There should be more partial-private options in health and education

[Middlelanehogger]

People often say that for social mobility reasons we should abolish private schools or private hospitals as it's unfair that there's "one system for the rich, one for the poor".

However I think this thinking is backward. We should encourage more gradual step-ups that enable people to slowly inject more of their own personal money into the system as they move up the income ladder and become able to do so.

For example, currently I have the choice to go to my underfunded, busy NHS GP, or a completely private GP and pay the full costs. Likewise I could send my kids to state school or go completely private.

Great if you can afford the "completely private" option.

But there isn't an intermediate option. In Australia for example, you get a govt rebate of say $30 for every GP appt. This covers a basic GP, or you could apply it towards a more expensive GP with a nicer waiting room or late operating hours etc that costs say $50 (i.e. you only pay the $20 difference, vs $0 in the free option).

In the UK you either pay £0 or £50. There's no £20 option.

In the Australian system, the health system overall gets an extra $20 that wasn't there before (from the extra top-up), and more people are able to access the nicer services (because more people can afford $20 than $50).

There's a similar argument to be made for private education. Why can you not "move" your state school funding to a private school to offset the costs? It would allow a smoother mixing along income levels instead of the harsh cutoff/separation we have today.

Eliminating inequality is completely impossible due to human nature, but keeping a harsh separation between "the rich" and "the poors" also isn't the answer. It just keeps "the rich" even more in their bubble.

@Watchagotch72 that's really interesting; thanks for typing all that out.

Just goes to show another world is possible.

I had to take my daughter to a GP in France last summer. The service was good and we were able to get a speedy appointment even though as holidaymakers we weren't registered.

Part of the cost should have been covered by EHIC. Finding out how to claim back in the UK was very complicated but I managed it. I finally got a reply on 4th July THIS year (so it took 11 months) telling me how to obtain the small amount due.

I don't think UK health services would be able to handle any form of joint responsibility for paying. It's been "free" for too long.

I had a ‘cardiac incident’ in one of the poorer EU countries.An ambulance arrived after about 10 minutes, the ED was immaculate and pretty empty. The staff spoke English, the procedure they diagnosed as being needed was done within 48 hours. All I had to show was my EHIC card.I only paid 10Euros for a tv at my bedside which arrived within 30 mins.The receptionist even called a cab for my accompanying relative. I was so glad to get sick
there and not need my local understaffed and frankly crappy hospital.

if they can do it, why can’t we?

Completely agree with everyone saying it would widen inequality for many reasons.

Also, "choice" only really works in areas with enough people to make that an option. My large, rural, county has 5 secondary schools (all state). If my kids didn't go to the nearest, the next nearest is about 40 minutes drive (longer on public transport) away. There aren't enough people here to make running multiple schools viable.

Other countries do do this and it can be a way to get more money into a system

I haven’t thought about it much but on the face of it could be a good way to go

I prefer it to withdrawing people from private - as for education plans - in a bid to get support

I agree it would widen the gap between the absolute highest and lowest levels of service.

However, for the average person, this is irrelevant from a social mobility perspective. What matters is how many jumps up the ladder are actually available to you personally.

Let's say today there are two levels of service. On a scale of 1-10, 10 being best. Today you have the option of getting "level 3" service for free, or "level 8" service for ££££.

A govt voucher system opens up the possibility of people getting levels 4-7 service for £-£££.

Yes, it also offers the ability for super-premium services to offer up to level 10 service. And there's the chance that without pressure from normal middle-income people, standards for the absolute poorest who are less able to advocate for themselves will drop to level 1 service. So the range is now 1-10 instead of 3-8.

But now it's the full range from 1-10 and not just "3" or "8".

From a social mobility perspective, it gives people more options to move up the ladder. Social mobility usually doesn't happen in leaps - it happens in steps, over time.

It's worth noting that for schools, people already try to get "level 4-7" service by buying houses in catchments for good/outstanding state schools. People will always try to get better service if they can. Why should we not acknowledge this instead of ideologically sticking to some theoretical idea of absolute equality that doesn't exist in the real world?

From a social mobility perspective, it gives people more options to move up the ladder. Social mobility usually doesn't happen in leaps - it happens in steps, over time
But social mobility doesn't just mean there's steps up, though that's how we often think of it.

Just like you can have marginal gains and marginal losses, in your system there's steps up and steps down.

Over time the steps down add up and the children/families who already are feeling the effects of 10+ years of austerity, intergenerational poverty, intergenerational poor education outcomes etc are likely to find themselves even more limited as the quality of education declines. The next generation of parents with lower outcomes are even less able to get good jobs, even less likely to promote literacy at home and then there's a whole class of society who are basically groomed to be at the bottom as an underclass. This underclass are therefore likely to have fewer options, less money, less influence, are more likely to be in precarious employment, more likely to have long term health conditions, destined to be trapped in poor quality housing, and don't have the means to challenge their situation or fight for basic rights and so on.

I might be deeply deeply cynical but it concerns me because there's some people in power who would probably salivate at the idea of keeping a proportion of the country in poverty, desperate, with limited options and no choice to accept terrible working conditions.

@LolaSmiles are you saying we shouldn't have any steps at all in case some people fall down the ladder?

I think they're saying that the poorest in society don't need their lives or health to be any worse than they are currently.

It's not a poor child's fault that they are brought up in deprivation, and if they are unable to access decent healthcare you end up with a really unhealthy bottom chunk of the population. The poor health of the population when we needed to conscript them for WWs 1 and 2 was what resulted in minimum housing standards coming in (WW1) and in the NHS (WW2).

Obviously that's a big oversimplification but I 100% think we shouldn't be making healthcare any worse for the worst off in society.

More options for op but fewer options for most people. Also means your money is going on slightly better health care rather than something you are really interested in.

No because you end up with a tiered system where those who can afford to pay get a decent fit for purpose service, and the poor get something crap but have no choice.

Wealthier people tend to have more power to make change, and their desire to improve public services benefits poorer people who have no choice.

Also we need wealthier people paying into a public system that subsidises people too poor to fund their own. If people start going privately they tend to start wanting lower taxes and the whole point of taxation to redistribute wealth/benefit is gone.

I think they're saying that the poorest in society don't need their lives or health to be any worse than they are currently
That is what I'm saying.

The current system already has a lot of options for parents topping up with things they can fund (eg catchment areas, private music lessons, enrichment opportunities, paying for sports coaching, private tutors).

There's also already the option for paying for independent schools, which whilst are out of many of our budgets, some aren't any more expensive per month than childcare for under 2s depending on school and area.

Any system that's deliberately designed to create an underclass and ensure generations are trapped in poverty as public services are shredded isn't a system I'd want.

A huge huge percentage of people make up the bottom rung. And what they end up with is nothing or your "level 1" which is unacceptable. So yes, we take it off the table.

When everyone has to have the same you tend to find that the richest people advocate to ensure that what everyone gets is level 6, not level 3.

I'd actually do away with the private option entirely. Its divisive and takes good doctors away from everyone else.

I pay for tutors and lots of good extra curricular activities for mine, that feels like a good half way house between state and private.(plus ensuring we bought in a decent catchment)

Completely agree.

Privatisation has ruined quite a lot of public services. Free schools and academies already mess up the preferred model for functional schools. So please let’s not float mad ideas like this

Somethings similar exists in Ireland for health and education. Not going to talk about the disaster that is the health system, but it does work for education.
There are a lot of small step up options.
My dc is about to start at a secondary that costs around €4k a year. Boarding is €11k.
Loads of grants and buseries available if you are the right religion, struggle with full fees or tick other boxes.
Government pays teachers but money goes towards additional teachers to keep class sizes smaller and extend to a longer day.
I dont know if any private school in UK close to that price.
Also options for final year, like A level college. Many go to it just for last year and pay for that year only.

The health system is really awful, even though you can have a combination of public and private. Private consultants have private clinics around their public work. It's a really unfair system which different waiting lists.
There used to be something called semi private in maternity care. Think it's gone now.

May I be as bold as to make an alternative suggestion?

How about those who are able to afford private healthcare and education pay the same proportion of their income in tax as teachers and nurses do?

One just has to look at the Prime Minister's tax returns to know how messed up our current system is.

In Australia the basic is very very basic, all my Australian friends pay quite a lot for top up insurance

YANBU, I fully support your ideas. It's crazy that something like that isn't possible.

My OH can't have MRI scans in the "tubes" (he's got incurable cancer and needs regular MRI scans to monitor bone deterioration etc). He's "wasted" numerous NHS scan appointments over the years because they kept insisting they'd try different ways, i.e. sedation, shorter durations, etc., but he literally never managed once! Heaven knows how much money the NHS has wasted in abortive scans!

He researched for himself that there are "open" standing MRI scan machines, but they're only available privately. After a lot of messing around with the oncologist etc., we finally got details of the exact scan they wanted, and arranged to have it done privately. Cost was £1,200 which we had to pay. We'll have to keep paying it yearly for the oncologist to monitor the bones.

Personally, I think the NHS should be paying a contribution of the amount it would cost them for a normal scan, and for us to pay the difference. After all, had the NHS got such machines themselves, they'd have saved the costs of several abortive tube MRI scans! And OH isn't the only one - the private MRI scan firm also had a long waiting list and said they got lots of NHS patients who couldn't have NHS "tube" scans.

It's not as if the private MRI scans are a matter of choice - it's not like jumping the queue or getting better coffee/biscuits which is most people's perception of going private. It's essential and necessary for his cancer treatment. After all, cancer patients aren't having MRI scans for the fun of it!

There's a similar argument to be made for private education. Why can you not "move" your state school funding to a private school to offset the costs? It would allow a smoother mixing along income levels instead of the harsh cutoff/separation we have today.

This is how a lot of us managed to attend the top grammar school in our City, back in the day, until the scheme was stopped in the mid- 70s, meaning the very capable, but not rich dc were no longer able to go, and the school moved from accepting the most able, to accepting the most able out of those families who could afford the fees

This. And health. It doesn’t float my boat.

How would you do away with the private options completely?

Ban them? Make them illegal?

So how would you stop people going abroad for private education/health services then? We, in the UK, can't stop people going abroad can we? Or would you ban that too!

The "rich" would just educate their children abroad and, as many already do, travel abroad for health treatments (don't a lot of people go abroad for dental work in the old Eastern European countries, Turkey, etc??).

Look at euthanasia - we can't stop people going to Switzerland to end their lives can we?

In reality, what would happen with your idea is that everyone gets the same crap services. I can guarantee that service levels etc won't increase as you seem to think.

I'd agree for healthcare but not for children and not for education.

I think that's how education works in Ireland - the private schools get some level of funding, and as a result, you pay for a year what other people pay for a term. Boarding seems to be more common too (although I wouldn't exactly call it affordable) which increases the options for kids who live out in the sticks.

I am a big fan of the NHS, but do always find it strange that I can see anyone from a GP to a specialist consultant, have operations and hospital stays, support from therapists, rehabilitation centres etc, and not pay a penny, but then when I go to either the optician (medical care but specifically for my eyes) or to the dentist (medical care but specifically for my teeth) I pay. I pay for a check up, and I pay for any treatment / glasses to correct my vision.
Even though the dentist is an NHS dentist - I still pay.