It is well-known that the austerity ushered in by Cameron's new Conservative goverment heavily contributed to excess deaths.
After a decade of continued underfunding of public services, leading to a collapsed social and health service, you realise the question really isn't that deep
Well known anecdotally perhaps, but this is the first time I've seen a major publication link the two issues (possibly I don't read enough of the news). Hopefully we see more like this.
> the five local authorities with the highest average life expectancy can expect to live 83.6 years, which is nearly 10 years longer than the 73.9 average in the five councils with lowest life expectancy at birth.
https://www.theactuary.com/news/2022/08/24/uk-house-prices-s...
The good thing about trading the livelihood of future generations for the livelihood of the current generation through reckless spending is that the future generation doesn't get a vote.
There is a difference between defunding and underfunding. It doesn't take much to realise ~6% (average) increase is quickly eroded by inflation and population changes.
NHS funding has been effectivley stagnant [1]
There are also more complex issues beyond a single percentage metric.
Your original post said NHS budgets were undergoing austerity -- meaning spending cuts. Now that that's been shown to be utterly false, your terminology has evolved to "stagnant".
NHS funding increases are over 2,000% higher than France, a comparable first-world country, since 2010 -- according to World Bank data.
If the UK has "stagnant" spending increases, what's happening in comparable countries with way less spending increases? France has 0.3%/year healthcare spending increases in that period.
6.5% is not stagnant. It's not austerity. In fact, it's OVER DOUBLE the rate of inflation, contrary to your claims of "erosion by inflation". NHS funding is skyrocketing in real terms and in per capita amounts, over and above inflation.
To claim spending increases are eroded by either inflation or population changes is a lie. It's rising per capita at over 2x inflation. Zero erosion, except perhaps in the fever dreams of The Guardian journalists.
Before Brexit was concluded, a lot of EU citizens in the UK started leaving. Why wait until the turmoil kicks you out when you can be proactive. Just like people start interviewing for a new job before the old company finishes going bankrupt.
The effect mentioned started before Brexit, so the link has to be with something else - in the article's conclusion it's a related Tory problem, austerity
this is true, but the tory nonsense has exacerbated it. i (in uk) have a commercial carer (not nhs; i am bedbound) from lithuania (or estonia, or latvia - she keeps telling me & i keep forgetting) who is lovely, smart and kind. her only failing is that she can't cook, but that gives me an interest - last week i taught her how to do scrambled eggs on toast!
we need more people like this in the uk, not fewer. but our vile government will never get a clue.
Not really, the UK government lowered the bar for work visas significantly post Brexit and the NHS is on the approved sponsors list. Anyone who would have been affected was given a visa.
I’m not sure that’s the case. My partner works in the NHS and the vast majority of her colleagues are European or Commonwealth immigrants: Romanians, Polish, Nigerians, and Indians in the main.
A bit offtopic, but does anyone who has worked with media organisations in the past know, how much an individual developer time is spent in creating an interactive feature report like this? Also, are there publishing tools that allow creation by something like drag and drop in the CMS or is it often custom frontend code?
My understanding is that these places slowly accumulate their own libraries for some semi-automated framework (like svelte for example, though I don’t think this is svelte). This knowledge comes from my working in a media watchdog, and my own analysis of the New York Times’ code so the economist may be different. I also (obviously) don’t have first class access to these things only what we’ve been able to probe using osint tools and analyzing the javascript/html/css.
Ah, thanks for the insight. That would make sense, I will try to probe around more to see if it is possible to make them more accessible to other media publications as well.
As a Brit I can't help but notice that on every axis, our country appears to be in decline at the moment. Even before Brexit, things hadn't been going well, as this article shows. It's making me seriously consider moving away.
I want to have hope that as a country we can turn around this societal regression, but I fear it's a deeper problem than just the current government. The class system and an unhealthy nostalgia for when we were more important in the world seem to be holding us back.
I am not sure how in a totally integrated free market world, a country like UK can compete with US or China. The amount of funding US can put into new areas like green energy and the internal market and capital it offers is something UK can't compete with. This is why UK origin founders are one of the biggest cohort of immigrant unicorn founders in US.
Although, I am not sure where a Brit would move to, if they want to have similar social systems. Most of the EU also seems on the path to decline as well.
Also, unlike say a German or a French expat, a British expat would have little problem moving to US, Canada, Australia or NZ as there is little language or culture barrier, so if those countries do well, why won't a skilled Brit just moved there.
Taiwan, South Korea, and Israel all have much lower populations than the UK and yet remain important global influencers.
It isn't all about population. The USA has 1/4 the population of China and yet technologically is a peer competitor. Japan had less than 1/2 the population of the USA in the 1980s and was a technological peer competitor.
With wise investment in capital equipment, education, and technology, even small, resource-poor countries can punch far above their weight. The UK remains a sufficient economy to serve as a foundation to rise significantly above its current situation. Imagine a UK with a $150,000 USD average income, thanks to intensive investment for a generation. If that sounds unrealistic, so would our current level of average incomes to people living in 1900. Somehow we've just lost the belief that we can continue to dramatically increase our quality of life.
Between its nuclear deterrent and soft power, the UK could remain a global power for at least the next couple of centuries if it chose to do so.
I wonder what the electoral interest would be in a UK political party that advocated the goal of doubling the nation's per capita income in 10 years?
To be honest it is all about population. Industrial/technological first mover advantage has now gone really. You need the concentration of talent that only drawing from a very large pool can achieve. US, EU, China are the 3 poles at the moment - with Africa and South America as potential for the future if they can get their governance sorted out.
The UK stopped being a global power after Suez - not for nothing is Brexit known as 'Suez for slow learners'
A nation with a 10x higher per capita of truly productive scientists and engineers (with a well functioning R&D system that wasn't just publish-or-perish or other friction that reduces efficiency) would perform roughly as well as a nation with 10x the population. Somewhat but not perfectly analogous to how some countries invest more, or more wisely in their military budget, and have equivalent military power as much larger countries.
So if the UK invested such that it had 10x the per capita scientists and engineers, let's say 10% of the population vs 1%, then it could compete with a nation of 680 million.
If it also invested more wisely in capital equipment, business efficiency, legal efficiency, and so on, it might be able to get further multipliers and compete with the biggest economies in the world.
> So if the UK invested such that it had 10x the per capita scientists and engineers, let's say 10% of the population vs 1%, then it could compete with a nation of 680 million
With the equal outcome approach taking over universities and sciences being considered the unfashionable stream unlike East Asia, how would you do this?
Even if you are able to, why won't these trained people just leave for US when they realise they are compensated more and taxed less there?
> With the equal outcome approach taking over universities and sciences being considered the unfashionable stream unlike East Asia, how would you do this?
Clearly that approach is harmful and is preventing the economic development of nations, which in turn harms those who need assistance because there’s a smaller tax base.
But as other nations 'catch up' and turn out productive scientists and engineers in similar ratios, the disparity in the denominator becomes overwhelming. E.g. China.
To add an example. Israel with 9.3 million population has more productive scientists and engineers than whole continent of Africa with 1.2 billion population.
you could try raising the level of education. breeding a whole bunch of people and hoping some of them teach themselves to be useful isn't really a great way of maximizing intellectual output
certainly education is vital to a modern economy (and society), but I suspect that you hit diminishing returns at our current levels - not many more can really benefit from e.g. post graduate studies. Sending ~50% of school leavers to uni in the UK has arguably been counter productive, as instead of a path for the talented to rise, uni has become more a rubber stamp for entry into the middle class and course content has become diluted (and then loans on top to pay for it all)
> but I suspect that you hit diminishing returns at our current levels
I think there are plenty of uses for another million bioengineering grads. Combine the grads with R&D funding and we’d see a regular cadence of medical miracles.
Similar for materials scientists, robotics engineers, etc.
Also on a low tech side, a million more teachers, teaching much smaller classrooms, might pay for itself many times over.
Israel has an existential threat next door and the region where they have to exist and their past drives them to have real ingenuity in innovation.
Taiwan and South Korea are modelled after Japan like obedience to authority and way higher tolerance for tough work conditions than a western European nation. Is it realistic to assume that a Brit would work 12 hours in a job?
I am not trying to say UK lacks the talent to do it, it absolutely does have the talent and historical pride to do it, but as a nation it is too distracted and bogged down by social chimeras to be like South Korea/Taiwan.
> Taiwan and South Korea are modelled after Japan like obedience to authority and way higher tolerance for tough work conditions than a western European nation. Is it realistic to assume that a Brit would work 12 hours in a job?
1st, historically Western European countries absolutely did work 12 hour days, back when that made any kind of economic sense, despite the human misery it creatd.
With modern knowledge work, a forced 12 hour day is probably not going to help anybody achieve more. Although a very very highly educated, very very highly compensated, might choose to work longer hours, but hours aren't what would cause the higher productivity.
A forced 12 hour work day doesn't make people achieve more, but if you have to compete with others whose output is 1.3x of yours by putting in those extra hours, people will do it with efficiency.
> Although a very very highly educated, very very highly compensated, might choose to work longer hours
Yes, like SV companies are able to do but not sure how this will work in UK.
> I wonder what the electoral interest would be in a UK political party that advocated the goal of doubling the nation's per capita income in 10 years?
Probably about the same as the electoral interest in a party that promised everyone a perpetual motion machine, which would be about as capable of achieving its promises. (The recent UK electoral record of promises you'd have to be utterly delusional to believe isn't bad actually, just helps to have a lot of backing from the status quo!)
The UK already has more global influence than Taiwan, South Korea and Israel and massively outsize influence for a country making up less than 1% of global population and an even smaller fraction of its land physical resources, it's just this global influence isn't guaranteed to be used wisely, never mind benefit the lifespan of the average citizen.
SK & Taiwan have working hours that would be considered hellish in West. At the top level & for immigrants, US working hours are similarly hellish. The British may be just as productive per hour, but they could never keep up on time. Personal life in SK/Taiwan is non-existent as demonstrated by the countries having the 2 lowest fertility rates in the world. On the contrary, Israel is another story of fertility rates. At ~3.0, they have so many young people, that there is always ample labor available to support Govt. money-sinks like welfare and healthcare.
All of these nations are a glowing endorsement for conscription. Conscription lifts the entire population to a certain level of mediocrity that helps avoid labor unemployability. It's no surprise that other successful nations include Singapore & Scandinavia.
Israel's high fertility rates are driven by Arabs and ultra-orthodox Jews (haredim), two groups that, by and large, do not drive entrepreneurship and the tech sector. Quite the opposite, in fact, the haredim are exempted from military service and around 60% of them live off welfare.
And the only country in Scandinavia with real (universal) conscription is Finland.
Agriculture is something like 2% of the economy of the netherlands. Additionally, the vast majority of agricultural production in the other countries you mentioned is consumed domestically. The netherlands isn't richer because of agriculture in any way whatsoever. Its richer because its population is much more productive across its entire economy.
> the vast majority of agricultural production in the other countries you mentioned is consumed domestically.
A sensible argument, lets see...
2019 Arable Land (Million Hectares):US 157.7, India 156, Russia 121.6, China 119.5, Brazil 55.8, Nigeria 34, Ukraine 32.9, Argentina 32.6, Netherlands 1
Arable Land/Population (Hectares): US 475 000, Brazil 260 000, China 84 630, Netherlands 57 000
> Agriculture is something like 2% of the economy of the netherlands.
And employs only 2% but for the size of the country it seems quite the accomplishment?
>British expat would have little problem moving to US,
Yeah it's the lack of integration/internal market/capital that really disadvantages UK who is #3 in scientific output, respectable per capita basis as well. Low switching costs less factor on pure science than ability to commercialize/convert into value add, i.e. actually making stuff. Which others have covered under culture, IMO medium/large sized countries like UK need to work twice as hard for 10% advantage to stay competitive like east Asia. This isn't the 60s anymore where half the globe is rebuilding/playing catchup, it's not enough to just work smart/efficiently when competitors working smart but also _hard_, even if hard is less efficient but eeks out enough extra competitiveness to matter.
> Most of the EU also seems on the path to decline as well.
Far from it, the EU is at the forefront of many things, especially when it comes to regulation. The influence reaCh has had on manufacturing worldwide demonstrates that it remains one of the three big players on the global stage. Its commitments to social democracy and privacy of its citizens gives it a unique edge in some respects over the US.
I don’t quite understand the sequence of events that brought us here, but I am convinced that we need to kick the Conservatives out at the next election at the very least.
I don’t think “many times” is an accurate characterisation.
The Tories have been in power for about 12 years now. And anecdotally I feel we did a lot better during the last Labour government (questionable overseas military action notwithstanding).
Might have changed things in 2017 or 2019. How close it was spooked the establishment so much that they had to create a massive campaign of false smears to force out the radicals in the Labour Party…
I don't think the conservatives are the problem per-se, rather it's a flawed political system that rewards the biggest bullshitter, imposes no penalties for lies, misconduct and conflicts of interest, and a term limit that's way too long so the feedback loop is extremely long.
I hate the Conversatives as well and would like to see them booted out of principle but I'm not under the illusion that the other option is going to do any better long-term beyond some minor post-election platitudes.
FWIW As a US citizen I feel similarly. The switching cost feels too high to move, as I can't really see myself living somewhere other than the West Coast (family, friends etc)
It's a shame humans don't have more empathy and sympathy for each other, and that governments have been so obviously co-opted by the wealthy and powerful for their own benefit.
One of the things that does make me feel better is being more involved in my neighborhood and local politics, where occasionally things you do can have a real impact. (For example I got a stop sign installed on my street, people still speed but usually they'll stop at it, making the neighborhood a tiny bit safer)
Point to a single time in history this hasn't been the case.
Things are a lot better now than they used to be.
The only thing that has really changed is that the post-war American boom is over. Cheap labor, cheap money, cheap everything has returned to baseline and reached the costs felt elsewhere in the industrialized world.
Things aren’t better at all. People say this because we have better technology, medicine, etc. but there was never a time in the past when humans had the life sucked out of them as they do now. We are raised inside boxes, our whole lives elapse inside boxes staring at screens and our social and emotional brain networks atrophy, leaving us damaged and hollow. Like zombies. There is no escaping the state. The law is absolute, there is no chance of escape or starting over. There is no land that is mysterious, the world has been collapsed. There’s no mystery in the world compared to before. AI gets better by the month and now most people can’t rationalize or ignore it: humans will face obsolescence soon. This is bad not just for the obvious reasons. We ingest chemicals and environmental contaminants that make us extremely sick. People are keeling over from heart attacks, obesity much more than they used to. I’ve read a lot of history and I would much rather live in 1720 than 2020.
I don't know honestly, never been to any of these places and after moving around several times within the US I realize how nice it is to just be setted in one place, but here's what I would consider: Netherlands (I really like biking), Germany (Cologne seems like a nice vibe), France (Probably Paris, Food obviously, but I also really appreciate people's willingness to protest stuff)
Hard disagree. Paris is lovely and gets more so every day with reduced car traffic increased greenspace etc. You're mad.
The only place better is Amsterdam
Nederlands has not so great weather. If you're used to the West Coast and like to cycle, try Girona. A bit more wet though. Pay is obviously a lot lower than you may be used to.
Where would you move, and for what? The “wealthy and powerful” enjoy similar if not better corporate and investment tax rates in most of Western Europe as on the west coast of the US.
The social services those countries have that we don’t are largely paid for by the middle and upper middle class, not the “wealthy and powerful.”
Everywhere has problems, it’s less about perfection than simply being a better option. I’ve generally considered Canada the best option for a while. English speaking, low crime, same time zone with family, etc.
New Zealand, or one of the Nordic countries aren’t that far behind. Australia, England, and Western Europe etc are much lower, but still have plenty going for them.
The biggest thing America has going for it is my friends and family happen to live here.
Crime rates are a city by city and neighborhood by neighborhood issue. Most of the USA is very safe; my city has zero murders most years. The statistics are thrown off by a few neighborhoods in a few cities like Chicago that have degenerated into third-world war zones. While that's a terrible situation and we need to fix it, most HN users can easily avoid those places.
Even the “safe” parts of the US aren’t all that safe.
Ontario which includes Canada’s largest city and 38% of the population had a lower average murder rate between 2016 and 2020 than every single US state but New Hampshire. Quebec population 8.5 million is significantly lower.
These statistics aren’t completely equivalent due to various factors, but it’s close enough for reasonable comparisons.
You’re comparing a rate - murders over population, of a province with a vast rural population with few murders to US cities where murders are concentrated.
The most populous “city” in Wyoming is Cheyenne with 63,957 people. Ontario meanwhile includes Toronto population City:2,794,356, Metro Area: 6,202,225.
If you want to talk cities, Toronto has a 2x - 3x higher per capita murder rate than my city in the US, so like GP said, it depends where you are. Sure you can generalize over a whole country, but ultimately what will matter is a city by city comparison where you actually are. And I'm safer here than Toronto.
I can’t find any independent US city with crime rates that low. If by city you mean some wealthier part of a larger metropolitan area then compare it to a similar portion of Toronto.
A lot of those still seem to have lower violent crime rates than Toronto, Brampton, Mississuaga, and probably every other >200k population place around Toronto. So it's like I said, best to refrain from huge generalizations like Canada / USA when it doesn't matter for our specific circumstances.
Or, keep saying 'Even the “safe” parts of the US aren’t all that safe.' from an area that is more violent than mine in the US...
Boise Idaho is the only independent city (not part of a larger metro area) on that page listed with a lower murder rate than Toronto.
However, it’s not consistent year to year going from a vastly higher 5 per 100k in 2007 then dropping to 0.5 in 2008, then back to 2.9 in 2009 etc. Looking at the most recent years it’s roughly comparable with Toronto, but the long term average is higher. Suggesting it’s a more dangerous city with higher annual variance in rates. https://www.city-data.com/crime/crime-Boise-City-Idaho.html
Violent crime statistics are based on different standards in different areas and are therefore much harder to actually compare than dead bodies. Even with dead bodies there’s some ambiguity for people who died after the fact from injuries and when murder is more ambiguous etc. Violent crime rates between states let alone countries face different definitions, levels of reporting, etc so you really need to closely examine both raw data and methodology to do a solid assessment. Simply looking at official data from a Wikipedia table etc is very misleading.
One day, on my way to work, there was a two hour backup, because the Eisenhower was closed for a murder investigation.
One day at work, making gears, I heard what sounded like fire-crackers... turns out there was a shooting in front of the gear factory. I had to drive through a murder crime scene to exit the parking lot.
Per capita numbers don't erase that from my memory.
Chicago’s per capita murder rate is much higher than the US.
In 2021 Chicago had 29.6 per 100k people where the US averaged 6.5 per 100k in 2020. The 4 least dangerous districts in Chicago are actually slightly below to the US’s average murder rate. https://www.judiciary.senate.gov/imo/media/doc/Ander%20testi...
The point of roughly equivalent sized cities is small entities can be much larger statistical outliers. A small city can go from a higher rate than Chicago one year to 0 the next year. Meanwhile Chicago’s numbers don’t really change with a single mass shooting etc.
I'm not talking about what's perfect or not perfect. I'm talking about why OP thinks "the wealthy and powerful" are the reason for whatever shortcomings they perceive about the U.S.
Canada, for example, has basically the same corporate tax rates as the U.S. Canada's capital gains tax rate is effectively about the same as the U.S. for high income earners, because of only half of it is included in income. The social services are paid for by higher middle class taxes, including an 18% total VAT in Ontario.
Europe is far worse for everything being designed to serve the wealthy though.
Income tax is 40+% and VAT usually 25% so you lose so much income to the state.
Meanwhile there is often no property or inheritance tax, and capital gains tax much lower than income tax, so wealthy aristocrats and landowners pay a far, far lower amount of tax proportionally.
It's just that the wealthy in the US are mainly industrialists, whereas in Europe they're landowners and aristocrats.
In the long run, the British culture of checking, enduring, regulating and filling in insufficiency will be vital to balancing the world against a centralizing Asian power.
There's a growing longing in people's hearts - a pull - toward authoritarian and religious control. People are chasing Moby Dick's white whale and are filling their hearts with that craving and emotional desire to follow a goal.
It can be really disruptive to a culture that depends on satisfying wants, giving results to clear needs and obtaining what's lacking.
Britian needs a clearer, beautiful relationship to it's future and maybe we can move past nostalgia for the 1800s.
There will be no centralizing Asian power in the long run (this century). China has a fair bit of influence now, but with all the domestic problems it has, it cannot remain stable for much longer and is in for a long, irrecoverable decline.
Really? They have been saying 'this year marked the first decline in China's population' for 30 years? Because that is what China stated this year. Also that they had over reported their population by 100 million. For 30 years you say... huh, I must of missed that.
True it will go in waves this century, but in 160yrs was my aim with that comment. Maybe too long of a time frame to think about, but the next big change in structure will be then.
I'm considering leaving the country as soon as I'm able to also.
The thing that concerns me the most is that I believe many people here have a fundamental misunderstanding of challenges we face as a country, and our class divide seems to contribute to this misunderstanding. As someone who comes from a poorer background and now socialises with people who are fairly affluent it's always surprising to me to see how much misunderstanding exists between the rich and poor in the UK. It's so bad that people often accuse me of lying or have no ability to related to what I'm saying.
I've tried to remain hopeful, but I'm starting to come to accept the answers politicians provide for our problems will always more of the same: higher taxes, more spending, more immigration, etc. If we want go get out of this mess I think we're going to need some new ideas and some very stronger leaders who are willing to make very unpopular decisions.
This isn't xenophobia. I can explain my reasoning here if need be. Have I to say this because some people are likely to assume bad faith.
The mains two would be that in general the upper-middle class and wealthy don't understand the financial incentives of the poor. And the poor tend to believe everyone with a job earning more than £35,000 is "rich" and needs to be aggressively taxed.
For example, when I tell people that most of my family choose to have children in their early twenties as a means to move out of their parents homes those who are wealthier simply don't believe me. They simple don't understand that if you have no skills and your family have no money, you're not going to afford a house no matter how hard you work as a cleaner or cashier.
So this means that most people in my family who live in nice houses are actually unemployed, and typically single mothers. While those who work generally live with their parents or in small run down flats.
Further, it's very common for these people to be getting so much support from the government from various disability allowances, child support, and benefits such as support for energy bills, free school meals, disability cars, etc, that they actually can't get a job because doing so would dramatically reduce their standard of living. So for example I know a single mum with 5 kids who is a drug addict. A large part of the problem is that she has nothing going on in her life so she just sleeps all day and then does drugs in the evening. My girlfriend tried to help her get a job a few years back but the adviser told it wouldn't be financially sensible decision given how much she'd lose in benefits income and support. And well, now she's a prostitute because it's cash in hand and she recently been in hospital for liver failure... I could give you countless stories like this from my family.
But the point I'm trying to make is that if you're poor and working class you won't be able to ever afford a house in the UK. So instead you're basically forced into claiming benefits, and to improve your standard of living you need to learn how to exploit the system while doing illegal things on the side. The thing you're not incentivised to do is work.
On the other side of the coin my family believe myself and those social with are "posh", because we earn say £50,000 - £100,000 and most of us can just about afford a 2-3 bed home by 30. I know a women who was impressed by a guy she was dating recently because he had a £38k income and was a manager in a retail store. I mean, that's not a bad income, but if you're middle class you would never consider that wealthy...
I'm pretty lucky because despite going to crappy schools I was autistic enough to be good at computer stuff which allowed me to break the cycle. But even I'm in no position to afford children right now. And realistically me and my girlfriend only have 5 or so years to get our finances in order if we want to have them. So in all likelihood I will never be in a position to afford children and I have above average income.
The truth is a household income of around £60,000 in the UK won't go that far after tax and expenses if you're living in a major city. You might get to a good place eventually, but you'll never afford a family before you turn 30. You might afford it by maybe 35-40, but this assumes you make a lot of good decisions (or have wealthy parents).
So I get quite upset when my family tell me I'm wealthy because I envy their lives so much. I want children like them yet I know that I'll probably never have them. Instead I work long hours and I'm worrying constantly about budgeting. So given what I see, when I hear cries to raise taxes on people like myself to give even more to people on benefits it pisses me off a little.
My controversial take on this is that we should not be giving pensioners non means tested benefits. The majority of our tax goes to free health care, state pensions and various other state benefits for wealthy elderly retirees. And almost none of this support is means...
Largely agree with what you're saying, not so much on retirees, yes they should be means tested, but I have seen old people getting robbed of their homes to pay for some shitty nursing home.
Instead of creating a government policy based on "managing the decline" as they are doing, they should consider policies that will promote improvement.
As a country we're going through a period where people don't WANT things to work. They want them to get worse. That's the Brexit vote and Boris "obviously incompetent" Johnson and 50 other similar examples. It's a very under discussed phenomenon.
Everywhere has problems, I've lived in many countries.
I never moved back to the UK mainly because of the cost of housing though, it feels like such a rip-off - like almost US-level prices, but nowhere near US-level salaries or Scandinavia-level new build quality, etc.
But really everywhere has issues, once you move abroad you'll see how much you take for granted - language, technology, etc.
I've been seeing reports of this across several different countries and various reasons are always given for the cause. However, they are always grasping at straws.
I wonder what the common similarity that each of these deaths has over the past 3 years.
The "problem" here is only that life expectancy has not continued to increase at the rate it was increasing up to around 2010.
I see no reason to assume that life expectancy would continue to increase indefinitely at a linear rate. Most interventions that increase life expectancy (e.g. mitigating major causes of non-age-related death) are subject to diminishing returns.
In my district in the UK, there were occasions when average wait times for an ambulance for a Category 1 incident (eg. person not breathing) reached 48 hours last month.
The target is 90% of patients reached in 15 minutes. Yet the reality is the average wait was 48 hours.
I can't see any way that kind of thing isn't contributing to a shorter life expectancy.
How does something like that even happen...? All I can consider is the relatively small size of the UK, and how one can drive from one side of the other in the UK in just 15 or so hours...
Concerted efforts by the Tories over decades to defund public health so that they can raise a generation of people who sincerely believe that it's best for the country for the government to get out of Healthcare and leave that to the more efficient private sector.
It's a very slow process that requires first the defunding, then some brainwashing via television. The American model.
The UK NHS budget has been steadily increasing. You can't plausibly claim that the Tories have defunded public health over decades. Some might claim that the funding should have increased at a faster rate, but there are limits to what any society can spend on healthcare.
It's easier for people to believe in a personified evil with a face that can be hated and a body that can be killed than it is for them to accept that many of our biggest problems are intractable hyperobjects which are simultaneously nobody's fault and everybody's fault.
I do not think anyone would have a problem with intractable hyperobjects if the King, Prime Minister, and others also had to wait in the same queue at the emergency room.
What people have a problem with is that the problem seems to be tractable for some, and not for others, and whether or not those “some” are worthy of it.
Just cause the dollar amount is increasing doesn't mean it isn't being defunded. You have to account for inflation, population size, and population age distribution.
NHS spending has increased by over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.
Want a comparison? France's healthcare spending increased 0.3% yearly in the same timeframe. The UK is outpacing France's spending increases by 2,066%.
The spending argument is made from political propaganda, not from fact.
France is still in the EU and has lots of former colonies to extract healthcare workers from. Their cultural diplomacy is one of the best compared to any former European colonialistic power.
Could you provide a source for that? Such an increase would imply a doubling of the budget over that time period. I can't find anything that suggests the NHS budget has doubled since 2010.
From what I can gather, the NHS spending adjusted for inflation increased modestly over the time period.
Taking into account the fact that costs in the healthcare sector have increased more than CPI globally, that increase could well correspond to a decrease in purchasing power.
That doesn't yet take into account the UK specific issues around Brexit.
What are you saying exactly? How much should spending have increased to account for inflation, population size, and population age distribution? Please give a specific number. Would that be a good use of limited resources?
Obviously NHS funding can't continue growing faster than inflation forever. That is unsustainable. At some point the NHS would consume the entire government budget.
And also, the population distribution can't continue skewing older indefinitely, that's unsustainable. At some point geriatrics would make up the entire population.
And yet, both of these trends can continue for quite some time, and one trend can outweigh the other for quite some time.
For example, I spoke to a doctor that has to travel between multiple hospitals during the course of their work.
There used to be an in-house service that the NHS owned for transporting medical staff between locations.
That has been privatised as in a contract has gone out for tender and a company won to do the service.
The service used to be reliable.
Now they often have to book Ubers out of pocket to get where they need on time.
The inhouse service is gone. So of course and renewals are going to cost more.
When people talk about the deterioration of the service, a common counterargument is that the money being spent is going up as a way to shut down conversation.
First order problem, the hospitals have no beds. This means that ambulances end up waiting for hours and medics twiddling their thumbs at the ER until the staff can finally take the patient. Medics can't just abandon the patient because there legally needs to be a proper handoff. So your emergency can't be responded to quickly because we can't trivially spin up thousands of new medic units to spend all their time waiting in line at the hospital.
Second order problem, the hospitals have no beds because of a lack of long term care services. From the article...
> There is an acute lack of beds in the accident and emergency department, or A&E, as emergency rooms are called in Britain, which are overcrowded because of an inability to find room for patients elsewhere in hospitals. That is because patients ready to be discharged from the hospital often have nowhere to go as a result of dwindling social services — which have been hobbled by a lack of government funding and severe staffing shortages.
Now the question is why aren't there enough non hospital care services? Could be many reasons, but I'd speculate that it's a combination of a) an increasing population of old, sick people who need care in a society whose demographics are beginning to turn upside down, and b) because Brexit means it's drastically harder to import poor, foreign workers willing to do the shitty job of elder care for low wages. If this prognosis is correct, it starts to beg the question of whether Britain's world renowned health care system was only possible because it could extract excess, cheap labor from poor countries to take care of their old people, when Britain's own young people were never going to do that work for the wages offered.
b) is not exclusive to Britain. A very large portion of the US benefits from poorer countries to the south with high birth rates and porous borders. Probably applies to almost all large developed countries.
In the EU it's the east European countries. Without Bulgarian and Romanian workers the Austrian elderly care system might already have collapsed.
There were even highly pucliciced exceptions during strict lockdowns
Yea, but we are starting to see upcoming issues with nurses in the US where some places just don't have enough. Granted, this is more because hospitals are trying to keep their number of nurses as low as possible. The hospital my wife works at, they suppress the number of nurses when they in fact need more and just hire travel nurses on demand. Then they complain that travel nurses cost too much. I don't think pay is the only factor here. Nurses get paid great by hospitals, but also still get treated like shit. My wife doesn't even get bathroom breaks during her 12 shift and most of the time no lunch break because there is never a nurse available to cover for a 30 minute lunch or a 5 minute bathroom break.
> when Britain's own young people were never going to do that work for the wages offered
Too true. I’m from Canada where we worry nurses will go south of the border, but was recently in London at an NHS hospital and was talking about this with a nurse. Pay for nurses in Canada is on par with a Jr Developer here. (Still low for the hours and effort required!) By comparison, nurses in the UK make about as much as an intern or admin assistant. After all, single payer means there isn’t much pressure to raise wages from other sectors, you’ve a monopoly on nursing so you can set the wages at whatever level keeps staffing adequate, which isn’t the same thing as paying a living wage…
My understanding is, to a large extent "beds" really means "physical bed and sufficient staff to support the patient in it" and the ingredient most missing is the latter.
Doctors tend to be ridiculously overworked in the UK. This is much worse recently - first doctors were off sick / isolating due to Covid. That means less doctors to do the same jobs having to work harder. That drives more doctors to either leave or take long term sick leave - goto 1.
The care home vaccine mandates were far more impactful than Brexit. There were mass resignations when the government forced care home workers (and only them) to take the COVID shots.
I don’t get why people are even bothering to call at this point, surely you’re better off calling a taxi or driving the person yourself and then just carrying them into the ER and shouting for help. They’re in the building that way and they can’t just ignore a collapsed person in the middle of a hallway
I remember an article that some ambulance drivers are doing it as volunteering (they are trained). There could be a rideshare/gig-economy take on deploying more ambulances+drivers subsidized by hospitals/government: and drivers can be called in on-demand during surge - local community folks would be driving anyway.
I understand EMT are very well trained. You would want those techs to be as trained as possible. So that could be the limiting factor.
There isn’t much point in going to A&E - there are no doctors. I amputated my fingertip (halfway up the final joint, with a blunt instrument - crushed the thing off) a week ago and was told to go home and use glue and tape to close the wound, and to throw away the tip. I’ve been dunking it in meths to sterilise and dry it.
They literally did nothing. Contrast to Latvia where I bisected my thumb with an axe and they put it back together about 20 minutes later and charged me €9.
I also have a 8 week old child - zero checkups, no vaccination appointments available, no doctors appointments available. No follow ups for my wife after birth. Oh, and we had to do it all at home, as there is no space in hospital for childbirth - the beds are all full of people who should be in old people’s homes, but there are no spaces in homes for them to move to.
I am ridiculously glad to be back in Portugal as of today, and tomorrow I will take her to the village clinic, where she will finally have a medical inspection.
Defunding of old people's homes (and lack of staff) seems to be a problem in my here in FInland as well. Elders who aren't in good enough condition to live alone end up just flooding ER rooms. Nurses visiting at home may be cheaper, but it's not a working solution for everyone.
Username checks out. You're in decent company, I believe Randolph Fiennes also self amputated his fingertip after it got frostbite on one of his expeditions.
Where injuries are, to use a morbid phrase, ‘incompatible with life’, a paramedic can declare them dead, but a doctor needs to issue the certificate with the cause of death.
How does the caller know an ambulance is coming? How do we know the call didn't end up in a black hole?
We see where the driver is on Doordash. Similarly there should be a text message confirmation with a tracking link to the ambulance on the way and the destination hospital.
This is a fine technical solution to a different problem. The issue is not that people don't trust the ambulances, or want to keep track of them to feel more in control. The issue is that there aren't enough ambulances in the first place, not enough beds to put people in when they arrive at hospitals, nor enough people to treat them when they've got a bed.
I don't necessarily think it's a bad idea in general, but adding tracking to ambulances is not going to magically make them turn up faster.
As I understand it, there are enough ambulances if they are just transporting people to a hospital. There are not enough ambulances if they are being used as overflow beds for the hospital because the patients cannot be admitted because of lack of space.
> In my district in the UK, there were occasions when average wait times for an ambulance for a Category 1 incident (eg. person not breathing) reached 48 hours last month.
This is a pretty shocking number. Where can I read more about this?
The waits are crazy long because hospitals are full, so the ambulances end up outside the hospital entrance for a long time, waiting for a free bed for their patient/passenger.
Your linked page has no reference to wait times on category 1 calls exceeding 48 hours (nor anything close). Neither do any of the results I clicked through on the _extremely_ helpful SERP link.
I did find this page[0] which says, referring to category 1 calls:
> In December 2022, the response time crossed 10 minutes, the worst performance on record.
So it certainly sounds like an _average_ wait of 48 hours for a category 1 call is not at all grounded in reality.
And in terms of average wait times by area, the Guardian published the following data in Dec 2022 (based on a FOI request to ambulance trusts):
<quote>
For category one calls, the most urgent, where an ambulance is meant to arrive within seven minutes, several areas reported waiting times close to or more than 15 minutes.
The longest average wait for such calls was in Mid Devon, with a time of 15 minutes 20 seconds, almost three times as long as the average of 5 minutes and 48 seconds in Hammersmith, west London.
</quote>
So the 48-hour average waiting time claim does not stand up to scrutiny.
Sorry, but this is just wrong. There is absolutely no way that an average wait time - usually 7 minutes - for a cat 1 call will be 48 hours. Unless someone made a heinous mistake and somehow forgot a call one time, it never "on occasion" goes to 48 hours. As soon as it goes over a relatively small number (30 mins odd) they start bringing in other districts to help.
Are you really telling me that we just decided to let people die for 2 days straight? Got any proof on that one?
To actually answer your question and not bow to the HN-is-reddit comment above: London draws on Kent/other surrounding areas temporarily... big cities (usually) feed into small ones. This (usually) is how it works. In the case of COVID we saw 999 response units being shipped all over the country, including call handlers (ie. England handling Scotland's calls) and response units. There are SO many plans in place for this/time-slip/major incident handling that it's mind boggling.
Source: worked for the NHS, still alive despite there being 48 hour cat 1 waits and no ambulances in the entire country.
Lots of cuts to services over a decade before COVID.
Then COVID came and routine treatment is paused, and now yes - we are in a situation where people aren't getting ambulances and at the same time ambulances are piling up outside hospitals as there is no space to take patients.
TLDR - yes, outlet government has been running down the health service to the point people are dying.
"In January, the average response time for a category 1 incident (where an immediate response is required to a life-threatening condition such as a cardiac arrest) was 8 minutes and 31 seconds. Although this is an improvement from the four preceding months, which were all over 9 minutes, the average across 2019 for comparison was 7 minutes and 12 seconds, and the ‘standard’ is 7 minutes.
This is even more pertinent for category 2 incidents, which include strokes and require rapid assessment and/or urgent transport and the standard is 18 minutes. In January this was over 38 minutes, and it passed 50 minutes in October and December. Although the standard was not regularly met pre-pandemic, the average across 2019 was still 23 minutes."
There's a muddled statistic from BBC News here[2]:
"Average waits of more than 90 minutes to reach emergency calls such as heart attacks - five times longer than the target time - with waits of over 150 minutes in some regions. Response times for the highest priority calls, such as cardiac arrests, taking close to 11 minutes - four minutes longer than they should"
(I don't know a difference between "heart attack" and "cardiac arrest".)
"The Royal College of Emergency Medicine believes up to 500 people a week could be dying because of the problems accessing emergency care."
But there are news articles of individual much longer waits:
"When Martin Clark, 68, started suffering with chest pains at home in East Sussex in November, his wife immediately called an ambulance. But none came. She phoned another three times before her and her son decided to drive Martin to hospital themselves 45 minutes later." - https://www.bbc.co.uk/news/health-64243044
"More than half of Staffordshire's ambulances queue outside Stoke hospital on New Year's Eve [...] Some Category One calls - like heart attacks or anaphylactic shocks - have taken him 25 minutes to respond to, compared to a target time of around seven minutes due to a lack of available vehicles because of the queues." - https://news.sky.com/story/more-than-half-of-countys-ambulan... -
Alternatively, I don't understand why we don't have more doctors in the US and drive down prices. I mean, I understand why the AMA wants that, but doctor-work doesn't seem that hard and I have no idea why they need to make mid-six figures.
I could be very wrong, of course, but it seems like most people I went to school with are capable of most doctor work.
If I'm not mistaken medical degrees in the US are postgraduate (in the UK it's undergraduate, albeit it takes more years than is typical), which increases the cost of training of a doctor (both tuition and "opportunity cost"). If you studied for 8+ years in university to become a doctor, the prospects of working as a "slave" on low salary is really unappealing.
Working as a doctor, even at a lower wage, isn't anything like being a slave. And yes, it probably means dropping the education requirements somewhat. People don't need to take that long after graduation to order some tests and prescribe some antibiotics.
And the average US doctor has student loans of around £207,340, so the point stands. UK doctors do pay towards their education, but it’s heavily subsidised.
Compared to the student costs to other UK students. It is the exact same - a preferential subsidization would see medical students get a cheaper education within the UK.
It is hardly genuine comparing to the US system, which is the most expensive in the world.
What is the comparative cost to other European countries?
It's interesting that you can see the one area where the UK welfare state still exists (the 70+ bracket, e.g. pensions), the UK mortality rate has kept a pretty close track to the EU average.
I think anyone with a passing understanding of the UK could see the answer coming a mile off.
This is the inevitable result of the brutal austerity programme pushed through by the Cameron government. It's hard for me to see Brexit outside of this context as well.
What riles me about this piece is that the Economist was championing these exact policies at the time.
203 comments
[ 2.6 ms ] story [ 130 ms ] threadAfter a decade of continued underfunding of public services, leading to a collapsed social and health service, you realise the question really isn't that deep
https://www.theguardian.com/business/2022/oct/05/over-330000...
https://www.independent.co.uk/news/health/austerity-thousand...
Some of the research:
https://openaccess.city.ac.uk/id/eprint/21490/1/‘Dead%20peop...
https://bmjopen.bmj.com/content/11/10/e046417
There's a mountain of evidence that the policies were democidally harmful and economically counterproductive.
Although they did increase financial inequality - which some people seem to consider a good thing rather than a bad one.
https://twitter.com/jburnmurdoch/status/1606223922474627073
> Britain’s grim winter of strikes, falling incomes and a worsening NHS crisis is not some unfortunate series of events
> It’s the inevitable result of a decade of Tory austerity that steadily weakened the state’s capacity to respond to shocks
The average age in the UK is lower than the EU.
Not only has it increased in raw numbers, it's increased per capita, making this argument false by any measurement.
NHS funding has been effectivley stagnant [1]
There are also more complex issues beyond a single percentage metric.
But I am sure you know that
[1] https://www.nuffieldtrust.org.uk/news-item/the-past-present-...
NHS funding increases are over 2,000% higher than France, a comparable first-world country, since 2010 -- according to World Bank data.
If the UK has "stagnant" spending increases, what's happening in comparable countries with way less spending increases? France has 0.3%/year healthcare spending increases in that period.
6.5% is not stagnant. It's not austerity. In fact, it's OVER DOUBLE the rate of inflation, contrary to your claims of "erosion by inflation". NHS funding is skyrocketing in real terms and in per capita amounts, over and above inflation.
To claim spending increases are eroded by either inflation or population changes is a lie. It's rising per capita at over 2x inflation. Zero erosion, except perhaps in the fever dreams of The Guardian journalists.
we need more people like this in the uk, not fewer. but our vile government will never get a clue.
It's all very bespoke.
I want to have hope that as a country we can turn around this societal regression, but I fear it's a deeper problem than just the current government. The class system and an unhealthy nostalgia for when we were more important in the world seem to be holding us back.
Although, I am not sure where a Brit would move to, if they want to have similar social systems. Most of the EU also seems on the path to decline as well.
Also, unlike say a German or a French expat, a British expat would have little problem moving to US, Canada, Australia or NZ as there is little language or culture barrier, so if those countries do well, why won't a skilled Brit just moved there.
It isn't all about population. The USA has 1/4 the population of China and yet technologically is a peer competitor. Japan had less than 1/2 the population of the USA in the 1980s and was a technological peer competitor.
With wise investment in capital equipment, education, and technology, even small, resource-poor countries can punch far above their weight. The UK remains a sufficient economy to serve as a foundation to rise significantly above its current situation. Imagine a UK with a $150,000 USD average income, thanks to intensive investment for a generation. If that sounds unrealistic, so would our current level of average incomes to people living in 1900. Somehow we've just lost the belief that we can continue to dramatically increase our quality of life.
Between its nuclear deterrent and soft power, the UK could remain a global power for at least the next couple of centuries if it chose to do so.
I wonder what the electoral interest would be in a UK political party that advocated the goal of doubling the nation's per capita income in 10 years?
The UK stopped being a global power after Suez - not for nothing is Brexit known as 'Suez for slow learners'
A nation with a 10x higher per capita of truly productive scientists and engineers (with a well functioning R&D system that wasn't just publish-or-perish or other friction that reduces efficiency) would perform roughly as well as a nation with 10x the population. Somewhat but not perfectly analogous to how some countries invest more, or more wisely in their military budget, and have equivalent military power as much larger countries.
So if the UK invested such that it had 10x the per capita scientists and engineers, let's say 10% of the population vs 1%, then it could compete with a nation of 680 million.
If it also invested more wisely in capital equipment, business efficiency, legal efficiency, and so on, it might be able to get further multipliers and compete with the biggest economies in the world.
With the equal outcome approach taking over universities and sciences being considered the unfashionable stream unlike East Asia, how would you do this?
Even if you are able to, why won't these trained people just leave for US when they realise they are compensated more and taxed less there?
Clearly that approach is harmful and is preventing the economic development of nations, which in turn harms those who need assistance because there’s a smaller tax base.
I think there are plenty of uses for another million bioengineering grads. Combine the grads with R&D funding and we’d see a regular cadence of medical miracles.
Similar for materials scientists, robotics engineers, etc.
Also on a low tech side, a million more teachers, teaching much smaller classrooms, might pay for itself many times over.
Absolutely agree on more teachers though.
Taiwan and South Korea are modelled after Japan like obedience to authority and way higher tolerance for tough work conditions than a western European nation. Is it realistic to assume that a Brit would work 12 hours in a job?
I am not trying to say UK lacks the talent to do it, it absolutely does have the talent and historical pride to do it, but as a nation it is too distracted and bogged down by social chimeras to be like South Korea/Taiwan.
1st, historically Western European countries absolutely did work 12 hour days, back when that made any kind of economic sense, despite the human misery it creatd.
With modern knowledge work, a forced 12 hour day is probably not going to help anybody achieve more. Although a very very highly educated, very very highly compensated, might choose to work longer hours, but hours aren't what would cause the higher productivity.
> Although a very very highly educated, very very highly compensated, might choose to work longer hours
Yes, like SV companies are able to do but not sure how this will work in UK.
Probably about the same as the electoral interest in a party that promised everyone a perpetual motion machine, which would be about as capable of achieving its promises. (The recent UK electoral record of promises you'd have to be utterly delusional to believe isn't bad actually, just helps to have a lot of backing from the status quo!)
The UK already has more global influence than Taiwan, South Korea and Israel and massively outsize influence for a country making up less than 1% of global population and an even smaller fraction of its land physical resources, it's just this global influence isn't guaranteed to be used wisely, never mind benefit the lifespan of the average citizen.
It is much easier to organize for smaller countries.
SK & Taiwan have working hours that would be considered hellish in West. At the top level & for immigrants, US working hours are similarly hellish. The British may be just as productive per hour, but they could never keep up on time. Personal life in SK/Taiwan is non-existent as demonstrated by the countries having the 2 lowest fertility rates in the world. On the contrary, Israel is another story of fertility rates. At ~3.0, they have so many young people, that there is always ample labor available to support Govt. money-sinks like welfare and healthcare.
All of these nations are a glowing endorsement for conscription. Conscription lifts the entire population to a certain level of mediocrity that helps avoid labor unemployability. It's no surprise that other successful nations include Singapore & Scandinavia.
And the only country in Scandinavia with real (universal) conscription is Finland.
Is this true? Would love to read about it as a Brit in North America!
Agricultural exports (billions): US $134.8, Brazil $87.2, Netherlands $81.3, China $72.7
Population (millions): US 331.9, Brazil 214.3, Netherlands 17.5, China 1412
Size (km²) US 9834000, Brazil 8516000, Netherlands 41850, China 9597000
https://dutchreview.com/culture/dutch-nitrogen-crisis-explai...
A sensible argument, lets see...
2019 Arable Land (Million Hectares):US 157.7, India 156, Russia 121.6, China 119.5, Brazil 55.8, Nigeria 34, Ukraine 32.9, Argentina 32.6, Netherlands 1
Arable Land/Population (Hectares): US 475 000, Brazil 260 000, China 84 630, Netherlands 57 000
> Agriculture is something like 2% of the economy of the netherlands.
And employs only 2% but for the size of the country it seems quite the accomplishment?
https://www.topuniversities.com/university-rankings/universi...
But laugh a little, we sell more Cheese than France and Italy!
2020 top exporters of Cheese (billions): Germany $4.79, Netherlands $4.11, Italy $3.57, France $3.49, Denmark $1.71
And more beer than Germany!
2020 top exporters of Beer (billions): Mexico $4.89, Belgium $2.08, Netherlands $2.08, Germany $1.28, US $0.503
You see how I'm making your point for you?
Perhaps semiconductors from Hong Kong is a better example.
Yeah it's the lack of integration/internal market/capital that really disadvantages UK who is #3 in scientific output, respectable per capita basis as well. Low switching costs less factor on pure science than ability to commercialize/convert into value add, i.e. actually making stuff. Which others have covered under culture, IMO medium/large sized countries like UK need to work twice as hard for 10% advantage to stay competitive like east Asia. This isn't the 60s anymore where half the globe is rebuilding/playing catchup, it's not enough to just work smart/efficiently when competitors working smart but also _hard_, even if hard is less efficient but eeks out enough extra competitiveness to matter.
Far from it, the EU is at the forefront of many things, especially when it comes to regulation. The influence reaCh has had on manufacturing worldwide demonstrates that it remains one of the three big players on the global stage. Its commitments to social democracy and privacy of its citizens gives it a unique edge in some respects over the US.
I don’t quite understand the sequence of events that brought us here, but I am convinced that we need to kick the Conservatives out at the next election at the very least.
The Tories have been in power for about 12 years now. And anecdotally I feel we did a lot better during the last Labour government (questionable overseas military action notwithstanding).
The end of said switcheroo. The decline more or less coincides with the current Tory run.
I hate the Conversatives as well and would like to see them booted out of principle but I'm not under the illusion that the other option is going to do any better long-term beyond some minor post-election platitudes.
They just literally wait their turn, terrible incompetence and no accountability.
It's a shame humans don't have more empathy and sympathy for each other, and that governments have been so obviously co-opted by the wealthy and powerful for their own benefit.
One of the things that does make me feel better is being more involved in my neighborhood and local politics, where occasionally things you do can have a real impact. (For example I got a stop sign installed on my street, people still speed but usually they'll stop at it, making the neighborhood a tiny bit safer)
Sure isn’t Canada. Sure isn’t anywhere in the EU. Super-duper-sure it isn’t anywhere in Asia.
Things are a lot better now than they used to be.
The only thing that has really changed is that the post-war American boom is over. Cheap labor, cheap money, cheap everything has returned to baseline and reached the costs felt elsewhere in the industrialized world.
Paris is probably one of the worst places to live in Europe. Looks nice on postcards and it's nice to visit when you never live there, though.
You've repeated a cliche about the city.
Did you live there? Anything particular?
That made you decide: "never live there, though"
Even the best place in the US is worse than Paris
The social services those countries have that we don’t are largely paid for by the middle and upper middle class, not the “wealthy and powerful.”
New Zealand, or one of the Nordic countries aren’t that far behind. Australia, England, and Western Europe etc are much lower, but still have plenty going for them.
The biggest thing America has going for it is my friends and family happen to live here.
Ontario which includes Canada’s largest city and 38% of the population had a lower average murder rate between 2016 and 2020 than every single US state but New Hampshire. Quebec population 8.5 million is significantly lower.
These statistics aren’t completely equivalent due to various factors, but it’s close enough for reasonable comparisons.
Edit: I'm an idiot and can't read.
The most populous “city” in Wyoming is Cheyenne with 63,957 people. Ontario meanwhile includes Toronto population City:2,794,356, Metro Area: 6,202,225.
Yet, your more likely to be murdered in Wyoming.
A lot of those still seem to have lower violent crime rates than Toronto, Brampton, Mississuaga, and probably every other >200k population place around Toronto. So it's like I said, best to refrain from huge generalizations like Canada / USA when it doesn't matter for our specific circumstances.
Or, keep saying 'Even the “safe” parts of the US aren’t all that safe.' from an area that is more violent than mine in the US...
However, it’s not consistent year to year going from a vastly higher 5 per 100k in 2007 then dropping to 0.5 in 2008, then back to 2.9 in 2009 etc. Looking at the most recent years it’s roughly comparable with Toronto, but the long term average is higher. Suggesting it’s a more dangerous city with higher annual variance in rates. https://www.city-data.com/crime/crime-Boise-City-Idaho.html
Violent crime statistics are based on different standards in different areas and are therefore much harder to actually compare than dead bodies. Even with dead bodies there’s some ambiguity for people who died after the fact from injuries and when murder is more ambiguous etc. Violent crime rates between states let alone countries face different definitions, levels of reporting, etc so you really need to closely examine both raw data and methodology to do a solid assessment. Simply looking at official data from a Wikipedia table etc is very misleading.
One day at work, making gears, I heard what sounded like fire-crackers... turns out there was a shooting in front of the gear factory. I had to drive through a murder crime scene to exit the parking lot.
Per capita numbers don't erase that from my memory.
In 2021 Chicago had 29.6 per 100k people where the US averaged 6.5 per 100k in 2020. The 4 least dangerous districts in Chicago are actually slightly below to the US’s average murder rate. https://www.judiciary.senate.gov/imo/media/doc/Ander%20testi...
The point of roughly equivalent sized cities is small entities can be much larger statistical outliers. A small city can go from a higher rate than Chicago one year to 0 the next year. Meanwhile Chicago’s numbers don’t really change with a single mass shooting etc.
Canada, for example, has basically the same corporate tax rates as the U.S. Canada's capital gains tax rate is effectively about the same as the U.S. for high income earners, because of only half of it is included in income. The social services are paid for by higher middle class taxes, including an 18% total VAT in Ontario.
Income tax is 40+% and VAT usually 25% so you lose so much income to the state.
Meanwhile there is often no property or inheritance tax, and capital gains tax much lower than income tax, so wealthy aristocrats and landowners pay a far, far lower amount of tax proportionally.
It's just that the wealthy in the US are mainly industrialists, whereas in Europe they're landowners and aristocrats.
Surely when things are in decline, the more nostalgic one becomes, and the less willing one is to let go of things that clearly aren't working.
See Simon Wren Lewis's war against "media macro": https://mainlymacro.blogspot.com/2023/02/fiscal-reporting-at...
> an unhealthy nostalgia for when we were more important in the world
Really? Are you not seeing the connection there?
There's a growing longing in people's hearts - a pull - toward authoritarian and religious control. People are chasing Moby Dick's white whale and are filling their hearts with that craving and emotional desire to follow a goal.
It can be really disruptive to a culture that depends on satisfying wants, giving results to clear needs and obtaining what's lacking.
Britian needs a clearer, beautiful relationship to it's future and maybe we can move past nostalgia for the 1800s.
The thing that concerns me the most is that I believe many people here have a fundamental misunderstanding of challenges we face as a country, and our class divide seems to contribute to this misunderstanding. As someone who comes from a poorer background and now socialises with people who are fairly affluent it's always surprising to me to see how much misunderstanding exists between the rich and poor in the UK. It's so bad that people often accuse me of lying or have no ability to related to what I'm saying.
I've tried to remain hopeful, but I'm starting to come to accept the answers politicians provide for our problems will always more of the same: higher taxes, more spending, more immigration, etc. If we want go get out of this mess I think we're going to need some new ideas and some very stronger leaders who are willing to make very unpopular decisions.
This isn't xenophobia. I can explain my reasoning here if need be. Have I to say this because some people are likely to assume bad faith.
For example, when I tell people that most of my family choose to have children in their early twenties as a means to move out of their parents homes those who are wealthier simply don't believe me. They simple don't understand that if you have no skills and your family have no money, you're not going to afford a house no matter how hard you work as a cleaner or cashier.
So this means that most people in my family who live in nice houses are actually unemployed, and typically single mothers. While those who work generally live with their parents or in small run down flats.
Further, it's very common for these people to be getting so much support from the government from various disability allowances, child support, and benefits such as support for energy bills, free school meals, disability cars, etc, that they actually can't get a job because doing so would dramatically reduce their standard of living. So for example I know a single mum with 5 kids who is a drug addict. A large part of the problem is that she has nothing going on in her life so she just sleeps all day and then does drugs in the evening. My girlfriend tried to help her get a job a few years back but the adviser told it wouldn't be financially sensible decision given how much she'd lose in benefits income and support. And well, now she's a prostitute because it's cash in hand and she recently been in hospital for liver failure... I could give you countless stories like this from my family.
But the point I'm trying to make is that if you're poor and working class you won't be able to ever afford a house in the UK. So instead you're basically forced into claiming benefits, and to improve your standard of living you need to learn how to exploit the system while doing illegal things on the side. The thing you're not incentivised to do is work.
On the other side of the coin my family believe myself and those social with are "posh", because we earn say £50,000 - £100,000 and most of us can just about afford a 2-3 bed home by 30. I know a women who was impressed by a guy she was dating recently because he had a £38k income and was a manager in a retail store. I mean, that's not a bad income, but if you're middle class you would never consider that wealthy...
I'm pretty lucky because despite going to crappy schools I was autistic enough to be good at computer stuff which allowed me to break the cycle. But even I'm in no position to afford children right now. And realistically me and my girlfriend only have 5 or so years to get our finances in order if we want to have them. So in all likelihood I will never be in a position to afford children and I have above average income.
The truth is a household income of around £60,000 in the UK won't go that far after tax and expenses if you're living in a major city. You might get to a good place eventually, but you'll never afford a family before you turn 30. You might afford it by maybe 35-40, but this assumes you make a lot of good decisions (or have wealthy parents).
So I get quite upset when my family tell me I'm wealthy because I envy their lives so much. I want children like them yet I know that I'll probably never have them. Instead I work long hours and I'm worrying constantly about budgeting. So given what I see, when I hear cries to raise taxes on people like myself to give even more to people on benefits it pisses me off a little.
My controversial take on this is that we should not be giving pensioners non means tested benefits. The majority of our tax goes to free health care, state pensions and various other state benefits for wealthy elderly retirees. And almost none of this support is means...
While I think Brexit was unwise, it passed for this exact reason: things hadn't been going well.
I never moved back to the UK mainly because of the cost of housing though, it feels like such a rip-off - like almost US-level prices, but nowhere near US-level salaries or Scandinavia-level new build quality, etc.
But really everywhere has issues, once you move abroad you'll see how much you take for granted - language, technology, etc.
I wonder what the common similarity that each of these deaths has over the past 3 years.
I see no reason to assume that life expectancy would continue to increase indefinitely at a linear rate. Most interventions that increase life expectancy (e.g. mitigating major causes of non-age-related death) are subject to diminishing returns.
The target is 90% of patients reached in 15 minutes. Yet the reality is the average wait was 48 hours.
I can't see any way that kind of thing isn't contributing to a shorter life expectancy.
It's a very slow process that requires first the defunding, then some brainwashing via television. The American model.
https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-...
What people have a problem with is that the problem seems to be tractable for some, and not for others, and whether or not those “some” are worthy of it.
Want a comparison? France's healthcare spending increased 0.3% yearly in the same timeframe. The UK is outpacing France's spending increases by 2,066%.
The spending argument is made from political propaganda, not from fact.
Could you provide a source for that? Such an increase would imply a doubling of the budget over that time period. I can't find anything that suggests the NHS budget has doubled since 2010.
From what I can gather, the NHS spending adjusted for inflation increased modestly over the time period.
Taking into account the fact that costs in the healthcare sector have increased more than CPI globally, that increase could well correspond to a decrease in purchasing power.
That doesn't yet take into account the UK specific issues around Brexit.
The spending argument is nuanced and complex. Declaring that it's "not from fact" just reveals your partisan leanings.
https://www.health.org.uk/news-and-comment/charts-and-infogr...
And yet, both of these trends can continue for quite some time, and one trend can outweigh the other for quite some time.
Ay, there's the rub.
For example, I spoke to a doctor that has to travel between multiple hospitals during the course of their work.
There used to be an in-house service that the NHS owned for transporting medical staff between locations.
That has been privatised as in a contract has gone out for tender and a company won to do the service.
The service used to be reliable. Now they often have to book Ubers out of pocket to get where they need on time.
The inhouse service is gone. So of course and renewals are going to cost more.
When people talk about the deterioration of the service, a common counterargument is that the money being spent is going up as a way to shut down conversation.
Salaries not increasing with inflation.
Staff finding it harder to stay in the UK after Brexit.
Closure of many hospitals, a gradual move (including the previous gov) to many more privatised services.
All these things have increased costs without improving the service.
First order problem, the hospitals have no beds. This means that ambulances end up waiting for hours and medics twiddling their thumbs at the ER until the staff can finally take the patient. Medics can't just abandon the patient because there legally needs to be a proper handoff. So your emergency can't be responded to quickly because we can't trivially spin up thousands of new medic units to spend all their time waiting in line at the hospital.
Second order problem, the hospitals have no beds because of a lack of long term care services. From the article...
> There is an acute lack of beds in the accident and emergency department, or A&E, as emergency rooms are called in Britain, which are overcrowded because of an inability to find room for patients elsewhere in hospitals. That is because patients ready to be discharged from the hospital often have nowhere to go as a result of dwindling social services — which have been hobbled by a lack of government funding and severe staffing shortages.
Now the question is why aren't there enough non hospital care services? Could be many reasons, but I'd speculate that it's a combination of a) an increasing population of old, sick people who need care in a society whose demographics are beginning to turn upside down, and b) because Brexit means it's drastically harder to import poor, foreign workers willing to do the shitty job of elder care for low wages. If this prognosis is correct, it starts to beg the question of whether Britain's world renowned health care system was only possible because it could extract excess, cheap labor from poor countries to take care of their old people, when Britain's own young people were never going to do that work for the wages offered.
Same for doctors, dentists, etc. too.
Too true. I’m from Canada where we worry nurses will go south of the border, but was recently in London at an NHS hospital and was talking about this with a nurse. Pay for nurses in Canada is on par with a Jr Developer here. (Still low for the hours and effort required!) By comparison, nurses in the UK make about as much as an intern or admin assistant. After all, single payer means there isn’t much pressure to raise wages from other sectors, you’ve a monopoly on nursing so you can set the wages at whatever level keeps staffing adequate, which isn’t the same thing as paying a living wage…
Doctors tend to be ridiculously overworked in the UK. This is much worse recently - first doctors were off sick / isolating due to Covid. That means less doctors to do the same jobs having to work harder. That drives more doctors to either leave or take long term sick leave - goto 1.
But the problem isn't with the ambulances, it's with overcrowded hospitals.
I remember an article that some ambulance drivers are doing it as volunteering (they are trained). There could be a rideshare/gig-economy take on deploying more ambulances+drivers subsidized by hospitals/government: and drivers can be called in on-demand during surge - local community folks would be driving anyway.
I understand EMT are very well trained. You would want those techs to be as trained as possible. So that could be the limiting factor.
They literally did nothing. Contrast to Latvia where I bisected my thumb with an axe and they put it back together about 20 minutes later and charged me €9.
I also have a 8 week old child - zero checkups, no vaccination appointments available, no doctors appointments available. No follow ups for my wife after birth. Oh, and we had to do it all at home, as there is no space in hospital for childbirth - the beds are all full of people who should be in old people’s homes, but there are no spaces in homes for them to move to.
I am ridiculously glad to be back in Portugal as of today, and tomorrow I will take her to the village clinic, where she will finally have a medical inspection.
We see where the driver is on Doordash. Similarly there should be a text message confirmation with a tracking link to the ambulance on the way and the destination hospital.
I don't necessarily think it's a bad idea in general, but adding tracking to ambulances is not going to magically make them turn up faster.
An idea for ambulances shortages ^
This is a pretty shocking number. Where can I read more about this?
E.g. https://www.nytimes.com/2022/12/20/world/europe/uk-ambulance...
The waits are crazy long because hospitals are full, so the ambulances end up outside the hospital entrance for a long time, waiting for a free bed for their patient/passenger.
I did find this page[0] which says, referring to category 1 calls:
> In December 2022, the response time crossed 10 minutes, the worst performance on record.
So it certainly sounds like an _average_ wait of 48 hours for a category 1 call is not at all grounded in reality.
[0]: https://www.nuffieldtrust.org.uk/resource/ambulance-response...
<quote> For category one calls, the most urgent, where an ambulance is meant to arrive within seven minutes, several areas reported waiting times close to or more than 15 minutes.
The longest average wait for such calls was in Mid Devon, with a time of 15 minutes 20 seconds, almost three times as long as the average of 5 minutes and 48 seconds in Hammersmith, west London. </quote>
So the 48-hour average waiting time claim does not stand up to scrutiny.
https://www.theguardian.com/society/2022/dec/01/ambulance-wa...
Are you really telling me that we just decided to let people die for 2 days straight? Got any proof on that one?
Source: worked for the NHS, still alive despite there being 48 hour cat 1 waits and no ambulances in the entire country.
Then COVID came and routine treatment is paused, and now yes - we are in a situation where people aren't getting ambulances and at the same time ambulances are piling up outside hospitals as there is no space to take patients.
TLDR - yes, outlet government has been running down the health service to the point people are dying.
"In January, the average response time for a category 1 incident (where an immediate response is required to a life-threatening condition such as a cardiac arrest) was 8 minutes and 31 seconds. Although this is an improvement from the four preceding months, which were all over 9 minutes, the average across 2019 for comparison was 7 minutes and 12 seconds, and the ‘standard’ is 7 minutes.
This is even more pertinent for category 2 incidents, which include strokes and require rapid assessment and/or urgent transport and the standard is 18 minutes. In January this was over 38 minutes, and it passed 50 minutes in October and December. Although the standard was not regularly met pre-pandemic, the average across 2019 was still 23 minutes."
There's a muddled statistic from BBC News here[2]:
"Average waits of more than 90 minutes to reach emergency calls such as heart attacks - five times longer than the target time - with waits of over 150 minutes in some regions. Response times for the highest priority calls, such as cardiac arrests, taking close to 11 minutes - four minutes longer than they should"
(I don't know a difference between "heart attack" and "cardiac arrest".)
"The Royal College of Emergency Medicine believes up to 500 people a week could be dying because of the problems accessing emergency care."
But there are news articles of individual much longer waits:
"When Martin Clark, 68, started suffering with chest pains at home in East Sussex in November, his wife immediately called an ambulance. But none came. She phoned another three times before her and her son decided to drive Martin to hospital themselves 45 minutes later." - https://www.bbc.co.uk/news/health-64243044
"More than half of Staffordshire's ambulances queue outside Stoke hospital on New Year's Eve [...] Some Category One calls - like heart attacks or anaphylactic shocks - have taken him 25 minutes to respond to, compared to a target time of around seven minutes due to a lack of available vehicles because of the queues." - https://news.sky.com/story/more-than-half-of-countys-ambulan... -
"A Grimsby woman thought to be having a stroke had to wait eight hours for an ambulance - and spent a further eight hours in the back of it outside hospital waiting to be seen." - https://www.grimsbytelegraph.co.uk/news/grimsby-news/distrau...
"A Southend pensioner was left waiting eight hours outside a hospital after a 48 hour delay for an ambulance [for a fall and cut head]." - https://www.echo-news.co.uk/news/20205197.southend-pensioner...
[1] https://www.nhsconfed.org/articles/what-latest-data-tell-us-...
[2] https://www.bbc.co.uk/news/health-64254249
When your healthcare strategy is "just employ slaves so we can have free healthcare" of course people will die.
I could be very wrong, of course, but it seems like most people I went to school with are capable of most doctor work.
Did you leave a "not" out of this part?
The NHS pays for the fifth and final year, as Student Fianance (England) will not cover the cost.
Medical students have the same student loans of £60k+ as any other student doing a four year degree
It is hardly genuine comparing to the US system, which is the most expensive in the world.
What is the comparative cost to other European countries?
This is the inevitable result of the brutal austerity programme pushed through by the Cameron government. It's hard for me to see Brexit outside of this context as well.
What riles me about this piece is that the Economist was championing these exact policies at the time.
https://www.economist.com/leaders/2010/10/21/ouch
Everyone these days loves to hate on the spivs and chancers that emerged from this mess, but it's people like Cameron and Osborne who got us here.