re doing are pretty fucking important – and often urgent and extremely time-sensitive. In certain paranoid fantasies, this means we could all fall foul of the above-imagined surgeon hostage-taker at any moment; in practice, the end result of this aspect of the job is all that unpaid overtime I was so bewildered by earlier.

If you’ve reached the end of your thirteen-hour shift and your colleague who’s supposed to be taking over hasn’t turned up to relieve you, working to rule would imply that you sod off regardless once it’s time for you to clock out, potentially leaving whoever you were caring for without anyone actively attending to them (or dumping responsibility for their care on someone else who’s around but who already has an overflowing case-load of their own). So what often happens is that you just have to keep working, beyond the time you’re getting paid for, and well beyond the point at which my knees would’ve buckled and brought on my third emotional breakdown of the night.

The same thing that makes it hard for them to take industrial action without risking harm to innocent bystanders, also makes it clear why industrial action is such an important option when they go so unappreciated. And yes, I mean they should be appreciated with money. If you expect someone to save your life, and deal with drunk idiots turning up in A&E night after night, and not complain when they’re regularly demonised for objecting to their pay being cut again, and to love what they do so much that they’re not even doing it for the money anyway, then I think not making it even harder for them to get by while they earn a salary in the stratospheric levels of slightly above the country’s median income is the least you can fucking do.

Be glad that nurses and midwives aren’t full-on going Galt. We’d miss them more than if every CEO in the country fucked off to join their money in the Caymans.

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Midwives are going on strike. Sorry babies, back inside you go. I know you’re ready to emerge from the womb and take your first breaths of air marking the start of your lifelong journey in the outside world, but that’s officially a picket line you’re trying to cross. Did you just rupture that amniotic membrane? Scab! Scab!

Yeah, so, that’s kinda obvious and has all been done. But there’s some serious bullshit going on here which has driven tens of thousands of medical professionals to vote massively in favour of industrial action in a recent ballot. It’s clearly something they don’t do lightly, since in the case of the Royal College of Midwives it’s literally never happened before, and the last NHS strike due to issues with their pay was over thirty years ago.

Frankly, I’m a little alarmed by the levels of patience and professionalism that midwives, nurses, paramedics, and others appear to have consistently shown about this. I’ll let the Chief Executive of the RCM explain why something’s finally being done now:

Each year, the independent NHS Pay Review Body (the PRB) takes evidence from the government, employers, trade unions and others about how much staff in the NHS should be paid, and based on all that it makes a recommendation. It takes a range of factors into account, including what’s affordable. This system takes the setting of pay out of the hands of politicians, and places it in the hands of independent experts. Every year since the PRB was founded in the early 80s, its recommendation has been accepted. Some years the government and employers grumbled that the pay rise was too high. Some years the unions grumbled that it was too low. But every year it was accepted by all sides. This year, that fair, independent, long-established way of doing things was ripped up when the government took the unilateral decision, now being implemented by employers in the NHS in England, not to honour the PRB’s recommendation of a 1% across-the-board rise in NHS staff pay.

Midwives’ pay was frozen for a couple of years recently, before rising 1% last year. Due to an obscure economic phenomenon called “inflation”, though, what this actually means is that everybody in this job took a real-terms pay cut, and then another, and then another. This year, they were expecting to take another, and this would have been considered acceptable, because it was the formal recommendation of an independent body.

Which still sounds like magnanimity taken to a frankly foolhardy extent in my book, but apparently the government weren’t happy even with this, and are planning to cut healthcare workers’ wages even more than they were already going to. Because austerity. Times are tough. We’re all in it together.

This is the same government, by the way, which doesn’t seem to be worried about finding the funds for a new high-speed rail line, a 9% pay-hike for its own members (taking their basic salary to £74,000, before expenses), and FUCKING TRIDENT.

But no, efforts to make sure women don’t die while they give birth to children is totally where we should squeeze financially. Some of those midwives start on nearly £25,000 a year, you know.

Way more of the public want to see NHS workers get the 1% pay increase they’re asking for – which, remember, is a real-terms pay cut – than wanted to elect this government that’s trying to slash their pay even further. Way more.

I don’t have time tonight to get into my whole other rant about the weirdness of “working to rule” as a form of industrial action, but I have to highlight the latter half of this statistic from the RCM ballot, quoted by Cathy Warwick in that article I linked to earlier:

82% voted in favour of strike action, with 94% voting in favour of taking action short of a strike (for example, refusing to work overtime unless paid for it).

94% voted in favour of “refusing to work overtime unless paid for it”.

Take a room full of 16 midwives facing a pay cut for the fourth consecutive year. Statistically, one of them wants to keep on working without being paid so as not to cause a fuss.

Not even sure how to start thinking about that one.

Give medical professionals some decent fucking money for saving all your lives all the time.

Thank you.

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Someone asked Amanda Palmer recently about her health insurance situation. She then asked the rest of the world.

#InsurancePoll is trending! EVERYBODY ANSWER & RT! 1) country? 2) occupation? 3) have health insurance? 4) why/not? (cost to you/employer?)

This post is a summary of my ensuing twitrant.

#insurancepoll 1) UK, 2 & 3) doesn’t matter and nope, because 4) thank Loki for the NHS

There presumably already exists more and better quality data than is emerging on that hashtag, but not more human stories.

It was a long while before I really got the conversations on American TV shows about health insurance. Because I’ve never had or needed any.

Because I’ve always just gone to the hospital and gotten anything sorted that needed sorting. Because we have an NHS.

Because some bloke called Nye Bevan had this crazy idea about treating people based on medical need rather than how rich they are.

I only slowly came to understand the American situation through the gradual absorption of pop culture. It got scarier the more I learned.

I still don’t get it. You have Medicare, so, what? Old people can’t be expected to provide for all their health needs but poor people can?

When did a profit-driven health service start seeming like a *good* idea to anyone, anyway?

Seriously, if your infrastructure for dealing with medical emergencies is driven by a compulsion to make money, what the fuck do you expect?

“But government’s so incompetent and inefficient!” Sure, let’s let rich people make our decisions for us instead. No way that’ll backfire.

Government *does* suck, so don’t just nationalise healthcare, socialise it. Let doctors et al. run things and let’s all of us support them.

A poorly formed, un-nuanced, tweet-length soundbite of an idea? Yes. And I wish anything else being said made any more sense.

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About $10,000,000,000,000 has been squirrelled away by 92,000 people.

A tiny little subsection of humanity, described appropriately by the Guardian as a “global super-rich elite”, has amassed this fortune, extracted it from various of the world’s economies, and hidden it under a metaphorical Cayman Island-shaped mattress to reduce their tax liability.

This is what happens when you encourage personal accumulation of wealth for its own sake, and sanctify those who succeed in the scramble to the top. You allow the “job-creators” to hoard unimaginably colossal piles of resources, denying their use to any of the rest of us.

What is even the point of anyone having that much money? What personal hedonistic joy are you going to derive from the second billion which you couldn’t reach with the first? It just becomes about getting a high score.

The total amount tucked away in private banks is apparently $21,000,000,000,000. And yes, it really is meant to have that many zeros. I have to keep double-checking, too. To put that in a little perspective, if you look at the cost of the NHS and scale it for population, then this off-shore stash could pay for the entire USA to have its own nationalised healthcare service, providing every single person in the country with the kind of social safety net enjoyed by every other nation in the developed world.

Twenty-six times over.

But it’s not going to. Because some successful capitalists earned that money, and now its all theirs to do what they want with it.

This is a completely fucked system.

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– If you’ve been only half paying attention to the internet as much as me lately, you’ll still be confused about this “Kony” thing you’ve been hearing about. Well, it’s actually a guy. An African warlord, and not a very nice African warlord as African warlords go, by the sound of it. There’s been something of a clusterfuck surrounding him lately – or, rather, surrounding a particular campaign for his arrest – which is nicely summarised here by BoingBoing. The filmmakers who’ve done so much to publicise his name lately have also responded to some of the criticism.

– JT Eberhard explains as nicely as he can to a 14-year-old girl why he hopes her birthday wish doesn’t come true.

The NHS bill is beyond repair. An even more overwhelming majority of people who actually work in and use the industry are opposed to the Conservatives’ plans for reform.

– Christians’ “relationship with Jesus” is like a lot of teenagers’ girlfriend who lives in Canada.

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My new favourite answer to right-libertarianism.

– The black-and-white, either/or, tribalistic partisan divide in US politics is damaging and nonsensical. Here’s a Republican supporting gay marriage.

Rick Santorum thinks women are unsuitable for some jobs because of “other types of emotions” that they have. What really makes him evil is the senseless use of the phrase “more unique”, though.

– Back in the UK, we’re learning more and more about the few groups who support Lansley’s NHS reforms (generally the same ones who stand to personally profit from it). For instance, General Healthcare Group’s parent company Netcare sold human organs on the black market.

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