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#more#economy#gas#policy#war#https#nhs#high#prices#britain

Discussion (39 Comments)Read Original on HackerNews

tonyedgecombeabout 17 hours ago
I generally agree with the article but there are a couple of issues.

>France has roughly the same population as the U.K., but almost 50 percent more homes.

France also has four times the land area compared to the UK.

>The Economist ties Britain’s energy scarcity to its overly rapid and haphazard push for decarbonization; having banned coal, and with natural gas now extremely expensive due to the Ukraine war, the UK has been forced to rely on hideously expensive offshore wind power.

The dash for gas came about well before decarbonisation was on the agenda. It was instituted by Thatcher after the coal miners strike and because we had an abundance of it in the North Sea.

https://en.wikipedia.org/wiki/Dash_for_Gas

The NHS is struggling because we have an unhealthy population. A lot of that can be put down to behaviours we have adopted from the US (poor diet, car centric lifestyles and lack of exercise).

pjc50about 15 hours ago
> The NHS is struggling because we have an unhealthy population

I think we should stop pretending the NHS doesn't have quality and availability issues, which are validly pointed out in the OP article. I was shocked to discover that the NHS is paying out £60bn in compensation: https://www.bmj.com/content/391/bmj.r2211

Some of that seems to be claims inflation, but it also has to indicate a very real problem. The NHS runs an extremely "lean" system where people are triaged and it errs on the side of under-treatment. That saves money on treatment, but has other costs that don't immediately appear.

There are whole areas which are systematically under-funded to the point of nonexistance. If you're going to try for an adult ADHD or autism assessment, you're going to wait a very long time.

I don't have any answers myself, but I do wonder if going for the sacred cow of "free at the point of use" might work. But NHS dentistry isn't free and still experiences massive funding problems.

roryirvineabout 15 hours ago
The problem with changing the 'free at the point of use' principle is that under any likely replacement it would continue to be free for expectant mothers, children, the disabled, and the elderly - precisely the people who consume the largest proportion of healthcare resources.

And that means that introducing per-appointment charges would likely have only a very minor effect on reducing waste & improving availability. Healthy people of working age would see it as imposing extra charges for no tangible improvement.

Either that, or you'd need to be looking at introducing a two-tier NHS, which I don't think many people would be happy with - "it might work in Europe, but what if it ends up being more like America?" would be the worry.

I think your point about the importance of triage to being able to running "lean" is a better place to look for improvements. The Single Patient Record ought to make automated triage a lot more reliable, for instance. And taking a broader view of ongoing health & economic impacts would help with your ADHD/autism assessment use case, as well as similar issues affecting people of working age (maternity care, being another obvious example).

ben_wabout 14 hours ago
> The problem with changing the 'free at the point of use' principle is that under any likely replacement it would continue to be free for expectant mothers, children, the disabled, and the elderly - precisely the people who consume the largest proportion of healthcare resources.

The disabled were scapegoated for much of my teens, I wouldn't be surprised if that continues; the elderly… I won't be surprised if someone realises an old person who needs treatment to live, doesn't get it, dies, isn't going to vote against the party responsible for that in the next election the way a pensioner whose income doesn't rise with the cost of living will be able to.

Mothers and children are still going to be important to look after. But with ever-decreasing fertility rates, I wonder if this has become much cheaper per capita already, and the "true" (steady-state) cost for this part of the NHS is therefore hidden, just as old-age care costs were hidden when the population pyramid was the old shape?

mishellaneousabout 15 hours ago
i think instead of asking the best way of dividing the costs, we should ask why does it cost so much. we've managed to bring down immensely the cost of technology over the past decades everywhere else.
tonyedgecombeabout 14 hours ago
>I think we should stop pretending the NHS doesn't have quality and availability issues, which are validly pointed out in the OP article.

I don't think anybody is pretending it doesn't. We just need to ask why it has got so bad since Covid and why we seem to be struggling more than similar European countries.

ben_wabout 14 hours ago
> France also has four times the land area compared to the UK.

This is not by itself of great importance.

There's several different meanings of "built on", but even with the most expansive definition for this purpose, the UK could double how much is "built on" at a cost of around a tenth of what isn't: https://fullfact.org/economy/has-92-country-not-been-built/

There's other reasons to say "perhaps not a good idea" to a higher population (food security, energy security), but the land is there for more (or simply bigger) housing.

tim-projectsabout 18 hours ago
Britain and the US are nothing alike in the sense that in Britain, if you are valuable high earning worker you get actively punished for it with heavy and arguable unjust additional taxes. There are real incentives to working less and retiring early in Britain, so that's what most do.
benj111about 18 hours ago
>and with natural gas now extremely expensive due to the Ukraine war, the UK has been forced to rely on hideously expensive offshore wind power

But the wind is cheaper than gas. Yes you could argue that if we had stuck with coal that would have been cheaper than gas or wind, but the long term threat and the long term most expensive option is clear. Wind and solar gives energy independence, so we aren't reliant on a market that could be turned upside down by one country invading another.

mytailorisrichabout 18 hours ago
Even the popular claim that "natural has is extremely expensive due to the Ukraine war" is misleading. In the UK and Europe high prices are by and large the result of policy and in fact high prices is exactly the aim.
brooksyd2about 17 hours ago
I'm not sure that is true. The reason prices are high in the UK is that the government guarantees specific strike prices to investors to bring investment into new renewable infrastructure. So if someone builds a new offshore windfarm, they are guaranteed a certain return. The underlying strike price is calculated from the cost of natural gas, and therefore the price is being effected by various things, such as the US-Iran war. It is not designed to be a high price, it is just how the government has chosen to attract investment, specifically keeping the underlying price linked to gas.
tonyedgecombeabout 17 hours ago
Companies do bid against that strike price and if it is too low then they don't bid.
ahartmetzabout 17 hours ago
In Germany: 0.06 € / kWh was policy, 0.14 € / kWh was mainly Ukraine war. It's currently at about 0.10 € (policy + Ukraine war + Iran war). Taxes are fairly low: 0.0055 € / kWh and the usual 19% VAT.
mytailorisrichabout 17 hours ago
It is policy to ban shale gas and more North Sea gas. In Germany it is also policy to exit nuclear, like it was policy to depend on Russia. VAT is policy. The Ukraine War is a convenient way to deflect from all the policy choices made over the last 20+ years, while still achieving the aim of high prices.
pjc50about 17 hours ago
Note on the economics here; why don't we look at the whole picture rather than one or two countries? Clearly America should be top of this list, right? https://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28no...

.. no, that's Monaco. OK, so clearly we should exclude "microstates which are tax havens for billionaires" from the list. Does raise question about whether "excessive financialization of the economy" is actually bad: Monaco is entirely finance and tourism.

We then have to decide whether "finance microstate doesn't count" applies to Ireland and Switzerland. Let's give ourselves the benefit of the doubt and say yes; we're trying to get to a table where USA #1 and UK #2 appears.

So then we get to .. Norway? Not often held up as an economics model, more of a social model. It turns out that being a low population petro-state is also great for GDP. Let's rule those out as well, which takes care of Qatar. Finally we get to the US.

We're then left with only Denmark, Netherlands, Australia, Sweden, Israel (!), Austria, Germany, and Belgium above the UK in the table.

So I would say the lesson is not necessarily US exceptionalism or expensive European gas (which affects half that list, and note Israel is famously almost the only non petrostate in the Middle East), but that the UK is actually doing a lot worse than we realize for idiosyncratic reasons (probably including, but not limited to, Brexit).

Should we look at this table and copy whatever Ireland is doing to have twice our GDP? Would the average Brit recognize that Ireland is twice as rich as the UK? I'm not sure.

(The list of problems in the article is fairly valid, but they're unable to synthetize between "everything is underfunded" + "debt is bad" => the only arithmetically possible solution, "raise taxes")

inigyouabout 17 hours ago
> Israel (!)

What did you mean by that (!)?

pjc50about 15 hours ago
Very different economy from the rest of that list. Economically it's like an Ireland (high tech and services) that spends 8% of its economy on war. And receives significant foreign aid.
throw64259about 14 hours ago
US foreign aid received per capita is about $300 - against a GDP per capita of about $70,000.

(On the US side the aid sent is $10 per capita per year).

lou1306about 16 hours ago
> Another lesson that Americans have already learned is the peril of excessive financialization of the economy

Don't mean to be blunt, but when did that happen? How has a country where you can finance your burrito [1] "learned the perils of excessive financialization"?

Also, a lot of this (especially the slower recovery after 2008) reads more as the perils of being the periphery of an empire vs being the core.

[1] https://finance.yahoo.com/markets/stocks/articles/uber-techn...

barry-cotterabout 19 hours ago
> Whether or not the Brits need our advice, we need to have our own internal discussion about what’s going on over in the UK and how we can use it to inform our own choices. And although there are still a few things to admire across the pond, the UK mostly now functions as a cautionary tale for the U.S. — yes, despite Trump, and guns, and high health care costs.

> Whether you think the UK has been falling behind America economically for a decade or for two decades depends on which set of prices you use to measure living standards. If you use the two countries’ national price indices, the UK has been growing slower than the U.S. since the financial crisis of 2008; if you use PPP prices, as Paul Krugman prefers, the UK’s relative stagnation has come only since Brexit in 2016:

jpfromlondonabout 17 hours ago
>if you use PPP prices ...

it was still on the uptrend until 2020 when switching off the economy squashed all growth and not just in Britain but other major continental economies too, Germany has actually been in and out of recession multiple times since.

2016 added some turbulence to domestic politics and econ but until then our recovery from the GFC had been fast, occasionally faster than the rest of the G7.

ahartmetzabout 17 hours ago
Germany isn't doing great, but these current recessions are low grade. Nothing like mid 90s and mid 2000s, unemployment data: https://www.wsi.de/de/erwerbsarbeit-14617-arbeitslosenquoten...
pjc50about 17 hours ago
> 2020 when switching off the economy squashed all growth

The exception here is the US, again. And what did they do differently? Massive QE and "helicopter money". Anti-austerity worked extremely well for growth, even if the debt went up.

jpfromlondonabout 17 hours ago
Counter-cyclic fiscal policy and QE does work, absolutely, but it's likely dependent on size of economy because in most cases austerity works better...but in most cases the economies are much smaller than America's; Ireland, Estonia, Latvia, Lithuania, Italy, Greece (since austerity was forced upon it), HK, Britain could likely've been more austere during the GFC and seen more growth.

Then again although not comparable to America's it's possible that the British economy was/is large enough to sustain even more liberal fiscal policy but given the dependence on import and that it's primarily a service economy I doubt it.

America is truly exceptional.

spacedcowboyabout 17 hours ago
As someone who moved from the UK, to the US and back to the UK, my money goes a lot further in the UK.

I can afford to not work at all here. With health insurance, property taxes, and general outgoings per month being so much higher in the US (California, at least), there was no way I could retire early over there.

And whereas it's easy to hand-wave away "Trump, the healthcare, guns, ... " in a dismissive sentence, those things have real impact on a society and on the individuals living in that society. There's a reason [1] I moved away from the US, and will never return. Money-über-alles has its downside.

It's also worth noting (since the author brings it up) that the Mississippi comparison is pretty bogus. According to data from the Office for National Statistics and the US Census Bureau, median household wealth in Great Britain is substantially higher (around £300,000, or $403,000)[2] compared to the US ($175,000) [3] and Mississippi ($59,000). GDP and personal wealth are not the same thing.

1: https://news.ycombinator.com/item?id=44217106

2: https://www.ons.gov.uk/peoplepopulationandcommunity/personal...

3: https://www2.census.gov/library/publications/2024/demo/p70br...

pjc50about 17 hours ago
> there was no way I could retire early over there.

It seems that the UK is becoming the new Portugal (warm retiree destination with stagnant non-retiree economy)

spacedcowboyabout 17 hours ago
That seems quite a claim from one datapoint...