In message 485cea45@qaanaaq, at 12:47:17 on Sat, 21 Jun 2008, Andy
Hall remarked:

It all depends what hourly rate the dentist needs to earn where he lives.
That would only set the bare minimum.
Minimum what?

Remuneration.

But for what lifestyle?

It would be perfectly possible for GP surgeries to offer a
comprehensive range of paid services which could be delivered far more
cost effectively to patients than via the current arrangements.

That may well be true, and quite a lot of work is being shoved in their
direction these days, that used be done in hospitals.

That's still not an answer to my question about you getting your NHS
contributions back.

So one more time. The NHS has the option to deliver viable dentistry
through three different means. It is currently failing to use any of
them. Ultimately it becomes a case of **** or get off the pot. I
would prefer that it gets off the pot. Should that situation arise,
the money thus saved could be redistributed for other healthcare
purposes, thus reducing the need to raise more funds from taxation.
That would probably require parliamentary intervention since there is
little or no customer control of NHS spending.

If it's redistributed like that, then you still aren't getting a refund.

There is no justification for paying for a service that not only is
one not receiving but which to a large extent isn't being delivered.
The same could be said for education. But there's no scheme for
refund of taxes there either.

No, and there should be. For example, tax relief on school fees.

Or a voucher system.

This leaves the NHS with the three choices mentioned above.
Dismantling of NHS dentistry would be a good place to begin as a way
to dismantle the rest of it.
NHS dentistry has a poor image, and is severely affected by the
"postcode lottery" effect.

The NHS and its customers waste far too much time fussing about
postcode lotteries and far too much resource in attempting to create an
equal for all system. Life isn't equal and never will be.

I wouldn't mind if people in London and the southeast had significantly
higher prescription charges and dental fees, to reflect the higher
delivery costs.

I've never been sure why there are fees at all though - you don't
pay fees when you visit your GP.

It's a matter of time taken. The average GP visit is 7 minutes or
twice that for a double appointment. It takes about an hour to do a
filling properly, much more for more complex work.

That's irrelevant. Time in hospital can be counted in days, but there's
no fee.

But I agree that filling in an insurance claim form for every £50, 7
minute, GP appointment is a really good way to waste time and money.

But they can break even as long as they don't have Mercs?
That's the sort of thing, yes. And as you agreed in your reply,
having the latest Merc when you can't afford it is very much a
self-inflicted injury.

Circular argument. Why shouldn't it be possible for a dentist to
afford a Merc if they want one?

Or a road sweeper. (Own a Merc, not a dentist own a road sweeper!)

It would be far better for the NHS to give up the pretence and for
patients to pay dentists directly. In that way, cost of treatment
would, as is quite reasonable, be linked to the local cost of living.
It is for virtually everything else that we buy.
Or scrap the fees entirely, which is the way the rest of the NHS
works.

Except that it doesn't. Note earlier point about prescription charges.

As you hinted, the vast majority (85%) are free. Another 5% are paid for
by "season tickets".

The insurer paid for all of it with no discussion at all.
It works at the moment because only a small number of people use
private medicine, and only for a few of their medical needs; and the
cost of the policies is largely covered by employers.

If there were more people using private healthcare, the market would
open for more professionals to work in it.

Ah, more cost.

If the huge drain of funds into the NHS were reduced, people would
have more disposable income and the insurance market would offer a
wider range of coverage than it does today.

Rubbish. The Americans spend twice as much on healthcare as it costs to
run the NHS. And that's before you allow for the fact that a large
proportion of the public can't afford healthcare at all (so aren't
spending anything).

The reason you see all that spam for buying "meds" is just as much to
avoid the fee for seeing the GP, as it is to avoid the vastly inflated
retail prices for prescription medications.

The cost of policies is not largely covered by employers. If they
fund the policy, they have to pay NI contributions on that. The
employee has to pay tax at his highest marginal rate and possibly NI as
well. There is insurance premium tax as well. Therefore for the
employee only half of the cost is covered and for the employer it is a
factor in his profitability which ultimately impacts on the price of
his goods and services or on his return to shareholders - i..e. money
taken out of the economy.

You make it sound soooo desirable to have this insurance.

Trying to scale it across the entire population, for every ailment
and treatment, when people are paying for their own insurance, is a
problem. People will skimp on the insurer who will then quibble over
the justification and cost of every procedure.

That is then their choice.

What, to have insurance and therefore need to quibble, or not have
insurance at all? I don't think anyone invented a no-quibbling insurance
company yet.

I have not said that the state should not contribute to *funding* basic
healthcare, only that it should not be in the *delivery* business. The
U.S. system provides for more choice. The missing component is the
addition of government funding to make basic healthcare affordable for
everybody.

The problem that would create, even though it sounds desirable at first,
is that a too-good "basic" and free healthcare system would end up
getting most of the business. Like it does in the UK.

It's only "no quibble" because it's too difficult to quibble, so
most patients are reduced to laying back and thinking of England.
It's far easier to quibble with the NHS than an American insurance
company.

Have you tried quibbling with the NHS? I've done it, and it has
involved considerable effort.

Have you tried quibbling with an American insurance company? I've done
both, and the NHS is easier every time. One aspect is that you can get
different answers from different doctors in the NHS, but you'll get the
same answer from every claims department in the USA.
--
Roland Perry