GREENER THAN VEGETABLES!
Tuesday, September 4, 2007 at 06:12PM LOL - have you read the Conservatives plans to sort out the dysfunctional NHS?
Well, call me Dave wants patients who refuse to change their unhealthy lifestyles to be denied treatment by the NHS. In a bid to ease spiralling levels of obesity and other health concerns, a Tory panel said certain treatments should be denied to patients who refuse to co-operate with health professionals and live healthier lifestyles. And those who do manage to improve their general health by losing weight and quitting smoking, for example, would receive "Health Miles" cards. Points earned could then be used to pay for health-related products such as gym membership and fresh vegetables. Oh yea, I can really see that one working, can't you????
Here's my alternative deal to Dave. How about that those of us who want to live our lives in the way WE see fit be given the tax-breaks to opt-OUT of the NHS and make our own health-care provisions? How about the UK population are treated as adults and given the chance to make adult choices about health-care. All I really need from the NHS is the Accident and Emergency provision, normally ghastly anyway, and I will pay the appropriate taxes for that, but NOTHING else? Is that a deal, Dave. Not one penny more in tax for your all powerful NHS. You see, I do not want political creeps like Cameron telling US what we should eat, what we should drink, how and when we should exercise. I hate the Nanny State and Cameron is a bigger Nanny than even Labour!
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Reader Comments (35)
LOL, time for you to get into your PJ's.
signed,
nanny
Of course there will have to be government inspectors to make sure that those who claim to have quit smoking really have.
And the fatties will have to be policed too for signs of unlicensed girth.
There may be a case for a hotline where concerned friends and neighbours could report smokers and gluttons who backslide or fail to keep to their commitments.
The Smoke Tuck And Zeal Inspectors (STAZI) would be a memorable name for this new public service.
The instruments of the state are simply not functioning for the benefit of those for whom they were intended. Hospitals are now where patients contract often fatal disease and the police now attack the public. Check this out to see how bad the 'public services' are becoming and ask whether things would be any different under Dave?
http://www.thisislondon.co.uk/news/article-23410896-details/Pedestrian+hit+by+police+car+suffers+broken+foot+-++and+£80+penalty+for+'denting'+vehicle/article.do
The Standard article you link to makes an interesting point, but it rests entirely on lifting a vague quotation about lifestyle choices from 50 pages of turgid writing on health policy which actually makes no mention of denying people treatment.
Of course, such denial is already government policy. And disappointingly, much of what is in the official Conservative document on health is footling detail or empty management-speak which might have been scripted word for word by officials in the health department.
Michael Ancram's paragraph on the NHS was much better ...
So David with your private system, would you feel aggrieved if your premiums were driven up yearly by obesity? Or would you expect obese people to pay higher premiums or top up their healthcare themselves? Aditionally how would go about reducing tax burdens brought about by obese people seeking say emergency treatment without healthcare cover?
'By redirecting the increased cost to those responsible, one arrives at a solution that provides incentives for leading a healthy lifestyle while not unfairly burdening the segments of the population that elect to make health-conscious choices' From a paper on the growing burden of obesity on the private system in the US "Super Size My Premiums"
David, you're entirely too sensible for your government.
Alison, some insurance providers and employers in the US are already increasing premiums for the obese and smokers - the smokers are saying fine, the obese are screaming discrimination. I certainly don't think it's unreasonable to have people with self-inflicted higher health risks to pay more for insurance.
Denying coverage/care under government run universal health care seems pretty brutal considering ya'll are paying taxes for a system that insures everyone has comprehensive medical care.
Good point Daphne. I fail to see how a govt can deny treatment to people who have paid in taxes for that Health Service. It's a gimmick that would only end up being overturned by the courts.
Hi Daphne - I dont see this as really any different in many ways because we pay so little already towards healthcare here. Way less than yourselves per person average for example. If someone chooses to be obese you should have to make additional payment into the system whether private, via premiums, or through the NHS.
Alison,
My point is why must we pay a penny to an NHS if we do not wish to use it? How much tax revenue goes into the NHS? Why is financial choice not an option?
Colm - the system is unchanged and underfunded because we pay so little. In spite of radical changes in life expectancy, treatments and lifestyle choices. We should either all pay more to cover this or expect obese, smokers, drinkers, drug addicts to supplement the system with additional payments. Equally i think people should be able to top up payments to suit themselves as and when they can financially and then be entitled to supplementary service - thereby creating a universal system that gives people choice. Like the French private-public hybrid.
The other option id support is to stop it being free at the point of need (again like France). We could then recupe the £68 million lost in health tourism in this country every year.
I agree with you Alison. I have read your posts and other information on the French system and I think it comes across as the best system I have been aware of.
smokers do pay more. Check the tax on cigarettes.
'Why is financial option not an option.'
I'll tell you part of the reason. Most people who pay taxes,including those in the public sector, especially those who work for them selves don't pay an awful lot either David. The stamps that you can buy or whether you pay for it yearly thru your accountant, aren't an awful big contribution as is, and those in work are usually well. If all you need is A and E, I can understand your POV, but what about later on when you will need the NHS. Don't say you won't, get real.
You are perfectly free NOW to opt out of universal health care if you choose, try BUPA. Infact you can float between the two. What about those who can't afford it, like many OAPs? What will a tax break do for them?
You may choose to be a Conservative with a capital C, but noblesse oblige days are gone improvements have been made. The NHS is in a bad state, no doubt about it, but it's better than nothing for many.
Are you living in an ivory tower down there in Donaghcloney, come up to the big city and see some of the places people are living. There are terrible conditions for many Unionist and Nationalists alike.
Thats why financial option is not an option, It may be ok for you but not for the many.
p.s. David, NO tax revenue goes into the NHS, contributions (NI) is paid seperately.
Typhoo,
You're right. So, can I please stop paying NIC?.
If you are self employed as you say then (class 2 )your total contribution each week is £2.20 thats less than five dollars.
If not and you pay higher rate ie for those who earn over one hundred pounds a week but less than 650 you can pay up to eleven percent. NO you can't opt out, but your contribution is EXACTLY the same as somone who would earn over £100 per week, that means many low paid people will pay the same as you. It's not a fair system, but people opting out because they are ok at the minute and then trying to opt in when they get old or sick isn't the answer either is it David?
I just checked to make sure and we pay $260.00 a month for health insurance for a family of 4. That includes major medical as well as regular doctor visits and prescriptions. We have a $1200.00 yearly deductable we must meet before 100% paid coverage kicks in. Our doctor visits cost $20 a pop and medicine is $5. We also take advantage of a tax free medical savings account. Our coverage is incredibly good and affordable.
I wasn't aware David was a company director so it was from not knowing rather than a mistake. This may be useful,to work out anyones situation
http://www.direct.gov.uk/prod_consum_dg/idcplg?IdcService=SS_GET_PAGE&siteId=en&ssTargetNodeId=259&ssDocName=DG_4015904
As I have said previously Dave the Prat is really going all out to win the election and may even succeed in 2030. The next election I want to see is for the leadership of the Tory Party .
David Vance asks why must we pay a penny to an NHS if we do not wish to use it? The answer should be that we should not. However, the more important question is - why should we have to pay money into the NHS if we are not to be allowed, for lifestyle reasons, to receive treatment when required?
The boy (little boy) David needs to be taken away by the men in white coats if he does not realise the illogical stance he has taken.
Peter T.
It isn't only the NHS that is paid for by NIC, but state pension, or incapacity if you fall ill. If you don't want to pay, then perhaps there ought to be a way to opt out, as long as when you get old frail and sick you don't opt in again. Most of us pay the same percentage of our income but there are some who benefit more from contributions. I've no problem with it if we are all paying more or less the same contribution. However, I hope you don't opt out and then decide you may need incapacity if you meet with an accident or get a disease, or get old and need a pension.
Once the NHS was the envy of the world, a universal system for all no matter what, with a little effort it could be the envy of the world again. The population of this country need a safety net, no one knows what is going to happen tomorrow.
In a market (those thing that provide goods and services better than anything else) people who live unhealthy lives would pay more for their healthcare (and thus have an incentive to change). Instead, the healthy subsidise the unhealthy and they have no financial incentive to change their ways.
I find the analogy of a safety net amusing when talking about the NHS or other such nationalised industries: governments don't provide safety nets for acrobats, but acrobats still have safety nets! Even the ones who go without say it's a fair cop when they fall, and gain the benefit of a more wow-ing performance (and thus better profits).
In other words you are agreeing with Cameron that incentives should be given - and your reason is that it is because it is market driven? Not much difference between you then.
The concept of a safety net won't be amusing if you sommersault and fall and break your neck and can't do another performance.
Daphne: That is cheap! Are you with a company-sponsored program? And are you HMO, or private physician select? (I'm shopping insurance...) It could be that California insurance is high due to litigious environment (compared to Texas)
Although I would think that the gun shot wounds would up the premiums down there. ;)
Typhoo,
I agree with Cameron that incentives should be given. Incentives matter. However, I don't agree that continuing to charge unhealthy people at the same rate as the healthy and yet refusing them service is the way to do it. His idea is not in the least bit market driven: everybody being forced to have health insurance and being forced to buy that health insurance from the government is not a market, it's a racket. Refusing to actually render the services promised is not making it more like a market, it's just making it an even crummier racket.
I'm sure I'd be alright in the acrobatic world. Young and healthy I'm not like to fall, and I'm a catious sort so there'd be at least a mat to land on and as I get older I'll switch to a full blown net, maybe a harnass too (like to see the NHS provide those). But suppose I went without any of that, maybe I'd get hurt, but that's the gamble I choose to take. On the other hand I would save on nets and have the money to spend on things I'd rather have, like an education, getting on the property ladder, investing in my own company and so on (they're very expensive nets these).
I assume you support the state provision of safety nets for acrobats then?
Oh and Patty,
In California 72.6% of its 2,503 murders (1,817) used a firearm. In Texas, 61.3% of its 1,407 murders (862) used a firearm. So actually Cali is the shootier state :P
CL
I agree the NHS is in a sorry state, that's not what I'm defending, what I am defending is the principle that all pay the same into a hat and that services are rendered. A bit like the concept of going out with a gang of friends and pooling the money. For example, I pay the same as everybody else but I don't take alcohol. And they'll say to me, thats' not fair, if all you want is a lemonade, while we down more expensive drinks, but its the principle, if we all go out together and that is the deal everybody else works on.
I agree entirely about incentives. I don't drink or smoke but I pay the same as those who do. Yet look how many have smoke and alcohol related illnesses, same with drugs.
I totally understand about your own company, my own son is selling his and taking his family to Dubai, they leave today the 5th of September so I can truly understand. But the paltry sum you spend each week on NIC won't get you your own company.
If you are the cautious sort, then if I were you I'd pay NIC. Someone like Gordon Brown may come along and eat up any pension you have or any savings you have for your old age. Which I'm sure will come to us all.
We all have beefs with the system, but the NHS is a concept I'd support though if it doesn't change it can't survive.
Typhoo
I support it but want change. And we certainly dont pay enough.
In all the time ive used the NHS ive had excellent healthcare and hospital cover. My mothers life was saved in NHS A&E following an accident with an excellent standard of healthcare throughout and since. My own hospitalisation on two occassions were dealt with promptly and immediately in clean excellent hospitals. I hardly had to wait. None of my family have had poor service and I know we are not the only ones.
I also now pay an additional top up for private healthcare.
However to have good debate on healthcare it is pointless taking the cases that work. And we certainly do not in this country!
ATW concentrates mostly on the bad things - which are there to force a debate on private - lets be realistic about it and deal with the sticky side of private.
The US example:
Premiums for employer-based health insurance rose by 7.7 percent in 2006. Small employers saw their premiums, on average, increase 8.8 percent. Firms with less than 24 workers, experienced an increase of 10.5 percent
The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $11,500 in 2006. Workers contributed nearly $3,000, or 10 percent more than they did in 2005. The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).
Since 2000, employment-based health insurance premiums have increased 87 percent, compared to cumulative inflation of 18 percent and cumulative wage growth of 20 percent during the same period
Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by 2008.
According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers' earnings since 2000.
The average employee contribution to company-provided health insurance has increased more than 143 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.
The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 a 16 percent increase
One in four Americans say their family has had a problem paying for medical care during the past year, up 7 percentage points over the past nine years.
30 percent say someone in their family has delayed medical care in the past year, a new high based on recent polling. Most say the medical condition was at least somewhat serious
A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance.
Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.
Retiring elderly couples will need $200,000 in savings just to pay for the most basic medical coverage. Many experts believe that this figure is conservative and that $300,000 may be a more realistic number
47 million Americans are uninsured - covered in taxes - im not sure if that includes the illegal immigrants who in some states use the system to give birth for example)
Wow, Alison,
Your post and statistics are impressive. It makes me realise how very lucky we really are.
Typhoo,
I have no problem with egalitarian health insurance as you describe. Personally I would go for a more traditional system of insurance but I'd not force that taste on others. My objection is that everyone in Britain is forced to be part of such a scheme.
I wish your son good luck with his business.
Alison,
Interesting statistics but I have to say most of them don't tell us anything useful. Healthcare costs are rising, so what? If it's more expensive for private firms it'll be more expensive for government. Indeed, a lot of the price rises are caused by state healthcare itself - 50% of US healthcare spending is done by the state, and they vastly over-consume which raises prices for everyone else.
The most important statistic your raise, I think, is this one:
"The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $11,500 in 2006. Workers contributed nearly $3,000, or 10 percent more than they did in 2005. The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712)."
Firstly, very few people earn minimum wage for any length of time. Students, new immigrants etc. Almost no one earns minimum wage for their entire life. Secondly, a family of four would presumably have two wage earners, not one, so their income before benefits would be $21 424 if both earners made minimum wage - enough to have healthcare and survive ok. However, most won't need to buy health insurance because their employers provide it for them. I know a woman in the midwest who has two kids and an unemployed husband. She earns minimum wage at Wal-Mart but has health insurance via them and lives a reasonable life - the apartment isn't damp, they never go hungry etc.
Incomes would be higher if they didn't pay so much in tax to fund government healthcare.
Also, the average healthcare package is hardly a fair bar to measure by. Since average family income in the USA is $44,334, so the average family healthcare plan is designed for them. Cheaper packages are for lower income workers and those are more affordable.
And lastly, medicare and mediaid take care of those without health insurance, and they can pay out of pocket (which is often better value for money).
47 million Americans may be without health insurance, but are they any worse off? No! There is no discernable difference in health between those with and those without health insurance and those without pay only slightly more in out-of-pocket healthcare expenses. For most people, it's actually better deal to go without health insurance and pay out of pocket. What you really pay for with insurance is peace of mind so perhaps those without halth care just don't value that as much as they do the money they save. Isn't that fair enough?
When people are given free healthcare by government, they consume around 22% more healthcare (it's free!) but gain no health benefits from this increase. This over consumption drives up prices, and so raises taxes and lowers incoems, wastes time and resources etc.
The US healthcare industry is far from perfect, but most of the deficiency is not due to any knid of inherent inability of markets to provide healthcare, but because of government interference. If the market were left to its own devices, I think you'd find that there would be more and better healthcare administered to more people for less than the current 50-50 system (though when you factor in regulation etc it's more like 70-30) or a 100% state system as in the UK.
Im an American friend of Alison's, id like to contribute to this debate. I know something of the French system she favors.
CL: We have to deal with these costs and frankly the provision all round. Its better to deal with the cost of getting sick out of pocket? You are kidding me. Didnt you read the statistics above? You are obviously banking on never getting sick yourself and then having the worry. We have huge issues of poor insurance provision and we still are not able to give people the reassurance of care - something which i do believe a civilised nation should offer in some way. The AMA, Big Pharma and the Insurance Companies stand in the way of any real change to the health care system in the US and are ripping us off. 'When people are given free healthcare by government, they consume around 22% more healthcare (it's free!) but gain no health benefits from this increase' which is why Alison was proposing the French system which is not free at the point of need, does not have government involvement in the samw way as the UK and provides choice.. You pay up front and are reimbursed. You are also not needlessly supporting anyone who hasnt paid into the system. '47 million Americans may be without health insurance, but are they any worse off?'. Yes they are. They do not get treated efficiently or properly and so become a consistent and repeat user of the system. And refer to the stats she provided above for the insurance shortfalls and nos of people who end up delaying treatment who DO have insurance.
As I said I’m an American and was living in France for the last 20+ years in one of the largest cities so I think I can make a fair comparison between healthcare in France and the USA.
When I need a doctor’s appointment I called my generalist and usually got in that day or the next. My doctor has no nursing or secretarial staff though some do. When it’s my turn she greets me in the waiting room and leads me to the examining room. Small practices seem to be the rule here rather than the exception.
The ophthalmologist, urologist, dermatologist and dentist I saw run small practices. Each shares a receptionist with one or two partners and no nursing staff and no lab. If lab work is needed you’re sent to a local laboratory to do blood work or whatever and get all back the same day.
My experiences in the States are of large practices where you get to spend precious little time face to face with the doctor. The French system is better, easier, more efficient, user friendly, professional and provides a level of care for all without half as much government interference you find in the UK or frankly the US.
I consider the health care I’ve gotten here to be better than that I’ve received in the States. I consider the doctors to be as well trained and knowledgeable there as in the States.
They charge reasonable amounts for their services, do an excellent job, don’t have to pay outlandish liability insurance premiums and get paid fairly for their work.
Bottom line: I’d rather be sick in France than in the USA
Ive been advised to point out the following too!
I used to be 100% anti-"socialized" medicine until I lived in France. I dont think you even can call it socialized in reality. There I found out that the health care was excellent. I would recommend that people get the facts themselves because they are quite clear. The health care lobby has obfuscated the facts so that people who are free marketers like me reflexively believe their propaganda. However, a close examination of the issue will shed light on the fact that France has a superior health care system although with issues like all. Philosophically, I don’t like that, but the facts and experience are telling me it is true. If anything the UK would be best placed to examine this system as an option.
Oh I don't dispute that France offers better healthcare than the US does currently. The US system, though good in many respects, is a festering husk of special interests, interference and regulation. All in the name of helping people of course, but it ends up doing the exact opposite. Moving towards a French system might well be better than the current system, but it is not the best system.
"the French system which is not free at the point of need, does not have government involvement in the samw way as the UK and provides choice.. You pay up front and are reimbursed. You are also not needlessly supporting anyone who hasnt paid into the system."
To clarify: the French government does not regulate or run any hospitals or other medical practices (except military hospitals)? Taxes that pay for healthcare are voluntary i.e. I can opt out entirely and get no health insurance, or opt to go 100% private and get no government aid? Nobody is covered who doesn't pay (excepting private charity)? If you're going to pay taxes for healthcare, but then pay out of pocket and get reimbursed...what's the pont? Why not just pay out of pocket and do away with the taxes? That's just the government borrowing your money to pay back when you get ill, only without interest. Why not keep the money and spend it yourself when you get ill (you can put it in a savings account or invest it and have more money instead of the same but later)?
"'47 million Americans may be without health insurance, but are they any worse off?'. Yes they are. They do not get treated efficiently or properly and so become a consistent and repeat user of the system."
That's not true. Americans without health insurance are just as healthy as Americans without. They also spend only slightly more on healthcare via out-of-pocket expenses than those who do have health insurance.
I dont have time to go into the French system now, maybe someone else can. It is not free at the point of >need< basically - which works very well.
Your system wont work paycheck to paycheck or in the event you havent had time to save for the cancer or trauma you find you suddenly have. what you are saying is that people basically have had it if they get ill. The fixed libertarian approach to this is deeply flawed. Lets be realistic. That is not the best system. I would called myself a Progressive Libertarian. So I believe that there are places government should keep their mitts out of, and others where government needs be involved for some commonality. Ultimately getting people back to work quickly benefits us all.
BTW i should fix something said earlier. You can no longer bankrupt medical debts. If something like this happens to your family, you will remain financially enslaved to your medical creditors for the rest of your life!
" you will remain financially enslaved to your medical creditors for the rest of your life!'
You mean similarly to those other creditors, as when you take out a mortgage, or a student loan, or any commitment involving any capital sum? No-one seems to mind those in quite the same way. Perhaps it is just a matter of getting priorities right.
State and hospital run payment schemes are usually offered on very favourable terms - at least that is my experience, hardly a financial enslavement, more like a commitment.
Anyway what else would you rather spend your money on? I always thought good health was priceless...