To think the time has come to abolish the NHS healthcare model

[OptimismvsRealism]

Free at the point of use also means denial of care to a lot of people. What torture to know that new medications are arriving regularly (eg lecanemab) but it's only for the very wealthy.

The UK is different from how it was in 1948. We should be brave enough to move on from then.

Hypothetically, if you were a minimum wage worker, how much would you be prepared to pay?

I would be happy with a European style model with some level of insurance and some payment up front.

However I think everyone has to pay something for their healthcare, even if it's a very small amount for the lowest income groups.

I think allowing some groups to get it for free leads to overuse by those groups as they have no reason to limit their demands.

See massive overordering of pharmaceutical products by those who have free prescriptions - often having to be binned by family in whole bin bags at the end of life.

Yes, let's get rid of one of the only things we still have to be proud of and should be prioritising for help.

I'd happily get rid of the Royals way before I even considered getting rid of the NHS.



I agree. It's a complete waste of time. I'd rather pay and get a proper service rather than be conned by saying treatment is free when it isn't available in the first place. If its not available it isn't free.

Agree, the NHS isn't working and at this rate, can't be projected to work. The definition of madness is to keep doing the same thing and expect a different result: I hope the current government has the balls to introduce a percentage charge at the point of use and for medicine. That would be a start, it would discourage abuse, and maybe even start dismantling the assumption that we should be grateful for any care at all, good or bad, because it's freeee.
It really doesn't have to be 100% free or the American system, there are many effective models to learn and take from, if only we wanted to evolve.

The thing is, an average person cannot plan for it in advance - there is no such thing as a long-term care insurance policy you can take out, so you are left either selling your home or ploughing through savings (obviously people have different views on whether this is fair or not) or your local council has to fund it for you.

This used to exist. I don’t know whether it just became uneconomic or whether people didn’t want it any more.

All of these countries, regardless of their funding models, spend more per capita on healthcare than the UK.

www.statista.com/statistics/236541/per-capita-health-expenditure-by-country/

https://www.statista.com/statistics/236541/per-capita-health-expenditure-by-country/

Well aren't you lucky you can afford to pay eh. What would you propose for the majority of people who couldnt?

It’s highly amusing you trust any UK government to adopt the European models when everyone knows full well they will adopt the USA model and it will become all about making profits and not about care.

Definitely needs a root and branch reform, with actual health- not illness- at its heart. For example, 10% of the total NHS budget (10%!) is spent on diabetes care, the bulk on complications. Not all of that is preventable, but a good chunk is, especially if things like planning systems (build stuff people can walk to, no food deserts, early community intervention, simply reducing poverty) also swing in. But it needs serious joined up policymaking.

Lots of things cost the NHS more because we intervene too late when things get complicated or are in crisis. It's also structurally sexist and racist as we see in outcomes for women and BAME people.

Tweaks won't work. The Kings Fund has some interesting stuff on other models. It can't be preserved in aspic forever but that doesn't necessarily mean people can't access care, there are lots of other ways of doing things.

Working for the nhs I fully agree that it doesn't work. The principle is amazing and honourable, but the reality is that it is incredibly inefficient, with lots of wastage, bottlenecks - it's like a load of jigsaw pieces that don't quite fit together, there are overlaps and gaps, and it's too huge to figure it out, like a rubix cube, you fix one bit and mess up another. Lots of incompetent staff which nhs hrs processes make it almost impossible to get rid of.
And then there are patient attitudes, the missed appointments, abuse of nhs equipment, rudeness and aggression towards us. There seems to be this attitude that because it doesn't cost the patient anything. I advised a patient that a specific treatment was not suitable for their child, their response was 'well I want it, other children have got it so I am entitled to it, it's not as if you are paying for it so why are you being so awkward'. This sums it all up, a level of entitlement, lack of respect for our professional opinions and thinking that it's free, when it not, someone has to pay.

The issue in SanFran is the opioid crisis. I go often too. Sadly - there are many reasons for that including greedy medics, greedy pharma execs, inadequate governance and yes - poor rehab services. Rehab services are extremely poorly funded in the UK too - we are just fortunate we don't have the other factors to create that perfect storm.

Medics are not incentivised financially to prescribe in the UK. But neither are they in Europe - so the US examples are not valid here. Just scaremongering

Any system can be improved or updated to deliver better outcomes - it is worth a serious evaluation of the NHS funding model

@StaunchMomma

Well seeing as though the Royal family is a net contributor at an estimated £1.7bn per year (Investment monitor) and the NHS is a massive drain at £181.7 bn , I'm not sure that's a good idea.

Have you noticed the same in countries in Europe?
No country is perfect but many countries have a better system than the UK.

I resent paying taxes to be told pfo by the NHS so I have to pay for my ADHD medication, my perimenopausal vagina and my anti herpes suppression. There's precisely nothing I get from the NHS except stress. So why am I paying for it?? My dad is on a years long waiting list for new knees - he's crippled. My mum has skin cancer and they won't see her until November. What am I paying for? Ex pats to come home and demand free care? Enough.

The nhs is post coded, which is wrong, national it is, it seems to largely focus on diabetes, cancer , epilepsy and dementia, when in reality nuro conditions don’t get much funding or new drugs.
Take MND, Parkinson’s ( which I have) MS to name a few.
Maternity and A &E also suffer, a consequence of under funding, prob bad management, it seems responsible to set limits of costs in certain areas.
Should ivf be funded, or un needed domestic surgery?
As it is, lots take more out than they put in, clearly not good money wise

I forgot to mention my husband with progressive kidney disease who can't get the best treatment for it so just has to wait for them to fail.

Absolutely fuck the NHS tbh. America is not the only alternative.

Can someone please explain to me the mechanism by which adding insurance companies into the mix leads to better care?

Surely it is just another layer of admin to suck up money that could be spent on care? Even if the insurance companies are state-run?

Genuine question as I always feel I am missing something here. I am inclined to think e.g. the german system is simply better because more money is put into it - but do the insurance companies have any role in that?

If we had an insurance based model you probably wouldn’t get the drugs NICE won’t approve anyway unless you were rich enough for gold-plated insurance. But there would be no fuss about it because it would be “your fault” for buying the wrong insurance product. Also health insurance isn’t cheap - just back from mainland Europe where our healthcare was £800/ month even with the kids’ package being heavily subsidised. You also get weird anomalies in an insurance-based system. The doctors are effectively free agents so some give you a tonne of antibiotics even if you don’t want them, others refused to ever give them even if you’re suffering with a nasty bacterial infection and ask if you’ve considered echinacea. The NHS provides a good “line in the sand” about what sensible healthcare is

No. My brother died in America because of the cost of healthcare.

You do understand that isn't the only option?

Private healthcare has always been available in the UK. It was part of the deal Bevan made to convince consultants to join the NHS. And it is why the agreed to NHS payscales - so they can make more money privately.

The NHS is a monopoly and medics - like most professionals value autonomy. Of course they should be able to be self-employed and provide their services to anyone who can afford it. In return, they provide their service at a subsidised rate to the taxpayer

European healthcare systems aren't perfect either, many are 2 tier depending on if your work pays top ups, they have similar issues with staff shortages in some countries too. American healthcare is a nightmare for all but the most affluent, I know 2 people who lost their homes and life savings because them in one case, and a dc in the other got cancer and they had to pay 10% of the bill! Australia has significant top ups, if you rely just on the state it isn't great and so on. Healthcare is expensive and just because a drug has been developed it doesn't mean it's worth using at a society level - 3 months extra life, 6 months slower deterioration etc has to be looked at whether that really is worth it for the quality of life and cost to us all. The same applies I should add to most American healthcare too, only the rich get everything!

We need a system similar to France or Germany.