General election 8th June

I forgot a ‘for example’ in that paragraph. Imagine how the Daily Express or Mail would react to HIV patients being asked to pay for their own treatment, or the obese, or…

I think this is the most important thing. It’s a discussion that needs to take place.

The NHS was always considered as the place you went to get better. Anyone would receive the treatment, irrespective of their financial position, that would enable them to recover from their illness and get on with their life. And it would be free, paid for through general taxation.

But care for the aged, especially those with dementia, is different in that these people won’t get better, they will just deteriorate, possible over years or even decades.

I think that most people will agree with these principles: we should care for these people well; their financial position should not impact on the care that they receive. If they wish to ‘go private’ then they can do that at their own expense.

My preference is that the care is paid for through general taxation. It should be a basic right, available to all and free for all that need it.

The practical problem is that we seem as a country to be unwilling to pay enough tax for services at the level that I think they should be. We need to raise taxes. My preference would be much higher inheritance tax, combined with much better avoidance systems, together with real enforcement of transfer pricing taxation that would prevent companies from moving profits offshore. But that’s not going to happen.

In the absence of sufficient quality of care for the elderly ill, I think that this is a reasonably pragmatic system. It’s not perfect, but as long as the surviving spouse is not indirectly liable, it makes some sense.

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I could replace ‘dementia’ with ‘Motor Neurone Disease’ or any other horrible condition, or at an extreme ‘Down’s Syndrome’ etc. As soon as you make free at the point of use conditional on the disease or disability you have fatally wounded the NHS. It is then a matter of how long it takes the NHS to die [insert your own death by 1000 cuts jibe here].

I am not in any way anti- Tory or pro-Labour. My current travails leave me strongly of the opinion that the NHS, and social care, is the area that needs to be defended most urgently. Feck Brexit, or most of the rest of the issues being debated. I will cast my vote in favour of the candidate most committed to the NHS at the local level.

There’s an element of that, for sure. But it’s never been the whole story. The NHS has always cared for the dying as well as those who are going to get better. It’s also always cared for people like me. I’m never going to get better from diabetes, but with the right drugs and decent support I could expect at age 18 to live a pretty normal life for many decades (so far, so good, more-or-less).

The NHS has become the victim of its, and society in general’s, success. People have got better. Which means they’re now getting to be old. To be blunt the problem is that we haven’t worked out how to stop an expensively large number of them (us) needing a long period of care before they (we) die.

VB

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Is there an insurance you can take out to cover long term care home costs?

I can’t see the problem here, we are trying to increase the help for people that can’t afford care, by asking those that can to pay for their own… Surely that’s an ethos that can’t be argued against?

The reality of all care and health costs are that everyone has to pay more (even the poor I’m afraid)… Taxing the top 5% at 100% won’t cover the costs…

As an example my friend in the USA pays $3,500/month for health care insurance for her family (3 of them btw) plus the excess is $500!!
So though US taxes are less, healthcare is a significant expense…

This is why this is not a progressive move. It is not based on ability to pay, but rather on assets. Those with large stocks of wealth will be pay a small proportion of their wealth. I’m all for user pays, but lets do it fairly.

Meanwhile, there are a lot of articles like this cropping up:
http://www.independent.co.uk/life-style/gadgets-and-tech/news/dementia-tax-google-adverts-conservatives-stop-reading-policy-controversy-election-2017-manifesto-a7748646.html

It can be argued against. The counter-argument is that the costs of care should be borne by everyone (through taxation) - not just by those who need it having to pay for their own if they can. It’s the same as the argument for an NHS (my wife pays for it although she’s hardly ever needed it). It’s the same as the argument for a state school system (we don’t have kids, but we pay to educate other people’s and we’re happy to do so).

VB

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You’re right, I’m wrong. I had thought it a reasonable, pragmatic solution to a specific problem. Instead it’s a rather general problem (that we don’t fund the NHS enough), and there is an obvious solution (pay more in general taxation). We have the ways in general taxation to implement progressive taxation, so we should use those.

There would have been if the politicians had chosen Andrew Dilnot’s approach (a cost cap, not a cost floor). But private sector insurers are risk-averse so if the possible cost is very, very large, which it might be for some people, then it seems that the premiums the insurers demand get too high for the scheme to work (I confess I don’t really understand why this is, but it seems it is this way).

VB

Isn’t that the worst of both worlds? A cost cap would mean the poor pay a huge percentage of their wealth while the rich pay a tiny amount, and it still undermines the while principle of the NHS being free at the point of use!

So the tax on the poor would increase, there’s no other viable alternative, is there??

Other than an increase in tax for people who aren’t poor or better off corporations?

Also remember that the arbitrary split between care and healthcare is bad for outcomes as well (geriatric patients not being able to be discharged for example), not just financially.

We’ve been through that, but please feel free to put forward a workable plan…

Seems the majority view here is that those with vast amounts of wealth, both income and assets, can cover the costs of those without… Fair enough, but at what level do you class someone as wealthy, (income plus assets) and at what point should you get everything for free?

The fact is that the money has to come from somewhere. There are myriad ways of distributing the burden between richer and poorer. A scheme with a cap could include a floor too. The question was asked about insurance and it seems the lack of a cap is a serious problem for that. Insurance can work for the poor - my mum could just about remember her parents who, though poor by any standard, still managed to pay into a small health insurance scheme pre NHS.

I should say I’m not a big fan of insurance which, it’s implied, would be provided through the private sector. I struggle with the idea that those in need should have to put money into the pockets of shareholders as well as paying for nurses, doctors, carers etc, but there you go. And it does indeed undermine the NHS principle. But the Tories seem dogmatically opposed to any tax-based scheme and despite that people still vote for them. So we are where we are.

VB

We are dying from the moment we’re born, though.

I do like this discussion though, as it has kicked off the debate around ‘What is the NHS for, and what what are the boundaries?’, which should have started years ago.

It’s not a binary thing. The vast majority of people are in the middle - they don’t get free everything, and they do contribute to the things they do get for free.

Maybe I should have said “those getting worse as well as those who are going to get better”. Mrs VB shouts at the TV every time there’s mention of lives being saved. She says lives are never saved, they’re just extended. We’re all going to die (or are we ?).

VB

Clearly May and the Tories don’t understand their key voters (older people), this will lose quite a few marginal Tory MPs their seat.

:thumbsup:

Would’ve been a lot easier to just keep schtum, and introduce it in a year, and blame Brexit…

Strangely unpolitician like really… :anguished: