The Tipping Point

I bet they serve imported tea, coffee and orange juice too!

I would just like to make a small observation - yes, the NHS is in a mess and really needs sorting out, whatever government is in power it never seems to be run efficiently and it's not the fault of the doctors and nurses. I can't comment on education as I know nothing about this.
My 84 year old Dad was admitted to hospital two weeks ago in the middle of the doctor's strike and I was very worried that it would be chaos in A & E with long wait times. Well, the opposite was true - as the doctor's were on strike people stayed away from A & E, this only goes to show that because it is free people go there too often.

£16 BILLION A YEAR by the end of this Parliament. I don't care what the percentages are, it's still an OBSCENE amount of money considering we don't know where most of it goes. To be fair though, the last time I looked, Gulf Stream jets don't come cheap.

Annifrance - good post (and I rarely say that!)

I have had experience of the French healthcare system when I worked there for a short time and I was amazed at how well it functioned. And I believe they have plenty of doctors and are not struggling to train and retain as we are.

The other thing I discovered is that the French appreciate that to have good services such as education and health care, you have to be prepared to pay for it via taxes.

In the UK successive governments seem to want to hold taxes down at any cost despite surveys showing that many people would accept increases if it could be shown they would go directly to the NHS.

But the points you make about the administration of the French health care service and the way this actually works so efficiently shows up the inefficiencies in our NHS and how things could be streamlined and improved and better use made of the funds we have.

I agree the french healthcare system is excellent for most people and areas. It's wonderful not to have to wait ages for an appointment, or to be told the results.
But there are shortages of doctors, both GPs and in hospitals, especially in rural areas.The canton where we used to live had no GP for a year or 2, then appointed someone from Africa.
Also it's not exactly free. For those of us who are of retirement age the British govt. cover 70-100% of the cost (paid directly to the french govt.)
Those who move to France before retirement age have to pay 8% pa of their income to belong, unless they're really impoverished, where there's a system to give free care (CMU). Having said that, there is , in theory, a rule that you're not allowed to emigrate to France unless you have enough income to support yourself.
Then there's the need to insure for the extra 30% - we pay 130€ pm for that. Before we had this topup we had a couple of big bills - 1450€ and 2500€.
French people pay into a fund during their working years for health, pensions etc.
And I believe the health system is massively in debt, but can't complain about the service we've had .

Anya - re taxes in France - as you say, when working you have to be prepared to pay a lot for what you get out. Income tax plus our equivalent of NI can add up to more than half of your basic salary. And that's not just for the "rich."

Daphnedill I didn't mean the GDP but the actual cost of medication, surgery etc. I can't remember the details without looking them up, but I had a schedule of costs for the hip replacement I had and it was considerably less than the cost under the NHS I am reliably informed. For said operation I paid a little under €1000 all told as I do not have a top up insurance. Worth every sou to have it here in France. So much better after care too.

Pensioners pay into the health service in France according to their income. I basically get it being on a British state pension, but pay taxes on the modest income from our gite.

Annifrance, I'm sure you're right about hip replacements. I've never had one, so I don't know. I do know that my daughter had an accident in a playground in France years ago and almost lost one of her toes. We had to wait hours for her to be treated and the bill came to over £300, even though we had a health card and insurance. We had to pay for dressings and antiobotics upfront. The paperwork to reclaim the money was so complicated that we gave up.

As a nation, France pays about 25% more for healthcare than the UK, so maybe it's no wonder it's better.

I'd better get my hard hat here, but pensioners in almost every country I know, except the UK, pay for health care and I wonder how much difference that makes. National Insurance in the UK is now 12% and pensioners don't pay, although they pay income tax. Successive governments have kept income tax low, but put up NI. For most working people the amount taken by the government has ended up being about the same, while the demands on the NHS from an ageing population have increased.

That is a thought daph If I thought the NI was ring fenced for welfare and the NHS then I would very much consider the proposition that everyone should pay within their means. How about the idea of no upper limit, or at least extending it?

I certainly agree with you about extending the upper limit. The lower threshold is £8060, so some people pay NI but not tax. Above £43,000 employees pay a lower rate of NI, so some higher earners, even those in the higher tax bracket, end up paying a lower combined percentage of tax/NI than low earners. Some (admittedly a few) pensioners have a higher income than low/average paid workers, who are the ones being squeezed.

I also agree with you that NI should be ring-fenced. Obviously pensioners wouldn't pay for the unemployment element or the pensions element, but I've always thought that it's unfair that the people who pay most for the NHS are the ones who use it least.

Nobody knows when they are going to need the NHS. That's why everyone pays into it when they are working, just in case they need it.
It is still supposed to be free at the point of need.
Those who need it least should just consider themselves lucky to not have needed it. It's like any other insurance.

I think that is where we disagree daph I firmly believe in the original aim when the NHS was set up, indeed when the entire welfare state was formulated,

Not quite sure what you mean, ww. When it was set up, the original idea was for it to be an insurance scheme rather than one generation paying for the next, but it was realised that the elderly wouldn't be included. There wasn't enough money at the time to pay for the elderly who hadn't contributed, so that's we have the system we have.

Life expectancy has increased ten to fifteen years since 1948 and it wasn't expected that the NHS would have to be for people well into their 80s. About 40% of the NHS budget is spent on the over 65s, many of whom wouldn't have been expected to be alive when the NHS was set up.

To be honest, I just can't see that it's sustainable in its present form. Working people are being squeezed and I don't think they can contribute much more. If the NHS is going to remain free at the point of delivery, somebody is going to have to be taxed much more. If you look at Treasury figures, it's difficult to see where £20bn or so can come from. I don't know of any other country where pensioners don't pay for health care if they can afford it.

According to the IFS, median pensioner household income after housing costs is now higher than the median working household income.

www.ifs.org.uk/publications/8026

I don't earn enough to pay tax, but I pay NI. I don't mind paying for ill people, but I do mind paying for people who have a higher income than I do, but don't pay anything, didn't pay as much when they were of working age and retired earlier than I'll be able to do. Younger people will be even more badly affected. Sorry!

I agree totally in the original aim of the NHS, but not only was the expectation of people living into their 80's or 90's pretty minimal, but also the very expensive treatments that are now thankfully available were not even anticipated in 1948. Apart from taxation which I don't think would ever be enough, how else can this goliath be funded other than by private means? I really don't know what else you can do.

None of us know when we may need it, and it is not unfair that the ones who pay most ( working, and younger) are the ones who need it least. I agree with djen and Whitewave on this (maybe much to their surprise)

It is a big problem niggly I admit, and probably taxes will need to go up at some point.

Blimey rose that deserves a drink I'll meet you down the pub

Yes the answer is that we need to pay just a tiny bit more tax. Which would be a blessing compared to the alternative of paying for private insurance. Which of course gets more expensive the older you are.
I've been visiting family in NZ and Australia where they have more fragmented systems. In NZ people pay for GP visits, hospital treatment is free but a lot of tests etc seem to be privately run. e.g. blood test centre in city high st.
The Australian system is 2 tier - with a kind of NHS-light for poorer people while the rest pay very heavy insurance cover for the kind of level of care we have grown used to in the NHS.

I have two cousins who live in Australia, and the one thing they miss and envy us for is our health service. (not our weather!!) One, now she is getting older is finding their system quite burdensome. Our Dutch friends are completely amazed at all the free health care we get. I couldn't quite gather what their system is, but I think it's a mixture of free, and private insurance. Dare I say it, but perhaps money could be saved on the cosmetic surgery front which is purely for vanity reasons? Perhaps people getting blind drunk and ending up in A&E.could incur a financial penalty? I know, how do you get them to pay?!! As has been said, a small raise in income tax specifically for the NHS would be preferable to Insurance premiums; but would it ever be enough?

I think there should be a referendum on the future of the NHS - it belongs to the people and not to the government of any shade to do whatever it wants at the time.

Have you had hip replacements in both countries to compare the two, annifrance? I know the NHS has its problems - as I'm sure all systems do - but my DBIL has had three hip replacements here. Two last year - one privately, one on the NHS - and the latter one was the best experience despite it being a very complicated procedure, with superb aftercare, including regular physiotherapy at his home which led to a very quick recovery. I can't imagine what you got for your 1000 Euro top up that made it worth every sou. But I'm sure others will have had bad experiences of the same operation, in the UK and on France.

Of course we need to look carefully at our failings and the plus points of other systems to improve our own, and I agree that the admin of the NHS can be dismal, but we have plenty to be grateful for too. Yes, the WHO ranking puts France at the top in Europe, and ours is only 15th - though interestingly this is higher than Germany, Denmark or Switzerland - but there are other ranking systems that put the UK and France much closer together. The Euro health consumer index, for example, which has them at 14 and 11 respectively.

I really don't understand this business of the working population needing the NHS least. Some of the elderly need treatment some younger people do as well. My DIL is involved in removing decayed teeth from young children and the cost of that to the NHS is enormous. I have family who have had expensive and excellent treatment and they are working age. The point is that they receive prompt and good treatment that enables them to return to their working lives asap. Perhaps we should all have our family medical histories looked at and those of us who happen to be reasonably fit should pay less? Nonsense? Of course it is. The NHS is there to care for everyone and this idea that some of the population should have to pay more, or less, is ludicrous.

Quite right, trisher. I've been lucky enough to have enjoyed good health and rarely needed the NHS, apart from giving birth. If I need more help now as I get older, I feel I've paid my dues. Either way, I'm more than happy to have paid towards those who need it more.

That is exactly how the welfare state was set up, it wouldn't work any other way. There when needed, let's hope we are lucky enough never to need it. But like house insurance we are all covered and we all hope our house will never burn down, but we are not willing to take a risk and assume it won't and not have house insurance. At least with the NHS we all pay the same according to means, but with house insurance some poor souls have difficulty getting an affordable premium, because of flood risk etc.

Like many others we have hardly used the NHS during our adult lives, but it was always there just in case! Now with the advent of Hpertension and Prostate Cancer we are using it more and more and we both feel extremely grateful for all the wonderful and compassionate care that we have and are getting without the worry of finance. However, affording an ever increasingly expensive institution is a serious worry for every thinking person in the UK. There are so many other organizations crying out for money, Education and the Prison Service to name but two, and keeping all these financial balls in the air must be well nigh impossible. No answer from me as I simply don't know!