Why would Reform voters accept that they will scrap the NHS?

I don’t think it’s up to you to decide what I should be concerned about, @JimBobsWife . Or to make assumptions about my finances. Co payments would inevitably impact detrimentally on the poorest in society and go against the basic tenets on which the NHS was created.

High taxation works well in Scandinavia, so it might be worth a try here.

I am not a fan of Farage but I don't believe he has ever suggested the US model is one to be aspired to.

No American to my knowledge would defend their system as optimal! It is insanely expensive and exclusionary.

It irritated me so much when people suggest that the only alternative to the NHS is the US model.

The NHS is a terrible model because it has all the wrong incentives. It's free so it is used excessively by some and wastefully (not turning up by others).

From an operational perspective while there are some hugely dedicated individuals it's is institutionally bloated and chronically inefficient. No one has any incentive to make things work better.

It needs abolition and replacement with a system (like in Ireland) where everyone pays something to see a doctor. So people think twice about using it only if they really need it.

Then it needs to work like private medicine and the insurance companies do. Where medicine is provided by private healthcare companies and paid for (typically on a tariff basis) by a govt regulated insurance fund itself funded by NI contributions.

The current 'model' of people paying for their own care because they are pissed off at waiting six years for a hip replacement is not an official model of care in the UK, as you well know. It doesn't allow for proper planning.

If we moved to a formal model of mixed payment methods, the poor people would be fine because they would be able to access care in a structured way. You got your cataracts fixed. Good for you. Maybe you should be more concerned that others don't have cash floating around like you do.

But you’ve just criticised the current model which allowed me to use my own money and take nothing from the NHS yet you want institutionalised co payments. What about all those poor people you were so concerned about?

I would also like to see a proper discussion on productivity in the NHS which has stayed static or decreased despite increased funding.

I'm sure the NHS doesn't care where the cash comes from. But that's not the point. We can't afford to fund the NHS in ever more ludicrous amounts from general taxation. Unless you agree with wealth redistribution via higher tax burdens.

So the money has to come via other models which is what the thread was discussing and some posters criticising.

No, it’s total spending which is often a combination of public spending and private insurance.

But I don’t think the NHS cares where its investment comes from. Money is money!

You said we currently have a system which was similar to what @GeneralPeter was envisaging. What was your actual point?

Is that all coming from general taxation in those countries?

It isn’t a sign that the system is beyond repair. It’s a sign that the NHS can’t manage on its current budget and needs considerable investment. Have a look at how much other Western countries spend on their healthcare.

This is the biggest factor in demonstrating that the system is beyond repair in its current form. It's 'spoiling the ship for a happorth of tar'. Imagine what extra benefits a blind person will need to claim after the dysfunctional NHS has let them go unnecessarily blind.
You can have the best BUPA cover but in an accident, you have no option but to go to your local NHS A&E. You can't be sure that you won't be waiting for hours on a trolley, that you will be treated well, that you won't suffer an adverse event. In short it is a lottery and you hope for the best.
Then you realise that because of the infinite demand, the NHS constantly refines its treatment protocols...letting people go blind is likely an unintended consequence of this.
I mean things like no longer doing ear wax removal, telling people they have to have multiple infections before removing wisdom teeth, doing hysteroscopy on women without anaesthetic.
It all involves making the patient/taxpayer suffer for longer before they are entitled to access 'free at point of use' care.
I would rather have a system which wanted to minimise my pain and suffering.

Yes, it's around 5-6 months where I live.

Did I say “in its current state”? No, you added that. The waiting lists for cataract surgery are much shorter now, I paid for my surgery in 2019 when they were two years long where I live, according to a friend they’re now six months but still too long.

And you’re a huge cheerleader for the NHS in its current state? Where poor people go blind on waiting lists?

I expect so. It wouldn’t have made any difference to them, would it?

That’s great for you. What about the people who can’t pay. Do they just go blind?

Our demographics have changed a lot, through aging. Healthcare costs increase massively with old age so this matters a lot, and we have fewer earners per old person too.

Our political system is just as bad at doing long-term reform but now has far less headroom to borrow. Our debt interest has more than doubled, and debt has almost doubled as a share of GDP.

These trends all get worse too.

I made this table, also with OBR projections for 2040.

It's never been that good though. There have always been long waiting lists, even in the Blair years. The only good thing about it was that you didn't often get a bill.
The model needs to be changed, as infinite demand cannot be met by working taxpayer funds alone. There is no competition for patients, they have no choice of provider really and healthy competition drives efficiency.

What is it about our demographics and political system that you think makes the NHS model unworkable? The NHS was rated number one in the world back in 2010 - someone else mentioned this up thread I think - do you think our demographics and political system have changed significantly since then?

I thought that’s what we’ve already got. Despite being a huge cheerleader for the NHS I wasn’t prepared to go progressively blind on the very long waiting list for cataract surgery so I paid. I’m very happy to stay with the NHS for all my other health needs.

I don’t think it’s the model per se that’s the issue. As in, properly funded a single-payer model can work.

I think that our model in combination with our demographics and political system is unworkable, becuase the funding gap will widen and widen until the system breaks.

We can’t significantly change either our demographics or our political system.

So we need healthcare reforms that will bring in new revenue streams, like a dual-track model with more and more insurance-based provision for those who choose it.

Oh yes, wiser spending. Says every government since around 1980. It’s all obfuscation and bullshit.