mirage

Bingo, sadly.

Agree entirely. (Of course effectiveness is a very subjective minefield though - who are we to decide that disabled lives are worth less than others?) Also, health care at the US top end can actually be worse than our middle. Michael Jackson being an extreme example.

Sorry, misread you. OK, so in that case everything I said apart from that confusion still applies. And what Dorkins said too. So why don't you address that point, that a higher maximum sum paid for QALYs doesn't tell you about efficiency without more information? [bTW, a QALY still isn't a monetary sum, however you phrase it. It's a year, a health-adjusted time interval. So while you are addressing the main point, why don't you just keep that clear to minimise confusion? ]

In any case, what are you on about here? Assuming you are actually talking about sums paid per QALY, is it a threshold or an average? You seem confused. You definitely described it as a threshold before. If it is an average, then by definition and your numbers the Dutch system must achieve fewer QALYs than us. Confused.

No it isn't. It is a quality adjusted life year. It is not how much you may or may not spend to achieve a QALY. It is not a pyament threshold. It is a measure of years of life, like your age, but adjusted for health. So you are wrong again. Don't give up though.

Yep. And regulations that don't allow import of cheaper drugs from abroad. And the way Medicare and Medicaid are structured and lots of other things, not least the barriers to entry. Then you have other fundamental problems with private provision of health care, such as information asymmetry and the agent problem - in other words the doctor is economically motivated to get you to pay a lot, not to benefit your health.

Anyway, what do you mean here? I didn't imply that the US was "full free market" in that post, did I?

OK Paying more for a QALY could either represent having more free resources because of efficiencies elsewhere or... Needing to spend more per life year because you are inefficient, whilst delivering fewer of those life years to the population. Like Dorkins said, you need to compare cost and QALY effectiveness of specific interventions and look at how many QALYs are actually being produced.

And yet you refered to it as a monetary value that represented the maximum paid per life saved. So you understood but just expressed yourself poorly, I'll assume. You are thinking about it too simplistically. Your conclusion about Holland may be true, but it doesn't follow from those numbers.

The US system is conventionally refereed to as a free market but is in fact a corrupt cartel, ie a poorly functioning market.

No you have made a mistake. The Dutch system could be more OR less efficient with those numbers. Dorkin is right.

So what? It is a transacting organisation in the economy. Any special features you choose to pick out have to have some relevance to the accounting argument you are trying to make. This has no relevance. "Controls the means of exchange" indeed! So what? So what? Really? And what about other companies that rely in turn on them? Where do you draw the line? You don't know. Net out tax consistently over the economy or don't bother. If you net out tax for doctors but not for Coke employees, then at least account for the benefit of not paying any tax for the doctors. I didn't claim anything of the sort. Reading comprehension.

All of which is irrelevant to the question of revenues. Credit creation is not a revenue. Interest payments are. It makes no difference to my point. All you are pissed off about really is control of money supply and profit skimming by the financial sector. Fair enough, but not the point here.

Not necessarily. Care is extortionate in the US, regardless of taxes paid for Medicade etc. It is expensive there because it is a constrained and poorly functioning joke of a market. It is expensive here because demand is from the richer patients who want a premium service and supply is constrained by the state. I don't really know how expensive it might be if we went full free market here. Would be interesting to see. There would be inefficiencies relative to the current model and also efficiencies. You could loosen up medical school numbers and add some supply there, but most of the wage bills are from non-doctors and recruiting them hasn't always been easy despite no such BMA imposed training limits.

QALY It is an attempted quantification of life in units of a year of life in perfect health. Where health is less than perfect a scale is used to reduce the QALY per year of life. An life saved in perfect health is not therefore one QALY, unless the patient only lives a year afterwards. Nor is a QALY the maximum the NHS will pay. The QALY is the year. The maximum the NHS will pay per QALY added is a separate matter. So I presume you are saying that the Netherlands will pay up to twice the NHS per QALY, on only a 20-30% greater budget per capita. I don't know if this is true, or how comparable the data are. The interesting thing here is that paying more per QALY could represent either greater efficiency in a health service, or less efficiency. You would obviously have to know how many QALY's were actually bought, wouldn't you, along with differences in patient populations.

Brilliant logic. It's true that you can just net out the tax paid back by public sector employees. And as I pointed out earlier it is true in the same sense that Coke doesn't pay an employee the gross salary, it just pays net and then pays the government some tax. so no one really gets paid what they get paid. "But Coke isn't funded directly by the government" So what? It's still true by the same (pointless) logic. What you forgot is that if the state employee doesn't really earn the gross salary, then what they "really" earn is the net 18k PLUS THE BENEFIT OF NOT HAVING TO PAY INCOME TAX. Which, er, adds up to their gross salary. So your point about the gross figure being merely a psychological sop is pretty wrong, isn't it? Do you just mean that you think they are overpaid by the state? Well so do I. All transactions in the economy net to zero so by this schoolboy error of an argument no one "really" gets paid anything since they just got it off someone else. Divide any closed economy into private and public sectors and each by definition entirely fund the other. Oh but only the private sector generates wealth? Not true in fact or principle, since you can make an entire economy public and generate at least some wealth. The crown estate generates lots of wealth. So again, you are only complaining about efficiency and value. You are annoyed at the waste of the state. Why not just focus on that?

This is a thinking error a bit like not being able to see the symmetry between public and private sector revenue. How would converting any set of salaries quoted in a single currency into any other currency at any exchange rate change the relative positions of those salaries? Further, since I presume you are really trying to get at relative purchasing power changes since then, the pound was stronger then than now, so in real terms GPs should have got relatively cheaper than then, all other things being equal.

And the only source of the private sector's money is the public sector, by those very same arguments. If you have a problem with the state, and there are many legitimate ones to air, then don't you think it is better to talk about those problems directly rather than making sophistic accounting points?

I fail to see the distinction you are trying to make. No one pays tax in net terms. Why not just pay everyone net? Why not have Coca Coca issue net pay slips with a big banner across the top saying "This is your real salary - don't think you pay any tax really"? Since after all it is really Coke that pays their tax for them. This is entirely analogous to the State funded NHS paying employees tax for them. Or for private companies that live on public sector contracts paying their tax. The state is just another organisation in the economy. Clearly there are arguments against some of its operations in terms of monopoly, compulsion and efficiency. But trying to advance those arguments by trying to impose a non-existent accounting distinction on some payslips and not others isn't going to help.

And how widely those figures seem to vary. On this very thread where Si1 quoted a mid-2000s Belgium GP at 20k. I would like to see what they get to charge for in those other countries, though I think that US and UK medics, particularly GPs are overpaid relative to optimum market rates.

Luckily all this will become moot long before most doctors retire.

And since all public sector net remuneration is ultimately recycled through the private sector, then that doesn't actually generate any wealth either. According to this variety of schoolboy logic at least.

Actually, what is the financial position of that pension. I've heard that it is more than funded by the contributions at present (yes of course it all comes from the taxpayer). I presume there is no "pot" of investments, but what is the projected inflow and outflow?

Engine starting being a good thing to do when a ship has sunk beneath the waves. Good analogy, Jon.

I'm sure that's true - rather like the US and UK in that regard. What I find odd though is that this debt expansion seems to be seen as a failure in terms of its immediate results in that Japan is tarred with the deflation brush. In fact, it seems to have maintained its position in the global GDP rankings. So what I don't see is what specifically is so bad about Japanese style deflation, ignoring the storing up of the debt problem for now.