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

[Gillemeow]

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"?

He’s one man. It’s barely a proper party. It’s only the same people who would be voting for a right wing incarnation of the Conservative Party. “Terrified” is nonsense.

I think you need to read up on how public insurance based healthcare system works. You seem to be confusing it with private insurance policies

They have an insurance based system in most of the western world and it works fine.

Most of the horror stories are from America, where healthcare is just insanely expensive and the wealth divide is enormous

Zero chance?? They're gaining popularity by the minute!! And I'm not happy about that, but you're wrong about zero chance.

In the UK if someone has a heart attack while undergoing a 7th round of chemo, the NHS records the cause of death as a heart attack and not cancer. Other healthcare systems don’t (speaking from experience, close relative).

It’s really easy to make the figures
look better/worse depending on the current agenda. Remember how they recorded Covid deaths?

Well at least they are not putting covid down Anymore!!

They might be totting it up in a general sense ie 20 loaves of bread and 10 packs of butter plus 1 vegan Marj but they're not going to be creating a bill for each person, with individual slices of bread and scrapes of butter then figuring out which insurance company to send it to, and if necessary chasing payment from them. The logging the payment from insurance companies against the patient's individual account etc etc

This is all time consuming stuff that will need EXTRA staff. Who pays for that?

Then there's the insurance companies. Quoting, confirming what's covered, collecting and chasing payments. Advertising their services etc etc. And let's not forget making a decent profit to pay their shareholders.

All this is nothing to do with medical care and will increase the overall cost for everyone. It makes more sense to continue paying for the NHS via taxes so as much as possible is spent on treating people rather than unnecessary admin.

Unless you’re in Scotland where they like to boast about everything being ‘free’ whilst not mentioning the extra tax everyone pays there, for an equally failing NHS model.

@Gillemeow Really recommend reading @Havanananana 's excellent post. I also live in a European country with a similar model, and absolutely everyone gets healthcare when they need it. You pay insurance to the government (like National Insurance except ring-fenced) and there are exemptions for people on low pay and unemployed. It's not like the US in any way. Nothing to be scared of at all.

They're not going to get in, but they could influence the Tories.

What a load of rubbish.

The problem is that if we want better services we need to be prepared to pay more. And directly funding a social model is more cost effective for the majority of citizens than introducing insurers, who are going to want their cut.

There’s a shit load more to the current work of NHS finance teams than “totting things up”. You really don’t know what you’re talking about.

And I think that's as it should be. Are tax rates higher though? Just the suggestion that people in this country should pay higher rates of tax has some people squealing. I don't in any case see how the NHS can be effectively reformed without government grasping the nettle and acknowledging that the social care crisis has to be addressed alongside.

Farage is ALL front.

For the people who have asked how the European system works in practice, here is some more context.

After WW2, Western European countries such as West Germany, France and Austria were in ruins, and everyone had to work together in order to get these countries back on their feet. One of the advantages of the situation was that things could be rebuilt from scratch - not just buildings but also ways of doing things. This was also the case to some extent in the UK, where the Labour government introduced Universal Healthcare through the NHS, despite the medical profession and the Conservatives being against it (and in favour of a US-style insurance-based Free Market model).

One of the key decisions made in the country where I live was that if everyone had to pull together, live through shortages and rationing and so on, then the rewards of the rebuilding programme had to be shared by everyone. In healthcare terms, this meant that the standards of care and treatment previously only available to those who could afford to pay for it should be available to everyone. This is one of the basic principles that still exists today.

What this means is that employees and employers both contribute to the Health Funds (just like UK NI). But - these Funds are ringfenced and the only political input is deciding the level of contributions. Unlike in the UK, politicians have not been allowed to use healthcare as a political football, and not been allowed to let contributions fall behind inflation and the increase demands of the ageing population. Most countries in Europe and the OECD invest more per capita in healthcare than the UK does. For example, Germany invests 30% more every year. Austria has twice as many doctors per capita as the UK - the result is that a GP can be seen just by walking in, there are minimal waiting lists for Consultant appointments or surgery. These countries also had Covid, they also have ageing populations, they also have immigration (at higher levels than the UK has) but still access to healthcare services is totally different to much of the UK.

At the end of the day, England has over 10% of the population waiting for an NHS appointment or treatment. In many places there are no funds available to employ more GPs or nurses, despite the increased demand. The decision to underfund - for staffing, buildings, facilities, systems and equipment - has been a political one. Hunt shafted the NHS when he was Health Minister, and now believes that "balancing the books" rather than "treating patients" should be the priority.

Ultimately, how healthcare is provided in the UK is a decision that has been made by voters. The Conservatives want to drive those who can pay into the arms of the private providers and everyone else can just lump it. Waiting lists get longer. Waiting times get longer. People suffer physically, mentally and financially as they wait for treatment or worry about what might happen if they fall ill. In the 5th wealthiest country in the world, healthcare is increasingly being rationed by price - a situation that is unimaginable and would be totally unacceptable in many other countries in Europe.

It’s on its arse NOW. Wasn’t in 2010. Not a link, but an OECD graphic.

He’ll never win anyway. Thankfully.
However the insurance top up in France works quite well to be fair. It’s not a huge amount and most private companies pay about half of it. Any illnesses like cancer heart disease chronic are covered even without insurance and people under a certain income get a state funded top up. You can make your own appointment with specialists , for blood tests, mammograms etc if you wish and waiting times are less usually.

But those people are already funding the NHS. It's the people using it that don't contribute a single penny to its running that cause the issue.

I would happily go with an insurance model rather than have the amount of tax we already pay increase

Well obviously but is working out the cost of an individual patient's treatment, bed and board, sending it to their insurance company and tracking payment on top of the work already done going to need more, or less staff? And will any of it benefit the patient or improve treatment?

Four main reasons:
i) cost: the aging population means the cost of funding the NHS decently (at whatever level of care that means for you) grows hugely every year. It needs to run just to keep still. It's not a matter of increasing tax a little, but a lot.
ii) politics: that would be fine if the public were prepared to pay. But raising taxes is very unpopular. People want the services but don't want the required tax rises. Politicians know this.
iii) intergenerational fairness: health costs are hugely loaded to the final years of life. Meanwhile income tax is paid by younger generations. Old people on average already cost the public purse much more than they paid in. With a rapidly shrinking worker-to-retiree ratio, younger people would need to bear an even heavier burden than they do already. Beyond a certain point it becomes unjust.
iv) incentives: if you make something free, people will tend to use more of it than if they had to pay what it cost to provide. But the cost is still there (to the state). Encourage people to use only what they need. There are various European models that retain a bit of this principle while protecting people from excessive costs.

Your patriotism comment reminds me of living in the US during the Obamacare debates. They also think they have the best healthcare system in the world. It just means it's the system they are used to, and mostly they don't know about any others. Similar to views of the NHS in the UK.

Again, you’re describing a US model. And teams already track all of those things at a transactional/unit cost level because it’s required for their funding to be calculated. No one gets bunged a load of money at the beginning of the year and just left to crack on, there’s an enormous amount of invoicing and payments going on between the different parts of the system.

Why not compel employers to provide private healthcare? Every employer I've worked for in the last 25 years has. More should be forced to

I think the NHS model is ok, not sacred or in a patriotic sense but just basic economic structure, but a few questions

Does it invite over bidding? Idk

Who pays more in France / Germany is it higher earners only? Ie at what income do you pay more for their model v the UK

Health of population and use of care homes also a factor. We are unhealthier

Loads to look at, I don’t actually just think change it. But on using private we’re still paying for PPP and I think Labour will use private to some extent. The latter isn’t too bad. Out of all the things they’ll do which concern me they ‘get away with’ using private in a way other parties won’t.