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  #81  
Old 18.02.2016, 09:02
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Re: Junior Doctors - NHS vs. Swiss

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It's also a common myth that NIC go exclusively to the NHS. I think only about 10% go to the NHS. General taxation also pays for the NHS.
Nope.


The UK Treasury has alawys ensured that the UK has no dedicated taxes - everything paid in whatever it is called goes into a general taxation pool. NIC has nothing directly to do with the NHS at all.


From your pov (as you are now in the UK I believe), payment of NIC is linked to your future state pension and certain other social security benefits. Nothing else.
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  #82  
Old 18.02.2016, 10:01
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Re: Junior Doctors - NHS vs. Swiss

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So many arguments have been made here, but I think most of them miss the most crucial issue: the NHS is free at the point of use. That means you can get a heart transplant costing thousands of pounds, or a lifetime of cancer treatment costing tens of thousands, and still just pay your usual rate of income tax. I'm going to make an assumption that the majority of EF users are, being expats, fairly well-off and a great many probably have company insurance. The fact that the NHS is free at the point of use instantly makes it invaluable to a huge number of people.

Finally, I recall someone mentioned the Mid-Staffs scandal. As tragic as these events are, consider the amount of patients treated by the NHS every day. Perhaps we would do well to get a news update every time a life is saved.
This "free at the point of use" is such a red herring. France, Holland, Germany etc. don't have the same model yet also have no health poverty like most in the UK would have you believe. Basically, if you're poor, you'll still get cancer treatment.

Regarding Mid Staffs, it's not a one off.
http://www.bbc.co.uk/news/health-35597244

Agree with some your cost savings measures though. I'd also ban any job with the words "diversity" or "equality" in the job title. Here's three openings for such positions ranging between £40k and £50k a year. Switzerland has a foreign population near 25% and remarkably no diversity managers.

https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914062488
https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914075601
https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914069364
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  #83  
Old 18.02.2016, 10:54
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Re: Junior Doctors - NHS vs. Swiss

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Nope.


The UK Treasury has alawys ensured that the UK has no dedicated taxes - everything paid in whatever it is called goes into a general taxation pool. NIC has nothing directly to do with the NHS at all.


From your pov (as you are now in the UK I believe), payment of NIC is linked to your future state pension and certain other social security benefits. Nothing else.
Where did I say the UK has dedicated taxes?
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  #84  
Old 18.02.2016, 11:08
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Re: Junior Doctors - NHS vs. Swiss

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We're looking at a massive brain drain hitting the UK's ability to provide any health care with the double whammy of the new junior doctors' contracts and the threat to send any foreign workers earning less than GBP 35k back to where they came from. So that's junior doctors and other medical staff leaving the country because the government would rather let Starbuck's and the likes off the taxation hook. The government is targeting the two areas that the voters care the most about.


Who's next? When are you going to say enough's enough?


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Heeeh, welcome to the rest of the world's world, UK. It was about time...
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  #85  
Old 18.02.2016, 11:18
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Re: Junior Doctors - NHS vs. Swiss

You want to solve the problem? Simple. Tax.

I dont mean more tax. I mean get the tax that is owed. Google, 130million? Takes the piss. Estimates vary, but the figure commonly used is that tax avoidance costs the UK £120Billion in missed revenue. Instead of screwing over the junior doctors, why dont we stop licking the boots of every big company, and insist that if they want to continue to have access to the UK markets, they have to contribute to it. even half of that £120billion would be a huge coup, and would contribute to solving a lot of problems in the UK, including healthcare.

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Sliding scale. Link GP registration to NI number/ HMRC records and have a nominal fee from each patient either monthly (to remain registered) or upon securing an appointment. Under 16s free, over 85s free. Subsidies for OAPS, students, unemployed etc.


But then that's just a tax hike by another name I suppose.


It's still not fair to reduce the earnings of junior doctors which, I believe, was the point at the start of this thread?
Sorry, but if you're going to do that, why let OAPs off the hook? They're the buggers that cost the NHS the most, make them pay more for it. Its only fair. Why should healthy 25 year olds pay for unhealthy 85 year olds?

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How's this for a business plan?

The supplier works, trains, researches, cares and basically gives their all.

The customer takes all the supplier can supply, but pays nothing at all for it.

The government (aka the tax payer) foots the suppliers' bill...

Will this idea fly??
The customer does contribute. Are you forgetting about tax, my dear?

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The NHS is a crazy model. That's why nobody else does it. But it's become such a big political tool that nobody will ever have the balls to replace it, not in our lifetime.

A huge percentage of it's biggest users have never contributed a penny towards it and and a huge percentage of it's biggest contributors have never used it.

I'm from the UK and I'd gladly see it replaced with a Swiss type model if i ever moved back there.

Just a throwaway example from this last weekend, a friend in the UK fell over and went to hospital, got an X-ray, was told arm was broken, told to come back today, three days later to see a doctor and discuss the break to decide what they'd do next, take some parecetemol meantime. Still not reset, still in pain, back tomorrow again. A friend here in CH fell skiing, same day, broke ankle, was in theatre within two hours having it reset properly, pins inserted, got out today, home help and cleaner supplied by insurance to help while the plaster is on.

Very different outcomes.. Considering they probably pay around the same towards their healthcare, just funded in a different way.
Then make the OAPs pay more. Just like they do in Switzerland.

How much does your friend pay for health insurance? If everyone paid an equivalent amount in the UK as they do in Switzerland, believe me, the complexion of the NHS would be far more rosy cheeked.

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Weekend care is a problem in a lot of places. Of course patients deserve great care no matter the day - or the time of day.


By the way, friend of a friend of mine had their three year old son turned away from a Basel hospital with a fractured arm because it was a Sunday and the radiographer wasn't in. It wasn't deemed an emergency. They were told to go back on Monday. And that, I believe, is the private model.


I'm not saying the NHS is perfect - I'm saying that on the whole, it does a good job under great strain.
Theres lots of guff about the NHS being poorer on weekends - i've yet to see a single reputable study confirming that fact.

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Yup, that's the problem. First you need a GP referral. Waiting times for GP appointments on the NHS are approaching 2 weeks. Here, I've never had to wait more than a day or two.
Here you pay a c***load more.
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  #86  
Old 18.02.2016, 11:35
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Re: Junior Doctors - NHS vs. Swiss

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Here you pay a c***load more.
Don't know what insurance you've got. I've got every extra going and the lowest excess and it comes no where near to 12% of my earnings. I reckon most people in the UK pay more than 500 chf NI contributions every month.
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  #87  
Old 18.02.2016, 11:44
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Re: Junior Doctors - NHS vs. Swiss

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Don't know what insurance you've got. I've got every extra going and the lowest excess and it comes no where near to 12% of my earnings. I reckon most people in the UK pay more than 500 chf NI contributions every month.
As per my link - Switzerland spends 11.4% of GDP compared to 9.3% for the UK.
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  #88  
Old 18.02.2016, 11:46
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Re: Junior Doctors - NHS vs. Swiss

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As per my link - Switzerland spends 11.4% of GDP compared to 9.3% for the UK.
A more meaningful measurement for the arguments here would be percentage of GDP per capita.
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Old 18.02.2016, 11:53
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Re: Junior Doctors - NHS vs. Swiss

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A more meaningful measurement for the arguments here would be percentage of GDP per capita.
You mean instead of dividing the healthcare spend by the GDP, you divide the healthcare spend by the population, and divide all that lot by the GDP divided by the population??

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Old 18.02.2016, 12:02
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Re: Junior Doctors - NHS vs. Swiss

If a country has a high GDP but spends the same percentage of GDP on healthcare as another country with a low GDP then with what you stated earlier, the figure is the same but in fact, with the same size population, the second country is spending a lot less per person on health care.
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Old 18.02.2016, 12:15
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Re: Junior Doctors - NHS vs. Swiss

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If a country has a high GDP but spends the same percentage of GDP on healthcare as another country with a low GDP then with what you stated earlier, the figure is the same but in fact, with the same size population, the second country is spending a lot less per person on health care.
If you are looking at % the population makes no difference. Sure the per person spend might be lower - but the % is the same.

One reason why they use the % is that you can't apply Swiss medical costs to the Democratic Republic of Kenistan - whose GDP is based solely of exporting young girls into the sex trade, processing of Poppies into high grade heroin and being the headquarters of Ken-tucky Fried Chicken.

1000usd of healthcare doesn't get far in Switzerland - it would get you a new kidney in the DRoK
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Old 18.02.2016, 13:30
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Re: Junior Doctors - NHS vs. Swiss

It's not about money. It's about time. If you have enough doctors to provide 100% cover 6am-9pm Mon-Fri and 50% cover all other times, then you try to make the same number of doctors cover 100% all the time then the doctors do have to work more hours, or you need to employ more doctors, add to that that at the same say you are no longer entitled to overtime, what do you think these doctors will face? Tiredness kills you know, I don't want to be seen by a doctor who has been working 100 hours.
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Old 18.02.2016, 17:36
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Re: Junior Doctors - NHS vs. Swiss

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It's not about money. It's about time. If you have enough doctors to provide 100% cover 6am-9pm Mon-Fri and 50% cover all other times, then you try to make the same number of doctors cover 100% all the time then the doctors do have to work more hours, or you need to employ more doctors, add to that that at the same say you are no longer entitled to overtime, what do you think these doctors will face? Tiredness kills you know, I don't want to be seen by a doctor who has been working 100 hours.
Sorry I can't follow that reasoning. It's all about money! (Time is money.)

- Employing more doctors costs money

- Paying them overtime costs money
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Old 18.02.2016, 17:56
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Re: Junior Doctors - NHS vs. Swiss

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It's not about money. It's about time. If you have enough doctors to provide 100% cover 6am-9pm Mon-Fri and 50% cover all other times, then you try to make the same number of doctors cover 100% all the time then the doctors do have to work more hours, or you need to employ more doctors, add to that that at the same say you are no longer entitled to overtime, what do you think these doctors will face? Tiredness kills you know, I don't want to be seen by a doctor who has been working 100 hours.
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Sorry I can't follow that reasoning. It's all about money! (Time is money.)

- Employing more doctors costs money

- Paying them overtime costs money



I think you're arguing different sides of the same point. Yes, it's basically about the money - but because the money isn't there it then becomes about the time. As MrsWooWoo says - the same amount of doctors cannot safely and effectively do twice (or whatever proposed percentage) the amount of work. It's like the (hopefully shelved) proposal to extend the school day to 8am -6pm for the students so that working parents didn't also have to find additional childcare. More staff would have to have been recruited, or contracts rewritten and pay adjusted etc etc etc. But the reality was that it was expected that the schools would absorb the changes with the staffing levels they had and somehow expand to fit... it wouldn't have worked. When would marking/planning etc have been done? And no, this is not me starting a teaching debate.


The system is under strain. The personnel are under strain. It will snap.
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Old 18.02.2016, 21:46
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Re: Junior Doctors - NHS vs. Swiss

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This "free at the point of use" is such a red herring. France, Holland, Germany etc. don't have the same model yet also have no health poverty like most in the UK would have you believe. Basically, if you're poor, you'll still get cancer treatment.

Regarding Mid Staffs, it's not a one off.
http://www.bbc.co.uk/news/health-35597244

Agree with some your cost savings measures though. I'd also ban any job with the words "diversity" or "equality" in the job title. Here's three openings for such positions ranging between £40k and £50k a year. Switzerland has a foreign population near 25% and remarkably no diversity managers.

https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914062488
https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914075601
https://www.jobs.nhs.uk/xi/vacancy/7..._ref=914069364
According to that article, such incidents have happened to over 1000 people in the past four years. Of course course just one incident would be one too many, but how many lives to do think the NHS has saved or made better in the last for years? I'd say it's probably in a different order of magnitude. That's all I'm going to say about that, though, because I agree with dodgyken that it's off-topic for this thread.

I think I agree with you about the equality and diversity stuff. Of course we all want those things, but it seems to me that these 'officers' never have much of a portfolio, and are just appointed because that's an easier and more visible thing to do than actually taking steps to improve equality.
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Old 18.02.2016, 22:34
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Re: Junior Doctors - NHS vs. Swiss

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So a thread started about whether junior doctors should be paid more derails into "I've had great care from the NHS" vs "The NHS is the work of the devil."

Step back from personal anecdotes and consider the bigger picture.

The question is actually rather simple: How should the healthcare of a "top 5" nation be funded?

Look at the various models used around the world, the US employs high personal health insurance premiums (often company funded) that allows each person to receive the highest possible care. The flipside of this is that the healthcare system perpetuates the need for healthcare - frequency of treatments, frequency of pharmaceutical use etc is higher in the US because each physician is run as a profit making business (Google for the average Physician salary for some scary numbers from the US). This funding method can allow extraordinary levels of care and medical advance, the downside is that the per person cost of insurance becomes very high and/or exclusions are made. This means that the most vulnerable are left exposed to massive medical bills or a lack of medical treatment. The starting point for "Breaking Bad" is a simple example

The UK sits on the other end of the scale - where the healthcare system is funded centrally via direct taxation of income. The theory being that the healthy (working) population are funding the system for those who need it most (retired/children), who the latter will in turn fund when the current workers are retired. In that way the NHS is funded in a socially responsible manner.

In the US the budget is market driven - new treatments arrive, a person needs extensive treatments etc etc - insurance premiums rise (against the individual); in Switzerland there would be a cross the board jump in premiums and in the UK there would be a 3 consultation period before it was decided that budgets wouldn't be cut.

According to the OECD the UK lags behind Switzerland by 2% in GDP healthcare spending.

Perhaps what the UK needs to consider is instead of operating a top down approach - do some level of analysis on a bottom up approach. Figure out how much the NHS would cost if all basic necessary treatments were covered free of charge at point of service. Then total up the additional services (alternative therapies, translators, management consultants, etc etc).

Then figure out how that can be funded - based on direct taxation (as is) and healthcare premiums (as per Switzerland semi-private/private).

The demand for healthcare services will increase over time as both the population ages AND the population are more aware of medical conditions. The solutions available are either to fund for the increase in demand, reduce demand or meet somewhere in the middle.
You do a fair job of describing the US system (at least prior to Obamacare; post-Obamacare, premiums are skyrocketing and bureaucracy as well). My only quibble is that what the patient pays in the US isn't really more than what they pay in CH (or even the UK), yet the doctors, level of care/service, facilities and technology are better (in fairness, then anywhere else in the world).

What I paid in the States wasn't higher than what I pay here. (I arrive at this conclusion by combining my US contribution and my US employer's (whose contribution otherwise would have gone towards a higher salary.)) It also wasn't more (when considering the higher tax burden) then what I paid in Ireland for (third-world healthcare) or the UK (for either second-world healthcare or third-world healthcare depending on where/who you ended up getting stuck with).

Bottom line: If it's something serious, you want to be in the US.
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Old 19.02.2016, 00:24
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Re: Junior Doctors - NHS vs. Swiss

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Bottom line: If it's something serious, you want to be in the US.
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Old 19.02.2016, 02:27
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Re: Junior Doctors - NHS vs. Swiss

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I think I agree with you about the equality and diversity stuff. Of course we all want those things, but it seems to me that these 'officers' never have much of a portfolio, and are just appointed because that's an easier and more visible thing to do than actually taking steps to improve equality.
It's a legal requirement for all public sector employers to have trained diversity officers on staff. I personally know three people who've had this job within their occupation (one training police officers, one in education and one in a high ranking government position), and it's definitely a full time, very demanding role.
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Old 19.02.2016, 02:33
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Re: Junior Doctors - NHS vs. Swiss

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Bottom line: If it's something serious, you want to be in the US.
Can't agree with you there. My mate in the US had cancer at 19, then again at 25. She's now 36 and has only had medical cover for the last two years because her employer offered to pay it (she's a set designer for ABC). She went 9yrs with no cover because she couldn't afford the premiums.
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Old 19.02.2016, 09:35
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Re: Junior Doctors - NHS vs. Swiss

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Can't agree with you there. My mate in the US had cancer at 19, then again at 25. She's now 36 and has only had medical cover for the last two years because her employer offered to pay it (she's a set designer for ABC). She went 9yrs with no cover because she couldn't afford the premiums.
Statistically, you're more likely to survive cancer for longer in the U.S. than most other places.

Whether you can afford the treatment is a different argument.
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