Thread by @danielgoyal

A thread for the ultra-wealthy.

If you are wealthy, you may think that if the U.K. switches from an NHS-model to a private model of healthcare it will either a) be better for you, or b) will not affect you.

Here is why you are wrong…
🧵

The main arguments for switching models to an insurance based one are that

1) “the wealthy will not subsidise the poor”, and that…

2) the wealthy can simply pay for the best treatment when they need it.

Neither premise will be borne out if govt policies are fulfilled

Firstly, the tax-burden even if an insurance model is brought in will likely remain unchanged or go up - we will not get a tax rebate or reduction.

Primarily because a state health system will always exist and likely cost around the same level (£3.5k/person/year).

Further, the only model that could conceivably make its way to the U.K. is the social insurance model (Germany, France, Japan, etc…). This is a means tested contribution - the more you earn the more you pay!

It will not be insurance with a fixed sum dependent on your risk of illness (US model). Indeed, the cost to high earners will likely be even higher (Germany £5.5k/person/yr)

This puts paid to the notion that moving away from a tax model stops the wealthy “subsidising”the poor.

It will though, almost certainly cost business owners significantly more if the U.K. adopt an insurance model.

It will be more expensive to do business without the NHS.

In fact, an NHS tax-based system (like Norway, NZ, Sweden, etc…) is an employers’ dream (assuming it is funded enough). All health costs, even industry related are picked up by the state and the contribution by the employer is minimal compared to places like Germany.

So, under any conceivable circumstance, changing the UK’s healthcare model will only incur more costs for the wealthy and significantly more costs for employers.

The second point that the ultra-wealthy can just pay for the best care out of pocket or through advanced private insurance also doesn’t work either.

It all comes down to the level of specialism you have access to…

A national health service has the massive benefit of being able to offer super-specialists. That is, because it is not “small hospitals” trying to provide as much care as possible (to maximise revenue) - like Germany -, the NHS is able to share - across large areas - services.

This means that we can have sub-specialists and super-specialists. For example, it’s not uncommon to have cancer surgeons for specific cancers. Or have neurosurgeons specific for certain traumas. Or spinal surgeons focusing only on the spine. Or cardiologists focusing on angios…

And while the NHS model is not unique, the U.K. is the largest country to provide such a service and as such we have an incredible level of super-specialism.

That all goes away with an insurance based model. Hospitals rely more on generalists than specialists.

So, at the moment if you are found to have a brain aneurysm or tumour or abscess that needs an operation, the best place to get that sorted is in the NHS.

If we move to smaller, private hospitals, that specialism is lost and the odds of surviving such condition (even if mega rich) falls significantly.

And no, fancy international clinics do not have such super-specialism.

So if you are an ultra-wealthy person living in the U.K., no amount of private healthcare cover will replace the level of advanced care you currently have access to in the national health service. If you don’t believe me, ask your insurance provider.

The rate limitation for NHS outcomes has always been primary care - access to a GP and their team. It is often the time to identification and intervention that dictates outcomes. What’s the point of super-specialism if it’s too late by the time you get to see them?

Now due to the failure to grow the NHS with the population we also have the rate limiting factor of waiting lists as well.

Changing models won’t change that. It won’t suddenly give us more GPs or greater access to care.

And even the ultra-wealthy will be worse off!

If you are ultra-wealthy and either live in the U.K. for significant periods or have businesses running here, there is no doubt lobbying for the bolstering of the NHS - especially GPs - is in your personal and business interests.

It’s also just decent.