Nice People Thread No. 14, all Nice and Proper

LydiaJ

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Generali wrote: »

The NHS model isn't sustainable. I know that British people like to support the fiction that the NHS is The Envy Of The World but it isn't true.

Ask yourself a simple question: If the NHS was the envy of the world, why has no other country copied it?

I can call a GP and get a same day appointment. I called my radiotherapist today and was offered a next day appointment. The reason? I generally pay for healthcare when I consume it so I consume in moderation. The fiction that the NHS is 'free' is going to be the undoing of the NHS at best and the undoing of the British state at worst.

Gen, we understand that the Aussie system works for you. That's great. But it doesn't mean a lot. Almost any healthcare system works for people who are earning a professional income and whose health care problems are within reasonable limits, financially speaking. How does the Aussie system work for somebody in circumstances like Sue's, with the restrictions that her boys used to cause on her opportunities to work when they were young, and their many health problems? Or a working but low income family who suddenly find they've got a baby with problems as major as, for example, Ivan Cameron's, requiring extensive care for the whole of his life?

Because I'd find it a lot easier to believe your "this system is great so the UK should have it too" statements if you could find a few people on low incomes or with really huge health problems who felt the same about the wonderfulness of it. As it is, I still haven't the faintest idea how those kinds of people would be provided for under the Aussie system, so I am unable to come to an informed conclusion as to whether the Aussie system is something I would like to see here. I'm open to being convinced, but I need more information than you're giving me so far, I'm afraid.

GDB2222

PasturesNew wrote: »

No idea. But you also then have other issues. Go up the stairs, how are you going to get to any newly created room? Now you have to take down a wall, create a corridor to the new bit, knock out the exterior wall to get through .....

It could be done ....but that doesn't mean it should be.

I don't need more bedrooms, I just want to "fix" as many problems as I can see here (irritations) .... and, since there's a man with a spade making a mess in the garden it'd be mad not to just go a little bit further and create one additional extra room on the back of the new entrance/loo/shower area being created.

The upstairs space could just be an enlargement of a bedroom. That might give you hobby space upstairs, for example. If it costs v little, it might be worthwhile.

silvercar

I know that getting meters moved is expensive. For the work involved.

GDB2222

PasturesNew wrote: »

Yes. That's true. And, when you said that, I thought of another "genius" idea.... and then realised my genius idea involved moving plumbing 12 away from services

Ultimately, the budget has to stop somewhere. Everything one does has a cost - and if you're not "fixing a problem" then the cost is a vanity project.... so, then, it's a huge "is it really worth it?" question. And, I think my answer is "no".

No requirement for a hobby space upstairs - my intended hobbies are a bit mucky, e.g. what if one were to wish to learn to make footstools from scratch (sawing, sanding, glueing). Or get into decoupage: sanding, glueing. Then there are other things involving blow torches and acid. All hobbies much better suited to a ground floor room with a large utility sink and a door to the outside. Not to mention lugging things in/out of the house; door from garden it's "lob it in, put it on the floor, walk away" ... if the room's upstairs that's a whole new bag of trouble.

Take beach shells, for example... if I were to wander to the beach and come back with them - I could lob them in the sink with bleach as soon as I came home ... then, rinse them and leave them out ..... then paint them and wash up the brushes etc.... then spray/glue them with a varnish coating and hang them up ...all while passing by the space so I am tempted to "do a bit more" each time I pass. Rather than it being a separate activity I have to actively walk upstairs and participate in.
My hobbies aren't reading, knitting and sewing, which are clean hobbies.

If you are thinking of selling some time then the assessment could include any profit on resale from the extra floor on the extension. If that adds a bedroom potentially it might be worthwhile.

GDB2222

PasturesNew wrote: »

I've got Come Dine With Me on the telly. Not watching it, it's just on .... and something caught my ears....

One chap's got a gadget where his meat texts him from inside the oven when it's cooked!

He stuck a probe in the meat, probe is attached to a wire, the wire plugs into his phone .... and it sends a text when the meat's 3 degrees away from being ready.

Blimey!

The man from IKEA says we are near peak stuff.

Generali

LydiaJ wrote: »

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Gen, we understand that the Aussie system works for you. That's great. But it doesn't mean a lot. Almost any healthcare system works for people who are earning a professional income and whose health care problems are within reasonable limits, financially speaking. How does the Aussie system work for somebody in circumstances like Sue's, with the restrictions that her boys used to cause on her opportunities to work when they were young, and their many health problems? Or a working but low income family who suddenly find they've got a baby with problems as major as, for example, Ivan Cameron's, requiring extensive care for the whole of his life?

Because I'd find it a lot easier to believe your "this system is great so the UK should have it too" statements if you could find a few people on low incomes or with really huge health problems who felt the same about the wonderfulness of it. As it is, I still haven't the faintest idea how those kinds of people would be provided for under the Aussie system, so I am unable to come to an informed conclusion as to whether the Aussie system is something I would like to see here. I'm open to being convinced, but I need more information than you're giving me so far, I'm afraid.

I am on a low income. I earn less than the average Sydney person as does Mrs Generali. People on here seem to think I'm loaded but I'm not. Between us we make approximately the average household income for Sydney.

I am happy to pay a little bit extra for access to health care and to actually be able to access it. The NHS system is appalling when GPs are being paid bonuses not to refer people to cancer services.

I have seen the NHS in action and it simply didn't provide adequate care and ultimately nobody gave a flying fox about it. The NHS routinely kills people (pace T Wells NHS Trust) and yet Poms maintain this pretence that the NHS is great. It isn't , it's just better than the system for uninsured Americans.

In the last two years I've had cancer and been treated for arthritis plus Mrs Generali has had pneumonia and I'm extremely pleased that I wasn't forced to go through the NHS.

GDB2222

PasturesNew wrote: »

New term. What do you mean by "the assessment" - who is that conversation with? Architecty type? At what stage?

I mean your own assessment, weighing the pros and cons. I don't want to paralyse you even more with indecision, but all your discussion is about what you need now. Which is absolutely fine if you intend to stay for ever, but then you mention that you're thinking of moving in a few years, which raises different issues.

LydiaJ

Generali wrote: »

I am on a low income. I earn less than the average Sydney person as does Mrs Generali. People on here seem to think I'm loaded but I'm not. Between us we make approximately the average household income for Sydney.

I am happy to pay a little bit extra for access to health care and to actually be able to access it. The NHS system is appalling when GPs are being paid bonuses not to refer people to cancer services.

I have seen the NHS in action and it simply didn't provide adequate care and ultimately nobody gave a flying fox about it. The NHS routinely kills people (pace T Wells NHS Trust) and yet Poms maintain this pretence that the NHS is great. It isn't , it's just better than the system for uninsured Americans.

In the last two years I've had cancer and been treated for arthritis plus Mrs Generali has had pneumonia and I'm extremely pleased that I wasn't forced to go through the NHS.

Perhaps I should have phrased my question more clearly. I am not under the impression that you are earning shedloads. I am under the impression that you are earning a reasonable wage and have a bit of slack in your finances - which is how I regard myself. If this month or this year you or I need to spend a bit extra on X, we can use some savings, or else we can compensate by spending a bit less on Y or Z, without having to go without essentials like food, heat, clothes etc. When I asked about "low income" I didn't mean "average household income". I meant "a lot lower than average household income so that any significant extra expenditure creates a real problem" - ie the sort of person to whom it would never occur to use the expression "I am happy to pay a bit extra for..." about anything. Think single parent on NMW, and you'll realise that their finances and yours aren't really comparable. I am not entirely sure what you mean by describing your household as both low income and average income in the same paragraph - as I understand those terms, they are contradictory, so you must mean something I haven't understood.

I am also not making light of your cancer, or Mrs Gen's difficulties either. I know they have been painful and scary and generally a very big deal for you as a person and the four of you as a family. But *financially speaking*, they are not in the same league as a severely disabled child who needs professional healthcare every day for the whole of their life. Your care has not cost, as far as I understand, as much as several large houses, for example.

In the US, a severely disabled child can quite easily cause the parents to go bankrupt. The *financial* effects on an adult of developing something expensive and incurable - maybe polycystic kidney disease requiring dialysis 3 times a week, or something like that - can also be catastrophic. What I keep wondering, whenever you are extolling the virtues of the Australian system, is what happens to Aussies who need, or whose children need, healthcare in the "mind bogglingly expensive" category - like Ivan Cameron, to choose an example of someone with whom I imagine most NP will be familiar. But when I try to ask this question, I never seem to be able to put it across in a way that gets me the details I am looking for.

If you can explain to me if, and if so then how, the Australian system provides for those whose healthcare needs are beyond the capability of any private individual to pay for, and beyond the maximum on their health insurance policy, or whatever, without ruining them financially, then I will be much more interested in it as a desirable system.

I am NOT trying to have a go at you. I am asking for information, because I really want to know the answer.

silvercar

Generali wrote: »

I am on a low income. I earn less than the average Sydney person as does Mrs Generali. People on here seem to think I'm loaded but I'm not. Between us we make approximately the average household income for Sydney.

Guilty as charged.

I thought that you had a fairly decent job in a sector (banking) that pays particularly well, therefore your income was above the average. I also thought that you got a lot of house for your money in Oz and that houses were particularly spacious.

Generali

LydiaJ wrote: »

Perhaps I should have phrased my question more clearly. I am not under the impression that you are earning shedloads. I am under the impression that you are earning a reasonable wage and have a bit of slack in your finances - which is how I regard myself. If this month or this year you need to spend a bit extra on X, you can compensate by spending a bit less on Y or Z, without having to go without essentials like food, heat, clothes etc. When I asked about "low income" I didn't mean "average household income". I meant "a lot lower than average income so that any significant extra expenditure creates a real problem" - ie the sort of person to whom it would never occur to use the expression "I am happy to pay a bit extra for..." about anything. Think single parent on NMW, and you'll realise that their finances and yours aren't really comparable.

I am also not making light of your cancer, or Mrs Gen's difficulties either. I know they have been painful and scary and generally a very big deal for you as a person and the four of you as a family. But *financially speaking*, they are not in the same league as a severely disabled child who needs professional healthcare every day for the whole of their life. Your care has not cost, as far as I understand, as much as several large houses, for example.

In the US, a severely disabled child can quite easily cause the parents to go bankrupt. The *financial* effects on an adult of developing something expensive and incurable - maybe polycystic kidney disease requiring dialysis 3 times a week, or something like that - can also be catastrophic. What I keep wondering, whenever you are extolling the virtues of the Australian system, is what happens to Aussies who need, or whose children need, healthcare in the "mind bogglingly expensive" category - like Ivan Cameron, to choose an example of someone with whom I imagine most NP will be familiar. But when I try to ask this question, I never seem to be able to put it across in a way that gets me the details I am looking for.

If you can explain to me if, and if so then how, the Australian system provides for those whose healthcare needs are beyond the capability of any private individual to pay for, and beyond the maximum on their health insurance policy, or whatever, without ruining them financially, then I will be much more interested in it as a desirable system.

The way it works is this.

I am well and I work. I have two choices:

1. Get health insurance which I must pay for myself. My employer cannot provide this. (Mine costs $240/month for a family of 4).
2. Do not get health insurance and pay extra income tax known as the Medicare levy which is 2% of my income above the $18,200 tax free threshold (known as the Personal Allowance in the UK I believe).

I now get sick and need to see a doctor. First stop is a GP. Who do I see? I now have a choice. Medicare will pay $37.50 to any GP I see so I can see one which charges $37.50 and not end up with out of pocket expenses or I can see one that charges more and pay the difference. Generally speaking I would choose the former although I have used more expensive doctors. Generally a more expensive one gives you more time and the offices are nicer.

The GP tells me he thinks that I have cancer and I need to have some tests to find out. The tests cost $200 of which Medicare will pay $70. The extra $130 must come out of my pocket and it is against the rules for insurance to pay. If I am super poor then I am receiving welfare and am expected to pay this cost from my welfare cheque. (There are exceptions to this, for example if you have to have a lot of tests or are ex-military).

Oh heck, I have cancer. I need an operation. What to do? As I am insured I get my operation done privately at nil cost. Davo, my uninsured cousin, would have the same operation done by the same person in the public hospital at nil cost. He will probably wait a week or so longer and won't have as nice facilities.

Then we both need radiotherapy. We both go to the public hospital and have radiotherapy at nil cost paid for in both cases by Medicare.

We then need physio as a result of our treatment. Normally physio isn't covered by Medicare but is covered by private insurance. However, as our need for physio is caused by a serious illness we get a 6 week physio program paid for in part by Medicare. Medicare pays all but $20 for each session, unlike the GP visit the extra payment is specified not the subsidy.

The difference between the UK and the Aussie system is that:

1. When we receive welfare we understand that some of that money will have to pay for medical treatment
2. Waiting times are between negligible and nil

Health care will always need to be rationed as there isn't an infinite number of doctors, nurses and hospitals. The only question left is how to ration it. The NHS seems to use a crazy system of rationing by queue based on political imperative. We use a system where we are encouraged by the tax system to self-fund for the most part and encouraged by the health system to use only as much health care as we need.

If my kid was diagnosed with a terrible disease then my insurers and the Medicare system would treat them at little or no out of pocket cost to me. Drugs needed would either be partly or wholly subsidised and health care would probably be provided through the private hospital system depending on where the facilities to treat are available.

One of the things that really annoys me about the UK public health debate is this ridiculous false dichotomy that is raised that you can have the UK or US system. If the NHS really is the envy of the world then why doesn't anyone else copy it?

@PN - There are lots of different minimum wages in Aus and lots of penalty rates for working on the weekend. I'd say a typical minimum wage earner in Aus grosses about $23-25/hr once you factor in penalty rates. Maybe $20-22 without. Taxes are pretty low here (VAT is 10% for example) so you keep more of your income as a rule. $2 = £1.