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Oh goodie. A nice simple one 🙂
Sure, more money could pay for more stuff. However, would it make it leaner, quicker, more efficient?
It's a pretty well know statistic that asprin (for example) costs the NHS 20 times more than it costs to buy at tesco. #facepalm
I'm not suggesting that we privatise healthcare but there are obviously things that the NHS can learn from industry. They should be incentivised to do that IMHO.
If it was my money, I would suggest taking a step back and targeting more of the extra funding at education (which I also think needs a radical rethink). Surely, it is the building block of our whole society. Get that right and we save billions from NHS through avoided costs, have more doctors and we win all round.
This however is a long term fix and governments only last a few years so this is unlikely to fit their agendas. Oh well, as we were..
If we are discussing whether VAT is progressive or regressive - then are we agreed that the NHS needs significantly more money and this needs to come from taxation?
I'm not sure why the non-expert nhs bashing experts always default to the 'not until it's sorted and more efficient' line. Is it not possible to imagine that both increased finance and increased efficiency in parallel is not an option? It would be naive to both believe the NHS is the last word in spending wisely but also that it would be possible to eradicate waste in any large organisation.
So yes, I'd be up for increasing our taxation if it went to the NHS. But then also an advocate about looking for improvements, educating the public about what is realistic and putting some pressure on those bring poor health upon themselves to sort their lives out.
all pay heavily on VAT
Erm...at 20%? = the lowest rate of Income tax.
A few zero rated categories means it's barely progressive - uselessly so in fact - when combined with the above.
PFI removes the procurement shambles of NHS building projects + they get maintained and will be in very good condition at the end of the concession compared to most NHS estates which are backlog maintenance disasters
A few zero rated categories means it’s barely progressive – uselessly so in fact – when combined with the above.
Has to be seen in association with additional taxes though - eg, petrol/diesel, alcohol, tobacco, sugary drinks etc - all of which punish less healthy options
The NHS doesn’t spend 20 times more on Aspirin than Tesco. ‘Well known statistics’!
The Daily Mail says it does and it’s all immigrants fault.
Erm…at 20%? = the lowest rate of Income tax.
Currently it is 20%, that could be changed. I was talking about VAT as a model of taxation.
Also as VAT is taken after income tax it which is progressive it gains income taxes progressive status.
A few zero rates is a bit disingenuous. Mortgage? Rent? Food? Then Gas/Electricity on a low rate. That means someone living on the breadline pays virtually no VAT.
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ade9933 wrote,
It’s a pretty well know statistic that asprin (for example) costs the NHS 20 times more than it costs to buy at tesco. #facepalm
</div>
It may be well known, but it's also horseflops. Just completely made up. They arrived at that statistic by dividing the average cost of all prescriptions by the cost of asprin at tesco.
The actual average costto the NHS of a prescription for asprin is £1.28 per prescription for aspirin, compared to 30p in Tesco. But that's still not a correct comparison, because a 30p packet of asprin is 16 tablets, but a prescription can be for larger amounts, and often will be because people who're prescribed it, like my dad, will be taking it for the long term.
Cocodamol is another one that they do this with- the average cost of a prescription of cocodamol is £5.59, whereas cocodamol is usually about £2.50 a packet in a chemists. But that's 500/8 strength whereas prescription strength goes up to 500/30 so each tablet can contain 4 times as much codeine. And that's 32 tablets whereas my prescription was for IIRC 200 tablets.
It’s a pretty well know statistic that asprin (for example) costs the NHS 20 times more than it costs to buy at tesco. #facepalm
Daily mail nonsense.
NHS Category M prices for 32x Aspirin 300mg dispersible tablets is 93 pence - Category M Prices - update for 1 August 2017 - NHSBSA
Online price 59 pence - https://www.theindependentpharmacy.co.uk/pain/aspirin
Prescription fee charge is £8.80 at item.
Not read the whole thread but just the OP
1) if they got rid of all the unneeded bureaucracy in the english system they could cut admin cost by 60%+ as in Scotland - no internal market, no purchaser / provider split, no expensive privatisations, no commissioning groups. That would free up around 12% of the NHS budget - yes thats right - admin costs in England are around ~20%, Scotland under 10% of total NHS costs
2) Private healthcare does not and cannot replicate the NHS and also leaches off the NHS by stealing the staff expensively educated / trained at the nations expense.
PFI removes the procurement shambles of NHS building projects + they get maintained and will be in very good condition at the end of the concession compared to most NHS estates which are backlog maintenance disasters
Utter utter nonsense.
PFI is a hugely bad deal where costs are hugely higher like 10 - 20 times the actual cost of the same building directly built and the buildings are shoddy, poorly built and barely fit for purpose. I have worked in PFI units and still do. Its very bad value for poorly built buildings.
Final point - the NHS is one of if not the most efficient healthcare service in the world providing more care for less money. Want the best american levels of care for all the UK population? double the NHS budget and it still would be less than the US spends to give good healthcare for a few and minimal for many.
Quite how we differentiate between deserving and undeserving is an interesting topic but it really needs addressing, we can’t go on paying at this rate for self inflicted issues.
I do hope you never ever fall off your bike, or have an at fault car accident.
I get what you’re saying re: lifestyle to a degree, but you’re also assuming that everyone is a “normal” person. One of the main reasons why people lead unhealthy lifestyles is stress and the mental health issues this causes. I’d happily pay a lot more than $100 if it was to address this.
I’m not suggesting that we privatise healthcare but there are obviously things that the NHS can learn from industry. They should be incentivised to do that IMHO.
Like how to spend more on bureaucracy than they do currently?
And as for PFI, one word: Carillion.
Like how to spend more on bureaucracy than they do currently?
And as for PFI, one word: Carillion.
Are you suggesting that the Carrillion situation was not created by government tampering and forcing a race to the bottom?
...and ok maybe the 20% stat was not spot on but are you really suggesting that NHS has nothing to learn from profitable, lean, customer-centric organisations with well motivated staff and happy customers? (not carrilion!)
NHS has nothing to learn from profitable, lean, customer-centric organisations with well motivated staff and happy customers? (not carrilion!)
It has stuff to learn yes but as it can't choose it customers, stop providing services to non-profitable customers etc,. then it is not the same.
<p style="line-height: 16.8pt; background: #EEEEEE; margin: 7.5pt 0cm 7.5pt 0cm;"><span style="font-family: 'Open Sans',serif; color: #222222;">[Utter utter nonsense.</span></p>
<p style="line-height: 16.8pt; background: #EEEEEE; box-sizing: border-box; font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial; word-spacing: 0px; margin: 7.5pt 0cm 7.5pt 0cm;"><span style="font-family: 'Open Sans',serif; color: #222222;">PFI is a hugely bad deal where costs are hugely higher like 10 – 20 times the actual cost of the same building directly built and the buildings are shoddy, poorly built and barely fit for purpose. I have worked in PFI units and still do. Its very bad value for poorly built buildings]</span></p>
Whilst you clearly care deeply about the NHS as do most people, I would respectively point out that your view is based upon a remarkably small sample and from a narrow perspective
The stats that you have regurgitated are the same nonsense stats that have been endlessly repeated unquestioningly that for large sections of society they have become the orthodox view.
They are based on articles written by politically motivated individuals, which choose to ignore issue like the end state of the buildings or compare services on a like for like basis. They are at best disingenuous but most likely poorly written and researched.
Regarding NHS buildings I would suggest that you research the topic thoroughly, those that have been developed by and operated by the NHS are and always have been beset by huge backlog maintenance issues.
Whilst you clearly care deeply about the NHS as do most people, I would respectively point out that your operational view is based upon a remarkably small sample and from a narrow perspective
PFI removes the procurement shambles of NHS building projects + they get maintained and will be in very good condition at the end of the concession compared to most NHS estates which are backlog maintenance disasters
Yeah maintenance is so good that you get pigeons in operating theatres and the PFI Company will cut the power in the middle of surgery because they have planned maintenance but never bothered talking to the NHS about it.
I think there is a place for PFI. I don't think hospitals are it.
Grumpysculler - is that’s true then there are a couple of important points
failure by the operator would cost them dearly the penalties would be punitive
the theatre would be declared unavailable and the payment deductions would be huge! + unavailability would be weighted to include the associated areas + ratchet up depending on the unavailability period
there would be deductions for reporting and planning failures
failure by the NHS to administer the contract
Pigeons could be from lots of sources including mall use of the facilities by the NHS staff...
t1000
How dare you patronise me.
You accuse me of swallowing propaganda - its you that has swallowed the tory playbook and accepted it as true.
PFI will always cost more - private companies have to borrow money at higher rates than governments and also pay profits to shareholders. Thats costs the NHS does not have.
the only reason for PFI is to keep borrowing of the government balance sheets and to enrich private companies who then bribe ( employ as non execs() the politicians who administer the contracts. Its about taking from the general taxpayer and giving to the rich and the tories
It is 100% true that PFI buildings are poorly built designed and maintained and hugely more expensive than directly owned and maintained - its designed that way. ERI by the end of the contract will have cost 20 times what the buyilding is worth and then the NHS will still not own the building.,
Sorry dude. I prefer folk with real knowledge and experience to those who swallow right wing dogma and treat it is fact. You know - folklike the kings fund or even what I can see with my own eyes.
I suggest you op-en your eyes to something other than a far right viewpoint and actually accept some of us know far more about the NHS and the problems of PFI Read the kings fund reports
Or red some of the academic analysis. I have read both
This article analyses the cost of using private finance to build hospitals under the UK government's Private Finance Initiative (PFI). Hospital trusts' annual payments to their private sector partners are higher than expected and are taking 11% of their budget. The additional cost of private over public finance for the first 12 hospitals is about £60M a year, which is 20–25% of the trusts' income. PFI charges create budget inflexibilities and are increasing the pressure on the NHS to cut their largest cost: the jobs, working conditions and pay of their staff.
https://www.tandfonline.com/doi/abs/10.1111/j.1467-9302.2008.00628.x?src=recsys
LOL, I’ve not had such a good laugh in a long time as when I saw your response….
What next are you going to double dare me… your outrage at being proved a fraud was predictable. As normal your response is indignation at being shown to be ill informed
The main problem is that you’re an ideological oozlum bird
Sorry if calling out your lack of knowledge and pointing out your experience is both miniscule and irrelevant upsets you. You have a long of history at being proven wrong on this forum and of serial regurgitation of headlines without substance.
As normal your response is to hurl ideological insults which are as inaccurate and poorly informed as the rest of your twaddle.
So working in one NHS hospital qualifies you to comment about PFI and the built environment …… PFI is not just healthcare….. The range of projects are very diverse…. I know you like to focus on your own little world but even within that your knowledge and experience is infinitesimally small.
BTW
You have one minor good point and that’s about the ownership of the Edinburgh Royal Infirmary … the ownership end state Edinburgh Royal Infirmary is an indictment on NHS Scotland… they ran the procurement process decided the contract form…. If you want to put anyone in the dock for that then its poor performing NHS staff which is the root cause…
Suffice to say your link was to an article with a narrow focus which did not compare like for like services, scope, risk etc. I could provide you with endless links from well-respected organisations but… it’s pointless as ever you are slavishly blinded by ideology.
I could embark on an extensive explanation however I don’t think it’s possible to dumb it down enough for you….
I can’t be bothered to respond further to your twaddle so I’ll leave the stage to you so that you can respond with more ideological bile and frantic googling.
I'm happy to contribute more the NHS but yes there does need to be conditions such as independent reviews into cutting waste (I'm sure the NHS already does a lot in this area and likely is nowhere near the public perception in terms of inefficiency but I'm also pretty sure a lot more could be done).
I also think it should be linked to making it legal for voluntary euthanasia, sure we have a problem with an ageing population putting more strain on NHS services/other public services but really how many of them want to be alive and sustained by a cocktail of expensive drugs? I'd certainly rather be dead than shoved in a care home and not able to remember my own name or be in constant pain whilst being cared for by whoever does it cheapest. I wouldn't even want to be in an expensive private care home if I had debilitating medical conditions and knew it was only going to get worse.
Genuine question for T1000,
Any good example of pfi working well ?
Some interesting points raised.
My own thoughts are that I actually would be reluctant to pay £100 extra per month, but believe we should, and on a flat rate basis (not means tested) A lot of Scandinavian countries have started doing this and its has apparently been beneficial.
If we give funding to the NHS it will continue to be spent and the over spend will continue so next year your £100 will be £120 etc etc.
We need as a nation to start talking more about death and quality of life. We can keep babies alive (but not living) that would have died 10 years ago at a cost of £1,000's per day and they will die within a few months. At the other end we keep the elderly living longer but with multiple comorbidities. Whats the fun in that?
Re PFI -This raises another issue. At one point in time NHS Trusts would have underspent and therefore be able to invest in capital programmes, the cash simply isn't there anymore so buildings are not fit for purpose, services can not expand. I have yet to hear of one PFI contract that has been good value for the NHS.
If you want to put anyone in the dock for that then its poor performing NHS staff which is the root cause…
Are you not contradicting your own view? In essence you are saying the private companies have fleeced the NHS. I was not that close to PFI's when they were awarded, however I do know that at a local level commissioners were forced to offer PFI's and the tender process meant that a tender had to be awarded even if it was know it would cost the NHS.
Time and time again I see private companies trying to exploit the NHS. Why don't private organisations stop this and actually see it as their opportunity to provide service to the NHS but not take the pee.
the ownership end state Edinburgh Royal Infirmary is an indictment on NHS Scotland… they ran the procurement process decided the contract form….
It was NHS Lothian and I believe that NHS Scotland opposed the plans.
failure by the operator would cost them dearly the penalties would be punitive
£28 a time apparently. I'll bet consort are quaking in their boots.
http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-17784981
https://www.scotsman.com/news/flies-halt-eri-operations-for-second-time-1-2672185
.
Why don’t private organisations stop this and actually see it as their opportunity to provide service to the NHS but not take the pee.
Because the contracts and tenders are structured so poorly by the public sector that decent companies never win? If the public sector were capable of running a half decent process, most of this crap wouldn't happen.
I agree with FuzzyWuzzy on the cost of keeping people alive on a cocktail of drugs, why should NHS money be spent on proploging a life that is essentially over when the money could be much better spent on saving a different life that has the potential to carry on for a long time? I know this will never happen as there would be far too much issue with the ethics of who to save or let die hence why we have the system where everyone is treated the same regardless of cost or future life expectancy.
For the record if I ever get to the stage where I need a daily bag of pills to keep me alive I will just not take them and let nature take it's course. Of course someone would then probably take out a court order to force me to take those pills and prolong my end journey against my wishes! I would welcome voluntary euthanasia as an option here but I know it will never happen.
<p>QE hospital in Glasgow is another shining example of PFI (in whatever clothes you care to dress it in) quality. </p>
t1000
The paucity of your argument is shown by the personal attacks on me which are a long way from the truth
For the record I have worked in 4 PFI hospitals over 25 years on permanent contracts plus bank shifts in others. I have close friends and family involved in other PFI hospitals and in PFI education services
Every building is shoddily built and not fit for purpose and far more expensive than directly built. PFI schools are exactly the same. I have no idealogical attachment to state ownership having managed at a senior level in private healthcare. I have also been a manager in state run healthcare and PFI.
My father was one of Scotland top education experts - I mean answering to ministers. I suspect he knows a lot more about schools than you do and I suggest I know a lot more about hospitals and healthcare than you do. My position is based on real widespread knowledge and reading of the academic and independent research. Whats your based on?
Edinburgh schools - the buildings are in an appalling state with all the PFI ones needing extensive repairs already and are actually unsafe hence having to be close or partly closed for months while repairs were made.
Independent sources such as the kings fund point out time and time again what bad value for money PFI in healthcare is and how inflexible it is compared to state owned.
So a challenge for you
1) an independent report showing any PFI to be good value for money with high quality buildings that are fit for purpose and provide the flexibility needed in modern day healthcare ( you said you could provide loads - lets see them)
2) an example of a single PFI project that has been good value for money
I will bet you will be silent because I know you cannot do either of those things
so put up or shut up. I suspect anyone not blinded by right wing ideology will be able to see where the truth lies
And on ERI - from memory ( so correct me if wrong) westminster insisted it was built PFI. ( ideologically driven) the only company prepared to do it would only do it if they retained the ownership at the end of the contract. thus lothian health had only two options. accept this very one sided contract or have no new hospital.
Its filthy ( private cleaners), the building is not fit for purpose in many ways, food is cook / chill / reheat bought from wales so special diets are almost impossible to organise and the food is ghastly. the windows do not open and there is no air con so temps on some wards in summer gets unbearable. the contractors refuse to do anything about this. It is actually dangerous for patients.
On the PFI I work in right now. the doorways are too small to get a bed thru and the PFI unit will not provide the manpower to dismantle beds to move them so beds that break mean they are out of use for weeks. One point we had 4 rooms out of use because of broken beds.. Equipment belonging to the PFI is usually broken and very cheap - one bath for example cannot be used as it does not meet basic safety standards used in the NHS despite being recently put in because the PFI contractors insisted on using a cheaper bath than the ones the NHS use
ther are not enough plug sockets in the rooms so we have to use extension cables and multi adaptors and have trailing wires over the floor - a trip hazard that is reported by me monthly but the PFI company refuse to add in more sockets so we are left working in unsafe conditions. etc etc etc. We are expecting none of the contracts to be renewed and are looking forward to this so these crap buildings are demolished and replaced with something better. Effing 9 mm plasterboard walls for goodness sake and they also had to be extensively modified recently to meet fire regs. No firewalls in the roof space. they should have been built with these firewalls in place but the contractors deliberately did not meet fire regs and were found out after an FAI in another unit lead to inspections of the roof space
t1000 - i suggest you look into the scandal of the edinburgh schools - walls without wall ties that collapsed, no fire suppression etc etc - and they still cost more than properly built buldings built to the correct standards if directly built
19 schools in edinburgh, 71 accross scotland share this same set of defects
I've worked on many PFI projects, most of which have made headlines over the years. I can honestly say they are rotten from top to bottom and the pure greed on show is sickening. Corners cut at every opportunity, costs to be saved regardless of the consequence and the attitude of my lawyer is bigger than your lawyer when any performance issues are raised. It's criminal really.
Edit: But I can't put all the blame on the contractors, those writing and awarding the contracts really were clueless.
But whose fault was that really? Why were trust managers put in a position that they were suddenly awarding building contracts?
The NHS is great. But it does seem to be struggling, and this is a bottomless pit. A decade ago it was the same "more money needed".
IMO the NHS has overreached and it offers too many things to too many people. It needs to be pared back in some way IMO.
Why? We spend less on healthcare than almost every other nation in the west. We spend less than half per person than the US, aound 75% of what germany spends
Pre blair ( iirc) it was around 8% of gdp, under blair this rose to almost 10% of gdp and the improvement was immense and measurable. Under the tories its been cut back to under 9% hence the issues. Germany is 12% of gdp
the NHS is one of the most efficient healthcare systems in the world - made less efficient in england by tory dogma
Why? We spend less on healthcare than almost every other nation in the west. We spend less than half per person than the US, aound 75% of what germany spends
US is a Rubbish comparison TJ as they spend more on admin and billing than most sane countries would tolerate, they also overspend on a lot of things to get the most from insurance schemes.
Also is GDP an accurate way to compare, population needs to be taken into account there too.
there is a major problem in most health care systems when they hit capacity is once you move to fire fighting, clearing the decks, target hitting you stop fixing the issues and deal with the symptoms. the massive problem is to go from that back to fixing people will take a massive increase in funding, resourcing and a huge mindset change.
I worked on part of this when I was in Oz
https://www.westmoreton.health.qld.gov.au/our-services/mecare-program/
It needed more staff initially rather than redeployment, needed more intensive work and resources at the early stages to pay off by reducing the long term burden on the health service.
£1200/year will sound like a bargain in a few years time
Germany then? 12% of gdp compared to our 8.5% (ish) Of course the german system being a hybrid system takes more in admin but even so.
GDP is a decent measure - both sides of the equation have population in it. Look at in cash per person ours comes out even worse
How do outcomes differ between the 2?
The more important part of my post was the second half though, more cash to do the same will simply lead to needing more cash to do the same.
Outcomes between germany and here? Little direct knowledge but my brother in law had prostate surgery in Germany using the latest techniques. Nerve damge is around 2-5% of cases. In the UK we use much older but cheaper techniques - nerve damage around 50% - that leaves you incontinent and impotent. I believe on most measures Germany would come out better.
Some links to analysis and data if you are interested
Link to IFS page on healthcare spending Inc % of GDP at fig 3
https://www.ifs.org.uk/publications/9186
OECD health indicators - only 220 pages. I worked with OECD on early versions of about 15years ago. All sorts of issues back then with comparable data between countries- I assume it's much better now
http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
Or do your own analysis
http://www.oecd.org/els/health-systems/health-data.htm
failure by the NHS to administer the contract
When someone lays the failures in a Private/Public arrangement squarely at the feet of one side… their agenda is clear.
the NHS is one of the most efficient healthcare systems in the world – made less efficient in england by tory dogma
careful TJ your prejudice is showing 🙂
Bits of the NHS are efficient, Lots of it is woeful. CCGs and Trusts are often staring at each other balefully across rooms with little trust or co-operation. There is still an amazing amount of silo thinking through-out the entire organisation, quite a lot of it isn't fit for purpose, (IT and Estates, I'm looking at you). I don't know a trust that isn't breaching it's waiting lists on something, but ego and petty arguments often gets in the way of finding solutions. I've seen an amazing amount of work gone into contracts that ultimately fail because the consultants don't like each other and so won't refer, sometimes wasting 10 or 100's of thousands.
There is whole discussion about what constitutes efficient/effective/productive in healthcare systems.
<span style="font-size: 0.8rem;">But all these are relative measure not absolute - so you really have to measure NHS healthcare efficiency against other systems</span>
It's bizarre to call a system inefficient just because it is not perfect not least because optimisation against one measure may not produce the best outcomes against others - cheapest isn't always best and diagnosis and care requires subjective judgements.There are multiple input and output factors which can be used to produce an array of measures.
Claiming NHS is inefficient because if individual examples of apparent inefficiency is a popular narrative used by the right to justify starving the system of money.
For what it's worth - I've always thought that a lot of financial/operational inefficiencies are around transactions and these are multiplied with the additional players in insurance based systems.
CCGs and Trusts are often staring at each other balefully across rooms with little trust or co-operation.
thats the inefficiency created by tory dogma that we do not have in scotland and why scottish health service has half the admin costs. Admin pre tory market reforms was 8% of total spend IIRC - it remains that in Scotland - its now 20% in England
thats the inefficiency created by tory dogma that we do not have in scotland and why scottish health service has half the admin costs
and which will have the mindset change to break the what we have always done and move things along to something better.
We can now deliver hip replacements to more people earlier, those replacement will not last until they die so they may need 2 or 3 more, the bill for that is already stacking up, it's growing faster than a funding increases as we add more people to the list. How do we fix that? While people squabble for political pints over a % here or there bigger problems unfold. We may be able to technically fix the effects of obesity but can we afford to? Like any good deal the monthly payments in the future seem affordable compared to the big up front costs but are they?
sorry dude CCGs and trusts in faux competition does not do what you want. I agree a big shift towards prevention and self treatment is needed and a public debate about rationing is needed.
I don't know if this is a scotland only initiative or even just local GPs but people with conditions like COPD are now routinely given unfilled prescriptions for the drugs they need in exacerbations so they do not have to visit a doc if they get an exacerbation and thus can start treatment more quickly. The result is less hospital admissions and reduced antibiotic and steroid usage
Thats the sort of initiatives that will help.
Hop replacements last 30 - 40 years so none one needs 3 and two is rare.
Thats the sort of initiatives that will help.
Only if it's part of a structured plan with the resources in the right place to deal with it? Did you read the MEcare link? There is a lot to that
Hop replacements last 30 – 40 years so none one needs 3 and two is rare.
Today or in the future? What age are people getting them?
Anything under 70 now is looking at 2, my dad was early 60's so if he is still going well at 90 should we cut his leg off? It's not just a bit of conjecture it's a stat that is being seriously looked at.
If he got one at 60 he might need a second if he lives actively to 90+. Even at 40 for the first one a third is very unlikely. Its not a huge expense or issue
the obesity / diabetes rise is the really worrying one along with people wasting professionals time on uneeded stuff and on missed appointments.
We have plenty of money for a good comprehensive healthcare system. More than 10% of the english budget is wasted on faux competition and this faux competition leads to greater inefficiencies add that to the 20% of the budget wasted on PFI in some trusts and by removing those two factors you could release so much money.
We have plenty of money for a good comprehensive healthcare system.
I spent time working at the more strategic level, it's not.
If he got one at 60 he might need a second if he lives actively to 90+. Even at 40 for the first one a third is very unlikely. Its not a huge expense or issue
So what data are you basing all this on, I know your working on the front line but how does that work at the big level?
A rich country like ours could easily afford German levles of healthcare. We chose not to. thats my point.
On the hip replacement issue - its just my wee bit knowledge. Hip replacements are by my understanding expected to last around 40 years. get your first one at 40, your second at 80 then your third at 120? Its not my feild tho but I seriously doubt that its a big issue compared to obesity and diabetes or smoking or alcohol; related disease.