The propaganda war continues – this is essentially an argument for selection, leading to different levels of service.

Such stratification is an inevitable consequence of privatisation (the inevitable end point in NHS reorganisation) requiring different bureaucratic systems to determine who is entitled to what, and who is able to pay for it.

Nominal charges for ambulances and A&E visits are just around the corner – then like Uni fees ……..
http://www.youtube.com/watch?v=UtKADQnjQmc

“Very un-liberal”

Quite, though it’s a word that seems to cause a lot of confusion these days. Especially amongst the Lib-Dems.

I don’t think “foul and abusive” was meant to be a deciding factor on whether someone gets charged for treatment. I think it was intended as a way of selling the idea by demonising the people who would get shafted by it.

You’re quite right to ask just how far down the rabbit hole he’s prepared to go. You could make a case for a lot of conditions being the patient’s fault. Got cancer? Ever exposed yourself to a risk factor, e.g. got a bit pissed once? No treatment for you!

Another question: let’s say I turn up at A&E with a gashed arm. I’m obviously very drunk, but my friends maintain that the injury was not my fault: someone took exception to my haircut and pushed me through a window. Should I still be charged on account of being naughtily drunk? How does A&E even determine what happened?

@ Chaise

The practicalities of such a policy are, as you suggest, problematic. Would there need to be a duty manager at every A&E checking the criteria of worthiness from a long list?

In the longer term I wonder what effect this would have on our caring professions. It would seem to select against compassion for one’s fellow human beings. Would the face of the profession change over time because of this kind of thinking?

It is already a ciminal offence to obstruct an ambulance, be abusive to staff in hospitals etc. So tackling this issue is a matter of enforcing existing law. One would have thought a health minister would know this.

>Do we charge drunk drivers for the injuries they receive, or the injuries they cause?

Yes we do, via Motor Insurance. It’s been in place for years:

“The National Health Service (NHS) is pushing up the cost of motor insurance, because of new rules which allow it to claw back treatment costs from motor insurers more efficiently.

That is from 2001.

“According to new figures from the Department of Health, the NHS claimed back £75.8m from motor insurers between 2000 and 2001.”

http://news.bbc.co.uk/1/hi/business/1519272.stm

[4] ‘In the longer term I wonder what effect this would have on our caring professions’ – the first question will be, how are you going to pay, rather than what is wrong.

@ 4 Cherub

“Would there need to be a duty manager at every A&E checking the criteria of worthiness from a long list?”

Presumably. Between this and the inevitable lawsuits when people were incorrectly judged to be responsible for their own condition and turned away, I’m not even convinced this would save money.

“In the longer term I wonder what effect this would have on our caring professions. It would seem to select against compassion for one’s fellow human beings. Would the face of the profession change over time because of this kind of thinking?”

Quite possibly. I like the fact that medics in general have a “We don’t care who you are, our job is to help you” thing going on. We don’t want to lose that.

” I’m not even convinced this would save money”

It would probably cost a great deal more.

The other matter to consider is the impact on people who tend to ignore minor symptoms and only present to the health service once things are too late (and treatment then becomes more costly). If those people start to think “what if they determine it is my own fault and send me a bill?” when they become ill, then this simply means people avoid going to A+E or their GP until they are in agony.

One of the most effective ways of saving money in the NHS is to turn month long stays into week long stays, week long stays into day stays, and day stays into people managing conditions outside of hospitals. This means far greater emphasis on primary care, managing chronic conditions, and in preventating ill health. All the evidence suggests the way you do this is to reduce barriers to accessing care earlier in the process (people get things checked out). Adding the prospect of having a judgemental bureacrat determining if it is your own fault is just stupid, and will increase the cost to the NHS over the long run. Unless the lib dems now think that those judged to be at fault should be left to die if they don’t have the finances.

Should we ‘penalise’ criminal politicians who have flagrantly stolen from the public purse, or should we promote them to a position in the Cabinet?
If you are a Lib Dem, then of course the latter position is to be preferred.
They are just Tories and share a similar position in the public affection – lower than vermi…………

Having spent too much time in the company of Tories it seems that Norman Lamb has gone native. After all, don’t all Coalition policies have to satisfy the ‘increase avoidable suffering’ test?

“If you get rat-arsed on a Friday night and get taken to A&E where you are foul and abusive to staff, is it right for the taxpayers to fund your life-saving treatment?”

Well as an analyst one trick I have been taught is when someone makes a statement is turn it around and play back the opposite.. so looking at Norm’s statement above I would ask the following..

“So if someone is injured due to drinking too much and is unwilling or unable to pay for the life saving treatment they require, it is acceptable to let them die”

yes I thought not!

and this is even before we go on to drinking too much – ok for chavs at A&E but what bout liver problems from prolonged drinking? What about smokers? what about speeding motorists? What about the “stupid” accidents we hear about? I think I could go on all day…

@ 9 Planeshift

“The other matter to consider is the impact on people who tend to ignore minor symptoms and only present to the health service once things are too late (and treatment then becomes more costly).”

Yep, I overlooked that one.

@ Redfish

“ok for chavs at A&E but what bout liver problems from prolonged drinking? What about smokers? what about speeding motorists? What about the “stupid” accidents we hear about?”

What, for that matter, about people who hurt themselves due to mental illnesses? Bulimics, self-harmers, than sort of thing?

If you get rat-arsed on a Friday night and get taken to A&E where you are foul and abusive to staff, is it right for the taxpayers to fund your life-saving treatment?

Of course, “taxpayers” and “drunk people” are completely and permanently disjoint sets. (Which is impressive going, given that we tax alcohol purchases at least twice)

Yea, I mean if a politician with a £65,000 salary and £100,000 expense account , and gold plated pension (all paid by the tax payer ) says something stupid, and someone then punches them in the face, why should they get NHS treatment?

The levelsurdity of this is never ending. Should boating folks have to pay the Coast Guard to come and rescue them? Should people who go mountaineering pay to be rescued when they fall off a cliff? Should footballers and rugby players pay for injuries they get kicking a ball around? Should farmers pay when they fall off their horses fox hunting? Should granny pay when she falls over because she would not use a walking stick?

I expect this stuff from tories, not lib dems. But the Lie Dems seem to have lost their minds.

Aren’t there laws to deal with people who are abusive? A doctors job is to heal sick, whatever!

This sentence screams ignorance on the part of the author:

“The message came straight out of the Lib Dem’s Orange Book. Lamb wants to deliberately break the cherished free-at-the-point-of-delivery principle of the NHS.”

The Orange Book’s chapter on the NHS is possibly one of the book’s most controversial. However the reform proposed by David Laws (basically to move to a nationalised insurance model similar to that seen across much of continental Europe) are explicitly designed to keep the cherished free-at-the-point-of-delivery principle.

There are two conclusions – either Richard Blogger is espousing about The Orange Book but hasn’t read it, or he has read it but seeks to mislead people about its contents. I don’t know which is worse.

Much is said about The Orange Book. Little of it is true.

The Elizabethan Poor Law introduced the distinction between the deserving and undeserving poor. The LibDems are evidently still stuck in that mindset.

How long will it be before those suffering from liver failure, lung cancer, obesity, bulimia or type 2 diabetes are considered as undeserving for having brought their afflictions on to themselves? Cardiac problems as the result of a stressful job, like bus driving? They should have changed jobs to something less stressful. Ethnic Afro-Caribbeans are especially susceptible to sickle cell anemia. Of course, we’ll need boards of guardians to decide how undeserving of NHS care are the afflicted.

@ Sally

Should boating folks have to pay the Coast Guard to come and rescue them? Should people who go mountaineering pay to be rescued when they fall off a cliff? Should footballers and rugby players pay for injuries they get kicking a ball around? Should farmers pay when they fall off their horses fox hunting? Should granny pay when she falls over because she would not use a walking stick?

You are asking if people should be prepared to pay the costs associated with the consequences of their actions and behaviour?

Is such a notion really so preposterous?

How much will it cost the NHS to run the boards of guardians to decide who is and who isn’t deserving of NHS care?

Will there be legal aid for patient’s representation at board hearings or will all the decisions be made behind closed doors without the presence of the patients concerned?

As they used to say, the devil is in the detail.

@ 21 pagar

“You are asking if people should be prepared to pay the costs associated with the consequences of their actions and behaviour?

Is such a notion really so preposterous?”

No, but leaving people to die because they’re poor is. The idea of everyone taking 100% personal responsibility sounds nice, but has terrible implications on closer examination.

So we join together to get those services more efficiently, paying for one mountain rescue service rather than each hiker hiring a Sherpa to follow him around. And as some people couldn’t afford them otherwise, we do it through tax rather than an opt-out system.

21 libertarian clap trap. Even Ayn Rand ended up on medicare. And she hated the moochers.

[24] the doyen of libertarianism on medicare – can this be true?

According to this report Rand was ‘a heavy smoker who refused to believe that smoking causes cancer’ (Miss Rand was a fatal victim of lung cancer) …… and something of a hypocrite, it seems?
http://www.huffingtonpost.com/michael-ford/ayn-rand-and-the-vip-dipe_b_792184.html

“Is such a notion really so preposterous?”

Place the principle in the concept of global warming, and we’ll see how many libertarians then agree with it.

@ Chaise

So we join together to get those services more efficiently, paying for one mountain rescue service rather than each hiker hiring a Sherpa to follow him around. And as some people couldn’t afford them otherwise, we do it through tax rather than an opt-out system.

Of course the services should be available and nobody is talking about leaving the poor to die.

But why should everyone be compelled to pay for the costs of the few people who want to walk up mountains? Should the mountaineers not pay for their sport, perhaps insuring themselves against the costs of needing rescued?

Should the idiot who sets off up Snowdon in a pair of flip flops not be asked to contribute to the consequences of his action?

@ Planeshift

Place the principle in the concept of global warming, and we’ll see how many libertarians then agree with it.

Not convinced about global warming as you might suppose.

But most libertarians would agree that polluters should pay for externalities- the cost of their pollution.

I think people who expose themselves to medical risk should be asked to pay a top up premium to the state funded through insurance. That way if they engage in risky behaviours they can pay higher premiums. It would also encourage individuals to be more responsible for their own health. This of course would not apply to children or the mentally ill.

@28 Pagar

‘Not convinced about global warming as you might suppose’

Is that because you do not understand science?

@ 27 pagar

“Of course the services should be available and nobody is talking about leaving the poor to die.

But why should everyone be compelled to pay for the costs of the few people who want to walk up mountains? Should the mountaineers not pay for their sport, perhaps insuring themselves against the costs of needing rescued?

Should the idiot who sets off up Snowdon in a pair of flip flops not be asked to contribute to the consequences of his action?”

I’m having trouble reconciling your first paragraph with the rest of your post. Say a poor person, who can’t afford mountaineering insurance, decides to hike up a mountain. He falls down a crevice and breaks his leg. Should we rescue him, even though he hasn’t paid, or leave him to die?

@ 29 MoCO

“I think people who expose themselves to medical risk should be asked to pay a top up premium to the state funded through insurance. That way if they engage in risky behaviours they can pay higher premiums. It would also encourage individuals to be more responsible for their own health. ”

I respect the principle, but there’s problems with this. Firstly, if you want it to be consistent, it’s gonna be really complex (50p for having a steak last night, £6 for staying at the ski resort for an extra day, £20 for not replacing the brake pads in your car in a timely fashion…), not to mention that the rules will have to keep changing as medical knowledge increases and technological/social change make things more or less dangerous. It’s unlikely to be this complicated or up-to-date in reality, so what’ll actually happen is that certain groups will get arbitrarily shafted.

Secondly, what do we do if they don’t pay? Abandon them? Or should we treat/help them regardless, but make it an offense to go rock-climbing without a permit, a la car insurance?

Thirdly, where’s the line that defines mental illness for these purposes? Do alcoholics, bulimics, and people with an eating fixation get a free ride, or do they have to pay?

Fourthly, how do we reconcile this with the possibility that this would price poor people out of doing some things, exacerbating an already sizable divide?

25, yes , it has come out recently that Rand ended up sucking at the state teat. The poster girl of the libertarian movement forced to rely on the state. Romney’s vice presidential candidate Ryan is great fan of Rand. Although since it has been pointed out to him that she was an atheist, he has tried to play it down. He does not want to upset the Christian crackers.

“But most libertarians would agree that polluters should pay for externalities- the cost of their pollution”

Oh totally, in theory. When it comes to a real world scenario that might actually impact on them, we get a massive effort at denying that their actions do impact upon others. See also: passive smoking, drink driving, sexually harrassing employees..

“Should the idiot who sets off up Snowdon in a pair of flip flops not be asked to contribute to the consequences of his action?”

If Snowdonia cancelled it’s mountain rescue team, or simply announced it was going to charge per callout, what impact do you think this might have on the local economy?

Do you think there would be as many visitors to the area? Do you think that people would be able to have employment in Llanberris? Do you think the hotels would be full in summer? Do you think the treasury would have as much income from VAT and taxes on alcohol from the tourists?

Do you think the millions of kids who developed an interest in outdoor persuits as a result of a visit would maintain a healthy lifestyle (and reduce costs to you) if they hadn’t had the experience? How many schools are going to organise trips to an area without an experienced mountain rescue team?

Real World 1. Libertarian economics 0.

Rand on state handouts? That brings me such Schadenfreude!

It’s a sort of attitude that stems from the bastardification of Britain caused by Thatcherism. That is, the growth of a mean-spirited, narrow-minded mentality that’s utterly divorced from the Christian traditions of this country but promoted as “common sense” by the Right and appeased by the Left.

Huh, and here was me thinking the whole Rand on handouts was common knowledge and old news already.

34 Quite. And think of all those DIY stores that will go bust when sales of ladders and power tools dry up when the risk of injury compels people to take no risks.

@ MOCO

Is that because you do not understand science?

I am not a scientist, but I know enough about the science of global warming to understand that it is lunacy to trust those who have a vested interest in exaggerating the data provided by unproven proxies and extrapolating that through flawed computer models producing results predicting Armageddon. And who then pretend the end of the world can be avoided if we all change our light bulbs and build some windmills.

@ Chaise

Say a poor person, who can’t afford mountaineering insurance, decides to hike up a mountain. He falls down a crevice and breaks his leg. Should we rescue him, even though he hasn’t paid, or leave him to die?

Of course we should rescue him- and later ask him to pay for the cost. At £1 a week if that is what he can afford.

In many areas of the USA, emergency fire cover is provided by a voluntary insurance premium. If a house catches fire, and the owner has chosen not to contribute, they still put the fire out if requested but will then charge the cost to the householder.

@ Planeshift

If Snowdonia cancelled it’s mountain rescue team, or simply announced it was going to charge per callout, what impact do you think this might have on the local economy?

Almost none, I should imagine.

People would not be deterred by having to pay a small insurance premium before hill walking any more than they are deterred from going abroad because they might need travel insurance.

@ 39 pagar

“Of course we should rescue him- and later ask him to pay for the cost. At £1 a week if that is what he can afford.”

That’s on the right side of acceptable, but it’s still not great. Considering that the original topic was the NHS, that kind of system would result in poorer people putting off going to the doctor, or refusing needed treatment, to avoid a lifetime of debt. Possibly getting a shorter lifetime as a result. As Planeshift points out above, it would also lead to people ignoring minor complaints in the hope that they go away, and allowing them to become major ones.

Or imagine our poor mountaineer thought he couldn’t afford the charges, so he tried to walk home on his broken leg, and ending up dying or permanently disabling himself.

Surely it is illiberal not “unliberal”?

[29] This of course would not apply to… the mentally ill.

Why not? There are quite a few cultures that consider mental illness to be at the least shameful and and at the worst a form of wickedness. I’d say it’s probably the least popular part of the N.H.S.

@39 pagar : The purpose of universally available healthcare, free at point of use, is that no-one falls through the cracks: it provides a minimum social floor below which we as a society are not willing to allow people to fall.

For a start, the riskiest thing you can do is age. So I assume we would be charging the shit out of pensioners every time they left their house, or went up the stairs for that matter.

Secondly, as an example, poor parents have poor children. I don’t want to live in a country where people with little disposable income are saddled with extra debt when they decide to take their kids for a wander in the hills and someone trips over, because they don’t have the ready cash to “pay a small insurance premium”.

One final thing. I love the “I’m no scientist but…” comment. Let them cure me of cancer, but god forbid they ask me to change my lifestyle because we’re knackering the planet. Burn them, I say! Burn them!

Oh dear, Sally and her off topic, drip-drip, low-level bigotry is back:

> He does not want to upset the Christian crackers.

@ JV

You are being very unfair to Sally.

Her bigotry is not “low-level”.

29: “I think people who expose themselves to medical risk should be asked to pay a top up premium to the state funded through insurance. That way if they engage in risky behaviours they can pay higher premiums. ”

What of those who are born with a genetic disposition to chronic or even fatal ailments? It is widely acceptable that genetic factors often apply in cases of breast cancer. Such individuals are likely to find private healthcare insurance prohibitively expensive if they can get it at all. Insurance companies will really like to know about the DNA of those applying to take out insurance cover.

That is the trouble with the argument that the market for private (profit-maximising) insurance cover for healthcare will ensure everyone becomes personally “more responsible” about taking care of their health.

Just in passing, a mate who works in rescue sort of things told me once that a lot more people these days hike up Snowdonia or the like, then get tired and so call the rescue people. Because they don’t feel like walking back down. He said it always happened in the past, but it is a lot more common now – partly because of mobile phones.

46. Bob B

What of those who are born with a genetic disposition to chronic or even fatal ailments?

While it is an interesting case it ought to be obvious that it is irrelevant to this discussion. No one would think that something you inherit is your fault. People with genetic complaints are not undeserving. So your repeated example is irrelevant.

It is widely acceptable that genetic factors often apply in cases of breast cancer. Such individuals are likely to find private healthcare insurance prohibitively expensive if they can get it at all. Insurance companies will really like to know about the DNA of those applying to take out insurance cover.

Indeed. But we have a one-sided system that means the public can find out about their genes but insurance companies cannot. Which means insurance will not be offered in the end. This is stupid.

That is the trouble with the argument that the market for private (profit-maximising) insurance cover for healthcare will ensure everyone becomes personally “more responsible” about taking care of their health.

No it isn’t. Not any more than the counter argument that the State will inevitably attempt to reduce medical costs by eugenics – as we are gradually moving toward. NHS Doctors now routinely try to persuade women to abort Down’s syndrome babies. Often those with any other defect as well. No doubt the State has a compelling interest in people with the gene for breast cancer not having more children. So reducing costs. But that does not mean such women will be prevented from having children any time soon. Any more than medical insurance companies might do this.

@ 47 SMFS

“Just in passing, a mate who works in rescue sort of things told me once that a lot more people these days hike up Snowdonia or the like, then get tired and so call the rescue people. Because they don’t feel like walking back down. He said it always happened in the past, but it is a lot more common now – partly because of mobile phones.”

A fair point. And yes, those guys are selfish twats. But that’s not necessarily an excuse for removing the safety net. It might be a reason for the emergency services telling people to bugger off from time to time, though.

According to the political spectrum the LibDems are Libertarian anyway not liberal left.

Makes me weep.

“The whole idea was poorly thought out.”

Plain stupid more like.

Hate that word “Chavs”, directed often at people from difficult backgrounds.
Still it must be good to have someone to look down on,knowing bad things could never happen to you or your family.

http://www.youtube.com/watch?v=1jGJavcSJTg

SMFS: “People with genetic complaints are not undeserving. So your repeated example is irrelevant.”

On the contrary, it is thoroughly relevant to the apparently persuasive argument that private profit-maximising insurance cover for personal healthcare costs would create a powerful incentive for people to be more responsible about taking care of their health. The essential point is that the chronically sick and those with inherited ailments will find it hard to impossible to get private healthcare insurance at affordable cost.

Your objection is therefore wrong – as well as being misleading. It’s important to be clear about this because those who press the “free market” case against “socialist” medicare often parade the insurance agument as an incentive for individuals to take personal resonsibility for their healthcare. May be, but free market insurance will also leave the chronically sick without cover. We need to be very clear about this.

A friend with long history of cardiac surgery has to take great care in covering all the many details of his long medical history when applying for travel insurance cover during trips abroad to see his son. Any slip in the detail and the insurance company could legitimately deny liability if he falls ill while travelling.

That kind of situation will increase with private healthcare insurance. Friends who have supplementary private healthcare insurance tell me about no-claims bonuses and annual limits to cover, issues which become increasingly significant if chronic cardiac problems develop.

“No doubt the State has a compelling interest in people with the gene for breast cancer not having more children. So reducing costs. But that does not mean such women will be prevented from having children any time soon. Any more than medical insurance companies might do this.”

What happens if early DNA analysis of women with family histories of breast cancer shows a genetic disposition is regular monitoring with pre-emptive surgery if necessary, sensible steps to prolong life expectancy and to reduce the prospective costs of cancer care.

I think we can expect increasing attention being focused on genetic medicine. Private medical insurance will doubtless take steps to avoid risks by gathering information about family histories etc and withdrawing cover on the grounds that insufficient information was provided about pre-conditions.

In the news today is the issue of legalising 3-parent IVF treatment to avoid avoid serious mitochondrial diseases inherited on the maternal side, such as muscular dystrophy
http://www.dailytelegraph.com.au/news/breaking-news/three-parent-baby-fertility-technique-mulled-in-britain/story-e6freuz9-1226476182853

Quite. If you play football you should not expect me – a couch potato – to pay for your sporting injuries. Ditto skiing, swimming and similar high risk activities. What if you sunbathe and get skin cancer. Your own fault, clearly!

If you choose to drive – never mind whether you are drunk or not, this is well known as one of the riskiest of life choices, so how can you expect the pedestrians among us to cough up for your accidents?

I think it’s perfectly reasonable.

” No one would think that something you inherit is your fault. People with genetic complaints are not undeserving. So your repeated example is irrelevant.”

Oh dear, how little you know the Christian cracker voters. Remember Glenn Hoddle and his Karma comments about people born with defects was punishment for what they did in a previous life.

[53] ‘If you play football you should not expect me – a couch potato – to pay for your sporting injuries’ – sure, but if you develop type II diabetes, or suffer a stroke or heart attack because of your sedentary life style will you expect others to pay for years of health care as well as a life long supply of statins, antihypertensives, biguanides, and anticoagulants?

Never any doubt in my mind that the lib dems are a much greater threat to the core principles of the NHS than the tories.

A party whose social niceness comes from sympathy rather than solidarity would inevitably not sympathise with such a large number of people that the NHS being free to all would become offensive to them.

Can’t sympathise with people who live different lives to you but are not victims? Join the lib dems and go into politics.

At least the Tories have to triangulate that, as much as they don’t like the state paying for anything very much, there’s votes in them there hills.

@ 54 Sally

“Oh dear, how little you know the Christian cracker voters. Remember Glenn Hoddle and his Karma comments about people born with defects was punishment for what they did in a previous life.”

To be fair, you won’t be getting many Christian votes by talking about karma and past lives. That’s a bit of a weird crossover.

@39 Pagar

”I am not a scientist, but I know enough about the science of global warming to understand that it is lunacy to trust those who have a vested interest in exaggerating the data provided by unproven proxies and extrapolating that through flawed computer models producing results predicting Armageddon. And who then pretend the end of the world can be avoided if we all change our light bulbs and build some windmills.”

You may not be aware that the models used are free for all to try out.
But a simple question. If you accept that CO2 absorbs infra red (this is easily demonstrated) it follows that it’s temperature will rise. If the temperature of the CO2 in the atmosphere rises the temperature of the planet will rise by the same logic.
The famous ‘hockey stick’ graph shows the meteoric growth of CO2 . Stick the two together and hey presto Global warming. The sad thing is once the permafrost starts seriously melting this will release Methane which I think is about 11 times as powerful as Co2 in absorbing heat by that time there is no turning back.

Make no mistake, Pagar, Global warming exists and in all probability there is nothing to stop it running away. The sad fact is that this situation was predicted by MIT in the late 60′s as I recall. In reality, because of propagation delays we were all probably doomed by the time the first evidence was available, so I agree,along with some Greens, that windmills and light bulbs aren’t the answer. I think the answer is that there is no solution and in less than 100 years the global population will significantly fall. Within 200 years,since there is nothing to stop the runaway, I doubt there will be anything left.

As to the models you refer to these have usually predicted warming to rise less that the reality ie have tended to be more optimistic than less.

@32 Chaise

Yes I accept there are difficulties to this principal but ,strangely like global warming, there is a need for negative feedback loops. Insurance provides this by disincentivising risk. In terms of your skiing and dangerous sports references this is exactly how foreign travel insurance works.

@46 Bob

‘What of those who are born with a genetic disposition to chronic or even fatal ailments? ‘

I think you will find that people do not expose themselves to genetic dispositions. Moreover I am not suggesting that we move entirely to a health insurance based health service merely that weight should be given to good behaviours as opposed to bad ones. The issue of obesity related disorders is I think a good example. I would be the first to admit that obesity is caused largely through the comodification of processed food that the state and industry largely encourage. Part of process includes the lack of proper public health funding as well as education and proper health education and enforcement. One just needs to see the reaction of Gove to Jamie Oliver, the food labelling debacle which has gone on for years and the Government’s ambivalent attitude to alcohol pricing to see that the state really isnt interested in its citizens welfare.
The power of insurance is that it doesnt rely on the State and it becomes personally empowering ie. it hurts bad behaviour and in doing so it immediately educates. I would suggest those asked to pay high premiums would be instantly curious as to why and would do something to reduce them.

On this issue of Breast Cancer, the BRCA1 and BRCA2 genes do provide a disposition to the disease by generally such cancers are caused the overweight, drinking, stress and childlessness – not genetic factors. Poor diet is also implicated particularly since most people in the UK are malnourished.

Punishing someone who is drunk by refusing to treat their injuries makes as much moral sense as punishing someone who is drunk by injuring them.

a&e,

[53] ‘If you play football you should not expect me – a couch potato – to pay for your sporting injuries’ – sure, but if you develop type II diabetes, or suffer a stroke or heart attack because of your sedentary life style will you expect others to pay for years of health care as well as a life long supply of statins, antihypertensives, biguanides, and anticoagulants?

Quite; if everything is risky, what risks do we pay for and how much? I pay £1 extra this month because I play football, but football is also good for me so we’ll discount it by 50p; I also swim, so we’ll knock off some more money; but I am addicted to cheesecake this week, so I’ll have to add on another £1; I walk to work, crossing several roads, so we’ll add on another £1, but walking is good for me, so we’ll take off 50pm… [cont. for each and every detail of my life]

@26

Like a carbon tax ?

The real issue here is the absurdity of libertarians. What these people really believe is that OTHER people should not get help. Hence the tea party people holding up signs saying “get the govt out of my medicare.”

It’s not welfare that they hate, but the wrong type of people getting it that irks them. Romney’s comments about those people who don’t pay tax being moochers, is quite funny coming from someone who won’t release his tax returns (quite common for Americans running for office) because he wants to hide how little tax he pays. Romney also has pledged to increase the defense budget. Just a different form of welfare, but for the right sort of people.

The messaging of this is actually genuinely frightening if you think about what it being suggested.

While people contrast how hard it would be to enforce consistently – there is no consistency intended. Basically alcohol in terms of drunkeness has become a handy euphamism for “horrible lower class types, not lovely white middle class people”.

This is why our lovely middle and upper class political world is so comfortable attacking alcohol. It conjours up, in the minds of those in politics, an impression of those awful reality TV shows and the occasional shock-doc about young people getting drunk and shaging and fighting.

It expressedly means “not people like you” to the membership of the Lib Dems.

And that is important. Like everyone, they want a free ride and resent other people getting stuff they don’t think they deserve. Of course being Lib Dem it isn’t the done thing to whinge about immigrants costing the NHS money. So they complain about working class people. But they would’t want that to be seen to be the case, so they take one stereotypical working class behaviour (binge drinking, which we’ve been doing for thousands of years) and use that as the euphamism.

While the Romans complained about Londoners not watering down their wine – our modern rulers actually use that complaint to build resentment and get their way.

@ MOCO

In reality, because of propagation delays we were all probably doomed by the time the first evidence was available, so I agree,along with some Greens, that windmills and light bulbs aren’t the answer. I think the answer is that there is no solution and in less than 100 years the global population will significantly fall. Within 200 years,since there is nothing to stop the runaway, I doubt there will be anything left.

Wow. You really have swallowed the hook, haven’t you?

You were only supposed to believe in it enough to be prepared to alter your behaviour so that someone could make some money. You weren’t expected to walk up and down cinema queues with a doomsday sandwich board.

However your fatalism is, in fact, refreshing from a warmist because it demonstrates a much more logical reaction to the scenario that is presented.

You understand that if you are correct, we’re doomed and that if I am correct, we’re not and that to pretend or believe that both of us turning the central heating down is going to make the slightest bit of difference to the outcome is just plain STUPID.

And don’t worry, by the way.

You’re wrong.

MoCO

“Yes I accept there are difficulties to this principal but, strangely like global warming, there is a need for negative feedback loops. Insurance provides this by disincentivising risk. In terms of your skiing and dangerous sports references this is exactly how foreign travel insurance works.”

Don’t you think that the fact that they were injured in the first place would count as negative feedback? Global warming’s different precisely because there’s often little-to-no impact for the perpetrator, because the effect is spread wide. Africans suffer for European pollution, for instance.

@ 63 m4e

“While people contrast how hard it would be to enforce consistently – there is no consistency intended. Basically alcohol in terms of drunkeness has become a handy euphamism for “horrible lower class types, not lovely white middle class people”.”

Good point. We’ve wandered off the original topic, which was just “punish horrid drunken people”.

“This is why our lovely middle and upper class political world is so comfortable attacking alcohol. It conjours up, in the minds of those in politics, an impression of those awful reality TV shows and the occasional shock-doc about young people getting drunk and shaging and fighting.

It expressedly means “not people like you” to the membership of the Lib Dems.”

Not sure whether this is a Lib Dem issue. One swallow does not a summer make.

But yeah, attitudes towards alcohol tend to take an “I’m all right, Jack” approach. Prefer to drink wine at £10 a bottle or more? Demand minimum pricing. Don’t drink at all? Demand it be taxed £2 to the unit, or banned. Drink beer? Demand spirits be heavily taxed.

I remember a great example: someone saying that we should solve the nation’s drinking problem by raising the legal age to 25 and putting punitive taxes on alcopops. I am a psychic, and thus have ascertained that this person is over 25 and doesn’t like Smirnoff Ice.

@62

‘The real issue here is the absurdity of libertarians’

How many do you know? I think it helps if you stick to issue.
An insurance based principle in essence is the most effective way of balancing resources against risk. Thats why insurance is used for pretty much everything. Pensions are set via a similar principal. I dont think its helpful to suggest this is necessarily a rich/poor divide or indeed a yob/decent folk divide. On the alcohol front I would suggest the Middle income groups and old would get hit worse on an insurance based system.

The downside of a free for all system is that anyone can abuse themselves at whatever cost . This is clearly unsustainable given the rise in obesity related diseases just for starters. Moreover insurance is a great way of undermining the production of the rubbish that most food manufacturers offer up these days.

@63

Any insurance system would probably hit the boozing Middle classes far more than the Saturday night folk so thats not really an argument.

MOCO

‘The real issue here is the absurdity of libertarians’

How many do you know? I think it helps if you stick to issue.

I think Sally @62 was posting on the wrong thread.

Not entirely uncommon…..

No this is not the wrong thread. This is about some fake libertarian lib dem who wants people to pay for medical treatment that he views as being not worthy. It’s classic fake libertarianism. Of course he should continue to get his salary and expenses, and his pension all payed for by the tax payer. Because in his mind he is worthy.

@ Sally

Romney’s comments about those people who don’t pay tax being moochers, is quite funny coming from someone who won’t release his tax returns (quite common for Americans running for office) because he wants to hide how little tax he pays. Romney also has pledged to increase the defense budget. Just a different form of welfare, but for the right sort of people.

Admittedly many of your comments could be cut and pasted seamlessly anywhere, but I really think this one should be on the Romney thread.

@70

So do you think the NHS should fund the medical consequences of all behaviours? If so how do think the implications of the obesity epidemic will be funded? What percentage of GDP would you go to for medical expenditure in this country?

@65

Bad experiences usually have a negative impact for the individual particularly if they are immediate and obvious. Many problems in medicine take years before consequences are apparent hence the need for a more actuarial approach. I was thinking more along the lines that insurance premiums would encourage a structural ‘risk aversion’ .
I know all this comes over as mean spirited but ultimately if the NHS picks up the real cost of booze(for example), the state and their pals in big business will continue to supply it in the required volumes. Insurance at least hits the individual with a potential view of their own medical future.

You are absolutely correct, Margin4error. Almost the entire legislative programme in the HoC for the last two centuries has been in some way connected to how the chattering classes can control the behaviour of the plebs. The Chatterati for all intents and purposes are the same group as the ‘ something must be done ‘ brigade. The something that needs to be done is invariably some form of regulated social control on the plebs for their ‘ own good ‘.

Those who have deep desires to control the behaviour of others kinda lost control with the decline of religious adherence. Therefore, other forms of control had to be developed to sate the puritan appetites. Health promotion fulfills the role perfectly for the contemporary puritans. So much can fit neatly under the banner of health, sex, food, alcohol, narcotics etc. Idleness is sinful moved seamlessly to exercise is the opposite of idleness and exercise is healthy. Health is also something that the Chatterati can easily promote through public information A.K.A. propaganda. It is one of life’s fascinations to watch the ever imaginative Chatterati invent new ways to persecute those they consider beneath them for their ‘ own good ‘.

53: “If you choose to drive – never mind whether you are drunk or not, this is well known as one of the riskiest of life choices, so how can you expect the pedestrians among us to cough up for your accidents?”

Exactly and as I recall, accidents per mile travelled are even higher for pedestrians although flying is much safer than either walking or driving. The implications for safest travel mode are clear enough. The real worry is that the incidence of accidents in the home is terrifyingly high.

I do look forward to reading the entertaining reports of the hearings of the boards of guardians as they decide which patients are deserving of NHS healthcare and which aren’t. I trust lawyers will be allowed to represent the interests of patients at these hearings.

@ 73 MoCO

“Bad experiences usually have a negative impact for the individual particularly if they are immediate and obvious. Many problems in medicine take years before consequences are apparent hence the need for a more actuarial approach.”

But in charging people for sickness/injury, you’re not penalising them until they’re being penalised by nature anyway. If it takes ten years before someone’s drinking leads to them being treated for liver damage, it’s ten years before you get to charge them for it. No advantage.

“I know all this comes over as mean spirited but ultimately if the NHS picks up the real cost of booze(for example), the state and their pals in big business will continue to supply it in the required volumes. Insurance at least hits the individual with a potential view of their own medical future.”

I don’t think it’s mean-spirited; like I said, I do sympathise. But I think the cure’s worse than the disease. Hence the list of problems I gave you. You’ve said you “accept” that there are problems but you haven’t said how you’d address them.

“So do you think the NHS should fund the medical consequences of all behaviours?”

But it does already. You can find risk in almost all activities. Once you go down this root it only benefits the rich, because taxes are cut, and services reduced. I would prefer to live in a society that we pool our wealth for many not a few rich people.

Pretty shit society with people grumbling about “why should I pay for streetlights,because I never go out in the dark, and why should I pay for the fire brigade because my house never burns down.” My experience is these people are usually at the front of the que, when they want something.

“lot more people these days hike up Snowdonia or the like, then get tired and so call the rescue people. Because they don’t feel like walking back down.”

There are 2 other options in Snowdon:

1. The train
2. Gravity.

Ok, last one isn’t quite an option – but it is a lot easier to go down than up. Even the most unfit of couch potatoes can get the train up in the morning, and stroll down in the afternoon on a good day. It’s when the weather goes bad that danger starts to happen.

But the argument you have made is essentially that because some people take the piss, we should charge for the service. A bit like saying that because some 999 calls are bollocks, we should introduce a premium rate number to replace it…..

@77 Sally

‘Once you go down this root it only benefits the rich, because taxes are cut, and services reduced. I would prefer to live in a society that we pool our wealth for many not a few rich people’

Why would taxes necessarily be cut in a particular way. Why would services necessarily be reduced? Please explain.

@76

I haven’t accepted any list as far as I know. I’m certainly not suggesting a tariff at point of sale .

An insurance based system would apply throughout someones life the premium depending on peoples lifestyle choices. I take it from others that life is pretty risky but some risks are significantly higher than others. Ultimately as a country these risks have to be paid for. I don’t minimise the impact of making people aware of these and thus lowering their overall costs. I think that awareness would have a direct impact in respect on risky behaviours, like poor diet in which the government are sadly uninterested .

@78

What about discretionary charging?

@52

Insurance doesn’t necessarily mean private insurance.
The insurance doesn’t have to include existing conditions unless behaviours associated with those conditions are deemed risky.Climbing Mount Everest with dodgy lungs for example

@ 80 MoCO

“I haven’t accepted any list as far as I know. I’m certainly not suggesting a tariff at point of sale .”

Well, @32 I gave you a list of four problems with your system. You didn’t address any of them, but said you accept that problems exist. So do you accept those four problems, or do you still need to address them?

“An insurance based system would apply throughout someones life the premium depending on peoples lifestyle choices. I take it from others that life is pretty risky but some risks are significantly higher than others.”

This runs into all four problems, for example.

“Ultimately as a country these risks have to be paid for.”

Sure. Nobody’s arguing against that.

“I don’t minimise the impact of making people aware of these and thus lowering their overall costs. I think that awareness would have a direct impact in respect on risky behaviours, like poor diet in which the government are sadly uninterested .”

I pointed out @76 that your system doesn’t seem to solve this. You’ve ignored what I said and just restated your position. I’m trying to be polite here, but this evasiveness is starting to annoy me.

@83

Probably didnt see them. Give me a mo

“I think people who expose themselves to medical risk should be asked to pay a top up premium to the state funded through insurance. That way if they engage in risky behaviours they can pay higher premiums. It would also encourage individuals to be more responsible for their own health. ”

I respect the principle, but there’s problems with this. Firstly, if you want it to be consistent, it’s gonna be really complex (50p for having a steak last night, £6 for staying at the ski resort for an extra day, £20 for not replacing the brake pads in your car in a timely fashion…), not to mention that the rules will have to keep changing as medical knowledge increases and technological/social change make things more or less dangerous. It’s unlikely to be this complicated or up-to-date in reality, so what’ll actually happen is that certain groups will get arbitrarily shafted.

It wont be up to date but driven on an events basis.
turn up to a surgery weighing 18 stone and you get the gold card. Go down to 12 stone and so does your premium.

£6 steaks are all in the noise. Everybody eats em so the bill goes to everybody (ie tax). Car brakes – I’m sure you would increase your car premium and talk to the cops too.
If you hurt someone the insurance strangely would cover it.

Secondly, what do we do if they don’t pay? Abandon them? Or should we treat/help them regardless, but make it an offense to go rock-climbing without a permit, a la car insurance?

Think National insurance. Permit idea sounds good but rock climbing isn’t going to hit the NHS budget hard.

Thirdly, where’s the line that defines mental illness for these purposes? Do alcoholics, bulimics, and people with an eating fixation get a free ride, or do they have to pay?

When they were all little they started saving in the insurance pot. Its done on an actuarial basis. Personally I like the drinks industry pay for the impact of drink on society but government says No.

Fourthly, how do we reconcile this with the possibility that this would price poor people out of doing some things, exacerbating an already sizable divide?

Poor people are always priced out of doing most things because they’re poor. What I’m suggesting isn’t to do with income distribution issues.Its an education process more than anything else.

Of course this would be less necessary if the state taxed crap food and subsidised healthy eating.

@64 Pagar

If I am wrong Pagar show me the science. Oh! I forgot your not a Scientist . Ok, show me some magic instead!

MoCO – as I’m sure you know models of health care have been discussed many times.
This paper, from 1999, compares the 3 main (western) schools of thought – the ‘Beveridge’ model, ‘Bismark’, and Private Insurance.
Then, as well as now, the NHS generally provides more for less when compared to systems where insurance is the predominant form of funding, especially private insurance.
http://ndt.oxfordjournals.org/content/14/suppl_6/3.full.pdf

Given that britain is unlikely to find any extra resources to devote to health care the first question to ask any proponent of an insurance based system is what clinical services must be cut to accommodate the higher bureaucratic costs of administering the various insurance schemes +/- monies diverted towards rewarding share holders.

It stands to reason that those with the best insurance policies will receive higher standards of treatment, and those sections of our society most likely to be able to afford the best policies will not be from the bottom of the social pile.

The reason why the NHS is still valued despite some of it’s well documented catastrophes is that it is a comprehensive system, driven by clinical need rather than ability to pay – in other words fairness is built into the organisation’s ethos.

Now you might think the likes of beardy branson will do much better but once you start looking at the actual performance of private providers delivering NHS services the evidence for better and cheaper outcomes is simply not there.

@ 85 MoCO

“It wont be up to date but driven on an events basis.
turn up to a surgery weighing 18 stone and you get the gold card. Go down to 12 stone and so does your premium.”

That’s fine for things like weight and smoking. But do I need to phone up the insurance company every time I play football?

“£6 steaks are all in the noise. Everybody eats em so the bill goes to everybody (ie tax).”

Tax on the steaks or income tax?

“Car brakes – I’m sure you would increase your car premium and talk to the cops too.”

They’re covered by the MOT, but there must be a space between best practice and legal minimum standards. How would this be reflected?

“Think National insurance. Permit idea sounds good but rock climbing isn’t going to hit the NHS budget hard.”

That didn’t answer the question: what are we going to do if people hurt themselves and haven’t paid? You can’t just say “think national insurance”, that’s a totally different system to what you’re proposing.

And what do you mean, it isn’t going to hit the NHS budget hard? Are you only charging for popular activities? Because that’s a bit unfair on the people who do those activities and get charged, while others go rock-climbing for free.

“When they were all little they started saving in the insurance pot.”

How do you propose to tax children?

“Its done on an actuarial basis.”

So this means that, not only are you charging people for bulimia, you’re charging them for things they have no control over, like diabetes. No thanks.

“Personally I like the drinks industry pay for the impact of drink on society but government says No.”

I see the appeal, but disagree. Drinks firms don’t force you to drink 18 pints then throw up on a prize-fighter.

“Poor people are always priced out of doing most things because they’re poor.”

Perfection fallacy. Just because a problem already exists, that doesn’t mean it’s ok to make it worse.

“What I’m suggesting isn’t to do with income distribution issues.”

Oh yes it is, because it’ll hit the poor hardest.

“Its an education process more than anything else.”

No, an education process would be things like “healthy living” lessons in school, ad campaigns, that sort of thing. This is a tax/insurance process that you still haven’t explained why it would have any educational value.

“Of course this would be less necessary if the state taxed crap food and subsidised healthy eating.”

Fruit and veg are already tax-free. The problem with vice taxes is that they’re not as directed as they first appear. Let’s say you and I both eat a massive pizza once a week. However, I’m a couch potato and the pizzas are making me fat, whereas you’re really active and the pizza is actually a calculated part of your balanced nutritional intake. I don’t see why, under your methodology, it’s fair for you to pay that tax as well as me.

Chaise

Just for clarity – I didn’t mean to suggest that the issue of dog-whistle attacks on working class culture and choices was an exclusively Lib Dem activity. It definately isn’t. It just happened that this article was a profound example of the practice and it came from a Lib Dem.

@ A&E

once you start looking at the actual performance of private providers delivering NHS services the evidence for better and cheaper outcomes is simply not there.

Maybe you’re not looking hard enough.

“Transforming an underperforming NHS hospital that was failing to attract patients is no easy task, not least when the hospital has become a lightning rod for opposition to rising private sector involvement in the state-owned health service.

But patients, staff and management are almost unanimous that, in just five months, substantial changes have taken place.

Circle says the Department of Health’s own performance data show that Hinchingbrooke’s accident and emergency department has gone from being one of the worst in the country to one of the best.

Meanwhile, its overall performance is ranked at number six out of 46 hospitals in the Midlands and east England, quite an achievement for a hospital previously labelled a “basket case” by Earl Howe, health minister.”

http://www.ft.com/cms/s/0/bd802a84-bbab-11e1-9436-00144feabdc0.html#axzz26pxWUE28

The fact is that independent surveys of healthcare systems in western Europe have rated the NHS as only mediocre. What distinguishes the NHS is that it combines a state-managed social insurance scheme to cover personal heathcare costs with a verging-on state monopoly providing healthcare services. Other healthcare systems in western Europe don’t have service provision by state run monopolies.

Centrally negotiated pay agreements in the monolithic NHS mean that hospitals and other healthcare supply units can’t respond to local labour market conditions.

LSE researchers predicted that the ensuing difficulty of recruiting and retaining nursing staff in regions with strong labour markets and relatively low unemployment would have worse medical outcomes on average than regions with weaker labour markets where it is easier to recruit and retain nurses. And that is just what they found:

“Hospitals in the north gain from a more stable pool of nurses. Southern ones have to lean on temporary agency nurses, who can be paid more but tend to be less experienced, less familiar with the hospital and less productive. Do southern patients suffer as a result?

“The economists look at the proportion of patients aged 55 or more, admitted to hospital after a heart attack, who die within 30 days. They find a strong link between this ratio and local private-sector wages. The higher the private wage, making it harder to get good nurses in the NHS, the higher the death rate: to be precise, if the private wage is 10% higher in one area than another, the death rate is 4-5% higher.”
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_TDVGGRSS

49. Chaise Guevara

A fair point. And yes, those guys are selfish twats. But that’s not necessarily an excuse for removing the safety net. It might be a reason for the emergency services telling people to bugger off from time to time, though.

I am not suggesting it was. But the welfare state exists because people are not selfish twats. Unfortunately it teaches people to be selfish twats. So we get more of them. We also get a lot of immigration which undermines the sense of community which stops people being selfish twats.

All of which means we will charge for everything in the end regardless of what anyone else here thinks. You will, in the end, change your minds. Or die and be replaced by people who are less soft hearted. Brazil with its shanty towns and billionaires in gated communities is our future.

52. Bob B

On the contrary, it is thoroughly relevant to the apparently persuasive argument that private profit-maximising insurance cover for personal healthcare costs would create a powerful incentive for people to be more responsible about taking care of their health.

I am sure that is true. But it remains irrelevant to this discussion. As no one is suggesting people with genetic conditions are undeserving. You may want to talk about it but it is still irrelevant.

The essential point is that the chronically sick and those with inherited ailments will find it hard to impossible to get private healthcare insurance at affordable cost.

You do not know that. They may, they may not. What they will get is an actual price based on actual risk. Rather than the rest of us paying for it.

Your objection is therefore wrong – as well as being misleading.

No it isn’t because you have clearly not bothered to read what I said much less understand it.

It’s important to be clear about this because those who press the “free market” case against “socialist” medicare often parade the insurance agument as an incentive for individuals to take personal resonsibility for their healthcare.

That may be true, but it is not true here. It may be relevant to some other discussion where people talk about the beauties of insurance, but it isn’t here.

May be, but free market insurance will also leave the chronically sick without cover. We need to be very clear about this.

Well no it won’t. It will give them the option of more expensive health care cover based on how sure everyone is they will demand more medical services. We may need to be clear about this, but it is not clear to me that we need to be clear about it here and now. When we are talking about something else entirely.

What happens if early DNA analysis of women with family histories of breast cancer shows a genetic disposition is regular monitoring with pre-emptive surgery if necessary, sensible steps to prolong life expectancy and to reduce the prospective costs of cancer care.

Up to the point the State decides that is not good enough and opts for sterilisation instead.

Private medical insurance will doubtless take steps to avoid risks by gathering information about family histories etc and withdrawing cover on the grounds that insufficient information was provided about pre-conditions.

Doubtless? You mean in your weird dreams they might? Insurance companies want knowledge. They are more likely to test, or failing being allowed to do that, they will look for one-sided information – ask people if they have been tested. As is perfectly reasonable. They will then offer appropriate insurance that reflects the true costs of the medical condition.

58. man on clapham omnibus

You may not be aware that the models used are free for all to try out.

Probably because it is not true. People have been sitting on their models and their source code for years. People have had to write FOI requests for them. But if you have al ink to some free ones, by all means, I am sure we would all love to see them.

But a simple question. If you accept that CO2 absorbs infra red (this is easily demonstrated) it follows that it’s temperature will rise. If the temperature of the CO2 in the atmosphere rises the temperature of the planet will rise by the same logic.

There is no question there, but no, this is not true. It works well in the lab. But the Earth is a vastly complex system we understand poorly. There are feedbacks. It may be that more CO2 means a rise in temperature which causes a rise in cloud cover which causes a drop in temperature and so the net effect is minimal. The evidence seems to suggest so. So you have no basis for making that childish claim.

The famous ‘hockey stick’ graph shows the meteoric growth of CO2 .

No it does not. The readings from Hawaii – which almost certainly have something wrong with them – show the rise of CO2. Different graph. Different people.

Stick the two together and hey presto Global warming.

If the Earth was a test tube in the lab. Sure. But not if, you know, it is a little bit complex.

The sad thing is once the permafrost starts seriously melting this will release Methane which I think is about 11 times as powerful as Co2 in absorbing heat by that time there is no turning back.

The Earth has been colder. The Earth has been warmer. A lot warmer. Redwoods once grew above the Arctic circle. Those methane deposits survived them all. They are very old. There is precisely no reason to think that a little moderate warming now is going to release them when vastly greater warming in the past did not.

Make no mistake, Pagar, Global warming exists and in all probability there is nothing to stop it running away. The sad fact is that this situation was predicted by MIT in the late 60?s as I recall.

Back then Greenies were calling for a mass release of CFCs to prevent global cooling? How interesting. No, you cannot say Global warming exists. Even if you did, there is no plausible mechanism by which it might run away.

As to the models you refer to these have usually predicted warming to rise less that the reality ie have tended to be more optimistic than less.

That is a flat out lie.

I would be the first to admit that obesity is caused largely through the comodification of processed food that the state and industry largely encourage.

Yeah because God knows it can’t be because lazy people eat too much.

Part of process includes the lack of proper public health funding as well as education and proper health education and enforcement.

If only those oiks had more nice middle class people like you to lecture them – after all, they can’t be smart enough to know eating too many chips makes you fat, right?

@ 89 M4E

Cool.

@ 92 SMFS

“I am not suggesting it was. But the welfare state exists because people are not selfish twats. Unfortunately it teaches people to be selfish twats. So we get more of them. We also get a lot of immigration which undermines the sense of community which stops people being selfish twats.”

That’s all more or less true.

“All of which means we will charge for everything in the end regardless of what anyone else here thinks. You will, in the end, change your minds. Or die and be replaced by people who are less soft hearted. Brazil with its shanty towns and billionaires in gated communities is our future.”

I think you’re doing that thing where you examine a current trend and assume it will continue forever at the same rate with no other factors coming into play. You know, the sort of thing that leads people to say that a country with a falling population will one day contain a minus number of people.

First, while I accept that local communities are not what they once were, I don’t think an end to local communities would herald the death of empathy. Knowing your neighbour is one cause of sympathy, not the only one.

Second, it’s likely that communities will change and be redefined rather than die. Thanks to the proliferation of transport, the rise of the internet, and gentrification, the focus on “local” is fast disappearing. I think this is a little sad, but probably more due to nostalgia than anything else.

Third, welfare hasn’t lead us to have a constantly rising number of unemployed people, which is what you’d expect if dependency begat dependency at a rate necessary to cause a continuing shift towards professional benefits claimants.

Finally, the effect of immigration in undermining communities is driven by the number of people seen as immigrants. In other words, fairly new arrivals, especially those with a poor grasp of English. If X immigrants arrive in a community over thirty years, in the meantime Y existing first-gen immigrants have died, and Z naturalised second- and third-gen immigrants have been born, who fit in and aren’t seen as immigrants at all.

@ SMFS

“If only those oiks had more nice middle class people like you to lecture them – after all, they can’t be smart enough to know eating too many chips makes you fat, right?”

To be fair, it wasn’t that long ago that I came to realise/accept that eating too much bread made you fat. I had little interest in nutrition till fairly recently, and before that tended to divide food into “good” and “bad”. Bread and cheese both qualified as “good”, so I didn’t watch my intake. I went from skinny to chubby. Similarly, I worried about my alcohol consumption for its own sake, but didn’t think about the calories in beer. There was a certain amount of self-deception involved, I think.

So while everyone knows that greasy chips make you fat, there are probably plenty of people who have an inaccurate idea of what specific foods are better than others. I bet loads of people don’t know that, unit for unit, they could halve their booze-related calorie intake by switching from beer to wine. And there’s the “credit and debit diet” thing: people eat lots of healthy food to “cancel out” pizza and burgers, which is great for vitamins but doesn’t help your waistline. This suggests that people have a hazy view of the issue.

Public education could help here, but it would have to be better than the preachy stuff you get in schools and in posters in the doctor’s waiting room, or the clumsy “Eat five fruit and veg a day for no particular reason!” campaign. It would have to focus less on scolding people for eating certain foods, and more on giving them the info: your body wants roughly X calories a day, that pizza you’re having for dinner contains X/2 calories, so you might want to have a light lunch.

@94

”You may not be aware that the models used are free for all to try out.

Probably because it is not true. People have been sitting on their models and their source code for years. People have had to write FOI requests for them. But if you have al ink to some free ones, by all means, I am sure we would all love to see them.”

Please go to http://climateprediction.net/ for a start to your education and hopefully participation

”But a simple question. If you accept that CO2 absorbs infra red (this is easily demonstrated) it follows that it’s temperature will rise. If the temperature of the CO2 in the atmosphere rises the temperature of the planet will rise by the same logic.

There is no question there, but no, this is not true. It works well in the lab. But the Earth is a vastly complex system we understand poorly. There are feedbacks. ”

Yes I agree there are feedbacks but these are not negative feedbacks ie. the pattern of change is not being opposed. All the significant feedbacks are reinforcing.

IE the air warms the water. The water melts the polar ice reducing the planets albedo (reflectivity) the lack of ice leads to further warming and then the permafrost melts releasing methane. Along with all that less absorbtion though deforestation more forest fires releasing CO2 and less predictability in weather systems leading to extinction of native vegetation. All positive feedback loops sadly.

”It may be that more CO2 means a rise in temperature which causes a rise in cloud cover which causes a drop in temperature and so the net effect is minimal. The evidence seems to suggest so. So you have no basis for making that childish claim.”

My understanding is that cloud cover has minimal effect because water strongly absorbs IR
What papers have you read which suggest the opposite? Please provide links.

”The famous ‘hockey stick’ graph shows the meteoric growth of CO2 .

No it does not. The readings from Hawaii – which almost certainly have something wrong with them – show the rise of CO2. Different graph. Different people.”

Atmospheric CO2 levels are measured at hundreds of monitoring stations across the globe.
Independent measurements are also made regularly by airplanes and satellites. Before 1958, CO2 levels were determined from air bubbles trapped in polar ice cores. In pre-industrial times over the last 10,000 years, CO2 was relatively stable at around 275 to 285 parts per million. Over the last 250 years, atmospheric CO2 levels have increased by about 100 parts per million. Currently, the amount of CO2 in the atmosphere is increasing by around 15 gigatonnes every year.

”Stick the two together and hey presto Global warming.

If the Earth was a test tube in the lab. Sure. But not if, you know, it is a little bit complex.”

Yes that is why there are complex models.I’m sure if you have something valid to add other than ‘its all a bit complicated for me ,being a non scientist, to understand’
then they would no doubt welcome your call.Models are never 100% accurate because all systems involve chaos even ones that look stable like the planets going round the sun. However finely tuned models are the best approximation to a predictive tool as we can get. Given the risks and the empirical data it would be more than foolish to ignore them. Unless you are a selfish fool of course. Which sadly characterises the position of most nation states not directly suffering at the moment and surprisingly some that are.

”The sad thing is once the permafrost starts seriously melting this will release Methane which I think is about 11 times as powerful as Co2 in absorbing heat by that time there is no turning back.

The Earth has been colder. The Earth has been warmer. A lot warmer. Redwoods once grew above the Arctic circle. Those methane deposits survived them all. They are very old. There is precisely no reason to think that a little moderate warming now is going to release them when vastly greater warming in the past did not.”

Yes but where are all the Redwoods now along with all the other vegetation that died and is now chemically broken down? Its under the ground and in some parts of the world frozen at the moment.

The permafrost is currently releasing Methane as we speak and like the polar cap is melting. The extent and impacts are largely unknown and at the moment left out the current models. Take a look at this for further info

http://www.lter.uaf.edu/pdf/1562_Schuur_Abbott_2011.pdf

”Make no mistake, Pagar, Global warming exists and in all probability there is nothing to stop it running away. The sad fact is that this situation was predicted by MIT in the late 60?s as I recall.

Back then Greenies were calling for a mass release of CFCs to prevent global cooling? How interesting. No, you cannot say Global warming exists. Even if you did, there is no plausible mechanism by which it might run away.”

Please provide some evidence for this. In any event it entirely irrelevant given that the models now and the computers to run them on are in a different league.I would be still interested in more information on this however.

”As to the models you refer to these have usually predicted warming to rise less that the reality ie have tended to be more optimistic than less.

That is a flat out lie.”

Please provide evidence to back up this statement.

”I would be the first to admit that obesity is caused largely through the comodification of processed food that the state and industry largely encourage.

Yeah because God knows it can’t be because lazy people eat too much.”

I am not sure where your data to correlate obesity with laziness comes from.Perhaps you could expand on this.Maybe as a first step you might like to contact to the current Communities Secretary. I’m sure he would have a view.

”Part of process includes the lack of proper public health funding as well as education and proper health education and enforcement.

If only those oiks had more nice middle class people like you to lecture them – after all, they can’t be smart enough to know eating too many chips makes you fat, right?”

Given the high currency put on slim figures in today’s society the notion of wanting to be obese runs counter I would suggest. So therefore people either aren’t aware of the effects of their eating habits or cant control them adequately . Either way its not good because of the association with so many illnesses and disabilities.
Eating chips makes you fat,right? Well not necessarily; depends how many and how often.They are however carcinogenic so I wouldnt recommend eating them in any event. Lack of exercise and incrementally eating more calories than you expend will cause weight gain.

Part of the issue is health education for everybody since the nutritional value of most foods is dropping due to the depletion of minerals in the soil and intensive farming. The issue regarding manufacturers putting salt and fat in processed food is possibly well-known but with poor labelling of foodstuffs impossible to translate at the checkout. The health dis benefits and consequent costs to the public purse are also known.It is clearly a legimate area for public health policy
I would say most of the population don’t know the impact of their eating habits. One particular group are children. You may have noticed there is an epidemic of obesity (and type 2 diabetes) amongst them.

Out of interest,do you regard Jame Oliver’s attempt at turning kids lives around through better diet as cultural imposition? Are studies showing better diet leads to better educational outcomes in children also cultural imposition ?

54. Sally

Oh dear, how little you know the Christian cracker voters. Remember Glenn Hoddle and his Karma comments about people born with defects was punishment for what they did in a previous life.

Isn’t it racism for Sally to criticize the religious views of so many Hindus and Buddhists? Christian Crackers are so rarely known for believing in Karma.

96. Chaise Guevara

I think you’re doing that thing where you examine a current trend and assume it will continue forever at the same rate with no other factors coming into play.

A quarter of British primary school children come from non-English speaking homes. Five of the top six countries of origin are India, Pakistan, Bangladesh, Somalia and Nigeria. If we got no more immigration ever again, the simple process of these people growing up and trending to the norm – that is, it will take a while for their birth rates to drop to the UK average – means White English people will become a minority in the UK.

So no I am not. You may not live to see Britain become a minority-majority country but your children will.

First, while I accept that local communities are not what they once were, I don’t think an end to local communities would herald the death of empathy. Knowing your neighbour is one cause of sympathy, not the only one.

What are the others? The local communities are not ending. They just aren’t communities. And they are filling with people whose culture does not stress that sort of empathy.

Second, it’s likely that communities will change and be redefined rather than die. Thanks to the proliferation of transport, the rise of the internet, and gentrification, the focus on “local” is fast disappearing. I think this is a little sad, but probably more due to nostalgia than anything else.

So local communities will become full of people who never speak to their neighbours? How is this helping your case?

Third, welfare hasn’t lead us to have a constantly rising number of unemployed people, which is what you’d expect if dependency begat dependency at a rate necessary to cause a continuing shift towards professional benefits claimants.

Well it has really, hasn’t it? Dependency certainly does begat dependency in many cases. But let’s agree it is not guaranteed. So what? Where’s the relevant? There won’t be a shift because the declining number of people with actual real jobs will increasingly not give a sh!t about the feral underclass and will refuse to pay for their lifestyles. As we can see happening.

Finally, the effect of immigration in undermining communities is driven by the number of people seen as immigrants. In other words, fairly new arrivals, especially those with a poor grasp of English.

So America, which has not had a lot of recent large scale Black immigration, should not have a problem with its African American community? Nor should Brazil?

If X immigrants arrive in a community over thirty years, in the meantime Y existing first-gen immigrants have died, and Z naturalised second- and third-gen immigrants have been born, who fit in and aren’t seen as immigrants at all.

If speaking English and immigration are the only things that matters. Brazil suggests otherwise. We have given up on race, but no one else has. Religion plays a role. So do values and culture. There is no reason to think that Black people in the UK will ever think of White people in the UK as their fellow countrymen in the same way that White people used to about other White people. America has shown racial differences lead to less sense of community. So has Brazil.

97. Chaise Guevara

To be fair, it wasn’t that long ago that I came to realise/accept that eating too much bread made you fat.

Because you listened to the bullsh!t the government told you. I fail to see how more bullsh!t from the government is going to be a solution. They do not know what they are talking about. So public education ain’t going to help.

98. Man on Clapham Omnibus

@94

Please go to http://climateprediction.net/ for a start to your education and hopefully participation

So you have managed to find one site where people *hope* to make climate models publicly available. Excellent. Good for you. Do you have a response that actually addresses the issues? Again, none of the important models that people actually use are public domain. Often they are defended quite strongly.

Which is not surprising because the East Anglia e-mail leak showed they are crap. Even their programmers think they are crap.

Yes I agree there are feedbacks but these are not negative feedbacks ie. the pattern of change is not being opposed. All the significant feedbacks are reinforcing.

Now you are simply lying. We do not know. We do know that shipping and airplane contrails seem to cool the planet. So clouds, on the whole, probably do too.

IE the air warms the water. The water melts the polar ice reducing the planets albedo (reflectivity) the lack of ice leads to further warming and then the permafrost melts releasing methane.

You are still pushing this methane bullsh!t? Good for you. That may happen. Or it may not. What we do know is that the Earth is not merely robust, it is massively robust. So the feedbacks cannot be all negative.

My understanding is that cloud cover has minimal effect because water strongly absorbs IR

So you don’t know what the f**k you are talking about. Fine. Clouds reflect incoming light back out to space. Thus keeping that IR out to start with.

Atmospheric CO2 levels are measured at hundreds of monitoring stations across the globe.

They are now. But Keeling did the grunt work back when it was not fashionable. But nice to see you admit your mistake.

Yes that is why there are complex models.

No, the models are not complex. They cannot be complex. They are in fact crud. As anyone with any grounding in Numerical Analysis or any experience in these sorts of models knows. They cannot be complex because we cannot solve these sort of equations. We can only approximate.

Models are never 100% accurate because all systems involve chaos even ones that look stable like the planets going round the sun.

Wow. It really is like talking to someone from the sixth grade. You think if you throw in concepts like chaos we will all think you know what you are talking about? There is a joke that someone asked Heisenberg about life after death. He said he wanted to ask God about two things – relativity and turbulence. And that he expected God might have an answer to relativity. It is not that the atmosphere is a little difficult. It is that these sort of aerodynamic problems are the hardest mathematics to model known to mankind.

However finely tuned models are the best approximation to a predictive tool as we can get.

Actually no. For a start they rely on “tweaking”. Which is to say, they run the models against past data and fiddle with the settings until they get something like the past record. Which people used to admit openly before I started pointing out this fraud and places like Realclimate deleted all their admissions. The models are not as good as simply assuming this year’s climate is going to be the same as last year’s. That is the best approximation we have.

Given the risks and the empirical data it would be more than foolish to ignore them.

No it wouldn’t. It would be sensible to ignore them. As they are useless.

Yes but where are all the Redwoods now along with all the other vegetation that died and is now chemically broken down? Its under the ground and in some parts of the world frozen at the moment.

Which is nice but irrelevant. Most of it is probably in the atmosphere actually.

The permafrost is currently releasing Methane as we speak

No it is not. At least not in any unusual amounts.

and like the polar cap is melting.

Depends which one you are looking at. The North is losing ice, the South is adding it.

Please provide some evidence for this. In any event it entirely irrelevant given that the models now and the computers to run them on are in a different league.I would be still interested in more information on this however.

Evidence for what? That some Greenies wanted a mass release of CFCs to prevent global cooling? See the first edition of James Lovelock’s Gaia. Their computers could be in a completely different league. It does not matter. There are inherent errors in trying to approximate the atmosphere. You cannot get away from them. The bigger your sphere of study, the longer you run it, the more important those errors are going to get. This is a law of nature like gravity. Deal with it. It means the models will never not be crap. Not until our mathematics is vastly better. For which, see Heisenberg’s quip.

Please provide evidence to back up this statement.

You are making the claim. You prove it.

Given the high currency put on slim figures in today’s society the notion of wanting to be obese runs counter I would suggest.

Strawman. No suggested they did want to be fat.

So therefore people either aren’t aware of the effects of their eating habits or cant control them adequately .

Or they don’t give a damn, or any one of a dozen other reasons. You sound like those Christians who say Jesus has to be mad or God.

Either way its not good because of the association with so many illnesses and disabilities.

A weak association.

Part of the issue is health education for everybody since the nutritional value of most foods is dropping due to the depletion of minerals in the soil and intensive farming.

Well at least you are amusing. Is there any batsh!t insane conspiracy theory you do not believe?

No, the models are not complex. They cannot be complex. They are in fact crud. As anyone with any grounding in Numerical Analysis or any experience in these sorts of models knows.

Wow, so General Circulation Models are “not complex”, and anyone with any grounding in Numerical Analysis knows this.

That’s truly the stupidest, most diametrically opposite to the truth thing I’ve read since… well, since I last read a SMFS comment.

If they’re so “not complex”, then why did it take millions of person-hours and the expertise of top numerical analysts and fluid dynamicists to program them? And why do we need the fastest supercomputers to run them? “not complex”, indeed. Genius.

Your argument is basically We can’t solve the Navier-Stokes equations, therefore we don’t need to worry about climate change. That’s a wonderful argument, really, very clever indeed. But it does rather ignore, well, the entire science of computational fluid dynamics.

102. Larry

Wow, so General Circulation Models are “not complex”, and anyone with any grounding in Numerical Analysis knows this.

That’s truly the stupidest, most diametrically opposite to the truth thing I’ve read since… well, since I last read a SMFS comment.

Well good for you Larry. I like to think I am continuing the education you obviously failed to get in school.

If they’re so “not complex”, then why did it take millions of person-hours and the expertise of top numerical analysts and fluid dynamicists to program them? And why do we need the fastest supercomputers to run them? “not complex”, indeed. Genius.

Umm, originally they were no such thing. When people started out they did not have millions of man-hours or a supercomputer. The point is that the atmosphere is so vastly complex – beyond our ability to model it in any detail for the foreseeable future – that they can expand their toys as much as they like. As long as they can scare someone into funding them. But their models will still not be complex enough. And they aren’t.

Your argument is basically We can’t solve the Navier-Stokes equations, therefore we don’t need to worry about climate change. That’s a wonderful argument, really, very clever indeed. But it does rather ignore, well, the entire science of computational fluid dynamics.

No it is not. My argument is that we cannot solve any approximation to the atmosphere and therefore models of anything more complex than, say, an aircraft wing (which you will notice requires wind tunnel work because the models are not complex enough even for a wing) is not going to tell us much worth knowing. Global warming will have to find evidence for or against elsewhere.

But then if you could read we wouldn’t be having this conversation would we?

And no, it does not ignore the field of computational fluid dynamics. It rather relies on it.

@ SMFS

“A quarter of British primary school children come from non-English speaking homes. [...] White English people will become a minority in the UK.”

I’ll take your stats on trust for the moment. Why are you concerned about whites becoming a minority?

[Me: "Knowing your neighbour is one cause of sympathy, not the only one."] “What are the others?”

Bog-standard empathy. Personal connections. Believe it or not, humans can care about people who don’t live within half a mile of their front door.

“So local communities will become full of people who never speak to their neighbours? How is this helping your case?”

It’s helping it perfectly. You seem to be stuck on local communities; specifically, you seem to think that they are the only form of communities.

“Well it has really, hasn’t it?”

Nope. Check the stats.

“Dependency certainly does begat dependency in many cases.”

True, and I’ve never argued otherwise. You want “beget” there, by the way. Present tense. Grammar and all that.

“But let’s agree it is not guaranteed. So what? Where’s the relevant? There won’t be a shift because the declining number of people with actual real jobs will increasingly not give a sh!t about the feral underclass and will refuse to pay for their lifestyles. As we can see happening.”

Nice try. But you just pretended to agree with what I was saying, if only for argument’s sake. And now you’re suddenly ignoring what I was saying. This is known as “having your cake and eating it.” You can’t agree that welfare won’t spiral out of control, then base your arguments on the assumption that welfare will spiral out of control.

“So America, which has not had a lot of recent large scale Black immigration, should not have a problem with its African American community? Nor should Brazil?”

Don’t know much about Brazil. The US doesn’t have a problem with black people, at least not in a big way. What it has a problem with is people who have been disenfranchised for several generations. A disproportionate number of those people are black. Guess why?

“We have given up on race, but no one else has. Religion plays a role. So do values and culture.”

Agreed. But they follow the same trends I already mentioned.

“There is no reason to think that Black people in the UK will ever think of White people in the UK as their fellow countrymen in the same way that White people used to about other White people.”

Are you aware of how ludicrous this sounds? The native black people I meet seem exactly as British as the native white people I meet. As one would expect. It takes someone like you for me to even think about the “threat” of black people, consider the evidence, and realise it’s not a problem.

Most of us stopped being scared of people with different skin about 30 years ago. Feel free to catch up.

“Because you listened to the bullsh!t the government told you. I fail to see how more bullsh!t from the government is going to be a solution. They do not know what they are talking about. So public education ain’t going to help.”

Nah, it was because I liked eating bread. So I convinced myself that bread was harmless. That was it. I’m not going to tilt at windmills when this was clearly a case of me believing what I wanted to believe.

If I’m wrong, show me the government’s “Bread Contains No Calories!” campaign.

But then if you could read we wouldn’t be having this conversation would we?

What I can read is that you’ve amended your position from saying that the GCM models are “not complex” to now arguing that they are “not complex enough”, and in doing so you’ve moved from being hilariously roll-on-the-floor ridiculous, to merely being wrong. I guess congratulations are in order – that’s definite progress!