To think the NHS will eventually have to be privatised ?

[Felixsmama]

When the NHS was founded 1 in 2 people died before the age of 65. It's now 1 in 8, the last 10 years of people's lives can be spent with multiple co-morbid conditions which are expensive to treat and keep under control. The NHS wasn't designed for what it's not having to do, we have an aging population. Shouldn't we start to have conversations about what going forward our health service should look like? There's multiple models not just the US one.

Fine, if you refund me the 40+ plus years of contributions I’ve already made (and am continuing to make).

and that illustrates my point, people don't want to pay more.

This.

@thejall when there are two few working people to support a functioning society then it will not matter how unpopular immigration its. It will become a necessity. Or people will have to retire later, so there will be more older people paying for healthcare. So older people will have to choose between working longer and paying more tax, or immigration. At some point that's going to tip in favour of immigration.

too not two !

If you make state pension means tested, people like me will just cash in our small private pensions and spend them before retirement and any savings as well. It only makes sense not to do that if you have a lot of savings or a big pension.
After a lifetime of savings, the average UK pension pot stands at £61,897.
So savings would be minimal.
I would spend everything and totally rely on the state and be entitled to benefits that I currently accept I will not get when I retire.

The NHS will continue to struggle because demand is unrestricted and treatments are becoming ever more complex and expensive, there has to be some kind of means tested access, maybe a halfway system between private and NHS if you pay more.

but we need it now

But if it's turned private they will pay more

And I have 13 years to state pension age, so lots of time to cash in my pension and spend it having fabulous holidays. I would retire at 67 with my partner with zero savings and the state can pay for everything.

@midgetastic yes but I don't think people get that or they then say they will dispose of all assets so that they can get it free

What you are talking about is rationing through the ability to pay. Be upfront about this.
You are suggesting a basic level of NHS care, then anything else people pay for based on whether they can afford it or not.

And I have 13 years to state pension age, so lots of time to cash in my pension and spend it having fabulous holidays. I would retire at 67 with my partner with zero savings and the state can pay for everything.

as I just said...

@antelopevalley would you object to a charge to your house?

Yes, clearly needs massive change to be more like the successful healthcare systems in other EU countries. Don't see what's wrong with charges for some things, and yes people need to stop wasting NHS time and money, and take some responsibility for their health. Of course there must be provision for those who cannot pay.

No, it means that I don’t want to pay in to a system for many years and then get nothing on out of it at the end of it because I’m somehow deemed to be ‘not deserving enough’ to receive a pension.

@EcoEcoIA we need them now though. Agree with the tipping point but we will be in competition with other countries that also have ageing populations. How attractive are we with high taxes, high living costs & low wages?

@ChitChatChatter so you have an issue with state pensions increasing for younger people despite life expectancy not?

@antelopevalley Anyone who got rid of their assets then they would end up on universal credit. If they own a house then that is an asset that the state should be entitled to sell. The state might have to support their rent in a shared HMO.
I'd end pensions freedoms and lump sums and go back to insisting on the purchase of an annuity or drawdown investment.

@thejall one of the high costs is housing. That is why we need to build more homes - newer building technologies are more eco friendly - heavilly insulated timber-frame SIPs - abolish the green belt - there are lots of golf courses that could be compulsory purchased and built on by local authorities fro social housing.

I am from Singapore, this isn't quite the system. 20% of your salary (there is a cap on this) would go into an account which has 3 components- savings for old age, medical care and housing; employer also contributes 16%. You have to have mandatory health insurance, but your premiums can be paid for using your healthcare 'savings'. The government subsidizes a large percentage of your healthcare treatments but this is dependent on your income and where you live i.e. if you live in a government flat (85% of the population) and have an average salary, the government will pay 80% of the cost if you opt to stay in the most basic hospital ward. The rest would be covered by insurance and healthcare savings, but there are also caps to what insurance will cover; this is to ensure that we don't have a US style scenario where hospitals end up charging whatever they want because insurance companies will pay for it. And of course, if you are very poor, there is a fund which will pay for 100% of medical bills.

It is a very different system, but it means that you have to take some personal responsibility/planning in terms of affording healthcare. Yes I haven't heard of anyone who died because they couldn't afford healthcare; but overall it is easier on your family if you made certain decisions i.e. paid for more extensive healthcare insurance. You should expect to have to cough up thousands at some point esp if you are very frail and old, even with the 80% government subsidy and healthcare savings and insurance, but at least its not tens of thousands. My grandma had a stroke and my dad paid the equivalent of £5000 for her treatment (she stayed a month in a hospital). That was after all the subsidies and insurance etc.

I would say that for most people, the uk system is less stressful cos a lot of people do worry about healthcare costs in singapore (even if they could theoretically afford it). Its just not a blank check.

I'm willing to consider alternative arrangements but full scale privatisation hasn't improved the railways, and look how much money energy companies are making, that were previously nationally-owned and are now private enterprises.

Really not sure that privatisation improves things for the users, only for the owners, and so until we can come up with a better alternative that improves patient care and outcomes, I'm going to be firmly against privatisation.

Oh and in case you're wondering, I've worked for the NHS and for an independent provider running contracts commissioned by the NHS so I do have some experience in this area.

An unpopular question:

How much are we willing to spend to extend the life of a given, say, 85yo?

For that amount of money, do we definitely want to spend it on care for that person instead of, say, educating the young, investing in energy security, addressing climate change, improving our military defences...?

The question of whether the spend should be private or public is secondary without engaging on the above first.

@EcoEcoIA how is building over every inch of green space going to help? Over building does not help with climate change, building on flood plains etc and quite frankly I didn’t choose to live in a built up urban jungle I chose to live in a small village with something to look at other than hundreds of houses all living on top of each other and I realise how NIMBY this makes me sound but I accept that

Demographics are only part of it.

The bulge in boomers impacted society right from when they came of age, from policy around education and jobs, to housing, regulation, and healthcare. This issue stems from Gen X expecting the same as what the boomers has, and to some points they got it, however partway through that generation the drawbridge started to be pulled up as it wasn’t sustainable. Policy’s still focus on boomers and older gen x with the future bring constantly mortgaged form millennials and gen z to pay back. It’s only not sustainable as we operate on a buy now pay later system of tax.

the issue is policy not the system one group made there way through the system not contributing anywhere near enough, we now have to pay the demographic price because there are less of the following generations so cost is now a concern.

do we need reform, yes but not in the us model, nor should we abandon the principle of free at the point of need.

privatisation can be used for good, however often it becomes a price race to the bottom with quality and standards slipping, and to maintain these wages get sliced to the bone, meaning while you can get greater cost benefits the question becomes at what detriment to society when wages get cut, and profit margins maintained to keep growth, and all the while executive remuneration increases further creating disparities.

take a watch of

what we need is a longer term strategy built by consensus and the needs of society and not subject to the whims of democratic change. Constant flip flopping wastes time, money and is subject to ideology and not sound strategy.

I personally think the nhs and a lot of public infrastructure should be in public hands, but at arms reach from ministers. Governments could set some key goals and targets but the main running would be by a separate body. (Similar to Bank of England with interest rates)

The older population in the UK is projected to grow, with people aged 65 and over making up 24% of the population by 2043 (17.4 million people). The proportion of the population aged 75 and over is projected to rise from 8% in 2018 to 13% in 2043, while the proportion aged 85 and over is projected to rise from 2% to 4%.

The gov haven't planned for this demographic shift