Monday, 15 May 2017

Fun Online Polls: Recycling & NHS queue jumping

The results to last week's Fun Online Poll were as follows:

It would be a good idea to charge refundable deposits on...

Glass drinks bottles - 13 votes
All glass jars - 12 votes
Plastic drinks bottles - 9 votes
Aluminium cans - 10 votes
Other, please specify - 0 votes
None of the above 7 votes

Total voters - 22

The low turnout might be because I messed up the widget, or maybe the topic is not that interesting.

That's not an overwhelming majority in favour of deposits. IMHO there are three main reasons for deposits:

a) To encourage recycling of valuable materials
b) To discourage littering, knock-on pollution
c) To discourage use of disposable materials, the production of which harms the environment in the first place.

In which case, the results are the wrong way round.
- Plastic drinks bottles got the lowest number of votes. They are a waste of raw materials but those materials aren't worth much. The point is that producing them causes pollution and they end up shredded in the oceans, so not a good thing.
- Aluminium cans got the second lowest number of votes, even though aluminium is the most valuable raw material and drinks cans are very likely to end up as litter.
- Glass got the most votes, even though it is not a particularly valuable raw material and is quite heavy to take back to the shop. Food jars are unlikely to end up as litter, and if they do they are completely inert so don't cause any knock-on pollution (although splinters of drinks bottles can cause injury or puncture tyres, I suppose).

All in all, I'm not sure what to make of it.
There was some wailing in The Guardian recently about people paying £145 to see a GP privately. Their arguments against are that this "will mean NHS patients without money will wait even longer for care" and it will lead to a "two-tier NHS".

Both those arguments are nonsense, the doctors are operating privately, so good luck to them. The real argument against is that these GPs are rent-seeking, they are selling earlier access to taxpayer funded healthcare.

For a more neutral look and a better example, see a Daily Mail article of two years ago:

Hospitals are letting patients jump NHS queues for knee and hip replacement surgery if they pay for the operations themselves.

Patients are being charged up to £14,000 for some procedures – almost treble the cost to the Health Service – leading to accusations that hospitals are ripping off the sick. Knee and hip surgery is being rationed across England, forcing some patients to wait in pain for more than a year to get to theatre.

Yet The Mail on Sunday has found that more than 40 trusts are promising patients they can have the ops in as little as a week – if they can afford it.

I don't see a problem:

a) a voluntary extra payment for a better service is not being ripped off, you pays your money and takes your choice. If the NHS doesn't do this, then surgeons will just do the operations privately for the same charge.

b) The NHS has to get money from somewhere. If it can get a bit more from better-off patients then in an ideal world and all thing being equal, either the taxpayer pays in a bit less or the NHS has a bit more money so waiting times will not go up.

c) The extra payment is just rent under the Von Thünen definition (money paid for shorter journey time) as it bears no relation to the cost of the operation, so the NHS might as well collect it as anybody else

d) It also illustrates my point that the value of a place in a queue depends on how many people are behind you, not how many are in front of you - if the normal waiting list time were two weeks, nobody would pay that much extra to get it done next week. So the NHS now has a perverse incentive to make waiting times even longer, that means it can actually boost the charge for queue jumping, that's the only downside I can see.

So that's this week's Fun Online Poll: "Is it acceptable for the NHS to allow patients to pay extra to jump the queue?"

Vote here or use the widget in the sidebar.


Kj said...

"So the NHS now has a perverse incentive to make waiting times even longer, that means it can actually boost the charge for queue jumping, that's the only downside I can see."

That's a bit of a problem. And in theory, the queue-jumpers, although paying their way, add extra days to non-paying queuers. I think it's fair to say that politically, this is bound to create resentment regardless of the economics of it. Having people pay for treatments at private medical facilities isn't ever going to be that controversial (ignoring the wailing about private GPs as you mention above). People paying privately also saves the NHS money by not having to do the surgery, so might as well just don't do it don't you think?

Graeme said...

Haven't we gone through this already with easyJet? You used to be encouraged to turn up early to get a good seat. Then they introduced speedy boarding for the people who did not want to arrive early. Then everybody bought speedy boarding. So now you just get allocated seating when you check in, as in the old days. The so called security enhancements that mean you have to turn up 2 hours before the flight probably contributed. If you have to arrive 2 hours early, then paying extra for speedy boarding just means you spend more time standing in a queue

Mark Wadsworth said...

Kj: " the queue-jumpers, although paying their way, add extra days to non-paying queuers"

No they don't. It is the same surgeons working in public and private sector. If they take a day off to do a private operation, that's one day longer the public sector patients have to wait.

And seeing as the NHS can earn and extra £9,000 'rent' from the queue jumpers, it can spend more on doing more operations so that the NHS patients don't lose out.

G, with EasyJet it is all or nothing. The NHS can be a lot more nuanced and simply auction off operations to the highest bidder, so next week costs £14k, in a month costs £5k and if you are prepared to wait a year, it is free.

The payers will be paying a large chunk of the cost of the NHS patients - the queue jumpers are paying with £ money and the NHS patients are paying with time.

It's a bit like private schools offering some free places to poor-but-clever children. The rich kids pay for the costs of educating the poor-but-clever kid.

Bayard said...

"Glass got the most votes, even though it is not a particularly valuable raw material and is quite heavy to take back to the shop"

Ah, but with glass, you are not talking about recycling, but re-use, which saves a lot more energy. As you point out, recycling glass doesn't really make sense. The raw material is cheap and it takes only little less energy to recycle it than it does to make it from new. The point about the deposit on bottles in the past was that the bottles themselves were valuable because they were going to be washed out and re-used. You can't do this with cans or plastic, which is why I, and I expect others, didn't vote for them.

Mark Wadsworth said...

B, yes, good point.

Recycling bottles makes more sense than just recycling glass.

The other upside to recycling jars and bottles is that manufacturers would agree a few standard sizes for everything, which would make stacking and sorting them easier.

Bayard said...

M, there are a few standard size jars left from the old days of re-using such things: there is a standard 1lb jar of honey and also you still see the standard jam jar, although I don't know if it is a pound.