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  • Emeritus Prof. Christopher MayChrisMayLA6@mastodon.me.uk
    Oct 10, 2026, 9:17 AM

    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

    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
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Replies

  • Claire McNab2legged@mastodon.ie
    Oct 10, 2026, 9:35 AM

    @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 insurance 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. 🙄

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  • gbsillsgbsills@vivaldi.net
    Oct 10, 2026, 11:00 AM

    @ChrisMayLA6 To put it bluntly, a free market is not possible when the consumers have to choose between their money or their lives.

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  • Emeritus Prof. Christopher MayChrisMayLA6@mastodon.me.uk
    Oct 10, 2026, 11:29 AM

    @gbsills

    Well, of course, a 'free markets not possible full stop - it needs regulations (either legal/formal or social/normative) to work, so that choice is one among a number that make the idea of 'free markets' merely economists' myth-making

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  • gbsillsgbsills@vivaldi.net
    Oct 10, 2026, 12:34 PM

    @ChrisMayLA6 It is true that all markets need some level of regulation to work. What I contend isthat the amount of regulation required to make a health care "free market" work is impractical to implement and impossible to sustain. We've tried that under Obamacare.

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  • woe2youwoe2you@beige.party
    Oct 11, 2026, 10:39 AM

    @ChrisMayLA6 @gbsills Those "efficiencies" have always been a crackpipe fantasy. No public system is ever so fucked that it costs more than taking a profit margin at every step.

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  • David Cantrell 🏏DrHyde@fosstodon.org
    Oct 11, 2026, 10:20 AM

    @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.

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  • Quixoticgeekquixoticgeek@v.st
    Oct 11, 2026, 11:22 AM

    @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.

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  • David Cantrell 🏏DrHyde@fosstodon.org
    Oct 11, 2026, 11:48 AM

    @ChrisMayLA6 but the letter is responding to someone talking about social insurance. For it to focus on failings of a different insurance system reads like a dishonest attempt at making a political point.

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  • Quixoticgeekquixoticgeek@v.st
    Oct 11, 2026, 11:52 AM

    @DrHyde @ChrisMayLA6 this is one of the problems when you talk about health insurance in the UK. People either think of Bupa, or the US system. And assume they all health insurance implementations are as evil as these and have all the same downsides. It makes having the discussion so difficult.

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  • Emeritus Prof. Christopher MayChrisMayLA6@mastodon.me.uk
    Oct 11, 2026, 1:37 PM

    @quixoticgeek @DrHyde

    But of course, that's not unreasonable expectation; any shift is likely (as so often in the UK) to be towards an American model, and to built on existing health insurance institutions - implementing a European social insurance system is so unlikely as to not really worth considering other than as a counter-factual though experiment

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