NotATrainspott
Established Member
- Joined
- 2 Feb 2013
- Messages
- 3,223
Not to dive too off topic, but nurses in the US are paid much more than in the UK. The median salary of a Registered Nurse in Texas is about $75k a year (£54k), or $15k a year more than the median household income. The average UK nurse is paid around £34k, compared to a median household income of about £30k.
People are paid what they are paid because of market effects, including collective bargaining. Train drivers are paid comparatively highly because relatively few people are willing or able to handle the responsibilities of the job. The few people who do qualify as drivers keep their salaries high by being particularly difficult to replace. A TOC is a bit stuck when negotiating pay because train driving requires the general skill (e.g. the standard rulebook) but also the right combination of route and traction knowledge. There may only be a few drivers around who are capable of filling a specific diagram slot, and the drivers all know that. Recruiting a new driver to fill a diagram is expensive, and once they can do the job, they'll align with the other drivers and demand high wages anyway. The need to retain traction and route knowledge means that it's not possible to keep a large pool of drivers around who can swap in when required.
The easiest way for a TOC to get a new driver when required is to poach one from another TOC, which drivers also know, so drivers can get even higher wages because of that intense competition for their services. If a TOC would be fined £10k a year due to increased cancellations if they don't get another driver on their payroll, they'll be willing to pay up to that extra £10k in salary (minus employment costs) for another driver.
The reason that nurses aren't paid that much is that their collective bargaining ability is severely limited. People can reasonably believe that a good feature of the NHS is its buying power. It's one of the (if not the) largest and richest healthcare institutions in the world. Suppliers of equipment and drugs know that they can't lose the NHS as a customer, so they offer low prices. This is actually a sort of monopoly in reverse, known as a monopsony: a single buyer dictating terms from all suppliers, rather than lots of customers being dictated by a single supplier.
If you're a nurse in the UK, you are in a sense a victim of monopsony. The NHS is your only real customer, so it can dictate terms. There may be jobs elsewhere but a lot of them are also funded either directly or indirectly by the government. This means that your ability to demand higher wages is very limited. There aren't any other employers willing to pay much more, so you can't so easily leave your current job.
The compounding problem for nurses vs train drivers is that train drivers are perfectly happy to strike and cause chaos if they don't like the terms on offer. We know that train drivers will strike, and that these strikes are very unpopular for some of the more politically important constituencies in the country. That said, a train driver strike doesn't actually affect too much of the everyday running of the country for people to notice, as most people aren't reliant on trains. The drivers know that they can survive weeks with no pay, but the government and TOCs will likely fold, so they're more willing to strike in the first place and more likely to win if they do.
Nurses strikes can't be as effective because nurses aren't willing to be as militant, for understandable ethical reasons. A nurses strike would be effective if it actually meant that sick and dying people genuinely suffered in healthcare settings. By doing much more limited action, like just working to rule or not doing overtime, the effects of a strike are much more limited. Indeed, if you can prove that the remaining nurses on duty can still do some of their job (even if ridiculously overburdened) then it might actually be seen as evidence that the striking nurses are surplus to requirements.
That said, a proper nurses strike would also affect a lot more people, a lot more seriously. It's easy to blame the government but they're acting as a sort of representative of the public will. If the government is underpaying nurses, that's because the people have decided they want to underpay nurses. Fighting against the government is to fight against the public will as expressed in elections. Demanding to be paid more is to demand that the public pay more in tax, or less money is spent on another thing the public want (e.g. education). The government can use this to their advantage if they are taking liberties with the public will. If nurses are actually allowing sick people to suffer and die, the public might be persuaded to do more drastic action to force them off the picket line (e.g. making them criminally liable for strike-related deaths).
The extra pay for US nurses comes from private and state-funded health insurance. These aren't a magic money tree. Private health insurance is an expensive but necessary purchase for most households or employers in the US. In the end it's not much different to a tax, but one which is levied more through market forces than a government-defined notion of fairness. The primary benefit a system like this has is that if the overall cost of providing healthcare goes up (e.g. due to an aging population), then the private healthcare insurers will pass this on directly as increased premiums. The same result of increased funding is entirely possible in an NHS-like tax funding model, but it requires the government and thus the electorate to accept that taxes must also rise. Deciding whether to raise taxes through elections seems to result in electoral cakeism, as few voters seem that keen on increasing taxes to the level that's actually required. Taking that decision out of their hands by putting it in the hands of a more technocratic market process isn't necessarily the worst thing in the world.
People are paid what they are paid because of market effects, including collective bargaining. Train drivers are paid comparatively highly because relatively few people are willing or able to handle the responsibilities of the job. The few people who do qualify as drivers keep their salaries high by being particularly difficult to replace. A TOC is a bit stuck when negotiating pay because train driving requires the general skill (e.g. the standard rulebook) but also the right combination of route and traction knowledge. There may only be a few drivers around who are capable of filling a specific diagram slot, and the drivers all know that. Recruiting a new driver to fill a diagram is expensive, and once they can do the job, they'll align with the other drivers and demand high wages anyway. The need to retain traction and route knowledge means that it's not possible to keep a large pool of drivers around who can swap in when required.
The easiest way for a TOC to get a new driver when required is to poach one from another TOC, which drivers also know, so drivers can get even higher wages because of that intense competition for their services. If a TOC would be fined £10k a year due to increased cancellations if they don't get another driver on their payroll, they'll be willing to pay up to that extra £10k in salary (minus employment costs) for another driver.
The reason that nurses aren't paid that much is that their collective bargaining ability is severely limited. People can reasonably believe that a good feature of the NHS is its buying power. It's one of the (if not the) largest and richest healthcare institutions in the world. Suppliers of equipment and drugs know that they can't lose the NHS as a customer, so they offer low prices. This is actually a sort of monopoly in reverse, known as a monopsony: a single buyer dictating terms from all suppliers, rather than lots of customers being dictated by a single supplier.
If you're a nurse in the UK, you are in a sense a victim of monopsony. The NHS is your only real customer, so it can dictate terms. There may be jobs elsewhere but a lot of them are also funded either directly or indirectly by the government. This means that your ability to demand higher wages is very limited. There aren't any other employers willing to pay much more, so you can't so easily leave your current job.
The compounding problem for nurses vs train drivers is that train drivers are perfectly happy to strike and cause chaos if they don't like the terms on offer. We know that train drivers will strike, and that these strikes are very unpopular for some of the more politically important constituencies in the country. That said, a train driver strike doesn't actually affect too much of the everyday running of the country for people to notice, as most people aren't reliant on trains. The drivers know that they can survive weeks with no pay, but the government and TOCs will likely fold, so they're more willing to strike in the first place and more likely to win if they do.
Nurses strikes can't be as effective because nurses aren't willing to be as militant, for understandable ethical reasons. A nurses strike would be effective if it actually meant that sick and dying people genuinely suffered in healthcare settings. By doing much more limited action, like just working to rule or not doing overtime, the effects of a strike are much more limited. Indeed, if you can prove that the remaining nurses on duty can still do some of their job (even if ridiculously overburdened) then it might actually be seen as evidence that the striking nurses are surplus to requirements.
That said, a proper nurses strike would also affect a lot more people, a lot more seriously. It's easy to blame the government but they're acting as a sort of representative of the public will. If the government is underpaying nurses, that's because the people have decided they want to underpay nurses. Fighting against the government is to fight against the public will as expressed in elections. Demanding to be paid more is to demand that the public pay more in tax, or less money is spent on another thing the public want (e.g. education). The government can use this to their advantage if they are taking liberties with the public will. If nurses are actually allowing sick people to suffer and die, the public might be persuaded to do more drastic action to force them off the picket line (e.g. making them criminally liable for strike-related deaths).
The extra pay for US nurses comes from private and state-funded health insurance. These aren't a magic money tree. Private health insurance is an expensive but necessary purchase for most households or employers in the US. In the end it's not much different to a tax, but one which is levied more through market forces than a government-defined notion of fairness. The primary benefit a system like this has is that if the overall cost of providing healthcare goes up (e.g. due to an aging population), then the private healthcare insurers will pass this on directly as increased premiums. The same result of increased funding is entirely possible in an NHS-like tax funding model, but it requires the government and thus the electorate to accept that taxes must also rise. Deciding whether to raise taxes through elections seems to result in electoral cakeism, as few voters seem that keen on increasing taxes to the level that's actually required. Taking that decision out of their hands by putting it in the hands of a more technocratic market process isn't necessarily the worst thing in the world.