Tax revenues don't work like that. A couple of years ago the institute of fiscal studies stated that about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%. The situation is only going to get worse and I don't see anyone on either side of the political divide coming up with any sustainable answers.If we were talking about a little institution costing only a few million - or even a few billion - a year, then I would agree wholeheartedly.
But the NHS budget for England for 2018 is I believe £122bn - a figure that pretty much everyone agrees is not enough, given the current demands, structures, levels of inefficiency etc. (We can debate what the fix is, either more money or greater efficiency, but that's a distraction: as it stands, £122bn is not enough.)
Even this sum equates to around £2,200 per person in England. So you average family of 4 is already paying nearly £10,000 per year, every year, for their healthcare. It's more money than some people pay for their home! Surely, at these astronomical levels already, we cannot simply just inexorably throw more and more money at it on the basis that it's a Good Thing?
Were we to fund it to the levels your post would imply (where tough choices about "can we afford to save this person's life?" don't come in to play) I cannot imagine how much that would cost, but I am sure it's not a marginal top up. Inevitably, and at all practical levels of funding, I think there will always be constraints and tough choices.
I've posted earlier that I don't know what the answer is, and that's true. But it seems to me that there's some "sacred cows" that we need to revisit. Is it right that everything the NHS does for us, has to be free? Perhaps we should be looking at a smaller core of free services and charges for more things? Perhaps we should even contemplate NHS cover not being free at all for people beyond certain income levels (like £150k / year perhaps). I know these sorts of things are contentious, but we cannot carry on as we are and some radical new thinking is needed I believe.
All good points.Are they really astronomical levels though? Compared to other countries? The UK puts in just over $3k per year per person. If you combine government funding and compulsory health insurance (which is effectively another tax, since it's compulsory) in other countries, you'll find that most of Western Europe is paying more than that. In France and Japan (2014), it's approaching $3.5k, and Belgium and Ireland are both around that too. Austria is in the high $3,000s. In Sweden, Germany, Denmark and the Netherlands, it's over $4k. The only difference is that a lot of these countries have an insurance company in the middle making profits, and none of them see significantly better results than the UK and all of them come below the UK in terms of efficiency of their health services. In terms of GDP percentage, the UK also doesn't spend as much as lots of other countries. We spend 9.7% of GDP on healthcare, compared to Austria, Denmark and Belgium (all 10.4%), Norway and the Netherlands (10.5%), Canada (10.6%), Japan (10.9%), France and Sweden (11%), Germany (11.4%) and Switzerland (12.4%). It's worth mention that the USA spends 17.2% of their GDP on healthcare, so government funding isn't everything, especially if it's being used to subsidize the profits of huge corporations.
In the Netherlands, you have to pay around €100 a month out of your salary for health insurance, but as you might imagine, poorer people get that subsidized. On top of that, you have to pay the first €385 per year of healthcare costs. The government just sets and enforces the rules, but everything else is privately run. And people who say that private companies run everything better would presumably argue that they do better, but is this the case? What do they get for their extra 33% funding? Is it 33% better services, or just a nice profit for the insurance companies? Every comparison I've ever read seems to put the UK as better in some areas and worse in others, but crucially, always better at the efficiency we're always told that only private businesses can offer (just like they have on the trains). Here's an unbiased comparison. It's quite amazing how well the NHS does when it's probably dealing with the most unhealthy population in Western Europe.
Tax revenues don't work like that. A couple of years ago the institute of fiscal studies stated that about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%.
Of course, but it's also evidence that current spending and moderate increases aren't unsustainable, and that the retirement and subsequent healthcare costs of the baby boomer generation aren't going to bankrupt the nation. Of course, this all assumes that the GDP doesn't tank after Brexit.All good points.
However, I am not sure that the argument that other countries spend even more necessarily justifies spending even more. Maybe the other countries are spending too much? One might certainly argue that the US is! The US' situation is a complete abortion with pockets being lined at every level and in every aspect of the industry. It's the very model of how NOT to do things if you want an efficient, fair healthcare system.
I don't share that conclusion. There's plenty of economies across Europe that are on the brink of bankruptcy.Of course, but it's also evidence that current spending and moderate increases aren't unsustainable, and that the retirement and subsequent healthcare costs of the baby boomer generation aren't going to bankrupt the nation. Of course, this all assumes that the GDP doesn't tank after Brexit.
What drastic changes do you suggest then? Personally, I think it's fairly simple. You increase taxes to meet the additional costs. But no-one will vote for that, least of all the baby boomers themselves. To be fair, the idea of a special NHS tax might be a goer in the sense that government might actually be able to raise that one without it being electoral suicide. But when people are alone in that voting booth, they might still vote against any tax increases on them personally.I don't share that conclusion. There's plenty of economies across Europe that are on the brink of bankruptcy.
Your throw-away line about baby boomers is very poignant though: unless some drastic changes are made, this problem is just going to get worse and worse and worse as the baby boomers reach retirement age and beyond. There are not enough young people around to continue to tax more in order to spend ever more on spiralling NHS costs.
What drastic changes do you suggest then? Personally, I think it's fairly simple. You increase taxes to meet the additional costs. But no-one will vote for that, least of all the baby boomers themselves. To be fair, the idea of a special NHS tax might be a goer in the sense that government might actually be able to raise that one without it being electoral suicide. But when people are alone in that voting booth, they might still vote against any tax increases on them personally.
Which economies are on the brink of bankruptcy? Any of the ones I mentioned?
What drastic changes do you suggest then? Personally, I think it's fairly simple. You increase taxes to meet the additional costs. But no-one will vote for that, least of all the baby boomers themselves. To be fair, the idea of a special NHS tax might be a goer in the sense that government might actually be able to raise that one without it being electoral suicide. But when people are alone in that voting booth, they might still vote against any tax increases on them personally.
What drastic changes do you suggest then? Personally, I think it's fairly simple. You increase taxes to meet the additional costs. But no-one will vote for that, least of all the baby boomers themselves. To be fair, the idea of a special NHS tax might be a goer in the sense that government might actually be able to raise that one without it being electoral suicide. But when people are alone in that voting booth, they might still vote against any tax increases on them personally.
Which economies are on the brink of bankruptcy? Any of the ones I mentioned?
But every time international comparisons are made, the NHS comes out as the most efficient. You're always going to be able to point to inefficiencies in a business. People are going to make mistakes. Things are going to be wasted. Obviously you do your best to stop it, but you have to accept that a certain amount of wastage is part of the costs of running a business.And the other thing is to find a way to further drive out waste and inefficiency. The NHS is brilliant at some things, but it's still riddled with inefficiency I think. And the reason for that I believe, is often a lack of fiscal accountability at the point of delivery. The person dropping off the oxygen bottle at the COPD sufferers home does not care that this is the 9th bottle in 2 weeks because the sufferer keeps leaving the valve open. It's a trite example I know, but it illustrates the point. Yes they have targets (and probably too many) but the goods and services NHS employees are dispensing are as far as they are concerned, limitless in quantity and free to dispense. When the reality is, it is far from free.
But by definition if you privatize parts of the NHS, it's going to be the profitable parts, unless you force them to do otherwise. It's like public transport. No-one is ever going to want to run a rural bus service, they're only going to want the routes in a big town or city.I know this is contentious but I do think there's scope for more privatisation and most importantly for doing privatisation better. If Spire can do hip replacements at less cost than the NHS can do them, then why not, provided the appropriate contractual terms are in place and the NHS as not just picking up all of the difficult and expensive work whilst the private companies cream it in. The reason Spire - for example - can do hip replacements more cost effectively is because they are accutely aware of the costs and the revenues. If the work needs doing twice because they cock it up, or the patient is in hospital too long because of some avoidable complication, then they are losing money. It focuses attention in a way I just don't think it is focused (enough) in the NHS.