Coffee House

When will we able to have a mature conversation about the health service?

28 December 2012

4:53 PM

28 December 2012

4:53 PM

Nigel Lawson described the NHS as the closest thing to a national religion that this country has. The NHS is certainly like a national religion to the extent that it is pretty much impossible to have a rational debate about it. There is often a choice posited between the NHS and no healthcare at all.

One can see this mindset in today’s Guardian article on the news that the Thatcher government in 1982 held Cabinet discussions about fundamental rethinking the size and shape of the state. Here is the section on the health service:

‘But the earlier version’s most controversial privatisation proposal concerned the health service: “It is therefore worth considering aiming over a period to end the state provision of healthcare for the bulk of the population, so that medical facilities would be privately owned and run, and those seeking healthcare would be required to pay for it.

‘”Those who could not afford to pay would then have their charges met by the state, via some form of rebating or reimbursement.”

‘The only exceptions might be the long-term institutional care of the “mentally handicapped, elderly” who “clearly could not afford to pay’

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What’s worth noting here is just what is still covered; the proposal is clear that the state will still pick up for the tab for those who can’t afford to pay. Those who could afford to pay would be doing so not through taxation but from their own income, presumably via various insurance schemes. One might not agree with such a system. But it is hardly immoral however much people try and denounce it as heretical.

I sometimes wonder when this country will be prepared to have a serious discussion about healthcare. I suspect that the Conservative Party has made the, sadly, correct calculation that it would be politically foolish in the extreme to try to lead one. But, at some point, fiscal circumstances might force this country to actually think about whether we need a healthcare reformation.

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  • 68

    Paying for healthcare from patient’s own money is never feasible. In USA health infrastructure is regressive lay financed and employers export low paying jobs as soon as possible. Infrastructure costs have to be paid by progressive tax. India has a model of total free market in healthcare and its infrastructure is so abysmal.

  • citizenx

    The problem with private healthcare paid for by insurance is that insurance runs out. I once met a friend of my parents’, back in 1989. He and his wife had been living in the USA, but had retired back to the UK. He told me the salutary tale of the architect who had built the Empire State building. He had developed a degenerative disease, and the insurance ran out. He spent all his money; then he and his wife divorced so that she was left with enough money for a small home and he could receive state assistance. The NHS is the backstop even for people who have health insurance in the UK and do not use it routinely. It thereby also keeps down the cost of insurance.

    The NHS has been a very efficient way of providing mass healthcare and while not perfect, it is particularly good at preventative medicine and dealing with chronic conditions. It is struggling to cope at the moment with the PFI debacle, which is sucking out money that could be used for healthcare.

    I would be interested to know the number of proponents of private healthcare who actually use the NHS.

    • Daniel Maris

      Well I think you hit several nails on the head there.

      That said, I am not sure the NHS as structured is that good at preventative medicine. I think a health voucher scheme where people got refunds – tangible cash – for being healthy and not using the NHS might be a more effective system, though still free at the point of use.

  • David B

    It’s just like immigration, the left wil not anyone talk about reform of the NHS. Just look at the abuse the conservative MP ( can’t remember his name) received for talking about the NHS on tv in the USA in terms which were not gushing enough for the BBC

    • Michael990

      Of course the left won’t talk about reform. The NHS is run by their unions, for their unions. It is interesting to observe the wall posters as you walk down the corridors of an NHS hospital. They are all entirely inward looking, giving the staff information on the ‘targets’ they’ve met, courses that have been run etc. etc.The patients just don’t get a look in.

      • David B

        Completely agree. I have described the NHS as a national employment service who have more interest in those employees rather than the patients. You only have to look at recent NHS scandals and how they have been treated then ask what would have happened if the same events happened in the private sector.

        The main principle of the NHS was health care free at the point of use. That is still a good objective, but the public sector objectives have taken over and it is out of control.

  • McRobbie

    I never could understand why people staying in hospital should not pay some thing towards their upkeep… they would pay for meals etc if fit and living at home. A few £’s a day and the NHS would be well financed and save the tax payer a fortune.
    Sorry, I may have caused an apoplexic collapse of the left whingers who call for everything to be free for all (except the tax payers) and increased the demand for hospital beds.

    • Magnolia

      The problem is that we’ve already paid loads and loads through our taxes.
      Taxes will have to go down for the middle classes if charges are introduced.
      I happen to believe that co-payments are a good idea but even the poorest should pay a tiny fee to show that access to health care comes at a cost.

  • Jebediah

    Never. The health service is treated as a religion and its employees as saints. Logically one can reasonably assume any state organisation with a million employees is probably pretty efficient. It’s almost certainly true that one could cut costs and provide a better service. Or keep costs the same, provide a better service and have ten percent more hospitals.
    But you can’t even start the conversation.

  • Q46

    In France, over 50% of healthcare is provided by the private sector.

    A State health insurance charge is levied on income, but the State fund reimburses only up to 70% of an agreed scale of charges. The percentage varies according to the treatment or drugs. Some charges are not covered, such as a daily 18€ hospital charge.

    The patient must pay the balance or buy top-up insurance to cover what the State does not pay.

    Povs get 100 % of charges on the agreed scale paid directly by the State fund, as does anyone with a chronic illness such as cancer or cardiovascular disease (although only for the particular condition).

    Thus nobody is excluded from an equal access to healthcare whatever their means.

    The WHO rate the French system as No 1 and the French are very pleased with it.

    Providers do not get any money unless they get patients, so just like any business they must meet patients’ needs and wishes or go out of business.

    Since procedures are a revenue stream, not a cost burden as they are in the NHS, there is a motive to test and treat patients, particularly the elderly who are the big revenue earners, rather than ignore them or hasten them to an early death.

    There is a collective stupidity in the UK, when it comes to the NHS, with reasoning not unlike battered wives who believe any inadequacy in their abusive spouse is their fault, and when he is not smashing their teeth in, blacking their eye, and breaking their bones, he is really a ‘good and loving’ husband.

    The people deserve all they get from their ‘World Class’ NHS and ‘dedicated’ staff, and I wish they would all stop moaning about such a wonderful thing.

    • TomTom

      WHO rated it No1 in 2000….since then Aarkozy has tried to control costs. France has the highest per capita consumption of pills on earth…it has a health system noone can afford

  • Boudicca_Icenii

    When the British people finally understand that they are no longer funding a NATIONAL Health Service with their taxes.
    Thanks to the EU – and Cameron, who recently relaxed the rules on treatment for illegal immigrants, – we are operating and paying for an INTERNATIONAL Health Service.
    When the borders are opened up to Romania and Bulgaria in 2014, you may rest assured that anyone from those countries requiring any kind of medical care will be over here like a shot. And they won’t go back.

  • http://twitter.com/VirCantium Vir Cantium

    The first step has to be to seperate the two key elements of the NHS in people’s minds: healthcare provision and health insurance. The state has no need to be involved in the former; however state provision of the latter is what guarantees the universal access free at point of delivery.

  • http://twitter.com/andywade andywade

    Well don’t sit around whining about it in dark corners of the Spectator. Put it in your manifesto. Run a general election campaign on a “We will abolish the NHS” ticket. See how far you get. It’ll be fun…

  • TomTom

    The Treasury does not want to PAY for Healthcare, it simply wants to take in the revenues from an NHS Fund. The NHS is a COST CONTROL system on Healthcare – every other system costs more because it does not RATION. GPs are used because the nation has too few Consultants and it saves money. The Government cannot afford to give tax incentives to the enployed and subsidies to the poor to pay for decent healthcare – just look at the costs in Germany and France !!! Britain is a low wage low productivity country – just watch Social Costs explode as employers and employees start paying for their children and wives separately and the children-rich benefit claimants get thousands of extra subsidy

  • rick hamilton

    Here in Japan the national health system is excellent and –
    like most countries – charges a small percentage for all treatment,
    except for the very poor. People are paying and they expect, and get,
    good service. If they are dissatisfied they go to another hospital/
    clinic/ doctor and the bad ones go out of business. Yes, healthcare is a
    business where efficiency and cost control matter, get used to it or go
    bankrupt.

    Giving everything out absolutely free is just plain stupid because
    people don’t value anything and you get uncontrolled waste. The
    Japanese have a saying for it: “There’s nothing so expensive as
    something that’s free”.

    • Daniel Maris

      Supposing what you say is true (you offer no evidence – you just assert it is the case) you can get exactly the same results in a free system with a vouchers.

    • TomTom

      radiotherapy is free in Tokyo but 8 US Naval Personnel are suing TEPCO for their dosage

  • lordylordy1

    It’s just the next €uro or EU in waiting, when its turn comes it will bow to the markets and crumble. The hardest hit will be those who were so devout to its indoctrination that they left themselves utterly vulnerable to the frailties of their own lifestyles.

  • http://twitter.com/lynneheal Lynne Heal

    the whole infrastructure has been wrong for many years. Maggie Thatcher when she was involved in the Falklands too the same year , have kept records of prrof where she did wrong there too .

  • Gary

    Why should health care not be free?
    Could you please elaborate the economic advantages, instead of insisting there is something immoral with the NHS.
    I find the tone of your blog condescending, ignorant and immoral and no different to the reasons why universal health care, pensions, collective barganing, free education were thought immoral illogical and ‘lazy’,100 years ago. One might have argued the same for the ridiculousness of the abolition of slavery (which I am sure you will see the advantages).
    Have you not studied the last 100 years? Or are you stuck in the last century.

    • Cynical Observer

      Why shouldn’t food and housing also be universally free?

  • Jen The Blue

    Since when has the state run anything efficiently?

    What matters is that people get the best treatment when they need it, and I suspect that it would be far easier and cheaper if the state were not the main provider.

    • http://twitter.com/TheRedBladder The Red Bladder

      Absolutely right. Let the doubters just look at the total mess the state made in security provision for the Olympic games. Thank heaven for the cheaper and more efficient service the private sector was able to offer!

      • TomTom

        Yes G4S should be nationalised and nuclear submarines privatised

    • TomTom

      Privatise Nuclear Weapons….i think we should teansfer operation of our Defence to Russia or China for cost efficiency

  • WIlliam Blakes Ghost

    I sometimes wonder when this country will be prepared to have a serious discussion about healthcare.

    Is that a multi-choice question for which the answers are:

    1) When the Labour party have been destroyed because whenever any of their sacred cows is mentionedf they fly into a seething diatribe of smears and lies?

    2) When our infantile media actually learn to do proper journalism?

    3) When the Government bankrupts itself?

    4) Any combination of the above?

    • 2trueblue

      Exactly.

  • Kevin

    State control of healthcare is critical to anti-theistic control of the country.

    If traditional Catholic hospitals were allowed to flourish once again, anti-theists would no longer be able to say that the Church is obsessed with family values, and patients in such hospitals would not fear being euthanased.

    So, yes, the NHS is a religion – for the anti-Christian.

  • Magnolia

    If the middle classes are going to have to contribute to paying for their health care then they will have to be taxed less.
    I’ve had serious illnesses in every decade since my teens and so I would never have been able to get health insurance at an affordable rate, and yet in between being ill I’ve been very healthy and productive. If my health care had been sub standard then I might have been left with expensive long term disabilities.
    I put this forward as an argument for quality care for all, free at the point of delivery.
    My big bang solution to our NHS problems is to get rid of the GPs.
    At a stroke £billions would be saved.
    Public health doctors could take over the infectious and environmental disease based elements and everything else can be managed by a revamped A&E and the specialist departments.
    If I have a problem with my ankle then I’d rather go to a rheumatologist or orthopaedic surgeon than be messed around by the GP.
    Those of us who want to continue with a family doctor can pay for it much as we pay for private dental and eye care now.

    • http://twitter.com/rlpkamath Rahul Kamath

      Hmm specialists and A&E types are paid vastly more than GPs. GPs are supposed to deal with basic stuff and only refer to specialists when needed. Also they are supposed to decide what specialist is needed, not the patient. I wonder if the real issue is that they refer too often. But I think that is controlled in some way right?

      • Magnolia

        Not true since the last Labour government equalised pay between GPs and hospital specialists.
        In the 1980s a hospital consultant had pay that was approx twice as much as the GPs thus reflecting their greater expertise.

        • 2trueblue

          Perhaps it would have been sensible to upgrade the GPs knowledge base. They have done little to deserve the uplift in their pay.

      • TomTom

        There are NOT enough Consultants – physical numbers

    • TomTom

      There are not enough Consultants

  • Daniel Maris

    I think rising health costs are a serious issue for all developed societies. We do need to look at ways of controlling costs. Maybe we should build in financial incentives through a health voucher scheme for people not to use the service. Maybe there should be an upper limit on what can be spent on us to keep us alive. Perhaps after age 85 only palliative care should be offered to us.

    • the viceroy’s gin

      We’ll put you down in favor of the death panel, then.

      • Daniel Maris

        Yep, definitely.

        Perhaps you haven’t seen anyone close to you live out a meaningless fag-end of existence, year after year. On reflection, it’s quite possible that’s what you are doing yourself on the evidence I’ve gathered from other threads.

        Your comment is strictly meaningless unless you are prepared to say you don’t care how long people’s lives are extended in such a twilight existence, with little mobility and no ability to interact with their families or contribute to society, and you don’t care however large the financial burden is that is placed on the active population…you don’t care if they can’t enjoy life at all and have to labour say 70% of the time or more just to fund the twilight existence of the aged and infirm. You don’t care because you believe the right to live long trumps all other rights.

        • the viceroy’s gin

          All those words, just to vocalize your agreement with Mengele.

          Nice.

        • Curnonsky

          As has been said before, who wants to live to 100? Anyone 99, that’s who.

    • http://www.facebook.com/jemima.khant Jemima Khant

      As someone who’s father was still working full time at 85 when he was LCP’d, with no consent, and with a CURABLE condition, having worked continuously since the age of 14, can I suggest you #### yourself and your stupid idea?

      • Daniel Maris

        Well Jemima, you father will have been part of a very, very small minority, numbering no more than a couple of hundred I would guess in a nation of 60 million.

        The point is we need a debate on these matters. Are you saying that the old and infirm can levy any costs they like on the young and healthy, completely impoverishing them ? It’s clear that drug treatments are going to keep people alive for longer and longer in a twilight, half-life condition, imposing incredible burdens on society. You are prepared to see people living in this twilight condition from 80-125 perhaps demanding incredibly expensive treatments to keep them alive, deal with all the natural cancers and so on that inflict them as they grow ever more aged and infirm? You’re crazy – that’s a horrible, immoral idea.

        Life is about living. Let us allow the youth of the country to live their lives as we did, to enjoy life, to be able to build a proper family life, without having to work 70% of their time keeping very aged people in that pointless twilight condition.

        Your father’s experience is no guide to public policy.

  • Daniel Maris

    Well this interesting snippet shows why the British people have always been right not to trust the Tories on the NHS. If I was in the Labour Party, I’d make much of this.

    But of course the premise of those discussions was wrong. The US spends far more than we do proportionally on health care. Free health services are actually pretty efficient and become more so as society becomes ever more litigious and insurance companies seek to cut back on what they provide for.

    The NHS is a noble beast and should not be put to the sword.

    • Mike Brighton

      I’m not so sure that the wilful neglect of the elderly bordering frankly on manslaughter if not murder in a number of disgusting cases is in any way noble

      • Daniel Maris

        Well if you can assure you me no such neglect has ever happened under insurance schemes in the USA, I will be pleased to hear that.

        • TomTom

          They have lawyers as part of their health system and bankruptcy as a payment option

      • Fergus Pickering

        And of course under any other arrangements the poor and old would dine on turtle soup from golden spoons. As they do in the USA.

      • TomTom

        Have you ever dealt with the NHS over a geriatric with terminal illness ? I suggest you do the grunt work of dealing with it rather than glib statements which simply lave the same idiots in control. Look at HCA in the USA

    • http://twitter.com/rlpkamath Rahul Kamath

      I don’t think anybody suggests going to the US system. But this view that the NHS is untouchable, that no reform is needed, that private provision or for profit-provision is dirty … It’s frankly ludicrous. The biggest defenders of these views are of course posh unions, the BMA, the RCN etc.

      • 2trueblue

        Most nurses no longer belong to the RCN.

    • 2trueblue

      How much do you actually now about the sharp end of the NHS?

      13yrs of vacuous tinkering did not in fact produce much improvement no matter how noisey they were about it. The previous government drew up contracts with doctors that were unsustainable, gave us more hospitals that were built on our grand childrens money, filled what were clinical areas with administration offices, put in layers of managers and administrators who had no medical training or understanding of how to supply real care. I am at a loss to see what they did to hand on a better service than they actually inherited.

      When the BMA stated last week that this government was going to bring about changes to the work done by GPs stated that this would require GPs to spend more time with their patients monitoring their conditions, and put huge pressure on GPs………… What does that tell you? Liebore put in a system where GPs were/are not actually doing what they should be doing, looking after their patients health. More people are turning up in casualty and being diagnosed with cancer than ever before. That is the legacy of the previous government and the task of trying to mend it will be the legacy of the Conservatives.

      • TomTom

        Do look back on Keith Joseph and his imposition of extra management in 1972

        • 2trueblue

          Peanuts in comparison to what Liebore put in place.

  • anyfool

    The NHS is a self fulfilling disaster and has been so from the day of its inception, it started of on the wrong foot with the contracts given to the most greedy cartel in the world, the medical profession. doctors were the first with their snouts in the trough and gulped so much down that no matter how much the trough was topped up it is cleaned out by all the others trying to catch up.

    That most of the staff have become lazy and unproductive is no surprise, the only surprising thing is that people still have faith in this poisonous legacy bequeathed by the Labour Party but sustained by the weak minded electorate who frighten even weaker minded politicians from all parties into supporting this cancerous growth on the country.

    the whole rotten edifice needs pulling down and a fresh contract with only the better elements retained at the same time cutting the pensions past and present down to a more realistic figure with a maximum pro rata pay out of less than the median wage.

    It can hardly be worse than the mess it is in now with thousands dying of neglect and thousands more put down like dogs with the misuse of the Liverpool Care Pathway.

    • 2trueblue

      The contract with the GPs was the biggest mistake which was purely down to the idiots of the last government. When nurses were trained on wards they were better trained in all aspects of nursing care. Those who took degrees are too far removed from the real meaning of care and feel they are above performing certain tasks. Managers entered the scene and the whole thing was meaningless. There was no one to look after the sick and conduct simple everyday care.

      Neglect is rampant as you say, but dogs are actually better treated, even in death. If vets treated animals as badly they would not remain in business.

      • TomTom

        “The contract with the GPs was the biggest mistake which was purely down
        to the idiots of the last government.” Last time I looked CONTRACTS have TWO parties required to agree terms……

        • 2trueblue

          OF course the BMA/GPs union like any other were quite happy with the terms and signed up to it. My gripe is that the last government actually agreed and drew up those terms which were expensive and then put in an idiot clause whereby doctors could opt out of the ‘out of hours’ cover. This was yet another massively expensive mistake from Liebore.

          • TomTom

            oUt of hours was unattractive after the Flowers Report decided not enough women were doctors…now 60+% Doctors are women and do not ike unsocial hours which interferes wirth famuiy life

            • 2trueblue

              The out of hours was a straight decision doctors made which had nothing to do with gender. They had to give up £6k i in return for not having to do it, and as they were now enjoying a great hike in their salary £6k was peanuts.

              Ah yes, equality, except for the one who is paying for it. Great idea to fill GP surgeries with women, another problem in GP provision, part timers and no continuity of treatment as they want to work part time.

      • barbie

        Now you’re talking; I’m one of those nurses who trained on the job. We were trained to nurse not stand in a nursing station and gossip for hours. Nothing was beneath us even a bit of cleaning, and mopping when needed. Today its different, and its got worse. Half of the nurses don’t speak English, and those that do are rude and stupid in some remarks. My recent stay in hosptial from a broken ankle; a nurse said out side my ward door, ‘is her getting up today’. I followed her onto the ward and said, ‘her’s up, and hers name is Mrs Stevens to you, and if I’d have approached a patient like you have and spoken like you have I’d have got thrown out.’ And I walked off. Stand up to them that’s the only way you’ll beat them.

    • Fergus Pickering

      Most of the NHS staff are lazy and unproductive? You have the evidence for this assertion. Try this one. Most rich men are lazy and unproductive. Lots of evidence for that, old son. Lawyers, bankers, politicians, livers on unearned income. The NHS staff who stopped me from dying last year seemed anything but lazy and I think enough of my life to say they re extremely productive. What you say is tosh. Oh, and whose pensions are you cutting? I suggest you could well afford to have your own cut in two.

      • Q46

        I worked in the NHS for five years, and worked on the supply side for 25 years. So I speak advisedly and have the evidence from personal experience.

        Staff are lazy, many incompetent, self-serving, unproductive and know they have a job for life, where reward is length of service or grade, not merit or productivity.

        They know at the least sign of criticism all they have to do is squeal ‘lack of funding’ and the political claque will take over and have an ‘in whose hands the NHS is safer and who can spend most on it’ cat fight, whilst the apologists who think NHS staff are so wonderful and dedicated, won’t hear a bad word said.

        • toni

          If one has had good treatment, like Fergus had, and been cared for by dedicated staff, that isn’t being an apologist, that’s stating an opinion based on fact which I understand is the experience of the majority of patients.

      • anyfool

        I had 20 years of observation while my wife suffered at the hands of these paragons and angels, botched ops, misdiagnosis three times, undiagnosed heart attack during an op, missing records, MRSA to add to her litany of wonderful treatment.

        Most short term or emergency treatment is good but you are quickly in and out, when you are actually a captive of the treatment programme long term it is a different kettle of fish.

        I see you finished with what socialists usually do (unbecoming of you), assuming i have a good pension to cut, Brown has already done that to bloat the public ones.

        You say, Most rich men are lazy and unproductive, but were they unproductive and lazy becoming rich, or are all rich in your circles hereditary or lottery winners, i do not know any rich so enlighten me

    • TomTom

      Your name is well chosen

      • anyfool

        So these thousands of patients did not and at this moment are not dying through filth and neglect.
        I might be well named but there is a difference between being a fool and being stupid,

        • TomTom

          Having spent 18 months dealing with NHS Trusts and DoH because of abysmal care for a geriatric relative dying of Stage IV Cancer I agree with you I am stupid. You in contrast are wise and erudite. Your wife is hale and hearty and my relation is cremated…you are the one with the answers. If only HCA could run the NHS and you could pay for health care you would enjopy Swiss clinics and the best physicians on earth because you would mortgage your house for care. You had 20 years of “observation”….I think your patience is exemplary, docile even…….but you should have done everything privately in the USA and taken out loans to pay for treatment – the option is open to you

  • Curnonsky

    Once the populace has become addicted to a State benefit there is no weaning them, regardless of how much they moan about its inadequacy. Any politician with an ounce of common sense about his career knows better than to come between an addict and his fix, and like any addict appealing to them to think about the future is pointless. So NHS will be sacrosanct – until it isn’t. Crash and burn, then reform.

    • Cynical Observer

      And we’re about to copy this horror in the US.

      • TomTom

        No we could end up copying the current US horror as we are with tuition fees where student debt in the USA has now reached $1 TRILLION with 30% default

  • Sally Chatterjee

    The proposed system there sounds just like the French or Swiss health systems which are excellent and often superior to the NHS. If the French can live with private healthcare paid where patients are reimbursed by the State it can’t be that scary.

    But surely Britain has extensive private healthcare within the NHS? My sister is a GP and her practice is a private business that simply contracts with NHS for services. And many hospitals were sold off by Labour to private companies under the PFI schemes in what is proving to be a rip-off. This is before we consider the pharmaceutical companies who provide the medicines or the many private contractors who supply cleaners, cooks and others to our hospitals. The NHS is actually rather reliant on private sector support.

    • TomTom

      Yes France is a sound economy with fortunately a booming economy and NO deficits at SNCF or in Healthcare. France is paradise and rumours tio the contrary are simply unfelling anti-Galic propaganda. Who could believe France is sclerotic and bankrupt ?

      • maninbath

        “unfelling anti-Galic propaganda”
        What on earth is this?

        • TomTom

          Work it out

    • TomTom

      “My sister is a GP and her practice is a private business that simply
      contracts with NHS for services.” but without NHS Cost-Rent it would be insolvent and it could never attract paying patients because it could never collect payment

    • 2trueblue

      The French system is so successful it is bankrupting them.

  • Marcus

    The ‘rich’ pay for the health care of the poor in the system proposed above.
    However they are not entitled to it themselves.

    In the current system they ARE entitled to use it themselves.

    Yet somehow the debate in this country is so crooked, the former method is considered to be less fair for the poor!

  • barbie

    Before the people of this nation have to face the prospect of paying for health care, perhaps the government should look to, the health tourists who should pay and don’t. 55 million per year and rising. Plus, the 11 billion in foreign aid which Cameron says is our ‘moral duty’, how insulting is this?
    We have our own begging at food banks, children who’s parents cannot afford winter coats, the elderly who are making choices of eating or heating, I could go on and on. Anyone in politics today who had one ounce of ‘moral fibre’ would look after their own first and have aligence to those who elected them. But no, we are told a lot of waffle to make Cameron look good on the world stage and his pontificating making him look and feel good. If he likes aid that much he should spend his own money, not taxpayers money.
    I now believe we have politicians so far removed from reality and the electorate, it is becoming farcial. We have Clegg lecturing, Miliband joining the fray, and Cameron telling us our moral duty, how stupid can they get and so out of touch. It is US who should bring them down to earth with a bump and refuse to never vote for any of them again, its UKIP for me and for many of the people I know. Time for even politics to come back to realism and reality. The reality is, many people cannot afford private healthcare, they are broke, and the NHS works fine if invested in properly. I know I worked in it, trained in it, and loved it. You have to look to the alternative and it’s not a nice prospect, believe me I’ve worked in both, ours is much better given its faults which can be rectified with time. Nothing us unrepairable.

    • Austin Barry

      It is our moral duty to give millions in foreign aid
      To disagree with the basic, pious proposition is, of course, racism.

      • Colonel Mustard

        No – q.v. Rahul Kamath

        • Wilhelm

          There’s nothing worse than a uppity, mouthy, smart ass immigrant who doesn’t know his place, Mr Kamath comes to mind.

          • ShoeOnHead

            “uppity”
            “doesn’t know his place”

            and this little dogwhistling bum stain decided bravado was called for. what are you some kind of monkey’s orphan?

            (shoe on head)

            • Wilhelm

              You have just confirmed my point.

              • ShoeOnHead

                you could never touch gloves and come out fighting.

                soup ladels at dawn.

                (shoe on head)

      • barbie

        That means that most of this nation is racist then, don’t be so silly, its all about who should pay and who gets it via NI and taxes. We owe foreigners nothing, and certainly not billions in aid, what are their own governments doing, buying ships and missiles that’s what.

    • 2trueblue

      Our political class are way out of touch on every level and surround themselves with advisers who are also out of touch. Charity should begin at home.

      Millipede is very quick to get on the bandwagon, as you say, he has little to be proud of, child poverty grew under his government, and the gap between rich and poor grew during their 13yrs in power. These facts are not actually repeated to him when he gets on his soap box.

  • http://twitter.com/rlpkamath Rahul Kamath

    Simple maths would argue that when the NHS is almost 1/4 of government spending, you can’t ring fence it when you are looking to cut a budget deficit. Cameron’s willingness to promise this ring fencing does feel like cowardice or politics as usual.

  • Enlightened One.

    The only reason ppl say the NHS is unstainable is because the casino bankers and the elite have stolen all our money.

    There can be no ‘rational’ debate now since the Tories have jump started the destruction of our NHS without fair debate.

    • Cyclops

      Yes, Gordon Brown gave all of our money away to his banker mates.

  • http://twitter.com/A_Liberty_Rebel A Libertarian Rebel

    Eventually, and sooner rather than later, the stark reality of fiscal mathematics – the state is, in effect, bust – will force the country, and its pusillanimous politicians, to confront the fundamental unsustainability of the NHS in its present form.

    Even without any change in its structural model, the combined effect of an increasing population demographic, rising individual longevity, and medical advances will rapidly bring us to the point where the entirely state-funded, state-delivered and free-at-point-of-use model becomes, quite simply, no longer tenable if only on cost ground alone.

    An honest political class concerned with something other than the exclusively intra-Westminster partisan positioning for millimetric psephological advantage would be laying this reality frankly before the British public, not pretending that all could continue blissfully on the present path were it only not for the other lot.

    • Daniel Maris

      Libertarians have nothing to say about anything to do with government, so I suggest you don’t bother exhaling air on this subject – just find some jungle and live there happily in a state of nature.

      • the viceroy’s gin

        Hmmmmm, apparently, judging from the compiled arrows, the readers find your comment basically ignorant and uneducated, while also finding the libertarian guy’s quite valuable.

        Fancy that.

        • Daniel Maris

          Just proves that a lot of liberatarian Ayn Rand-reading nutjobs inhabit this space. Let them stand as a “Libertarian Party” and see how many votes they get.

          The whole advancement of humanity has been achieved through social action not “libertarianism” which is a return to primitive ways.

          • the viceroy’s gin

            You mean, “return to primitive ways”… like your death panel?

            • Daniel Maris

              There are already “death panels”. You just aren’t admitting to it .

              • the viceroy’s gin

                No doubt, but there’s only you cheerleading for them.

        • Daniel Maris

          Also, isn’t it more than strange for a libertarian to invoke a popularity contest.

          • the viceroy’s gin

            Oh, I doubt it has much of any kind of “contest” aspect. The readers just seem to find your post ignorant and uneducated, and the libertarian guy’s useful… and by a very large margin.

            • Daniel Maris

              When a politician gets 40% of the vote he calls that “an overwhelming mandate”.

              • the viceroy’s gin

                Is that post supposed to mean something, or add something to the discussion?

                I only ask because you addressed it to me, and I find it nonsensical.

                • Daniel Maris

                  You need basic maths and a sense of humour to understand.

                • the viceroy’s gin

                  That’s still nonsensical, but much of what you say is that . And actually, I seem to have far more mathematical basics than you, not that that’s saying much, as you’re ignorant and uneducated.

                • http://twitter.com/dangroveruk Dan Grover

                  As someone who routinely – indeed, it’s practically my compass – disagrees with Daniel on basically every issue possible, I agree with him that the number of thumb-up’s or down’s is about as useful as the number of cheers Will Self gets on Question Time.

                • the viceroy’s gin

                  We’ll have to agree to disagree, then.

                • http://www.coffeehousewall.co.uk/ Coffeehousewall

                  Its generally a useful indicator.

        • http://www.coffeehousewall.co.uk/ Coffeehousewall

          There is a range of libertarian opinion. I guess many conservatives are libertarian to some extent or other.

    • TomTom

      Just look at Tuition Fees and how much more the Taxpayer now funds Student Loans

    • http://www.coffeehousewall.co.uk/ Coffeehousewall

      How do we establish an honest political class? Is honesty what a large proportion if people want?

  • Archimedes

    “I suspect that the Conservative Party has made the, sadly, correct calculation that it would be politically foolish in the extreme to try and lead one”

    Right, but it’s not going to be Labour that do it, the NHS being the one socialist scheme that supposedly worked and was sustainable, the testament to what every Labour government might be able to deliver, so the Conservatives should certainly be thinking about how to put the argument, and how to soften attitudes. The Conservatives should make sure that it’s known that the NHS is spiralling out of control, and that they are the ones doing everything they can to protect it, but that all that probably will not be enough in the end.

    • barbie

      If they did what UKIP propose and only treat British Citizens or those who had paid into the tax system for over five years, the call on the NHS would not be so severe. It has become an ‘international health service’ which British citizens pay for via taxes. The National Health Service as been abused and used by foreigers for years and it has to stop. Either pay or be refused treatment, like we are when we go abroad. That is the secret NI contributions and citizenship. If this were adhered to the reduction in expenses would be significantly reduced.

      • Archimedes

        To be honest, I’m not really convinced that the costs of foreigners using the NHS really amounts to that much – do correct me if I’m wrong – and I think that the additional administrative burden required to implement something similar to what you are suggesting would probably cost as much as, or more than, it would save.

        • http://twitter.com/rlpkamath Rahul Kamath

          You are not wrong. Panorama in its most Daily Fail of productions couldn’t uncover more than £40m in spending on foreigners pa against an NHS budget of over £100b.

          • 2trueblue

            They need to try harder.

          • Daniel Maris

            Well Rahul, depends what you mean by “foreigners”. Female genital mutilation has never been part of our culture in the UK, but there are now 14 NHS FGM specialist clinics that must in themselves cost tens of millions of pounds.

            I know you want us to be accepting of such practices, as part of this rich diversity we are now welcoming into the country, but I think you’ll find most people don’t recognise FGM as part of our cultural practice – and you can put a full stop at the end of that.

            • TomTom

              Indian healthcare seems to require Singapore to handle the difficult stuff

            • http://twitter.com/rlpkamath Rahul Kamath

              Well Daniel, if you want to consider anyone who didn’t land with the Normans as a “foreigner” then yes the bill would add up a bit. And where did I ever support FGM? But there aren’t any shades of grey in your world are there, just black and white.

              • Daniel Maris

                You’ve given us many paeans to the diversity immigration brings and never suggested you want to pick and choose your diversity. So I am afraid you get FGM as part of the wonderful mix.

                A foreigner for me is someone who doesn’t have any expressive command of the English language, knows nothing of the UK’s history, has no understanding of our cultural reference points and whose cultural reference points hark back to another homeland. That’s not to say a foreigner can’t become an integrated citizen, as millions have done over the years. It is only in recent years that it has become a political nostrum and technically feasible (thanks to satellite TV, modern telecoms, jet travel etc) that immigrant communities retain their home cultures.

                • ShoeOnHead

                  before we all start developing a bunker mentality…news just in: we say ‘no gracias’ to integration in andalusia.

                  no command of language. check

                  eastenders on satellite tv, and daily mail on lap. check

                  hermetically sealed communities. check

                  beer guzzling, belching, women. check (and those are some of the nicer ways the they describe us)

                  our own schools. check

                  setting electoral districts for political advantage. check

                  rejoice, rejoice, rejoice

                  (shoe on head)

                • Daniel Maris

                  I think it’s outrageous the way Brits go to Spain and expect to replicate British culture there, taking over whole towns. But it is a decision for the Spanish people, and they seem to have accepted the influx for the revenue it brings. I have never said immigration is wrong in all cases. I simply argue it is for the people affected by immigration (the Spanish in that case) to make a decision about whether they want it. Perhaps they do.

                  I wouldn’t be at all surprised if Spain paradoxically becomes a major bolt hole for people emigrating from the UK, so as to avoid the effects of mass immigration here. We will see.

                • ShoeOnHead

                  word.

                  (shoe on head)

                • Colonel Mustard

                  And they are still foreigners there. Still “expats”. No-one makes a claim for them as Andalusians. Moreover, no-one makes the claim that because of their influx there are no real Andalusians.

                • ShoeOnHead

                  dead on. acts civilisation state. is part of nation state. however, describing britain is like painting the wind. london part of nation state, acts-behaves like city state, and rightly (why are mayors more popular than ever – globally)

                • http://twitter.com/rlpkamath Rahul Kamath

                  Actually old bean, I’ve never made any paens to the ‘diversity immigration brings’. My pro-immigration arguments are strictly economic: Britain needs talented young people and above all workers. In fact a careful perusal of my posts by you would find me agreeing with pretty much everything you say above. Note that agreeing with you above does NOT require someone to become a ranting islamophobe. There are shades of grey.

                • TomTom

                  The NHS Budget = Budget Deficit

                • Daniel Maris

                  I did some rough calculations in my head on FGM. I’ve no idea how much they actually cost. But I can’t imagine when you take everything into account it is less than 10s of millions of pounds. It isn’t huge against the total budget – I was just putting that forward to disprove someone else’s absurdly low figure – based probably on those who declare themselves as foreign users of the NHS.

                • http://www.coffeehousewall.co.uk/ Coffeehousewall

                  There is also the cost of dealing with close relative marriages. The majority of genetic deformities in the UK are caused by close Pakistani marriages.

              • Colonel Mustard

                Ah, that old multi-cultural gambit so beloved of the black American expat Bonnie Greer- the English as a nation of immigrants – a mongrel nation. So, why are immigrants to India described as “expats”? Even British families in India with roots going back to before the 1800s are still “expats” and therefore “foreigners”. It is because the Indians retain a national and cultural identity despite colonisation, despite immigration and despite their class system and diversity of religion and language.

                It is one thing to be colonised but quite another for recent colonisers to make claims about the indigenes rights to be considered indigenous.

                For this reason I find your comment highly offensive. You are the one seeing things in black and white you insufferable hypocrite.

                • http://twitter.com/rlpkamath Rahul Kamath

                  I guess I’ll take your offense as a badge of honour Colonel, like I’m doing something right. Now back to the Cluedo eh, and the sherry.

                • Colonel Mustard

                  That just reveals your bigotry and hypocrisy. Nothing to be please about.

                  And I don’t drink sherry. Oh dear, another attempted stereotype crashes and burns.

              • TomTom

                Those who landed with the Normans WERE foreigners

            • http://www.coffeehousewall.co.uk/ Coffeehousewall

              Rahul lives in the US and does not appear to be British.

          • TomTom

            They have no way of doing the calculations as there is no billing system

        • 2trueblue

          Go to France and check out how they do it. Our daughter-in-law, who is French, moved to France with her British husband, she was 7mths pregnant and was asked to bank 2,000e with the hospital for her to attend for ante natal care. She had her baby and 18mths later they were given back 1,450e.

          Having worked in the NHS over 20yrs. the system of treating everyone who walks through the door regardless of contributions is crazy. If you check into a private hospital I understand they take your credit card/banking details, hardly an expensive administration exercise.

          • TomTom

            I like the Subsidy from Taxpayers in France because of Health running huge Deficits and arkozy and Holande unable to curtail expenditure; much as I admire the USA for not taxing but borrowing to live well. In fact the US interest payments to China will cover China’s Defence Budget according to a Canadian MP

          • Daniel Maris

            You obviously know nothing about administration if you think that’s “hardly an expensive” exercise. From a study by Woolhandler et al:

            “In 1999, health administration costs totaled at least $294.3 billion in the
            United States, or $1,059 per capita, as compared with $307 per capita in Canada.
            After exclusions, administration accounted for 31.0 percent of health care
            expenditures in the United States and 16.7 percent of health care expenditures
            in Canada. Canada’s national health insurance program had overhead of 1.3
            percent; the overhead among Canada’s private insurers was higher than that in
            the United States (13.2 percent vs. 11.7 percent). Providers’ administrative
            costs were far lower in Canada.”

            You can see the huge administrative costs associated with administration, especially competitive insurance systems.

            • TomTom

              That is very true and few countries have such a cheap health care system as in the UK which is why the Government is frightened to touch it….COSTS would EXPLODE as they have in the USA and Germany and France…….

              • 2trueblue

                That is because they do not have a national health service run on our model, free at the point of delivery.

              • http://twitter.com/rlpkamath Rahul Kamath

                Hmm, do you have comparative data on the UK/FR/DE? I thought healthcare spending as a % of GDP was roughly the same across all three countries, around 8%.

                • TomTom

                  Not so. The USA spends more public money on health care as %GDP than UK does. France runs huge deficits. USA runs around 17% GDP, Germany 11.6%, France 11,8%, UK 9.8%. Now I know I am a genius but can’t you start to look up your own data Rahul, it gets tedious doing your homework for you

                • http://twitter.com/dangroveruk Dan Grover

                  The US number, though, is a bit confusing, because the “total spent on healthcare” includes the “patient side” (ie insurance payments, medicare etc) AND the money spent by insurance companies, and then also the hospitals. So the same bit of money can be counted 3 times – once when a person pays their insurance, again when the insurance company pays the hospital, and then again when the hospital spends that money to buy a drug or service from a doctor.

                  I understand that the US figure is very large, but it’s not quite as clean cut as just comparing %GDP.

            • 2trueblue

              You are not comparing like with like. We were talking about the abuse of the NHS and how to ensure that we get the monies from those who are not entitled to use the facilities free at the the point of delivery. It is not rocket science. Private health or additional health insurance is a totally different discussion.

              • http://www.coffeehousewall.co.uk/ Coffeehousewall

                If all visitors had to have health insurance or deposit a bond then there would not need to be great administrative expense and the burden would be relieved.

        • http://twitter.com/lynneheal Lynne Heal

          wrong am afraid the HIV ones that use our NHS can cost 100s of thousands of pounds a week , that are NON UK residents

          • 2trueblue

            You are right. It would be cheaper if we sent them (those who come here purely for free treatment) home and sent them their drugs free of charge. A massive part of our drugs budget is spent on these drugs, no problem with that, but we should really sort it out.

          • http://www.coffeehousewall.co.uk/ Coffeehousewall

            It is cheaper to fund HIV treatment in Africa but even better to ask why it is so prevalent. One clue is that 75% of South African men admit to rape.

        • Fergus Pickering

          You could well be right, but you can’t say that here. The problem is really old people who won’t die. But since I am one I am hardly likely to vote for Christmas..

          • TomTom

            50% NHS Spending occurs in last 6 months of life. Most NHS Spending is on women

            • 2trueblue

              Rubbish.

            • barbie

              Who says so, in my nursing days men and women were equal in getting treatment. Spending on women might be higher because we have the children and have to have medical care, other than that your assumption is wrong. If you want to have less spent on women perhaps men should have less sex and reduce the populas??? just a thought.

          • Daniel Maris

            Yes but you clearly have all your marbles and presumably enough mobility to get on a computer screen. What if you had advanced Alzheimer’s and couldn’t engage in any leisure activities at all, not even watching the TV. Would you rather someone intervened to stop your pneumonia or would you rather it was acceptable for the medical profession not to strive to keep you alive in those circumstances. I think that’s what we all (since it comes to all of us) need to focus on.

            We need a legal framework that: puts a limit on when curative treatments for life threatening conditions are attempted (85 or 90 would seem reasonable to me); allows people to make living wills that define when they wish treatment to be withdrawn or positive euthanasia to be undertaken; provides legal protections for the vulnerable; and creates a new profession separate from the medical profession (Thanatician perhaps) who can administer voluntary euthanasia procedures in certain well defined circumstances so as to bring about death.

            • the viceroy’s gin

              Yes, a “legal framework”. That’s what’s needed. Schicklegruber pushed that through, first thing.

        • Boudicca_Icenii
        • barbie

          55 million per year and rising, that’s how much, why should they receive free treatment here, we have to pay when we go abroad. It does not need administrative burden at all, it simply means you prove who you are via your NI number, foreigners don’t have one and other things could be put in place as well to protect hospitals, GPs usually refer patients and those who are here illegally and not got citzenship could not or should not be referred.

        • barbie

          55 milion per year is what its costing us taxpayers, and why should we have to pay this amount at all, make them pay or no treatment, and the money re=invested into the NHS.

        • http://www.coffeehousewall.co.uk/ Coffeehousewall

          Actually the cost of immigrants and migrants to the NHS is vast.

      • http://twitter.com/rlpkamath Rahul Kamath

        Ah the convenient stealing foreigner bogey again. Favourite of all UKIPers as the source and solution for all our national problems. Keep dreaming barbie.

        • Malfleur

          You have the mindset of an anglophobic foreigner. Furthermore, your recent attack on Nigel Farage on another thread for allegedly fiddling his EU expenses marks you out as a cad. Educate yourself into UKIP’s grievances and those of the increasing numbers of Englishmen who support it: http://www.theyletyoudown.com/#

          • Colonel Mustard

            Yes, I’m afraid Mr Kamath is an anglophobe with an enormous chip on his shoulder who can be relied upon to besmirch these threads with equal measures of bigotry and hypocrisy delivered without self awareness.

          • ShoeOnHead

            first flushes of a relationship?

            (shoe on head)

        • barbie

          Oh I will, dream when we have our country back and we can really say what we feel. Make everyone who is not ‘British’ pay their way, and hope they drift away into the sunset.

        • barbie

          Well its rankled you hasn’t t, so the nerve must be a bit sore. As a taxpayer of many years even in retirement, I do object, and will continue to do so. Those who don’t like it, tough.

  • West ham

    Simple. Abolish NI and raise the income tax allownce to 20k. This would be aid for by abolition of all tax credits and the subsequent down sizing of the NHS. All people earning over 20k between 25 and 65 must have private health care. The NHS should still be available to all and free for visits to GP, A&E, critical and terminal illness and those under 25 and over 65

    • dalai guevara

      Why not just make it compulsory to prove health insurance status every time you seek treatment – when you are employed via your employer and NI, whilst you are unemployed via a guaranteed cover by the job centre.

      Observe the true level of unemployment rise by 100%, to pick a conservative figure. It’s tough when society faces reality, why not face this one?

    • belbylafarge

      You deserve to fll severely ill for making such a statement.

    • http://twitter.com/andywade andywade

      Sounds like a really good way to get loads of people to move heaven and earth to make exactly £19,999… and 99 pee.

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