So the NHS has long gone

[DarkKarmaIlama]

At what point do we think the government will do something about the massive elephant in the room the NHS has fucked off out of the window and is never returning.

This healthcare no man’s land is quite frankly terrifying. What are your predictions on this? All I keep reading is “it will get worse”. Can it actually get any worse?

Exactly this.

NHS needs radical, fundamental change and a shift to an insurance based model as soon as possible.

Can you say more re insurance based - do you mean private insurance?

NI is national insurance so wondering what the difference would be

The trouble with any private system is that cost is wasted in advertisements and promotion and recruitment

And in the regulation that is needed if you want to get good service and avoid rips offs

Rip offs - the richest Americans and overmedicated

Good service - because there won't be an nhs to pick up the pieces of failed surgery anymore

Agree with PP about waste in the NHS. It's a big black hole. However much money is ploughed into it, it will never be enough. The whole system is not fit for purpose - it was fine when people routinely died in their 60s and 70s but not now that people are routinely living into their 80s and 90s. I absolutely do not want to pay even more towards a system that is only good in parts. People need to get over the "sacred cow" aspect of the NHS. Nobody becomes mawkish about "our education system". Healthcare ought to be taken out of politics completely as political parties of all hues are merely pursuing their own agendas and are just as bad as one another when it comes to the NHS.

Can you say more re insurance based - do you mean private insurance?
NI is national insurance so wondering what the difference would be

What the superior European systems have in common is a highly regulated insurance offering (meaning that everyone is covered, even pre-existing), an element of co-pay that is often means-tested and - crucially - a right for the patient to choose a provider who actually wants a patient because it means they get paid by you and/or your insurer.

NI goes into a bucket - and it's not even a hypothecated tax - which is drained by an inefficient monopoly provider who wants not to treat you because it makes FA difference to their budget or salary.

We need more doctors and nurses if it's going to work though.

It's a total mess. DH had a kidney blockage a couple of years ago. In massive pain. Was offered a stent by the consultant which would need to be changed every six months while he waited on the list for the operation he needed. This would have meant he couldn't work in his manual job all that time. So he asked the consultant about him doing it privately. Yep, the operation could be done the week after. Wonder how many days the consultant was doing for the nhs as opposed to doing private work?

We did go on to have it done privately. On the day it was done privately there were two other men waiting who were nhs patients having it done at the private hospital. Done on the nhs because they had waited so long

The French and Germans are running much better healthcare systems. Sadly the government seems to be heading in the direction of replacing the NHS with an American style system - horrific!!

My brother in law had a broken arm 3 months ago. The surgery they performed was wrong, used wrong platinum, too many screws etc. His arm got infected, nhs gave him an appointment 2 weeks away. Eventually, bone got infected. Nhs saying nearest surgery time is 3 weeks (by then they'd say oh no, we need to amputate (!)) So BIL went private, head of ophthalmology in harley street told him you need a surgery today, infection eating away at the bone and he had a look at the X-rays and said platinum used was wrong, wrong placement, too many screws. Now he's going to sweden tomorrow to get some adequate health care. They'll be performing 2 surgeries there, first to get rid of the infection in the bone and secondly to change the platinum. Sorry but the NHS is finished, finished, finished and PALS will be hearing from us soon

And profit.

NI isn't insurance - it's just another tax.

Yes thanks for that it was more to get the differences.

Who pays more / less etc

Those who earn more pay more - on a sliding scale. Children are free. Government/taxpayer funds them.

The point is it’s not a monopoly provider which is an absolutely crucial difference. There are no French or Germans clamoring for our system - in any income bracket.

Totally agree with this

DH and I both have that kind of insurance but it doesn't cover lots of things. Still have to go to A & E for that.

Yep. For one thing it doesn’t cover childbirth or consequences resulting from that, which is a major problem. It also doesn’t cover accidents, ambulances or emergencies.

In Germany, everyone has to get mandatory health insurance which is provided by the state for most people. It is automatic enrolment (all pre-existing conditions covered), and the state will pay your premium if you are on unemployment benefits. If you earn above a certain level due to the sliding scale, its better to get private insurance as you would be paying more for the state health insurance.

Health insurance will cover most of the cost for doctor’s visits, medical and dental treatment, surgery, and prescription medication, but you still have to pay the following:
Up to €10 per quarter for a doctor visit.
The first €10 of most prescription medication.
Approximately €10 per day for hospital stays, for a maximum of 28 days per year.
The full price for prescription vision aids, such as glasses

Most countries that have universal healthcare operate an insurance system; countries i can think off the top of my head aer singapore, israel, japan, germany, france. The key is that in these countries, health insurance is mandatory, and so poor people are not excluded.

So with this health insurance, i would have paid NI throughout my whole working life and never claimed on it (bar 3 births). And we both paid way over the average of NI. And now i would be expected to also pay for private healthcase (which i know would be very expensive due to our age).

My private health insurance is free through my employer. Private health insurance is not an ideal solution for anyone bar the richest which is why the state has to get involved at some point. But people who are working probably should try to get some now because at least it does offer some protection.

The NHS only seems to exist for catastrophic and basic healthcare and yes probably for non complicated births! At the present moment. I don't see it changing. I also don't see the impetus to change anything.

I think what would happen is a lot of people would be going privately and hopefully the government will realize that hey if people are going to be paying private health insurance companies, we might as well try to claw some of that money back. But they will keep NHS free for the poorest. which is the correct thing.

I realise sorting the NHS is a massive job but a recruitment freeze on shit like "Director of Lived Experience" is an easy helpful step which hurts no one.

I also had free health insurance whilst working. Trouble is that when i retired the quotes they gave for it to continue were too expensive - i guess because they thought i might need to use it due to our age. So as people who arent super rich or super poor we sort of fall inbetween though seem to have spend shedloads of money (NI) on something that isnt always fit for purpose.

agree there doesnt seem much impetus for change. Its the much loved NHS, which doesnt seem to care about becoming streamlined and stopping waste.

Does this mean if you are an average earner and have high health needs you pay more?

Or is it fixed to income

If the former it is different to NI, if the latter I’m not sure where the key difference is

The charge though - that is the type of thing that changes behaviour. Aus has a nominal fee too.

We change behaviour based on even small amounts (an example is the plastic bag fee of just how small it can be)

Is the biggest impact the charge or something else in your view? Eg fee is linked to health or other

I was just listening to radio and 1 in 7 or 14000 people in beds don’t need to be there. That’s a major issue it seems

There's that, but their definition is "no medical need". Trying to turf out people who can't walk....I am okay with them being in hospital, but there should be social care beds. While there aren't, the person who can't walk or feed themselves needs the hospital.

In germany, its fixed to income. The difference is that the hospital would not be paid unless they treat you and you claim it back from the insurance company. So if the hospital had a zillion people on its waiting list, it would go bust as it would not be earning any money.

In singapore, its a complicated system where everyone has the mandatory insurance, plus health savings (8% of income) and as long as you opt for the cheapest ward in the hospital, 65-80% of hospital costs covered by the government depending on your income and property value. For the poorest, government would cover 100%.This does change behavior, people would choose the hospital that provides the most competitively priced treatments (governments state that all hospitals including public hospitals have to advertise their fees).

The NHS could start offering "co-payment" options for different levels of care, i.e. for a private room,

No way you could do this as every side room is full of COVID, flu, norovirus, D&V and c-diff. Side rooms aren't there for privacy/comfort, they are there for infection control and supporting at the end of life.