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JohnD

Who do they think they're fooling?

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This came through my door this morning.

IMG_20190317_164130[1].jpg

Discounting the Motherhood and Apple Pie items about world-class healthcare, and "ensuring every pound is spent wisely", because any party would call for those, they have the brass-bound cheek to say that they will use the "Brexit dividend" to fund the £20 billion a year extra for the NHS! (Not enough, when it was £22 Billion and not soon enough when it will be needed by 2020)

Do they still believe the lies on the side of the bus? When the National Institute of Economic and Social Research estimates that it will cost the UK £100 billion a year by 2030?  And the Centre for European Reform has said the British economy is already about 2.5 percent smaller than it would have been if Brexit wasn't happening. 

This is the sort of blind, selfish uncaring Torism that is epitomised by the ERG and all its works.     In a country where youths carry and use knives as normal, where schools need washing machines because their pupils' homes do not, where food banks are so needed that my local branch of Sainsburys collects donations in kind for them, where ambulances on duty get stoned and their windows smashed, all that Westminster can do is discuss the equivalent of how many angels can dance on a pinhead.   Pinheads, the lot of them.

John 

Edited by JohnD

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"A ten year plan for world-class healthcare"

Who would not want that?    But an interview published today shows how hollow are those words.

Sir Amyas Morse is the retiring chief of the National Audit Office, the body charged with monitoring the ambitions of politicians who control public spending.  Never shy of speaking his mind, in his final session at the Institute of Government he said, "When I see the words 'world-beating' my heart sinks."     Sinks, because he can point to all the grossly inflated, wasteful schemes that this Tory Government has failed on.    From smart meters that weren't and cost £500 million, to Crossrail costing an extra £2.8 Billion to complete two years late.   And that is without his opinion on the NHS, that the Tories claim to be fully funding, but in fact spending less on than Germany.

John

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I have my own personal take on the NHS.

The NHS is a work of Genius. But overstretched and overstressed. It needs far more money and infrastructure than taxes can possibly give it. 

In my opinion there should be a set point say 40000 GBP a year earnings, after which point you should have to have private insurance for healthcare, because at that point you can afford it (in theory) Below that then your healthcare is covered by the current system. That way when I go to hospital for my back problem, the insurance I would have to have had would pay the NHS for my care, or deal with it directly thus taking the burden from the NHS. Anyone who earns below the threshold and their families still get care free at the point of contact, and they are still contributing via taxes anyhow. Please note I am no expert on healthcare the NHS or private insurance. I am just looking at ways maybe we can fund the NHS properly and give the entire thing decent revenues

Discuss......

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1 hour ago, Bumblebee said:

In my opinion there should be a set point say 40000 GBP a year earnings, after which point you should have to have private insurance for healthcare, because at that point you can afford it (in theory) Below that then your healthcare is covered by the current system.

That is more or less how things are in France, the thresholds are a bit different but it's basically that.  The main difference, which came as a huge shock to me initially was that you're expected (usually) to pay upfront for e.g. a visit to the doctor and then you're reimbursed (the state picks up most of the bill and your insurance/or social services the rest). 

It still costs the state a fortune and everyone complains about it, but the service does seem better. 

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I understand what you're saying, Bb, but a threshold would be a very contentious point.      Even £40K might not be enough for someone to finance a difficult problem.

I can no longer quote what the real cost is of various treatments, but I was shocked by some veterinary enquiries I made recently.    I wanted to know how much radiotherapy treatment for a cat with thyrotoxicosis would be - it's definitive, curative and who wnats to give a cat tablets every day, the alternative?      The answer was £2000, and that was without any diagnostic costs or clincians' fees.    

For humans, I'd point to this NHS site.     That reports that the average cost of cancer tretament is £30,000 now, rising to £40K in 2021, and that will need an extra £5.2 billion a year for the NHS.   At present only 9% is funded privately (insurance) so that's an awful lot of premiums.

And what is the purpose of insurance companies?  Forget protection, reassurance, they are to make money for shareholders.   Why should anyone make money from cancer or any other disease?    There are no shareholders in the NHS!

John

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John

To be fair, the German system is insurance-based is is one of the healthiest (bad pun, sorry...) in the world and long pre-dates the NHS.  As I recall from my time there, everybody pays a mandatory monthly premium, much like NI, up to a certain threshold (I think it's around Euro 60k, above which it ceases to be a requirement, on the basis that if you earn that much, you must be bright enough to know that you need to make provision for health insurance without prompting).

Most people have a choice of which public or private insurance institution to join, subject to income and profession, and the system budget is, effectively, split into its three constituent parts of workplace accidents, long-term care and general healthcare.

A quick check on their financial status indicates that they collectively carry a surplus of Euro 8 billion at the moment.  I had a touch of pneumonia when I lived in Berlin many years ago and the care was outstanding.  And swift.

Paul

7 lines... phew!

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I think he meant people who earn more than 40K should have to pay for private insurance?

But putting hard limits is terribly difficult, and often unfair.

An example: Currently (I think) Child benefit stops if either parent pays higher rate tax. But 2 parents each earning just less still get CB. And down here one parent earning 50K a year could well be struggling, and bear in mind  one bed flat starts at 250k, small houses start at 400k and a pint is a fiver, many people wold be better off moving to a cheaper area of the country and taking a pay cut.... but that would be a tax disaster for the UK as it is those bigger earners who pay the bulk of personal tax.... And a different discussion. But maybe a thorough reform of the way we are taxed is required, not to mention the big companies who get away with murder. 

So what is the answer? I remember hearing a superb radio programme where some medical professor was being interviewed about NHS funding. And he explained you can NEVER finance the NHS enough, as the better the medicine/treatments, the longer we live, the more people will need medical treatments and so on. But indeed, somehow funding needs to be improved, and although much of the budget is probably sell spent, I am certain (having worked in schools, similar funding processes I expect) they get fleeced for some services. But maybe it is cheaper to ignore that than deal with it? That is quite possible. Tony stuck an extra penny on NI for the NHS, did that have a significant effect? Interested to know as I think NHS funding actually doubled from 97-05, but a clever bean-counter would be needed to work out where it all went.

 

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I agree John, and I was kind of speaking out loud. There has to be a better way to fund the NHS in a way it can grow with demands placed upon it getting larger.  It should always be free at the time you need it , that is the point. But we (as a society) need to accept we need to pay for it and to find a better way.  I only argue for insurance as an obvious solution, without giving thresholds much thought. Of course insurance being what it is they will try and get out of everything, I understand that too.  But I firmly believe in the NHS  and it needs to be protected in any way we can, and be financially secure. Lots of people already make money from cancer and other diseases, and I dont speak about Doctors and Nurses... Ge Medical/Siemens/Hoffmann la Roche/Boehringer Ingelheim, Kontron Pharma etc. I accept these make products to save people, but its capitalism, and ergo its all about the dollar/pound.

Yes Zetec that is what I was getting at. Once you earn XXXXX quid you must take out medical insurance. You go to the NHS and they bill your insurance co, or the insurance co sends you to its own place. Or a secondary stepped NI tax on a sliding scale once you hit XXXXX earnings. We need to act to protect.  7 Lines... Still too much John. I cant get to 5!

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Calm!  Cool, green fields!

I have no problems with people earning a living 'from disease'.   Doctors, of course, nurses, but also drug and equipment manufacturers, who all do a job.       Interest from investment is not work.

J.

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29 minutes ago, PaulAA said:

John

To be fair, the German system is insurance-based is is one of the healthiest (bad pun, sorry...) in the world and long pre-dates the NHS.  As I recall from my time there, everybody pays a mandatory monthly premium, much like NI, up to a certain threshold (I think it's around Euro 60k, above which it ceases to be a requirement, on the basis that if you earn that much, you must be bright enough to know that you need to make provision for health insurance without prompting).

Most people have a choice of which public or private insurance institution to join, subject to income and profession, and the system budget is, effectively, split into its three constituent parts of workplace accidents, long-term care and general healthcare.

A quick check on their financial status indicates that they collectively carry a surplus of Euro 8 billion at the moment.  I had a touch of pneumonia when I lived in Berlin many years ago and the care was outstanding.  And swift.

Paul

7 lines... phew!

Similar in France,

everyone has insurance to top up with varying degrees of cover. I now pay E25 to see a Dr, but get to see him the same day.

The health care & speed with which things happen really put the NHS to deep shame. A few years ago i was getting headaches, saw the Dr in the afternoon, blood test at the clinic that day & MRU scan the next morning, the surgeons were present during the scan & 2 doors out of there, the car park or operating, luckily it was the car park for me.

RR

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When in France a few years ago my youngest had an ear issue. I think the Dr was about E20, the medication about E10 and when we got to see the ear-man (for some unknown reason that took several days, and the ear-man had no idea why it was delayed) it was another E20. All came to less than the insurance excess, which surprised me.Very happy with the system over there....

Not sure how having to pay for appointments would go down in this country. But it seems elsewhere it works fine...however the "free at point of use"  bit could be a stumbling block.

Maybe we need to look at state pensions, and explain they can not be considered an entitlement, but should become a means tested benefit. The notion peoples NI contributions cover their healthcare and pension costs is just not sustainable. One step further, drop NI altogether for "us" (not companies) and bundle it with income tax. That would mean people like me and countless other self-employed/investors/directors etc would lose the loophole that reduces our tax/NI bill. 

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4 hours ago, RedRooster said:

 

The health care & speed with which things happen really put the NHS to deep shame. .

RR

Which is shared by the NHS, but it has been starved of finance and resources for so long now.

I apologise for forgetting the post the link that I referred to above, "Cancer survival rates 'threatened by rising cost' ", which may answer your point too, RR

https://www.nhs.uk/news/cancer/cancer-survival-rates-threatened-by-rising-cost/

JOhn

Edited by JohnD

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The cost of having your prostate out by one of the best in the land at what ought to be one of the facilities in the land was £ 20k. Paid for by private health insurance though my company, which I pay a fair chunk of tax on (although I’m also paying NI and potentially taking some pressure off the NHS).

Of course, having it done this way, there is no warranty to back it up, the private system in the UK relies on the NHS to pick up the pieces.....,

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 Seems to me NHS has been driven into firefighting mode. Smoking bans took decades while polticians failed to act. Likewise sugar, junk foods stil enjoy protection by politicians chasing votes. Preservig health has long been on the back-burner compared with curing disease. There's big profits in the latter, very little funding for the former. No wonder we're sick.

New Scientist last week exposed the dangers of "slip, slap. slop". It was one of the most effective health promoting campaigns ever. But it has resulted ina billion people globally becoming D3 deficient with adisease bureden that vaslty outstripped the benefits of redcued skin cancers. Compounding the issue, the correct level of serum D3 is disputed becasue there have been few trials of this defensove hormone. Why? its not patentable, so no profits to justofy expensive trials.

We have reached the point where we need to individually seek out healthy behaviours rather than rely upon NHS. But help in seeking out the best ways to preserve health is lacking. Charities are mostly disease focused, research oriented, "jam tomorrow". 

Where do you get health preserving advice? There was a brief profusion of "well man clinics" in the 80s - all gone. When did you last measure your BP ? -hypertension these days is mostly picked up at hospital visits for firefighting other issues. Yet hypertension is a serious risk for stroke, kidneys and heart. And so the viscius circle goes on......

Peter

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31 minutes ago, PeterC said:

 Seems to me NHS has been driven into firefighting mode. Smoking bans took decades while polticians failed to act.    Indeed, Peter.

 When did you last measure your BP ? -hypertension these days is mostly picked up at hospital visits for firefighting other issues. Yet hypertension is a serious risk for stroke, kidneys and heart. And so the viscius circle goes on......

Peter

Actually, Peter, unless they have a recent (2 years?) BP, and you are over 40, your GP will - or the nurse will - take it if you visit for any reason.   and many surgeries run screening clinics.

Why?  Because GP blood pressure screening is part of the NHS GP contract.   Because while its strapped for cash and resources, the NHS is not as stupid  as you imply.   Yes, high BP is a strong indicator of future morbidity, and the NHS knows that and does its best to find it before it makes someone ill.     but holding clinics and getting people to attends are different problems.

john

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4 minutes ago, JohnD said:

Actually, Peter, unless they have a recent (2 years?) BP, and you are over 40, your GP will - or the nurse will - take it if you visit for any reason.   and many surgeries run screening clinics.

Why?  Because GP blood pressure screening is part of the NHS GP contract.   Because while its strapped for cash and resources, the NHS is not as stupid  as you imply.   Yes, high BP is a strong indicator of future morbidity, and the NHS knows that and does its best to find it before it makes someone ill.     but holding clinics and getting people to attends are different problems.

john

John, I went 10 years without a need to see a GP or hospitlal, and was never called in.  Subsequently when I had to get attention for insect stings BP was not measured. Neither at GP or GP in hospital facility.  Now I measure it at home with our own Omron kit...£50 off Amazon.

Maybe Wales NHS is different from England.

Peter

 

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4 hours ago, JohnD said:

Actually, Peter, unless they have a recent (2 years?) BP, and you are over 40, your GP will - or the nurse will - take it if you visit for any reason.   and many surgeries run screening clinics.

Why?  Because GP blood pressure screening is part of the NHS GP contract.   Because while its strapped for cash and resources, the NHS is not as stupid  as you imply.   Yes, high BP is a strong indicator of future morbidity, and the NHS knows that and does its best to find it before it makes someone ill.     but holding clinics and getting people to attends are different problems.

john

See your GP?  What is this mythical unicorn of which you speak?.

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It's all very well having a civilised conversation on a Forum about possible different funding models for the NHS, possibly learning from other countries and how they do it but as soon as a politician tries to ask such questions they get shouted down by the 'privatising our NHS' mob.

 

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In the Netherlands, everybody is insured. It is mandatory, but you can choose your own insurance company. Something car insurance. Sort of semi-privatised. Costs are about 90 euros/month, but you can choose more expensive insurance. Children under 18 are FoC. All are covered with that. Free GP, free hospital etc. There's an annual 350 euro threshold (pay it yourself before insurance pics up the remaining bill) for special things like teeth-whitening etc.

Seeing a doctor is no problem: the same day. Hospital is mostly within a week (when it's not something 'bad'). Waiting times in the hospitals etc is never more than 30mins. Casualty Ward is longer of course.

Doctors, pharmacists, dentists - you name it, are all LTDs over here. A few years back, those one-man-band LTDs earned up to 1M euros annually. So the costs of medical care were extremely high. Aforementioned insurance companies + the government refused to pay that sort of money anymore and now these LTDs have to make a living out of a modest 300/350K annually.

 

Menno

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5 hours ago, Chris W said:

It's all very well having a civilised conversation on a Forum about possible different funding models for the NHS, possibly learning from other countries and how they do it but as soon as a politician tries to ask such questions they get shouted down by the 'privatising our NHS' mob.

 

More than 15% of GPs posts are vacant, representiong a shortfall of more than 6000.     The Royal College of GPs says that there is at least one vacant post in every practise.

When you consider the record of the Tories privatising - they call it "outsourcing" - other state services to Carillion, Interserve, G4S etc, keeping that sort of asset stripping out of the NHS seems like good sense.

JOhn

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35 minutes ago, MennoR said:

In the Netherlands, everybody is insured. It is mandatory, but you can choose your own insurance company. Something car insurance. Sort of semi-privatised. Costs are about 90 euros/month, but you can choose more expensive insurance. Children under 18 are FoC. All are covered with that. Free GP, free hospital etc. There's an annual 350 euro threshold (pay it yourself before insurance pics up the remaining bill) for special things like teeth-whitening etc.

Seeing a doctor is no problem: the same day. Hospital is mostly within a week (when it's not something 'bad'). Waiting times in the hospitals etc is never more than 30mins. Casualty Ward is longer of course.

Doctors, pharmacists, dentists - you name it, are all LTDs over here. A few years back, those one-man-band LTDs earned up to 1M euros annually. So the costs of medical care were extremely high. Aforementioned insurance companies + the government refused to pay that sort of money anymore and now these LTDs have to make a living out of a modest 300/350K annually.

 

Menno

This chart may be of interest:

image.png.c4d081fb77d76ef6e9414af3300a73cc.png

Menno says that costs of medical care in the Netherlands are extremely high.  They do spend more than we do, but not that much, just look at the graph.    We are at the bottom end of the middle group that Ireland leads, because the NHS has been starved of funds by a Tory led 'austerity' policy.   That policy was more an ideological vote winner than a measured, rational economic policy, and has long been overtaken by events.   The chanceller has more than enough spare cash to revive the NHS, but is keeping it in store as a protection against the awful impact of Brexit.

JOhn

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My neighbour who lives in the lane parallel to mine is a Dentist. Used to buy a new R/Rover every year and has a Porsche in the garage. About 5 yrs ago, he was no longer 'able' to buy a new car, due to the fact that dentists were 'wrung' by the insurance companies. Sadly for him, his lamentation didn't land here... 

Medical care is still extremely expensive - but not on doctor's wages. Nurses' wages, high end machinery cost a lot of money. A friend of mine is a self-employed financial controller for hospitals and medical care in general. His idea of cutting costs are pretty down-to-earth: "Top of the range operating theatres are idle during the evening, night and weekends. Doctors don't want to work those hours! Better use of that material (once bought) can cut costs!"

What these older dentist did: selling their practice + patients to younger people for over-the-top money. Millions sometimes; being their pension. The new dentists had to charge weird money to earn back that money. Now it is not longer allowed to charge that. Some dentists have gone bankrupt due to the fact that they've paid too much. Some university friends of my wife are dentists. One of them is struggling to keep 'afloat': practice, rent, assistants etc It takes a lot of money.

Finally, a sailing-mom (her sons sails in the NL National Squad) used to run her own dentist practice. She has moved to the university as a lector; better earnings, no more fuss.

Menno

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36 minutes ago, MennoR said:

My neighbour who lives in the lane parallel to mine is a Dentist. Used to buy a new R/Rover every year and has a Porsche in the garage.

Another reason to hate dentists.

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