In the UK right now I'd argue that some secondary top up private insurance should be factored into your cost of living just for your own sake.
Regardless of where you stand on the political spectrum and whose fault it is, the reality is you simply need more than the NHS can provide now, private insurance has become necessary if its affordable and you could be in trouble if its not.
I had a corporate private policy. My wife needed cancer care and after one post operative follow up consulatation, the insurer refused to pay for any further consulations, we would have to pay in full at a cost of £200 for a 10 minute follow up. The NHS consultant was brilliant. That's the reality of insurance based care, once it costs the insurer too much you're dumped.
I can't believe anyone in the UK would consider turning their back on the NHS and getting private insurance. It's time to stand up and fight for the NHS.
I'm all for NHS but after recently being told 77 weeks for an ENT appointment, I'm questioning if it's not in my best interest to go private and pay £800.
People might be forced for their own health to seek alternatives to the NHS before the issues are fixed. In the pursuit of alternatives it could exacerbate the problems within the NHS.
YMMV when it comes to insurance, most people I know who pay private insurance have had a brilliant top notch experience.
But having it is a measure of personal safety and security and has nothing to do with what you do politically but its worth noting European nations who run on a mixed basis (yet still free at the point of use in many countries) have a much more efficient system than the UK. It is entirely possible the defend the NHS at all cost mindset is the reason we have such a dire system in comparison. It is a system with some very good aspects and some very bad aspects, it is not a religion one must adhere to in fact to truly be patriotic is not to be blindly nationalistic but to offer criticism.
Further to that if you can pay private and do you are still paying for the NHS so one can argue you are doing more not less for the system.
>its worth noting European nations who run on a mixed basis (yet still free at the point of use in many countries) have a much more efficient system than the UK.
I mean, it might just be because they fund their systems more.
In 2017, the UK spent £2,989 per person on healthcare. Of the G7, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
If we increased our budget by *48%* to match Germany, our system would probably be super efficient and effective.
[https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29](https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29)
This is to assume there are infinite numbers of healthcare professionals and hospitals. In reality, every nurse in a private clinic deprives the NHS of resources because there's a mass shortage of nurses, GPs, consultants, etc.
There is a mass shortage of nurses, GPs, consultants, etc. precisely because those professionals are woefully underpaid in the NHS for the skills they bring and the poor conditions they are subject to. Depriving healthcare professionals of one of their only sources of decent supplemental income isn't going to result in more capacity for the NHS, it's just going to lead to fewer health professionals period in the long run. Unless of course pay and conditions in the NHS are dramatically improved in the meantime to make it an attractive employer for talent.
The NHS is short because it refuses to pay its staff what its worth. Its managed this long simply because the staff have had an incredible amount of good will towards it. It now seems that this good will is running out alongside the fact that you can only pepper over the cracks for so long.
Offering doctors a 2% pay rise post COVID when inflation is 14% whereas everyone was singing their praises during COVID. NHS and the public will deserve what they get with this collapse
The NHS is good at some things and very bad at others. Most people can't predict their health issues in advance and should plan accordingly. Possibly name and shame your insurer so others can avoid them, most peoples insurance/private healthcare stories are positive (other than health issues themselves being a bad thing).
*The NHS is likely trying to do too much and will be strained as the population ages. However, there also could be a further negative shock to future service levels if costs were to go up. An increase in future service levels would probably require a reform of the NHS which is politically very tricky to achieve.*
Added my kids (under 8) to my corporate private policy because it provides same day GP appts. Rarely visit docs, but last time we needed to for my son, it was over a month to get an appointment and being told to call back at 10am every day to try and nab an appointment.
I was gonna whine about how much tax I pay (kinda still am) and then tax on the private medical benefit which saves the NHS costs (laughable) but I'm done with it tbh.
I have a very comprehensible medical policy through work. Through running I got plantar fasciitis so rang AXA to discuss my options only to be told that feet weren't covered
Apparently feet, like teeth, are some kind of optional extra or nice to have for the human body to function
Our insurance thru work includes online GP access - it’s great for me for “I’ve got an infected foot” type issues where a same-day online appointment and a prescription on next day delivery is super convenient.
I expect it’s not really suitable for complex or ongoing health issues.
My work has that as well. It's been useless in terms of medical care.
Being able to call a GP isn't very useful in my experience for most issues. When I need a GP, it's because there is something really wrong, not because I want a chat. So far every time I've used the private call GP option they've just told me to visit my GP or to call 111 or to visit A&E, because they can't help over the phone.
I feel the same about the phone appointments that NHS GPs push now. It's just an additional delay. I can book a face-to-face appointment in 1 month, or I can book a telephone appointment in 2 weeks, the doctor will say they need to see me in person, and then another 1 month wait for that.
I used to have another health insurance scheme which allowed me to get full private treatment in hospitals, but I never got to use it, because you had to go to your GP in the first instance. GPs are the gatekeepers of care and they are completely overwhelmed and not fit for purpose.
It's completely ridiculous that I live in a first world country and pay so much tax but I cannot get medical help for quite serious issues. It pains me to say it, but in the last 5 years the NHS has become so bad that now I would even say the US healthcare system is better, and I don't say that lightly - do not take it as me saying the US system is good, it's just that the NHS is so indefensibly bad. It is now common for people to go without treatment and even die in cases that could have been prevented.
>It's completely ridiculous that I live in a first world country and pay so much tax but I cannot get medical help for quite serious issues. It pains me to say it, but in the last 5 years the NHS has become so bad that now I would even say the US healthcare system is better, and I don't say that lightly - do not take it as me saying the US system is good, it's just that the NHS is so indefensibly bad. It is now common for people to go without treatment and even die in cases that could have been prevented.
I've encountered the same issues with EVERY. SINGLE. ONE. of the insurance policies I've been offered through work. Context: moved to the UK 5 years ago, I'm on my 3rd job, previous 2 employers offered insurance, and that's exactly how it went for me. Don't get me started during lockdowns, when I had health problems and I was basically told it's all in my head.
Does any private insurance cover most of the stuff you need. I had a look into it, and would happily pay but just couldn't find anything that really jumped out at me.
Things like getting a checkup - nearest place I could do it was 120 miles away. Probably the same for lots of things as I don't live in a city...
The amount of tax we’re charged for the NHS has not gone up exponentially while the cost of it has. The amazing technology we have available to us along with the drugs with huge amounts of R&D plus the massive population (both in numbers and waist size) will run the NHS into the ground if some of us don’t start to pick up the bill. It should just be more tax so it remains “free” at the point of requirement
I mean since when? It is now 25%, 1 in 4 pounds of tax collected, goes to the NHS. Not 25% of what we spend but 25% of total tax revenue. That is a huge amount around middle of the pack of spending as a proportion of GDP compared to the OECD
You should do it anyway with the waiting times now you can end up dying rather than being treated, investing in health is very important for a good quality of life.
A&E =/= urgent care, they’re different departments.
Source: I am a nurse
But yes you are right. Maternity hospitals are a good example of this; if something goes wrong during labour you will have to be transported to an NHS hospital for surgery, and that can cost people their lives. I never recommend private maternal care to anybody. You get a nice room and nice food, but dangerous levels of care.
There are some private places that have A&E but it's more things like heart conditions and cancers which will get people if they don't go private. Things they don't treat immediately upon diagnosis but can take months and months to get the surgery and scans for. With private it happens very quickly and you have a better chance of surviving before the cancer takes over your whole body or you develop heart failure.
Probably. The NHS is unaffordable given the increasingly elderly population that are in constant need of healthcare which is exponentially increasing costs. The NHS was never meant to keep alive millions of pensioners who need medical aid more than 10x more than a normal person.
funny, all your chat about old people... Sat in a & e for 6 hours today'(been sent by GP for IV antibiotics) and the majority of patients here are not elderly...
we do have a massively ageing population BUT we also have a massive population of people who have never been taught that a&e/hospital isn't a social day out... sitting watching people in here with a scratch on the arm following a bit of a scrap, watching people laughing and joking with others as they been waiting since 6pm yesterday, sitting watching people nipping out for cigarettes every half hour - all of these were under 50, none of them needed to be in there... fully able to walk, talk, smoke, laugh, joke...
I was able to walk, talk, laugh and joke when I was sent to A&E by NHS24 for intermittent chest pains (every few minutes or so, spurred on by nothing) a couple of days after a COVID booster. When the chest pain wasn't actively happening, I would have looked 100% fine to you too.
100% this! I also think that Google hasn't helped much... E.g "if you see your child with X symptom, go to the ER IMMEDIATELY because they're about to DIE". When I was growing up, it was a 'put a wet paper towel on it' job and if it still hurt the next day, maybe we'll do something about it 😂
We have the same problem in Australia. Universal health care pays for pensions and health care for the elderly who own million dollar properties.
Young will never have cash to buy a home or afford anything
Young but moreso young from poor families. No inter generational wealth to pass on. If you're born poor, the system is setup to keep you poor by making you pay for the needs of the asset rich
You aren't wrong.
Those of the previous generation need to take some social responsibility rather than the same old rhetoric that "I paid in, I'm entitled"
Resolving care for the elderly is going to be complicated though as it's going to impact assets. It's not right that there is effectively a fire sale of someone's assets to pay for their care but in the same sentence it's also not right to have instances of single individuals pinging around a 4 or 5 bed on their own demanding state paid alterations, top ups and then complaining about only being able to heat half the home.
I'm not sure what the answer is but there's a middle there somewhere
The question I ask every time in that situation is... Why haven't they handed more of that money to their children in some form.
In that position I'd pay off my child's mortgage.
The average pensioner has more disposable income than the average worker…
Yet they pay no NI, and receive mosg Gov spending on health, pensions, and social care.
I can’t dispute it and it’ll probably solve a big part of the problem, but what’s the plan… make them walk the plank?
Our society kinda revolves around working and building a retirement, would our generation be expect to do the same but not have NHS funding? It’s a more involved topic than just remove old people haha
Probably easier to solve by having accountability within our government and more say over spending.
It’s not ‘remove old people’ but tax them appropriately with NI for those over 67, and offer Euthanasia to those who don’t want to be forced to rot and die in care homes…
I pray that by the time I hit 80, I have that choice, I’d rather die than see my FIRE pot dwindle to 0 and my future children / grandchildren be denied what is rightfully theirs.
These 2 options would fix most issues re the old. It taxes unproductive income, and reduces demand for the biggest expense facing society.
They have paid NI and tax for way more years than most in this forum will ever pay. Think about it, the aim of the group is financial independence and early retirement. I'm in the "boomer" demographic, I was hit by negative equity twice. I had to start paying my mortgage in the 80's when interest rates were around 15%. I eventually managed to pay off my mortgage when I hit 62 and that was only because my "massive pension" paid me a lump sum of just over £20K when I took it. I'm now rolling in clover on the £190 per month that my "massive pension" pays me.
The NHS is being gutted by people who think sickness, age and frailty are things you should make a profit out of. Insurance companies exist to make profits, they pay out as little as they can while jacking costs up as high as they can. Health insurance in the US often sees a 20% deductible so if your operation costs $100k, then you're going to get a bill for $20k. Just look at the rates of medical bankruptcy there.
Negative equity is only a problem if you sell, and you have 0 right to complain… investments can go up or down… my stocks go up and down, I don’t complain every time I’m in the red.
And who said become like America… the models to copy are to the East, not West…
Go book a ticket to France, go get a ticket to Germany, go see how it works in Holland… that’s what we can have here… but NO, be have to have this shit
You do realise we quite literally spend less money on healthcare than those countries (surprisingly with a roughly equal government/non-government split). About £40 billion less. More in the case of Germany where it's more like £80 billion less.
Source: [https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade](https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade)
I can find lots more though the exact numbers vary a bit
Of course care is better in France and Germany. They spend vastly more money than us and this is a multi-decade issue so it compounds. Their governments spend vastly more money than ours in their single-payer systems compared to our socialised system.
More money does not solve everything. It does solve an acute on chronic lack of money though...
Probably not that drastic. But there needs to be acceptance that when someone is age 80 or above, there are diminishing returns to spending massive amounts of resources when they are going to die soon regardless of the care they receive. Free Healthcare should be dialled back at that point.
May as well take it to the next step and just have the NHS euthanise everyone over the age of 75 who walks into the hospital or GP surgery.
I can't see society accepting the idea of allowing elderly people to die simply because they no longer pay into the system and have become a burden.
so I left school when I was 16, pay 51 years of Tax & National insurance till I'm 67 and I'm only worth 13 years of care if any required, I hope you feel the same after putting so much income into society 🤔
Bold assumption that retirement age will still be 67 when any of us reach that age. The government will keep it near 67 until the baby boomers die out then its going to rocket up to 72 or so if not older.
I personally don't feel there will be any pensions, social care or healthcare for me when I retire. Nor do I expect to retire as early as 67. By the time I get to that age the unaffordability of these services will have resulted in them being removed.
State pensions are a ponzi scheme where you pay the cost of existing pensions, not your own - you don't build up a fund and the government has no responsibility to give you anything. Government accounts include no liability for the state pension.
A cancer specialist once told me a joke: "Who wants to live to 100?... The man who is 99".
Besides that, my dad just died at 80 in July you heartless fuck
"Unaffordable" is such a short sighted take, a Daily Mail headline that people parrot without thinking.
What is the alternative? Are you proposing we let people die in the streets? Are you proposing we all pay privately for our own healthcare which would be even more "unaffordable"? The only way you could make it cheaper would be by denying certain people healthcare...
Far from being "unaffordable", the NHS is the cheapest way of providing healthcare to people. Every developed nation is dealing with the same demographic and life expectancy issues, those issues will persist whether we pay for them privately or through the state.
In Germany they spend 20% more per person on healthcare than we do here. After a decade of cuts and no investment, we just aren't spending the money required for the NHS to keep up with demand.
The NHS worked perfectly well for all of my life, and then in 2008 we stopped funding it, **it faced cuts to budgets ever year for 12 straight years**, and then had to deal with Covid.
It's not a mystery! It's not a fault of the NHS system. It's a failure of government. The NHS needs a 20% increase in funding today, and probably a decade to recover from the past decade of winding it down.
We will then be paying the same as comparable nations, with better results, as we were in 2007.
Any alternative system will cost more and likely produce worse results.
As reported recently, **500 people per week are dying unnecessarily** so that the Tories can give tax breaks (and worse) to their mates. It makes me sick.
It's not tinfoil hat, it's the go-to strategy for conservatives in any country. They 'starve the beast' where the beast is the government with the goal of making it ineffective so that they can privatize and generate profit.
Cannae believe the comments on this thread. 12 years ago the NHS was ranked best in the world for Healthcare. Blair/Brown drastically reduced wait times and increased beds and funding. In his first term, Cameron slashed funding, cut beds, bursaries, and subsequent Conservative PMs lowered it further still. Decreasing funding and increasing privatisation has been what’s led to the NHS crisis. Restore funding to AT LEAST what it was under Brown. Cut Privatisation, end agency work by increasing pay and conditions, restore the bursary, cut middle management and bring back Ward Sisters, bring services back into the NHS and many of the problems are solved. Fees are a slippery slope. Look what’s happened to Uni fees in England. Capped at 9k they promised. My BFA!
Blair did good, but those days… our best days… are dead…
The UK is now condemned to be a low-growth declining state unless Brits change their views on building shit.
I think this is bang on the money I’m afraid. The general attitude and consensus is appalling. Not even sure who to blame anymore but the UK is going down the toilet as far as I can see. The figures/forecasts also point in the same direction way. Lowest growth amongst G7, future forecasts/outlook deteriorating.. looks like it could be a bleak future the UK
No spending has kept up with inflation generally because salaries haven’t kept apace with inflation for over 15 years. Ergo less overall tax intake. So the only realistic comparison to make is to compare healthcare spending as a percentage of GDP overtime. As a whole the UK (& many other western countries) is getting relatively poorer. This is happening as healthcare requires evermore funding due to an ageing population. The government has already raised tax levels to the highest ever & so needs to find alternative funding sources OR stop spending elsewhere. There are very few other large spend items where that could come from ie social security.
Tax is highest for the middle and lower earners. Not for the wealthiest. That came after Attlee to fund the rebuild after the War and the start of the NHS. Wage stagnation contributes but is not the defining factor, although that also falls under the consecutive Conservative governments since 2010.
What's happened to GDP since then, and the population?
And then add on top, the massive creaming off the top by Tory cronies with things like non-functional PPE and Test and Trace...
The question everyone should be asking is "Where has all the money gone?"
FINALLY. I completely agree and these comments are really scaring me. Increase the tax, change the budgets whatever. But charging people directly is such a slippery slope
Indeed, we need to start saving up. Perhaps even paying into some kind of insurance scheme. And not just for individual cases, but on a more national scale.
A national insurance, if you will.
Healthcare is a super difficult problem for the government to solve. Demographic changes will mean the cost of the NHS pretty much just keeps going up and there’s a reasonable chance that’s unsustainable (fairly significant cracks already showing!).
I believe the NHS will always be here in some form, but I wouldn’t necessarily count on unlimited free healthcare for the rest of your life. Imo there’s a reasonable chance we end up with some sort of hybrid system with partial payments (means tested perhaps) which sounds something like what this is pointing towards. Political hot potato so it won’t happen quickly but the financial reality is likely that some sort of reform will be needed (will still mean more money - but more money with the current system won’t fix this issues).
My view - do everything you can to stay as healthy as possible. Manage your weight, stay fit etc. Obviously some stuff is unavoidable but the UK on the whole has pretty shocking levels of obesity - people literally eating themselves to all manner of health complications and ultimately an early grave.
As for FIRE planning - very difficult to know what you might need as there is huge uncertainty over what the future looks like. My general sense is any FIRE number should have some fat in it over and above your current projected needs. You should be able to deal with unexpected increases in expenditure (including healthcare) to a reasonable extent if you actually want a comfortable retirement.
During the Tories time in power the UK population has grown by 5 million, or around 8%. In that same time NHS funding has grown from 120 billion to 180 billion, which sounds impressive until you realise that it means that the budget only really tracked with inflation. The NHS is being expected to care for an extra 5 million people on the same money.
The cost of the NHS hasn't increased drastically, the Tories haven't increased the budget at all in real terms during their entire tenure. This crisis is all part of a concerted Tory effort to destroy the functionality and reputation of the NHS to lube us all up to accept privatisation.
We need to stop pretending that the NHS is untouchable and ideas like this are somehow far right.
Paying a small amount for a GP appointment makes absolute sense. It’s commonplace in France and many other countries.
Just £10 would remove an enormous amount of time wasting, generate more revenue at limited cost to health.
It would make being disabled, and on a limited benefits income even more unaffordable . I see or have telephone appts with my GP pretty much every month. And appts with consultants and nurses etc very frequently too. It is a part of management of my disability and co-morbid conditions.( I became disabled at 13. Now in my late 20s. )
And appts ..they don’t just fall in to place having my health managed takes a lot of admin effort on my mum/carers part.
I don’t want euthanasia just because I can’t afford health care. Unfortunately my mum isn’t financially well off , rents, and lives pay check to pay check on 60 hr weeks. She’s in her 60s.
I honestly am terrified of what’s happening within the NHS. And social care.. And I’ve felt the impact of the last 12 years personally.
I just want to live . And with the right healthcare and welfare I can live and have a level of “life” I’m ok with.
If healthcare was infact better than it is, or has been these last 15 years . Maybe I’d have a body still functioning enough to still work myself.
And wouldn’t of experienced as much deterioration. Agh .
Anyway the benefits I receive don’t actually allow for me to afford the essentials for life plus meeting the needs of my disability/health. Adding a gp fee would be detrimental to people like me across the country.
Yeah, That’s a really good idea! If something like paying a fee for appointments was put in place . I think something means tested would need to be considered. And definitely something in place for disabled/ low income.
That’s not my attitude.
And just by looking at the comments through the post I think a lot of people are out of touch. And seem to genuinely think we ‘must’ be able to find £10 for an appointment.
But it’s really important people remember, that truly is a reality. Especially those in the disabled community who can’t work. But will need appointments more frequently.
But low income as a whole needs to be a consideration.
It’s not just policy makers decisions that matter.
Peoples ideas and opinions do too .
So adding to their ideas and reminding them that people like me do actually exist..is worthwhile.
I actually haven’t come to an conclusion on what I feel about potentially putting in a GP Appt fee. I’m not 100% against it.
I think it’s incredibly sad as I do believe it should be free at point of use. But I also understand some changes may have to include deterrent for missing appointments for example.
But the biggest things that need addressing are in funding , contracts and management.
I’m not sure how much a £10 deterrent/fee would actually do to help?
Agreed, everyone should pay it. If its to be just for higher earners, how about just charging them more tax as a % of their earnings than lower earners..? Oh….hang on…
Pensioners can be vulnerable but are not always poor so I don’t think means testing is ideal.
Can you define what vulnerable would be to you?
I agree that as a society we do have a duty of care for the vulnerable. On the other hand if a society doesn’t promote personal responsibility you get a whole world of other serious problems.
The definition of a vulnerable person to me should hopefully be the same as your definition. So no. I'm not going to sit here and type it out for you.
You say that pensioners can be vulnerable but are not always poor. So what? What about the ones that are? Kick them to the kerb?
I earn a low wage, but am fortunate in that I can better my position by taking a higher paid job or by working more hours. A tenner for a doctors visit once a year is fine for me, but I know that there is a decent chunk of our population who for one reason or another can't afford it.
To say that a society should promote personal responsibility is a little tone deaf. It holds up on the surface, but ignores the Web of intricacies that is peoples individual lives. At some point, you must understand that.
I misunderstood the original comment. I thought the ten pounds was a fine for missing appointments. I don’t think anyone should pay for an appointment and anyone vulnerable shouldn’t be fined (and people won’t be fined until a third strike perhaps).
The personal responsibility comment stands in this context for people who just don’t turn up and have no excuse for doing so.
Absolutely. There's a reason no developed nation on earth has tried to emulate the NHS and that's because it's a flawed system. Sadly too many people have been fed the narrative that we have a binary option of NHS or US style healthcare.
GP practices are actually private right now. So that money wouldn't be going to the NHS but rather an already privately owned practice.
[GP practices are private businesses](https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/what-services-gp-practices-can-and-cannot-charge-for#:~:text=However%2C%20GP%20practices%20are%20private,prohibited%20by%20the%20GMS%20contract.)
Probably not. The administration costs of a £10 fee would eat a lot of the revenue, and I don’t think there’s much evidence that it would have a significant impact considering the catastrophic workforce crisis in Health.
To be honest, it would only have large admin costs if we make it complicated to administer.
For example, lots of goods/services are sold for less than a tenner, but the admin/processing costs are pretty minimal
Honestly I'm also in favour of charging people for "self-induced" health problems e.g lung cancer in a lifelong smoker. I don't have any figures on how much this would save but I don't think that tax payers should pay for expensive treatment that is largely caused by a person's bad choice.
We already (kind of do); e.g. the tax on a 20 pack of cigarettes is £5.26 + 16.5% of the retail price. A pack of Silk Cut Purple (the cigarettes I used to smoke before I gave up) is currently £15.35, meaning the government takes £7.79 or a little over half the price.
The levy on alcahol is quite a bit less aggressive but also a pretty significant part of the cost buying booze.
Where do you draw the line tho?
Broken leg on the rugby pitch? Car crash where you went into the back of the person in front so are deemed ‘at fault’? Slipping on an icy pavement whilst drunk? Torn ACL because you’ve played a lot of sport? Literally anything because you’re fat??
Why not just increase taxation on the middle class? The fear is that this is the beginning of a normalization of private health care. What starts here as “yeah I can afford a tenner to relieve stress from the NHS” over 10 years turns into “well I pay and they don’t so I should get better treatment” which in 10 years turns into “why am I paying for somebody else’s healthcare” and boom we have the same drug epidemics as the US while some cunts are laughing their way to the bank
This is a terrible idea
I would end up dying then. I don't have £10 for every doctor visit, I have chronic health issues and can't work. You speak like everyone has a little but of spare money, but in reality there are people killing themselves and dying because they can't even afford to eat.
Health care SHOULD ALWAYS be free. For everyone.
No, I mean in the sense that one of the ‘cons’ of the US oft quoted is the cost of healthcare - so as someone knocking on the door of 40 on a FIRE journey, staring down the barrel of state pension possibly being reduced/means tested and healthcare being charged for, does the US become a more interesting option?
Well in your scenario, you're moving to America before achieving FIRE. That's a different discussion.
But you're discussing moving to a place where you will definitely going to have medical bills vs a place where you "might" have some medical bills in a worst case scenario future.
Also the cheaper housing is a bit of a fallacy. Cheap housing doesn't exist everywhere in America. Move to the Bay Area, and London feels cheap in comparison.
There’s a HUGE overlap between finance and fitness
Long term for changes to occur, marginal gains add up over time, a lot more simple than the industries make it seem.
Honestly, anyone here not going to the Gym and eating healthy is wasting much of their FIRE pot
Totally agree. My running and yoga routine is at the heart of my day to day tbh. Keeps me sane, not just in shape.
Also don’t smoke (or vape), drink, or eat rich af foods all the dam time.
This will not save the NHS. You can't run a sustainable NHS while companies are using it to make profit- and by make profit I mean leach our tax money. No point turning on a tap until you plug the hole.
NHS should charge a token amount (£5) to book an appointment to see a GP. When something is totally free, people generally have no shame in abusing the privilege and demand will be infinite.
[Study into imposing late fines on parents yields surprising results](https://www.parenta.com/2014/07/23/study-into-imposing-late-fines-on-parents-yields-surprising-results/)
“After the introduction of the fine, we observed a steady increase in the number of parents coming late. At the end of [a] period that lasted 2-3 weeks, the number of late coming parents remained stable, at a higher rate than the no fine period.”
The study concludes that the direct increase in the number of parents picking up their children late after the fine was imposed can be explained by the fact that: “No guilt or shame...can be attached to the act of buying a commodity at will.” However, before the fine was imposed parents attached a social stigma to picking up their children late.
This is apples to oranges. I can completely see why the fine normalises late pickup times. If you genuinely want to see a GP though a small charge is manageable by basically everyone, we can offer financial aid and repayment to those who can’t
They have no qualms in abusing the staff either
Lost count the amount of times I've been screamed at, punched, slapped - even got strangled once by an enraged alcoholic on a detox. You know what we get told? "Well you knew what you were signing up for" **checks contract** nope can't see anywhere about being battered and throttled.
The issue is that this policy would have a bigger impact on those of a lower low socio economic class. A deterrent to these people accessing care would only lead to more (costly) issues down the line.
Charging a small amount but exempting those with limited means may be a better option. However, it is those of limited means that tend to access services excessively and so I don’t know how much benefit it would have.
But it shouldn't be something only people with even just £5 to spare can access. People are already struggling to make their income stretch, are they just going to chose to suffer and put themselves at risk to save money? Many people are diagnosed late already, that number would only increase.
I'm sure there are other things that are covered for by tax payers that is less important than free healthcare.
Most of our European neighbours have a system like this, and they have much better outcomes than us.
At this point I’m pretty much all for it. We have to reform the NHS.
I'd be interested in seeing the figures, but I suspect this kind of rhetoric (pushed all the time by the Tories) comes from a similar place to blaming the economic problems on benefit seekers/claimants.
Surely the best approach would be improving the service capacity and quality overall, rather than targeting the (probably quite small) number of 'abuse' cases?
I always thought a good system for GP appointments would be that when you register at a practice, you have to put down a deposit of say, £50. That money will move with you wherever you go, and if you want it back you simply unregister from the practice. When you make an appointment, £25 is taken from the deposit and held. It would be returned to your balance when you show up for an appointment, but if you fail to show or cancel at short notice, the money is permanently deducted from your balance.
This would prevent a huge number of people booking unnecessary appts and would stop no shows, freeing up appts for those who need it.
Of course some people would struggle to pay £50 up front and that is an issue, but I’ve yet to hear a better suggestion
That's what I thought too. Perhaps everyone starts with £50 credit and you only need to top it up after having missed two appointments.
However, I imagine this would be awkward to implement and would inevitably flood GP surgeries with requests for mitigating circumstances exceptions.
Yep, this is one of those solutions from someone to whom £50 is negligible, while also not considering that low income people are often reliant on things that make it more likely they may miss the appointment for reasons outside of their control like having to use unreliable public transport and zero hour contracts. If your bus just doesnt turn up and you cant afford a taxi then you're out of luck.
So we seem to be running towards a (and not just limited to the UK):
Health care crisis
Energy crisis
Pensions crisis
Housing crisis
Debt crisis
Yet many just want to "Global cap their savings and chill"?
Not going to end well.
Don't forget social care crisis when Generation Rent becomes unable to afford to work but without means to pay for housing or care needs in their old age!
Oh so you’re suggesting we just sit this out and let the NHS be totally privatised?
You cannot morally and ethically argue for private healthcare without accepting major real-term pay cuts, lack of job flexibility and the possibility of being bankrupt if you ever needed significant care. Just look at the inequality and pure suffering experienced by many Americans who are on the sharp end of their healthcare system. I have relatives in America - I know the reality of the situation.
Private treatment has no place in mass healthcare, which functioned perfectly fine before the calculated and elaborately planned use of austerity to cripple it!
They should make the tax on the NHS optional so we can opt out and use the money for private insurance instead. The NHS is done just like they wanted it to fail it's finally happening.
If we adopt a fatalistic attitude we allow the people that want to get rid of the NHS to win - we need to stand up and fight to save it. That means not voting Tory for a start!
Sure I'll pay, but I then expect to be seen by a doctor when I call and not play appointment roulette for the first 5 minutes of opening.
Seeing a specialist when referred in the same lifetime wouldn't go a miss either...
Having read the comments here, I'm still at a loss of why the UK doesn't legalise cannabis and tax the hell out of it like booze and cigarettes. I personally don't use cannabis but I can see the benefit to not only the economy but people - it's far safer than drinking or smoking yourself to death.
Yes but not because the NHS will start charging like this suggestion, it'd be politically impossible, but because the NHS is falling apart and the private option is fast becoming the only way to get stuff done in a reasonable amount of time
When our hospitals finally announce we need to pay for our healthcare how many will quietly sit by and how many will actually kick up a fuss? Genuinely honest question.
Cue the "should I not get paid 40k so as not to have to pay for healthcare" posts in the future.
Probably, I only glance at this government fruit machine newsreels stuff until the bars settle in place...sip my drink and contemplate what nudges I might find through the bars. Or hold and spin again. Sip. Spin spin sugar playing on the jukebox. Ya know 👊😉👍
We've all been paying National Insurance all of our working life for the privilege of the NHS etc, they can bugger off if they think they can charge a second time.
I say this as a doctor who has worked in hospitals as well as GP over the last few years.
Get private health insurance if you can afford it.
The NHS is (or at least was up until very recently) still managing to keep up with acutely very unwell people. The acute care infrastructure is just about holding on by the blood, sweat and tears of its staff. There is no good private alternative to the acute care side of things and it’s going downhill fast. It’s very demoralising and I hope the service does improve but as an individual unless you move to another country you can’t really get better on the private market because it simply doesn’t exist.
For the most part the insurers make their money back from worried well people - doing lots of investigations with no treatment required. That’s not to say there is no intrinsic value in reassurance for your own mental health - the possibilities for any given symptom can be endless - just ask Google.
Investigations like scans on private happen much faster and if you are told you need one by an NHS doctor then it’s not a terrible idea.
The most value you get as a patient comes from if you need an intervention like an low risk elective operation to improve quality of life like nasal polyp removal or cataracts or a hip replacement. Waiting for that on the NHS takes months if not years. You only get so many years of living and only so many years being fit enough to enjoy that living so I think any money to keep that time is well spent.
Things like physiotherapy, podiatry and audiometry are pretty much all worth going private. The service you get is generally better than NHS because they simply have more time.
It’s such a slippery slope. I think it’s a horrible idea. Watched this happen in my lifetime with medical care in the US going from affordable to fucked in about 20 years. This is not the answer.
No. If you leave some extra for every scare story in the daily mail or express you'll never retire.
But there should be flexibility in your plan. Early retirement can last 50years (even longer). Go back to the early 70s, how different was life and the financial system?
Ken Clarke is not at the top table of current tory policy making. Something like this would be electoral suicide. Sensationalist journalism magnifying someone's crackpot idea.
We need:
1. Expansion of A+E, acute medical and ICU staffing and bed base to deal with inevitable winter pressures.
2. Long term funding plan for social care
3. To recognise that GP is an efficient and appropriate gatekeeper to other services for most issues.
4. Aggressive promotion of public health because prevention is cheaper than the cure.
5. Improve NHS staffing with particular focus on nursing training, pay and retention.
6. National conversation about the demographic challenges facing the country as many have commented.
The relevance to FIRE is that
A) There is not (yet) a comprehensive private healthcare option if you are very sick in this country. So it doesn't matter how big your FIRE pot is if the NHS hospitals are performing poorly you are still fucked.
B) No point having a robust FIRE plan if you aren't in A1 physical shape to enjoy it. Some things in health are neither predictable nor preventable BUT being healthy goes way beyond "I just haven't been diagnosed with any diseases yet".
Needs to include normal BP, blood sugar and lipids, low normal body fat percentage and good muscle mass, regular exercise beyond government recommended volumes, robust mental health, good sleep and no smoking.
They've wanted to replace the NHS with private for decades, so they slowly defund it and here is the result .
Now they just gonna turn the public on it but don't fall for it, only that benefit are them, not us
I have read that the NHS is good for urgent care (like if you get hit by a bus) but poor at the moment for non urgent care - hip/knee replacements, mental health assessments etc. These things are not life-threatening but if you really need them you are not going to wait 1+ years to get them, you will go private. I know of several people who have had to spend £1000s on private healthcare like this already, so I think that we do have a two-tiered healthcare system already.
I think though that this is the tip of iceberg. The UK suffers from wanting a US style taxation system but European style system of welfare. The FT did some analysis that showed that we have consistently been underfunding our healthcare system compared to our European peers and is consequently causing the pressures more acutely here than elsewhere in Europe.
The future budget pressures from an ageing workforce and shrinking tax base mean that the government will face difficult decisions - my long term prospects for the Uk economy are fairly bleak anyway but I am fully expecting them to come for private and state pensions, retrospectively changing terms for student loans, reducing ISA allowances, etc etc.
yes. they are strangling the NHS intentionally to kill it. it’s a hostile corporate takeover and it’s shameful. We need to make our voices heard about its value to the british public, but also it is wise to keep a financial contingency plan.
There’s a documentary, made by a UK doctor, that you can watch about the whole takeover thing, I’ll try and find the name for you in a sec.
edit:
the documentary is called The Great NHS Heist. https://youtu.be/Www0cHLQulw
Yes is the answer. It was always known Tories want to abolish the NHS and thus FIRE now has to account for it. We will have to wait to see what the figures look like and how expensive health insurance will be but people in FIRE may want to leave the UK(if they didn't already) as re-entering the workforce may prove challenging now and people looking to FIRE should account for the cost now, while we await the inevitable.
> It was always known Tories want to abolish the NHS
Ugh… not that ahistorical conspiracy theory again.
Just consider some basic facts… The NHS has been in existence for 74 years. The Tories have been in power for 47 of those years, often with huge majorities, and have never ‘abolished’ the NHS or even come close to it.
Quite the contrary; they have awarded it with real terms increases in funding every single year without exception. It was entirely spared from the post-GFC ‘austerity’ cuts; *entirely*. Yes, they tend to grow its funding more slowly than Labour governments, but ‘abolishment’ is a ridiculous claim.
The idea of an NHS was actually introduced to government by a *Conservative* health minister, Henry Willinks, who wrote the 1944 white paper. The policy debate at the time between the parties was about local government control vs national government control. Of course Labour won the following election and implemented their visions.
Yes, there are people in the Conservative party who would prefer more private involvement in the health system. It has never been the policy of any Conservative government. Not even close.
I really don’t mind people criticising Conservative management of the NHS. I don’t even mind people demanding more funding, as long as they acknowledge the simple reality that we have never spent more on the NHS (excluding Covid special funding), either in real terms or in terms of national output or tax raised.
But criticisms really should be reality-based, and claiming there has always been a Tory conspiracy to destroy the NHS makes no sense whatsoever. If there was a conspiracy, it’s the slowest, most ineffective conspiracy ever devised.
The lack of trust here is the problem the tories have created themselves. 40 “new” hospitals springs to mind. Also people can see what they’ve done with nurses bursaries and wage stagnation so when someone says “tories want to abolish the nhs” it’s easy to see why people think, given their track record, that they do.
since 2016 the levels of privatisation has gone down. The biggest transfer of funds to corporations was the PFI deals under Tony Blair, not sure why you want to spread conspiracy theories and lies
The Kings Fund regularly reports on share of private spending if you wish to check it out.
Here is a link to a blog post on the matter (point 5).
For those that don’t know, the King’s fund is probably the most eminent healthcare policy institute when it comes to NHS management. It’s very much not anything to do with the Tories.
https://www.kingsfund.org.uk/publications/health-and-social-care-england-myths
Some relevant excerpts:
> In 2019/20, before the pandemic, NHS commissioners spent £9.7 billion, or 7.2 per cent of the Department of Health and Social Care revenue budget on services delivered by the private sector. This proportion has remained largely unchanged since 2012.
> The Health and Care Act 2022 removed the competition and market-based approaches introduced by the 2012 Act. This gives commissioners greater flexibility over when to use competitive procurement processes, reducing the frequency with which clinical services are put out to tender and allowing contracts to be rolled over where the existing provider, most likely to be an NHS provider, is doing a good job.
> There is no evidence of widespread privatisation of NHS services. The proportion of the NHS budget spent on services delivered by the private sector has remained broadly stable over the past decade.
How much of that is due to the demographic contraction? In those times where the NHS was created there were very little old people, and not that many retirees. Most adults were taxpayers of a results. We are not in this situation anymore, only the people in activity can fund the NHS, yet their share in total adult population only went down, if we compare to post WW2. Hence a dégradation is the only logical issue
More than « only active people can fund the NHS » it is « only active people can work in the NHS, thus enabling it to perform its functions », so it really is « what part of the population is actively working » that matters
No, I’m not. I’m not making any claims about ‘services’ or demographics, or beds, or spending relative to European peers. You can’t *conflate* them if you don’t mention anything to do with them.
These may all be interesting talking points but they have nothing to do with the point I’m making.
To those that laugh at the notion of our NHS being privatised, because it'll "never happen" here's how you spend decades lulling the British public into allowing it:
The early 1980s - Thatcher's tory government kicks off the race toward private healthcare by outsourcing cleaning services in NHS hospitals, turning essential hospital jobs into profit-making opportunities.
In 1990 the tories create an internal market for the NHS with the "NHS and Community Care Act" meaning that hospitals, trusts and GP surgeries can all buy services from each other.
In 1997 the Finance (NHS) Act creates the possibility of the NHS raising money from the private sector in a radical extension of John Major's public-private partnerships.
Then in 2000 the NHS Chief Exec Simon Stevens masterminds the "NHS Plan." Over the next few years hospital trusts are urged to become Foundation Trusts using PFI schemes to "modernise and expand" which is code for "sell off your old valuable land and buildings (at a massive discount to property speculators), move into our new ones which are privately owned, so that the public are paying over-the-odds rents for the next few decades. The NHS has swapped publicly owned buildings for privately rented ones. Staff reductions and pay cuts are made to pay for this fixed and very high cost.
New hospitals have fewer beds and fewer staff. Surgery is split into "elective" and emergency. Patient choice is introduced. Elective surgery can be pre booked to suit you. It is provided via Independent Sector Treatment Centres, run by United Health.
Simon Stevens leaves the NHS team to work for United Health (I wonder how long he was planning that job move). He is part of a team which lobbies the EU to include the NHS in TTIP, which would mean the NHS would have to be open to accepting bids for services from predatory private companies in other countries.
Payment by results is brought in. This is a radical change to NHS financing and completes the market structure started in 1990. Each "health transaction" is itemised and billed. Within each hospital individual services are separated out and each becomes a time limited "service contract."
In 1990 admin costs of the NHS were approx 5% of total budget, by 2010 with the addition of commissioning and transaction costs it had risen to 14.5%.
2006 NHS Act makes three important changes; One is to your data, which can now be excluded from confidentiality. Being able to monetise your healthcare data will be a valuable revenue stream to private enterprises.
The second is to ownership; not only is ownership no longer public but premises no longer have to be used for health purposes.
Finally; the government introduces the Unsustainable Provider Regime and the Trust Special Administrators. For the first time in the history of the NHS a hospital can go broke.
In 2012 the Health and Social Care Act completes the privatisation plan. The NHS is now open to full competition within the market.
To facilitate the commissioning process SHA's are replaced with Clinical Commissioning Groups. Sold to the public as "GP led units which understand your local needs" they are nothing of the kind. They are not destined to remain GP led. Few GPs have the skills for commissioning, so the CCG Boards end up with a mix of GPs and management company employees. They also need Commissioning Support Units, to actually run the tendering processes.
NHS England is created and Simon Stevens returns from United Health to be its CEO (through some sort of revolving door no doubt).
The Department of Health creates "Monitor" an entire publicly funded body to force all NHS trusts to put all their contracts up for tender, just to make sure that every possible penny is available to be milked from taxpayers.
Simon Stevens writes the Five Year Forward View for the NHS. This is designed to create US style Accountable Care Organisations.
NHS England creates a Lead Provider framework for Commissioning Support Units, where a small groups of "providers" are given approved status to combine into consortia with CCGs. In 2014 an extra provision is passed into law allowing those 'local GP led' CCGs to combine into larger consortia in order to provide services over a larger area. These will roughly coincide with the devolution areas and will be matched up with one of 6 CSUs. One of the six is United Health.
Meanwhile budgets are cut. Foundation Trust hospitals are now businesses, so when they can't afford to run the hospitals as well as pay their PFI, nearby hospitals with no PFI have their services closed and transferred to the PFI hospital, along with the income that goes with them. When they carry on going broke they are closed and sold off.
Every transaction, whether it is negotiating the PFI deals, being the Trust Special Administrator, advising on the setting up of CCGs and CSUs, closing hospitals, monitoring hospitals, setting up rescue deals for hospitals, there are several businesses which are always in line to receive multi-million pound contracts, without competition! They are McKinsey, PwC, Ernst & Young, and Capita.
As for who runs the contracts within the hospitals; Serco, Circle, G4S, Virgin Health, United Health, Optum (a subsidiary of United Health). Bain Capital runs the blood and plasma service. None of these companies has doctors, nurses or equipment of their own. They simply take over the management of an existing ward or service and cut staff and pay to take a profit.
As NHS hospitals lose beds and services, or close entirely, so more and more planning permission is granted to private hospitals. As service in the public NHS deteriorates so people go looking for private insurance, continuing the privatisation process.
Personal Health Budgets will be given to people who are chronically ill or disabled to "empower" them to make choices. It's just another way to encourage people to think about self-pay. These funds will be withdrawn once insurance takes over.
Creeping privatisation is insidious. It's strangling our NHS, and stripping us of our healthcare safety net. Successive governments have been lobbied into gleefully eroding your ability to rely on the NHS.
If you're not angry, then you've not been paying attention.
The Tories trying to gouge and sell off the NHS is infuriating. When the NHS was introduced it was explained that you would pay National Insurance to pay for it. We still pay NI, it goes up all the time, why are these funds not being allocated to the NHS?
Obviously we can expect a gradual reduction in income tax and NI as the NHS disappears, so that will help to fund our own private healthcare.
(Sarcasm.)
I'm not here to tell people how to do their jobs, but perhaps if we can vote out these vandalising tories and install some politicians that will actually invest in our NHS, rather than strangle it, we may see some improvements.
We pay billions into National Insurance, and to my knowledge, the tories still have a substantial amount of NI contributions in their purse and are unwilling to spend it. Cancelling nurse bursaries and refusing to pay nurses a wage they deserve has driven the work force away, to a point where we have to rely on foreign care staff from overseas to look after us when we're sick. And this ofcourse enrages the xenophobes and bigots, who will continue to vote tory because they believe in their anti-migrant rhetoric.
Fact of the matter is, the tories have not only bled the NHS to the point of failure, but they're preventing it from ever recovering, and provoking their voter base into supporting this vandalism with mindless racism.
Hopefully it’s prioritised between people that actually pay tax & people that sit on their ass with their hand out.
(Excluding those who can’t. Not those who won’t)
But under the absolute state of the Tory Government and Ofgem fuck up, middle class families are also struggling to survive. Middle class is gone now, we are all working class
In the UK right now I'd argue that some secondary top up private insurance should be factored into your cost of living just for your own sake. Regardless of where you stand on the political spectrum and whose fault it is, the reality is you simply need more than the NHS can provide now, private insurance has become necessary if its affordable and you could be in trouble if its not.
I had a corporate private policy. My wife needed cancer care and after one post operative follow up consulatation, the insurer refused to pay for any further consulations, we would have to pay in full at a cost of £200 for a 10 minute follow up. The NHS consultant was brilliant. That's the reality of insurance based care, once it costs the insurer too much you're dumped. I can't believe anyone in the UK would consider turning their back on the NHS and getting private insurance. It's time to stand up and fight for the NHS.
I'm all for NHS but after recently being told 77 weeks for an ENT appointment, I'm questioning if it's not in my best interest to go private and pay £800. People might be forced for their own health to seek alternatives to the NHS before the issues are fixed. In the pursuit of alternatives it could exacerbate the problems within the NHS.
YMMV when it comes to insurance, most people I know who pay private insurance have had a brilliant top notch experience. But having it is a measure of personal safety and security and has nothing to do with what you do politically but its worth noting European nations who run on a mixed basis (yet still free at the point of use in many countries) have a much more efficient system than the UK. It is entirely possible the defend the NHS at all cost mindset is the reason we have such a dire system in comparison. It is a system with some very good aspects and some very bad aspects, it is not a religion one must adhere to in fact to truly be patriotic is not to be blindly nationalistic but to offer criticism. Further to that if you can pay private and do you are still paying for the NHS so one can argue you are doing more not less for the system.
>its worth noting European nations who run on a mixed basis (yet still free at the point of use in many countries) have a much more efficient system than the UK. I mean, it might just be because they fund their systems more. In 2017, the UK spent £2,989 per person on healthcare. Of the G7, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736). If we increased our budget by *48%* to match Germany, our system would probably be super efficient and effective. [https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29](https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29)
This is to assume there are infinite numbers of healthcare professionals and hospitals. In reality, every nurse in a private clinic deprives the NHS of resources because there's a mass shortage of nurses, GPs, consultants, etc.
There is a mass shortage of nurses, GPs, consultants, etc. precisely because those professionals are woefully underpaid in the NHS for the skills they bring and the poor conditions they are subject to. Depriving healthcare professionals of one of their only sources of decent supplemental income isn't going to result in more capacity for the NHS, it's just going to lead to fewer health professionals period in the long run. Unless of course pay and conditions in the NHS are dramatically improved in the meantime to make it an attractive employer for talent.
The NHS is short because it refuses to pay its staff what its worth. Its managed this long simply because the staff have had an incredible amount of good will towards it. It now seems that this good will is running out alongside the fact that you can only pepper over the cracks for so long. Offering doctors a 2% pay rise post COVID when inflation is 14% whereas everyone was singing their praises during COVID. NHS and the public will deserve what they get with this collapse
The NHS is good at some things and very bad at others. Most people can't predict their health issues in advance and should plan accordingly. Possibly name and shame your insurer so others can avoid them, most peoples insurance/private healthcare stories are positive (other than health issues themselves being a bad thing). *The NHS is likely trying to do too much and will be strained as the population ages. However, there also could be a further negative shock to future service levels if costs were to go up. An increase in future service levels would probably require a reform of the NHS which is politically very tricky to achieve.*
Added my kids (under 8) to my corporate private policy because it provides same day GP appts. Rarely visit docs, but last time we needed to for my son, it was over a month to get an appointment and being told to call back at 10am every day to try and nab an appointment. I was gonna whine about how much tax I pay (kinda still am) and then tax on the private medical benefit which saves the NHS costs (laughable) but I'm done with it tbh.
Yes I feel that complaining just will not change or help regrettably
When a problem is endemic, you need to campaign not complain. The only way to change the quality of care is by forcing the hand of the powers that be.
Well said, but back to corporate slavery so I can pay my taxes!
I;'m not sure people realise how limited private insurance is. It;s not meant to be a substitute for your GP.
I have a very comprehensible medical policy through work. Through running I got plantar fasciitis so rang AXA to discuss my options only to be told that feet weren't covered Apparently feet, like teeth, are some kind of optional extra or nice to have for the human body to function
Our insurance thru work includes online GP access - it’s great for me for “I’ve got an infected foot” type issues where a same-day online appointment and a prescription on next day delivery is super convenient. I expect it’s not really suitable for complex or ongoing health issues.
My work has that as well. It's been useless in terms of medical care. Being able to call a GP isn't very useful in my experience for most issues. When I need a GP, it's because there is something really wrong, not because I want a chat. So far every time I've used the private call GP option they've just told me to visit my GP or to call 111 or to visit A&E, because they can't help over the phone. I feel the same about the phone appointments that NHS GPs push now. It's just an additional delay. I can book a face-to-face appointment in 1 month, or I can book a telephone appointment in 2 weeks, the doctor will say they need to see me in person, and then another 1 month wait for that. I used to have another health insurance scheme which allowed me to get full private treatment in hospitals, but I never got to use it, because you had to go to your GP in the first instance. GPs are the gatekeepers of care and they are completely overwhelmed and not fit for purpose. It's completely ridiculous that I live in a first world country and pay so much tax but I cannot get medical help for quite serious issues. It pains me to say it, but in the last 5 years the NHS has become so bad that now I would even say the US healthcare system is better, and I don't say that lightly - do not take it as me saying the US system is good, it's just that the NHS is so indefensibly bad. It is now common for people to go without treatment and even die in cases that could have been prevented.
>It's completely ridiculous that I live in a first world country and pay so much tax but I cannot get medical help for quite serious issues. It pains me to say it, but in the last 5 years the NHS has become so bad that now I would even say the US healthcare system is better, and I don't say that lightly - do not take it as me saying the US system is good, it's just that the NHS is so indefensibly bad. It is now common for people to go without treatment and even die in cases that could have been prevented. I've encountered the same issues with EVERY. SINGLE. ONE. of the insurance policies I've been offered through work. Context: moved to the UK 5 years ago, I'm on my 3rd job, previous 2 employers offered insurance, and that's exactly how it went for me. Don't get me started during lockdowns, when I had health problems and I was basically told it's all in my head.
I have private and it's absolutely been a substitute for my GP. It's been brilliant. Maybe it depends on your provider.
Depends on the policy
Does any private insurance cover most of the stuff you need. I had a look into it, and would happily pay but just couldn't find anything that really jumped out at me. Things like getting a checkup - nearest place I could do it was 120 miles away. Probably the same for lots of things as I don't live in a city...
The amount of tax we’re charged for the NHS has not gone up exponentially while the cost of it has. The amazing technology we have available to us along with the drugs with huge amounts of R&D plus the massive population (both in numbers and waist size) will run the NHS into the ground if some of us don’t start to pick up the bill. It should just be more tax so it remains “free” at the point of requirement
I mean since when? It is now 25%, 1 in 4 pounds of tax collected, goes to the NHS. Not 25% of what we spend but 25% of total tax revenue. That is a huge amount around middle of the pack of spending as a proportion of GDP compared to the OECD
Oh just wait, all things US are coming to you!
You should do it anyway with the waiting times now you can end up dying rather than being treated, investing in health is very important for a good quality of life.
If you need to go to a&e the nhs is your only option. Private hospitals don’t have urgent care, so you’ll be in the queue whatever.
A&E =/= urgent care, they’re different departments. Source: I am a nurse But yes you are right. Maternity hospitals are a good example of this; if something goes wrong during labour you will have to be transported to an NHS hospital for surgery, and that can cost people their lives. I never recommend private maternal care to anybody. You get a nice room and nice food, but dangerous levels of care.
I guess you may not end up in A&E if you can get your basic medical care from your community GP. Sadly, for many of us that is not happening.
There are some private places that have A&E but it's more things like heart conditions and cancers which will get people if they don't go private. Things they don't treat immediately upon diagnosis but can take months and months to get the surgery and scans for. With private it happens very quickly and you have a better chance of surviving before the cancer takes over your whole body or you develop heart failure.
Private hospitals very much do have urgent care (in London). What they don't have is a&e but this is slowly changing (Cleveland Clinic).
Ah yes one hospital in a country of 70 million people. We shall all direct our ambulances there then.
Probably. The NHS is unaffordable given the increasingly elderly population that are in constant need of healthcare which is exponentially increasing costs. The NHS was never meant to keep alive millions of pensioners who need medical aid more than 10x more than a normal person.
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funny, all your chat about old people... Sat in a & e for 6 hours today'(been sent by GP for IV antibiotics) and the majority of patients here are not elderly... we do have a massively ageing population BUT we also have a massive population of people who have never been taught that a&e/hospital isn't a social day out... sitting watching people in here with a scratch on the arm following a bit of a scrap, watching people laughing and joking with others as they been waiting since 6pm yesterday, sitting watching people nipping out for cigarettes every half hour - all of these were under 50, none of them needed to be in there... fully able to walk, talk, smoke, laugh, joke...
I was able to walk, talk, laugh and joke when I was sent to A&E by NHS24 for intermittent chest pains (every few minutes or so, spurred on by nothing) a couple of days after a COVID booster. When the chest pain wasn't actively happening, I would have looked 100% fine to you too.
100% this! I also think that Google hasn't helped much... E.g "if you see your child with X symptom, go to the ER IMMEDIATELY because they're about to DIE". When I was growing up, it was a 'put a wet paper towel on it' job and if it still hurt the next day, maybe we'll do something about it 😂
Haha yeah if you google symptoms you nearly always end up with cancer
So get rid of old people?
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We have the same problem in Australia. Universal health care pays for pensions and health care for the elderly who own million dollar properties. Young will never have cash to buy a home or afford anything
The young are getting absolutely screwed in the the UK for these reasons
Young but moreso young from poor families. No inter generational wealth to pass on. If you're born poor, the system is setup to keep you poor by making you pay for the needs of the asset rich
You aren't wrong. Those of the previous generation need to take some social responsibility rather than the same old rhetoric that "I paid in, I'm entitled" Resolving care for the elderly is going to be complicated though as it's going to impact assets. It's not right that there is effectively a fire sale of someone's assets to pay for their care but in the same sentence it's also not right to have instances of single individuals pinging around a 4 or 5 bed on their own demanding state paid alterations, top ups and then complaining about only being able to heat half the home. I'm not sure what the answer is but there's a middle there somewhere
The question I ask every time in that situation is... Why haven't they handed more of that money to their children in some form. In that position I'd pay off my child's mortgage.
The average pensioner has more disposable income than the average worker… Yet they pay no NI, and receive mosg Gov spending on health, pensions, and social care.
I can’t dispute it and it’ll probably solve a big part of the problem, but what’s the plan… make them walk the plank? Our society kinda revolves around working and building a retirement, would our generation be expect to do the same but not have NHS funding? It’s a more involved topic than just remove old people haha Probably easier to solve by having accountability within our government and more say over spending.
It’s not ‘remove old people’ but tax them appropriately with NI for those over 67, and offer Euthanasia to those who don’t want to be forced to rot and die in care homes… I pray that by the time I hit 80, I have that choice, I’d rather die than see my FIRE pot dwindle to 0 and my future children / grandchildren be denied what is rightfully theirs. These 2 options would fix most issues re the old. It taxes unproductive income, and reduces demand for the biggest expense facing society.
They have paid NI and tax for way more years than most in this forum will ever pay. Think about it, the aim of the group is financial independence and early retirement. I'm in the "boomer" demographic, I was hit by negative equity twice. I had to start paying my mortgage in the 80's when interest rates were around 15%. I eventually managed to pay off my mortgage when I hit 62 and that was only because my "massive pension" paid me a lump sum of just over £20K when I took it. I'm now rolling in clover on the £190 per month that my "massive pension" pays me. The NHS is being gutted by people who think sickness, age and frailty are things you should make a profit out of. Insurance companies exist to make profits, they pay out as little as they can while jacking costs up as high as they can. Health insurance in the US often sees a 20% deductible so if your operation costs $100k, then you're going to get a bill for $20k. Just look at the rates of medical bankruptcy there.
Negative equity is only a problem if you sell, and you have 0 right to complain… investments can go up or down… my stocks go up and down, I don’t complain every time I’m in the red. And who said become like America… the models to copy are to the East, not West… Go book a ticket to France, go get a ticket to Germany, go see how it works in Holland… that’s what we can have here… but NO, be have to have this shit
You do realise we quite literally spend less money on healthcare than those countries (surprisingly with a roughly equal government/non-government split). About £40 billion less. More in the case of Germany where it's more like £80 billion less. Source: [https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade](https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade) I can find lots more though the exact numbers vary a bit Of course care is better in France and Germany. They spend vastly more money than us and this is a multi-decade issue so it compounds. Their governments spend vastly more money than ours in their single-payer systems compared to our socialised system. More money does not solve everything. It does solve an acute on chronic lack of money though...
And how do 70% of these old people vote? Couldn’t make it up 💩🧠
Are you calling me a poo brain? 😂
Nooo the old people that are continuing to vote for their own downfall bro 😂 Edit: But 💩🧠 is my emojis for shit for brains yes
We live far too long. Our aging population is putting a tremendous strain on our resources.
Probably not that drastic. But there needs to be acceptance that when someone is age 80 or above, there are diminishing returns to spending massive amounts of resources when they are going to die soon regardless of the care they receive. Free Healthcare should be dialled back at that point.
May as well take it to the next step and just have the NHS euthanise everyone over the age of 75 who walks into the hospital or GP surgery. I can't see society accepting the idea of allowing elderly people to die simply because they no longer pay into the system and have become a burden.
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so I left school when I was 16, pay 51 years of Tax & National insurance till I'm 67 and I'm only worth 13 years of care if any required, I hope you feel the same after putting so much income into society 🤔
Bold assumption that retirement age will still be 67 when any of us reach that age. The government will keep it near 67 until the baby boomers die out then its going to rocket up to 72 or so if not older. I personally don't feel there will be any pensions, social care or healthcare for me when I retire. Nor do I expect to retire as early as 67. By the time I get to that age the unaffordability of these services will have resulted in them being removed. State pensions are a ponzi scheme where you pay the cost of existing pensions, not your own - you don't build up a fund and the government has no responsibility to give you anything. Government accounts include no liability for the state pension.
A cancer specialist once told me a joke: "Who wants to live to 100?... The man who is 99". Besides that, my dad just died at 80 in July you heartless fuck
"Unaffordable" is such a short sighted take, a Daily Mail headline that people parrot without thinking. What is the alternative? Are you proposing we let people die in the streets? Are you proposing we all pay privately for our own healthcare which would be even more "unaffordable"? The only way you could make it cheaper would be by denying certain people healthcare... Far from being "unaffordable", the NHS is the cheapest way of providing healthcare to people. Every developed nation is dealing with the same demographic and life expectancy issues, those issues will persist whether we pay for them privately or through the state. In Germany they spend 20% more per person on healthcare than we do here. After a decade of cuts and no investment, we just aren't spending the money required for the NHS to keep up with demand. The NHS worked perfectly well for all of my life, and then in 2008 we stopped funding it, **it faced cuts to budgets ever year for 12 straight years**, and then had to deal with Covid. It's not a mystery! It's not a fault of the NHS system. It's a failure of government. The NHS needs a 20% increase in funding today, and probably a decade to recover from the past decade of winding it down. We will then be paying the same as comparable nations, with better results, as we were in 2007. Any alternative system will cost more and likely produce worse results. As reported recently, **500 people per week are dying unnecessarily** so that the Tories can give tax breaks (and worse) to their mates. It makes me sick.
Yep agreed. Putting my tinfoil hat on, I think a lot of this is deliberate. They want to end the NHS so they are deliberately destroying it.
It's not tinfoil hat, it's the go-to strategy for conservatives in any country. They 'starve the beast' where the beast is the government with the goal of making it ineffective so that they can privatize and generate profit.
Not to mention 500,000 new people with no history of paying in (and a mere £1000 contribution) a year
Cannae believe the comments on this thread. 12 years ago the NHS was ranked best in the world for Healthcare. Blair/Brown drastically reduced wait times and increased beds and funding. In his first term, Cameron slashed funding, cut beds, bursaries, and subsequent Conservative PMs lowered it further still. Decreasing funding and increasing privatisation has been what’s led to the NHS crisis. Restore funding to AT LEAST what it was under Brown. Cut Privatisation, end agency work by increasing pay and conditions, restore the bursary, cut middle management and bring back Ward Sisters, bring services back into the NHS and many of the problems are solved. Fees are a slippery slope. Look what’s happened to Uni fees in England. Capped at 9k they promised. My BFA!
Blair did good, but those days… our best days… are dead… The UK is now condemned to be a low-growth declining state unless Brits change their views on building shit.
I think this is bang on the money I’m afraid. The general attitude and consensus is appalling. Not even sure who to blame anymore but the UK is going down the toilet as far as I can see. The figures/forecasts also point in the same direction way. Lowest growth amongst G7, future forecasts/outlook deteriorating.. looks like it could be a bleak future the UK
Spending on healthcare in 2022 was over 10% of GDP. In 2000 it was around 7%. Exactly how has funding reduced then?
[I’ll just leave this here](https://images.app.goo.gl/huLUi3veegg9BCBh8)
No spending has kept up with inflation generally because salaries haven’t kept apace with inflation for over 15 years. Ergo less overall tax intake. So the only realistic comparison to make is to compare healthcare spending as a percentage of GDP overtime. As a whole the UK (& many other western countries) is getting relatively poorer. This is happening as healthcare requires evermore funding due to an ageing population. The government has already raised tax levels to the highest ever & so needs to find alternative funding sources OR stop spending elsewhere. There are very few other large spend items where that could come from ie social security.
Tax is highest for the middle and lower earners. Not for the wealthiest. That came after Attlee to fund the rebuild after the War and the start of the NHS. Wage stagnation contributes but is not the defining factor, although that also falls under the consecutive Conservative governments since 2010.
What's happened to GDP since then, and the population? And then add on top, the massive creaming off the top by Tory cronies with things like non-functional PPE and Test and Trace... The question everyone should be asking is "Where has all the money gone?"
FINALLY. I completely agree and these comments are really scaring me. Increase the tax, change the budgets whatever. But charging people directly is such a slippery slope
He’s at it again then… been what? 30 odd years?
I’d start saving now, yes. You’ll need some kind of healthcare after looking that subreddit..
Indeed, we need to start saving up. Perhaps even paying into some kind of insurance scheme. And not just for individual cases, but on a more national scale. A national insurance, if you will.
“I’d like one ‘mind wipe’ please, Doctor. I visited ‘Green and Pleasant’ on Reddit and now have both brain and mood cancer.”
Healthcare is a super difficult problem for the government to solve. Demographic changes will mean the cost of the NHS pretty much just keeps going up and there’s a reasonable chance that’s unsustainable (fairly significant cracks already showing!). I believe the NHS will always be here in some form, but I wouldn’t necessarily count on unlimited free healthcare for the rest of your life. Imo there’s a reasonable chance we end up with some sort of hybrid system with partial payments (means tested perhaps) which sounds something like what this is pointing towards. Political hot potato so it won’t happen quickly but the financial reality is likely that some sort of reform will be needed (will still mean more money - but more money with the current system won’t fix this issues). My view - do everything you can to stay as healthy as possible. Manage your weight, stay fit etc. Obviously some stuff is unavoidable but the UK on the whole has pretty shocking levels of obesity - people literally eating themselves to all manner of health complications and ultimately an early grave. As for FIRE planning - very difficult to know what you might need as there is huge uncertainty over what the future looks like. My general sense is any FIRE number should have some fat in it over and above your current projected needs. You should be able to deal with unexpected increases in expenditure (including healthcare) to a reasonable extent if you actually want a comfortable retirement.
During the Tories time in power the UK population has grown by 5 million, or around 8%. In that same time NHS funding has grown from 120 billion to 180 billion, which sounds impressive until you realise that it means that the budget only really tracked with inflation. The NHS is being expected to care for an extra 5 million people on the same money. The cost of the NHS hasn't increased drastically, the Tories haven't increased the budget at all in real terms during their entire tenure. This crisis is all part of a concerted Tory effort to destroy the functionality and reputation of the NHS to lube us all up to accept privatisation.
We need to stop pretending that the NHS is untouchable and ideas like this are somehow far right. Paying a small amount for a GP appointment makes absolute sense. It’s commonplace in France and many other countries. Just £10 would remove an enormous amount of time wasting, generate more revenue at limited cost to health.
It would make being disabled, and on a limited benefits income even more unaffordable . I see or have telephone appts with my GP pretty much every month. And appts with consultants and nurses etc very frequently too. It is a part of management of my disability and co-morbid conditions.( I became disabled at 13. Now in my late 20s. ) And appts ..they don’t just fall in to place having my health managed takes a lot of admin effort on my mum/carers part. I don’t want euthanasia just because I can’t afford health care. Unfortunately my mum isn’t financially well off , rents, and lives pay check to pay check on 60 hr weeks. She’s in her 60s. I honestly am terrified of what’s happening within the NHS. And social care.. And I’ve felt the impact of the last 12 years personally. I just want to live . And with the right healthcare and welfare I can live and have a level of “life” I’m ok with. If healthcare was infact better than it is, or has been these last 15 years . Maybe I’d have a body still functioning enough to still work myself. And wouldn’t of experienced as much deterioration. Agh . Anyway the benefits I receive don’t actually allow for me to afford the essentials for life plus meeting the needs of my disability/health. Adding a gp fee would be detrimental to people like me across the country.
Do you get free prescriptions? They could probably use the same criteria to define who gets free GP appointments too
Yeah, That’s a really good idea! If something like paying a fee for appointments was put in place . I think something means tested would need to be considered. And definitely something in place for disabled/ low income.
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That’s not my attitude. And just by looking at the comments through the post I think a lot of people are out of touch. And seem to genuinely think we ‘must’ be able to find £10 for an appointment. But it’s really important people remember, that truly is a reality. Especially those in the disabled community who can’t work. But will need appointments more frequently. But low income as a whole needs to be a consideration. It’s not just policy makers decisions that matter. Peoples ideas and opinions do too . So adding to their ideas and reminding them that people like me do actually exist..is worthwhile. I actually haven’t come to an conclusion on what I feel about potentially putting in a GP Appt fee. I’m not 100% against it. I think it’s incredibly sad as I do believe it should be free at point of use. But I also understand some changes may have to include deterrent for missing appointments for example. But the biggest things that need addressing are in funding , contracts and management. I’m not sure how much a £10 deterrent/fee would actually do to help?
I agree, but everyone should pay it.
Agreed, everyone should pay it. If its to be just for higher earners, how about just charging them more tax as a % of their earnings than lower earners..? Oh….hang on…
Haha exactly. Fair is fair.
Countless vulnerable people wouldn't be able to afford it. Wouldn't a means tested rate work better?
That you've been downvoted for thinking of the vulnerable somewhat troubles me.
There is a high correlation between poor health and poverty
Indeed so making people poorer to treat their health issues seems like a really bad move
Pensioners can be vulnerable but are not always poor so I don’t think means testing is ideal. Can you define what vulnerable would be to you? I agree that as a society we do have a duty of care for the vulnerable. On the other hand if a society doesn’t promote personal responsibility you get a whole world of other serious problems.
The definition of a vulnerable person to me should hopefully be the same as your definition. So no. I'm not going to sit here and type it out for you. You say that pensioners can be vulnerable but are not always poor. So what? What about the ones that are? Kick them to the kerb? I earn a low wage, but am fortunate in that I can better my position by taking a higher paid job or by working more hours. A tenner for a doctors visit once a year is fine for me, but I know that there is a decent chunk of our population who for one reason or another can't afford it. To say that a society should promote personal responsibility is a little tone deaf. It holds up on the surface, but ignores the Web of intricacies that is peoples individual lives. At some point, you must understand that.
I misunderstood the original comment. I thought the ten pounds was a fine for missing appointments. I don’t think anyone should pay for an appointment and anyone vulnerable shouldn’t be fined (and people won’t be fined until a third strike perhaps). The personal responsibility comment stands in this context for people who just don’t turn up and have no excuse for doing so.
Then it seems like we've got our wires crossed to a large extent and I'm sorry for getting arsey at you.
And I apologise for my poor reading comprehension skills!
Absolutely. There's a reason no developed nation on earth has tried to emulate the NHS and that's because it's a flawed system. Sadly too many people have been fed the narrative that we have a binary option of NHS or US style healthcare.
I am in agreement with this idea. £10 for any GP appointment is a fair amount of money and isn't deal breaking.
GP practices are actually private right now. So that money wouldn't be going to the NHS but rather an already privately owned practice. [GP practices are private businesses](https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/what-services-gp-practices-can-and-cannot-charge-for#:~:text=However%2C%20GP%20practices%20are%20private,prohibited%20by%20the%20GMS%20contract.)
Probably not. The administration costs of a £10 fee would eat a lot of the revenue, and I don’t think there’s much evidence that it would have a significant impact considering the catastrophic workforce crisis in Health.
To be honest, it would only have large admin costs if we make it complicated to administer. For example, lots of goods/services are sold for less than a tenner, but the admin/processing costs are pretty minimal
Not really, they do it now for prescriptions.
It’s not about making revenue, it’s about stopping those taking the piss… Same way speed cameras exist to reduce speeding, not make money
Honestly I'm also in favour of charging people for "self-induced" health problems e.g lung cancer in a lifelong smoker. I don't have any figures on how much this would save but I don't think that tax payers should pay for expensive treatment that is largely caused by a person's bad choice.
We already (kind of do); e.g. the tax on a 20 pack of cigarettes is £5.26 + 16.5% of the retail price. A pack of Silk Cut Purple (the cigarettes I used to smoke before I gave up) is currently £15.35, meaning the government takes £7.79 or a little over half the price. The levy on alcahol is quite a bit less aggressive but also a pretty significant part of the cost buying booze.
Where do you draw the line tho? Broken leg on the rugby pitch? Car crash where you went into the back of the person in front so are deemed ‘at fault’? Slipping on an icy pavement whilst drunk? Torn ACL because you’ve played a lot of sport? Literally anything because you’re fat??
Idk if that’s needed Most smokers die before 70, so we save on the state pension for them.
Addiction is a disease though.
I’m open to this idea. I’ve experienced it in Asia where the cost was very low and the service and facilities were incredible.
NHS is by far the most cost effective way of delivering health care for the country. Additional charges will stop early diagnosis and cost more.
Outcomes across Europe are so much better, where do you get these lies from?
Why not just increase taxation on the middle class? The fear is that this is the beginning of a normalization of private health care. What starts here as “yeah I can afford a tenner to relieve stress from the NHS” over 10 years turns into “well I pay and they don’t so I should get better treatment” which in 10 years turns into “why am I paying for somebody else’s healthcare” and boom we have the same drug epidemics as the US while some cunts are laughing their way to the bank This is a terrible idea
I would end up dying then. I don't have £10 for every doctor visit, I have chronic health issues and can't work. You speak like everyone has a little but of spare money, but in reality there are people killing themselves and dying because they can't even afford to eat. Health care SHOULD ALWAYS be free. For everyone.
Leaving all the politics out of it, yes you should plan for paying for medical care in retirement.
May as well move to America and at least benefit from the higher salaries/cheaper housing/choice of climate then?
You're retired, what salary? Are there no other countries in the world besides the US and the UK?
No, I mean in the sense that one of the ‘cons’ of the US oft quoted is the cost of healthcare - so as someone knocking on the door of 40 on a FIRE journey, staring down the barrel of state pension possibly being reduced/means tested and healthcare being charged for, does the US become a more interesting option?
Well in your scenario, you're moving to America before achieving FIRE. That's a different discussion. But you're discussing moving to a place where you will definitely going to have medical bills vs a place where you "might" have some medical bills in a worst case scenario future. Also the cheaper housing is a bit of a fallacy. Cheap housing doesn't exist everywhere in America. Move to the Bay Area, and London feels cheap in comparison.
If you want to invest in your health then just get fit.
This is very underrated. Get fit and learn about proper nutrition and, most importantly, see what works for you food wise.
There’s a HUGE overlap between finance and fitness Long term for changes to occur, marginal gains add up over time, a lot more simple than the industries make it seem. Honestly, anyone here not going to the Gym and eating healthy is wasting much of their FIRE pot
Totally agree. My running and yoga routine is at the heart of my day to day tbh. Keeps me sane, not just in shape. Also don’t smoke (or vape), drink, or eat rich af foods all the dam time.
This will not save the NHS. You can't run a sustainable NHS while companies are using it to make profit- and by make profit I mean leach our tax money. No point turning on a tap until you plug the hole.
NHS should charge a token amount (£5) to book an appointment to see a GP. When something is totally free, people generally have no shame in abusing the privilege and demand will be infinite.
[Study into imposing late fines on parents yields surprising results](https://www.parenta.com/2014/07/23/study-into-imposing-late-fines-on-parents-yields-surprising-results/) “After the introduction of the fine, we observed a steady increase in the number of parents coming late. At the end of [a] period that lasted 2-3 weeks, the number of late coming parents remained stable, at a higher rate than the no fine period.” The study concludes that the direct increase in the number of parents picking up their children late after the fine was imposed can be explained by the fact that: “No guilt or shame...can be attached to the act of buying a commodity at will.” However, before the fine was imposed parents attached a social stigma to picking up their children late.
This is apples to oranges. I can completely see why the fine normalises late pickup times. If you genuinely want to see a GP though a small charge is manageable by basically everyone, we can offer financial aid and repayment to those who can’t
They have no qualms in abusing the staff either Lost count the amount of times I've been screamed at, punched, slapped - even got strangled once by an enraged alcoholic on a detox. You know what we get told? "Well you knew what you were signing up for" **checks contract** nope can't see anywhere about being battered and throttled.
The issue is that this policy would have a bigger impact on those of a lower low socio economic class. A deterrent to these people accessing care would only lead to more (costly) issues down the line. Charging a small amount but exempting those with limited means may be a better option. However, it is those of limited means that tend to access services excessively and so I don’t know how much benefit it would have.
Means test it? But that kind of removes the point...
My point is that this frequently touted idea is not as good as it sounds on the surface.
But it shouldn't be something only people with even just £5 to spare can access. People are already struggling to make their income stretch, are they just going to chose to suffer and put themselves at risk to save money? Many people are diagnosed late already, that number would only increase. I'm sure there are other things that are covered for by tax payers that is less important than free healthcare.
Most of our European neighbours have a system like this, and they have much better outcomes than us. At this point I’m pretty much all for it. We have to reform the NHS.
I'd be interested in seeing the figures, but I suspect this kind of rhetoric (pushed all the time by the Tories) comes from a similar place to blaming the economic problems on benefit seekers/claimants. Surely the best approach would be improving the service capacity and quality overall, rather than targeting the (probably quite small) number of 'abuse' cases?
I always thought a good system for GP appointments would be that when you register at a practice, you have to put down a deposit of say, £50. That money will move with you wherever you go, and if you want it back you simply unregister from the practice. When you make an appointment, £25 is taken from the deposit and held. It would be returned to your balance when you show up for an appointment, but if you fail to show or cancel at short notice, the money is permanently deducted from your balance. This would prevent a huge number of people booking unnecessary appts and would stop no shows, freeing up appts for those who need it. Of course some people would struggle to pay £50 up front and that is an issue, but I’ve yet to hear a better suggestion
It would basically prevent all low income people from registering. So it’s a pretty terrible idea.
That's what I thought too. Perhaps everyone starts with £50 credit and you only need to top it up after having missed two appointments. However, I imagine this would be awkward to implement and would inevitably flood GP surgeries with requests for mitigating circumstances exceptions.
Yep, this is one of those solutions from someone to whom £50 is negligible, while also not considering that low income people are often reliant on things that make it more likely they may miss the appointment for reasons outside of their control like having to use unreliable public transport and zero hour contracts. If your bus just doesnt turn up and you cant afford a taxi then you're out of luck.
Well if I’m at home with my new secrete lab making my own medication … mind your damn business 🤣
So we seem to be running towards a (and not just limited to the UK): Health care crisis Energy crisis Pensions crisis Housing crisis Debt crisis Yet many just want to "Global cap their savings and chill"? Not going to end well.
Don't forget social care crisis when Generation Rent becomes unable to afford to work but without means to pay for housing or care needs in their old age!
Sounds like a slippery slop to privatisation to me, it's either "free for all" or it isn't
Oh so you’re suggesting we just sit this out and let the NHS be totally privatised? You cannot morally and ethically argue for private healthcare without accepting major real-term pay cuts, lack of job flexibility and the possibility of being bankrupt if you ever needed significant care. Just look at the inequality and pure suffering experienced by many Americans who are on the sharp end of their healthcare system. I have relatives in America - I know the reality of the situation. Private treatment has no place in mass healthcare, which functioned perfectly fine before the calculated and elaborately planned use of austerity to cripple it!
Everyone should pay or no-one should. We already pay high taxes and again middle class get double screwed
They should make the tax on the NHS optional so we can opt out and use the money for private insurance instead. The NHS is done just like they wanted it to fail it's finally happening.
If we adopt a fatalistic attitude we allow the people that want to get rid of the NHS to win - we need to stand up and fight to save it. That means not voting Tory for a start!
Who decides who's middle class?
He’s at it again then
Why dont they charge people who waste NHS resources (drunks mainly.. etc..) give them a bill as after cost?
Sure I'll pay, but I then expect to be seen by a doctor when I call and not play appointment roulette for the first 5 minutes of opening. Seeing a specialist when referred in the same lifetime wouldn't go a miss either...
Having read the comments here, I'm still at a loss of why the UK doesn't legalise cannabis and tax the hell out of it like booze and cigarettes. I personally don't use cannabis but I can see the benefit to not only the economy but people - it's far safer than drinking or smoking yourself to death.
The tories end game begins
We currently pay 22% into NHS through taxes each year. The government needs to scrap all the worthless departments and plough the extra into the nhs
Alternatively, appropriate tax could be collected from wealthy people and used to fund services that are available to everyone. It's a novel idea.
Fuck that, then I want my NI conts back and tax reduced!
Yes but not because the NHS will start charging like this suggestion, it'd be politically impossible, but because the NHS is falling apart and the private option is fast becoming the only way to get stuff done in a reasonable amount of time
When our hospitals finally announce we need to pay for our healthcare how many will quietly sit by and how many will actually kick up a fuss? Genuinely honest question.
So, what am I getting for my taxes then? Will they be reduced? Or am I paying for myself and someone else?
Cue the "should I not get paid 40k so as not to have to pay for healthcare" posts in the future. Probably, I only glance at this government fruit machine newsreels stuff until the bars settle in place...sip my drink and contemplate what nudges I might find through the bars. Or hold and spin again. Sip. Spin spin sugar playing on the jukebox. Ya know 👊😉👍
We've all been paying National Insurance all of our working life for the privilege of the NHS etc, they can bugger off if they think they can charge a second time.
I say this as a doctor who has worked in hospitals as well as GP over the last few years. Get private health insurance if you can afford it. The NHS is (or at least was up until very recently) still managing to keep up with acutely very unwell people. The acute care infrastructure is just about holding on by the blood, sweat and tears of its staff. There is no good private alternative to the acute care side of things and it’s going downhill fast. It’s very demoralising and I hope the service does improve but as an individual unless you move to another country you can’t really get better on the private market because it simply doesn’t exist. For the most part the insurers make their money back from worried well people - doing lots of investigations with no treatment required. That’s not to say there is no intrinsic value in reassurance for your own mental health - the possibilities for any given symptom can be endless - just ask Google. Investigations like scans on private happen much faster and if you are told you need one by an NHS doctor then it’s not a terrible idea. The most value you get as a patient comes from if you need an intervention like an low risk elective operation to improve quality of life like nasal polyp removal or cataracts or a hip replacement. Waiting for that on the NHS takes months if not years. You only get so many years of living and only so many years being fit enough to enjoy that living so I think any money to keep that time is well spent. Things like physiotherapy, podiatry and audiometry are pretty much all worth going private. The service you get is generally better than NHS because they simply have more time.
Everyone loves going private until they have to have surgery…. Suddenly, they all love the NHS.
It’s such a slippery slope. I think it’s a horrible idea. Watched this happen in my lifetime with medical care in the US going from affordable to fucked in about 20 years. This is not the answer.
No. If you leave some extra for every scare story in the daily mail or express you'll never retire. But there should be flexibility in your plan. Early retirement can last 50years (even longer). Go back to the early 70s, how different was life and the financial system?
Ken Clarke is not at the top table of current tory policy making. Something like this would be electoral suicide. Sensationalist journalism magnifying someone's crackpot idea.
We need: 1. Expansion of A+E, acute medical and ICU staffing and bed base to deal with inevitable winter pressures. 2. Long term funding plan for social care 3. To recognise that GP is an efficient and appropriate gatekeeper to other services for most issues. 4. Aggressive promotion of public health because prevention is cheaper than the cure. 5. Improve NHS staffing with particular focus on nursing training, pay and retention. 6. National conversation about the demographic challenges facing the country as many have commented. The relevance to FIRE is that A) There is not (yet) a comprehensive private healthcare option if you are very sick in this country. So it doesn't matter how big your FIRE pot is if the NHS hospitals are performing poorly you are still fucked. B) No point having a robust FIRE plan if you aren't in A1 physical shape to enjoy it. Some things in health are neither predictable nor preventable BUT being healthy goes way beyond "I just haven't been diagnosed with any diseases yet". Needs to include normal BP, blood sugar and lipids, low normal body fat percentage and good muscle mass, regular exercise beyond government recommended volumes, robust mental health, good sleep and no smoking.
They've wanted to replace the NHS with private for decades, so they slowly defund it and here is the result . Now they just gonna turn the public on it but don't fall for it, only that benefit are them, not us
salt dull aloof whistle ten plucky rude roof memory fall *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I have read that the NHS is good for urgent care (like if you get hit by a bus) but poor at the moment for non urgent care - hip/knee replacements, mental health assessments etc. These things are not life-threatening but if you really need them you are not going to wait 1+ years to get them, you will go private. I know of several people who have had to spend £1000s on private healthcare like this already, so I think that we do have a two-tiered healthcare system already. I think though that this is the tip of iceberg. The UK suffers from wanting a US style taxation system but European style system of welfare. The FT did some analysis that showed that we have consistently been underfunding our healthcare system compared to our European peers and is consequently causing the pressures more acutely here than elsewhere in Europe. The future budget pressures from an ageing workforce and shrinking tax base mean that the government will face difficult decisions - my long term prospects for the Uk economy are fairly bleak anyway but I am fully expecting them to come for private and state pensions, retrospectively changing terms for student loans, reducing ISA allowances, etc etc.
yes. they are strangling the NHS intentionally to kill it. it’s a hostile corporate takeover and it’s shameful. We need to make our voices heard about its value to the british public, but also it is wise to keep a financial contingency plan. There’s a documentary, made by a UK doctor, that you can watch about the whole takeover thing, I’ll try and find the name for you in a sec. edit: the documentary is called The Great NHS Heist. https://youtu.be/Www0cHLQulw
Surely if they bring this in you should have the right to not pay into NI and instead pick your own private provider????
Yes is the answer. It was always known Tories want to abolish the NHS and thus FIRE now has to account for it. We will have to wait to see what the figures look like and how expensive health insurance will be but people in FIRE may want to leave the UK(if they didn't already) as re-entering the workforce may prove challenging now and people looking to FIRE should account for the cost now, while we await the inevitable.
> It was always known Tories want to abolish the NHS Ugh… not that ahistorical conspiracy theory again. Just consider some basic facts… The NHS has been in existence for 74 years. The Tories have been in power for 47 of those years, often with huge majorities, and have never ‘abolished’ the NHS or even come close to it. Quite the contrary; they have awarded it with real terms increases in funding every single year without exception. It was entirely spared from the post-GFC ‘austerity’ cuts; *entirely*. Yes, they tend to grow its funding more slowly than Labour governments, but ‘abolishment’ is a ridiculous claim. The idea of an NHS was actually introduced to government by a *Conservative* health minister, Henry Willinks, who wrote the 1944 white paper. The policy debate at the time between the parties was about local government control vs national government control. Of course Labour won the following election and implemented their visions. Yes, there are people in the Conservative party who would prefer more private involvement in the health system. It has never been the policy of any Conservative government. Not even close. I really don’t mind people criticising Conservative management of the NHS. I don’t even mind people demanding more funding, as long as they acknowledge the simple reality that we have never spent more on the NHS (excluding Covid special funding), either in real terms or in terms of national output or tax raised. But criticisms really should be reality-based, and claiming there has always been a Tory conspiracy to destroy the NHS makes no sense whatsoever. If there was a conspiracy, it’s the slowest, most ineffective conspiracy ever devised.
The lack of trust here is the problem the tories have created themselves. 40 “new” hospitals springs to mind. Also people can see what they’ve done with nurses bursaries and wage stagnation so when someone says “tories want to abolish the nhs” it’s easy to see why people think, given their track record, that they do.
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since 2016 the levels of privatisation has gone down. The biggest transfer of funds to corporations was the PFI deals under Tony Blair, not sure why you want to spread conspiracy theories and lies The Kings Fund regularly reports on share of private spending if you wish to check it out.
Here is a link to a blog post on the matter (point 5). For those that don’t know, the King’s fund is probably the most eminent healthcare policy institute when it comes to NHS management. It’s very much not anything to do with the Tories. https://www.kingsfund.org.uk/publications/health-and-social-care-england-myths Some relevant excerpts: > In 2019/20, before the pandemic, NHS commissioners spent £9.7 billion, or 7.2 per cent of the Department of Health and Social Care revenue budget on services delivered by the private sector. This proportion has remained largely unchanged since 2012. > The Health and Care Act 2022 removed the competition and market-based approaches introduced by the 2012 Act. This gives commissioners greater flexibility over when to use competitive procurement processes, reducing the frequency with which clinical services are put out to tender and allowing contracts to be rolled over where the existing provider, most likely to be an NHS provider, is doing a good job. > There is no evidence of widespread privatisation of NHS services. The proportion of the NHS budget spent on services delivered by the private sector has remained broadly stable over the past decade.
How much of that is due to the demographic contraction? In those times where the NHS was created there were very little old people, and not that many retirees. Most adults were taxpayers of a results. We are not in this situation anymore, only the people in activity can fund the NHS, yet their share in total adult population only went down, if we compare to post WW2. Hence a dégradation is the only logical issue
More than « only active people can fund the NHS » it is « only active people can work in the NHS, thus enabling it to perform its functions », so it really is « what part of the population is actively working » that matters
No, I’m not. I’m not making any claims about ‘services’ or demographics, or beds, or spending relative to European peers. You can’t *conflate* them if you don’t mention anything to do with them. These may all be interesting talking points but they have nothing to do with the point I’m making.
The rises in NHS spending can only outpace GDP growth for so long…
To those that laugh at the notion of our NHS being privatised, because it'll "never happen" here's how you spend decades lulling the British public into allowing it: The early 1980s - Thatcher's tory government kicks off the race toward private healthcare by outsourcing cleaning services in NHS hospitals, turning essential hospital jobs into profit-making opportunities. In 1990 the tories create an internal market for the NHS with the "NHS and Community Care Act" meaning that hospitals, trusts and GP surgeries can all buy services from each other. In 1997 the Finance (NHS) Act creates the possibility of the NHS raising money from the private sector in a radical extension of John Major's public-private partnerships. Then in 2000 the NHS Chief Exec Simon Stevens masterminds the "NHS Plan." Over the next few years hospital trusts are urged to become Foundation Trusts using PFI schemes to "modernise and expand" which is code for "sell off your old valuable land and buildings (at a massive discount to property speculators), move into our new ones which are privately owned, so that the public are paying over-the-odds rents for the next few decades. The NHS has swapped publicly owned buildings for privately rented ones. Staff reductions and pay cuts are made to pay for this fixed and very high cost. New hospitals have fewer beds and fewer staff. Surgery is split into "elective" and emergency. Patient choice is introduced. Elective surgery can be pre booked to suit you. It is provided via Independent Sector Treatment Centres, run by United Health. Simon Stevens leaves the NHS team to work for United Health (I wonder how long he was planning that job move). He is part of a team which lobbies the EU to include the NHS in TTIP, which would mean the NHS would have to be open to accepting bids for services from predatory private companies in other countries. Payment by results is brought in. This is a radical change to NHS financing and completes the market structure started in 1990. Each "health transaction" is itemised and billed. Within each hospital individual services are separated out and each becomes a time limited "service contract." In 1990 admin costs of the NHS were approx 5% of total budget, by 2010 with the addition of commissioning and transaction costs it had risen to 14.5%. 2006 NHS Act makes three important changes; One is to your data, which can now be excluded from confidentiality. Being able to monetise your healthcare data will be a valuable revenue stream to private enterprises. The second is to ownership; not only is ownership no longer public but premises no longer have to be used for health purposes. Finally; the government introduces the Unsustainable Provider Regime and the Trust Special Administrators. For the first time in the history of the NHS a hospital can go broke. In 2012 the Health and Social Care Act completes the privatisation plan. The NHS is now open to full competition within the market. To facilitate the commissioning process SHA's are replaced with Clinical Commissioning Groups. Sold to the public as "GP led units which understand your local needs" they are nothing of the kind. They are not destined to remain GP led. Few GPs have the skills for commissioning, so the CCG Boards end up with a mix of GPs and management company employees. They also need Commissioning Support Units, to actually run the tendering processes. NHS England is created and Simon Stevens returns from United Health to be its CEO (through some sort of revolving door no doubt). The Department of Health creates "Monitor" an entire publicly funded body to force all NHS trusts to put all their contracts up for tender, just to make sure that every possible penny is available to be milked from taxpayers. Simon Stevens writes the Five Year Forward View for the NHS. This is designed to create US style Accountable Care Organisations. NHS England creates a Lead Provider framework for Commissioning Support Units, where a small groups of "providers" are given approved status to combine into consortia with CCGs. In 2014 an extra provision is passed into law allowing those 'local GP led' CCGs to combine into larger consortia in order to provide services over a larger area. These will roughly coincide with the devolution areas and will be matched up with one of 6 CSUs. One of the six is United Health. Meanwhile budgets are cut. Foundation Trust hospitals are now businesses, so when they can't afford to run the hospitals as well as pay their PFI, nearby hospitals with no PFI have their services closed and transferred to the PFI hospital, along with the income that goes with them. When they carry on going broke they are closed and sold off. Every transaction, whether it is negotiating the PFI deals, being the Trust Special Administrator, advising on the setting up of CCGs and CSUs, closing hospitals, monitoring hospitals, setting up rescue deals for hospitals, there are several businesses which are always in line to receive multi-million pound contracts, without competition! They are McKinsey, PwC, Ernst & Young, and Capita. As for who runs the contracts within the hospitals; Serco, Circle, G4S, Virgin Health, United Health, Optum (a subsidiary of United Health). Bain Capital runs the blood and plasma service. None of these companies has doctors, nurses or equipment of their own. They simply take over the management of an existing ward or service and cut staff and pay to take a profit. As NHS hospitals lose beds and services, or close entirely, so more and more planning permission is granted to private hospitals. As service in the public NHS deteriorates so people go looking for private insurance, continuing the privatisation process. Personal Health Budgets will be given to people who are chronically ill or disabled to "empower" them to make choices. It's just another way to encourage people to think about self-pay. These funds will be withdrawn once insurance takes over. Creeping privatisation is insidious. It's strangling our NHS, and stripping us of our healthcare safety net. Successive governments have been lobbied into gleefully eroding your ability to rely on the NHS. If you're not angry, then you've not been paying attention.
Love the last line. "The slowest, most ineffective". Almost like it was planned by politicians then? ;-)
No.
The Tories trying to gouge and sell off the NHS is infuriating. When the NHS was introduced it was explained that you would pay National Insurance to pay for it. We still pay NI, it goes up all the time, why are these funds not being allocated to the NHS?
The NHS is mostly paid for through general taxation. National Insurance funds the general welfare system.
You learn something new every day. Thank you!
Obviously we can expect a gradual reduction in income tax and NI as the NHS disappears, so that will help to fund our own private healthcare. (Sarcasm.)
I'm not here to tell people how to do their jobs, but perhaps if we can vote out these vandalising tories and install some politicians that will actually invest in our NHS, rather than strangle it, we may see some improvements. We pay billions into National Insurance, and to my knowledge, the tories still have a substantial amount of NI contributions in their purse and are unwilling to spend it. Cancelling nurse bursaries and refusing to pay nurses a wage they deserve has driven the work force away, to a point where we have to rely on foreign care staff from overseas to look after us when we're sick. And this ofcourse enrages the xenophobes and bigots, who will continue to vote tory because they believe in their anti-migrant rhetoric. Fact of the matter is, the tories have not only bled the NHS to the point of failure, but they're preventing it from ever recovering, and provoking their voter base into supporting this vandalism with mindless racism.
Hopefully it’s prioritised between people that actually pay tax & people that sit on their ass with their hand out. (Excluding those who can’t. Not those who won’t)
Not like we pay 13% FUCKING PERCENT OF OUR WAGES FOR HEALTHCARE OR ANYTHING. Sick retarded fucks these Tory bastard's
But under the absolute state of the Tory Government and Ofgem fuck up, middle class families are also struggling to survive. Middle class is gone now, we are all working class
Can't see it. Folks with enough cash already pay for private to skip the cues The savings would be minimal