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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To be terrified by Farage/Reform's plans to replace the NHS with "an insurance based model"?

275 replies

Gillemeow · 08/06/2024 15:47

It seems to have been largely overlooked by the mainstream media but Nigel Farage on the debate last night was clear that he thought the NHS should be replaced by an insurance model.

Given that most of the country are already crippled by the current cost of living crisis, how does he expect people to pay this extra cost? If employers have spare cash to do it (as in France or the USA where many get insurance via their employer), why aren't they giving decent wage rises?

His plans would penalise people with existing health conditions. And which sex would end up paying more.for insurance? The one that gives birth and goes through menopause or the one that doesn't?

In France contraception is only free if you're under 26. What if you're not? Will the right wing's phrase of choice on children change from "don't have children of you can't afford them" to "don't have sex if you can't afford it"?

OP posts:
Thread gallery
11
Voterswung · 08/06/2024 16:52

@MaryMaryVeryContrary yes!.
My goodness have you seen our cancer rates v other places it's all shocking

cardibach · 08/06/2024 16:52

ilovesooty · 08/06/2024 16:45

I never said I was particularly happy about it but I think some kind of reform is inevitable. It might be some insurance based model or it might be gradual means testing. Just saying that we should tax the rich more isn't feasible.

In most European countries with partially charged systems the government lays more per capita for health care…

MaryMaryVeryContrary · 08/06/2024 16:53

Voterswung · 08/06/2024 16:52

@MaryMaryVeryContrary yes!.
My goodness have you seen our cancer rates v other places it's all shocking

Quite. Our ‘free’ healthcare has had huge cost in terms of lives lost. Our population is too lazy and unhealthy for it to be even remotely workable. With a hard working and health conscious public it might be - but it definitely isn’t here; now.

Havanananana · 08/06/2024 16:53

Farage is taking advantage of the fact that people have not understood how the French/German/Austrian "Krankenkasse" model works.

From The Telegraph:
In a call to “change the model” of healthcare in the country, Mr Farage said: “There are countries right next door to us, there’s one country, France, it’s a very different way to funding the NHS.”

The bold type is mine. He's talking about how the NHS is funded, not how healthcare is delivered.

He said that in France “those who can afford it through their taxes pay into an insurance scheme”, while “those that can’t afford it, don’t pay in, so it’s for the mutual benefit of everybody.”

In France all residents must have some form of health insurance, whether state or private. The state system covers everyone regardless of income level or employment status. If your household income is below a certain threshold, you may be eligible for free health insurance coverage.
Healthcare in France is partly funded through social security contributions. Employees paid 7 per cent of their salary toward health coverage in 2023, while employers paid 13 per cent.

That was the original intention of National Insurance in the UK. That was how the "Social Contract" was framed - pay your tax and National Insurance contributions, and you won't need to worry about your healthcare and pension. The major difference in the UK is that the healthcare (and pension) contributions are not ringfenced and politicians got involved, and contribution rates have not kept pace with inflation. Idiots like Hunt actually want to decrease the rate of employer NI - either he doesn't understand how the Social Contract was supposed to work, or he's deliberately wrecking it in order to push people into the arms of the private medical providers.

Social Security contributions - "Compulsory health insurance" in these European countries - do not go to private insurance companies, do not exclude existing conditions and are administered completely separately from government interference. The "Krankenkasser" (Mutual Health Funds) operate largely without political meddling but are public bodies operated at arms length and do not make a profit. People who do not work (students, carers, people on maternity leave, people who are ill etc) have their contributions covered by the State.

For context - I live in an EU country. My wage slip shows my gross wage, the income tax deduction, the "Healthcare Insurance" deduction that I have paid, and the contribution paid by my employer (so exactly like UK NI) and also my Pension contributions and those made by the employer. In financial terms, these rates are a little higher than in the UK, but not significantly.

The second issue concerning Universal Healthcare is how this is then delivered. In the UK, it is delivered mainly by the NHS, with an increasing number of private healthcare companies also providing services to NHS patients. In Europe delivery comes from a variety of providers. Some are private. Some are State-owned. Some are charities (hospitals in many States were originally founded by charities or religious orders). Some are linked to universities and healthcare training establishments. The key feature is that the patient can choose where to be treated and the providers are all paid the same - there are set tariffs for operations, consultations etc. that limit what the providers can charge, and the Health Funds will only pay according to the tariff. If patients want to pay more for a specific surgeon, or for a single room, or for additional services etc. this has to come from their own pockets, or from a separate, commercial insurance policy.

This approach has no similarities with the US model, where healthcare is totally privatised and run for profit and the public healthcare system provides only the very basic level of healthcare. This model must never become the default model in the UK - but unless people wake up to what Hunt and the Conservatives have been doing for the last 14 years or more (from the beginning they never supported the idea of the NHS or Universal Healthcare) then the UK is in danger of sleepwalking into the Free Market, profit-driven US model.

StillCreatingAName · 08/06/2024 16:55

Gillemeow · 08/06/2024 16:40

Shocked at the amount of people who seem to be happy with the proposal of an insurance based system.

Are the insurance companies going to be working for free? What about the extra staff hospitals will need to tot up the bills? Epidural cost, gas and air, emergency C-section, 4 slices of post labour toast, it all adds up.

And that money on all the extra admin is going to come out of our pockets and not be spent on any kind of medical benefit for anyone.

Will there be a sign on the hospital door "only xxx insurance accepted here"?

And then there's the, yes you do need xyz treatment but sorry your policy doesn't cover you for it, you'll have to manage without unless you can pay £££.

Yes the NHS is struggling, yes it needs more money but an insurance based system will be biased in favour of the rich and cost ALL of us more. For example, who's going to pay the benefits for those unable to work because they can't get the medical treatment they need or have to wait years for treatment?

OP this reads like an episode of Grey’s, it would never be like this. You are aware that there’s already a private health system in operation- no pun intended- here in the U.K?

KnittedCardi · 08/06/2024 16:56

luckylavender · 08/06/2024 16:02

The NHS was in very good shape in 2010. Ranked no 1 in the world.

For cost effectiveness, not outcome!

Neap0l1tan · 08/06/2024 16:58

Havanananana · 08/06/2024 16:53

Farage is taking advantage of the fact that people have not understood how the French/German/Austrian "Krankenkasse" model works.

From The Telegraph:
In a call to “change the model” of healthcare in the country, Mr Farage said: “There are countries right next door to us, there’s one country, France, it’s a very different way to funding the NHS.”

The bold type is mine. He's talking about how the NHS is funded, not how healthcare is delivered.

He said that in France “those who can afford it through their taxes pay into an insurance scheme”, while “those that can’t afford it, don’t pay in, so it’s for the mutual benefit of everybody.”

In France all residents must have some form of health insurance, whether state or private. The state system covers everyone regardless of income level or employment status. If your household income is below a certain threshold, you may be eligible for free health insurance coverage.
Healthcare in France is partly funded through social security contributions. Employees paid 7 per cent of their salary toward health coverage in 2023, while employers paid 13 per cent.

That was the original intention of National Insurance in the UK. That was how the "Social Contract" was framed - pay your tax and National Insurance contributions, and you won't need to worry about your healthcare and pension. The major difference in the UK is that the healthcare (and pension) contributions are not ringfenced and politicians got involved, and contribution rates have not kept pace with inflation. Idiots like Hunt actually want to decrease the rate of employer NI - either he doesn't understand how the Social Contract was supposed to work, or he's deliberately wrecking it in order to push people into the arms of the private medical providers.

Social Security contributions - "Compulsory health insurance" in these European countries - do not go to private insurance companies, do not exclude existing conditions and are administered completely separately from government interference. The "Krankenkasser" (Mutual Health Funds) operate largely without political meddling but are public bodies operated at arms length and do not make a profit. People who do not work (students, carers, people on maternity leave, people who are ill etc) have their contributions covered by the State.

For context - I live in an EU country. My wage slip shows my gross wage, the income tax deduction, the "Healthcare Insurance" deduction that I have paid, and the contribution paid by my employer (so exactly like UK NI) and also my Pension contributions and those made by the employer. In financial terms, these rates are a little higher than in the UK, but not significantly.

The second issue concerning Universal Healthcare is how this is then delivered. In the UK, it is delivered mainly by the NHS, with an increasing number of private healthcare companies also providing services to NHS patients. In Europe delivery comes from a variety of providers. Some are private. Some are State-owned. Some are charities (hospitals in many States were originally founded by charities or religious orders). Some are linked to universities and healthcare training establishments. The key feature is that the patient can choose where to be treated and the providers are all paid the same - there are set tariffs for operations, consultations etc. that limit what the providers can charge, and the Health Funds will only pay according to the tariff. If patients want to pay more for a specific surgeon, or for a single room, or for additional services etc. this has to come from their own pockets, or from a separate, commercial insurance policy.

This approach has no similarities with the US model, where healthcare is totally privatised and run for profit and the public healthcare system provides only the very basic level of healthcare. This model must never become the default model in the UK - but unless people wake up to what Hunt and the Conservatives have been doing for the last 14 years or more (from the beginning they never supported the idea of the NHS or Universal Healthcare) then the UK is in danger of sleepwalking into the Free Market, profit-driven US model.

Edited

Thankyou this is such a good and informative post.

KnittedCardi · 08/06/2024 16:58

Well the socialist French seem to be quite happy with it, and the rest of Europe run similar systems.

As others have said, it is a moot point, as Reform won't be running the country. However you might want to find out about social insurance systems in other countries, because they work really well, and there would be nothing to be terrified about at all.

CitrineRaindropPhoenix · 08/06/2024 16:58

Itsnotallaboutyoulikeyouthink · 08/06/2024 15:53

Well the nhs isn’t working in the current climate so something has to change. And why not have some sort of insurance policy? Is it fair that the celebrities that are millionaires can in theory use the nhs and many do!

Of course it's fair that celebrities and millionaires can use the NHS. If they're resident in the UK they will have paid far more in tax than they're ever likely to cost in treatment and are hugely subsidising it for everyone else. If they're not resident in the UK they pay the full cost of treatment anyway.

What an utterly bizarre thing to get worked up about.

Notsonifty50 · 08/06/2024 16:58

@Havanananana Excellent post. I can't bear Farage and what he stands for but I completely agree with him about the NHS.

HandAndFootInMouth · 08/06/2024 16:59

No, in fact I think it’s a good idea.
Our system is broken, it can’t continue.
France has a much better health system.
What’s to be scared of?

Neap0l1tan · 08/06/2024 17:00

HandAndFootInMouth · 08/06/2024 16:59

No, in fact I think it’s a good idea.
Our system is broken, it can’t continue.
France has a much better health system.
What’s to be scared of?

Have you read the thread?

genesis92 · 08/06/2024 17:01

Why on earth are people scared about a new model for healthcare?! One based on our European neighbours that has proven to work and it better for everyone.

People find it so hard to think outside the box. The NHS model does not and is not working anymore. No amount of extra money is going to help it, especially with the insane net migration numbers over the last few years.

Obviously Labour's plans to fund the NHS more is to close the non Dom tax loop hole.....if people actually believe that's all it takes then give me strength 🙄

You do realise Labour will probably be the party that enforces strong change and reform for the NHS eventually. Because they are the only party that will get away with it without constant backlash. All parties know they have to change the NHS, but they're just playing chicken with each other

amylou8 · 08/06/2024 17:01

I'm Nigel supporter and a reform voter, but they categorically won't win this election, so you have nothing to be terrified about...yet! In 2029 however they will be the opposition, or heavily involved in a more right wing Tory party, undoing the disaster that is about to happen.

StillCreatingAName · 08/06/2024 17:02

Notsonifty50 · 08/06/2024 16:58

@Havanananana Excellent post. I can't bear Farage and what he stands for but I completely agree with him about the NHS.

Exactly this.

Autumn1990 · 08/06/2024 17:03

The NHS is working very well in some parts and in some parts of the country.
I do wonder how people would afford insurance. There’s many posters here on household incomes of over 100k saying they’re struggling. How would existing conditions be dealt with? There are many people who can’t afford dental treatment, can you imagine how it’ll be if they can’t afford medical treatment as well!

The thing about farage is he’s unlikely to be elected but what he says to an extent controls the debate. That’s how we ended up with the brexit referendum!

Voterswung · 08/06/2024 17:04

@Havanananana thanks for that in depth explanation. We have relatives in the eu who seem to have a swift more effective health care system with I believe self referral?

Do you think it's a good system? It sounds very good to me.

genesis92 · 08/06/2024 17:04

Autumn1990 · 08/06/2024 17:03

The NHS is working very well in some parts and in some parts of the country.
I do wonder how people would afford insurance. There’s many posters here on household incomes of over 100k saying they’re struggling. How would existing conditions be dealt with? There are many people who can’t afford dental treatment, can you imagine how it’ll be if they can’t afford medical treatment as well!

The thing about farage is he’s unlikely to be elected but what he says to an extent controls the debate. That’s how we ended up with the brexit referendum!

We already pay for the NHS through our taxes. You'll see no difference if we have to pay a little insurance (for better healthcare) and less in taxes

Voterswung · 08/06/2024 17:05

@Autumn1990 not good enough.

In one hospital one dept could be amazing and another risking lives. It's not acceptable to be so patchy

Pigletsoink · 08/06/2024 17:06

Don’t be.

Everywhere else in Europe the model is insurance based. I come from a country (EU) where it’s like that, deductions are made from wages a bit like NI in the UK. Children, the disabled, pensioners and people who are unemployed have the credits still as the government pays for them (like NI credits in the UK).

It really does work much better. I have some very recent experience with the NHS and it’s safe to say the public healthcare in my country is far superior, faster and less waste of funds and time. Also a lot more accountability for wasting public resources on non-medical rubbish. There are far fewer if any ‘diversity officers’ but you get seen and treated a lot quicker.

ExpressCheckout · 08/06/2024 17:08

A few points:

First, the UK is way, way above nearly all countries on a selection of measures, see the statistics here: https://data.who.int/indicators/i/3805B1E/9A706FD. I really wish people and politicians would stop saying how awful it is. It's not.

Second, and I'm saying this as someone with a lot of experience working in the NHS: a lot of money is wasted, and staff sickness at levels which can only be explained by a failure in HR policy and culture of 'being off sick for six months'.

These levels would be unacceptable in any other industry, however 'stressful'.

Third, the public, media and politicians have conspired to make the NHS into some kind of national religion. Nobody is allowed to criticize it, and staff are constantly portrayed as suffering angels. Some are, but many are not.

We need a proper Royal Commission to examine all of this.

Fourth, yes, we do need compulsory health insurance with thresholds for people who cannot afford it. Having compulsory insurance would create accountability for both the users and the providers of the service.

At the moment we have neither, and that is the problem.

Last, and I have said this on here before, but we need to rid ourselves of the 'parasite class' of leaders in our public sector. NHS, Universities, Royal Mail, etc. are all infected by this mediocre cabal of people on constant 'job rotation'.

9A706FD

https://data.who.int/indicators/i/3805B1E/9A706FD

PianPianPiano · 08/06/2024 17:10

Gillemeow · 08/06/2024 16:40

Shocked at the amount of people who seem to be happy with the proposal of an insurance based system.

Are the insurance companies going to be working for free? What about the extra staff hospitals will need to tot up the bills? Epidural cost, gas and air, emergency C-section, 4 slices of post labour toast, it all adds up.

And that money on all the extra admin is going to come out of our pockets and not be spent on any kind of medical benefit for anyone.

Will there be a sign on the hospital door "only xxx insurance accepted here"?

And then there's the, yes you do need xyz treatment but sorry your policy doesn't cover you for it, you'll have to manage without unless you can pay £££.

Yes the NHS is struggling, yes it needs more money but an insurance based system will be biased in favour of the rich and cost ALL of us more. For example, who's going to pay the benefits for those unable to work because they can't get the medical treatment they need or have to wait years for treatment?

Do you think hospitals don't currently have finance teams to "tot up the bills"?! Are you imaging some sort of big free for all where money is just dished out and spent with no accounting at all?! Or do you think all of those things are currently free for the hospitals and so no need to "tot up the bills" for them?

Pigletsoink · 08/06/2024 17:11

luckylavender · 08/06/2024 16:02

The NHS was in very good shape in 2010. Ranked no 1 in the world.

lol. Link please. It’s on its a**e. Even the healthcare system in the Eastern European country I’m from is more efficient.

OvaHere · 08/06/2024 17:14

YABU to be terrified about Reform (this election anyway). The only thing worth paying attention to is what will be in the Labour manifesto about the NHS and what Wes Streeting has to say who will almost certainly be the minister for health by July 5th.

NHS changes are coming in one form or another. I think all parties and all politicians know this whether they admit it or not.