Re: Donald Trump : Sun Dec 08, 2019 4:22 pm  

sally cinnamon wrote:

Maybe by abuse of the NHS he means people who smoke and drink and eat fatty food and create problems that the NHS has to pick up. They will defend their lifestyle as it's a "free country" and it's "not the role of the nanny state to tell me how I should live my life". However, they're happy to expect the taxpayer to pick up the bill for treatment that they have caused.

Now an insurance based system, where insurers had information about peoples lifestyles (surely achievable in the era of big data and multiple transactions) would enable insurers to price health premiums appropriately. So if you are making transactions purchasing cigarettes, alcohol etc, your insurer gets to find out and can adjust the expected risk and so put your premiums upward. This would be more efficient from a market perspective and would create incentives for people to live more healthy lifestyles. Unfortunately the critics of the NHS don't tend to be too keen on this idea!

If everybody stopped smoking and drinking tomorrow the country would be skint fairly quickly. What about all the tax revenue we get from alcohol and tobacco? I object more to junkies who cost us a fortune and pay no tax on their "habit". Also people who drink and smoke die earlier so they will on average take less pension payments.

Re: Donald Trump : Sun Dec 08, 2019 6:02 pm  

This idea is the dumbest I have heard. What you are saying is that because those on low incomes or no incomes who are by circumstances also the least healthy should pay more to access healthcare.

Re: Donald Trump : Sun Dec 08, 2019 10:40 pm  

Sal Paradise wrote:

To clear this up I am not suggesting we move to an insurance-based system. Health care in the US will be move expensive as there is a profit element plus as has been mentioned before the cost of drugs is higher. Also the US are prepared to push the boundries in terms of clinical treatments i.e. use live humans for practise but charge them massively for taking part in the trial!!

The cost of drugs in the US is higher because you get countries like the UK with monopsony purchasers being able to use their market power to drive down the prices of US drugs that they purchase.

If the UK didn't have this then it would return more money to the US pharmaceuticals which will allow the US pharma companies to lower the prices to US citizens.

Now if this was the other way round, and we were having to pay more because other countries were using their healthcare system's market power to drive down prices of British-invented, British-produced drugs, so other countries were paying less for British drugs than we were, we would be pretty outraged and would be asking why our government wasn't doing something about it.

Which is why Trump will have this as a top priority for the US in trade negotiations to the UK and make sure the UK pays higher sums in drug prices to enable that to cross-subsidise cheaper drugs in the US. From their perspective it is perfectly reasonable. The UK can protest and refuse if it wants, in which case - no deal with the US, or as seems to be fashionable to describe it now, 'we can trade with them on WTO terms'.

Re: Donald Trump : Mon Dec 09, 2019 9:53 am  

sally cinnamon wrote:

The cost of drugs in the US is higher because you get countries like the UK with monopsony purchasers being able to use their market power to drive down the prices of US drugs that they purchase.

If the UK didn't have this then it would return more money to the US pharmaceuticals which will allow the US pharma companies to lower the prices to US citizens.

Now if this was the other way round, and we were having to pay more because other countries were using their healthcare system's market power to drive down prices of British-invented, British-produced drugs, so other countries were paying less for British drugs than we were, we would be pretty outraged and would be asking why our government wasn't doing something about it.

Which is why Trump will have this as a top priority for the US in trade negotiations to the UK and make sure the UK pays higher sums in drug prices to enable that to cross-subsidise cheaper drugs in the US. From their perspective it is perfectly reasonable. The UK can protest and refuse if it wants, in which case - no deal with the US, or as seems to be fashionable to describe it now, 'we can trade with them on WTO terms'.

In the UK we only use 10% of US sourced pharmaceuticals so the impacts of this need to be put into context. I fully understand Trump's desire to get prices up but nobody in their right mind would add additional costs to a sector already struggling with funding.

There would have to be some significant gains in other areas to justify some movement in pharma.

Re: Donald Trump : Mon Dec 09, 2019 10:48 am  

The gains will be political - simply 'getting a deal' with the US will be seen as a big feather in Boris Johnson's cap, especially given that 'the establishment' have said that it will take 7 years or more to do a deal with the US.

You can get a deal signed off with the US very quickly if you are willing to concede what they want, as they will basically draft up the deal for you. There aren't that many gains to be made with a US deal anyway as the US isn't particularly keen on opening its markets, they do deals to promote their own industries' opportunities abroad particularly agrifood, pharma and digital tech firms.

But the detail of it won't really matter to most of the public. Even concerns about them lowering food health standards - these will be more than an issue if we get pressed in to lowering standards by India or China, but if it comes to accepting US standards most people would think well if I went to the US I wouldn't mind eating their food etc so what's the problem.

The biggest barrier to a trade deal with the US will be if Boris has conceded everything to get a deal with the EU, because that will tie us to standards that will be incompatible to the Americans and their interest in a deal will drop rapidly. But Boris may figure that it plays well politically to stand up to Brussels and no-deal them at the end of the transition point, and then go for a rapid concession to the Americans to paint himself as the man who took us out of the EU and signed a deal with the Americans when nobody thought he could.

Re: Donald Trump : Mon Dec 09, 2019 10:55 am  

wotsupcas wrote:

If everybody stopped smoking and drinking tomorrow the country would be skint fairly quickly. What about all the tax revenue we get from alcohol and tobacco? I object more to junkies who cost us a fortune and pay no tax on their "habit". Also people who drink and smoke die earlier so they will on average take less pension payments.

Where have you been ?
There has been a smoking ban in operation for 10 years and although this has killed plenty of local pubs, it's hardly bankrupted the country.
The cost of dealing with health issues massively out weigh the revenue for the exchequer.
Aside from the obvious, such were the rates of tax on cigarettes and booze that, the black market took over anyway, meaning even less tax going into the pot.
As for the junkies, it's a fine line between heavy drinker and alcoholic and for drugs, just what is your solution ?

Re: Donald Trump : Mon Dec 09, 2019 11:00 am  

sally cinnamon wrote:

The gains will be political - simply 'getting a deal' with the US will be seen as a big feather in Boris Johnson's cap, especially given that 'the establishment' have said that it will take 7 years or more to do a deal with the US.

You can get a deal signed off with the US very quickly if you are willing to concede what they want, as they will basically draft up the deal for you. There aren't that many gains to be made with a US deal anyway as the US isn't particularly keen on opening its markets, they do deals to promote their own industries' opportunities abroad particularly agrifood, pharma and digital tech firms.

But the detail of it won't really matter to most of the public. Even concerns about them lowering food health standards - these will be more than an issue if we get pressed in to lowering standards by India or China, but if it comes to accepting US standards most people would think well if I went to the US I wouldn't mind eating their food etc so what's the problem.

The biggest barrier to a trade deal with the US will be if Boris has conceded everything to get a deal with the EU, because that will tie us to standards that will be incompatible to the Americans and their interest in a deal will drop rapidly. But Boris may figure that it plays well politically to stand up to Brussels and no-deal them at the end of the transition point, and then go for a rapid concession to the Americans to paint himself as the man who took us out of the EU and signed a deal with the Americans when nobody thought he could.

I don't disagree with anything you have written - I do think it would be political suicide to increase costs in the NHS without a more positive outcome somewhere else that covers the costs and some. I do think no deal is a distinct possibility especially if the Tories have a working majority.

Re: Donald Trump : Mon Dec 09, 2019 11:03 am  

wrencat1873 wrote:

Where have you been ?
There has been a smoking ban in operation for 10 years and although this has killed plenty of local pubs, it's hardly bankrupted the country.
The cost of dealing with health issues massively out weigh the revenue for the exchequer.
Aside from the obvious, such were the rates of tax on cigarettes and booze that, the black market took over anyway, meaning even less tax going into the pot.
As for the junkies, it's a fine line between heavy drinker and alcoholic and for drugs, just what is your solution ?

All good points - the country is awash with class A drugs - kids use them every weekend and very few get addicted are will building up a medical crisis in the future?

Re: Donald Trump : Mon Dec 09, 2019 12:02 pm  

Sal Paradise wrote:

All good points - the country is awash with class A drugs - kids use them every weekend and very few get addicted are will building up a medical crisis in the future?

Unlikely - and if so, certainly one that would pale into insignificance alongside the impact of the perfectly legal alcohol, which costs the NHS, Police and Social Services a huge amount in terms of reaction, clean-up and ongoing issues.

We have a quaint and puritanical attitude towards drug use in this country, which comes from a position of government ministers being wilfully uninformed about the whole issue - and a desperate desire to appease those people who want to see (some) drug users punished; resulting in disproportionately long prison sentences for young, working class kids, particularly black kids, for doing exactly what journalists and politicians have admitted to doing themselves. It seems we perceive the harms are much less when it involves posh people snorting it up behind closed doors?

Anyhow - it's a whole other subject - but there are some models, most notably Portugal, that demonstrate that a shift in public policy towards drug use can have some really positive effects; I would like to think that we'll get there, if for no reasons other than very practical, economic ones.

Re: Donald Trump : Mon Dec 09, 2019 2:25 pm  

bren2k wrote:

Unlikely - and if so, certainly one that would pale into insignificance alongside the impact of the perfectly legal alcohol, which costs the NHS, Police and Social Services a huge amount in terms of reaction, clean-up and ongoing issues.

We have a quaint and puritanical attitude towards drug use in this country, which comes from a position of government ministers being wilfully uninformed about the whole issue - and a desperate desire to appease those people who want to see (some) drug users punished; resulting in disproportionately long prison sentences for young, working class kids, particularly black kids, for doing exactly what journalists and politicians have admitted to doing themselves. It seems we perceive the harms are much less when it involves posh people snorting it up behind closed doors?

Anyhow - it's a whole other subject - but there are some models, most notably Portugal, that demonstrate that a shift in public policy towards drug use can have some really positive effects; I would like to think that we'll get there, if for no reasons other than very practical, economic ones.

Do you if legalised it and the government supplied these drugs that would help or would this simply push this underground or cause problems with organised crime as you cut off a major source of revenue for them?

I agree with all you put by the way