Rebuilding the NHS

Purely an assertion of a very contested statement with not even a citation to give the appearance of objectivity.

I'd have thought this to be common sense. People are happy to buy expensive things for themselves when they see a direct and personal benefit, but are less likely to pay the same cost to have it shared amongst the whole of society. It's why we have a market for Rolex watches, Porsche's and £5m houses when there's people that can just about afford food. It's why millions of people have private healthcare instead of donating the premiums to the exchequer. It's likewise why millions give to charities that they feel personally connected too, rather than donating to the treasury.
First line is not true.
Your graph backs up my point? The spike in tax as a % of GDP corresponds with UK recessions in the early 80's and 70's? The Guardian (strangely enough) put it perfectly "Britain’s overall tax take – revenues as a share of annual national income – stood at 34.4%, its highest sustained level since it was on its way down from the high levels seen during the second world war. "

In terms of spend to GDP which in truth is more pertinent as we still need to spend during recessions, despite tax take dropping. This follows the same trend. Apart from spikes during recessions we're at an all time high in line with 2007 spend and spend in the late 80's (post recovery) and are at a greater level that throughout the 90's and also the 00's until the recession (under Blair/Brown).
united-kingdom-government-spending-to-gdp.png

Second line is an assertion contradicted by the fact that the Tory party is in power.
The Tories are taxing and spending more than ever (including more than the tax and spend policies of the Brown years); whilst pledging to spend even more, even the Guardian have said this. I see no evidence given these historic highs that they aren't taxing close to the maximum that can be extracted in non-recession peacetime. Of course this spend to GDP will spike again 2020 and 2021 due to COVID-19.
Third line is not true regarding corporations or rich individuals, both as a rate and as revenue.
Both graphs are completely disingenuous. Corporation tax isn't the sole tax a business has to pay; they have to pay payroll taxes, premises taxes, product taxes, fuel taxes, insurance taxes. Individual tax rates also don't show what the richest are physically paying. If you implemented a 99.9% tax on PAYE earnings above £500k what do you think would happen to tax receipts above £500k? They would reduce from 45% of the current declared figured to receiving no taxes whatsoever, as people would change their habits accordingly.

The average household tax for the top 10th decile from 00-01 year to 17-18 year is as follows:

Total wages - increased 68%
Total tax - increased 71%

The average household tax for the top 10th decile from 1990 to 17-18 year is as follows

Total wages - increased 270%
Total tax - increased 288%

The average household tax for the top 10th decile from 1980 to 17-18 year is as follows

Total wages - increased 774%
Total tax - increased 781%

Annoying I can't find the OECD data on the top 1% of househounds. However by Googling "top 1% UK tax historic" the first few articles state:

"The top 1% have seen their share of total income tax payments rise from 25% to 30% since 2010 as policy reforms particularly under the coalition, increased income tax for the best off while reducing it for those on more average incomes. " November 2019 Accountancy Daily

"The top 1% of earners in the UK now account for more than a third of income tax paid to the government, following changes over the past decade that have left almost half the population exempt from making payments. In research underlining the dual nature of Britain’s income tax structure, the Institute for Fiscal Studies said above-inflation increases in the personal allowance to £12,500 a year meant 42% of adults paid no income tax. The thinktank said the top 1% of all adults accounted for well over a third of income tax, adding that the tax and benefit system was progressive. Meanwhile, the share of income tax paid by the top 1% of taxpayers – a smaller slice of the population because so many people pay no income tax – has risen from 24% of the total in 2007-08 on the eve of the financial crisis to 30% currently. “Unlike the increases in previous decades, this has not been driven by a rising income share at the top,” the thinktank said in a briefing paper. “Rather, it reflects policy reforms: there have been income tax rises for high-income individuals (the additional rate of income tax above £150,000, the withdrawal of the personal allowance above £100,000, substantial cuts in income tax relief for pension contributions, and a net real reduction in the higher-rate threshold), even while increases in the personal allowance have reduced or eliminated income tax for those with lower incomes.” November 2019 The Guardian

It isn't a contentious or even an arguably point that the Tories have been taxing the rich and giving tax breaks to the poorest over the past decade.
Last line is another assertion and an invocation of another controversial concept, and yet again is in contradiction with the facts
Tax as %age GDP: (source is just wiki)
Belgium - 47.9%
Germany - 44.5%
EU avg - 35.7%
UK - 34.4%
Switzerland - 27.8%
I's impossible to compare taxation to GDP across completely different economies. If your economy is underpinned by manufacturers then you can extract more taxation . If you're economy is underpinned by banking and financial services you'll be able to extract less. If your country is based on being a tax haven you'll extract even less (e.g. Ireland and many island countries). That's why you'll never see Ireland or Switzerland extracting 35% of tax to GDP, because in doing so their tax take would reduce. It's interesting for example that Ireland's corporation tax is the lowest in the EU, but their corporation tax receipts to GDP are the highest. The same is true of other tax havens.

Countries like Switzerland, UK, SIngapore, Korea, Japan etc will never be able to extract Belgium or Norwegian levels of tax to GDP and if they did it would repress GDP growth and tax take. If they attempted to do so you'd see GDP lag/fall as fluid companies moved to more competitive environments; but tax to GDP rise (albeit with lower tax take). This is already happening with UK businesses moving to more competitive environments like Singapore due to increases in taxation over the last 10 years. This is why we've seen depressing levels of GDP growth across Europe (high tax countries), but then places like Ireland and Singapore (low tax) have seen great GDP growth. The Tories made an active decision to reduce GDP growth but increase taxation to GDP.
To sum up you take a world that looks like this, with the UK govt paying for almost all healthcare costs despite receiving the lowest taxes including individual ad corporate taxes and say that the main problem with the UK healthcare system is high taxes.
Again single taxes can't be isolated to prove a point. The whole tax environment needs to be factored in. I've also never said that the problem with the UK is high taxes, I've agreed that funding is the problem. The argument is how we extract funding from an economy that already has historically high taxes and historically high debt.

If we increase taxes we will repress GDP growth as businesses will relocate to Ireland, Singapore, US and wealthy individuals will relocate to tax havens. This will result in a net fall in taxes which obviously won't help funding of the NHS. If we allow for an insurance based healthcare system you'll see that wealthy people will spend far more on healthcare and also aren't a burden on the state. Someone earning £500k per annum should not be receiving benefits from the government in the form of free healthcare, especially as they don't appreciate the healthcare they receive. If you gave a poor man a new Kia Rio free of charge as his only form of transport they'd be very happy, if you gave a millionaire the same offer he'd despise it. Give him the option of a free Kia Rio or the option to buy his own Porsche and he'd opt for the latter every time.
Let's rephrase your argument. You believe that the way to approach the situation of increasing healthcare costs seen across the world including in the UK is to shift the burden to individual expenses. Since your original premise is that UK expenditure can't keep up with demand, and that redistributive taxes are unacceptable, what this means is that <total care> will be redistributed - triage by income.
I don't think redistributive taxes are unacceptable, I think they have a limit in every country. The UK are close to that limit.
Edit - won't be responding further. was bad enough digging up dozens of graphs to see what was actually true in what I was replying to (not much is the conclusion)
Agreed let's leave it there.
 
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One things that's become very clear through the pandemic is the rampant personification of the NHS. People treat it like it's some kind of demi-god. There will never be the much needed reform because of that.
 
One things that's become very clear through the pandemic is the rampant personification of the NHS. People treat it like it's some kind of demi-god. There will never be the much needed reform because of that.

Very true. I thought working in Australia would be quite similar but the systems, the approach of the general population towards the healthcare systems are totally different.

Even the way the docs and nurses think about it all is totally different.
 
I took a relative to A&E after his GP suspected he'd had a heart attack. We waited 10 hours to see a Doctor. Went in at 7pm, left at 5am. Spent most of that time in 2 waiting rooms and eventually a corridor which was turned into a waiting space.

It definitely needs investment.
 
Interesting discussion overall.

I wanted to ask a question to get people's views on something that may be a little sensitive, I certainly don't mean any offence.

One of the discussions I've had before is a sort of taking stock of the NHS. It's initial intention and what its role has become.

Would people be against a sitting down and seeing what the role of the NHS should be and basically look at what it shouldn't?

The sensitive but would be discussions around IVF, gender based surgery, obesity related surgeries (gastric bands etc) and cosmetic related surgeries. Free or contribution based or even fully paid by patient?

Also within that some of the care in hospitals. I spend/spent a lot of time in hospital with my son and the tasks of changing his nappies or feeding and general small tasks that nurses would have to undertake if I or my wife were not there. Should that be a given? As in family should be undertaking that? Even the moving the patient from x-ray to ward etc. Should that be left to porters or should family be doing it, in the simpler cases eg wheelchair rather than bed?
 
Interesting discussion overall.

I wanted to ask a question to get people's views on something that may be a little sensitive, I certainly don't mean any offence.

One of the discussions I've had before is a sort of taking stock of the NHS. It's initial intention and what its role has become.

Would people be against a sitting down and seeing what the role of the NHS should be and basically look at what it shouldn't?

The sensitive but would be discussions around IVF, gender based surgery, obesity related surgeries (gastric bands etc) and cosmetic related surgeries. Free or contribution based or even fully paid by patient?

Also within that some of the care in hospitals. I spend/spent a lot of time in hospital with my son and the tasks of changing his nappies or feeding and general small tasks that nurses would have to undertake if I or my wife were not there. Should that be a given? As in family should be undertaking that? Even the moving the patient from x-ray to ward etc. Should that be left to porters or should family be doing it, in the simpler cases eg wheelchair rather than bed?

Sometimes there’s a physical treatment required for a mental health issue. It’s that simple.
 
Sometimes there’s a physical treatment required for a mental health issue. It’s that simple.

I accept that. And I guess that is why it wouldn't be an easy discussion and I didn't want my comment to cause offence.

It's interesting you mention mental health because that is one of the issues discussed when I was involved in the discussion and the point was made that health needs maybe change and that needs a discussion on its own.
 
One of the discussions I've had before is a sort of taking stock of the NHS. It's initial intention and what its role has become.

Would people be against a sitting down and seeing what the role of the NHS should be and basically look at what it shouldn't?

I'd argue there are far wider systemic problems within the NHS which is causing a lot of it's challenges. From the area I know well, and have had experience, the organisation has one of the most inefficient procurement processes known to man, and the NHS are often overpaying for basic supplies due to the framework structure it employs. There's some fundamental elements which need addressing, and then some of the treatments you are mentioning probably doesn't even come into a discussion as to whether it's subsidised or part paid by the patient.
 
I'd argue there are far wider systemic problems within the NHS which is causing a lot of it's challenges. From the area I know well, and have had experience, the organisation has one of the most inefficient procurement processes known to man, and the NHS are often overpaying for basic supplies due to the framework structure it employs. There's some fundamental elements which need addressing, and then some of the treatments you are mentioning probably doesn't even come into a discussion as to whether it's subsidised or part paid by the patient.


Yeah I agree with you. Having worked for local authoirities and the PCT I've often said the money wasted is on supplies etc. Along with consultants for short term feasibility studies and what not.

The points I was raising was in relation to how some of the conversation was progressing with regards to people potentially paying into the system.