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Independence - how would you vote?


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Independence - how would you vote  

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"Rich people don't need prescriptions".

So? If everyone can get them then you don't need to means test, and everyone gets the same treatment that they already pay for in tax. Incidentally, when the snp abolished them, they stated that it was cheaper than keeping them with all the caveats and exemptions.

The tax that people have paid should bear absolutely no relation whatsoever to their entitlement to use state services. General taxation is not an individual "paying for" stuff from the state. It is individuals having a proportion of their income taken away from them so that the state provides services it considers to be necessary and expedient in serving the public interest.

And yes, the SNP said it was cheaper to abolish prescription charges. It wasn't really the whole story though. As has been pointed out several times, the breadth of prescriptions available on the Scottish NHS was less wide than that in England, especially in relation to cancer drugs, as a direct result of that policy decision by the SNP. And you've got to remember that a lot of prescriptions are already free or heavily subsised in England *anyway*. Free prescriptions has meant that more medication is not covered *at all* by the NHS than would otherwise be the case, and it has made it more difficult to part-subsidise other medication that would simply be too expensive to fund in full.

Things should be smaller, leaner, more efficient, simpler, and without all that bureaucracy. But with means testing for everyone and everything. Its a trojan horse, just as we've seen in England.

Perhaps you can direct me to a single individual on the thread that says everything should be means tested? I've explicitly acknowledged that where it is cheaper to provide a service free at the point of use to all than by means testing that you should choose that option instead.

Yes, precisely. And the point I was getting at was that the 'harrumph, moar efficiency' brigade overlaps significantly with the means-testing brigade. How, precisely, is means-testing to be conducted without a vast and invasive bureaucracy?

The way it's already done in countless situations, from dental care, to eye care, to certain welfare benefits, to tax thresholds. Means testing can be done a whole litany of different ways with varying levels of "bureaucracy" and varying levels of efficiency. You're making generalisations that simply aren't supported by the evidence. You're demonstrating certain individual schemes in specific countries not to have worked and extrapolating this towards a universal statement. One which is not correct.

It is jaw-dropping to see the number of people in the UK who want to imitate failed systems from elsewhere in the world solely in the name of ideological purity.

Nothing to do with ideological purity here. I'm more concerned about people who profess ideological purity about universalism while using examples of policies that often aren't universal and which are prejudicial compared to other systems adopted by other countries which do not adopt the same said "universalism" principle.

To be clear, if means testing actually, y'know, worked to save money and increase availability of niche drugs and create a more equitable healthcare environment, I'd be all for it, but it simply does not achieve these things. At all. The only reason to favor means testing is an ideological attachment to it, because it doesn't work.

This isn't true. It's lead to a wider range of cancer drugs being available in England than in Scotland. That's a fact.

In Sweden you are charged £20 to see a doctor.

In Germany your health insurance is more than likely to be issued by your employer.

In France you pay for certain prescriptions, depending on whether the state covers that drug.

Are these healthcare systems evidence that a universal system free at the point of use is *always* better? Or do they get by just fine with their systems and have notable advantages and disadvantages as compared to our own, but which don't make a significant difference to levels of satisfaction with service, health outcomes and equality and so forth? The answer is of course the latter.

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What a lot of Unionist cant. Nobody's protecting the rich, it's cheaper and easier to abolish prescription charges than it is to means test them, it's also better for society as a whole. The idea that the Scottish NHS isn't buying certain drugs because they can't afford them is also utter rubbish. The criteria is "bang for your buck", not "the buck". The same thing happens in England & Wales. You should ask someone with a long term condition whether they think universal free prescriptions is a good idea or a bad one. The Unionist parties exploitation of cancer sufferers for political gain is absolutely disgusting and it's no surprise to see you parroting them.

Why is it better for society as a whole that rich people not have to pay for medicine at the point of use when it is conceivable that them paying for it might lead to more drugs and a wider range of drugs being available to those who need them? Why is your criteria "bang for your buck" rather than just "bank for the buck"?

It isn't "exploiting cancer sufferers" to point out that England has better cancer drug provision than Scotland, to point out that that costs money, and that one of the ways they pay for it is by having modest charges on some prescription drugs. It is an entirely legitimate part of the broader debate about how we best provide services to those that need them.

But someone, somewhere, might Get Something For Nothing that They Don't Deserve.

The so-called 'centrist liberal' mindset is really one of punitive inefficiency if you look at its actual outcomes. It is more important to be ideologically pure than it is to actually formulate working policy that meets its goals effectively and cheaply. A more expensive policy is more desirable if it prevents people from benefitting when a 'centrist liberal' declares that they aren't worthy of benefit.

Read what my posts actually say or f**k off. This is the absolute opposite of what I've said.

I specifically said at the outset that if in a particular case it could be shown that the cost of means testing was greater than the amount saved and it could be shown that the "universal" service had at least as wide access and depth of coverage as a means tested alternative, then the universal service should be the one adopted. Don't fucking lie about what I've said to pursue your own agenda.

My opposition is not to individual universal schemes. My opposition is to the dogma that universalism is necessarily better or an inherently desirable outcome in and of itself, rather than just one of many instrumentally useful means to reach more important targeted objectives that its advocate plead in support of it.

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My mother and her health financial russian roulette doesn't seem great value to be honest.....

http://www.telegraph.co.uk/health/9562066/Bed-blockers-cost-NHS-4-million-a-week.html

It costs the NHS an average £255 to keep a patient in a hospital bed overnight.

I'll grant you, it's the Telegraph and the costs of an overnight stay may be different in Scotland but at the English rate of £7.85 that equates to over thirty-two "free" prescriptions per overnight stay.

Dishing out 32 scripts to keep people from reaching a hospital bed in the first place seems good value to me.

Not to mention the cash saved on SSP as well as worry for both the patient and their families.

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People seem to be under the impression that the choice is either "fund all prescriptions" or "fund no prescriptions". There is a middle-ground, and sometimes it will be more cost-effective and better for healthcare access if some drugs are part-funded, and in some instances it will be cheaper to means test contributions for those that are only part-funded.

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I've never been convinced by the free prescription argument to be honest, and I'm quite happy with the English system. If it really is cheaper to dole it all out for free then fair enough, but the system in England where children, the elderly, those on benefits, those with chronic conditions etc don't pay while others spend a modest fee seems to strike a reasonable balance between bringing money in and protecting those who need help.

ETA: Should say 'certain chronic conditions' before someone pulls me up on it.

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Why is it better for society as a whole that rich people not have to pay for medicine at the point of use when it is conceivable that them paying for it might lead to more drugs and a wider range of drugs being available to those who need them? Why is your criteria "bang for your buck" rather than just "bank for the buck"?

It isn't "exploiting cancer sufferers" to point out that England has better cancer drug provision than Scotland, to point out that that costs money, and that one of the ways they pay for it is by having modest charges on some prescription drugs. It is an entirely legitimate part of the broader debate about how we best provide services to those that need them.

1/It's not my definition of bang for buck, its the NHS's, thank f**k. What the f**k does bank for the buck mean?

2/Please provide proof that England's drug provision is better than Scotland's

3/ Perhaps you haven't noticed but Labour in particular have been exploiting actual cancer patients in their propaganda this year.

Free prescriptions are not a problem compared to the likes of PFI, which alone has left this country £30 Bn in debt and climbing.

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I've never been convinced by the free prescription argument to be honest, and I'm quite happy with the English system. If it really is cheaper to dole it all out for free then fair enough, but the system in England where children, the elderly, those on benefits, those with chronic conditions etc don't pay while others spend a modest fee seems to strike a reasonable balance between bringing money in and protecting those who need help.

Well exactly. This is the point. Certain vulnerable groups and conditions were already exempt from prescription charges. The only case for a *universal* service free at the point of use is if it can be demonstrated in the particular instance that it is less expensive than a form of means testing to provide the same service with an equally good level of access.

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Was paying for prescriptions a big issue before SNP abolished them?  I can't really recall.  It isn't something that high up the agenda for me

It was a big thing for those with long-term illnesses or low wages. Over £7 a pop in England now. Imagine if you needed five or six presriptions a month?

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I think some universal benefits should possibly be means tested(winter fuel allowance being a classic example), but definitely not health related benefits such as free prescriptions.

Ability to pay should never cross someone's mind when considering their healthcare.

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It was a big thing for those with long-term illnesses or low wages. Over £7 a pop in England now. Imagine if you needed five or six presriptions a month?

For £30 you can buy a certificate which covers you for as many prescriptions as you need for 3 months. And if the person is on income support, or suffers from certain long term conditions it's free anyway.

I really don't see what's so bad about it.

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1/It's not my definition of bang for buck, its the NHS's, thank f**k. What the f**k does bank for the buck mean?

2/Please provide proof that England's drug provision is better than Scotland's

3/ Perhaps you haven't noticed but Labour in particular have been exploiting actual cancer patients in their propaganda this year.

Free prescriptions are not a problem compared to the likes of PFI, which alone has left this country £30 Bn in debt and climbing.

1. Why? I'm asking you to justify it. You're the one that brought it up not me.

2. England set up a cancer drugs fund at a cost of approximately £200million a year, which widened access to cancer drugs. It allowed doctors to prescribe drugs not covered by NICE either because they haven't reviewed the merits of its inclusion within NHS England's budget yet or because they have decided that other drugs are more cost or clinically effective or carry less risk. The existence of prescription charges as a source of revenue has helped England to have this fund which enables experimental or supplemental drugs cover under the NHS where individual clinicians can demonstrate a special case justifying the use of a drug not normally covered. This leads to wider access to cancer drugs in England than in Scotland. This information is freely in the public domain and I'd recommend you read what Cancer Research UK have to say about it.

3. Haven't seen this. I don't really listen to Labour in Scotland. Could you provide some examples by way of context?

I don't recall condoning recent governments' use of PFI in healthcare and I don't see why it is relevant to the question about provision of pharmaceutical products on prescription.

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I think some universal benefits should possibly be means tested(winter fuel allowance being a classic example), but definitely not health related benefits such as free prescriptions.

Ability to pay should never cross someone's mind when considering their healthcare.

I agree with the last point entirely, but you should always consider the cost of administering and policing any means tested benefit. Is it really worth employing people, renting premises, buying equipment, etc. for a benefit worth £200 or £300 p.a.?

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People seem to be under the impression that the choice is either "fund all prescriptions" or "fund no prescriptions". There is a middle-ground, and sometimes it will be more cost-effective and better for healthcare access if some drugs are part-funded, and in some instances it will be cheaper to means test contributions for those that are only part-funded.

Do you think the implementation of this would lead to some people who should be taking drugs not taking those drugs?

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Do you think the implementation of this would lead to some people who should be taking drugs not taking those drugs?

It might do. that's one of the trade-offs. I've already mentioned it. The policy of rationing to present a universal service also leads to this outcome though. People that should be taking certain drugs won't be taking them because they're not on the NHS Scotland approved list, there isn't the money there by way of a discretionary fund to acquire them for that specific set of circumstances, and the drugs are unaffordable because they're not even being subsidised to any extent by the state.

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For £30 you can buy a certificate which covers you for as many prescriptions as you need for 3 months. And if the person is on income support, or suffers from certain long term conditions it's free anyway.

I really don't see what's so bad about it.

Yep, what's needed now is implementing the same procedure for doctors' appointments, hospital visits etc: after all, so long as the plebs get a certificate option and selected groups a free ride, who would rightfully complain?

That would be the same slippery slope to part-privatised clusterfuck well underway in England. Good job everyone!

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1. Why? I'm asking you to justify it. You're the one that brought it up not me.

2. England set up a cancer drugs fund at a cost of approximately £200million a year, which widened access to cancer drugs. It allowed doctors to prescribe drugs not covered by NICE either because they haven't reviewed the merits of its inclusion within NHS England's budget yet or because they have decided that other drugs are more cost or clinically effective or carry less risk. The existence of prescription charges as a source of revenue has helped England to have this fund which enables experimental or supplemental drugs cover under the NHS where individual clinicians can demonstrate a special case justifying the use of a drug not normally covered. This leads to wider access to cancer drugs in England than in Scotland. This information is freely in the public domain and I'd recommend you read what Cancer Research UK have to say about it.

3. Haven't seen this. I don't really listen to Labour in Scotland. Could you provide some examples by way of context?

I don't recall condoning recent governments' use of PFI in healthcare and I don't see why it is relevant to the question about provision of pharmaceutical products on prescription.

1/Justify what? NHS England has a comittee that decides whether a drug is effective enough to buy, so does Scotland.

2/ It's not up to me to provide evidence for the statements you make. You know the drill.

3/Not on me phone.

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