There is nothing special about the nhs

Newnoel

Mistermeaner wrote: »

One of the things I would look at... is to abolish the final salary pensions...

This



One of the reasons for doctors refusing to do overtime and retiring early (after their hugely subsidised medical training) is the super generous final salary pension scheme, paid for by taxpayers / patients


Final salary schemes are a distant memory in the private sector, because they are completely unaffordable.


Moving to an employer/employee matched defined contribution model, would free up substantial costs for health delivery, in addition to allowing the very highest paid medical professionals to do extra work without worrying about punitive pension taxes.

GreatApe

westernpromise wrote: »

Strictly then it's a monopsony.

Pretty close

Unless you are a doctor or have close family members who are, then the NHS is great it purchases us doctors at cheap prices.

I could imagine a competitive system where doctors are paid even less and healthcare is even better and this could work in a private system only it would just be my imagination because I know them doctors are pretty smart and given half the chance will rig the medical system to their own financial benefit. $250,000 average physician salary in the states...nuts....id rather pay out doctors... nuts... and the NHS more or less allows for this

So long live the NHS !!!

peachyprice

Herzlos wrote: »

The only people paying into the NHS who won't use it are those with private medical cover, and potentially those that will live a perfectly healthy life without having any kids and then die suddenly.
For everyone else who gets old, ill or has accidents, they'll make use of it.

If they have an accident or take a turn for the worse after a private operation they may still have to use the NHS, there is little provision for private intensive care and A&E beyond 'urgent' care outside London.

Tromking

Newnoel wrote: »

This



One of the reasons for doctors refusing to do overtime and retiring early (after their hugely subsidised medical training) is the super generous final salary pension scheme, paid for by taxpayers / patients


Final salary schemes are a distant memory in the private sector, because they are completely unaffordable.


Moving to an employer/employee matched defined contribution model, would free up substantial costs for health delivery, in addition to allowing the very highest paid medical professionals to do extra work without worrying about punitive pension taxes.

The adoption of private sector style pensions by the NHS would destroy their ability to recruit and retain quality staff

Pennywise

lisyloo wrote: »

It’s my view from where we are at the moment that the wealthier elements (people and businesses) could give a bit more.

Labour trebled NHS spending in a decade, but didn't "cure" it of its inherent inefficiency, waste, and attitude problems. But, hey-ho, GPs got a pay rise and can work office hours and there are lots of shiny new hospitals!

Labour raised NIC to "save the NHS" - but just squandered the money.

You can't just keep pouring more money into a leaky bucket, at an ever faster rate as the holes get bigger. You need to fix the leaks first!

My OH has spent the last 18 months having various treatments for a serious condition spanning two separate hospitals. We've seen first hand the sheer inefficiency and stupidity of the NHS. Both hospitals insist on doing the same tests (blood tests, MRI scans, x-rays, bone marrow sampling, etc) - it's crazy, they either refuse to accept the tests done by the other hospital or they claim they can't access the results! Same with our GP surgery - they claim they can't access blood tests their own nurses have taken blood for, but which were requested by the hospital consultant, so take the same blood test again under their own name as they say it's easier and quicker for them to order as new test themselves than try to get the consultant/hospital to share the results of their tests. It's shambolic. Then you have the scenario when the test results differ - we saw one consultant in hospital A who said a particular test result was fine (and gave us the number/score) and stopped treatment, only for us to go to a different consultant in hospital B who said their test showed the same test with a much higher number/score and told us we needed to go back to the first consultant to start treatment again - of course, first consultant decided his tests were right and refused. So what do you do when you're piggy in the middle?

Only last week, went to see the ENT dept about a recurring sore throat, referred by the GP who thought that a stronger or more specific antibiotic might be needed. Had breakfast as normal, went on my own, and when I got there, they were planning to do a load of tests and I was booked in as a day patient - turned out they couldn't do them as I should have fasted! Absolutely nothing in the appointment letter about doing tests or fasting or being in all day - as far as I knew it was just a simple "meet and greet" the consultant like all previous referrals have been over the past 40 years! Yet again, inefficiency causing waste of resources! The left hand just hasn't a clue what the right hand is doing.

Pennywise

Newnoel wrote: »

One of the reasons for doctors refusing to do overtime and retiring early (after their hugely subsidised medical training) is the super generous final salary pension scheme, paid for by taxpayers / patients

And, of course, the penal marginal tax rate of 62% on their earnings between £100k-£126k. Of course doctors and dentists claim they want to work part time for "work life balance" but in reality, it's to avoid losing 62% of their earnings for the extra day or extra shift or whatever. (They'll also suffer NHS pension deductions too so that means their "take home" is even less!).

This is because of the withdrawal of the tax free personal allowance for those earning over £100k (like lots of older/experienced doctors and dentists). It's very well know and has been written about in the medical journals.

The lifetime pension allowance reduction has also had an impact as lots of ageing doctors and dentists are finding their "pension pots" are breaching the lifetime limits and they're suffering a penal tax charge on their pensions too! This was another "tax the rich" initiative.

Both are classic examples of how the "tax the rich" rhetoric can spectacularly back-fire. In this case, it's helping to worsen the shortage of doctors as they're choosing to work fewer hours to avoid penal tax rates and avoid breaching the lifetime pension pot limits.

westernpromise

I'm in that demographic that pays most of the income tax. I look at the whining, entitled rabble that I subsidise, and frankly, I don't think they're worth it; I don't think they deserve it; and they certainly aren't grateful for it.

peterbaker

westernpromise wrote: »

I'm in that demographic that pays most of the income tax. I look at the whining, entitled rabble that I subsidise, and frankly, I don't think they're worth it; I don't think they deserve it; and they certainly aren't grateful for it.

I'm in the demographic that knows the type that whines on that they pay most of the income tax and look down their spiv noses at the lower paid. I don't think they have a clue about social responsibility or how to run a bath or what is a proper marginal rate of tax for their sort. Their name is Jack and they're alright and that's all they care about.

Malthusian

Tromking wrote: »

The adoption of private sector style pensions by the NHS would destroy their ability to recruit and retain quality staff

Nah. The vast majority of NHS staff have no idea how good the pension is. Most of them don't value it even if they're (automatically) signed up to it. Those that do appreciate it would still be happy with a DC scheme, because it could pay very generous rates of employer matching while still being much lower cost than the DB scheme. Indeed high employer contributions would be a necessity to get the unions to agree - which of course they probably never will anyway.

They aren't going to get a better pension scheme in the private sector. They might get a more generous overall pay package in the private sector, but that's the case already.

Pennywise wrote: »

Both are classic examples of how the "tax the rich" rhetoric can spectacularly back-fire.

Back-fire? It's working exactly as intended. Doctors are poorer (although possibly happier), the nation is poorer, but also more equal. The purpose of complicated and regressive taxation systems is not to raise money (simpler tax systems raise more money) but to exercise power. There are no unintended consequences in politics.

"Taxing the rich" is supposed to affect doctors in the way it does. High-earning doctors are part of the rich (with "rich" defined by our taxation thresholds). Simple as that. You don't get a free pass because you get rich by healing the sick and injured. St Paul didn't say "money is the root of all evil, unless you earned it from being a physician, or a vet, or something else nice, for verily, then it's fine".

lisyloo

Is your MIL really "fabulously wealthy"? What is her net worth currently? My MIL's net worth is around £150,000 cash + £250,000 equity in the house. That will last 6 years and then she will be effectively bankrupt. Although she is 90, it is likely she will survive those 6 years - then what?

About £160k which I reckon will last about 5 years.
She’s very unlikely to last that long, but if she did we’d hope she’d stay in the same facility paid for by the local authority.
There is a safety net. I don’t think its good enough for everyone but there is one there. I’d rather she spent her money on whatever she needs rather than us (sadly there is very little opportunity now for her to enjoy her money).

Are you saying you would like massive tax increases to pay for free personal care all round so the rich can pass on their inheritances?
Just to be clear I’m not in favour of that.

Also, what is this silly idea you have that "most" do not end up in residential care? How can that be proper even if true? Average life expectancy is close to 90.

I think you are misunderstanding average.
Approx 20% of men don’t make it to retirement, so there’s plenty of the population that die before reaching the age when they need full time care. There is also a period where people can manage at home.
It’s hard to find stats but according to this article (US) it’s 40% of “seniors” who will need long term care. So 60% die before they need it and thats the % of “seniors” which excludes the 20% of men who die before becoming senior.

https://www.elderlawanswers.com/how-likely-are-you-to-need-long-term-care--15501

We are in agreement that the tax take needs to be raised just not on exactly how.
As discussed on question time last night sometimes this can be achieved by cuts in the tax rate I.e. tax rate cuts incentivises more business to come to the uk and increase the nominal tax take.