Our bloated NHS - it’s beyond ridiculous now.

I know nothing about Singapore. I do know that in Germany pensions, healthcare and benefits operate as separate "pots". In the UK, the point is that any division between National Insurance and taxation is now meaningless. Whenever headlines are written about reductions in income tax, people ignore the increases in National Insurance. In reality, we should add the two together to calculate any "income" tax. For most working people, the rate of National Insurance is now 13.25% on the majority of their earnings and is about to be increased by over 10% to 14.75%. For basic rate working age taxpayers, that's 34.75% on their earnings over the threshold. Pensioners pay much less, while those on lower incomes pay disproportionately more because NI is capped. It doesn't really matter where the money "comes from" - ultimately, it all comes from the same place.

When National Insurance was first introduced it was "sold" as a fund for the NHS, pensions and other benefits, but I don't think it's ever operated like that.

I think we all understand that we're not paying into our fund and drawing on it as needed.
I think, however, that is (or was) how it operates in Singapore.

Johnson said he had a plan to make health and social care work effectively, to prevent ‘bed blocking’.
I won’t be surprised to see any funds directed to Health, who would be responsible for deciding what proportion goes to social care. Social care has always been the poor relation. Loads of work has gone into building frameworks to combine health and social care but you can bet that will all be forgotten in the latest attempt to re-invent the wheel

Taxation doesn't actually fund anything, if a country has a sovereign currency, which the UK has. The Bank of England can literally produce money at the click of a button and let the Treasury spend whatever it wants. That's how the Covid response was funded.

Taxation follows spending and serves a number of purposes, such as controlling money supply and creating greater equality. That's (very briefly) what Maizie meant. (Google MMT.)

When National Insurance was first introduced it was "sold" as a fund for the NHS, pensions and other benefits, but I don't think it's ever operated like that. All taxes and NICs just go to the Treasury and nothing is ring-fenced. The NHS is funded out of a melting pot.

And would your idea of people over the pension age include those who are already on either just basic SRP or pension credit also be expected to be taxed?

No, I wouldn't ~Chewbacca

But there are some retired people who could easily afford a 5% ringfenced NI contribution.

But if that's not how it is funded then we needn't worry about paying more tax!

I know the NHS is funded mainly from taxation although we are led to believe NI contributions fund it
^No, we've been told for decades that it's funded from taxation, but it isn't.

Ah well, I've been put right on Gransnet previously and told quite firmly that the NHS is funded from taxation.

Motto - don't believe anything you read on Gransnet.

growstuff

Whilst I agree with all that Maizie, I also think that the burden of taxation could be spread more fairly - that, of course, includes those squirreling money away in offshore accounts and others, but there is very clear evidence that sections of the non-pension working age population are paying a disproportionate percentage of their income to the state than others.

A comparison between what people pay for healthcare in Germany and the UK (and who pays for it) shows very clearly why the service provided is generally better - no matter that healthcare is administered by state-regulated "Kassen" in Germany.

I agree with both your points, growstuff. That should be one of the functions of taxation; fairer distribution. There is no reason why the 'income' element shouldn't be progressive and that those doing the squirreling just shouldn't have quite so much to squirrel and leave it doing absolutely nothing of any benefit to anyone Dead money...

We had a whole thread about it quite recently. Full of the moderately well off defending the very rich

Whilst I agree with all that Maizie, I also think that the burden of taxation could be spread more fairly - that, of course, includes those squirreling money away in offshore accounts and others, but there is very clear evidence that sections of the non-pension working age population are paying a disproportionate percentage of their income to the state than others.

A comparison between what people pay for healthcare in Germany and the UK (and who pays for it) shows very clearly why the service provided is generally better - no matter that healthcare is administered by state-regulated "Kassen" in Germany.

Ask Callistemon, who introduced the idea.

Personally, I think anybody receiving above a certain income should pay, regardless of age. Those receiving basic state pension and/or pension credit only wouldn't reach the income threshold.

I know the NHS is funded mainly from taxation although we are led to believe NI contributions fund it.

No, we've been told for decades that it's funded from taxation, but it isn't.

Taxation just doesn't fund spending. We know very well (or should) that the government can issue money when it pleases, without having to tax to fund it or 'borrow' it from anywhere. We have a sovereign currency, we can do this and have done for a long time. If the government, via the Bak of England, hadn't been issuing more money into the economy We would all be scrabbling round for an ever diminishing share of of a finite pot as our population increases.

Since the Global Financial Crisis in 2008 there has been some £450 billion issued in the form of Quantitative Easing by the BoE. Specifically to save the banks in the GFC, to bolster the falling pound after Brexit vote and to pay for the costs of the covid pandemic.

Has this caused inflation (the current inflation has a number of causes, but it certainly isn't caused by too much money in the economy)? No, it hasn't.

Has it meant increased taxation to 'repay' it since 2008? No, it hasn't.
The current tax increases are, inexplicably, damaging to the economy and economically illiterate.

If there was the political will a large injection of money into the Health and Social Care services wold be really good for the economy; so much private business would benefit from it; from NHS suppliers to the local shops and businesses where the NHS employees spend their wages. And most of it is taxed back, you can't do much in this world without paying a tax of some kind or another.

If we, the populace, could take this on board then we could be thinking completely differently about the funding of public services (and why most of the issued money ends up in the hands of the already very rich, like the covid money).

Taxation has a number of useful functions and, of course, the revenue from it helps to ensure that the government doesn't have to issue more and more money, but funding spending is not one of them.

Working pensioners will have to pay 1.5% anyway, so I don't understand why those who can actually afford not to work shouldn't have to pay.

Pensioners who don't work are not working for a whole host of reasons other than just because they can afford not to. Most of us, having worked for more than 50 years non stop, are too old and exhausted to work any more. Others are too frail, have long term or life limiting illnesses and work is an impossible option for them. And would your idea of people over the pension age include those who are already on either just basic SRP or pension credit also be expected to be taxed?

I agree. At the moment, National Insurance starts at a lower rate than the personal tax allowance and is capped for higher earners, so the lowest earners pay a higher proportion of their earnings, which doesn't seem fair.

PS. Most German pensioners pay 14.6% of their pension for health insurance, which goes some way to explaining why more is available to spend on healthcare.

GrannyGravy13

growstuff

I agree with your post Callistemon. I think it's time the retired paid more towards the NHS.

Not going to be popular with pensioners struggling with energy, food, fuel increases and a myriad of other price hikes already.

No, and perhaps it should cut in at a higher point than the tax personal allowance.

I wasn't suggesting the full rate, perhaps 5%? ringfenced for the NHS but have been told it would be too expensive to administer.

Otherwise a system like the French or German one.

I think hospices should receive more Government funding too.

growstuff who pays what tax is a different conversation.

The NHS is far from perfect, something needs to be done, unfortunately the something is the sticking point.

GrannyGravy13

growstuff I was responding to your post regarding pensioners.

The what about -insert group list could go on ad infinitum

I know you were. So why should pensioners be any different from working people? In some cases, they have a far higher income and don't have the same outgoings. Working pensioners will have to pay 1.5% anyway, so I don't understand why those who can actually afford not to work shouldn't have to pay.

growstuff I was responding to your post regarding pensioners.

The what about -insert group list could go on ad infinitum

GrannyGravy13

growstuff

I agree with your post Callistemon. I think it's time the retired paid more towards the NHS.

Not going to be popular with pensioners struggling with energy, food, fuel increases and a myriad of other price hikes already.

What about working age people struggling with the same ... plus mortgages, childcare costs and prescription charges?

growstuff

I agree with your post Callistemon. I think it's time the retired paid more towards the NHS.

Not going to be popular with pensioners struggling with energy, food, fuel increases and a myriad of other price hikes already.

I agree with your post Callistemon. I think it's time the retired paid more towards the NHS.

I would be very wary about advocating yet another wholesale change. I don't know whether people are aware, but Clinical Commissioning Groups have been abolished and replaced with Integrated Care Boards (in England), which is involving all sorts of organisational changes. Some of the changes are intended to address some of the issues mentioned on here, but problems have been created elsewhere in the system. I think I'd like to see these changes bed in and then look to tweaking the system, while committing not to sell any more to private providers.

As far as I’m concerned, and I have thought this for a long time.

We need a full and comprehensive national debate on the way forward.

The other thing that seems to me would be useful would be a really good analysis of the whole service; how the elements can be integrated and work together more effectively. But that could upset many vested interests and would work against the tory plan of breaking it into nice saleable units

The theory is, I suppose, that it would be run more efficiently but still be free at the point of delivery.
However, that is not going to work because no private company is going to take on a contract for altruistic reasons. They will want their profits, depriving the service of money and keeping salaries low.

I know the NHS is funded mainly from taxation although we are led to believe NI contributions fund it.
What I don't understand is why those who are retired don't pay a portion of NI towards NHS funding.
We are more likely to be users of the service.

The French system sounds interesting.

As I mentioned in an earlier post - it's just huge and cumbersome.
Can it ever be run efficiently?

As one of its pressing problems seems to be communication problems, with IT systems that don't talk to each other it seems to me that a huge investment in overhauling the IT might be called for. Though that is really unlikely to happen.

The other thing that seems to me would be useful would be a really good analysis of the whole service; how the elements can be integrated and work together more effectively. But that could upset many vested interests and would work against the tory plan of breaking it into nice saleable units.

Yes, it's huge, but if we're going to have decent health and social care provision with the objective of caring for the population from cradle to grave, as in Beveridge's conception, without money being siphoned off to private enterprise (apart from for provision of all supplies and medicines which are a legitimate and necessary use of private provision) we have to be prepared to spend the money on doing it properly. (And the money can be found. It's the will that is weak)

Yes, translators are needed.

I'm not sure about Welsh/English though,as I've not yet met a Welsh person who doesnt have an excellent command of English, including those whose first language is Welsh. They include my friend who is a teacher and my Consultant.