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> that's not what anyone wants The NHS has been turned into what is effectively a state religion in some quarters. It's untouchable. It can't be criticised.

by rleigh 4y ago

> that's not what anyone wants The NHS has been turned into what is effectively a state religion in some quarters. It's untouchable. It can't be criticised. It's immune to meaningful improvement and reform at this point. Yet everyone I know who works for the NHS has a litany of stories about the inefficiency and waste. And it consumes an increasing proportion of the GDP. Eventually, something will have to give. Its been on an unsustainable path since its inception. It's always been in crisis and needed increasing amounts of cash. Cash that we taxpayers have no choice but to pay up. The NHS isn't optional, it's mandatory. If we have the option to opt out of paying for the NHS and go private, many will do so. I already have to pay twice over. I pay privately through my employer's plan, and then again for the NHS. I suspect if there is the possibility of opting out and going entirely private, many would do so. At this point it's the only way to ever get a GP appointment for many of us. The problem with the debate here is that it's always framed in terms of UK vs US funding models, both of which are horribly broken in different ways, and never looks at other European countries or other systems around the world, some of which have systems which work better and provide better health outcomes for less money. If we were to privatise it along French lines, for example, it might be a massive improvement all around. But that debate has never happened.

neilwilson 4y ago
"I pay privately through my employer's plan, and then again for the NHS." And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable. There is a supply side limit on doctors and nurses, which means private healthcare works like the Fast Track queue at Alton Towers. All it does is allow people with money to jump the queue at the expense of everybody else. And remember that since the inception of the NHS Primary Care, ie the GPs, have always been private businesses. Yet that is the bit that is completely on its knees at the moment. This isn't a private vs public argument. It's far more fundamental than that. It how do we share out increasingly scarce resources in a country that is getting poorer.
- rleigh 4y ago
  > how do we share out increasingly scarce resources We make people pay for them. Like we do with every other resource on the planet. Healthcare is something which should be accessible for all, and we can of course subsidise the less well off. But it still ultimately needs paying for.
- robertlagrant 4y ago
  > And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable. It's not a system doing it. Healthcare professionals are choosing to work for private companies instead of the NHS. If you would like to ban that, then say so, but don't pretend there's an amorphous system to blame.
  - neilwilson 4y ago
    There is an amorphous system to blame - too much demand and not enough supply. Some of that demand has money, therefore the private system will take capacity away from the NHS to supply the money. Of course it will. That is jumping the queue. Therefore as a society we have to ask whether we want to uphold the NHS's founding aim: "Healthcare free at the point of delivery based upon need not ability to pay". We can't fix the supply shortage by taxing the rich. But we can stop the queue jumping by constraining who private healthcare is permitted to treat and in what order. For the record I don't like the Fast Track queues at Alton Towers either. That's not the British way. In Britain we stand in line - whether Lord or Leper.
- googlryas 4y ago
  > It how do we share out increasingly scarce resources in a country that is getting poorer In this instance, the resources are humans, and it seems you want to force humans to do something they don't want to do. If you want slave-doctors just say so. It worked for the Romans I guess.
  - forgotusername6 4y ago
    This is the argument I hate the most from Americans w.r.t. nationalised healthcare. It's unbelievable
matthewmacleod 4y ago
I find this is a common and totally unjustified take. The NHS is fairly frequently subject to alteration and reform in various ways, and there is no real truth to the “piles of bureaucracy and waste” stories - it remains broadly pretty efficient as a healthcare system when compared with other developed countries. You’ve also misrepresented the nature of private healthcare in the UK - this is almost universally not a replacement for NHS services. It will offer you things like faster GP appointments, consultants, and routine operations. It will not replace many of the specialist or emergency services offered by the NHS, leaving you dependent on it anyway. A bigger “problem with the debate” is that we so frequently find people like yourself who are insistent on having some kind of “debate” without really knowing about what, or why.
- rleigh 4y ago
  > You’ve also misrepresented the nature of private healthcare in the UK I mentioned that we don't have the right to opt out of paying for the NHS. It's not possible go entirely private. If you could opt out, you could pay that money to a private provider instead and entirely forego the use of the NHS. That isn't an option today. But it should be.
  - simonswords82 4y ago
    I think if you’re forced to go private due to long nhs wait times the money you have spent on paying for the nhs via your taxes should be refunded to cover private care cost
  - XorNot 4y ago
    "opt out" is how conservative parties kill public healthcare systems. Because the public healthcare system winds up subsidizing the private one: private insurers dump bad risks onto it when they get too expensive too insure, after years or collecting the payments that don't go to the public system. It's the definition of privatizing profits and socializing risk. You want to opt out? You get to opt all the way out. You don't get to come back, it's a one way street. Still keen?
ricardobayes 4y ago
I just don't know why that is, every piece of that puzzle I have met, was really efficient and generally doing a good job. Spain is now trying to fix this and pensions by doubling self-employed tax. UK should probably follow suit, UK self-employed tax is ridiculously low. 20% on profits until 50k pounds won't cover a functioning healthcare system (or pensions for that matter).
- loriverkutya 4y ago
  In the UK id you are self employed you still need to pay National Insurance which is as far as I know used for funding healthcare.
  - yetanotherloser 4y ago
    It's not reserved for anything and hasn't been for ages.
- yetanotherloser 4y ago
  What on earth? UK selfemployment tax is far more aggressive than this and the tax authorities have been on an aggressive campaign against selfemployed people for many years, leading loads of people - including me - to give up selfemployment and end up paying LESS tax as a result.I miss selfemployment! but it doesn't bring enough benefits to justify being reamed AND demonised. And fuck the NHS. Smash the shit out of it. We'll all die exactly the same number of times without it, but be healthier and happier on the way.
- Nextgrid 4y ago
  I disagree with the threshold you mention. 50k£/year isn't exactly "rich", and even less so given the current conditions with regards to inflation, housing prices being through the roof, etc.
- nly 4y ago
  Total tax on someone in the UK earning the median full-tike salary of ~£32K is actually only ~15%
_benedict 4y ago
You are not paying twice over. Your private insurance is dramatically cheaper than it would be if it covered everything covered by the NHS. You do have overlapping cover, but the most expensive cover (GP, long term chronic conditions, emergency care) are provided by the NHS. It’s far from clear that you would pay less if you had to cover the whole through a private policy.

by rleigh 4y ago

neilwilson 4y ago

"I pay privately through my employer's plan, and then again for the NHS." And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable. There is a supply side limit on doctors and nurses, which means private healthcare works like the Fast Track queue at Alton Towers. All it does is allow people with money to jump the queue at the expense of everybody else. And remember that since the inception of the NHS Primary Care, ie the GPs, have always been private businesses. Yet that is the bit that is completely on its knees at the moment. This isn't a private vs public argument. It's far more fundamental than that. It how do we share out increasingly scarce resources in a country that is getting poorer.

rleigh 4y ago
> how do we share out increasingly scarce resources We make people pay for them. Like we do with every other resource on the planet. Healthcare is something which should be accessible for all, and we can of course subsidise the less well off. But it still ultimately needs paying for.
robertlagrant 4y ago
> And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable. It's not a system doing it. Healthcare professionals are choosing to work for private companies instead of the NHS. If you would like to ban that, then say so, but don't pretend there's an amorphous system to blame.
- neilwilson 4y ago
  There is an amorphous system to blame - too much demand and not enough supply. Some of that demand has money, therefore the private system will take capacity away from the NHS to supply the money. Of course it will. That is jumping the queue. Therefore as a society we have to ask whether we want to uphold the NHS's founding aim: "Healthcare free at the point of delivery based upon need not ability to pay". We can't fix the supply shortage by taxing the rich. But we can stop the queue jumping by constraining who private healthcare is permitted to treat and in what order. For the record I don't like the Fast Track queues at Alton Towers either. That's not the British way. In Britain we stand in line - whether Lord or Leper.
googlryas 4y ago
> It how do we share out increasingly scarce resources in a country that is getting poorer In this instance, the resources are humans, and it seems you want to force humans to do something they don't want to do. If you want slave-doctors just say so. It worked for the Romans I guess.
- forgotusername6 4y ago
  This is the argument I hate the most from Americans w.r.t. nationalised healthcare. It's unbelievable

matthewmacleod 4y ago

I find this is a common and totally unjustified take. The NHS is fairly frequently subject to alteration and reform in various ways, and there is no real truth to the “piles of bureaucracy and waste” stories - it remains broadly pretty efficient as a healthcare system when compared with other developed countries. You’ve also misrepresented the nature of private healthcare in the UK - this is almost universally not a replacement for NHS services. It will offer you things like faster GP appointments, consultants, and routine operations. It will not replace many of the specialist or emergency services offered by the NHS, leaving you dependent on it anyway. A bigger “problem with the debate” is that we so frequently find people like yourself who are insistent on having some kind of “debate” without really knowing about what, or why.

rleigh 4y ago
> You’ve also misrepresented the nature of private healthcare in the UK I mentioned that we don't have the right to opt out of paying for the NHS. It's not possible go entirely private. If you could opt out, you could pay that money to a private provider instead and entirely forego the use of the NHS. That isn't an option today. But it should be.
- simonswords82 4y ago
  I think if you’re forced to go private due to long nhs wait times the money you have spent on paying for the nhs via your taxes should be refunded to cover private care cost
- XorNot 4y ago
  "opt out" is how conservative parties kill public healthcare systems. Because the public healthcare system winds up subsidizing the private one: private insurers dump bad risks onto it when they get too expensive too insure, after years or collecting the payments that don't go to the public system. It's the definition of privatizing profits and socializing risk. You want to opt out? You get to opt all the way out. You don't get to come back, it's a one way street. Still keen?

ricardobayes 4y ago

I just don't know why that is, every piece of that puzzle I have met, was really efficient and generally doing a good job. Spain is now trying to fix this and pensions by doubling self-employed tax. UK should probably follow suit, UK self-employed tax is ridiculously low. 20% on profits until 50k pounds won't cover a functioning healthcare system (or pensions for that matter).

loriverkutya 4y ago
In the UK id you are self employed you still need to pay National Insurance which is as far as I know used for funding healthcare.
- yetanotherloser 4y ago
  It's not reserved for anything and hasn't been for ages.
yetanotherloser 4y ago
What on earth? UK selfemployment tax is far more aggressive than this and the tax authorities have been on an aggressive campaign against selfemployed people for many years, leading loads of people - including me - to give up selfemployment and end up paying LESS tax as a result.I miss selfemployment! but it doesn't bring enough benefits to justify being reamed AND demonised. And fuck the NHS. Smash the shit out of it. We'll all die exactly the same number of times without it, but be healthier and happier on the way.
Nextgrid 4y ago
I disagree with the threshold you mention. 50k£/year isn't exactly "rich", and even less so given the current conditions with regards to inflation, housing prices being through the roof, etc.
nly 4y ago
Total tax on someone in the UK earning the median full-tike salary of ~£32K is actually only ~15%

_benedict 4y ago

You are not paying twice over. Your private insurance is dramatically cheaper than it would be if it covered everything covered by the NHS. You do have overlapping cover, but the most expensive cover (GP, long term chronic conditions, emergency care) are provided by the NHS. It’s far from clear that you would pay less if you had to cover the whole through a private policy.