American using Britain’s NHS (2015)

Thanks for parenthetically instructing us not to share anecdotes at the end of a statement which isn't even that.

https://www.statista.com/statistics/266141/pharmaceutical-sp...

That's per capital spending on pharmaceuticals. Two things to note from that: 1) The highest by far is in the US, that's absolutely true. 2) Substantial amounts are still spent in other wealthy countries.

American healthcare payers - insurance companies and their agents - also impose controls on what they will pay for drugs and for which conditions. They don't seem to be as effective in enforcing them since they haven't got the kind of monopsoninistic power as either single payer systems like Canada or constrained multi-payer insurance markets like the Netherlands.

That Americans overpaying for drugs helps to subsidise R&D that everyone benefits from seems like it make intuitive sense. I'd question whether the evidence supports a complete halt to innovation if the US adopted pharmaceutical price controls unless the price control they adopted was to restrict prices to cost of production - something that no government single payer health service does.

In the NHS, these decisions are made by the NICE which determines how many quality adjusted life years are gained from the use of a drug and then checks to see if they clear a threshold CBA value. It's worth noting that £100k+ cancer drugs that actually work are still frequently approved under this system. Recently, NICE approved Soliris at £330k/yr for treating aHUS. That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that.

Moreover there are goods and services such as fighter jets where there is a single US government buyer and innovation still happens. Conceptually it doesn't appear that this needs to be a barrier to innovation spending.

Public funding of drug research is a better driver for the discovery of improved treatments than private pharma investment - under the current model, drug companies aren't incentivized to develop novel treatments (see Nexium), or to develop treatments that would improve outcomes for the greatest number of people (see Pfizer abandoning research into Alzheimer's and Parkinson's treatments).

Since the Bayh-Dole Act passed in 1980, pharma companies have profited hugely by purchasing patents held by publicly-funded researchers, and commercializing them with virtually no controls on the resulting drug prices. Even private development of drugs still relies on publicly-funded and publicly-available research. The assertion that the institution of stricter price controls would eliminate innovation seems to be untrue - I don't think that scientists are incentivized to do research solely by the promise of lucrative patents. Stricter price controls would likely mean that the government would have to participate more directly in the clinical trial phase, which would be a good thing, as there are minimal checks against manipulation of clinical trials.

What's the Tory's stated public position for their 30 year goals and what immediate and mid-term changes have they made in order to achieve that?

Fiddling is _not_ needed.

Planned, careful, forward looking, evidence based change (that's not focused on shifting funds towards private profit) is certainly required.)

It's just like education, every new minister (usually entirely new to the field) dicks around changing stuff because they want to justify their pay and because not changing it might seem like someone else had a good idea and that apparently is complete anathema to our current politicians.

Any time that independent body fucked up or did a bad job, they'd simply claim they didn't get enough money from the government to do the job. Whether that was the truth or not. The "cross party" oversight would then take positions according to their party priorities, if in power blame the independent body for doing a bad job, if not in power blame the government for not giving them enough money.

Unless of course that independent body had separate tax raising powers for just the NHS?

In which case I can't see how they can't be elected as they have the power of taxation.

You can't get politics out of the NHS, it spends too much money raised by taxation.

The system interfaces with every area of life, and with capitalism. Western Capitalism says the amount spent on healthcare should grow until all available money becomes profit for the Capitalists.

Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia because it mines the metals that make the earphones used in mp3 players by students training to be teachers, to encourage them to teach more sport to children so that when those children grow up they'll need less heart bypass surgery.

Meanwhile the Siberian mine leads to contaminants in the ocean that cause excess cost to all health regimes around the world ...

Health encompasses all parts of life, it needs selfless, holistic, planet-wide approach. You could spend £150 Trillion in health and still find more areas of spending to address.