That's pretty close to how it works in Canada. The difference is the difference between "free" and $60/mo if your income is sufficiently high.

So, in addition to the nominal required subscription, we optionally pay for additional services at hospitals like private rooms, etc. We also pay for additional health insurance that covers prescriptions, full dental and some discretionary medical procedures that aren't, or are partially covered in the universal plan.

The efficacy of the system is manifest in one of it's largest problems: Large numbers of non-Canadians scamming the system with fake medical cards. In BC, we're currently rolling out a revised personal identification system, in large part, to address this.

In case a US cousin here on HN is tempted to make some hay with that "non-Canadian" thing, please, reconsider. :) Also note, the reason that we bother to harass you folks with how far from optimal you've strayed on this topic is that the wacky ideology 'free market blah blah', leaks into our countries and is a huge distraction from pushing our systems forward. We have to keep fighting these fights that, in all practical terms, are long dead. If you guys were to get a grip on your own setup, the rest of the world would heave a huge sigh.

I used to live in the UK, but now live in Canada. There are a few problems, but for the most part healthcare works very well in both countries and the vast majority of people are happy with it. You just get issues in fast-growing cities like Calgary, but those issues are being resolved. I agree that most of the objection to free healthcare in the US is wacky ideology. The ridiculous thing is that they have free education, but nobody is whining about having a commie education system :)

"whether you're going to use it or not"

Wat? This is the exact use case of insurance. It protects you should you need it, but ideally you won't.

The point is, you're forced to pay for the government "insurance" (which is actually called insurance, although it's not actually insurance), even if you have private insurance on the side that pays for most things the government insurance would, and more. Thus, "don't need it".

But NI covers other stuff such as unemployment. Also, I'm pretty sure it's still cheaper than US health insurance in total.

No, NI is just tax. It doesn't "cover" anything.

The point still stands: even if you have private health insurance, you still have to pay your share of the NHS, even if that share is not a line-item anywhere.

> It doesn't "cover" anything

Yes, it does "cover" other stuff, and gaps in your NI payments can leave you not getting that other stuff. That's why you're allowed to top up your NI payments.

EDIT: Also, while it's true about health insurance (if you go private you have to pay both) it's not true for pensions. You get a reduced rate of NI if you opt out of the national pension scheme and opt in to a recognised provider.

"Other stuff" is state pension. Which is an earned entitlement, not an insurance.

National Insurance for an employee on £50k would be under £5k, tax just under £10k, the other £5k for National Insurance comes from the employer, not the employee. Total deductions on £50k are under £15k.

Personally (as a British citizen paying British taxes and paying taxes on over £50k) I don't mind it much. I've been to the hospital once in my life (when I was born) and I've only been to a doctor once in my life too (I was 16, given antibiotics) and I would much rather I personally "lose" money on taxation while everyone in the country gets the healthcare they need than an American style system where I save money but there are people that can't get the healthcare they need. I also have private health insurance.

As a private individual that does not make use of national services National Insurance isn't great but as a British citizen it's fantastic. My other tax paying family members feel the same.

The fact that the £5k is charged to your employer, not you, doesn't mean you didn't "pay" it (you never "paid" taxes anyway, they were deducted before the money was ever in your hands), it just makes the system more opaque (and makes people believe they pay less in taxes than they actually do).

I agree that it's a fundamental property of modern societies to ensure universal health care, one way or the other. What angers me about the UK model is how the system handles a scandals like Stafford Hospital: with anything less than total fury. At Stafford Hospital (est. 400-1200 patients died as a result of poor care 2005-2009). One manager resigned, one was suspended on full pay. Years later, some meagre compensations has been paid out, some apologies and an inquiry which one party will now use to push the same reforms (maybe they're sensible, maybe they're not) they always wanted to push, and the other party will try to block them for the same reasons they will always try to block them.

Yadda yadda yadda, in the meantime, people died, no-one felt any consequences. The same people in the same organisation that let this happen are still here. And no, I'm not vengeful-blood-in-the-street-type person, but I'm not seeing the whole "Shit, this is a systemic failure, we're all part of the system, thus we're all responsible. How do we fix this?"

If you were earning £50,000 as a self employed person (after all expenses) the national insurance contributions would be less than the national insurance contributions of an employed person. For 2013/2014:

£50,000 Employee: Tax £9,822.00 NI £4,214.64

£50,000 Self Employed: Tax £9,822.00 NI £3,217.03

I hope you're not forgetting that 2 pounds 70 a week Class 2 NICS we self-employed get stung for. The horror!

> You're missing the point that you're not paying for yourself, you have to pay for others too.

There's no way to avoid that, unless you're willing to accept that poor people get no medical treatments at all.

That's a little bit simplistic.

(https://www.gov.uk/national-insurance)

(https://www.gov.uk/working-tax-credit/overview)

You pay national insurance if you earn over £149 per week. (Which is less than your £8,000!!) You pay 12% on anything between £149 and £797, and then 2% on anything over £797.

That sounds like a lot. English NI isn't just for health care, it's for some benefits and pensions too.

And people are eligible for Working Tax credits, which cuts that number down a bit.

You get a reduction in national insurance if you opt out of the pension and opt in to a recognised scheme.

I understand how the UK works as I lived there - I was just simplifying it. However I don't believe it's a big issue that you pay twice. People in the USA still pay school taxes when they send their kids to private schools and nobody seems to be complaining. If it's a big deal then you could refund the school/health portion that people pay in taxes.

Straw man.

You are going to use it... it's just a question of when and how severely the need will be.