UK Health Service Fears Huge Legal Fight Over Unwanted Contracts 127
DMandPenfold writes "The Department of Health is concerned that Fujitsu, CSC and BT would team up against it in a multibillion pound legal fight, should it decide to scrap the disastrous NHS National Program for IT. Fujitsu walked away from a £709 million contract in 2008, and remains locked in legal wrangling with the government over claims for the majority of the value. Today, MPs urged the government to seriously consider abandoning the program and therefore to consider terminating the remaining CSC and BT contracts, worth £3 billion and £1 billion respectively."
related? (Score:3)
I read the summary and "disastrous NHS National Program for IT" reminds me of UK Taxpayers' Money Getting Wasted On IT Spending [slashdot.org].
both sides are to blame here - government agencies are often really bad in project management and contractors are abusing this...
Re:related? (Score:5, Insightful)
This is a different kind of problem. The government generates huge sets of requirements and then gives a contract to a company with a track record of failing to meet the requirements, then acts surprised when the project fails.
The NHS system is particularly irritating, because their current system is a room full of folders containing paper. It would be trivial to deploy a database system to store the more relevant information (although the storage requirements if you want to store x-rays and CT scans get insane) in a way that's easy for doctors to access. The software is only a couple of months work for a single programmer and could be deployed by the existing IT staff. It would then make life easier for everyone involved.
Instead, the government specifies a system with an insane list of requirements for a huge number of unusual use cases, and then wonders why the project fails.
Re:Stupid start to it anyway (Score:4, Informative)
Actually, the worst part is that healthcare IT has very good specifications already. In fact, all the standards needed to implement a system like this with maybe half a million pounds (initial buildout - scaling would of course cost more) exist. HL7, CDA, and multitudes of other specs already solve all the problems with storing EMRs, and there's several solutions already from some big name vendors already to solve the problem (where I work, we use Agfa).
Re:related? (Score:5, Interesting)
Whilst you trivialise the problem to a degree (scalability and reliability of an NHS sized system is not trivial) it still shouldn't take a small team more than a few months, and a budget in the hundreds of thousands of pounds, to build such a system. This could then be incrementally evolved over time on a budget in the hundreds of thousands per annum (maybe low millions depending on speed of development). You do then have the data entry problem to consider, but that is surmountable for a fraction of the budget of these big IT solutions.
However that's not how the government thinks. They want to go all encompassing from day one, speccing out a bloated and unworkable unholy mess that the end user doesn't want or need, and certainly doesn't understand, that takes a budget several orders of magnitude more than is required. Then throughout the project more and more people will hear about it and give their input or point of flaws, causing massive amounts of feature creep and confusion, affecting budgets, delivery time lines, and ultimately the quality of the end product.
As a final anecdote, as a small web agency we once were involved in the build of a website for a London borough. We were in competition with some much bigger agencies, but we went back with a good proposal, some great design concepts, and what we felt was a fair budget. The decision maker loved our whole proposal except for the cost - he actually made us double the cost of the build, simply because that then matched his budget so that it wouldn't be cut the next year (spend it or lose it!) and because it brought it in to line with the bigger agencies (so his managers wouldn't think our offering was less feature rich because it was cheaper). This way of thinking is not unique to the the public sector but is endemic throughout it, and the big suppliers prey upon this.
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(scalability and reliability of an NHS sized system is not trivial)
Depends on what you're doing. I have a friend who works in the medical records department at the local hospital. A lot of her job involves running from one end of the hospital to the other because the doctor needs a specific file in 10 minutes and only just realised. A system where every doctor had a tablet PC of some kind and could call up all of the records in a hospital would be really simple to design and deploy. It wouldn't have to cover the entire NHS, just the one hospital. That's only a few TB
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If one hospital had paid for the development of such a system and specified that they own the copyright on the resulting code, they could have released it under an open license and other hospitals could have used it easily.
Fraid not for so many reasons - each hospital has its own budget, out of which comes everything from drugs purchases to theatre time to IT systems, so you would end up with one hospital spending the money.
Which means that they would want to use it as a profit centre with regard to other hospitals, so they would sell it to other hospitals. Unfortunately, working practices between hospitals (hell, between departments within hospitals) are very different, so the package would have to be heavily customised for
Re:related? (Score:4, Informative)
In current systems, a doctor in a hospital can access basically any patient entered into that hospitals system - but when the audits bring that access up, and it will within the week, you have to be able to justify the access pretty damn well or you will face a disciplinary.
Actually, now would be a damn good time to explain how most UK hospitals work...
During the day, all departments are staffed, with consultants, registrars, Foundation Year 1 and 2's.
At night, most hospitals run "Hospital at Night", where everyone buggers off home aside from half a dozen or so junior grade doctors (consultants and permanent registrars stay on call, but you literally have to call them, training scheme registrars and FY2s get to run the hospital) - who have to cover the entire hospital (aside from A&E and a few very specialist departments).
So, while the hospital may take 400 or more doctors to run during the day, thats reduced to a handful at night - and what that means is that while you may get a doctor who has trained (or is training in) in the department you were admitted to, at night its pot luck.
So that night doctor needs full access to your patient record to treat you, even though they may only ever see you once.
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No need to worry about the tablet being stolen because the tablet is never given the data (outside of screen scrap from the server).
Re:related? (Score:5, Insightful)
I am a senior doctor in the NHS and am one of many trying to unravel some of this unholy mess to work out which bits are workable.
The obvious stuff - own a basic infrastructure, use open standards, manage contracts tightly and locally, encourage a diverse IT culture within and outside hospitals and use competition to drive down price and drive up performance - this just didn't happen. As the parent says - a centralised system specified by obsessive compulsive people who don't touch patients and with an irresistible urge to gold plate everything.
The NHS doesn't even own the N3 network - it rents it off BT.
We are tied down with a vast number of closed systems that will cause untold unhappiness, waste and frustration in years to come - my hospital is about to go live with CERNER, which has a Windows 3.1/ 'visual basic by a first year programmer' look and feel. It takes >30 seconds to authenticate every time you want to do anything (often)! this alone will steal many hours of medical and nursing time waiting.
They as the parent says, the contracts were poorly specified, carved up by the usual management consultancy clowns and their mates, and then just left to fester.
Unfortunately, the people running the whole thing were not equipped with the mental or managerial experience to make it work. There was one head of IT, Richard Grainger, who might have had a chance at doing it properly from the off, but was brought in too late when the carve up had taken place, and ran away as fast as he could. The rest is history.
What they could have done differently?
1. read ' the mythical man month'
2. pay someone to re-engineer VISTA in c++/ c# / java
3. get some people in who are successful doctors, not just the nearest beardy muppet who doesn't want to touch patients any more.
COI: IAANHSD
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I'd be interested it getting involved, as a Haematology SpR and an interest in open-source and open-standards. I imagined the NHS would be the perfect poster-child for an open-source project funded by the government to create a hospital system, possibly running on linux (if not the terminals, then at least the backend), which could then be used possibly by others in developing countries. It would then be modular, and updateable, and wouldn't result in the NHS relying on one piece of proprietary software,
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Electronic referrals from GPs (family doctors) for hospital treatment are in the tens of thousands per day and GP2GP record transfers for people changing doctors are becoming widespread. All NHS sites are
Agreed (Score:2)
digital radiology works, but is generally a standalone system and poorly integrated.
GP to GP transfers - well that would have happened anyway.
Lorenzo is totally dead in the water. Involved in product testing of modules in last 3/12 - doesn't even get to first base. hopelessly broken.
Yes CERNER Millennium works, but is a maladapted dinosaur, with the same evolutionary potential.
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Aside from software issues, one of the major issues the suppliers had was trying to be too helpful; every hospital will insist they are somehow unique and by pandering to every possible requirement the scope of the software build simply exploded.
Vendors do this all the time - since usually it is in their interests to do so. Most contracts are time-and-materials, so the more you shoot yourself in the foot, the more money the vendor makes.
Why would an analyst for the vendor fight some bigwig doctor over the feature they want which will add six months and six million dollars to the project? First, they tick off a stakeholder who is used to getting what they want. Second, they make six million dollars less. Third, they make the project get six mont
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he actually made us double the cost of the build, simply because that then matched his budget so that it wouldn't be cut the next year (spend it or lose it!)
I genuinely feel sorry for anyone having to work within those constraints, and hope the policies contribute to the (relatively) quick death of their organizations. Here's how my company's budgeting works:
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Welcome to the wonderful world of government. While I won't pretend that such things don't happen in corporations, eventually it catches it up to them, as you say. In government, you never have to worry about that. It's a wonderful thing when you don't have to depend on people voluntarily giving you money.
Uh huh... (Score:2)
"t would be trivial to deploy a..."
Almost every time someone says this about an IT problem, that usually means they don't understand the complexity of requirements, and you'll end up spending 10x as much as you think you will.
I'm not defending the integrators in this case (we don't know enough about this project to say who is at fault), but there is rarely a large IT project that can be solved as simply as "throw up a data base and...".
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The point is that a trivial system would address 70% of the needs. A massively complex system would address 100% of the needs. We could cheaply have had the trivial system deployed over a year ago. The complex system is millions of pounds over budget and still not finished.
Which is the better solution?
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Given that these are healthcare-related data with personal identification information, if the 70% covered by the trivial system does not include security, then there's good reason to hold out for the 99.99% solution (no complex system is ever 100%) rather than use the 70% solution in the interim.
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Instead, the government specifies a system with an insane list of requirements for a huge number of unusual use cases, and then wonders why the project fails.
The contractors are at fault - they bought into a project that was obviously going to fail. They could have done the decent thing, and told government that the requirements needed scaling back, but all it takes is one of the competing contractors to say it was doable and they would all fall in line. Of course, the contracts are so badly written that
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Who decides what is relevant or not?
Everything would be recorded anyway, because most doctors are realistic enough to know that they don't (generally) know what is wrong with a patient, but are working to a working hypothesis. So, if that working hypothesis turns out to be wrong and they've discarded the data that didn't conform to their working hypothesis ... then they've got to do it all again. Plus there's serious ri
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The Register had a discussion on this some time ago. Basically, every health board patient record system had evolved to completely different formats for ranging from basic details like names and addresses to additional information pages on medical conditions. Imagine trying to merge 200+ separate and constantly evolving online job application webpages into a single unified webpage format including portfolios and show-reels, then you'd understand what they have to do. Add to that, the standard need for consu
There was a time when... (Score:5, Informative)
Summaries actually summarised the article, and not just reposted the first two paragraphs of it...
(The below is my opinion, not a summary of the article)
Basically, what has happened is that the Great And Wonderful NHS Computerised Records System has been in the doldrums for so long that we have ended up with a situation where every GP (community doctor for those not in the UK, they run their own clinics outside of hospitals) and every hospital has implemented their own computer records system, with the large majority of them incompatible with each other.
The only semblance of the NHS wide system to come to light in a customer facing manner has been the emergency care records, which is a computerised subset of your entire record meant to be accessible to every A&E (ER) department in the country - but they still haven't rolled it out to everyone, and it won't be rolled out to everyone it would seem.
It has gotten to the point where the NHS requirements have changed so much that the contracting companies are now walking away from their contracts because they are being asked to do so much more work under the original commitments.
This whole thing has been collossally mismanaged from the start, the current government just gets the blame for the result...
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The whole NCRS project was doomed from the start; they made the assumption that the best way to make clinical records available across the country was by way of a gigantic central database and the proceeded to design it without consulting any of the users, using smartcards that were obsolete before the project started (so they can't be used for anything else like SSO because nobody supports them anymore) and changing the requirements every couple of weeks. Oh, and there's no fine-grained access control so t
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HL7, CDA, and a national private network. Problem solved. Yes, it'll be expensive - but you don't need to "define" anything because everything you need is defined already.
In case you're wondering, I just described New Zealand's entire health system. The central government holds the demographic record, and your GP holds the medical record. Obtaining that record is a simple matter of requesting it from the GP that holds it, who will then deliver it to you via the national health network and it's received
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There's already a national private network (N3) so we're halfway there.
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HL7, CDA, and a national private network. Problem solved. Yes, it'll be expensive - but you don't need to "define" anything because everything you need is defined already.
I was just thinking the same thing, particularly in response to the posters writing that GPs and hospitals have gone forward with their own computerized system that are now not interoperable.
For those who don't know, HL7 [hl7.org] includes, among other things, an XML schema for health care information. Let each office or organization build their own system--with a list of 'best practices' from the NHS to reduce reinventing the wheel--and use the existing standard for inter-org communications.
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Don't get me started on SSO, my wife changed rotation yesterday, and despite not going outside of the deanery, she still had to submit all the same paperwork yet again, and pick up no less than four usernames and passwords for hospital systems...
Four.
Four, for crying out loud. Without ever having to leave the one building to use them all.
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In the UK a GP is a specialisation - a non-specialised doctor remains a Senior House Officer, or FY2, and can be employed by a hospital as such (they can make great money doing locum work as an FY2). To become a GP after your FY2 year, you have to go through a 3 year training course to specialise in that area, and GPs get paid quite well in the UK, all things considered.
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They also get good hours. Another reason why it appeals
The real question is... (Score:2)
Getting paid for things that don't work. (Score:5, Insightful)
Maybe governments should start writing contracts that only pay up if a usable systems s delivered at the end of it ?
OK know this is a gross oversimplification but at least it would give the people doing the work some decent motivation to make sure it did actually work in the end.
I was brought in as a capacity planner on a former NHS computerization contract about 30 years ago. After 3 months there s was obvious to me that what the were doing, the very silly way they were doing it was not going to ft on the IBM mainframe they had specified to do this.
On pointing this out to them I was told that some very highly paid consultants had said it was going to work and who was I, a lowly contractor, to question their wisdom even though this was the job they brought me in to do.
I was asked to produce some pretty pictures and my contract was not renewed.
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Sure, you can do that if you're willing to pay ten times as much for the work. And write a complete spec that never changes during the course of development.
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For which they'd have to pay an order of magnitude more for, possibly more than just trying multiple times and ditching the failures.
And of course no one is going to sign up for it unless the requirement are written in stone at the start. Good luck with getting that to happen.
I, Pencil: My Family Tree (Score:1)
Once again, this proves anything that needs to get done, gets done, privately (doctors implementing their own electronic database) without the need of government. The government's version is more costly, inadequate, corrupt, full of nepotism and fraud. The private system does what needs to be done without the heavy hand of government, better, cheaper, faster. And all without the threat of force.
This reminds me a lot of the essay I, Pencil: My Family Tree [econlib.org]. Anything that needs to be done can be done bett
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Once again, this proves anything that needs to get done, gets done, privately (doctors implementing their own electronic database) without the need of government.
Except it doesn't do what needs to be done, only the easy part of what needs to be done. It's fine as long as I only fall ill close to home, but if I need to see a doctor when I'm at the other end of the country, well fine, I can see a doctor, but they won't have access to my medical records.
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You're missing the point. When it becomes necessary to have your records moved around like that, and the need outweighs the cost, it will happen naturally by private hands. It is the path of least resistance. Anything else is going to be fulfilling needs that are not needed (unnatural), like the government providing an education to people who are starving to death.
Nobody is going to know the needs of a system like this better than the people who are running and implementing the system not some governme
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Anything else is going to be fulfilling needs that are not needed (unnatural), like the government providing an education to people who are starving to death.
Yeah, fuck those guys!
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You're missing the point. When it becomes necessary to have your records moved around like that, and the need outweighs the cost, it will happen naturally by private hands.
And what would the driver for that be? I have the need, the doctor bears the cost. Sure, the the people who are running and implementing the system know the needs of the system better than some government bureaucrat, but they have no incentive to meet them. Your sort of free-market libertarianism doesn't seem to have an effective mechanism for dealing with negative externalities.
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I'm glad you asked!
Your need is the driver . Believe it or not, your doctor is trying to serve please you. Adding value added services like portable records do this. And draw your business away from doctors who don't implement this technology. If a doctor not implementing the technology loses too many patients they either a) implement the technology or b) go out of business. Both courses are totally natural and not compelled through the use of force.
How many c
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Your need is the driver . Believe it or not, your doctor is trying to serve please you.
I'm sure my doctor is -- she seems to be a nice person. But I'm not sure I would be her choice of charity donation.
Adding value added services like portable records do this. And draw your business away from doctors who don't implement this technology.
My doctor has pretty much all the business she can cope with, and so has no incentive to draw more business. Besides, I would need to know when choosing a GP everywhere that I might visit in the future, to check that they had data sharing with doctors there. Doesn't work.
What sort of strange world do you live in where you trust your life with someone who you don't trust with the money you pay them?
Perhaps you should read the original article, and learn that it relates to the UK, and that I don't (directly) pay my doctor.
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Latest I've seen show indicate that costs are going to go UP significantly with Obamacare.
Of course, part of that is that Obamacare included Medicare cuts as part of the cost-balancing, and the Medicare cuts are unlikely to actually happen (in general, contrary to popular rumour, Medicare cuts in the budget don't happen, because Medicare payouts are low enough now that many doctors won't take Medicare patients) since that would cause even more doct
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The private industry is bad to the extent that the government has fettered the free market. For instance in the U.S., the government prevents the sale of health insurance across state lines. It causes much less competition and drives up prices.
In the healthcare industry the government regulates everything making it difficult to business at all, because of all the bureaucratic red tape a roll of micro-porous tape that you can get at CVS for $1.50 ends up costing $25.00, and who pays for that? Certainly
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Re:Socialism Sucks (Score:5, Insightful)
I'm sorry, but you particular view of the world breaks when people need to work together that have no reason to work together other than that 'The People' would like them to.
Localized private companies don't want to invest money in being able to exchange data with other localized private companies (possibly in a completely different country), since they don't have any use for such a system.
And if you get hit somewhere where the local company doesn't have coverage, and you unfortunately die because you're hyper allergic to penicilline.. Well. That's not their problem, now is it?
That's what you have government for, to have some sort of control over all the little fiefdoms. Although I agree with you that what government tends to do nowadays is far overreaching.
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Name a single example where private individuals failed to step up to the plate and deal with a real problem?
Today, if I change doctors, and I have numerous times, they request information from my last doctor, this system, that has been around for as long as doctors have been around, has yet to fail me. As far as allergies are concerned, people with unusual or extreme allergies carry around a medical bracelet or necklace that describes the allergies. Furthermore, if you cannot be identified because yo
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Pollution.
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99% all solutions for pollution in existence today have come from the labor of private individuals, without being forced to do so by the government. How can you government is superior? Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using? A car that runs on air? What is this thing that the government has that you think private industry is incapable of possessing?
The strictest socialist government in the world is also the world's w
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99% all solutions for pollution in existence today have come from the labor of private individuals,
Citation needed.
Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using?
Strawman.
What is this thing that the government has that you think private industry is incapable of possessing?
Rhetorical question, based on complete ignorance of the reason behind government.
The strictest socialist government
Citation needed that that is China (on multiple levels).
in the world is also the world's worst polluter,
Citation needed.
while most free market companies promote their 'green initiatives' without force from the government.
Citation needed.
Because they think it will help promote their public image which will result in more profit.
Citation needed.
The solution to smog did not jettison as a projectile from a government gun, but though talented engineers in private companies.
Citation needed.
At least with private industry polluting there is recourse if their actions have harmed you.
Citation needed.
Can you say the same about the government?
Rhetorical question, based on complete ignorance of how government works.
Wow, that was fun. You made every factual statement up out of whole cloth, and are ignorant of t
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Since the government in the U.S. does not control or own any industry, it follows that all innovations for any industry come from private industry. I was being kind when I gave the government %1, but I would say the burden of proof is on you to prove the 1%, the 99% is self evident. The DOE does not make anything the EPA does not make anything. If you still need a citation, I'll need to know how you want me to quantify it. I assure you, no matter how you count it, innovation belongs to private indust
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Since the government in the U.S. does not control or own any industry, it follows that all innovations for any industry come from private industry.
Only by a very narrow definition of industry and control. What do you call SEC and EPA regulations?
Are you suggesting that the government has a "magic" power plant does not pollute that private industry is incapable of using?
Do you know what a strawman is? It's an argument that no is making, created for the sole sake of knocking it down. The quote is a strawman, because no one is making the argument you're making.
What does government posses that private individuals do not?
Really? You're asking that question? I'll just put out a really, really obvious example: what's more effective, a private individual shooting at trespassers, or the US Army shooting at trespassers?
I have read more volumes about government than I even care to list here.
Notice I didn't say anyt
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Useless. Just to give an example. One of my customers is a ceramics manufacture, the EPA requires that he have all sorts of licensees to do what he does, among those are two gems that I'll never forget. 1) Silica dust from ceramic manufacture (aka sand) is a n
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Since you clearly can't make coherent arguments on your own, I'll just respond to your valid points.
Voltaire wrote Candide, not Rousseau, my apologies. What you missed though was that Candide is all about the human condition, albeit written in a form a bit less dry than Bastiat. And since the human condition is at the root of ANY discussion about government, it actually is a useful text.
You're also right that Bastiat demonstrates the logical fallacies in Proudhon's ideas. I just happen to agree with some of
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My arguments are perfectly coherent, you just choose to ignore them. If you're bored and have more time I'd love it if you went back and argued some of them, I do enjoy it.
I apologize if you were
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Mmh. Clear arguments. I can actually live with this. Onward...
On Proudhon
While there are certainly socialist tendencies in some of his writings, he is actually closer to a Libertarian or an Anarchist than a Socialist. He explicitly disavows communism and generally rails against against any power source that can cause someone to control someone else. The reason that I find him more coherent than Bastiat is that he correctly understands that the entire concept of property is completely arbitrary. He furthermore understa
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I presume you are American.
Your country has large numbers of people who cannot quit jobs they hate because they need health insurance from a large employer. They cannot consider working for a small business. (This is the experience of someone I know directly.)
Large numbers of your population have no insurance at all.
Your country won't have decent public transport because it's for teh commies. You woul
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I live in the UK and i am no fan of the NHS, its outcomes are some of the worst in the western world and the staff in my experience are rude, unsympathetic and terminal jobsworths.
I now have private medical insurance for my family due to the utter incompetence of the NHS, if I or someone i loved were ill i would genuinely be frightened for their safety being treated in an NHS hospital.
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You present a false dichotomy AND a strawman. In one sentence. Clever. To spell it out for you: Doctors existing does not imply access to doctors. NHS doctors existing does imply access.
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Ignorant AND stupid. Libertarian indeed.
The point that you keep missing - I still don't know if that's deliberate ignorance or not - is that the AC was referring to the fact that without the NHS, he wouldn't have ACCESS to doctors. Something that is very different from doctors not existing, but that has the same impact for him.
I'm sure the next thing you're going to trot out is that it's his own fault that without the NHS, he wouldn't have had the money for a doctor. I mean, infants should be personally res
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You sound to me like a 14 year old. Now you may not be 14, but that is how a 14 year old sounds, not a civilized adult. I will respond to you only in an effort to educate you, but really, there is no reason to be so childish.
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Just because it's kinda funny at this point...
If NHS never existed, a doctor would still save his life
Since the AC was an infant, he couldn't have paid the doctor. Assume for a second that his parents weren't able to pay, either. How does the doctor get paid, in the absence of a government or a corporation subsidizing individual health care? Do doctors work for free? If not enough doctors volunteer to work for free, do you require charity work them to perform charity work?
"only NHS can provide ACCESS to doctors"
Your use of quotes is incorrect. I said " he wouldn't have ACCESS to doctors". I know this
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Ya, that's right, the cooperation most of the time pays the doctor, but the cooperation is the hospital, not even the insurer, and maybe the hospital has to charge more to offer this 'free' service, so be it. I don't think the government needs to get involved though, they can only cause problems.
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Just a few things, since it is getting late:
Ya, but the costs there need to have their decimal points moved to the left one.
Beats me - I based that on the cost of my crown, which was about $800 total, with me paying %50. And that's with Delta Dental. Maybe I need to talk to your employer about a job.
And I don't think Bastiat would throw a sick baby into the wilderness.
Again, I think you don't recall Bastiat as well as you think you do. To wit:
"This question of legal plunder must be settled once and for all, and there are only three ways to settle it:
1. The few plunder the many.
2. Everybody plunders everybody.
3. Nobody plunders anybody."
His conclusion is
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A the end of my blathering there are two quotes from The Law. Bastiat addresses philanthropy specifically in the second quote, and indirectly in the
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Interesting insurance experience. I never had anything remotely resembling that kind of dental plan when I was a contractor. Prices were pretty eyewatering then, and one reason I was happy to switch to salaried.
Government philanthropy.
Very true that Bastiat only talks about government run programs being bad. However, we were talking about Medicaid, a government run philanthropy. Bastiat would have been apoplectic about its existence.
People on welfare
I'm sure you are aware of the argument from anecdote. I personally know one person who is a product
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I'm not sure if you knew this, but dentists are doctors.
Yes I'm guessing unless the private doctors pay you, free will be cheaper. And that's why they have to consult the government. There's a finite number of dentists to fix teeth and whole lot of teeth, so some people need to come before others, old people should go after young people, healthy people are more viable so they should come befo
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The same can be said in reverse. Some leave their jobs to go to a job that has better health care. At least we have a choice. Tell me what your plans are when you find that your health care is poor? And BTW when was the last time you visited a dentist? I pay $150.00/yr for dental insurance through Delta Dental, I pay $20 fo
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You are labouring under the delusion that no private healthcare is available to UK citizens.
Guess what? It is.
In the same way that your country has govenrnment funded education and private education.
Thankyou for bringing up slavery. Abolished in Britain before the United States.
"The entire state of California is easily navigable via public transpiration."
False. I have direct personal experience of this. A half hour walk to a bus stop with one bus per hour is not usable public transport. NB This is *not* fro
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A) Riverside is extremely rural
Rural means farms to people who speak English of any dialect. I have been to Riverside, it is not rural. It has poor public transport. I have seen it myself. Go to any suburb in California and you are stuck on island it is nearly impossible to leave safely without a private car.
What do you mean? Than who is? I'm pretty sure the head of government is the head of state since state and government mean the same thing.
Is it true that you need a link to tell you what Head of Governemnt and Head of State mean?
Not giving you the link, look up the government of Ireland, Germany, Japan, United Kingdom, Netherlands. Commonwealth countries are interestin
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Now, compare this to the number of government's anywhere offering any of this. Draw your own conclusions.
The conclusion I draw is that your insane libertarian fantasy is just that. For all of these wonderful little demonstrations you've quoted, I don't see EHRs rolled out in a standardized fashion anywhere. If you are correct, there should be some evidence of interoperable EHR adoption by now. Got any takers?
The VA (standards based) doesn't talk to Kiaser nor Giesinger nor Mayo nor even the military system. In your wonderful fantasy land I would expect the VA (US Veteran's Administration, government run) t
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The UK government in this situation is (attempting) to fulfill a need of society by commissioning the construction of a piece of 'public infrastructure' that the government deemed the society needed.
Actually, the real problem in the UK is that, because, since WW2, we have alternated between socialist and capitalist governments, we have ended up with an infrastructure that sometimes combines the social conscience of capitalism with the freedom and efficiency of socialism. We have socialist structures that conservative governments hate and want to fail, but can't openly abolish because the voters actually rather like them (and know damned well that even if they were abolished, we'd only see token tax cut
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Rather than experiment with individuals, why not let the natural course of things take place? You seem to agree that the government can only bungle things, so wouldn't it be better if they were to just step back? Government interference in any industry turns that industry from natural order to chaos by substituting the laws of nature with their own versions, causing uncertainty and inefficiency.
I fail to see the value added by having the government do things that the private individual is perfectly capab
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Roads.
Public transport.
Water supply.
Government built the telephone networks originally in this country, then handed the network to a private monopoly in the late 80s. BT was very profitable at that time.
Not sure if any advanced country has an entirely laissez faire education system? (Private primary and secondary schools have a much easier job - they cherry pick clever children and can discipline and eject the real troublemakers.)
Public service broadcasting provides much better news than conglomerates.
BBC r
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I also cannot think of a single example, national defense and courts not withstanding, where the government can do a better job than private industry. In fact, I challenge you to find me a single example..
The NHS provides a reasonable level of healthcare to the *entire* population at a cost per head of about 60% of the US system.
I realize you will not accept this because of your ideology, but it commands a *very* high level of support from the UK population which is why right-wing parties who wish to get el
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I also cannot think of a single example, national defense and courts not withstanding, where the government can do a better job than private industry. In fact, I challenge you to find me a single example..
I patiently await your reply.
Well, according to the WHO [who.int] the USA spends more per capita on its nice capitalist healthcare system (that the right wing parties are fighting so hard to defend) than any other country, including all the free healthcare systems.
Of course, because that money isn't taxes that's fine and dandy, and everybody has the Gawd-given freedom to cross their fingers and hope they don't get ill.
But I guess middle-class Americans do have good teeth.
Oh, and a few years ago, most of the world listened to the ultracapita
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we spend more money and get a better product.
You really did drink the Kool-Aid didn't you? Too much by far. "A better product"? By what metric? So you can get the MRI that you don't need faster? So you live longer (oopsie), so you have better prenatal outcomes (oopsie again), so you have better mental health coverage (damn, lots of oopsies).
The US health care system is an incredible, expensive, inefficient mess. Yes, part of this is the government's fault. Quite a bit of government intervention has come directly from attempting to reign in ille
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I'm not sure what the cause of some of the statistics
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I know, I had cancer, the day I found my lump I was in an MRI.
If we're doing anecdotal evidence, last time I had a MRI (invented at my local University, by the way) on the NHS I waited a whole week - and that was non-urgent (plus I had other scans and tests while I was waiting). If it was suspected cancer it would have been quicker. A relative had bowel cancer and it was successfully removed within a few days. Another relative has a rather neat home kidney machine and truckloads of supplies delivered to their door every fortnight - all without them worrying about wher
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I went ahead and did the news search "USA health care horror" and it did result in some hits, but not a single one talked about a horror story in a US hospital, maybe I missed it and you can point that one out. Even after trying Obama can't seem to find any horror stories about the US health care system [frontpagemag.com] s
Minimum Viable Product (Score:1)
I guess no one in the NHS has heard of the term "Minimum Viable Product". Build the simplest thing that works and provides some value to someone, then iterate and improve from there. As the saying goes, "A complex system that works is invariably found to have evolved from a simple system that worked. A complex system designed from scratch never works and cannot be patched up to make it work. You have to start over, beginning with a working simple system."
Needs an Act of Parliament (Score:1)
Forbidding the Government to make any contract which it cannot terminate within 3 months of announcing its intention to do so.
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No, you just need to set realistic contracts - here are some restrictions that I have been discussing with others around the military contracts debacle, where entire programmes can go through development only to be cancelled prior to the purchasing phase, meaning the development is wasted money that has still been spent.
1. Set a fixed ceiling for contractor-driven budget overruns, something like 115% of original budget. Anything else after that must be covered by the contractor.
2. Require every change to t
Governments do IT very inefficiently (Score:1)
Governments do IT very inefficiently, they are also clueless when outsourcing but they think that they're good at it. Vendors have teams who manage deals all the time and a government agency thinks that it can draw a team together every few years and not get skinned by the vendors. It a bit like the hometown team going up against a bunch of pros.
Internal government IT departments make these vendors attractive because they're monopolies, if the business want to wind down costs that means cutting services, th
NHS didn't know what it wanted. (Score:3, Interesting)
As someone who was involved with the project from early on...
The NHS really didn't know what it wanted, it just knew that it kinda wanted some sort of joined up system, and that it had a massive wodge of cash to spend.
Result? Even when the project was years late, the NHS was STILL delivering requirements.
Add to that entrenched company's refusing to be a part of the project and working against it from the outside (One of the biggest GP software suppliers did this), good old fashioned stupidity, and a reporting structure that was classically backwards, everyone could see it would have issues.
The big suppliers are far more astute than government is. They could see several years down the line that the project would get canned, especially if the Tories got in, so they started building to that conclusion to the project (and turned it into a self-fulfilling prophecy).
One last kick at everyone involved... the GPs themselves. Under the ideas of "privacy", they fought the system wholesale. Despite the system having adequate safeguards in place. The reality is that the system would make it easier to expose bad practice among HCPs, and harder to bury evidence when needed by FOI requests. You can't sell that system to the people who are using it... it would be like making politicians vote for making themselves more transparent. Never going to happen.
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s/health/defence
The UK is once again in the ludicrous situation it was in of having actual government ministers go on TV and tell the country it's cheaper to go ahead and build pointless aircraft carriers than stop the projects right now. We see once again the level of courage they had with the banks - who just announced *bonuses*, not investments or redundancy payments, freaking *bonuses*, of £14bn - paid for by the real workers. Announced co-incidentally the day the Murdochs were publicly grilled, s
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Electronic health record [wikipedia.org]