Author Topic: Doctors' Strikes (UK)  (Read 5090 times)

Jubal

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Doctors' Strikes (UK)
« on: January 12, 2016, 03:11:00 PM »
Today, major doctors' strike action in the UK because the government are trying to make them work absurdly long hours.
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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #1 on: January 12, 2016, 03:13:58 PM »
-1 for the NHS where doctors can and will strike against their central controller.

Jubal

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Re: Doctors' Strikes (UK)
« Reply #2 on: January 12, 2016, 03:22:26 PM »
I'd rather doctors were striking if it helps them defend good working practices and high quality care. It's also not all doctors, it's the less well paid juniors (and about 40% of them are still in work to cover emergencies).
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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #3 on: January 12, 2016, 03:37:37 PM »
Less well paid juniors? Isn't that the point? People today don't seem to understand that you have to start at the bottom and work hard to move up, especially if you're a doctor. Kids just wantin' their money for nothing and checks for free. :(


Jubal

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Re: Doctors' Strikes (UK)
« Reply #4 on: January 12, 2016, 03:53:48 PM »
Nobody's arguing that juniors should have a massive pay rise, just that the government shouldn't fix their contracts to make them work more hours a week than is safe for people doing emergency care. Also "junior" here is very relative, it covers anyone who's not a high-level consultant.

But yeah - this isn't a strike over pay rises, it's a strike over unsafe working conditions. I'm pretty sure very few people understand working hard to work up as well as most of the medics I've met.
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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #5 on: January 12, 2016, 04:01:46 PM »
I thought it was normal for doctors to work long/irregular hours anyway? Part of the job and such. I agree though, this is what happens when the government sticks its hands in things.

Jubal

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Re: Doctors' Strikes (UK)
« Reply #6 on: January 12, 2016, 05:14:41 PM »
Yes, they already do work long hours... basically the government is proposing a new contract change which will increase the maximum number of hours they're allowed to ask doctors to work, and decrease the number of cases in which they have to pay overtime, instead of actually trying to employ more doctors.

I'm aware you'd like to use this to snipe at the NHS, but it really is a pretty good system and we're all still confused why you haven't got it yet. Yes, it does sometimes mean you pay more taxes, but it's a lot more cost effective, we spend a far lower percentage of our GDP on healthcare than you guys do (9% to about 15%). And the higher cost-effectiveness means that most people pay less overall, as the higher taxes will be more than made up for by not having to pay for medical care or insurance at any other times. We also don't have the problem of perverse incentives, the NHS has a massive incentive to improve public health whereas private/insurance based systems have a massive incentive to get people to pay for more expensive treatments. I mean, different countries different systems, if you guys want to prioritise keeping things out of the hands of the government and paying businesses rather than taxes then that's your business, but it's fair to say we're pretty happy with our NHS.
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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #7 on: January 12, 2016, 05:37:24 PM »
It's not our choice what the government prioritizes, in theory it is but not in practice. Our government wants to spend our taxes on the military so they can blow armadillo up. If they decreased military spending we could easily afford an NHS. However I'm of the opinion that government meddling is usually worse than letting the system work itself out. The real fault in our healthcare is insurance companies. If not for them doctors wouldn't charge as much as they do. But what did the government do rather than put some limits on the insurance companies? They made insurance mandatory.

Jubal

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Re: Doctors' Strikes (UK)
« Reply #8 on: January 12, 2016, 06:04:00 PM »
Yeah, US military spending is pretty staggeringly high... I've never dealt with insurance companies for healthcare but yes, I can see that does complicate the system. I guess my opinion is that government intervention varies as to how effective it is; sometimes directly funding things is more cost-effective, sometimes competition is better to drive prices down, it just depends on the service/product.

Certainly I can agree that some of the worst results seem to come from the government trying to keep half a market and then fumbling around with it rather than just directly funding the thing - private finance deals in the UK (ironically brokered by the last Labour government) have ended up putting some hospitals into debt, and Obamacare, whilst I'm sure I'm more behind it than you are, does I think suffer from being a halfway house. It would've made a lot more sense as a whole bill IMO if the Senate hadn't refused to add a public insurance option (which would've ultimately over time ended up with you guys having a system more like France or Germany and would at least have stopped local/regional insurance monopolies being such a major issue).

I guess the insurance thing is difficult - it does mean a lot of incentives to up prices, but on the other hand it's presumably necessary in the current US system to allow most people to afford treatment. What would your ideal healthcare system include/what would you like to see happen to it (beyond presumably the repeal of the ACA)?

Also, topic split.
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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #9 on: January 12, 2016, 06:32:21 PM »
No insurance, all medical industry non-profit, I don't know. :P But imagine the cost decrease if the doctors didn't have insurance to bill and could only charge for what the services actually cost.
I actually don't mind the ACA, it's the lack of choice that I despise.

Jubal

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Re: Doctors' Strikes (UK)
« Reply #10 on: January 12, 2016, 06:50:12 PM »
I agree, minimising bureaucracy is always nice! I guess my concern would be that some operations and treatments (things like chemotherapy) are genuinely expensive, and some folk aren't going to be able to pay for that themselves even with a pretty efficient network of non-profit and charitable hospitals (which was, incidentally, largely the system we had pre-NHS, and it does have some advantages). Though one could pull the cost of a lot of the drugs and stuff down with suitable copyright/patent reforms, many of them are actually pretty cheap to produce, it's just that the drug companies sit on the patents forever and can charge what they like for them.

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comrade_general

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Re: Doctors' Strikes (UK)
« Reply #11 on: January 12, 2016, 06:56:16 PM »
Enough help could be found for something like chemo, which I think would dramatically decrease in cost as well. I sometimes think one of the reasons cancer hasn't been cured yet is that it is a most profitable business in treating it. Big pharma needs cutting too. One purpose of the government should be to protect us from bureaucracies not become one itself. Easily the most powerful one.

Glaurung

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Re: Doctors' Strikes (UK)
« Reply #12 on: January 12, 2016, 07:46:24 PM »
... the drug companies sit on the patents forever and can charge what they like for them.
Much as I dislike disagreeing with people, my understanding is that this is not so.

I think the life of a patent in the US is 20 years (it's probably similar in other countries), and since the patent has to be filed fairly early in the drug discovery process, well before it can actually be sold, the period when it's actually producing a profit for the patent-holder is quite a bit shorter. Once it's out of patent, anyone can make it (subject to getting a suitable manufacturing licence) and the original patent-holder gets no money from them.

Bear in mind also that the cost of developing a new drug is of the order of a billion US dollars. That R&D cost has to be covered from income on existing drugs, or else there will very shortly be no more new drugs. Very often, the drug companies cannot charge what they like; in countries with state health systems, for example, drug prices will, be negotiated between the manufacturers and the state, and end up below the manufacturers' list prices.

My source for all of this? The In The Pipeline blog. I've linked to it before, in connection with some exciting chemistry; it's written by a chemist working in drug discovery, and unsurprisingly he has quite a lot to say about drug pricing.

I sometimes think one of the reasons cancer hasn't been cured yet is that it is a most profitable business in treating it.
Again, I disagree. "Big pharma" could make a fortune with an effective, reliable cure for cancer, and indeed is spending fortunes at the moment in the search for cures. The reason it hasn't been cured yet is simply that it is very, very difficult. Biological systems are orders of magnitude more complicated than any sort of engineering. In fact, there isn't an "it" to cure - the thing we call cancer is a multitude of different diseases, each of them a different way in which the growth of human cells can go wrong, and very often requiring different treatment. The source for all this is, again, In The Pipeline.

comrade_general

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Re: Doctors' Strikes (UK)
« Reply #13 on: January 12, 2016, 08:08:34 PM »
I should've said "half-think". ;)

Jubal

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Re: Doctors' Strikes (UK)
« Reply #14 on: January 12, 2016, 09:36:59 PM »
I'll admit of course to exaggerating on the "forever", but I'd still argue that there are some serious idiosyncracies to the system that push prices up. The pharmaceutical industry within its patent window can charge a vast amount more than the cost of actual manufacture & distribution - yes, some of that needs to cover R&D, but it's hard to tell how much of it because companies have been pretty successful in resisting pressure to release any sort of detailed figures. The billion figure is very widely disputed and nobody has ever offered any sort of breakdown of where that goes (good article here). They also have high incentives to bundle as much of their operations into "R&D" as possible as those areas come with associated tax breaks, and are often incentivised to go through processes of subtly tweaking older drugs to create new ones, the "me-toos" (all the benefits of the patent without the costs of such extensive initial research), which shouldn't have such high R&D costs.

And that's before we get onto the marketing system and the trials system, both of which are pretty badly broken (marketing especially in the US where there's no centralised buyer to butt heads with the industry, and trials pretty much everywhere). Trials don't help on the costs either, as it's become common practice for "volunteers" in the study to actually be paid, which introduces yet more perverse incentives (especially when outsourced to countries where this can suddenly be someone's main income stream). Cancer is indeed a high-profile issue and probably mostly hasn't been solved because it's difficult to do so - what gets left behind are treatments for problems like malaria or AIDS, because they mainly affect people who are too poor to buy drugs, which is another major black mark on the current system.

I'm unconvinced that in the long run a wholly for-profit drug manufacturing system has benefits that outweigh the disadvantages. R&D costs must be inflated by not sharing research, for one thing; drug companies have to be sealed boxes for current research, which is a bizarre opposite of where research science is. The profit motive I think is what one can also identify as the driver behind the fact that many trial results go totally unpublished (especially if negative), and the huge drug marketing industry which prioritises sales over patient welfare. If it is the case (which it may be) that the drug industry in its present form can only survive by being as thoroughly mercenary as it evidently is, we may be in need of a fairly fundamental re-think.
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