Can anyone explain how Reform’s Insurance based health system will work?

[BurntBroccoli]

I’ve looked at the manifesto and it’s confusing? A lot of Reform voters are now saying Farage will keep the NHS for poorer people but if you aren’t, you will have to go private. A bit like dentists or vets I suppose.

What is point you are classed as better off? How will the “NHS” be funded if no one wealthy is paying in?

Anyone?

I pay into one of those schemes where I get money back for things like opticians and dentist treatment. I wonder if a dual system like that would work, so we'd have to pay for more like doctors appointments but that you could claim it back if you paid into a regulated monthly scheme. But it would have to be paid by more people I suppose to make it viable, which would have to include those on a low income and pensioners.

My area is a couple of hours from the nearest coast and I've never heard of 'small boats' landing on the Yorkshire coast yet I'm sure that what Reform voters will be voting about. It's not a council issue.

Great idea, the people who are better off pay more - like income tax! So why not keep the NHS and have a tax increase ring fenced for it. Full disclosure, I'm a moderately well off pensioner who pays tax on a teachers' pension and I'd be happy to pay more tax for this rather than privatisation.

Nail on the head. Everyone wants a better NHS, but they want "someone else" to pay for it!

Or we could scrap NIC and add it to income tax rates so that everyone on the same income pays the same taxes. There's no way on Earth that workers should be taxed more, they're already paying income tax, NIC, and student loan repayments, whereas a pensioner on the same income is only paying income tax. THAT's where we need to start looking to raise taxes - unearned income, such as pensions, dividends, interest and property rental income. Workers have been squeezed enough.

Same goes for a lot of people's kids. I really do think if we streamlined DWP/HMRC we would find a lot of the tax and childcare evaders and manage to rustle up a few billion.

Sorry to hear that, but glad that it's not just my OH who suffers the nightmare of managing a serious long term health condition.

And yes, I'd forgotten about the way they make the drugs available at different places without telling you, so that you turn up at hospital A as normal only to find they're waiting at hospital B and of course, it's impossible for them to transport them back to where they should be, so the patient has to travel to go and get them.

OH has had his monthly chemo for collection at our local hospital pharmacy for five years. For the last six months, it's be random as to where it's ended up. Heaven knows how they managed to have it for collection at the same place for 4.5 years and then suddenly they're using a random number generator as to where it ends up for collection for the last six months.

As you say, there's no one available/capable of dealing with it. It's all fragmented so you end up having to phone multiple people for the simplest of things, like picking up prescription drugs.

It really is like a part time job on it's own just managing appointments etc and having to deal with the consequences when they change one but don't change all the others relating to it (even when it's same the department), where the buck is just passed to the patient to sort it out themselves.

We desperately need to tackle the black economy. Tax evasion, benefit fraud and CMS fraud in the black economy costs the country tens of billions. Yet, the politicians and authorities seem as if they don't care. Hence why it's taken so long to start to tackle the money laundering Turkish barbers.

@Jane958

What I could see is some kind of nominal charge per person per month, so a health tax, if you like.

Good idea, but wouldn't work, because the "usual suspects" would object, i.e. benefit claimants, OAPS, etc., so it would just become another tax on workers.

People who are actually net contributors to the NHS deserve better treatment than those who aren’t. Excepting genuinely disabled people and those who paid in all their lives and are now retired.

@Badbadbunny That’s spot on. NIC and income tax should apply to everyone. Stopping nic when you are using the NHS more makes no sense. One overall rate that recognises all income would be better. And that is me being a turkey voting for Christmas! I’m well aware younger people pay too much and the word “insurance” needs scrapping! It’s no such thing. It’s a tax paid by working people under 65.

Nail on the head. It would hit me too as I'm semi retired and heading to retirement, so will soon be exempt from NIC, but why should I be? The "insurance" part of the name definitely needs scrapping as it gives the wrong impression - it's not insurance, it's a tax!

When I look at my son's payslip to see all the deductions, and then he has a stupidly high rent to pay out of his net wages for his tiny flat rental (plus ever increasing utilities, council tax, etc), I could weep. I fully understand why today's youngsters feel angry. It's crazy when he has to pay a stupidly high rent out of his net wages, yet the OAP he's paying the rent too doesn't have to pay NIC on the profits they're making!

Something has gone very wrong with our tax system and it needs massive reform.

The phone numbers go to an answer phone and you leave a message. Nobody ever rings back so you just have to hope somebody listened to it and actioned it. Sometimes they have, sometimes they haven't. It is stressful and stress isn't good for anyone who is already unwell.

Yup, like upthread, OH was ringing and leaving answerphone messages back during covid to try to re-arrange his chemo. But the dept had moved hospitals, hadn't forwarded the number and hadn't notified patients. The sheer scale of incompetence is breath taking.

This kind of response is massively unhelpful.
Shouting down anything to do with Reform will not make them go away unfortunately.
The OP asked a question and it is much more sensible, mature and intelligent to either attempt to answer it or say you don't know (which you clearly don't as your response is a list of silly knee -jerk reactions).
Engaging in debate is the only way to persuade people that Reform is not necessarily a good idea for the UK.

In France, there is a minimum contribution to your healthcare which is paid by the social security system and then the rest is for you to pay for. The vast majority of people have health insurance which reimburses all or part of the difference. If you are employed then your employer has to provide mandatory healthy insurance as part of your salary and benefits package. Mine costs about 50€ per month. If you are on an extremely low income then you can access government funded health insurance free of charge to cover this part.

So, for example, I go to the GP. The appointment costs 25€. I pay by card. The doctor also takes my social security card and records how much I have paid and what the appointment was for.

A few days later, social security reimburses me 17.50€ and my health insurance reimburses me 7.50€.

Healthcare professionals are classed as either Sector 1 or Sector 2. Sector 1 professionals have to charge the fees set by social security, which are entirely reimbursed by social security. So if you see a Sector 1 professional, you get everything reimbursed even if you don't have health insurance. Sector 2 professionals can charge what they like, but I think the trade off is that they pay much higher taxes. (Healthcare professionals are generally self employed.)

So if I see a Sector 2 specialist, say a gynaecologist for a pelvic ultrasound, the appointment might cost me 70€, I get 23€ reimbursed by social security, and my health insurance might reimburse me anything from 23€ (meaning I end up paying 24€ in total) or it might pay the whole amount. It depends how good your health insurance policy is.

If you have something like cancer, everything is covered and you just have to fill in the paperwork and it's all taken care of.

I found it very difficult to get my head round the system at first, there are a lot of pitfalls and it's very very complicated to understand. I'm sure there are many people who don't get everything they are entitled to because they can't figure out the paperwork.

But on the other hand, I can't deny that the healthcare I've had since moving here has been absolutely world class.

After suffering recurrent miscarriages and finally deciding during the pandemic that enough was enough, I was able to shop around for the best gynaecologist, get an appointment within a matter of days, and get treated quickly.

There's a fantastic app for booking appointments where if you choose the doctor you want and book literally any appointment, you can activate an alert feature and you'll get a message as soon as someone cancels an earlier appointment. I've been able to get seen really quickly this way.

I also had two sick children right before Christmas, the night before we were due to drive to the UK for the holidays. At 2am, when one of them had vomited several times and the other had just woken up with a fever, I managed to get a double appointment with the out of hours doctor at 5:45 am, a 15 minute drive away. By 6:15 am we were back home with two prescriptions for antibiotics.

I was very dubious at first but I can't deny that it is a better system.

And don't even get me started on how superior the maternity care is.

Exactly, just like the idiot Brown's comments about "that bogoted woman" - any sensible disucussion/conversation is lost when someone goes into "insult" mode as it just makes them look stupid.

The way to deal with Reform is proper dialogue and explanations as to if and why they're wrong, but more importantly, workable ALTERNATIVES to solve the problems we face.

We need more awareness and publicity of alternative systems that work so that we can properly fend off the lazy uninformed "But America" comments.

Its been a complete failure because the way it was administered and predetermined financial envelopes meant there was no actual competition.

Loads of conditions where the Tariff payments dont cover the cost of treatment, so absolutely no incentive to prioritise those patients.

Block contracts, because the ICBs decide on what is affordable, not what needs to be done, so, once youve donebl your X,000 hip replacements per year, any others are being done at a loss to the hospital.

I agree. America is America. Their healthcare system is for profit.

But in other countries insurance based systems can and do work very well.

I quite often see posts in Facebook groups by Americans who are travelling in France and need to see a doctor and are worried about insurance. They are generally told not to worry because in most cases if they just go to a doctor and pay for the whole thing out of pocket it will still cost them much less than even the deductible on their American health insurance.

In America it is common for women whose babies are due in January to have an elective induction or C-section in December because they've already hit their deductible for the year but if they give birth in January they'll be into the following year and they'll have to absorb their whole deductible for the next year before they can claim anything.

That €50 is a tiny proportion of the actual cost though, the french government spend €460 per person per month on healthcare.

There's loads of ways of admistering it, but this much will always be true - a fully insured system will be unaffordable for a large proportion of people who need it most, some form of social insurance is probably the most fair and affordable system, and it matters not whether you do that through copayments, top up insurance or increased taxes as long as the money goes in.

No, sorry, the 50€ per month is what I pay for my own private health insurance which tops up the government paid care.

So in my example for a GP appointment, the appointment costs 25€, social security pays 17.50€, my insurance that I pay 50€ a month for pays 7.50€.

Obviously the social security part comes out of general taxation which means I am also paying a lot towards that, I just don't know how much because it's not itemised on my payslip.

At the moment I'm certainly not spending 50€ a month on healthcare so technically I'm paying for health insurance I don't really need, but for about 4 years when I was having fertility treatment and babies I was reimbursed a lot more than 50€ a month from my health insurance. It's swings and roundabouts really.

This annoyed me.. I can give you many many many many examples when an ambulance did not turn up till 5 hours later, leaving elderly person lying on the floor with broken bones, or they even died.. because the triage was rubbish and they did not think it to be so severe or had no free ambulances.
But, though some idiot could eventually have the single crazy idea of calling an ambulance due to a lack of supply of a commonly found item.... an ambulance will not be dispatched!
At least this is a disabled or injured person and they do get their carers to bring shopping, which is part of the care, actually.
Farage et all feed on this stupid accusations. Now, the majority of UK hard working population, we are all entitled idiots, are we?....
Not the already rich, greedy, inmoral ones who want to make yet more money out of our suffering... Those, according to some people's narrative, are the "nice" ones. Disabled and ill people are the ones dragging us down.
And the "fun" (infurating!) bit is that they believe we actually believe the rubbish they spout out!

Er -- quite the opposite! In the unlikely event that reform won, they would have a majority in parliament and could pass whatever they liked as long as they agreed on it. Not a guarantee, but the parliamentary system is quite straightforward.

the US president has no power over Congress except a bully pulpit and no guarantee they'll be of his party. He also has to get the bill passed in both the House and the Senate -- the Senate is massively powerful unlike the Lords. It's why the US has never passed anything like a universal health care bill. It's incredibly difficult to get everyone to agree.

Spain does have a NHS + workplace insurance.
So if you have an accident at work, it is the mandatory workplace insurance which covers it. You may still have your surgery or treatment in the public hospitals, depending on which agreements the insurer has on.
For the rest, the tax funded system kicks in.
Taxes in Spain are heavier than UK, by quite a bit.
It works ok. GPs, in my opinion, are much much better. They do not gatekeep the system (as it seems like in some cases in UK), but their target is to spot issues as the earliest stage and sort then.