[Misc] UK healthcare/NHS funding

[virtual22]

I think all the while that the Pandora papers are proving that the ultra rich are doing anything but paying their fair share, it hurts to think of asking for more money from those that are already paying, and those that can least afford it compared to the super rich. The UK is losing billions each year in revenue due to this and little seems to be happening. You have the well known cases of the bigger companies making billions and paying next to no tax. The action on these seems to be moving at a snails pace and whilst what they may be doing is "legal" it's not right and should have been changed years ago.

Once everyone is paying their fair share then yes, I'd be more than happy to pay more should the system still need it.

 

[KZNSeagull]

Anything free will always be abused. 2m A&E visits per month (pre-pandemic, dunno the figures now). That's ridiculous. The Freakonomics guys suggested a nominal charge to David Cameron when he asked for their ideas but he described that as political suicide. Paracetamol on prescription which effectively costs £10 a time, something that can be bought in a supermarket for 30p. Crazy. Something has to change.

 

[beorhthelm]

I think all the while that the Pandora papers are proving ...

that a lot of rich people exist and take advantage of legal loop holes to hold some assets. who knew? they are mostly foreigners holding foreign assest and little to do with this issue.

 

[Weststander]

I’m not sure there is consensus on what we want from the NHS. The demands on the service and its provision certainly bears little resemblance to the service set up in the 1940s. It has become bigger and bigger because of the mantra of free at the point of delivery and because of advances in medical science. We seem trapped in a perpetual systematic underfunding as defined by these two factors. We can never catch up. Personally I would go for both of your options. Higher taxes to pay for a better basic service more in line with the vision of the Beveridge Report and compulsory insurance for the rest. Can’t see either happening though as the Right is against higher taxes and the left is against medical insurance.

I really like what [MENTION=409]Herr Tubthumper[/MENTION] explained is the case in Germany, on a previous thread.

Anyone on these shores lazily assuming that it's just a better funded version of the NHS, paid for by the rich, would be wrong.


Healthcare system costs in Germany
Germany is one of the biggest spenders on healthcare in Europe. It spends 11.1% of annual GDP on healthcare expenditure. Only Switzerland and France spend more in terms of GDP percentage. German healthcare spending works out at just over €4,000 per inhabitant each year.

Public and private insurance contributions cover the majority of costs. On top of this, everyone has to pay a fee of around €10-15 for their first medical visit every quarter. You don’t pay this if you don’t seek any help during that quarter. Those with private health insurance can reclaim this.

Health insurance in Germany
If you are an employee and you earn less than €57,600 a year (€4,800 a month in 2017), you have to take part in the government health scheme – Gesetzliche Krankenversicherun or GKV – taking out health insurance as soon as you have signed your work contract.

The scheme is administered by around 110 Krankenkassen (non-profit making associations) which must all charge the same basic rate of 14.6% of your eligible gross salary; up to a maximum of €4,350 a month in 2017 (€52,200 annually). This amount is shared equally between you and your employer. You have to stay with a particular Krankenkasse for 18 months, after which time you can switch to another government scheme. Employed workers only pay contributions if they earn over €850 per month.

GKV covers you for primary care with registered doctors, hospital care (both in- and out-patient) and basic dental treatment. Non-working dependents living at the same address and registered with the Krankenkasse are covered at no extra cost.

GKV does not cover consultations with private doctors, private rooms in hospitals, alternative or complementary treatments, dental implants, or glasses/contact lenses for adults. You can read more in our guide to health insurance in Germany.


The bottom line is that it's better funded per capita and a class above ours.

 

[Mellor 3 Ward 4]

Undoubtedly the NHS is under-staffed at so many levels.

.

It's the WORLD's 5th largest employer - I would suggest there are enough people, but perhaps not all employed doing the right thing......

I would happily pay more tax - if it's guaranteed to go to the right places.

 

[Neville's Breakfast]

I really like what [MENTION=409]Herr Tubthumper[/MENTION] explained is the case in Germany, on a previous thread.

Anyone on these shores lazily assuming that it's just a better funded version of the NHS, paid for by the rich, would be wrong.


Healthcare system costs in Germany
Germany is one of the biggest spenders on healthcare in Europe. It spends 11.1% of annual GDP on healthcare expenditure. Only Switzerland and France spend more in terms of GDP percentage. German healthcare spending works out at just over €4,000 per inhabitant each year.

Public and private insurance contributions cover the majority of costs. On top of this, everyone has to pay a fee of around €10-15 for their first medical visit every quarter. You don’t pay this if you don’t seek any help during that quarter. Those with private health insurance can reclaim this.

Health insurance in Germany
If you are an employee and you earn less than €57,600 a year (€4,800 a month in 2017), you have to take part in the government health scheme – Gesetzliche Krankenversicherun or GKV – taking out health insurance as soon as you have signed your work contract.

The scheme is administered by around 110 Krankenkassen (non-profit making associations) which must all charge the same basic rate of 14.6% of your eligible gross salary; up to a maximum of €4,350 a month in 2017 (€52,200 annually). This amount is shared equally between you and your employer. You have to stay with a particular Krankenkasse for 18 months, after which time you can switch to another government scheme. Employed workers only pay contributions if they earn over €850 per month.

GKV covers you for primary care with registered doctors, hospital care (both in- and out-patient) and basic dental treatment. Non-working dependents living at the same address and registered with the Krankenkasse are covered at no extra cost.

GKV does not cover consultations with private doctors, private rooms in hospitals, alternative or complementary treatments, dental implants, or glasses/contact lenses for adults. You can read more in our guide to health insurance in Germany.


The bottom line is that it's better funded per capita and a class above ours.

And also a mention in that piece for the high level of health spending per capita in Switzerland. We lived there for a while and like everybody else we paid private medical insurance and benefitted from their health system. Insurance premiums are set by the Government and everyone qualifies for cover. The insurers are merely overseeing the system whereas such a system is often mistakenly characterized in this country as an evil capitalist plot. I think some of the confusion arises because people think of the very flawed American system that is not compulsory.

 

[Nobby Cybergoat]

I think all the while that the Pandora papers are proving that the ultra rich are doing anything but paying their fair share, it hurts to think of asking for more money from those that are already paying, and those that can least afford it compared to the super rich. The UK is losing billions each year in revenue due to this and little seems to be happening. You have the well known cases of the bigger companies making billions and paying next to no tax. The action on these seems to be moving at a snails pace and whilst what they may be doing is "legal" it's not right and should have been changed years ago.

Once everyone is paying their fair share then yes, I'd be more than happy to pay more should the system still need it.

You're completely right.

Collecting money from these people is very hard. Every nation struggles with this to a degree, but I have no faith that this government is making any effort whatsoever.

The starting point should be to totally pull out all the stops to collect everything possible from tax exiles and amazon starbucks etc

This would require unprecedented international coordination, but post covid, and with Biden making the right noises about collective tax rates there, in theory should never be a better time

It would also require having a government willing to tax it's own party donors. ie not this one

 

[Thunder Bolt]

Anything free will always be abused. 2m A&E visits per month (pre-pandemic, dunno the figures now). That's ridiculous. The Freakonomics guys suggested a nominal charge to David Cameron when he asked for their ideas but he described that as political suicide. Paracetamol on prescription which effectively costs £10 a time, something that can be bought in a supermarket for 30p. Crazy. Something has to change.

You can only buy two packs of paracetamol at any one time. People who suffer with arthritis take paracetamol on a regular basis, so get prescriptions for 80 at a time, so they don't have to visit the shops every other day. There are the odd one or two people who ask for prescriptions for their kids but doctors won't sign them unless there is a medical reason for it. Please don't believe the silly Facebook memes.

 

[Westdene Seagull]

Myself, or my immediate family, have had need to use the emergency NHS care at least five times in the last two years and every time they have been excellent. The biggest problem is so many people turning up at A&E that really don't need to.

Where the NHS isn't so good is the after care and pre-care. So for example - Mrs WS recently broke her ankle. Initial treatment was fantastic but all follow up treatment has had to be chased - it's like they hope if they don't contact you then you might just not bother and so save them some time.

Don't even get me started on GPs - not really NHS and basically have a God complex and are more interested in making money than seeing sick people.

 

[KZNSeagull]

You can only buy two packs of paracetamol at any one time. People who suffer with arthritis take paracetamol on a regular basis, so get prescriptions for 80 at a time, so they don't have to visit the shops every other day. There are the odd one or two people who ask for prescriptions for their kids but doctors won't sign them unless there is a medical reason for it. Please don't believe the silly Facebook memes.

It's not a meme. There is a sign in our local chemist urging people not to get paracetamol on prescription if they can avoid it.

Edit. It may well be a meme but I have not seen it.

 

[rippleman]

Whilst we are looking at ways to raise funds for the NHS, NatWest has just been done for allowing ONE customer to launder £400m through its account over a 2 1/2 year period.

The banks are, and always have been, complicit in money laundering. How about every time they get caught, they are fined a multiple of ten times they have assisted the criminals to launder? That would be a fine start to the fund.

But oh no, I'm being silly. Politicians allow the banks to do whatever they want because they wouldn't want to jeopardise their lucrative non-exec directorships when they retire from politics. No sirrreeee.

 

[Harry Wilson's tackle]

Sorry to pick up on just one small part of your post, but I must make the point that insurance companies look to find get-out clauses. My cousin's daughter died in her 40s from liver cancer, because her insurance wouldn't pay out. She was refused treatment.



I am extremely wary of this government's motives (to put it mildly) A lot of their backers own insurance companies ie Aaron Banks.
When they boast of 40 odd new hospitals, when it is 40 odd refurbished hospitals (have they all been refurbished yet?) then their motives are extremely suspect.

No, that's fine, and I'm very sorry to hear that.

I was thinking more of a national(ised) insurance scheme that guarantees the best available treatment based on need. That's what I understood the Canadian system to be. I think the German system is silimar (@herr tubthumper can correct me if I'm wrong)

I deplore the American system where even the 'fully' insured are stuffed if they get sick twice. I remember reading about fully insured people having to sell their homes to pay for treatment after getting a serious illness, then finding their insurer would not 'renew' (and no other would take them on), then having a relapse.

As for HMG, I honestly haven't a clue what they are up to. There are some tories who are fully signed up to the welfare state, and are not capitalist ideologues. Others are different. Boris himself is an iconoclast liberal, and is capable of anything, albeit he will franchise out all the work to his cabinet because he's so lazy and feckless. I really don't see anything in him beyond the desire to be in power and have a laugh. Some of his cabinet may well be different. I think Sunak is there to make a difference. What he thinks constitutes a difference is not yet clear.

As for Banks and the various other freaks like the Wetherspoons owner, sure they would sell off the NHS without blinking. I don't know how much influence they have, though. In that regard, the way Boris has hidden his agenda (if he has one) behind dense clouds of wafting wiff-waff and piffle is actually quite masterful. Worrying, but masterful. I hope he gets bored and walks, soon.

 

[dsr-burnley]

As for Banks and the various other freaks like the Wetherspoons owner, sure they would sell off the NHS without blinking. I don't know how much influence they have, though. In that regard, the way Boris has hidden his agenda (if he has one) behind dense clouds of wafting wiff-waff and piffle is actually quite masterful. Worrying, but masterful. I hope he gets bored and walks, soon.

It is impossible to sell the NHS. The NHS is a principle that all patients can have the necessary treatment free at point of sale. That is not something which can be sold.

There is a school of thought, which certainly wasn't shared by Gordon Brown, that no-one should be allowed to make a profit out of healthcare. And obviously people who have that viewpoint won't agree with the idea of outsourcing tratment, using private hospitals, the GP system, and so on. But that isn't the same as selling off the NHS, because the NHS is a principle, not an operating system.

 

[Audax]

On the bigger question, I’m all for a hybrid private/public health system.

The Aussie system is a hybrid - story about it here: https://www.vox.com/2020/1/15/21030568/australia-health-insurance-medicare




On a completely separate note, I'm also currently experiencing some of the shortcomings of the NHS here in the UK. It's Baby Loss Awareness Week next week - did you know that the NHS, as an institution, couldn't care less about the mental health and well being of grieving parents? We're left to find our own way through contacting charities (Tommys, Petals, Cradle, Sands) who may or may not be able to support you depending on which hospital you were seen by. The charities themselves appear to be underfunded, and as a result far too reliant (in Cradle's case) on social media to deliver their services.

There's big gaps in the NHS. Mostly in areas where the majority won't know or care that those gaps exist. But if you ever encounter any of those gaps, you're very much left to fend for yourself.

 

[um bongo molongo]

across europe healthcare is provided as a mix of public and private, usually with additional insurance for most employed. for some reason we are horrified by the notion of private healthcare, despite most being not for profits, and ignoring GPs are private.

until we want to accept new models of funding and delivery of healthcare, its not going to change substantially.

Saved me writing the same thing. And the minute someone raises this topic, there are howls of ‘privatisation’ which prevent any reasoned debate. To some extent, the mess is one of our own making therefore, as we seem to hold the NHS in the same regard as a religion, and to suggest it’s a broken system seems tantamount to blasphemy for many, despite the clear evidence that it is.

 

[dazzer6666]

The NHS is not broken, it is just run by a massive workforce of over paid incompetents who want nothing more than to continue with the status quo, leaving others to literally kill themselves helping others.

Pretty much what my daughter says. Crap management, crap infrastructure/technology, crap admin....and now too much demand...all leading to way too much stress on frontline staff in turn leading to loads of sick leave and resignations, creating a vicious circle. Interestingly she's moved off the wards into a senior research nurse role recently on a stage 1 clinical trial within a very small team - no stress, own office, flexible hours, loads of available training etc etc etc. NHS are managing the project but I think the drug company is funding it..............
[MENTION=21158]Weststander[/MENTION] - hope everything is OK - despite the wait the treatment from the NHS is usually second to none.

 

[dsr-burnley]

If the government taxed the dodgepots like Amazon, Google etc and they paid their fair whack, and went after the foreign billionaires money laundering in the UK, then poor old Peter Bottomley wouldn't have to scrape by on just £82K a year - and we could invest the tax yield in the NHS.

Unfortunately, the OP has overlooked the fact that with ever-increasing prices, the UC cut, the NI rise etc etc many people are not in a position to bear the burden of increased taxes and therefore less take home pay.

I agree a tax hike is the way to fund the NHS - but from those corporations and individuals who are best placed to afford it. But a Tory government putting up taxes for the wealthiest individuals and big business is never going to happen; they have their own vested interests to protect.

How about recovering all the money paid out to Hancocks friends and family to provide PPE that never happened. There's a good few millions to start us off

Amazon in a year makes sales of the order of $500 billion and net profit of $30 billion. About $30 billion of the sales are in the UK, so pro rata that would make $2 billion profit, or £1.5 billion pounds. very round numbers of course.

In the year ended 2020, Amazon paid £492m in direct UK tax. That would be about a third of the profit, and standard corporation tax is 19%. In round numbers, they're paying higher than their share, but that's probably just because the numbers are so very approximate. But it certainly doesn't suggest they're underpaying.

In any case, how much of Amazon's worldwide profit should be diverted to the NHS? The NHS has an annual budget of £159 billion for 2021-22. Over $200 billion. Amazon's entire worldwide profit would only pay for 2 months running costs for the NHS.

It's the same problem with rich individuals. Forbes (admittedly in 2017) listed 40-odd UK billionaires, many of them overseas visitors, who between them had assets of £192 billion. If the income on £192 billion was taxed at 50%, how much would it raise? £5 billion? And for that we would have to get the agreement of the rest of the world that they won't want a share at all.

I'm not saying that rich people should or should not be taxed more. I'm just saying that the budget of the NHS is so vast that taxing even the very largest and richest individuals and companies will only scratch the surface of the problem.

 

[raymondo]

Do something about the richest 0,1% putting all their money in tax havens and a significant part of the problem is solved.

Unfortunately, throughout history - regardless of nation and regardless of ruler - no one has seemed to be willing to solve this.

I agree with this. I think the reason nothing gets done about it is because political leaders everywhere are tied up in it themselves: own multiple properties, have their own shell companies, have money they want to protect from the taxman, suck up to the ultra rich because they are/ hope to be part of that club, and they want the donations... I've have enough of it and have no idea what to do about it. I write to my MP (Conservative) and he always replies, just spouting the Tory party line: e.g. 'we have a committee that investigates many properties bought by overseas people (shell companies) and I can assure you we'll be bringing anyone to court whom we suspect has bought a property through money laundering' etc etc. It's mainly bullsh#t.

 

[pb21]

In round numbers, they're [Amazon and others] paying higher than their share

Technical/legal fair share, yes.

Subjective/'moral' fair share, arguably not.

 

[stewart12]

i'd happily pay more tax if it meant better public services

problem is I don't trust this government to use public money properly so really all raising taxes would do is give a few more handouts to Johnson's chums