If you wanted to insure yourself in some way against the risks of debilitating illness so as to be able to afford treatment , you could pay into a plan. Basic assurance. The modern equivalent would in effect be co-pay. Given the number of unnecessary 999 callouts and trips to A &E has the time now come for this? Or are you happy to continue to be taxed thru the hoop?
Search RollOnFriday
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happy with the current system thanks.
If we sent people a bill for calling 999 without it actually being an emergency, they'd stop doing it real quick. I know the Irish Fire Brigade charge a call out fee for non emergency stuff.
In November 2022 I fell very ill and called 111 for some advice, the doc was so concerned she sent me an ambulance whom I persuaded it wasn't that urgent.. then a few days later my GP called another one and I told him I'd just get an uber.. when I got out of hospital the whole thing happened again and this time I accepted the ride in the ambo..
I'll avoid an ambulance as much as possible and I think others should do the same, if you can walk, you can get to A&E yourself.
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The call centres are pretty good at filtering out the time wasters. The 8 hour wait lying on the garden path with a broken hip might deter the others.
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time wasting in the NHS is tiny compared the huge efficiencies the NHS brings with lack of paper pushers, buying power and shared infrastructure and lack of incentive to provide unnecessary treatment. It has many weaknesses but waste is not a reason to reform it, all other systems are far more wasteful.
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the idea that any other system will somehow offer better value is not only wrong, it is perversely wrong. It may offer better access and non urgent services, but it wil be far more expensive.
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Unless you require users in certain tax brackets to pay for their treatment albeit they can choose whether they get insurance or use their own cash. I'd happily get BUPA to pay my claims into the NHS for treatment.
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BUPA might not like it so much.
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Think they'd just add the NHS as another approved provider.
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Why ask people in higher tax brackets to pay for their own treatment? Surely it is better just to tax them sufficiently to fund the service properly?
The idea that we cannot afford the taxes for the NHS but we can somehow afford some other system that will be MORE expensive overall, is bizarre.
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what people actually mean is that young healthy people should pay less (because they can get insured for less). that is stupid because we nearly all get old so why not spread out the cost over a lifetime rather than being faced with higher bills when you are older?
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Guy people don't like paying tax because they can't see where it goes. People though are happy to spend tens of thousands on medical care where they can see a direct benefit so you'd actually get more money out of them and the current NHS budget can be redirected to helping those who genuinely need free treatment.
It's like the new investigation into vet's charges. It's bonkers that people will spend the money they've saved for a house deposit on keeping an elderly cat alive for a few weeks. I'm afraid that if Saildog and Sailcat develop any major health conditions I'll just pay the one off few hundred quid to finish it humanely.
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The insurers do spread the cost over your lifetime. My dad is paying a higher premium than when he was younger but that's because he now has known health conditions he didn't have back then that mean that BUPA over the final ten years of his life will have paid out around 5 times the money they've received from him in premiums. Forty years ago they will have done their sums on what they expect to pay out in his old age and worked out what they'd need in the years when he wasn't having lots of treatment to cover his overall cost.
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These are tough decisions no animal should have to put up with due to an owner's penury. It's time we had a properly funded cat and dog health service. If we each paid a small amount just think how it might improve poor saildog's lot.
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To be honest not even sure I'll pay for the jab as I've got a spade and plenty of possible burial spots.
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Guy people don't like paying tax because they can't see where it goes. People though are happy to spend tens of thousands on medical care where they can see a direct benefit so you'd actually get more money out of them and the current NHS budget can be redirected to helping those who genuinely need free treatment.
Sorry you are saying they would prefer to pay tax for the NHS AND pay for it themselves? That seems unlikely to me.
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which system would you prefer to replace it with?
The Irish one where you pay for it in your taxes but if you have a full time job, you are also required to have VHI (Voluntary Health Insurance, which is really expensive and doesn't cover everything)
Or the American system where even with the health insurance you are barely covered and an unexpected illness can bankrupt you?
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Well Guy I hate to tell you but I know a lot of people who happily pay their tax and also happily pay for their own medical treatment and would still do that if they could get the latter through the NHS. In fact I think some of them would get a weird saintly aura for feeling that they were helping those less fortunate than themselves. I pay tax and pay for my treatment on the basis that I can afford it and would rather that limited NHS resources are kept free for someone who can't afford to pay.
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Eddie in between the two. So anyone in the top two tax brackets either has to self-fund or have insurance as the reality is a lot of those people already have insurance as a work perk.
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Sorry Sails I am struggling with what you are advocating, sounds like you are advocating the current system where everyone pays in but those who can afford to and want to can have private health insurance additionally?
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taking the middle classes out of the nhs would be an absolute disaster for the service. It would start to
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No Guy. You pay your tax and NI as normal as we know that they don't even remotely cover the cost of the things they are meant to cover and then if you are a top rate tax payer and you need anyting other than emergency treatment you either have to pay the cost from your own funds or take out insurance to cover it.
So for example with my snapped achilles back in the day I would have had the initial A&E consultation for free as it was an emergency to ascertain why my foot was purple and hurt like hell but then if I'd gone with the NHS to have it repaired (they had someone ready to operate next day but I opted for a second opinion) I'd have had to pay the cost of the operation or claim on insurance if I had it. So I'd have got the same NHS treatment that was offered but I'd have covered the cost so they could then use that money to pay for someone who couldn't afford the same treatment.
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Good managers, planners and administrators are usually not found in the public sector anymore. This cannot help the situation.
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so that means elderly top rate tax payers will have to pay far more in top up insurance than younger top rate tax payers despite the fact that there income is likely to be lower in later years. That seems perverse to me.
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the real cost to the NHS is not the relatively young injuring themselves, that is comparatively as cheap as chips it is those with long term serious illness and the elderly.
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who would have to pay far more in private top up insurance under your proposed scheme
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it is far better that people pay in accordance with what they can afford (through progressive tax) and take out in accordance with what they need. Not only is that equitable amongst the population as a whole it is better for the individual who over a lifetime is likely to have a lower income at time of most need for medical care.
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Guy if your income is reduced in retirement you are no longer a top rate tax payer. Similarly they don't have to buy insurance and I've known a few people who've simply set up an investment fund when they were younger and they now use that to cover their later life medical expenses. This would have people paying in what they can afford as those who should be able to afford it would be paying leaving free at the point of delivery care for those less able to afford it. There would be more money in the system as the NHS would be directly recouping the cost of a lot of treatment currently paid for from government funds. It's basically means tested treatment.
The existing insurance system already means that there are lots of 30 somethings with work health insurance who are paying a premium based on the amount they are expected to take out later and who are also being taxed on the benefit.
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Sails, even the US recognises that the cost of private health insurance for the elderly is prohibitive or sometimes impossible to get and subsidises it heavily with the medicare programe.
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interestingly the US spends more on subsidising private health care per head than the UK does for the entire NHS per head.
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The NHS is
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"wild inefficiency"
This is so so wrong, it may not be the best, but it is by some considerable distance the most efficient medical system in the developed world. Why?
Very few paper pushers/administration - because very little invoicing and pushing money about gets done
No incentive to over-treat, which creeps in whenever there is a profit making element to service provision
Near monopoly purchasing power means medicines and equipment can be bought far cheaper than in many countries and hospitals are not competing with each other for staff
Less waste on frivilous "hotel services" that private providers feel oblige to provide.
Relatively cheap borrowing for capital projects.
The only problem with the NHS is that we spend far less on healthcare per head than most of the developed world. That is why we have fallen behind. When Blair brought spending up to european average waiting lists disappeared, we were attracting doctors even from places like Germany and everything in the garden was relatively rosy
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so if it needs more money, and it does, lets base it on ability to pay not from those unfortuntae enough to be sick or old
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Insurance is available for the elderly even my old man who has cancer, ashtma, heart failure and a hernia. My point is its means tested so my parents and their chums who can afford to pay do rather than that money currently just ending up in the private system. That way the poor elderly can all be treated as there will be more money in the system.
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there will be more money in the system if we increase funding through general taxation, which is far fairer than asking the sick and old to pay based on some arbitrary cut off line of income, which will inevitably lead to hardship for many. Also I suspect that those who pay private health insurance will object to being treated by the NHS with its waiting lists and dingy waiting rooms and inconvenient appointment times and will want to be continued to be treated privately, or are you suggesting banning private healthcare?
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No you can still go private but plenty of things where people would wait if you had a better resourced system with shorter waiting lists. Not sure about your local NHS trust but mine has a couple of new hospitals that are not at all dingy and provide a range of appointment times.
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"not sure about your local NHS trust but mine has a couple of new hospitals that are not at all dingy and provide a range of appointment times."
So why do they have private health insurance?
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These frivolous hotel services might work in NHS.
NHS premium. Available to high net worth patients. Private room, turn down service. Nurses with big tits.
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you can already pay for a private room in many nhs hospitals I think - not sure about the big tits.
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They're the only things that can save the NHS now.
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This is so so wrong, it may not be the best, but it is by some considerable distance the most efficient medical system in the developed world. Why?
Very few paper pushers/administration - because very little invoicing and pushing money about gets done
No incentive to over-treat, which creeps in whenever there is a profit making element to service provision
Near monopoly purchasing power means medicines and equipment can be bought far cheaper than in many countries and hospitals are not competing with each other for staff
Less waste on frivilous "hotel services" that private providers feel oblige to provide.
Relatively cheap borrowing for capital projects.
The only problem with the NHS is that we spend far less on healthcare per head than most of the developed world. That is why we have fallen behind. When Blair brought spending up to european average waiting lists disappeared, we were attracting doctors even from places like Germany and everything in the garden was relatively rosy
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We spend 10% less on healthcare than Germany. I'd be happy to pay more taxes to fund that. Would you?
In terms of actual facts, we spend about the same as comparative wealthy countries, and get roughly the same healthcare outcomes: https://ourworldindata.org/financing-healthcare
The NHS does its job well. And the free at point of use for everyone is one of the few things that make me proud to be British.
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A fair response Medley and I agree lack of funding is not the only problem in the NHS system but I believe the benefits of the universal system outweigh the problems if funded to a comparable level with systems used in other countries.
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hipho - your chart is comparing government spending per head, the proper comparison is total spending per head because the universal system means a greater proportion of healthcare funding is done by government.
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Guy they have insurance because they also like the flexibility to choose where they have treatment and also because it opens up the opportunity for treatment that isn't available on the NHS. My dad is being ketp alive by a drug that hasn't yet been approved by the NHS who are still running trials on it (I also know someone who's involved in the trial).
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The NHS doesn't approve drugs, the MHRA does.
Then NICE decides whether they're value for money.
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🤣 Sailo on this thread
"I know a lot of people who happily pay their tax and also happily pay for their own medical treatment and would still do that if they could get the latter through the NHS"
imagine paying for treatment, ending up with NHS standard of care, and being happy with it. i want some of whatever drugs Sailo's friends are on, please.
"simply set up an investment fund"
so simple. if only all those people using food banks had thought about this.
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In many European countries there is state provision and there is private provision and one is basic and awful but reliable and the other is more luxe but capricious. I wouldn't like a split system.
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That said I'd also like to stop having to pay thousands of pounds a year because the potbanggang refused to see me.
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Sailo all over the place on this. His plan is apparently for higher rate tax payers to not be eligible for NHS services but rather they must pay for their own health insurance on top of the taxes they pay towards the NHS that will in turn pay for them to use the NHS. Utterly bizarre.
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I'm pretty unenamoured with spending so much in tax and knowing that the social contract has broken down to the extent that if I or any of my fellow citizens had a heart attack or stroke the state has gone from basically guaranteeting it will get to me in 5-10 minutes to saying I could die on my lawn waiting 12 hours for anyone to bother getting to me.
I've generally tried to be in the "pay your taxes, and do it gladly" camp. but it's getting very hard.
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The problem is the management of both government and health departments. It's not just a problem in health but seen most acutely there by most citizens. The terrible methods for promotion of senior managers are coming home to roost. Lots of strategy eager beavers with no appreciate of delivering things that need to be delivered.
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It's against all our interests to just give up, though, nothing else can give the wrap around care we need from cradle to grave
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I've generally tried to be in the "pay your taxes, and do it gladly" camp. but it's getting very hard.
I agree, because we have the worst government in modern times. People say New Labour taxed hard (although not as hard as the last few years) but when they put money into public services they improved, the NHS dramatically, it has taken years of Tory misrule to reduce it to the state it is in again. And then the right have the cheek to say it is a systemic problem and the NHS does not work.
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They did put money into public services, but they put an awful lot on the PFI credit card that is still being paid. I know the Tories started that particular wheeze but Labour turbocharged it. It all comes back round to the same thing - everyone (not someone else, everyone) has to pay more tax, and actually quite a lot more tax. Otherwise, it will all continue to be fvcked.
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(Also mega-high public debts in an era of "high" (normal in any medium term view) interest rates has utterly boxed in any future government. When they said "there is no money left" last time, they were nowhere near where we are now. Debt servicing costs would be the second biggest government department if it was one.
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I used to work for one of the largest providers of Primary Care services to the NHS. I can tell you the NHS is an administrative shambles made worse by successive governments, centralisation and decentralisation. There is no way to fix it unless you start again, which obviously isn't practical. It's a massive political hot potato and will always be so. You have the likes of NHS England, NHS Digital and NHS X all fighting each other, blocking initiatives and taking credit for each other's minor achievements. If 20% of all tax revenue (c. £200bn) isn't enough then no amount will be. NHS D for instance recently had hundreds of IT contractors on more than £1k a day which was way over market.
It's a great institution and I would hate to lose it but i'd never work in healthcare again supplying to the NHS again, it's hugely depressing when you see the inner workings.
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what is "enough" is for UK to spend the same percent of GDP per capita as other developed countries (not just government spending all spending). on healthcare If we do that and the NHS is still not fit for purpose I will happily admit time for fundamental change. Until then, no dice. We spend much less on healthcare than most countries and then wonder why it is not as good.
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Faff how many higher rate taxpayers do you know using a food bank? They are exactly the kind of people who need the health serve to remain free for them.
Guy it's not that complicated. They are eligible for NHS treatment but must pay the cost of it unless it's an emergency. How they pay is up to them but I would expect most to use insurance to lay off the risk as they'll already have it in some manner. It's not a top up at all so where my achilles op cost I think £3k or thereabouts I'd be expected to pay all of that so for that treatment I'm cost neutral to the NHS.
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That is like saying the children of people over a certain income are not entitled to state education. You cannot expect people to pay taxes for public services and then expect them to pay for them again when they use them. Of course if they choose not to use them that is a different question. You also pitching the cut off line at higher rate tax payers, presuming you mean the 40p level rather than the 45p level (at 45p it wont make much difference) you are talking about pulling many perfectly normal "squeezed middle" lower middle class workers into paying for healthcare on top of everything else. It is ridiculous.
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Any more ridiculous than pulling them into a 60% tax bracket to cover the cost of the services they use? Bear in mind a big proportion of them will already be covered to some extent. In 2017 the private healthcare market in this country was apparently worth $11bn dollars so imagine if you even managed to divert a third of that back into the NHS.
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well if they are already covered for private health its not going to save the NHS much is it? You cant have it both ways.
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Guy their insurance would be able to be used for paying for their NHS treatment as well.
If you want to go really radical you could have a hierarchy of injury so if you injure yourself willingly doing a high risk activity then you have to pay versus someone who has an accident going about their normal life. So for example if I knacker my achilles farting about falling down a ladder sailing I have to pay but if you're a builder and you fall down a ladder at work you get it fixed for free.
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"Faff how many higher rate taxpayers do you know using a food bank?"
sorry, sails, i was just making fun of the idea that setting up an investment fund was a simple solution that would be available to any meaningful number of people.
more seriously, you mentioned that taxpayers in the top two tax bands should be paying for their own care (on the basis, if i understand it correctly, that some of them get insurance through work already so they might as well all self-fund? good luck with that).
as guy mentions, that would catch a huge number of people who have been dragged into higher rate tax. i doubt whether many of them would feel wealthy enough to pay for their own care, whether that be pay-as-you-go, insurance or even the Saillaw Asset Management Healthcare Opportunities Fund.
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Fine so you can adjust the criteria to make it higher rate taxpayers who don't also get any kind of tax credits, etc. There's a pretty big cohort of people out there who currently pay for private treatment who could be pumping that money into the NHS so they are cost neutral leaving funds to be used to treat more people for free.
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Caught by a strong gust of wind in the Solent our intrepid sailor is caught off balance and hurts his foot. The crew reduced to just one dentist and an IT technician must take drastic steps.
Just bite down on this piece of leather Sailo. I'll go get the bonesaw. Arrgh. This hot tar should staunch the bleeding if you wouldn't mind holding that flap of skin while I cut. Think of the cost to the NHS. Dammit. He was a good man. Damn good sailor.
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Sails once again what you are saying makes no sense. If they are currently paying for private treatment they are not costing the NHS anything so how does going through the NHS and paying for their treatment improve anything? Or are you saying that not only should they (1) pay taxes to fund the NHS and (2) pay for their own treatment or insurance but also (3) that payment to the NHS for their own treatment should not just cover the actual cost but also include a profit element that subsidises other peoples treatments? That really is a triple whammy!
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You have to have some way of people paying the true cost of the NHS and you'll never get there through tax alone. There are plenty of people who go private for most things but then revert back to the NHS for the really heavy lifting like heart surgery where you want to be near a decent ITU in case of complications so you'd get that money back for starters.
I have considered that and I would pay a profit element and don't have a problem with that. Suspect if it was say 10% it may well be cheaper than the private equivalent so quite tempting.
My system would chuck a load of staff who are currently lost to the NHS back into the system with no overall cost to the system but a load of extra capacity.
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Saillo is the Dawn Handbags of the NHS AICM £5
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I think the premise of Sailo's system is that everyone who currently pays to be treated privately, will in future pay to be treated instead on the NHS, meaning more lovely munnies to go round.
It's not clear yet where the NHS will find the extra capacity for these returning patients. Nor how the patients who were paying to go private will be enticed by the prospect of now paying to go back into the NHS with its poor service, long waiting lists, limited treatment options etc, all of were which presumably were (even when the service was free) factors driving them to go private in the first place.
I think he was just about to explain all this.
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Sorry being dim today as thinking about other things but yes my alternative model does work on the basis that people who pay pay a small profit margin.
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Indeed Faff you effectively reduce the private sector pushing staff back into the NHS to provide more appointments and with people paying extra you provide more money to start sorting out the service and waiting lists. May have to use a bit of stick but I know plenty of people who would be willing to pay more and go back to the NHS if they thought it would benefit the system.
The heart of the issue is that a system that was designed to treat you for the ten years between retiring and dying is now doing infinitely more but with no acknowledgement of that fact and people still thinking that their NI covers their pension and healtcare.
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I think Sails is trying to put a spin on his belief, shared by many on the right, that the NHS as we know it should be abandoned and that people should take out their own private insurance with a safety net for those that cannot afford it. I dont agree but it is an honest opinion rather than the rather nonsensical reforms he is trying sell here
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Nobody 'pays' for the NHS or any other public service. The government creates the money through the central bank and taxation then destroys the money that's been created. We both create money and issue debt in our own currency.
The only limit on what the government can spend on something is the inflationary pressure and the value of the currency v. other currencies.
It's amazing the groupthink that there are other limits.
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The NHS delivers all that it does for everyone in the country for the sum IIRC of c.£4,500 per head whereas a typical private premium is c.£1,500. The latter is riddled with exclusions, only covers a fraction of what is available on the NHS & is of course not universal. To treat the two as equivalent services is ridiculous. The private sector will never be able to deliver an equivalent service to the NHS for less money. Even in the deliberately fund starved sabotaged state in which the vultures and parasites advocating for private interests hope to keep it the NHS is still ridiculously good value for money.
Like water and power and any other essential utility the only thing increased private sector involvement yields is worse provision.
e.g. Hospitals
https://www.ox.ac.uk/news/2024-02-29-new-study-links-hospital-privatisation-worse-patient-care
e.g. - Care homes
https://www.ox.ac.uk/news/2024-03-18-new-analysis-most-care-homes-closed-industry-regulator-are-run-profit
e.g - Health outsourcing in general
https://www.ox.ac.uk/news/2022-06-30-health-outsourcing-linked-higher-mortality-rate-oxford-study
You'd think that with the rivers and seas teeming with untreated shit as a result of decades of privatisation of the water sector, bringing with it risks to public health not seen since the 19th century, people might learn something. Privatisation of public services does not provide better services. And why would it? The whole point is to provide as little as possible for as much as possible.
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While I don't disagree with any of that, Fond Of Cheese, the problem I have is that whenever I do encounter the NHS I generally find it to be so woefully organised with such contempt for the end user, in areas where improvement would cost very little or even nothing to improve, that you end up wondering whether a monopoly supplier is really the answer.
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