I'm going to ramble on here Col, and it's not to be critical it's because I'm thinking it through as I write.....
Because the system you propose is very similar to the US system, which clearly has different levels of quality. The vast majority GPs are not part of the NHS at the moment and they never have been, they are all small businesses with NHS contracts. You would have to bring them into the NHS or pay them to collect the consultation fees for the NHS. I'd guess you'd end up with NHS GPs and private GPs.
Your system means that the richest 25% of the population pay for the other 75%, or supplement what the majority pay, and don't actually have the same access to the things that they are paying for. It's incredibly socialist Col, I'm shocked at you
. They do this already of course because they pay more tax, but your system would mean they continue to pay more tax and on top would have to pay private health insurance, which in the US takes up about 15% of income. So in effect you are taxing the rich (if you call people earning £75k rich) an extra 15%. So it's clearly not worth earning more than £74,999 for most of the 25%, because you are not only taxed on the additional earnings but have to pay for your healthcare directly - you'd have to be earning over £100k to end up with the same disposable income as before. Much more if you have a chronic health problem.It would have the advantage of making it very explicit to everyone how expensive health care is, which is no bad thing. That's why I prefer a universal obligatory health insurance system, taking it out of general taxation ( which should fall as a result - ok I am now on fantasy island) and doubtless including different levels of premium according to income. I'd like my annual statement to show me how much I've contributed and how much I've cost the system. If I want to buy extra levels of service (largely faster access and nicer facilities rather than better quality clinical care as it works at the moment) it's my choice to get additional private health insurance. But for me access to (high quality) health care for all is the sign of a civilised society, my concern is that the NHS often does not provide this and also that it's taken for granted, no one should think they are getting something for nothing.
Actually I think we both want the same thing (I may be wrong) and are just testing out different ways of getting there. Yay dialectics!
As I said above, funding is just one part of the equation. Doubtless we need more, but I fear that there is something broken in the organisation which means we wouldn't see the improvements expected with extra cash.
I'll bore you with an example of the perversity of the system at the moment. My industry, branded prescription medicines which we develop and sell, has negotiated an agreement with the government to manage NHS costs. Once spending on these types of drugs exceeds £8bn in a financial year (less than 8% of the NHS budget) the industry reimburses the extra spending to the NHS. In other words we have capped the NHS risk on innovative, patented medicines. It's a great deal for the country. The idea was that the money we give back would be invested in providing new drugs which would challenge the normal budgets. That gives us an incentive to regard the UK (or it may be just England and Wales) as an important place to launch new products early. Stupidly, the industry neglected to make this a compulsory part of the system. In reality, the reimbursed cash has been used to prop up failing services, not on medicines. As a result doctors and patients in the UK don't have the same choice of medicines, especially new medicines, that other western countries do.
Sorry for droning on so much.
