Originally Posted by 4(T)

Here is an idea for a radical solution:

At the moment, people who really care about their personal health often feel that they have to go private - if and when they can afford it - in order to access services such as comprehensive annual health screening, physio or prompt treatments, etc.

Given that the NHS is probably completely ungovernable in its current size and state, and that the above-mentioned "go private" individuals end up paying twice for their medical support (i.e. tax and private medical subscriptions), I wonder if health provision could/should be entirely split in two - and those who wish to go private be allowed to "opt out" of the national system?

- Clearly, both sides would be self-contained: the private industry would not be allowed to dump problems patients back over the fence (although both sides would still be free to buy and sell services off each other) and "opt-outers" would not be allowed back into the NHS without means testing or similar;

- "Opt-outers" would claw back 20% of their tax payment (roughly the share of State spend consumed by the NHS); this very significant amount of money would enable consumers to pay enhanced private medical subscriptions, in turn funding private infrastructure and services at least at the level of the NHS. The huge increase in private subscribers should enable private medical providers - who are competing against each other - to drive down general subscription levels;

- the NHS would then shrink in a managed way to size appropriate for the section of the population remaining as welfare recipients. This reduced size would be a better fit for the extremely limited management capabilities of government.


Do I get a Nobel prize?

Private companies do not want difficult work or unplanned work, they want easy in and out work.

A brilliant plan ad private insurance is fine until you get really really sick then your fucked.

Originally Posted by 4(T)

Do I get a Nobel prize?

No, because the income tax system is redistributive and your idea would hinge on a notionally equal level of contributions from each individual, which is not what happens.

I would argue the wealthier have a responsibility to contribute to the general health of the whole population. This has at least been the political consensus since 1948.

Originally Posted by brighton hippy

A brilliant plan ad private insurance is fine until you get really really sick then your fucked.

Not only that - the cost of premiums is usually linked to personal demand for services. Or to put it another way, poor health is penalised by the extraction of larger premiums.

Originally Posted by Pyianno

No, because the income tax system is redistributive and your idea would hinge on a notionally equal level of contributions from each individual, which is not what happens.

I would argue the wealthier have a responsibility to contribute to the general health of the whole population. This has at least been the political consensus since 1948.

UK politicians are currently all socialist, as that is the only route to getting elected these days. Ergo the NHS mess can never be fixed. However, the consensus amongst the private tax-payers who fund everything is rapidly breaking down, people are fed up with paying huge levels of tax for public services of all types that are deteriorating. We are no longer talking about rich Victorian philanthropists doing something about the health of poor people, but people on average salaries having to fund health and other services for millions of other people who actually lead a comparative lifestyle.

Private health works perfectly well in countries where the public health system does not offer an open door policy. In my scheme, i'd make the private industry answer to exactly the same regulators and commissions as the NHS for issues of quality of clinical care and ethics, and I'd rely on the market to fairly quickly ensure that private companies deliver a full package - i.e. a private subscriber is soon going to make a selection based on consumer reviews and other information sources.

Originally Posted by OldSnowy

My bold.

I do so very hope so. Get this through to your brain - the NHS is a failure.
- It does not make efficient, or even slightly efficient, use of the resources thrown at it.
- It's not been copied as it is crap. Some other Countries may have a similar scheme, but none has anything as inefficient and monolithic as the NHS.
- It consistently provides healthcare results lower than that of other European Nations.
- It is ruled by massive vested interests (TUs of the Doctors and Nurses for a start).
- It has a management system from Hell.

It's crap. Scrap it, copy the French, or German, or Australian, or Irish, or any other fucking system. The NHS is causing unecessary sufferering and premature death for thousands of peple each year - it's time it was ended.

The UK proportionately spends less money on healthcare than all of those countries.

Originally Posted by 4(T)

Private health works perfectly well in countries where the public health system does not offer an open door policy. In my scheme, i'd make the private industry answer to exactly the same regulators and commissions as the NHS for issues of quality of clinical care and ethics, and I'd rely on the market to fairly quickly ensure that private companies deliver a full package - i.e. a private subscriber is soon going to make a selection based on consumer reviews and other information sources.

Private health care systems cost considerably more than does the NHS. The United States spend almost double as a proportion of GDP for no universal access and worse outcomes.

Competing providers with their own management heirarchies and (for many) shareholders are inevitably going to duplicate a lot of functions. Management costs (plus profit margins) are thus much higher (both proportionately and in absolute terms) in marketised systems than in socialised ones.

You can have a system which denies access to those who do not, or cannot, contribute, but it is likely to be more expensive than the current system. 'Choice' in this case is actually a very inefficient prerogative to be able to exercise.

Originally Posted by mush_dad

No I'm not,

We don't live in a 'true' democracy in the orginal sense of the word.

We live in a representative democracy. We elect representatives to represent our views. We do it at the ballot box roughly once every five years. Those views are taken into account and weighed up alongside expert opinion, external events, preceeding legislature, economic conditions, advances in technology, markets and economics. And then they make laws for us and run departments for us too.

I don't agree with everything any goverment does, and I often don't agree with 'public' opinion either, but I get on with it. I vote for my representitive based on a whole mix of issues and if in my judgement they can be trusted to get it right most of the time I don't expect to be consulted personally on every issue of spending or provision.

I stick to my original point that people if left to their own devices will remain fat, lazy, tattooed, binge drinking smokers (well that's just their wives) and expect the NHS to continue picking up the tab when their health deteriorates.

Funny that, because it was all over the news a year or so ago that middle aged, middle class, bottle of wine a day drinkers were a huge drain to the NHS. Strange, no-one seems to remember that any more.

Originally Posted by Whet

Funny that, because it was all over the news a year or so ago that middle aged, middle class, bottle of wine a day drinkers were a huge drain to the NHS. Strange, no-one seems to remember that any more.

Right up there with lifelong burdens on the public purse with delusions of political grandeur.

Originally Posted by filthyphil

Right up there with lifelong burdens on the public purse with delusions of political grandeur.

ONly those of us who are incurably ill.