h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

"Deaf" and "hearing impaired" actually have quite different meanings. A Deaf person uses a sign language as his/her preferred means of communication, while a hearing impaired person relies on speachreading and/or hearing aids. Of course, the boundary between the two groups is not clear cut, but all categories have fuzzy edges.

TRiG.

John Ried on Today Monday at about 8.40 trying to explain how unfair and expensive AV is...quite sad really the way he is trying to do it.

MAK:

I'd be very cautious about 'Most People Think...' statements. They often turn out to mean 'Most of the Kind of People I Mix With...'

Take myself. I profoundly disagree with...well...all the priorities on your list. But I don't think that makes me any kind of peculiar outlier. However, for myself, I'd be very wary of assuming that my views were the default, common sensical position. So should you be.

But I don't think that makes me any kind of peculiar outlier. However, for myself, I'd be very wary of assuming that my views were the default, common sensical position. So should you be.
I wasn't assuming that it would be the same views as mine, some views the same, not neccessarily to the same degree, others different and in some cases significantly different. I think that immigration mostly has been quite positive boosting the general economy and generating revenue for businesses and government that have enabled taxation to be lower and unemployment to be lower than it would otherwise be. I know though that a very large number of people view immigration as bad and inevitably leading to higher unemployment. Most people are much more favourable towards applying trade restrictions on imports and on tariffs, I am in favour of Free Trade and generally in favour of laissez faire. I am much more concerned with strong policing and surveillance than most people and much more sceptical with regard to the benefits of state provision of personal healthcare. I know that a lot of people are under the impression that personal healthcare is the main thing maintaining the health of the nation and generally I think that infrastructure provision and things such as air quality and water quality are of far greater significance and that the NHS mostly is just trying to patch people up and has a drugs budget that is running out of control and needs significant curtailing. I know that there are lots of people who think that limitless amounts of money should be flung at the NHS, I certainly don't assume that people think the same as I do.

A lot of people have given up voting and it tends to be mainly people from more of what at one time would have been described as being right wing Labour views (not that the terms right, left or centre have much meaning outside of 18th century French National Assembly.

"But I don't think that makes me any kind of peculiar outlier. However, for myself, I'd be very wary of assuming that my views were the default, common sensical position. So should you be."
That should have been in quotes.

In fact a lot of the time I am sure that the general prevailing position on many things is not a common sense position. And human beings generally are fundamentally flawed.

>>>. 'I know that a lot of people are under the impression that personal healthcare is the main thing maintaining the health of the nation and generally I think that infrastructure provision and things such as air quality and water quality are of far greater significance and that the NHS mostly is just trying to patch people up and has a drugs budget that is running out of control and needs significant curtailing'

Do you have any scientific evidence that air quality and water quality will improve quality of life more than spending money on treatments?

You can measure things like this using QALYs and talk about the cost of improving quality or length of life for 1 year. It may well be the case that you would get more QALYs by improving infrastructure than by treating certain diseases.

Which water-born diseases concern you? Cholera? - that doesn't have a great impact on the national health. What about which air-born diseases? Asthma perhaps. Do you have evidence that improvement in air quality would improve the lives of people with asthma. Any others?

Would you care to suggest which treatments? Certain expensive chemotherapies for instance?

People will want these whether or not they are available on the NHS. Therefore if they are not available there will be an erosion of the universality of health care and the rich will live longer than the poor. Are you ok with this? If you are that's fine - it's a personal position that I'm not going to argue with. It's not one that I'm ok with personally.

"Do you have any scientific evidence that air quality and water quality will improve quality of life more than spending money on treatments?"
Life expectancy actually dropped during the Industrial Revolution in many areas, huge numbers of people died in epidemics in the Middle Ages, a lot of conditions are largely related to environment, even where there are genetic factors. People getting insufficient amount of calories or too much in the way of calories, or insufficient vitamins or minerals, people eating or drinking too much, stress caused by high frequency low level crimes.

Certainly medical staff in the main do their best, but there are also issues of side affects of drugs unknown at the time that later turn up. SSRIs at one time were said not to cause personality problems, over time it has become admitted that they do, drugs such as thalidomide, huge levels of addiction to various painkillers and tranquilisers and people trading in prescription drugs. The hugely rising drugs budget and falling productivity in the NHS. The fact is that generally something causing a problem will go on tending to cause problems unless the root cause is addressed and most of the treatments are dealing with the effects rather than the cause. I rather think it encourages people to rely on the NHS rather than trying to think things out for themselves.

The concept of mental illness when by definition it must relate to something physical, that diagnosis relies on physical signs in the main, that people may come to believe they have something they don't - there have been studies where people have as part of the study been required to present with symptoms that would get them diagnosed with a particular psychiatric condition and then after academics conducting the studies have had great difficulty getting them released, frequently it is then assumed they have the condition because they have previously been diagnosed with it and it's on their records.

>>The concept of mental illness when by definition it must relate to something physical, that diagnosis relies on physical signs in the main, that people may come to believe they have something they don't - there have been studies where people have as part of the study been required to present with symptoms that would get them diagnosed with a particular psychiatric condition and then after academics conducting the studies have had great difficulty getting them released, frequently it is then assumed they have the condition because they have previously been diagnosed with it and it's on their records.

Well I believe it was *a* study, rather than ~studies~...and not really a study in the commonly accepted scientific sense of the word at that.

Agreed, though, that this observation gives cause for concern. What it hinted at (but didnt conclusively demonstrate) is that some people might be misdiagnosed *for the particular illness impersonated*, and possibly that diagnostic criteria for that illness should be revisited. What it did not show is that that illness does not exist. And it most absolutely, definitely didnt show that all mental illness either is misdiagnosed or doesnt exist. I doubt that's what the study authors would claim, either.

I will grant that mental illness is difficult to diagnose. But what is the Real World impact of this? Its not, in fact, well people being banged up against their will. Get real! Psychiatric beds are scare and patients have to present a severe threat to their own or others wellbeing before they are admitted. The impact is - and health professionals will readily admit this - that patients are too often either undiagnosed or misdiagnosed with one rather than another illness. Typically, a person with a psychiatric disorder will have to wait for many years to get a sound diagnosis and to receive appropriate treatment.

There are *tons* of studies to back this up. All of them point to a huge problem which, Im afraid, requires a greater injection of money than weve been prepared to make hitherto.

"All of them point to a huge problem which, Im afraid, requires a greater injection of money than weve been prepared to make hitherto."
8% of GDP is a lot to spend on one area of spending, it's the 2nd highest area of public spending in the UK after Welfare. The budget on the NHS is double what it was as a proportion of GDP at it's low in the 1950s, it's higher than spending on Defence, Police, Courts and Prisons put together.

I'm not saying that illnesses don't exist, rather that their detection needs to be evidence based, especially where public money is being spent and very powerful drugs are prescribed.

There is also the problem that the rate of technological development can exceed the capacity of the NHS to fund it, implications for the tax burden and for the budget deficit and the effect on other departmental budgets have to be taken into account.

In fact in comparison the arguments over the difference in costs of AV and the existing system even using the figures given by the No campaign are tiny in comparison with a fraction of NHS spending.

The argument that changing the voting system will mean expensive voting machines is bizzare, David Cameron arguing that everywhere where the voting system was changed that machines were introduced and then pointing out that the US as part of it's system FPTP (of course it is filtered using primaries and for Presidential elections there is the Electoral College system so better or worse it's not the same), but of course he failed to mention that US States use voting machines in the main now.

It has to be said that David Cameron had some valid points about John Humphrys argument regarding how preferences are redistributed, either John Humphrys didn't realise that people voting for the party that wins or the one that comes second or others only eliminated on a party reaching 50% that the lower preferences then aren't counted, as well as of course that he and others seem to have failed to pickup on the fact that voting machines are just becoming more common generally regardless of the voting system. Obviously some people end up not voting for someone elected whatever the system, in direct referendums some win and some lose, whatever the system some peoples votes will end up not affecting the result.

8% of GDP on psychiatric medicine? I think not. Which is what I was talking about.

OK - so *you* were talking about medicine in general which, you suggest, can slash its budgets through better water, cleaner air...etc. Actually, youre probably right. Id add a few more to that. Nutrition. Housing. All the unhelpful lifestyle choices that go with inequality. And the whole general malaise of C21st capitalism.

Weeeellllll....if you want to tackle health spending by tackling some of the root causes, Im kind of with you. But *until* weve fixed Society, I guess well have to put up with an expensive sticking plaster.

*But not that expensive*. Not comparatively speaking. Compared with other high per capita GDP countries, we're at the lower end. http://en.wikipedia.org/wiki/Health_care_system#Cross-country_comparisons (US is the outlier: their healthcare providers have been ripping them off and theyve been paying through the nose for the privilege).

But how to interpret that data? One theory would be that these countries are doing well despite the burden of their high spending. Another would be that they're doing well *because* of their high spending. Healthier people = higher GDP. (Obvious, when you think about it: what's the productive capacity of a Malawian AIDS sufferer?) There's a similar equation for education: Teaching is a profit-generating activity (Who generates more money? PhD technologists or illiterate labourers?.)

8% of GDP on the NHS, if they raise one thing then the money for it has to come from somewhere either through cutting something else or increasing total spending.

>>8% of GDP on the NHS, if they raise one thing then the money for it has to come from somewhere either through cutting something else or increasing total spending.

Nuh-uh. Thats just plain, bad economics.

The fiscal* equation, like all good equation, has two sides. Obviously you can spend more money if you raise more in taxation and/or borrowing. With taxation, to some extent you can simply do it...well...just by doing it. Or you can do it by Progressive taxation, e.g. redistributive taxation. Similarly with borrowing. You can just borrow - although eventually you find the vigs a killer.

But you have to look a bit wider than strict fiscal matters and consider the wider economy. If youre smart you tax and borrow for investment, which yields growth. Growth sorts out a lot of things: with growth, our lives continue to improve; without growth we get out-competed.

So where does NHS spending fit in? Well...here you have to look wider than fiscal matters. The Conventional Wisdom (I use that phrase advisedly ) is that its A Drain on Resources. It isnt, of course. If we didnt have it, wed soon find ourselves in a right economic pickle. Think of it as an investment in our continued productive capacity. Looking around at the countries we want to be like - 8% of GDP looks about right. Certainly not egregiously high. Bit on the low side, maybe.

But




I trust we all know that fiscal is not interchangeable with financial, economic, etc. etc.?

There are countries with a variety of systems around the world, the US had massive growth in the 20th century and yet the system they use in healthcare is pretty much just a subsidy scheme for private medical companies. People also privately spend vast sums of money, so far as unneccessary treatment goes it is one of the worst. They spend less than the UK these days on publicly funded personal healthcare, but up until the 1990s the UK spent less than the US in public funding on it and got far more out of it.

New Zealand has a part publicly funded system with 30% of costs having to be funded privately and it is reckoned to be the most cost efficient public healthcare system in the world. It's easy to get caught up in the assumption that it is mainly a matter of more money, apart from anything else there are means of raising revenue through commercialisation and cross subsidising vulnerable groups, there is the importance of encouraging people to try and sort things out themselves, in a lot of cases people have problems, but not ones that are medically related.

The richest countries in the world mostly are ones rich in natural resources, where investment in R&D (including military R&D) is high and entrepreneurial activity is encouraged, if the NHS developed and patented it's own drugs the amounts paid to the drugs companies would be hugely lower. Transport needs to be a priority and crime, ambulances have to get where they are going, as to the police, a lot of NHS spending is going on treating people injured in disorder in town centres.

A Vote No card just arrived, so far as I was aware the thing that people in Australia wanted to get rid of was the requirement to list all candidates in order and compulsory voting. Australia has actually had fewer coalitions than the UK and in fact were less hung than the UK was last year. Australia mostly is held up by the Conservatives as a shining example of libertarianism and laissez faire economics among the 10 most wealthy countries in the world; Fiji mostly seems to be doing well. A lot of the people of the world don't eat marmite and that's a great shame. In how much of the world does the head of state grant assent to legislation in Norman French?

>> A lot of the people of the world don't eat marmite and that's a great shame.

There's vegemite, as well..

>>A lot of people have given up voting <<


Why might this be?

I know why *I* don't often vote ..
That would be because I don't agree with either Labour OR Conservative, and most of the time my vote seems a waste of time, as it seems to be one or the other gaining power ..

I will be voting for AV on thursday .. if it's good enough for the politicians (to use in their internal elections), it's good enough for me!

A rather nice illustration of why AV is actually more straightforward than FPTP from the point of view of the voter....

http://yfrog.com/z/h8tmhp

A few people havep osted in this thread that perhaps a "No" vote is better because AV isn't the right reform and a better one owuld be preferable. I am not being facetious here, this is something I honestly don't get and owuld love to have it spelled out to me.

How exactly is a "No" vote going to bring about the possibility of some better reform? What is the mechanism?

For me a "No" vote would be seen by the Tories as the end of the debate. And the Labour "No" campaign would for at least a couple of generations use the "No" vote as an argument that people had spoken against reform (even if in reality they had only spoken against AV) and would use this to ensure that Labour were against any further and better reform.

If the two biggest political tribes were out of pure selfish self interest likely to block meaningful reform (and I am certain this is how a "no" vote will be used). I just cannot see how a "no" helps us move to a better andm ore inclusive politics. I'm a member of the Labour Party but I think our two party oligarchy is dangerous and corrosive for politics and political discourse.

So simply how does a "No" vote help anyone who wants a better politics?

FB

Well my view is AV changes nothing, perhaps introducing a slight bias towards the centre left, but certainly not a move towards true PR.

I think that Labour are facing electoral oblivion. Scottish independence looks worryingly possible and this will remove a raft of safe labour seats at a stroke. In England, changes to constituencies and numbers of MPs will also hamper Labour. Under FPTP, it is said by such people as Jack Straw that Labour will never win another election. The only route available for Labour in that case is electoral reform. PR especially would help Labour.

To force a dominant Tory party into another referendum will take a massive effort and the type of campaign only a major party like Labour could undertake.

A yes vote to AV will only offer Labour the false hope of future success.
A no vote means they have to pursue electoral reform.

Imo