There is nothing special about the nhs

Nasqueron

Mistermeaner wrote: »

All but the top point in your list are not even scratching the surface

You said you would rather fund cancer treatment than helping a trans person, you were vague, I was asking you for clarification

Mistermeaner wrote: »

And the contention would be more taxes - you appear to have decided that a few people should pay more taxes to fund this behemoth even more - is that correct?

No, I said there should be a progressive NHS tax, amongst other suggestions, that is to say the more you earn, the more you pay as with the normal tax system, perhaps 1% for lower rate tax payers, 2% for higher rate and 3% for top rate, who knows, something along that idea. Using emotive language is daft, the US system costs far more than the NHS as a pound for pound comparison due to hospitals inflating costs to insurers due to providers like pharmaceutical firms inflating medicine costs etc

Mistermeaner wrote: »

One of the things I would look at (in addition to reducing size and scope) is to abolish the final salary pensions (or care of whatever they are now) and also look at pay generally

There's no shortage of skilled and unskilled workers want to enter the profession

Not sure what unskilled workers you're talking about (cleaners don't get paid well nor do they get final salary pensions). Skilled workers are leaving in droves for better pay and conditions elsewhere - plenty of countries give incentives for British staff to leave. Knocking their pay and pensions down is only going to increase the shortages

Mistermeaner wrote: »

I would also overhaul the bma who have for too long controlled the training of doctors such as to deliberately limit supply and inflate wages

Evidence?

Mistermeaner

Nasqueron wrote: »

You said you would rather fund cancer treatment than helping a trans person, you were vague, I was asking you for clarification

that wasn't me

Nasqueron wrote: »

No, I said there should be a progressive NHS tax, amongst other suggestions, that is to say the more you earn, the more you pay as with the normal tax system, perhaps 1% for lower rate tax payers, 2% for higher rate and 3% for top rate, who knows, something along that idea. Using emotive language is daft, the US system costs far more than the NHS as a pound for pound comparison due to hospitals inflating costs to insurers due to providers like pharmaceutical firms inflating medicine costs etc

I've genuinely no idea of the numbers; what sort of increase would that represent and does it address (the perceived) shortfall?

Also how does this address the issue of sustainability? With costs rising year on year wages (and therefore tax) would need to keep pace

Nasqueron wrote: »

Not sure what unskilled workers you're talking about (cleaners don't get paid well nor do they get final salary pensions). Skilled workers are leaving in droves for better pay and conditions elsewhere - plenty of countries give incentives for British staff to leave. Knocking their pay and pensions down is only going to increase the shortages

Plenty of unskilled (or perhaps I should have stated low skilled) workers in the NHS; you mention cleaners - porters, reception staff etc. etc. - many of whom are on LGPS type schemes or the various iterations of the NHS pension.

Nurses cover a wide spectrum of skill ranges (including HCA's) and colleges / universities that provide the routes to these jobs are oversubscribed - the profession is still attractive to many (we could talk separately about academic vs vocational training)

Right at the top GP's and doctors appear overpaid and the silly life time allowance on pensions if pushing people into early retirement - you could look at this another way and say that the pension schemes are overly generous if someone is hitting lifetime allowance in their early 50's

Nasqueron wrote: »

Evidence?

shortage of trained doctors in UK: https://www.bbc.co.uk/news/health-37546360

bma cutting numbers of training places
https://www.bma.org.uk/news/2012/december/bma-accepts-cut-in-student-numbers-to-reduce-unemployment

Herzlos

Mistermeaner wrote: »

I know that my monthly deductions (tax and NI) are in excess of £3k so from my perspective it would be much better for me to pay by the USA charges you mention.

You'd be surprised. Your health insurance policy could easily cost more than your NI contributions, and then you've still got the co-pay/excess to cover.



That'd put you at over about £100k/year, and then you're still only paying about £500/month in NI. $800/month health insurance isn't uncommon, and the average family plan is about $1100. Then you're still easily paying $500+ for any medication or treatments.


The only way you win from the US system is if your employer covers your healthcare, and you don't ever use it.

Nasqueron

Mistermeaner wrote: »

I've genuinely no idea of the numbers; what sort of increase would that represent and does it address (the perceived) shortfall?

Also how does this address the issue of sustainability? With costs rising year on year wages (and therefore tax) would need to keep pace

A flat 1% tax rise would be £5.4bn to £6.2bn (October 2018 figures). Obviously a tax that was higher for top earners would rise more.

A shortfall by 20/21 (based on figures in 2015) of £30bn was expected without any efficiency improvements/reduced spending (source) if spending was only increased by inflation. The 1% tax rise would cover the recent (Nov 2018) government pledge to spend £20.5bn over the next few years to 2023/24. As the population is going up and people live longer we need to fund it more or accept we can't provide as much.

Mistermeaner wrote: »

Plenty of unskilled (or perhaps I should have stated low skilled) workers in the NHS; you mention cleaners - porters, reception staff etc. etc. - many of whom are on LGPS type schemes or the various iterations of the NHS pension.

Much of the NHS low value work is outsourced to contractors who don't get LGPS or final salary schemes (around 7.5% of NHS spending is on third party contractors covering all sorts of work). The lowest NHS band has a top salary of £17,460 a year

Mistermeaner wrote: »

Nurses cover a wide spectrum of skill ranges (including HCA's) and colleges / universities that provide the routes to these jobs are oversubscribed - the profession is still attractive to many (we could talk separately about academic vs vocational training)

Right at the top GP's and doctors appear overpaid and the silly life time allowance on pensions if pushing people into early retirement - you could look at this another way and say that the pension schemes are overly generous if someone is hitting lifetime allowance in their early 50's

Your suggestion that courses are oversubscribed is disingenuous, given we clearly aren't getting enough staff, reflected in the reality of NHS shortages - the NHS is something like 14,000 nurses short of full cover, other figures I've seen suggest it could be as high as 33k short even now. In fact, nursing course applications have been falling since the bursary was removed, the numbers were down 1/3 since 2017 and in 2018 the number taking up the course was down 3% - UCAS figures show there were 32580 applications in 2018, down from 48230 before the bursary was removed

Even if nurses are training, they are either going private or elsewhere; similarly despite your suggestion GPs are overpaid, we are around 3000 short, predicted to be 7000 short by 2023-24. The introduction of tuition fees in 2016 and removal of bursaries

Mistermeaner wrote: »

shortage of trained doctors in UK: https://www.bbc.co.uk/news/health-37546360

bma cutting numbers of training places
https://www.bma.org.uk/news/2012/december/bma-accepts-cut-in-student-numbers-to-reduce-unemployment

Neither of those links is evidence of your assertion that the BMA deliberately keeps training numbers low, the second one says the BMA accepted the government's report to reduce numbers, not that they asked for it - and the link even says that changes in 2012 wouldn't be seen until 2025!

Here is a link from the BMA supporting creating MORE training places!

https://www.bma.org.uk/news/2019/january/no-surprise-as-review-calls-for-more-medical-student-places

Mistermeaner

Herzlos wrote: »

You'd be surprised. Your health insurance policy could easily cost more than your NI contributions, and then you've still got the co-pay/excess to cover.



That'd put you at over about £100k/year, and then you're still only paying about £500/month in NI. $800/month health insurance isn't uncommon, and the average family plan is about $1100. Then you're still easily paying $500+ for any medication or treatments.


The only way you win from the US system is if your employer covers your healthcare, and you don't ever use it.

being as the vast majority of people are paying way less than me how is the NHS being paid for then? Is it uber efficient or funded by more than NI (i.e. taxes)

lisyloo

Mistermeaner wrote: »

Anecdotal I know but 2 sisters I know have talked openly about being surprised to be able to get their boobs done on the NHS, boastiung about how they claimed PND to get 'free boob jobs' - potentially isolated incidents I am sure but where you have a free at point of use comprehensive service like the NHS it will always be open for misuse and exploitation

Sorry, just catching up.


In which case we agree and this is where the NHS is currently.
"Boob jobs" and other cosmetic surgery are only available if there is health issue (either physial or mental).
I totally agree that exploitation os the system is wrong and it should not be used for vanity reasons.
The problem we have (as with whiplash) is that doctors have no objective ways to measure pain either physical or mental and unless they have a strong reason they are in a position where they must believe their patients reported symptoms.

Nothing nasty here as far as I can see - quite a valid discussion and exchange of views.

Ok I take that back then.
I just believe the majority are not exploiting the system and are sufferers and it seems mean to pick on people.

I could flip the assertion round and ask why (some) people think its OK to demonise those who have done well for themselves in wanting to keep as much of their hard earned wealth to spend as they see fit, rather than having it forceably taken off them and spent in ways others deem more worthy.

I don't think making people pay taxes is demonising them.
My opinion is that it's gone too far the other way with disabled and the poor suffering.
I am not saying the system is perfect by any means, but I believe fundamentally in the rich subsiding the poor and don't really see any alternative to that fundamentally if we don't want people to suffer.
I have to pay some taxes I don't like (the IR35 thing has our lives no hold to an extent - we may have to give up jobs, move home etc.). Do I feel demonised ? - no I don't.
You are not being asked to pay 100% and there are various ways to reduce your tax burden (as I'm sure youre very well aware).

lisyloo

Mistermeaner wrote: »

Not easy to address but I do think we need to face up to the reality that prolongation of life isn't necessarily a good thing or indeed sustainable.

I agree and I've just had an Aunt (96) die and I have a MIL living a sad life in a nursing home.
We accept that if you found a dog that couldn't eat or stand and was in pain you'd put it down.

Famliies would agree with you on this.
However the difficulty is how do you deal with medically well people?


Believe me we wouldn't want to be like that and understand the issue but how and crucially when would you end their life?


People seeem to know with pets, but noone Ive met could make the decision with a human famliy member.


we are very well aware that if a dimesia patient is othrewise healthy then they need to be kept alive e.g. a nursing home cannot let a physically well person starve to death. So if they can't remember to swallow they need to be force fed.


I defy you to tell us where you'd draw the line and who (safely) decides when life is not worth living. Believe me I'm not motivated to keep these people alive but I have first hand experience so I can see the difficulty.

If you look at todays situation the govt has tentatively started raiding older peoples assets to pay for their care; in 30 years there will be alot of pensioners without pensions who will have sold their homes (should they happen to have one) to fund their retirement - there will be nothing for the govt to take and sell.

actually theres a cap on care fees coming in April 2020, so it's not as bad as peeople think.
Personally (and this is the opposite of vested interest) I don't think elderly people should be able to hoard empty homes that they aren''t capable of looknig after whilst expecting poorer tax payers to fund them.

My view is that the current healthcare system, state pension and general welfare state divorces individuals from the realities and costs of life leading to poor decision making (spend spend spend today safe in the knowledge the safety net is always there)

Agreed.

I would encourage and incentivise far more personal responsibility through removal of the safety nets (and as a result of cost reductions reduce taxes for all)

In most cases I don't think that would work.

In the example of your supermarket worker working for 58 years their ability to accumulate wealth was in part restricted due to tax etc they will have paid but also because there spending power was greatly reduced when having to compete for housing with e.g. all of the folk on housing benefit - in other words the benefit of her working all those years was greatly reduced because others who did nothing as productive during that whole time ended up with similar outcomes.

I don't think that argument stacks up in times of incredibly low unemployment.
That person like many would not have been able to stop being a NET taker (she is self-funding right now though).

Thrugelmir

Mistermeaner wrote: »

being as the vast majority of people are paying way less than me how is the NHS being paid for then? Is it uber efficient or funded by more than NI (i.e. taxes)

Borrow now pay later.

Trouble is can only go on for so long.

GreatApe

I am pretty right wing but I like the NHS because it is a counter to the medical profession taking the !!!! which given half a chance they definitely will do

A doctor in the UK is paid what? £35-50k a year?
A doctor in the USA is paid what? $200,000 - $300,000 a year?

The reason is primarily thanks to the NHS monopoly it can dictate wages and because it is such a behemoth the government and the NHS can keep and have to keep the uk medical profession more honest than it ideally wants to be (except GPs which managed to slip though the net and bag huge wages)

Sometimes you need monopoly to counter the monopoly of professional groups banding together to limit numbers and competition to drive their own wages sky high

So long live the NHS
Until the robots take over 20-30 years form now

Herzlos

Mistermeaner wrote: »

being as the vast majority of people are paying way less than me how is the NHS being paid for then? Is it uber efficient or funded by more than NI (i.e. taxes)

I'm not sure, but it's at least partially because there's no incentive for a US style medical system to be cost effective - quite the opposite. Potentially you're paying more for the excess (co-pay) under the US system than similar treatment is available for privately elsewhere in the world. Often it's cheaper to travel to somewhere else like Canada or Cuba and pay for treatment.



What you are paying for there, and not here, is all of the overhead of the insurance system and you can be certain the health insurance companies are making plenty of profit.