edit: and of course you'll rely on NHS for any emergency.
[1] at least not without paying out of pocket for the significantly more expensive premium coverage. Some now offer phone consultations but you still need to go to the GP for referrals and prescriptions.
I mentioned that we don't have the right to opt out of paying for the NHS. It's not possible go entirely private. If you could opt out, you could pay that money to a private provider instead and entirely forego the use of the NHS. That isn't an option today. But it should be.
Employed middle aged workers in the USA pay about the same as we do for the NHS to support Medicare, Medicaid and CHIP through taxes, and then have to pay about the same again to actually get health care for themselves. Plus the system that costs twice as much as ours per citizen still leaves tens of millions of Americans without health insurance. It's utterly godawful. Our current system where everyone supports the NHS, and if you want top up services you pay for it, ensures solid funding for everyone's health care. The fact that my private care actually subsidises the NHS by reducing demand on it is a feature, not a bug. There's also the fact that private health care increases overall investment in health care, so in emergencies the NHS can call on private medical facilities which otherwise wouldn't be available. I know there's a fairness argument, but in practical terms our system benefits everyone.
For what it's worth if you have the money you can get some pretty world class care here. My dad had cancer and due to my mom's really good (publicly provided mind you, she worked for the school system) insurance got my dad great care and he's still out an about to this day
In this scenario, why should an NHS ambulance pick you up when you don't contribute? Surely it should prioritize those on public healthcare? Some poor lad whose leg is broken from a fall?
Because the public healthcare system winds up subsidizing the private one: private insurers dump bad risks onto it when they get too expensive too insure, after years or collecting the payments that don't go to the public system.
It's the definition of privatizing profits and socializing risk.
You want to opt out? You get to opt all the way out. You don't get to come back, it's a one way street. Still keen?
We are forced to spend a significant fraction of our salaries on the NHS whether or not we want to. If we feel that this is not good value for money, or of poor quality, we don't have any real option of choosing to pay an alternative provider. Like all nationalised industries, it's inefficiently run because top-down administration of huge organisations blunts initiative and freedom of action. It's run by Whitehall and politicians, with little input from those actually doing the real work. And the result is that it's in perpetual crisis, with COVID having pushed it right over the edge. Is it really fit for purpose? I don't personally think so, and haven't for many years.
Competition is good for many reasons. It improves the quality and value of goods and services. The NHS has no real competition. There's no direct cost of failure, no direct cost to poor purchasing decisions, no direct cost for poor quality of service, and no real driving reason for improvement in the quality and efficiency of its services. They get the money anyway.
Other healthcare systems in Europe have fully private provision--you have the choice of where to take your money, even if you paid into a public system. If a particular hospital or clinic is providing poor or expensive service, you can take your money elsewhere which is better quality and better value for money. That's a very real incentive to drive improvement and efficiency. That is not the case for the NHS system. There is no choice, and the incentives to improve are minimal.
If there is to ever be any improvement in the NHS, there needs to be competition. The NHS should be somewhere you choose to have treatment because it's the best option, not because it's the only option.
On a small scale, there is some degree of separation. Sometimes the NHS pays for treatment in private facilities, and sometimes private insurance pays for treatment in NHS facilities.
Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.
> It's run by Whitehall and politicians, with little input from those actually doing the real work.
If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.
Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.
> It's run by Whitehall and politicians, with little input from those actually doing the real work.
If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.
> If there is to ever be any improvement in the NHS, there needs to be competition.
What is "choose and book"? We tried competition, and it dramatically increased costs without doing anything at all to improve care. We're now spending considerable amounts of money rolling back some of that law.
A mess in what way? Do you have to wait 2 years for a private dentistry appointment? Because that's the current wait time for an NHS psychiatrist.
If you can't afford private treatment you go on the NHS. At the moment NHS dentistry is simply not available for very many people. Those people cannot get treatment at all. But for psychiatry, the vast majority of people who need a psychiatrist will get same day or next day access. This is one of the problems - that's a statutory function, they must provide it, and so community care has been cut in order to meet the statutory function.
> Because that's the current wait time for an NHS psychiatrist.
This is untrue in the way that you've presented it. I'm not able to find this statistic any where - what's your source for it please?
There are long waits for some community mental health services, but these are mostly caused by decades of underfunding of MH treatment. Also, your argument says that this problem would be fixed with competition. We've competition and right to choose for first episode of mental health care since 2014[1] and that competition has done nothing to improve things and in many situations has made things worse.
For Early Intervention in Psychosis services (these are services for people with their first episode of psychosis) the current numbers[2] are that 83% of people were seen within 2 weeks after referral.
The number of people in contact with specialist mental health services has increased[3] since 2019 from 1.3m to 1.6m people. This is combined with a decrease in bed numbers and a complex change from CCGs to ICSs. New referrals data is complicated (one person can have multiple new referrals; someone already in contact with services can have a new new referral) but the trend is increasing[3]. The number of young people accessing MH services has increased a lot over the past 12 months, from 575,000 in Mar 2021 to 690,000 in May 2022.
[1] https://www.england.nhs.uk/wp-content/uploads/2018/02/choice...
[2] https://www.england.nhs.uk/south/our-work/mental-health/earl...
[3] MHDS Mental Health Time Series data dashboard
Regarding competition, the NHS hasn't really tried competition seriously now, has it? Not really. Not actually doing a complete decoupling the insurance funding and the service provision. The "choose and book" isn't that, is it? It's a small attempt, which is better than nothing, but it's not really surprising that it didn't drive a huge amount of change, when it's not really going to have a big impact upon the bottom line.
You’ve also misrepresented the nature of private healthcare in the UK - this is almost universally not a replacement for NHS services. It will offer you things like faster GP appointments, consultants, and routine operations. It will not replace many of the specialist or emergency services offered by the NHS, leaving you dependent on it anyway.
A bigger “problem with the debate” is that we so frequently find people like yourself who are insistent on having some kind of “debate” without really knowing about what, or why.