[Politics] Tory meltdown finally arrived [was: incoming]...

[Herr Tubthumper]

Might be a controversial opinion over here in the UK - where you've been used to having free-at-the-point-of-access to the NHS for decades - but I think for the long term health (excuse the pun) of the NHS, we should switch to a means-tested system. Retain the existing NI / tax funding, retain free-at-access for those who do not have the means to pay, but for those who are better off switch to a subsidised system where those individuals who can afford to pay do so on a sliding scale dependent on their ability to pay.

I would also suggest that for those who can afford it, we should be encouraged to get private health cover. The NHS and private health should provide the same levels of cover, but the only way to achieve that IMO is to move more people into the private system and take some of the pressure off the NHS. Perhaps one way to do that is to legislate that employers must provide private health care to their employees who earn over a certain amount (tie it to existing thresholds, such as when Child Benefit gets phased out). Payment to be taken from the pre-tax salary. Wouldn't be too hard to do - a lot of employers already give their employees the option of doing this, it would just be a shift to having it mandated instead.

And yes, under the above ideas I would be one who would be (at least partially) "paying my own way". And I would happily do so.

I would also suggest that there should be some cases where "free-at-access" can be waived and an individual forced to pay full whack. It's harsh, but if someone goes out on a Saturday night, gets sloshed, and falls over breaking a leg or something stupid like that ... they should be (if they can afford it) be paying the full cost of their treatment. Ambulance call outs aren't cheap, it's high time people in this country became a little more aware of what it costs the NHS when they choose to do something stupid and end up needing an ambulance trip. (Been there, done that, got the hole in my bank account a little over 20 years ago in Australia).

In the German system you pay 14% of your salary (split between employer and employee) but can opt out of this and get private health insurance. This obviously becomes attractive to higher earners as private becomes a cheaper option than paying 7% of your salary.

I really don’t agree with your forced-to-pay-full point though. Care should be provided on medical need and medical need alone.

My take on all of this is health care is actually very routine and very simple. Care itself isn’t really the issue, it’s how it’s provided, managed and funded. What makes it such a mess in the U.K. is under-funding and repeated political and ideological driven reforms, re-structuring and centralisation. I’d take one of the many successful health care management models used around the world, work out how much it will cost to run in the U.K., work out what percentage you all need to pay to fund it and have this as a separate ring-fenced health tax. I’d have an independent body running it. Job done and move onto fixing education.

 

[A1X]

To return to the original purpose of the thread...

[tweet]1496400910695768069[/tweet]

It also seems that questionnaire was effectively an interview under caution. So the PM is under caution from the police. What a wonderful place to be in.

 

[beorhthelm]

In the German system you pay 14% of your salary (split between employer and employee) but can opt out of this and get private health insurance. This obviously becomes attractive to higher earners as private becomes a cheaper option than paying 7% of your salary.

I really don’t agree with your forced-to-pay-full point though. Care should be provided on medical need and medical need alone.

My take on all of this is health care is actually very routine and very simple. Care itself isn’t really the issue, it’s how it’s provided, managed and funded. What makes it such a mess in the U.K. is under-funding and repeated political and ideological driven reforms, re-structuring and centralisation. I’d take one of the many successful health care management models used around the world, work out how much it will cost to run in the U.K., work out what percentage you all need to pay to fund it and have this as a separate ring-fenced health tax. I’d have an independent body running it. Job done and move onto fixing education.

this rational approach wont get anywhere because its too political. any change will be seen as a move to the maligned US system. the general veiw is there only two models in the world, one free and completey nationalised, the other complety private and paid for on demand. even though both those models dont exist in reality, just false public perceptions.

 

[Audax]

this rational approach wont get anywhere because its too political. any change will be seen as a move to the maligned US system. the general veiw is there only two models in the world, one free and completey nationalised, the other complety private and paid for on demand. even though both those models don't exist in reality, just false public perceptions.

Yup, and that perception exists despite there being successful hybrid systems in various places around the world. The irony being that the NHS could probably be improved a lot for those who need to use it if the UK system did become hybridised and those who can afford to pay their own way, do (at least in part).

 

[Gwylan]

In the German system you pay 14% of your salary (split between employer and employee) but can opt out of this and get private health insurance. This obviously becomes attractive to higher earners as private becomes a cheaper option than paying 7% of your salary.

Many years ago, I had a ride using the Mitfahr Zentrale system (it's a neat German idea where car drivers offer a space in the car for a small fee) and my driver worked for health insurance company. We were driving from Braunschweig to Hamburg, which is a fair distance, and he spent 80% of the journey describing, in detail, all the intricacies of the German health system - it was one of the most boring couple of hours of my life.

I'm sure the German system works well but I'd hate to adopt something like it and go through all that again

 

[Nobby Cybergoat]

Yup, and that perception exists despite there being successful hybrid systems in various places around the world. The irony being that the NHS could probably be improved a lot for those who need to use it if the UK system did become hybridised and those who can afford to pay their own way, do (at least in part).

You make your point well, but I totally disagree. Free at the point of delivery, for me, is a fundamental, no matter how idiotic the receiver of the treatment is (whether a drunk or an anti vax). We need to levy enough taxation to pay for this and there are currently a set of people at the top doing very nicely who could be paying a whole lot more.

 

[Neville's Breakfast]

You make your point well, but I totally disagree. Free at the point of delivery, for me, is a fundamental, no matter how idiotic the receiver of the treatment is (whether a drunk or an anti vax). We need to levy enough taxation to pay for this and there are currently a set of people at the top doing very nicely who could be paying a whole lot more.

Perhaps it’s the open ended cheque required that explains in part people’s reticence in voting for your political party. The NHS isn’t free. People pay taxes. They might be more inclined to contribute more in a German/Swiss system. We are not talking the free for all of the voluntary payment American way. Rather it would involve compulsory health insurance with premiums set by the state. The people at the top doing very nicely would then no longer be able to structure their finances to minimize their tax bill and avoid paying for healthcare.

 

[Nobby Cybergoat]

Perhaps it’s the open ended cheque required that explains in part people’s reticence in voting for your political party. The NHS isn’t free. People pay taxes. They might be more inclined to contribute more in a German/Swiss system. We are not talking the free for all of the voluntary payment American way. Rather it would involve compulsory health insurance with premiums set by the state. The people at the top doing very nicely would then no longer be able to structure their finances to minimize their tax bill and avoid paying for healthcare.

a) I don't have a political party. I've voted for 3 different parties at the last 3 elections and plan to continue this promiscuous behaviour
b) It's wasteful to have a parallel mechanism to taxation for deciding people's ability to pay. Taxation is a better way of raising the money in my view.
c) Free at the point of use is a point of principle for many. Even if it's expensive, it's a statement of the sort of country we want to be.

 

[Mellor 3 Ward 4]

As for Neville, flukey or private & lying to cover his support for those who instigate and facilitate the erosion? Or is that me being cynical again?

Unnecessary comment IMO.

 

[Harry Wilson's tackle]

Many years ago, I had a ride using the Mitfahr Zentrale system (it's a neat German idea where car drivers offer a space in the car for a small fee) and my driver worked for health insurance company. We were driving from Braunschweig to Hamburg, which is a fair distance, and he spent 80% of the journey describing, in detail, all the intricacies of the German health system - it was one of the most boring couple of hours of my life.

I'm sure the German system works well but I'd hate to adopt something like it and go through all that again

Lol!

Rather like the road layout in our towns, much of which dates back hundreds of years, some things cannot simply be torn down and rebuilt from scratch.

Plus I am mindful that those who wish to defund the NHS are the same crowd who want to defund the BBC and who were in the 'Brexit now, deal with the consequences later' gang. There place, in my opinion, is deep in the sea.

 

[Neville's Breakfast]

Lol!

Rather like the road layout in our towns, much of which dates back hundreds of years, some things cannot simply be torn down and rebuilt from scratch.

Plus I am mindful that those who wish to defund the NHS are the same crowd who want to defund the BBC and who were in the 'Brexit now, deal with the consequences later' gang. There place, in my opinion, is deep in the sea.

I won’t derail this thread any further but I think the point being made was simply alternative methods of funding the NHS rather than defunding. Seems to me that there is ideology on both sides insisting on what they consider a pure system. Anyway, let’s get back to bashing the Tories

 

[Nobby Cybergoat]

Lol!

Rather like the road layout in our towns, much of which dates back hundreds of years, some things cannot simply be torn down and rebuilt from scratch.

Plus I am mindful that those who wish to defund the NHS are the same crowd who want to defund the BBC and who were in the 'Brexit now, deal with the consequences later' gang. There place, in my opinion, is deep in the sea.

Just like those within the right of the Conservative party, who have helpfully been "researching" Europe over the last 5 years, then moved on the "research" Covid and are now moving on to "research" climate change. Incredible how such a small band have time and willingness to do so much research

 

[Harry Wilson's tackle]

Perhaps it’s the open ended cheque required that explains in part people’s reticence in voting for your political party. The NHS isn’t free. People pay taxes. They might be more inclined to contribute more in a German/Swiss system. We are not talking the free for all of the voluntary payment American way. Rather it would involve compulsory health insurance with premiums set by the state. The people at the top doing very nicely would then no longer be able to structure their finances to minimize their tax bill and avoid paying for healthcare.

There are numerous objections to your proposals but the over reaching one is simply this: a system paid for by taxation is what we have, and the NHS is a challenge only because people (and I understand this but don't agree with it - my 'socialism' I guess) object to paying for something when the are not using it, and because it has been restructured to be like a (failing) business, allegedly, (though I'm not entirely sure of this, it could be more cock up hen conspiracy) so it can be privatized.

So why does the NHS have to be radically altered? You seem to object primarily (which is why it is your first statement) to the 'open ended cheque'. That is simplistic. If there is a demand for more money to pay for the healthcare we all want, that demand won't change even if the NHS is flogged off tomorrow. Costs are costs. And for decades the cheque has not been open ended, and health care rationing has gone on for as long as I can remember (albeit it is disguised by the creation of waiting lists, and expensive therapies being deemed 'not cost effective') and it started when Thatcher began 'closing wards' to save money, with attendant job losses because staff were not required to man wards that were closed, and then Major initiated (and Blair to his shame, albeit he was caught in the prevailing tide, embraced) 'PPI/PPF'.

The NHS has to be radically altered in the minds of some primarily because they fundamentally object to it. They object to the socialism of using tax for the benefit of all. They feel empowered to object because of the rise of private medicine and the dream of paying less tax. And it maps to a certain narrative (that anything socialist is wrong).

Improving the NHS is simple, albeit it will result in a considerable amount of unemployment in the management class, because much of the best improvement would come about by removal of the internal market, faux competition, and the furiously industrious bean counting that goes with it and is needed to keep the post-Thatcher imperative serviced.

This is the problem. While medicines are rationed and queues become longer, no expense is spared creating new directorates, divisions, and faculties designed to collect information, strategize, plan, have meetings, employ additional staff to cope with the management and strategizing, and employ further staff to consult on the restructuring of the management, and reconsider strategy in the light of Covid and Brexit, and create further worksteams of management, quality control and compliance assurance, and of course employ legions of minions to collect and collate all the information and write reports to inform discussion at the weekly meetings.

We don't need all that shit. It is a mountain of job creation by people whose imperative is like that of the hydra - cut off the head so that two new ones can grow; more management needs more management to manage and evaluate the management of the management. It's what management (without an end game) does.

Compulsory health insurance? Pah! How will that change health care delivery? It will be the same bonkers over managed system delivering it all.

(And I haven't even mentioned how publicly educated medics still moonlight on the back of their subsidized training to engage with private pactice; I can tolerate that, provided it doesn't contribute to staff shortages....).

Bottom line, the vision for the NHS must sit foresquare inside a truly socialist framework, funded by tax and freed of the internal market and bean counting. Way more than half the people employed in the NHS are not involved in health care delivery (not doctors, nurses, technicians, pharmacists etc). That is grotesquely wrong and the product of the law of unintended consequences in my view, but can be shamelessly exploited as wasteful and inefficient and expensive (which it is) by the anti-socialists who want the NHS destroyed.

 

[Neville's Breakfast]

There are numerous objections to your proposals but the over reaching one is simply this: a system paid for by taxation is what we have, and the NHS is a challenge only because people (and I understand this but don't agree with it - my 'socialism' I guess) object to paying for something when the are not using it, and because it has been restructured to be like a (failing) business, allegedly, (though I'm not entirely sure of this, it could be more cock up hen conspiracy) so it can be privatized.

So why does the NHS have to be radically altered? You seem to object primarily (which is why it is your first statement) to the 'open ended cheque'. That is simplistic. If there is a demand for more money to pay for the healthcare we all want, that demand won't change even if the NHS is flogged off tomorrow. Costs are costs. And for decades the cheque has not been open ended, and health care rationing has gone on for as long as I can remember (albeit it is disguised by the creation of waiting lists, and expensive therapies being deemed 'not cost effective') and it started when Thatcher began 'closing wards' to save money, with attendant job losses because staff were not required to man wards that were closed, and then Major initiated (and Blair to his shame, albeit he was caught in the prevailing tide, embraced) 'PPI/PPF'.

The NHS has to be radically altered in the minds of some primarily because they fundamentally object to it. They object to the socialism of using tax for the benefit of all. They feel empowered to object because of the rise of private medicine and the dream of paying less tax. And it maps to a certain narrative (that anything socialist is wrong).

Improving the NHS is simple, albeit it will result in a considerable amount of unemployment in the management class, because much of the best improvement would come about by removal of the internal market, faux competition, and the furiously industrious bean counting that goes with it and is needed to keep the post-Thatcher imperative serviced.

This is the problem. While medicines are rationed and queues become longer, no expense is spared creating new directorates, divisions, and faculties designed to collect information, strategize, plan, have meetings, employ additional staff to cope with the management and strategizing, and employ further staff to consult on the restructuring of the management, and reconsider strategy in the light of Covid and Brexit, and create further worksteams of management, quality control and compliance assurance, and of course employ legions of minions to collect and collate all the information and write reports to inform discussion at the weekly meetings.

We don't need all that shit. It is a mountain of job creation by people whose imperative is like that of the hydra - cut off the head so that two new ones can grow; more management needs more management to manage and evaluate the management of the management. It's what management (without an end game) does.

Compulsory health insurance? Pah! How will that change health care delivery? It will be the same bonkers over managed system delivering it all.

(And I haven't even mentioned how publicly educated medics still moonlight on the back of their subsidized training to engage with private pactice; I can tolerate that, provided it doesn't contribute to staff shortages....).

Bottom line, the vision for the NHS must sit foresquare inside a truly socialist framework, funded by tax and freed of the internal market and bean counting. Way more than half the people employed in the NHS are not involved in health care delivery (not doctors, nurses, technicians, pharmacists etc). That is grotesquely wrong and the product of the law of unintended consequences in my view, but can be shamelessly exploited as wasteful and inefficient and expensive (which it is) by the anti-socialists who want the NHS destroyed.

A system funded by compulsory health insurance would not change anything with regard to people paying for something they don’t use. That’s the whole point of insurance. I am fundamentally pro NHS Harry. I just don’t think it has to be funded in its current way. That doesn’t mean I want it destroyed. Far from it. Germany is not a right wing country yet does things differently so you cannot dismiss all objection as emanating from dark corners of the Tory party. Nothing will change though and we will continue with all of the problems you describe precisely because of the ideological warfare of the two opposing binary views. It all just becomes another platform for insult. The thread has moved off in a different direction from that originally intended and I am partly to blame for that for which I apologize.

 

[Thunder Bolt]

Just like those within the right of the Conservative party, who have helpfully been "researching" Europe over the last 5 years, then moved on the "research" Covid and are now moving on to "research" climate change. Incredible how such a small band have time and willingness to do so much research

Whilst claiming extra expenses but not actually showing any results of this 'research'.
Nice work if you can get it!

 

[Westdene Seagull]

Might be a controversial opinion over here in the UK - where you've been used to having free-at-the-point-of-access to the NHS for decades - but I think for the long term health (excuse the pun) of the NHS, we should switch to a means-tested system. Retain the existing NI / tax funding, retain free-at-access for those who do not have the means to pay, but for those who are better off switch to a subsidised system where those individuals who can afford to pay do so on a sliding scale dependent on their ability to pay.

I would also suggest that for those who can afford it, we should be encouraged to get private health cover. The NHS and private health should provide the same levels of cover, but the only way to achieve that IMO is to move more people into the private system and take some of the pressure off the NHS. Perhaps one way to do that is to legislate that employers must provide private health care to their employees who earn over a certain amount (tie it to existing thresholds, such as when Child Benefit gets phased out). Payment to be taken from the pre-tax salary. Wouldn't be too hard to do - a lot of employers already give their employees the option of doing this, it would just be a shift to having it mandated instead.

And yes, under the above ideas I would be one who would be (at least partially) "paying my own way". And I would happily do so.

I would also suggest that there should be some cases where "free-at-access" can be waived and an individual forced to pay full whack. It's harsh, but if someone goes out on a Saturday night, gets sloshed, and falls over breaking a leg or something stupid like that ... they should be (if they can afford it) be paying the full cost of their treatment. Ambulance call outs aren't cheap, it's high time people in this country became a little more aware of what it costs the NHS when they choose to do something stupid and end up needing an ambulance trip. (Been there, done that, got the hole in my bank account a little over 20 years ago in Australia).

No, no and no. The whole point of the NHS is that it is universally available to ALL British citizens regardless of wealth or status ( obviously excluding eye care and dentistry - which are a different discussion but I believe should be free at the point of delivery ).

"Means Testing" is a political phrase, more often used to deny people benefits than target them at the people that really need them. I'll give you an example of how they don't really work. A few years ago both myself and Mrs WS were out of work at the same time. For both of us our only income was JSA. We thought it might be a good idea to apply for 'working' tax credits - I've put the word working in inverted commas as you can claim if you're not working. Problem being that your eligibility is based on your previous tax year minus one. So if you tried to claim today it would be based on the 20/21 tax year. Same for JSA. Forget the fact that at THAT point in time you have ZERO income - it's what you've earnt nearly two years ago that counts. Council tax reductions work on the same theory.

Applying that same policy to health care will only see people avoid health care - and many will die. If you're happy to pay extra then go get private health insurance - although be aware that private health providers often send emergency cases straight back to the NHS.

The NHS should remain, always, free at the point of delivery and free to EVERYONE. It just needs extending to dentistry and eye care. 'll happy pay extra in my taxes / NI if necessary for this to continue / happen.

 

[Machiavelli]

Means-testing introduces new layers of bureaucracy into the NHS. One of the reasons we get a (largely) good service and pay a comparatively small amount for our healthcare is that there's no bureaucracy over who, what and how healthcare is received.

 

[usernamed]

I agree the NHS has suffered over the years, and I don't think it is much to do with underfunding, but the consequences of making it like a business, with a market model imposed at every level of resourcing, whether it makes sense (when buying from outside the NHS it does) or not (charging my department for the use of my office, employing hoards of people to shuffle money from one department to another, and a load of other people to count every penny transferred, using a ****ing employment agency to assign students to help run my practicals, and employing hoards of people to calculate, acquire and manage overheads charged when one department provides a service to another department, etc etc).

What exactly do you object to, though - not being seen on the day (well, go private, then) or having to hand over your hard earned cash, by way of taxation, to fund a socialist health care system (meaning that other people may benefit from your hard earned cash, taken by taxation)?

If you simply object to it being a bit shit, we could all pay a bit more tax to make it better, of course. But that isn't part of the conservative vision, and even labour are reluctant to suggest it (although think Corbyn did so) because, as you rightly infer we all want a great health service bur refuse to pay for it (with that bit of your post I agree).

So we have this market model that was brought in to stop the NHS wasting money. It is an absolute joke.

However I maintain that free at the point of use is a brilliant element of the NHS. It won't get better by making it 'pay at the door'.

I have been working in the same hospital for most of the last 33 years, and I have seen a shabby but slick operation turned into a shiny but clunky and constipated behemoth owing to the imposition of market values, outsourcing, privatization and the like.

A cynic might think it has been modified in order that it will fail and have to be sold off in chunks to the private sector.

This. Entirely this. The “reforms” visited upon the NHS have been designed to open up opportunities for (mainly American) private healthcare firms who have more cash than they know what to do with, and are looking for new markets.

As a fellow English speaking nation, we have the best “effort required” vs “potential reward” ratio. The lobbying has been insistent and lasted decades.

 

[Audax]

No, no and no. The whole point of the NHS is that it is universally available to ALL British citizens regardless of wealth or status ( obviously excluding eye care and dentistry - which are a different discussion but I believe should be free at the point of delivery ).

"Means Testing" is a political phrase, more often used to deny people benefits than target them at the people that really need them. I'll give you an example of how they don't really work. A few years ago both myself and Mrs WS were out of work at the same time. For both of us our only income was JSA. We thought it might be a good idea to apply for 'working' tax credits - I've put the word working in inverted commas as you can claim if you're not working. Problem being that your eligibility is based on your previous tax year minus one. So if you tried to claim today it would be based on the 20/21 tax year. Same for JSA. Forget the fact that at THAT point in time you have ZERO income - it's what you've earnt nearly two years ago that counts. Council tax reductions work on the same theory.

Applying that same policy to health care will only see people avoid health care - and many will die. If you're happy to pay extra then go get private health insurance - although be aware that private health providers often send emergency cases straight back to the NHS.

The NHS should remain, always, free at the point of delivery and free to EVERYONE. It just needs extending to dentistry and eye care. 'll happy pay extra in my taxes / NI if necessary for this to continue / happen.

I disagree. Done properly, it can work. I wouldn't argue that the Australian system is perfect, but it is a system that works and it does incorporate elements of means testing. It's been a long time since I was directly exposed to it, but it doesn't result in people avoiding health care and it doesn't price people out.

For starters, the example you provide of the means testing you experience: I absolutely agree with you that that is a load of BS. Means testing should always be based on an individuals' *current* ability to pay, not on some historical ability. It should also be based on current liquid assets - I disagree with including the notional on-paper value of a house (for example), which I believe the Aussie system does look at.

There are genuine flaws with the 100% taxation based funding system that the UK uses. For starters, it's far too easy for those with the funds to pay for clever accountants to (legally) avoid.

Ultimately, though ... I'm flexible. We all want the same end product: a robust, well run, efficient health service that ensures that everyone has affordable (ideally free at point of access), easy access to health care where everyone pays a fair share into making that happen. Whether that's done purely through taxation, or other means, I'm not that fussed. But on the evidence of the last 10 years or so (and having a wife who works in the NHS and seen it all from the inside) I very much doubt either party will have the political fortitude to do it purely through taxation - which means looking at alternative options.

 

[Wardy's twin]

The last 2 years is a pretty good indicator of what happens when the private organisations get involved with health i.e. the huge amounts of profit made on PPE by individuals and don't get me started on the pharma companies exploiting people in a bad position.

The NHS is far from perfect (have spent 3 years in close attention) but the principle is right and it needs improving. There is waste , incredible amounts, but its a very large organisation and hard to control at times and even harder when its given a battering by government and puts people in charge to run as a short term business rather than a long term process e.g. recruitment of doctors & nurses should be much more structured and tied into the education process.

There are examples where private money helps the NHS , the Royal Marsden is a great example of this but the key point is its not there to make a profit....