Doctors Strike - First in 30 years. Should they?

[Francesca R]

One person's "envy" is another's moral case for redistribution of income. The former term is generally used by the political right, which does not like redistribution much.

Since an accepted role of the government is to redistribute from rich ("lucky") to poor ("unlucky"), then in cases where public sector policy redistributes in the wrong direction, I regard it as an ethically legitimate complaint that this should not happen, and calling that complaint envy, and/or arguing that it is just bad luck (or "you should have fought harder for yours") for outsiders that they face the tax bill to fund the retirement incomes of insiders who are some of the top 1-2% of earners, is poor and smacks of right-wingery to me.

Apart from that, it is something of a legacy anomaly that doctors (who are private contractors or partners in private enterprises) are eligible for the NHS pension fund anyway.

My objection to all public sector DB pensions and fixed retirement ages is far more for the reasons outlined in the thread I linked above, which is the intergenerational unfairness that results from such "mortgage the future" arrangements. Politicians of either stripe can not be expected to not do this over time, and they will only "fix" it when it is so late in the game that the sacrifices imposed seem just as unfair, or more unfair to those who have promises made to them broken.

This kind of thing is one of the most powerful arguments IMO for constitutional limitation of governments' ability to bind as yet unborn generations into non-contingent claims exacted by the generations that precede them. Unfortunately even countries with constitutions have no such limitations written in to them as far as I know.

 

[Beerina]

 

[Francesca R]

There was some union rep on the radio claiming that the scheme was actually in surplus - but it seems hard to believe that it will be in 10-20 years time when there are large retirements of doctors with long life-expectancies ahead of them.

The pension scheme is unfunded, or PAYG, so "in surplus" just means that current contributions are larger than current payouts--which go to the retired scheme members who paid, or had paid on their behalf, lower contributions--yet receive more generous payments than most active scheme members (current contributors) will get.

What it will be like in 10-20 years is the stuff of forecasts of longevity, demographics, inflation and real rates of return, and net migration. Maybe other things too. If it was easy to get such projections right, there would never have been a pensions problem in the first place. The moral issue is who should pay what and why (or who should benefit) when they are wrong. It shouldn't be those who were merely lucky/unlucky to be born at the right/wrong time.

Also, almost every special interest in this type of process has an incentive to say "the scheme is fine the way it is" except the future taxpayer, who either has weak representation (relative to unions, industry lobbies, medical colleges, even patient groups), or no representation at all. So it is hard to believe such statements at face value.

 

[WildCat]

To me it comes back to sheer envy. Private sector employees are envious of public sector pensions. (We) Private sector workers didn't fight hard enough for our pensions and now we're envious of those who are still fighting for theirs.

The problem in the private sector is they can't just raise taxes or print money when the projected pension fund returns fall short. At the end of the day it's math you're fighting. If defined contribution plans are peforming badly, so are the pension funds.

Human beings suck at predicting the future, and will always err on underfunding pensions to spend more now on other things, especially when by the time the feces hits the fan it will be someone else's (future generations) problem.

 

[psionl0]

If doctors don't have the right to strike then the alternative is that they vote with their feet as politicians continue their ideological war against doctors' remuneration.

 

[Soapy Sam]

True- and they probably have more saleable skills than most workers, but in the current global economic climate, where would they go that gives them a better deal than they already have?

 

[Beerina]

The US still has easy-in work visa for doctors. Come on over! We love, and appreciate you here, where you have the sovereign right to pursue your own economic ends as a doctor.

For now.

 

[WildCat]

If doctors don't have the right to strike then the alternative is that they vote with their feet as politicians continue their ideological war against doctors' remuneration.

And where will they go? They'd need to find a country with both a shortage of doctors and one offering a higher pay benefit.

 

[WildCat]

The US still has easy-in work visa for doctors. Come on over! We love, and appreciate you here, where you have the sovereign right to pursue your own economic ends as a doctor.

For now.

And we pay ours so much people die in the streets because they can't afford the rates.

 

[psionl0]

And where will they go? They'd need to find a country with both a shortage of doctors and one offering a higher pay benefit.

There's a shortage of doctors alright. It happens through natural attrition when a career as a doctor starts to look unattractive.

If you don't know your local GP well, you could wait weeks to get a medical appointment.

 

[WildCat]

There's a shortage of doctors alright. It happens through natural attrition when a career as a doctor starts to look unattractive.

If you don't know your local GP well, you could wait weeks to get a medical appointment.

Which country will British doctors flee to en masse?

 

[psionl0]

Which country will British doctors flee to en masse?

Is that what they are going to do?

ETA Maybe "vote with their feet" is slightly misleading. My point is that if doctors are not allowed to protect their working conditions then they will be whittled away. This will result in fewer new entrants (and lower quality entrants) to the medical profession. The same thing happened with school teaching.

 

[WildCat]

Is that what they are going to do?

ETA Maybe "vote with their feet" is slightly misleading. My point is that if doctors are not allowed to protect their working conditions then they will be whittled away. This will result in fewer new entrants (and lower quality entrants) to the medical profession. The same thing happened with school teaching.

Is there evidence of that happening?

 

[Francesca R]

[ . . . ] the alternative is that they vote with their feet as politicians continue their ideological war against doctors' remuneration.

What country are you talking about? GPs in the UK are the highest paid in the world I think. The OECD health division publishes international data. (Not sure how recent the latest update is). The Labour government agreed to a very high compensation deal with the BMA in 2004.

There's a shortage of doctors alright. [ . . . ] If you don't know your local GP well, you could wait weeks to get a medical appointment.

Again, what country? Individual practices in the UK (England anyway) have their own appointments systems but you don't have to wait weeks for appointments if you are sick as far as I know.

I agree that that sort of wait is sometimes necessary for non-time-sensitive appointments. But that is because all GP visits are free to use, and there is almost always going to be a shortage (in other words, rationing) for a free resource because demand is effectively unbounded. To satisfy it, the government would need to increase GP pay through the NHS to even loftier heights. But it is not correct to point to rationing of a fully subsidised service as a justification that GPs are underpaid.

(This is one of several areas, in my view, where most other European universal health systems are superior to the UK. In particular there should be a co-pay for GP visits or a limit on free visits, or some way of using a price-incentive instead of a rationing one)

 

[Rolfe]

I thought he was saying that people in the USA have to wait weeks to see a doctor, which indicated that there was work there for more doctors to come in and mop up the demand.

I don't know about England, but in Scotland you can always get an appointment within 24 to 48 hours. Last time I had to see the doctor I phoned at 8.30am and was given an appointment for 2.40pm the same say. Later, the doctor scolded me for not having insisted on a morning appointment, due to the nature of the injury I had sustained. (My excuse was that I felt it wasn't that urgent, and time proved me correct.)

Rolfe.

 

[Francesca R]

My GP keeps messing about with its appointments system but currently has a "walk in" from 10am which will get you seen before the morning surgery is done. However they let people sign up for it from 9.15am, and people queue before that. So the upshot is that the time between putting your name on the list and seeing a doctor (one of 6; you don't get to choose which) can be 4 hours. If it's urgent they tell you to go to University College Hospital A&E which is about 2km away. You can usually take a view on approximately what time your appointment will come up so that you don't have to wait at the practice all that time. Most folks will be walking distance. With just a small amount of extra tech I'm sure they could rig up a service that texts you when you're near the top of the list but those sorts of investment come out of practice revenue (from the NHS) and are budgeted locally I think (this is pre-tory reforms).

However, if you want a non-walk-in appointment you do have to wait a week or more. Similarly for a clinic appointment such as a blood test. And with the walk-in thing, they zealously don't let you bring up more than one medical issue.

I have previously worked at companies that lay on a private GP, which they do to keep staff from taking a whole morning off to see their NHS doctor. Those cost the firm at least fifty quid a go IIRC, for 10 or 15 min slots.

 

[psionl0]

What country are you talking about?

You're too clever to not know where I live.

 

[Francesca R]

'Fraid not.

 

[psionl0]

Well I figured out that you live in London.

 

[Rolfe]

You're too clever to not know where I live.

Very convenient for the airport.

Funny, I was at the namesake the day before yesterday. It rained all day. I guess it doesn't do that where you live?

Now do the same with my location. If you can.

Rolfe.