NHS fallen to 31 in the world since Tories took over.

growstuff

Yes, I am listening Maizie and my point stands. The people who cost the NHS most are contributing the least. Most pensioners in most countries continue to pay a healthcare tax.

Even with MMT, taxation needs to be distributed. At the moment, it's not distributed fairly.

My point is that individuals do not need to 'contribute' anything because it isn't paid for by taxation. Taxation ensures that there isn't surplus money sloshing around in the economy to cause inflation. It withdraws surplus money from circulation. Think of it like a tap filling a sink, government spending being the tap. If there is no overflow (taxation) in the sink water will spill over the edge and cause a lot of damage. That is the limit on spending. Until the overflow is reached (and while ever there is something the money can be spent on it can't be reached) the government can issue and spend as much as it needs. It mostly comes back anyway through taxation; all financial transactions are subject to taxation. The only money that doesn't eventually come back is that which is sent offshore (which is why offshoring should be controlled)

taxation needs to be distributed.

I agree that it should in order to distribute the country's wealth more fairly. That's a secondary function of taxation.

And of course, the more that comes back through taxation the less needs to be newly created.

But spending comes first.

If we, as a nation, have decided that the people's health is sufficiently important (both to themselves and to the economy in the form of a healthy workforce) to offer health services freely we shouldn't be constrained by notions of 'deserving' or 'ability to pay'.

(I feel like the local nutter for having these views but I never seem to have been on the majority side of a debate)

I highly recommend Stephanie Kelton's book 'The Deficit Myth'.

The NHS was set up in 1948 and was designed to cope with the infectious diseases of the time- polio, diphtheria, TB etc it was thought that once these were dealt with the population Would be healthy and there would be fewer demands on the service. Of course that hasn’t happened and demand has increased. If we were designing a health service now we wouldn’t choose the same model

@MaizieD
The reason that the NHS was good under Blair's government was that it was given enough money to be good.
Bear in mind that a lot of that funding was through PFI, which became a serious burden on the NHS in later years

What position is the NHS in the list of 'free at the point of contact for anyone in the world who happens to be in the UK' hospitals, I wonder?

You can't compare public services to private ones worldwide and, if the private ones rate so much better, then surely that's a better way to go!!!

I forgot to add that I worked in the NHS in the 70’s and people complained about it even then. It was of course much less sophisticated in those days but I don’t think there ever really was a golden age of the NHS.

Certainly, the NHS where I live now in Scotland has gone downhill in the past 10-15 years under the SNP. It’s just so inaccessible (prior to CV) with so many ‘pathways’ that need to be followed to access assessment and/or treatment. It took nine months for me just to have a scan and get the results.

dayvidg

@MaizieD
The reason that the NHS was good under Blair's government was that it was given enough money to be good.
Bear in mind that a lot of that funding was through PFI, which became a serious burden on the NHS in later years

PFI funding was for buildings, not for clinical care.

I worked in the NHS in the early 70s, too, SuDonim. Just when the old structures were being swept away with the introduction of RHAs and AHAs. (Lots of nostalgia for Matrons among the older staff)

I don't think any organisation is ever perfect; there will always be cause for complaints and room for improvement, but by the early 21st C the NHS was being ranked very high in International comparisons.

P.S I do know that PFI was a bl**dy disaster. Too much inexperience versus companies with lots of experience and very sharp lawyers.

dayvidg

@MaizieD
The reason that the NHS was good under Blair's government was that it was given enough money to be good.
Bear in mind that a lot of that funding was through PFI, which became a serious burden on the NHS in later years

But it wasn't!!

Who says it wasn't, Callistomen?

Are you citing an academic study of the NHS 1997 - 2009 which reaches that conclusion?

growstuff

Callistemon

Re the Swiss system, one of our erstwhile posters had said, I think, that it was quite costly. They had to pay quite a lot per month for healthcare.

I think we do need to pay a separate, set amount to fund our healthcare system or pay more in income tax which should be ring fenced for the NHS.

The problems with some systems arise when people are just above the level of earnings to receive free healthcare but struggling to pay essential bills. Someone on a slightly lower wage would receive free healthcare.

Some of the financial problems of the NHS could be solved overnight by charging everybody, including the economically inactive such as pensioners, a health tax, which is what happens in many other countries.

How much would you be prepared to pay?

Oh yes, I agree, growstuff.

But whenever it is mentioned I have been told, quite firmly, that it is funded out of taxation.

I believe that we should all, pensioners included, be paying an extra NI 'stamp' for our healthcare, not to fund it totally but as a much-needed contribution.
As we do not pay a NI stamp after pensionable age but many of that age group are users of the NHS I do not think we should be funded by our prior contributions.

I say it wasn't, Maizie.

The Francis Enquiry says it wasn't.
Tony Blair put up the NHS for sale and started dismantling it.
Cherie Blair benefited.
Changing the system so that many newly qualified doctors found there were no jobs for them so they emigrated.

You in England are still paying for Blair's PFI ventures. Pulling the wool over the eyes of the public.

There is no excuse in Wales for the poor performance as PFI never really took off.

Dayvidg, the problem with the health system being under Labour is the " free for all " jobs for the boys, including non-jobs and because of the over-spend of money that's thrown at them, in turn, creates years of austerity from a conservative government when they step in so the reins have to be pulled in on spending. It's happened religiously after a Labour government.

Look at Brown and the gold reserves, selling when its prices were rock bottom out of desperation because the economy was sinking during his office as PM. Half of this precious cargo-----gone !

I remember Brown's Big Clean of hospitals.
They had been in power for about 12 years then and super bugs such as MRSA, C difficile etc had become rife in hospitals throughout the country.

The Lancet said that Brown's Big Clean lacked scientific evidence and was 'pandering to populism'.
Although it was claimed that new money would be available for the deep clean, it was in fact money that had been held back from NHS Trusts by Strategic Health Authorities.
Bureaucracy which all costs money which was needed for frontline services.

It is a sorry fact that "pandering to populism" is often what politicians do.

quizqueen

What position is the NHS in the list of 'free at the point of contact for anyone in the world who happens to be in the UK' hospitals, I wonder?

You can't compare public services to private ones worldwide and, if the private ones rate so much better, then surely that's a better way to go!!!

I don't understand your logic. The vast majority of developed countries with a private healthcare system pay more per head for it.

... or to be patronised.

Maizie* I am fully aware that spending precedes taxation. I really don't need a lecture.

Didn't mean to lecture you, growstuff, but it seemed to me that you were still talking as though the NHS was paid for from taxation.

Anyway, what I say makes not the slightest impression on anyone...

I find the whole MMT thing really interesting and very logical.

This from Whitewavemark2...................

No luck so far but will keep looking.
Live found this and know that it was mentioned because the U.K. has fallen another place.

www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiIzLGW5-fqAhW_QRUIHY3WBAoQFjAEegQIBBAB&url=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fhealth%2Fnhs-world-ranking-uk-healthcare-worse-ireland-spain-slovenia-30th-lancet-a7744131.html&usg=AOvVaw1-N3hJ2q9t7mcWaIhT0Q18

The article is 3 years old.

PinkCakes

This from Whitewavemark2...................

No luck so far but will keep looking.
Live found this and know that it was mentioned because the U.K. has fallen another place.

www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiIzLGW5-fqAhW_QRUIHY3WBAoQFjAEegQIBBAB&url=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fhealth%2Fnhs-world-ranking-uk-healthcare-worse-ireland-spain-slovenia-30th-lancet-a7744131.html&usg=AOvVaw1-N3hJ2q9t7mcWaIhT0Q18

The article is 3 years old.

Yes and if you’d read the conversation, you would have realised that. It is only relevant in so far as I have recently read that the NHS has slipped further down the rankings but I’m buggered if I can find the link.

Well I found this link from 3 years ago

www.bbc.co.uk/news/health-40608253

MaizieD

^Some of the financial problems of the NHS could be solved overnight by charging everybody, including the economically inactive such as pensioners, a health tax, which is what happens in many other countries.^

How much would you be prepared to pay?

Nobody is listening, are they?

TAXATION DOESN'T FUND SPENDING

We have a sovereign currency. Government can create as much of it as it wants to. It could fully fund the Health service if it wanted to. It doesn't want to.

So long as people go on believing that taxes pay for everything the government can get away with underfunding and selling bits off to private enterprises while everyone goes along with their 'we can't afford it' line.

The King's Fund seems to think that the NHS is funded from general taxation, supplemented by money from NI contributions and some patient charges.

We know that Governments can create money but why not fund it better by increasing general taxation or by a healthlrvy?

Health levy

From a macro-economic point of view, the King's Fund is wrong.

The government can quite literally create money. It can do that at the click of a button by the Bank of England, as it has done with the current crisis. It can also issue bonds. People are queuing up to buy bonds because the government is seen as a safe investment. Pension funds rely on deficit spending by the government because they own hold huge stocks of government bonds. If nobody wanted the money pension funds hold, they'd be in real trouble. While interest rates are so low, it really doesn't matter whether the government has a debt or its balance sheet is in deficit.

Most money the government "creates" or borrows eventually comes back to the Treasury via taxation, whether as direct or indirect taxation.

So why does a government need to tax?

There are many reasons. Firstly, it needs to control the money supply; otherwise there would be rampant inflation. Secondly, it needs to direct spending. It needs to collect the money back in a cyclical process. If it didn't (and left the economy to market forces) it would never be able to control the money going to health, education, infrastructure, etc. It would never be able to achieve its aims.

Thirdly, it seeks to redistribute wealth. People are selfish and, left entirely to market forces, those with more than average would never contribute to those with less than average. However, societies are more complicated than that.

Even the most heartless need the majority of people to have money they can spend. Otherwise, they wouldn't be able to make a profit. A developed country also needs educated and healthy citizens to be efficient workers. It needs good infrastructure for businesses to flourish. There's a very good reason that businesses (particularly those selling "intellectual" services) choose to do business in Europe, the US, etc rather than in most parts of Africa.

Anyway, I'm digressing.

The King's Fund is correct in claiming that the NHS is funded from taxation and NICs - on the government's balance sheet. However, the government could choose to create more money for the NHS, if it wanted. Eventually, it would need to collect the money back to avoid inflation, but any Conservative government is reluctant to collect more back from the wealthiest.

Extra money in the economy would almost inevitably find its way into the pockets of the wealthiest, but those people don't want to pay it back. That's the problem! They claim they've earned it by hard work and entrepreneurship, but that's not really the case in a marketised economy. The people making money out of the NHS are the drug companies, the equipment suppliers, the builders, etc etc. Increasingly, people providing clinical services to the NHS are making money. It's estimated that the NHS's own internal market (created by the 2011 Act) costs £30 billion in admin costs, such as negotiating procurement and legal fees for drawing up contracts.

Clicking a button to create money is the easy bit (as Sunak has found out) but deciding how that money is going to achieve its goals and claiming it back, so it recycles, is much harder.

(Sorry for the length of that - I've actually left loads out, but it's really not as simple as people seem to think.)

Health spending does need to increase - probably by about 25% to bring it in line with countries such as Germany and France. The trick is to do that without increasing inflation. It's actually a small part in a fundamental rebalancing of how people are taxed and, therefore, contribute to the way the country is run.

I also think the internal market needs to be scrapped as a matter of urgency. We've seen in the current situation how the whole system has been chopped up and isn't working well as a co-ordinated whole. Everybody is competing against each other and trying to offload responsibility/blame.

The NHS also needs to listen to its users (patients). My personal bugbear is the way the personalised GP service is being run down in favour of remote consultations and lack of continuity. The government doesn't want the current model of GP partners and favours salaried GPs working to a script.