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Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

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Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#101

Earlier quoted context omitted.

No, that's relatively new. The NHS used to own its radiography suites. It used to own its land and buildings. It used to hire doctors and nurses and support staff directly. But because of a [also recent] forced-tender system, and high breakthrough prices on in-housing projects, it was deemed "cheaper" to let private providers burden the upfront costs of equipment, land and building management, and short contract mana…

If you're unaware of how tender breaks public services, here's an example. Hospital needs a new MRI suite. To them, this would cost £2m for the machine, £400k for the room, and £500/h in running cost, £1.4m/year. The first 5 years costs are: £3.8m, £1.4m, £1.4m, £1.4m, £1.4m, ... But which trust has £4m in their back pocket for y1 cost? Even if they did, it's a large project so has to go out to tender. A capital-inve…

I don't have much to add, but I just took a re-watch of Monty Python's Meaning of Life. The opening scene (after the intro short film) is amazing in that it's only a couple minutes and shows many of the pathologies of a modern health system (despite being 40 years old now), while also being hilarious. It depicts the birth of a child where the mother is basically an afterthought to all the expensive machines that the doctors get to play with. As soon as they have the lady's legs in stirrups, a gaggle of onlookers is welcomed into the room, but the husband is asked to leave since he's "uninvolved". But most important the amongst the crowd is the administrator who explains how they cleverly use accounting to manipulate the costs of the medical equipment.

To cap it off, when the mother asks if the child is a boy or a girl, Graham Chapman responds, "it's a bit early to start putting roles on it".

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#102

Earlier quoted context omitted.

> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. If you are serious, I have bad news for you. The situation is going exactly as expected. That’s the traditional Tory plan. Defund, complain it doesn’t work now that it doesn’t have money then make private. British voters can only blame themselves. Between Brexit and decades of voting for the worst of the Tory, if they were l…

Socialized medicine was always going to be unaffordable in the long term. If it wasn't a burden, then the 'cost cutting' measures probably wouldn't have been implemented. Having the government in charge of something means it's always going to be inefficient.

> Having the government in charge of something means it's always going to be inefficient.

A peculiarly American dogma. The irony of trotting it out on the field of healthcare is lost on you, I suppose, but gave me a laugh. Thanks.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#103

Earlier quoted context omitted.

> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. If you are serious, I have bad news for you. The situation is going exactly as expected. That’s the traditional Tory plan. Defund, complain it doesn’t work now that it doesn’t have money then make private. British voters can only blame themselves. Between Brexit and decades of voting for the worst of the Tory, if they were l…

Socialized medicine was always going to be unaffordable in the long term. If it wasn't a burden, then the 'cost cutting' measures probably wouldn't have been implemented. Having the government in charge of something means it's always going to be inefficient.

[deleted]

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#104

Earlier quoted context omitted.

I feel like healing the sick, and caring for the poor, is something from a certain religion that some aspects of the Republicans would like to make the state religion. I've never understood the dichotomy between America's religious zeal, and the disinclination to put it into practice unless you're targeting abortion or gay people. Very selective.

I'm not American, I'm British and feel as though our approach to healthcare is hobbled by people who think the NHS is some saintly miracle and not a very expensive bureaucracy which provides mediocre value for money.

Firstly, I apologise for assuming there.

Secondly, I agree that the NHS is described in almost hagiographic terms by some, especially left-leaning Americans.

On the mediocre value for money, I don't doubt at all that the NHS could change to be better.

That said, from my antipodean point of view, it appears to me that the Tories have been running the classic neoliberal play of "Set metrics that the public service will need more funding to meet, underfund them, point to the inability to meet your metrics as a) obvious proof that the government is inefficient and n bloated and b) reason to carve off the easy services for private sector businesses to fulfill at taxpayer expense, aforementioned private sector businesses often having been good donors, or close personal affiliations to members of your Cabinet. Bonus points if retiring MPs become members of their C-suites or board of directors"

So yeah, the NHS definitely could be better, but I don't think the issues are inherent to it.

Incidentally, our Tories have used that play repeatedly, hence why it's so familiar to me.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#105

Earlier quoted context omitted.

If you're unaware of how tender breaks public services, here's an example. Hospital needs a new MRI suite. To them, this would cost £2m for the machine, £400k for the room, and £500/h in running cost, £1.4m/year. The first 5 years costs are: £3.8m, £1.4m, £1.4m, £1.4m, £1.4m, ... But which trust has £4m in their back pocket for y1 cost? Even if they did, it's a large project so has to go out to tender. A capital-inve…

What prevents them from accepting an offer that has economics closer to the in-house funding cash flow? I’m not from the UK so please forgive the question. Also, since I’m from the US, your example reminds me of Bobby Bonilla Day, jeered at as an awful deal for the sports team but in reality a fair present value exchange for forgoing a large short-term contract. (I realize unit specific numbers are just an example.)…

You mean an offer that delivers an equivalent 15Y cost to buying it yourself? There's no return on the investment. If the NHS had any sense they'd in-house finance brokering; try and thumb the scales towards the raw £22.4m instead of the external £30m, by offering 15y bonds, but spending time on putting together internal bids with external finance for tender seems to be frowned upon.

Publicly Funded Infrastructure is a thing for Big projects, but what usually happens is the people asking for the money are so local and desperate that those with the money call the shots. A recently built nearby hospital has it in their PFI contract that they have to repaint the whole hospital with a specific provider every year for 30 years at whatever number they come up with. I'm not sure if the NHS trust even ends up with the buildings. Many school-improvement projects go through PFI and end up with public land being transferred to private interest. "Give us your old buildings and land, and £50m and we'll build you a new shiny one that's further away that you can rent from us forever." It's the budgetary simplicity that sells these awful deals.

Where it's important to draw the distinction between the NHS and the Bobby Bonilla deal is the UK government can generate money for public capital infrastructure through public debt and taxation. When they need money for war, state funerals, or propping up banks, they just do it and we burden the cost. They could say "We need a dozen MRIs in the next few years", raise some tax revenue, make a bulk deal, and actually make the saving the NHS was designed to make. They could in-house road building, centralise a prefabricated school building factory, employ local government services directly.

But public debt is bad and saving up is apparently somehow worse, and in any way competing with private companies [with deep ties to Ministers] is strictly verboten so we're left bouncing between external private providers and PFI.

Even before the corruption, I do understand the scale of the problem insofar as anyone can understand volumes of money that end in "tn". But shying away from it, cowering behind awful deals while losing public assets isn't a solution either.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#106

Earlier quoted context omitted.

I feel you're kinda moving the goal posts here. From "always going to be unaffordable" to "Service will continue to be trimmed until the system collapses"

That's what unaffordable means. If it's unaffordable, you can't maintain it indefinitely. You might maintain it for some time, but inevitably it's going to have its budget cut, which will induce more problems, rinse, repeat.

That's not unaffordable, that's not afforded.

Choosing not to pay for something —when you pay for so much else— isn't the same thing as not being able to afford its upkeep. It's an active decision, not a passive imbalance.

There is a level of healthcare that we cannot afford, but pretending that we're there already when we know privatising elements is going to make it more expensive for everyone is not honest. There are enough variations on the theme to know what works, and that our current system —while starved, and poorly served by central political whimsy— still delivers the best value out of any healthcare system.

As I've said elsewhere, subsidised childcare, after-school programmes, and mental and social health care all network together to keep us working at our best. Not only are they cheaper when centralised, relieving the burden makes people happier. Having to choose between your health and your job is no way to live and this ethos of welfare, having your citizens' backs is a key aspect of high-tax society. Once you stop worrying about poor people with less, life is better.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#107

Earlier quoted context omitted.

What prevents them from accepting an offer that has economics closer to the in-house funding cash flow? I’m not from the UK so please forgive the question. Also, since I’m from the US, your example reminds me of Bobby Bonilla Day, jeered at as an awful deal for the sports team but in reality a fair present value exchange for forgoing a large short-term contract. (I realize unit specific numbers are just an example.)…

You mean an offer that delivers an equivalent 15Y cost to buying it yourself? There's no return on the investment. If the NHS had any sense they'd in-house finance brokering; try and thumb the scales towards the raw £22.4m instead of the external £30m, by offering 15y bonds, but spending time on putting together internal bids with external finance for tender seems to be frowned upon. Publicly Funded Infrastructure is…

Appreciate the response. Hopefully they regain financial aptitude.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#108

Earlier quoted context omitted.

That's what unaffordable means. If it's unaffordable, you can't maintain it indefinitely. You might maintain it for some time, but inevitably it's going to have its budget cut, which will induce more problems, rinse, repeat.

That's not unaffordable , that's not afforded . Choosing not to pay for something —when you pay for so much else— isn't the same thing as not being able to afford its upkeep. It's an active decision, not a passive imbalance. There is a level of healthcare that we cannot afford, but pretending that we're there already when we know privatising elements is going to make it more expensive for everyone is not honest. Ther…

What you're describing is a communist welfare system. Little incentive for individuals to work hard, you'll just increase the number of people totally dependent upon the system. Not sustainable.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#109

Earlier quoted context omitted.

That's not unaffordable , that's not afforded . Choosing not to pay for something —when you pay for so much else— isn't the same thing as not being able to afford its upkeep. It's an active decision, not a passive imbalance. There is a level of healthcare that we cannot afford, but pretending that we're there already when we know privatising elements is going to make it more expensive for everyone is not honest. Ther…

What you're describing is a communist welfare system. Little incentive for individuals to work hard, you'll just increase the number of people totally dependent upon the system. Not sustainable.

I'm not. That's socialism. Investing in public services that make life and society better. It's many key components short of communism.

Re: Palantir Had Secret Plan to Crack UK’s NHS: ‘Buying Our Way In’

#110

Earlier quoted context omitted.

That's not unaffordable , that's not afforded . Choosing not to pay for something —when you pay for so much else— isn't the same thing as not being able to afford its upkeep. It's an active decision, not a passive imbalance. There is a level of healthcare that we cannot afford, but pretending that we're there already when we know privatising elements is going to make it more expensive for everyone is not honest. Ther…

What you're describing is a communist welfare system. Little incentive for individuals to work hard, you'll just increase the number of people totally dependent upon the system. Not sustainable.

If your definition of “communist welfare system” is a handful of services being subsidized than I’m afraid you’re already living in a communist dystopia.
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