Post by @ChrisMayLA6@mastodon.me.uk

Here's a great letter from Susan Jones (a retired insurance underwriter) on why the NHS will *always* cost the UK less than a private health insurance system;

which emphasises that those arguing for such a shift are either misinformed, or (more likely) just do the bidding of their corporate sponsors with little actual interest in the UK's fiscal politics.

Further reasons to ignore the clamouring for a US-like health system, should you really need them!

#NHS #Health #insurance
h/t Guardian

2 media files

In Dining across the divide (4 October), the young participant, Ted, is quoted as expressing his “desire to abolish the NHS and replace it with a social insurance model. This would still have provision for free treatment at the point of need, but people would pay through insurance systems, and they would choose the level of cover they’ve got. Those models deliver far better outcomes for patients.”

As a retired insurance underwriter, I must disagree profoundly with Ted’s assertion. Let’s concentrate on business fundamentals. Insurance comes in two “flavours”: first, events that become likelier as time goes on – eg, life assurance. The older you get, the more likely you are to die and the more premium is needed to cover the risk; and second, events whose likelihood stays essentially the same over time, eg home insurance – the likelihood of a house burning down is much the same for everyone and the cost is spread evenly between policyholders. — In Dining across the divide (4 October), the young participant, Ted, is quoted as expressing his “desire to abolish the NHS and replace it with a social insurance model. This would still have provision for free treatment at the point of need, but people would pay through insurance systems, and they would choose the level of cover they’ve got. Those models deliver far better outcomes for patients.” As a retired insurance underwriter, I must disagree profoundly with Ted’s assertion. Let’s concentrate on business fundamentals. Insurance comes in two “flavours”: first, events that become likelier as time goes on – eg, life assurance. The older you get, the more likely you are to die and the more premium is needed to cover the risk; and second, events whose likelihood stays essentially the same over time, eg home insurance – the likelihood of a house burning down is much the same for everyone and the cost is spread evenly between policyholders.

Clearly, medical insurance is flavour one. Premiums need to rise with age. To reduce premiums and keep customers, insurance companies apply ever-increasing “excesses” and “co-pays” and can refuse to cover pre-existing conditions. The more you need medical insurance, the more expensive and difficult it is to get.

There is also the business case. When you buy an insurance policy, premiums are calculated to include the cost of claims (about 60%); administration (about 10%); sales (about 20%); shareholder profits (about 15%); less investment returns (about 5%).

In contrast, an NHS-style system does not require either sales costs or shareholder profits. Of course, there would be no investment return – but nevertheless, it is still about 30% cheaper to operate than an insured healthcare system. Like most sound business ideas, it’s simple arithmetic.
Susan Jones
Biggin Hill, London — Clearly, medical insurance is flavour one. Premiums need to rise with age. To reduce premiums and keep customers, insurance companies apply ever-increasing “excesses” and “co-pays” and can refuse to cover pre-existing conditions. The more you need medical insurance, the more expensive and difficult it is to get. There is also the business case. When you buy an insurance policy, premiums are calculated to include the cost of claims (about 60%); administration (about 10%); sales (about 20%); shareholder profits (about 15%); less investment returns (about 5%). In contrast, an NHS-style system does not require either sales costs or shareholder profits. Of course, there would be no investment return – but nevertheless, it is still about 30% cheaper to operate than an insured healthcare system. Like most sound business ideas, it’s simple arithmetic. Susan Jones Biggin Hill, London

#nhs #insurance #health

13 Boosts

0 Likes

David Cantrell 🏏

@DrHyde@fosstodon.org 22 hr. ago

@ChrisMayLA6 are those two people not talking about different things though? One talks about social insurance, one talks about denying coverage for pre-existing conditions. I've not heard of anyone in the Netherlands, for example, being told that pre-existing conditions aren't covered.

Emeritus Prof. Christopher May

@ChrisMayLA6@mastodon.me.uk 21 hr. ago

@DrHyde

well in the UK, private insurance expressly excludes pre-existing conditions....

David Cantrell 🏏

@DrHyde@fosstodon.org 21 hr. ago

@ChrisMayLA6 and that’s not relevant to a discussion about social insurance like what exists in many European countries.

Emeritus Prof. Christopher May

@ChrisMayLA6@mastodon.me.uk 20 hr. ago

@DrHyde

ah yes, but I'm in the UK & the letter focussed on the UK....

1+ more replies

Quixoticgeek

@quixoticgeek@social.v.st 21 hr. ago

@DrHyde @ChrisMayLA6 my Dutch insurance doesn't have much of an issue with pre existing conditions, because of the level of regulation by the government. But there are issues with things just not being covered. Or only covered in very specific ways. The Dutch system effectively privatised the profits, while socialising the costs. Insurance Vs the NHS isn't the true dichotomy people think it is. The actual comparison should be insurance Vs the current NHS Vs a properly funded NHS.

2legged

@2legged@mastodon.ie 2 days ago

@ChrisMayLA6 One of the NHS's problems is that the post-1988 imposition of internal market mechanisms required rigorous cost itemisation. This created administrative overheads mimicking inurance systems.

An IT pal was one of the first doing this in 1989. He wasn't politically minded, so was shocked to find huge hostility from clinical staff. For some reason they were outraged 😡 that this youngster was paid way more than them to spend lottsa money on IT which made their jobs slower & harder. 🙄

Emeritus Prof. Christopher May

@ChrisMayLA6@mastodon.me.uk 2 days ago

@2legged

Yes, but of course by raising internal costs, the insurance model then didn't look as expensive... it was (as many of us did & continue to say) a Trojan Horse

Woozle Hypertwin

@woozle@toot.cat 2 days ago

@ChrisMayLA6 @2legged

This is what happens with social programs in the US, too: rather than get rid of them (which would be unpopular), the "conservative" party changes and constrains them in ways that effectively destroy their ability to function -- which results in people complaining about how terrible they are, which lays fertile ground for proposals to replace them with more "efficient" capitalist solutions.

A recent-ish example is how the "conservative" GOP sued Obamacare to allow states to refuse its built-in expansion of Medicaid -- which, despite the fact that it clearly benefited them*, GOP-controlled states proceeded to do.

(* or, to be specific, their official constituents -- the citizens of those states -- rather than their de-facto constituents, i.e. their largest donors.)

2legged

@2legged@mastodon.ie 2 days ago

@woozle Please don't call those people "conservative", even in those scare quotes. They don't conserve anything, nor do they moderate the pace of change, as Edmund Burke advocated in his classic conservatism.

These people are a righrwing variant of #Maoism. They want permanent revolution, laying waste to everything. Call 'em rightwingers, but don't let them hijack the word "conservative".

@ChrisMayLA6

~43 more replies

Woozle Hypertwin

@woozle@toot.cat 2 days ago

@2legged @ChrisMayLA6 I know -- I've ranted about that repeatedly. I only use the word because it's what they call themselves ("right wingers" may not evoke the same group, to anyone reading my comments), in both US and UK, and I put it in quotes to indicate it's inaccurate.

lp0 on fire :verified_coffee:

@lp0_on_fire@cupoftea.social 20 hr. ago

@woozle @2legged @ChrisMayLA6, it seems to me that the name which you're really looking for is “selfservative”.

Woozle Hypertwin

@woozle@toot.cat 19 hr. ago

@lp0_on_fire @2legged @ChrisMayLA6 I believe I have at times referred to them that way -- at least in my head...

2legged

@2legged@mastodon.ie 19 hr. ago

@woozle @lp0_on_fire In theory, I like the term "#selfservative". Recasts the feckers as self-serving.

But in practice, it makes me think of self-service tills at supermarkets, which leave me feeling multiply degraded.

@ChrisMayLA6

Woozle Hypertwin

@woozle@toot.cat 19 hr. ago

@2legged @lp0_on_fire @ChrisMayLA6

aww, I like those. Can go at my own pace (if there's not a line) and not have to interact with anyone (usually).

2legged

@2legged@mastodon.ie 19 hr. ago

I Iike that theory, @woozle. But they rarely work for me.

In practice, i find myself being marked as a suspected thief, standing beside a flashing light while the till yells "unexpected item in bagging area".

The self-service inspector woman has a dozen other suspects ahead of me, and is giving me dirty looks 'cos I have aready needed her help twice on this one visit.

I always come out feeling as humiliated as I did when I'd had a run-in with school dinner monster.

@lp0_on_fire @ChrisMayLA6

lp0 on fire :verified_coffee:

@lp0_on_fire@cupoftea.social 11 hr. ago

@2legged @woozle @ChrisMayLA6, I can only imagine that you're putting something extra on the bagging area scales (bag? hand? accidentally unscanned item?) or you're rearranging items already on it (there have been occasions when I've wanted to do that but have had to resist: the device does not cope with that and I don't think that it reasonably can without opening an item-substitution loophole which certain kinds of people most definitely will not exploit). However, if you happen to be able to cause electronic kitchen scales etc. to do strange things just by being nearby…

I seem only to find occasional problems with bar codes: usually, something silly like not noticing that the original bar code being inadequately covered by a reduced-price bar code label or the bar code is mangled in some way, but I once had one item (cost ~£2) reliably misidentified as something else (cost ~£250) – either it was consistently misread or, more likely, there was an error in the database…

Woozle Hypertwin

@woozle@toot.cat 11 hr. ago

@lp0_on_fire @2legged @ChrisMayLA6

The obvious "you are trying to steal something" trigger is if you scan something and then the bagging-scale doesn't detect an item of the right weight being added.

It can also be confused if something on the bagging-scale is leaning up against some other part of the station, so that it doesn't weigh as much as it should. This can also be triggered by heavy reusable bags sagging during the bagging process.

More recently, they added cameras to the self-checkout at Costco, and my station triggered a "you might be stealing something" because my head happened to be blocking the item when I put it down in the bagging area.

It is, indeed, very annoying and kinda daft that they feel the need for all that...

lp0 on fire :verified_coffee:

@lp0_on_fire@cupoftea.social 11 hr. ago

@woozle @2legged @ChrisMayLA6, yes, also plausible causes; I'll just note that the sagging problem is, at least some of the time, avoidable but takes some planning (possibly including deferment of bagging) and a little extra time. Fun little exercise, particularly when you realise that you've messed it up again and are going to trigger The Bagging-Area Alert no matter what you do next.

Still, these days I'm probably just too used to having the bulk of the shopping delivered and, when actually visiting a shop, buying relatively few items and putting them in a pocket, backpack or bag after paying…

Woozle Hypertwin

@woozle@toot.cat 11 hr. ago

@lp0_on_fire @2legged @ChrisMayLA6

Grocery delivery is a little like human checkout: On the one hand, I feel guilty for making someone go to all that effort for my groceries when they probably have their own shopping to do, and for supporting the "gig economy" companies; on the other, it's giving someone a job... (...but is it a living wage? benefits?)

In a way, getting a human to shop for you and deliver everything is even more "automation" than going yourself and using the self-checkout... I wonder if anyone has studied this in detail.

lp0 on fire :verified_coffee:

@lp0_on_fire@cupoftea.social 10 hr. ago

@woozle @2legged @ChrisMayLA6, other things to consider…

Vans making many scheduled deliveries vs. many car journeys.Seems like a net win, environmentally speaking, to have widespread use of deliveries for the weekly shopping.
Disability, lack of suitable transport, loss of driving licence… yes, there has been and still can be reliance on family or neighbours.

(I've never used the likes of Just Fat and Deliverugh and probably never will. Just the mere fact that there are take-aways, should I want something from one, within convenient walking distance sees to that; never mind environmental issues if the delivery person uses a fossil-fuelled vehicle for the job.)