.

[selectortone]

The mistake is believing that the NHS is ever going to perform like the private system, or that the private system will ever be able to take over fully for the NHS

The lions share of funding for private healthcare in this country comes from companies giving it as a benefit for their employees. The logical progression there is that the NHS gets starved to death and we end up in the serfdom you have in the USA where people are virtually indentured to their employers because of their health benefits and the astronomical cost of private medicine.

The philosophy behind the NHS is that it is run for the benefit of its customers, not shareholders. I know that's a difficult concept for many Americans. But if all the money that private companies here pay private health companies went to the NHS, and the government stopped de-funding it in real terms it would be a lot healthier.

 

[D_W]

The lions share of funding for private healthcare in this country comes from companies giving it as a benefit for their employees. The logical progression there is that the NHS gets starved to death and we end up in the serfdom you have in the USA where people are virtually indentured to their employers because of their health benefits and the astronomical cost of private medicine.

The philosophy behind the NHS is that it is run for the benefit of its customers, not shareholders. I know that's a difficult concept for many Americans. But if all the money that private companies here pay private health companies went to the NHS, and the government stopped de-funding it in real terms it would be a lot healthier.

You're not indentured, you can get a different job. But what's true is if you want to make minimal income and just coast effort-wise, the health care part of it will make that more difficult.

If you wanted to be self-employed starting at a later age, things would be difficult until you had a tax return for a low-paid year and could go out to the federal exchange and get a subsidy.

Here's where people go off track - they save no money at all and then complain that they're indentured to jobs because they couldn't afford a couple of hundred dollars a month for bridge coverage.

The truly poor here don't pay, though - they're on Medicaid.

I would imagine you have a hidden problem that nobody really wants to discuss with the NHS, which is utilization and demands from the average person now outstrip what the average person is willing to pay, and it's easy to blame it on a small group who already is funding everyones' way at a disproportional share.

This is a natural progression - from grandparents and aunts and uncles who would've been more sparing and had great appreciation for what they were paying for, and contributing because the personal responsibility to society would've been there, to a huge cross section believing that what you get and what you pay should have nothing to do with each other. And that group becomes the majority.

I do think the system in the US causes a fundamental issue that people don't plan for - paying for healthcare in retirement prior to medicare eligibility. Once you're 65, pressure is off. Everything is super cheap and you bear almost no responsibility for being a heavy utilizer. But if you want to retire early, you have to fund that cost of faff around keeping your income low (which means you can't take a bunch of retirement income out to spend it on leisure) after the first year so that you qualify for subsidized coverage. I believe that before out of pocket costs, that's about 9% of income. The fedgov picks up the balance.

 

[flying haggis]

Part of the NHS's problem is that we are seen by many as the International Health Service. Anyone not from this country requiring health care in this country should have to have health insurance before the get treated or a means of paying for it upfront.

 

[D_W]

In the year 2000, GB paid 1021 pounds per capita for health care utilization.

In 2021, this figure was 3405. Before covid in 2019, it was 2647. These are only the public health spending dollars.

In 2000, gdp per capita was about 28,000 pounds, and in 2021, it was slightly over 47,000.

Just as I mentioned above (but went and tracked down statistics), I think you are failing to factor in how much more health care is being utilized in the UK, and you have a group of taxpayers who probably aren't interested in paying a greater % of their earnings to cover the increased utilization.

This only really ends one way - strain on the system and it's not a coincidence that private care has popped up.

Since 2007, GDP has been flat or declined slightly - or really since 2005. This stagnation goes from blair until now. The translation of this is that it's likely that the revenues toward the NHS based on payroll have changed little as the GDP also has not.

This is where entitlement comes in. There are not enough "rich people" to just pay for everyone regardless of what they want. The middle class has to bear some part of this because they are incurring the cost and are the bulk of the group.

2005 spending if bogeying the same period of time that GDP has stagnated has doubled.

At what point do rank and file citizens start recognizing that they are actually incurring much greater costs and utilizing health care at a much higher rate and they will need to pay more because they are. AS in, utilizing shows that they value the care system - almost across the board, but not enough to allocate a much larger share of income?

In the US, this sort of happens automatically, though it's not neatly done - it's fractious. But we have a problem with overutilization here. At the same time, we also are saddled with paying (active workforce) the cost of this each year, and as long as we keep utilizing at a higher and higher rate, it suggests that we only want to complain about the price, not do something with it.

The NHS has this detached as two separate issues - everyone wants to utilize, but paying for that seems to be detached in the minds of most as a political issue, and supposed corruption and cost leaks or small groups of additional covered folks get the blame. But those issues are tiny compared to the real problem- the fact that far more care per individual is being issued.

 

[clogs]

I for one have been very happy to pay my taxes to keep the NHS going...
but I do object to Karens getting bigger boobs and all the other transgender cr@p that everyone has to pay for....
If u need IVF or ur bits cut off and folded in u should save up for it and pay privately.....
Unfortunately the system is overloaded.....
Not so long ago a foreign lady arrived in the UK with a difficult multiple birth.....
after the birth and initial care she did a runner back to west Africa and never paid.....
I would like to see ID cards, the rest of the world have em, so u dont pay in u get nowt....
Most countries in Europe, when u go for medical care they first want to see ur credit card....
no card no service or without the E111 or what ever it is now, if it still exsits....

I had a serious accident and badly damaged my shoulder joint...
It needed physio and an injection of steroids and 2 other chemicals to releive the pain etc....
it would be free if I used the local hospital but would take a few days.....
OR
pay the same specialist in his private clinic and get it done as a walk in off the street...
€75euro's.....I'm happy to pay.....
the physio was done by my wife with instruction from youtube......hahaha...
as for the payment it would have cost that much to park at the hospital or more due to the many visits needed....
So I say I got it cheap....
My daughter is a trainee Paramedic......I'm grateful for all those that work within that organisation....
The county in which she works have been replacing the Ambulance fleet from Merc's to Fiats due to costs.....
They now realise that it was an expensive error.....somebody in charge should be sacked without pension for wasting the money....
My guess it was a hand back somewhere along the way....
It's just a shame the NHS run by overpaid donkey's....

 

[Jacob]

....
Most countries in Europe, when u go for medical care they first want to see ur credit card....
no card no service or without the E111 or what ever it is now, if it still exsits....

No prob before brexit. My wife had major sessions in a french then a german hosp at no cost (or a little fee for the room or something I seem to remember). Brexit was a ghastly mistake. So many things are simple if just reciprocated country to country.

.....
It's just a shame the NHS run by overpaid donkey's....

You mean the management? Staff are generally low paid. NHS generally considered very cost effective

 

[D_W]

My comments above, for anyone reading them aren't "criticism of the UK system from an american's point of view", they're more a matter of how politics gets people to focus on solving minor problems without addressing the significant issues that are actually the core of the problem.

In the US, we don't have the choice for a basic health care system - I would use it. Especially if I could get the discount between NHS and the actual cost I pay in benefits.

We have a huge problem here - that is, more care is provided by publicly funded systems than private, which surprises most people, and the private system high cost is subsidizing the public system. utilization here is out of control, and cost per service is also higher. but solving only one or the other doesn't fix our overall issue. The biggest part of the problem is the payment for services and the services you choose to utilize are not well attached. There are two payers, or three sometimes, and the average individual who continues to utilize more has no ideal who is paying how much. So the fact that we have a "private system" isn't really accurate - the information is too difficult for the average person to parse.

And until you're an individual, there is no real personal incentive to be healthy outside of the medical sense of the word.

Which is an issue for both us and the UK - the per capita costs will only continue to outstrip income as countries' full of obese people age. We are 42% obese in the US and the UK is at 28, exactly 2/3rds). The rate in the UK is about where it was in the US in 2000, which should mortify you guys. It looks like the change in those percentages (relative growth in obesity rates) has been about the same for both countries. Ours have gone up 50%, and so have yours.

 

[John Brown]

I for one have been very happy to pay my taxes to keep the NHS going...
but I do object to Karens getting bigger boobs and all the other transgender cr@p that everyone has to pay for....
If u need IVF or ur bits cut off and folded in u should save up for it and pay privately.....
Unfortunately the system is overloaded.....
Not so long ago a foreign lady arrived in the UK with a difficult multiple birth.....
after the birth and initial care she did a runner back to west Africa and never paid.....
I would like to see ID cards, the rest of the world have em, so u dont pay in u get nowt....
Most countries in Europe, when u go for medical care they first want to see ur credit card....
no card no service or without the E111 or what ever it is now, if it still exsits....

I had a serious accident and badly damaged my shoulder joint...
It needed physio and an injection of steroids and 2 other chemicals to releive the pain etc....
it would be free if I used the local hospital but would take a few days.....
OR
pay the same specialist in his private clinic and get it done as a walk in off the street...
€75euro's.....I'm happy to pay.....
the physio was done by my wife with instruction from youtube......hahaha...
as for the payment it would have cost that much to park at the hospital or more due to the many visits needed....
So I say I got it cheap....
My daughter is a trainee Paramedic......I'm grateful for all those that work within that organisation....
The county in which she works have been replacing the Ambulance fleet from Merc's to Fiats due to costs.....
They now realise that it was an expensive error.....somebody in charge should be sacked without pension for wasting the money....
My guess it was a hand back somewhere along the way....
It's just a shame the NHS run by overpaid donkey's....

You might think the transgender thing is cr@p, but I expect the troubled souls who take such extreme action would disagree. Do you happen to have any idea what percentage of the NHS budget goes on gender reassignment? How does that compare to the cost of obesity, alcohol abuse or smoking?

 

[D_W]

You might think the transgender thing is cr@p, but I expect the troubled souls who take such extreme action would disagree. Do you happen to have any idea what percentage of the NHS budget goes on gender reassignment? How does that compare to the cost of obesity, alcohol abuse or smoking?

At what point was the smoking percentage of the population higher than it is now? Not disagreeing with the premise - these are the little bits that ignore addressing that the average person is ringing up twice as much service as they were 17 years ago, but the overall economic activity in the country is almost unchanged per individual.

Smoking related costs are generally on the decline from one country to the next, and the actual cost of pensioner and health care benefits for a lifetime smoker is less than it is for a nonsmoker. Why? Because they generally live long enough to have a full working lifetime, and the end of life care may be higher per year, but the shortened expected lifetime far more than offsets the higher per year costs.

This is something that's bothered me for a long time - I work in a numbers-related profession. People hear that smokers cost the public benefit system more - they don't. I never bothered to look to find actual documentation until last year. The taxes paid by smokers subsidize other things unrelated to them and the actual directing of dollars toward healthcare is not the case here, though it's often given as a reason for the taxes. It's like saying people drive cars too heavy, implementing a tax and then diverting 5% of the new tax to road repairs and the other 95% is free pet money for politicians.

Obesity is a bigger problem - it's increasing, it's more universal, the health care cost is more uniform and obese people don't pay a fat tax.

I am at the lower end of the "obese" schedule in the US, by the way, but with no health care costs yet attributed to it.

 

[D_W]

Well, what I just said above hasn't been that unknown for that long - I just searched it again and the first hit is an article in the NEJM in the US...

....published by the Dutch Health Care Ministry in....wait for it.....

1997.

Stating that initial cost declines would be moderate and outweighed by increased costs due to longevity in the long term.

...and that didn't even address the difference in cost for public pensioners.

 

[TRITON]

The thing that annoys me the most about private healthcare here in the UK is all they have is consulting rooms. They have no medical infrastructure, no surgical units., no operating theaters. All of which is carried out at a publicly funded NHS hospital.
Sure they rent the time, but NHS operations are put off in favour of private clinics using the facilities.
And thats what we can expect for the future. If you're only NHS, you'll be pushed further down the waiting lists, or have a lesser service, as the private companies take over fully the hospitals the public have invested in.

 

[Jameshow]

The thing that annoys me the most about private healthcare here in the UK is all they have is consulting rooms. They have no medical infrastructure, no surgical units., no operating theaters. All of which is carried out at a publicly funded NHS hospital.
Sure they rent the time, but NHS operations are put off in favour of private clinics using the facilities.
And thats what we can expect for the future. If you're only NHS, you'll be pushed further down the waiting lists, or have a lesser service, as the private companies take over fully the hospitals the public have invested in.

Not true, there are plenty of private hospitals with theatres and wards etc.

What I doubt they have is intensive care provision.

 

[D_W]

What is the tax rate that individuals pay for health care now vs 17 years ago? Has the actual payment per taxpayer doubled?

I guess my point here is that if the average person is consuming twice as much but the system isn't bringing in twice as much and other funding is needed, to have priority is kind of difficult to do in making a case.

The combination (from the US standpoint) is weird unless the contribution by the private health care is what's allowing NHS to be solvent.

In the US, medicare is provided at a low cost - medicare negotiates this so that the federal costs are lower than they would be if done at full cost. The system itself relies on private payers to make ends meet then, but I don't know that there is a difference in priority. if medicare-eligible scheduling was a little bit less customer friendly, realistically, medicare enrollees couldn't make the case that they should get the same priority as a first-dollar high-reimbursement private patient. One can exist without the other, but not the other way around.

 

[John Brown]

At what point was the smoking percentage of the population higher than it is now? Not disagreeing with the premise - these are the little bits that ignore addressing that the average person is ringing up twice as much service as they were 17 years ago, but the overall economic activity in the country is almost unchanged per individual.

Smoking related costs are generally on the decline from one country to the next, and the actual cost of pensioner and health care benefits for a lifetime smoker is less than it is for a nonsmoker. Why? Because they generally live long enough to have a full working lifetime, and the end of life care may be higher per year, but the shortened expected lifetime far more than offsets the higher per year costs.

This is something that's bothered me for a long time - I work in a numbers-related profession. People hear that smokers cost the public benefit system more - they don't. I never bothered to look to find actual documentation until last year. The taxes paid by smokers subsidize other things unrelated to them and the actual directing of dollars toward healthcare is not the case here, though it's often given as a reason for the taxes. It's like saying people drive cars too heavy, implementing a tax and then diverting 5% of the new tax to road repairs and the other 95% is free pet money for politicians.

Obesity is a bigger problem - it's increasing, it's more universal, the health care cost is more uniform and obese people don't pay a fat tax.

I am at the lower end of the "obese" schedule in the US, by the way, but with no health care costs yet attributed to it.

I admit that I knew that, too. I was making a point, and got carried away. However, it might be too early to say, but I would guess that transgender people are less likely to procreate, and maybe that should be factored in.
It's a pointless and nasty argument, and I'm sorry I let myself be dragged into it.

 

[baldkev]

I said before how evreyone on benefits has the latest iPhone and people got upset with me.

At least you agree.

To be balanced, i wasnt suggesting everyone on benefits has the latest iphone
I was illustrating the ways I could burn money each month ( which i dont do )
My downfall is tools.... i can 'justify' those easily because i 'need' them for work

Some people are good with money, others arent, but to be fair, most people buy stuff to make them feel better, its the scale that varies. Some people get trainers, some people get an iphone.... i want a mini digger

 

[D_W]

I admit that I knew that, too. I was making a point, and got carried away. However, it might be too early to say, but I would guess that transgender people are less likely to procreate, and maybe that should be factored in.
It's a pointless and nasty argument, and I'm sorry I let myself be dragged into it.

That's a fantastic point, actually - would having the option and going a more nontraditional route result in lower future costs. It does, unfortunately, seem to be correlated with lower life expectancy, but I don't know what that's compared to. It may be the individual in general is part of a very high risk class and it actually goes the other way.

The way you mentioned the smoking was what prompted me. There are so many things said that seem to make sense and they become a football. The smoking cost strain on society is one of them, and the public costs in the US are so heavily weighted to late life since public health care and retirement generally start at or near 65, and the tax burden much higher on smokers (to the point that for them, the average share of household income for a smoker is not bonkers) that it started to not make sense. So I looked it up, and of course, the info is freely available out there.

Both political sides use this "common sense".

In the US, more than 90% of road wear is caused by heavy trucks. If we could bother to wait a couple of days longer and use rail, a lot of this would be lessened. I've heard a lot of farmers complaining about the chance (I'm descended from farmers) that electric cars won't "pay their share" when they're driving trucks on subsidized licensing costs, receiving subsidized insurance and all kinds of other direct and nondirect payments (while building equity owning land) and are also notorious for overloading trucks when hauling to sell grain. it may not be a surprise to anyone here, I talk the same way in real life..."wait, who is paying a fair share and who isn't".

you can bait someone like that into "they need to pay for the wear and tear on the roads that they won't be paying for...it's just common sense".

I hate to be proven wrong, so it causes me to think and reflect. Most people don't care if they're wrong - it causes them to shift lanes and try to attack from a different direction. "without trucks you'd starve!!!".

 

[baldkev]

No. They should pay more tax, because they have more money. People with no money can pay no tax. People with little money can pay little tax. People with the most money should pay the most tax. It's not difficult to understand and it's how the world works.

No. I complain about under investment in state schools.

No it doesn't. Relatively easy and routine work gets done privately, nowadays expensively paid for by the state - the taxpayers. The difficult stuff gets done by the NHS. The NHS has been gradually privatised over a number of years

No. They should not have charitable status and should be subject to the same imposed standards as state schools so that we have a level playing field. As it is the wealthy get massive assistance in exam results and tend to dominate top University entrance. The result is they are over educated beyond their ability with the glaringly obvious effect of having blatantly idiotic old Etonians in positions of power and influence throughout the land. You know who they are just as well as me.

Punishment has nothing to do with it. Nor vilification or tribalism. Anyway it's the left who attract most vilification. You shouldn't feel so sorry for yourself!


So if you fell on hard times you'd just grin and bear it? Shuffle off and die? Do you not use publicly paid for facilities such as the road network, to name just one? Do you have a private army or do you rely on the police and the armed forces? Do you think the nation's health was better before the NHS ? and so on ad infinitum
It's very odd how often one has to explain to some people how the world works, as though they've only just dropped from the trees and started walking upright!

Relating to private healthcare and your comments, his point was that it takes the burden off the nhs, not that the private sector doesnt do nhs work.... so yes, it reduces nhs costs and waiting times. The fact that the nhs subbies work out wasnt in question or part of the statement

 

[Flynnwood]

This did shock me yesterday. I've known this chap for nearly eight years, he's about 40 something and has done very well for himself financially (UK).

"We found my Dad dead on Friday at 8am. I called an ambulance and was told it would be about 45 minutes."

"Eight hours later, a funeral director arrived to take the body away. No Doctor involved. And no ambulance."

Fast forward to Wednesday:
"I've been running around trying to get a Death Certificate to register his death.
At some point, someone asked me: 'What do you think he died of?'"

(The son must have been quite stressed at this point, but he would not have made that up)

On a separate note. a colleague had met with a Paramedic this week. We are not certain of the size/location but the Paramedic said:
"We normally get around 5,000 calls per day. Yesterday it was 8,000."

 

[D_W]

On the other hand - the worst thing to happen to me healthwise was complete break of quadriceps tendons in a fall. 10 years ago. Potentially permanent disability unless treated (sewn back together) very quickly 24 hours.
Was rescued by ambulance in deep snow, wooshed off to hosp, examined by teams of people including trainees with clip boards, sewn back together again very quickly. Two nights in hosp and thrown out.
My only complaint was that they kept waking me up in the night to see if I was OK and offering me cups of tea.
Lots of after-care, hosp visits and monitoring with adjustable splints, about a year to recover as it's a big one, worse than bone fracture.
So what?
I found an American chat group on the topic as it's a major sports injury, skiers etc (I just fell down some steps). The stories they had to tell were appalling - insurance checks, delays, enormous bills, delayed operations with bad outcomes , etc etc.
All NHS, I paid absolutely nothing and had top notch treatment.
Happy to pay taxes! All for one and one for all!

You should cling to your anecdotes about care believing the outcomes and level of care in the NHS are better than the american system.

I'm guessing your tax contributions are far less than your cost to the NHS system, so it's pretty easy to be a big fan of it. I think folks in this situation should do a little more to recognize that someone else is paying the way for them.

Here's a more realistic story from people I know - they moved to london for work for four years. One of their kids had a broken bone, they went to a hospital and the hospital sent them to another one because they first didn't have xrays. It ended up taking most of their day for something routinely handled here (stabilizing the break, doing the work and discharging the patient kind of all in a row). The only thing they didn't like about England was the health care. I'm sure they didn't love the costs, either, but if you live in NYC here, it's barely different.

If you are a payer in the US system, the care here is better. The system is overwrought with confusion in costs and excessive costs and utilization, but the care quality is high and the wait times are pretty much nothing. It's not easy to get good data on actual quality of care or outcomes because most rankings apply a very fat factor to whether or not care is public (which is not an outcome, but treated as if it is) when assessing care quality.

 

[John Brown]

To be balanced, i wasnt suggesting everyone on benefits has the latest iphone
I was illustrating the ways I could burn money each month ( which i dont do )
My downfall is tools.... i can 'justify' those easily because i 'need' them for work

Some people are good with money, others arent, but to be fair, most people buy stuff to make them feel better, its the scale that varies. Some people get trainers, some people get an iphone.... i want a mini digger

I want a Giant Hadron Kaleidoscope.
You can't always get what you want.