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.

I agree with many pp that this would create an underserved underclass. I also think this kind of thinking is the beginning of a slippery slope. The tories have been strategically stripping the NHS of funding and resources for years and years because they want private healthcare. The NHS does need money - but it needs to come from government, not directly from users at the point of use. Imo.

There isn't a world where there's only one system that the rich have to participate in. Ban public schools and people will just go back to private governesses...

My employer was so irritated by staff absences involving the NHS that they brought in a private GP just for our staff who sits in our building and we just email for an appointment that we can get within hours, same day.

This is the kind of thing that's available already today... for some.

In Australia I used to go to a GP who took some bulk-billed patients (i.e. free) and some who paid extra. I paid extra (and got some conveniences like late appointments) but the money went to the overall practice which was used by people from a range of walks of life.

In the UK I just ignore the existence of the NHS GP and wouldn't be affected if they went away tomorrow.

I don't think that makes for a better more caring more integrated society.

PS I wish I paid the same % of my income in tax as nurses do!!!

Bet Rishi Sunak’s glad he doesn’t.

The problem is that if only the poor use the free service, it no longer matters to politicians and it will quickly become sub standard. While those who are slightly better off get a much better service that is subsidised.

The poor are already disadvantaged in so many ways - we need to be getting the rich to use the same services as everyone else, not getting rid of the poor to their own rubbish service.

I wouldn’t want private care being normalised. I think we are moving into dangerous territory in thinking that private healthcare is ‘better’. Obviously the NHS is in a state but healthcare being profit driven can never truly work in the best interests of the patients. You end up with up with unnecessary prescriptions/treatments/ testing and unscrupulous medics. Just look at the USA.

There are lots of other ways you can step up the ladder. Purposely deciding to give poor people worse healthcare and education than they currently get, so that better off people benefit, is a disgusting attitude frankly.
Presumably you are going to expect poor people to staff these better, state subsidised hospitals and schools that they can't afford to use themselves?
You do not need private education to do well in school, there are lots of ways for parents to help their offspring do well that don't cost 10s of thousands. As for health care yes the current system is shit and not for for purpose but that is down to years of Tory government and their ideology. It is not inevitable.

Well said

I agrée.

it works well for health care, but education is a completely different matter. Healthcare issues are often short-lived, they affect people of all ages and ask stages of life, and are unpredictable with different things happening to individuals at different stages. For education, it’s a one off. We have one shot to get it right for children. Every single child needs educated, and educated well. It really doesn’t matter if an adult has a knee replacement privately or on the NHS - the end result of a working knee is the same. But put one child through Eton or Winchester, and another through the local comprehensive and the outcomes and life chances will probably be very different.

Very, very well said.

@SnackSizeRaisin Purposely deciding to give poor people worse healthcare and education than they currently get, so that better off people benefit, is a disgusting attitude frankly.

That's... not what I suggested?

"Allow people to inject some of their own money into the system to get additional marginal benefit for themselves at their own cost" doesn't map to what you're saying at all.

If I paid for my daughters heart surgery to happen sooner than it would otherwise, what happens to the person who is due to have surgery whose place she has taken?
If I someone is paying for that heart surgery, what happens if someone is born needing heart surgery, since we have paid do we keep the date and let them take their chances?
If I've paid for an intensive care bed for my daughter for the night, then she gets to use it and never mind the victim of the hit and run who comes in?

Yup a hugely well thought out plan.

Benenden has served us well for health and only 11 pounds a month.

whether it’s what you want or not, it’s what happens. If you can get current average education from the state, or supplement by £200 a month and get 30% better education then the people who can afford it and can get accepted pay the £200 a month and the education that’s left for those who can’t pay goes down hill. In part because the harder to educate kids won’t be accepted for just £200/month so far more of them are left for the state to educate. But also because, once you’re getting a subsidy of X to buy the education you want, there’s more incentive to pressure politicians to cut funding and taxes by X and just pay for what you want yourself. This leaves behind those who can’t afford to pay.

Eventually, in real terms the subsidy from the state goes down and the privately funded proportion goes up and those who can’t afford to pay are screwed over.

So what's the point in being "rich" then? Why would people work hard to get qualifications, promotions, to get higher paid jobs, often with stress and longer hours if they couldn't benefit?

US is an extreme case and it's annoying that it's so often trotted out as the alternative instead of looking at all the other countries who don't have an NHS but also nothing like the US system.

Because the people who couldn't afford to top up would be left with shitter service. Worse schools. Worse doctors. Wider inequality.

They can. There’s this thing called private healthcare those of us who can afford it can use if we choose. It’s particularly useful if you need an operation because you can jump the queue and get operated on more quickly than the people who can’t afford it by the same doctor.

Other countries do manage it and avoid some of the negatives mentioned below

If it effectively brings more into education or healthcare overall as more people add extra then it can be a good thing

People want to strip this away atm by making private harder to access so similar tax rebates would go down badly. Basically even if it works well they wouldn’t vote for it.

Agree and never understood why it’s always used to compare considering the vast difference of population and the differing laws and practices between each state other as than another moan about the country especially by posters who have never stepped one foot there or have experienced the system themselves.

Healthcare in the UK isn't a zero sum game. I've had about 6 procedures with private docs (endometriosis, varicose veins). Both docs are well beyond state retirement age. They each do a list a week in NHS which I have no hope of getting onto without waiting years. If they hadn't operated on me, my place would have been taken by another private patient; not an NHS one. Care was all in private hospitals.

If they were forbidden from working privately I guess they'd retire (or work privately in their countries of origin).

Private adds to the overall capacity.

So what's the point in being "rich" then? Why would people work hard to get qualifications, promotions, to get higher paid jobs, often with stress and longer hours if they couldn't benefit?
People who are already rich, even higher middle income, have plenty of benefits and options.

It doesn't mean it's a great idea to deliberately design a system like the OP proposes on the principle that entrenching an underclass is an acceptable thing to do.

There should be a minimum level of public services that is effective and appropriate. Anyone deciding that this should be ripped up and the most marginalised should be trapped in a system with an offer that's substantially worse than current services is either naïve or heartless in my opinion.

The very rich, like the current government, really do not care about middle and lower income families. Dismantling public services might sound good to those who will probably get by ok, but they'll be next in the firing line when other services, working terms and conditions, union participation etc become the next target of attack.

I also suspect we'd also end up seeing price increases to match the taxpayer voucher value and then private companies (probably with links to the right people) charging extortionate amounts to the taxpayer to run the services nobody else wants. It would be yet another way of redistributing taxpayer money into the pockets of very rich political donors.

What you're describing is what already happens! More income = higher rate of tax and NI which is meant to fund these things. They aren't free, they're free at point of use, and we're all being shafted into thinking ideas like this would help.

@LolaSmiles There should be a minimum level of public services that is effective and appropriate. Anyone deciding that this should be ripped up and the most marginalised should be trapped in a system with an offer that's substantially worse than current services is either naïve or heartless in my opinion

This is what the op is suggesting - a minimum level that effective and appropriate for all, but also options to ‘upgrade’. The revenue from people willing to upgrade partially subsidises the basic option, and you end up with better facilities, better equipment, properly paid professionals who stay in service (and more of them). I understand the scepticism, but there are mechanisms to ensure this happens - lots of countries do so with varying levels of success, and some do it very well.

I think the bigger issue is a cultural one - the British would have to accept inequality. Yes, inequality already exists, but we don’t accept it. The principle of equality is sacred, especially around healthcare. The brits would rather have a shit system for all / raise barriers to private until only the mega wealthy can find alternatives than accept that inequality is inevitable.

@LolaSmiles Private companies are most definitely not interested in "running the services nobody wants". Do you have any idea of how capitalism works...?

Currently we are trapped in a system where 90% of the population is the underclass receiving subpar service with no way to improve it for themselves. The rich ALREADY HAVE THE SUPERIOR SERVICE RIGHT NOW.

@Notinmynamethx I have a high income which is purely personal income (i.e. no companies or offshore accounts involved) so I pay a high rate of tax for... the exact same service. I'm talking about paying more to actually get more service.