Hospital Treatment Tourism

[tanglewood]

Come on - even Gordon Brown now admits that raising the higher income tax rate to 50% reduced the amount of tax collected. It's called the Laffer Curve.

By all means call for an ideological increase in tax rates for high earners. But at the same time you must introduce spending cuts to schools and hospitals.

The vast majority of the money needed to run public services already comes from just a relatively few high earners. You may not like that but it is true. Getting the rate just right to extract the maximum amount of money from this group is an art form, and in the UK it seems the £50,000 threshold for a 40% rate is the perfect revenue-raising formula.

In your view maybe,the HMRC could close the loopholes and let the rich know that there's no hiding place for tax evaders/avoiders.
Of course that would need a straight and honest system society that looks after the week and needy and not skewed to the rich and powerful.
If you think that's a revolutionary outlook you'd be right,YVMV mine won't.

EDIT:-just to add,the gap between the rich and the poor is increasing at an alarming rate,one needs to ask where do the rich earn their money,is it not from exploitation of the poor and if they're paying the majority of the tax in the UK then so they should and IMO it isn't enough as things stand.

Wrong. The gap between rich and poor is narrowing in the UK, and it widening in most other developed nations. It has been narrowing for a while now and at a rate faster than any other developed country :

OECD :

"Income inequality in the UK grew steadily from the mid-1970s and only dipped briefly in the mid-1990s, the OECD said.

"We found it starts narrowing from the year 2000," said Mark Pearson, the head of the OECD's social policy division. "It is really quite a remarkable reduction since then - the largest fall in all developed countries, at a time when inequality has been rising in most developed countries."

ONS :

"There has been a gradual decline in income inequality in the last 10 years, with levels similar to those seen in the mid to late 1980s."

https://www.ons.gov.uk/peoplepopulation ... ending2016

In other words, not since Margaret Thatcher was prime minister has our society had lower income inequality.

Facts are so easy to find thanks to ONS that you really don't have to labour under these faulty perceptions.



I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[bovlomov]

If she was self employed, you could be sure she would source individually wrapped instruments, and source different quality instruments for different jobs. And she would seek the best prices too.

All you have posted assumes the best of the individual and the worst of the collective. In practice, we can easily find examples where devolved decision making has been catastrophic, just as we can find the same of centralised decision making.

There are all sorts of reasons why that midwife might make a bad choice. For a start, you can hardly expect her to spend hours each week comparing prices in medical suppliers' catalogues, and keeping up to date with regulations and standards for every item. Has she the training to make such decisions? Is that an efficient use of her time? If she makes a bad choice, what will be the consequences? Will every health professional have to be individually audited?

I think it's a lot more complicated than you make out.

[Psamathe]

Don't confuse NHS costs with NHS inflation.

An ageing population will increase costs. But that doesn't explain why the price of incontinence pads in the NHS is going up at twice the rate of inflation in the rest of the economy.
...

A (Press) report I read was saying how purchasing prices across the NHS are a complete joke

Other examples include a box of syringes bought for £12 by one hospital while another pays £4 and surgical gloves costing £1.27 for one hospital and as little as 50p for another.

One of the problems being that the way our politicians have re-structured the NHS (along open market economy basis) the Trusts are independent so any cooperative buying can only really be setup by local (individual Trust) decisions to cooperate with other Trust similarly inclined. The central NHS of old would have been able to ensure best prices were paid across the entire service.

Ian

More devolution is needed, and more rewards to staff for the savings they find might work.
.....

This is still something I find strange. Throughout my career we (myself and my colleagues) always worked to do they best we could, for the company or organisation to be the best it could, etc. We never got bonuses or direct rewards (no overtime, nothing like that). It was doing the best we could that motivated us. But there were indirect rewards in the long term; all the different companies/organisations I worked (including governments and QUANGOs) recognised a good job done and an employee who worked for good of the company, who put in that bit extra and, over time, promotions, share options, flexibility (with trust) came. These days people seem to need bonuses on a frequent basis just to get them to do their job. To me, if you work in a purchasing department part of your job is to seek the best deal on purchases you process (and that might include exchanging information with other comparable organisations where permitted). So I still have something of a problem understanding the bonus/reward culture employment seems to have fallen into these days.

Ian

[tanglewood]

A (Press) report I read was saying how purchasing prices across the NHS are a complete joke
One of the problems being that the way our politicians have re-structured the NHS (along open market economy basis) the Trusts are independent so any cooperative buying can only really be setup by local (individual Trust) decisions to cooperate with other Trust similarly inclined. The central NHS of old would have been able to ensure best prices were paid across the entire service.

Ian

More devolution is needed, and more rewards to staff for the savings they find might work.
.....

This is still something I find strange. Throughout my career we (myself and my colleagues) always worked to do they best we could, for the company or organisation to be the best it could, etc. We never got bonuses or direct rewards (no overtime, nothing like that). It was doing the best we could that motivated us. But there were indirect rewards in the long term; all the different companies/organisations I worked (including governments and QUANGOs) recognised a good job done and an employee who worked for good of the company, who put in that bit extra and, over time, promotions, share options, flexibility (with trust) came. These days people seem to need bonuses on a frequent basis just to get them to do their job. To me, if you work in a purchasing department part of your job is to seek the best deal on purchases you process (and that might include exchanging information with other comparable organisations where permitted). So I still have something of a problem understanding the bonus/reward culture employment seems to have fallen into these days.

Ian

True, and sad these things change. But change they have, so what do we do other than lament?

Maybe it's because the average length of time in a job now is down to about 3 years, and not the fabled 30 years of days gone by. Waiting for the long term benefits doesn't work if you are not there for the long term.

Getting a bonus for a great idea that saves public money and getting it before Christmas is very attractive and motivating.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[bovlomov]

Facts are so easy to find thanks to ONS that you really don't have to labour under these faulty perceptions.

It depends how you define it. The picture is complex.
https://www.equalitytrust.org.uk/how-ha ... ty-changed

Since the early 1990s, changes in inequality have been less dramatic than the change from 1979 to 1991. After falling slightly over the early to mid-1990s, inequality, as shown by the Gini coefficient, reached a new peak of 0.358 in 2009–10. Inequality fell in 2010 and has stayed relatively level since.

Rising inequality has seen a dramatic increase in the share of income going to the top, a decline in the share of those at the bottom and, more recently, a stagnation of incomes among those in the middle.

In 2010, while the top 10% received 31% of all income, the bottom 10% received just 1%7. In terms of wealth, in 2010 (the latest year for which data is available), 45% of all wealth in the UK was held by the richest 10%. The poorest 10% held only 1%.

It depends which bits you choose to quote.

[reohn2]

Tanglewood
http://www.independent.co.uk/news/uk/ho ... 97038.html

[Psamathe]

More devolution is needed, and more rewards to staff for the savings they find might work.
.....

This is still something I find strange. Throughout my career we (myself and my colleagues) always worked to do they best we could, for the company or organisation to be the best it could, etc. We never got bonuses or direct rewards (no overtime, nothing like that). It was doing the best we could that motivated us. But there were indirect rewards in the long term; all the different companies/organisations I worked (including governments and QUANGOs) recognised a good job done and an employee who worked for good of the company, who put in that bit extra and, over time, promotions, share options, flexibility (with trust) came. These days people seem to need bonuses on a frequent basis just to get them to do their job. To me, if you work in a purchasing department part of your job is to seek the best deal on purchases you process (and that might include exchanging information with other comparable organisations where permitted). So I still have something of a problem understanding the bonus/reward culture employment seems to have fallen into these days.

Ian

True, and sad these things change. But change they have, so what do we do other than lament?

Maybe it's because the average length of time in a job now is down to about 3 years, and not the fabled 30 years of days gone by. Waiting for the long term benefits doesn't work if you are not there for the long term.
...

You prompted me to do some maths and my average time in each job was actually only 3.6 years! (OK, some jobs were only 1 year others a lot longer - and all the jobs I had were interesting and I never changed because I was bored or unchallenged).

(I'm putting off repairing a puncture after today's ride and if I can keep posting/reading for another 30 mins I wont have time to do it today - hence my off-topic ramblings!).

Ian

[tanglewood]

Facts are so easy to find thanks to ONS that you really don't have to labour under these faulty perceptions.

It depends how you define it. The picture is complex.
https://www.equalitytrust.org.uk/how-ha ... ty-changed

Since the early 1990s, changes in inequality have been less dramatic than the change from 1979 to 1991. After falling slightly over the early to mid-1990s, inequality, as shown by the Gini coefficient, reached a new peak of 0.358 in 2009–10. Inequality fell in 2010 and has stayed relatively level since.

Rising inequality has seen a dramatic increase in the share of income going to the top, a decline in the share of those at the bottom and, more recently, a stagnation of incomes among those in the middle.

In 2010, while the top 10% received 31% of all income, the bottom 10% received just 1%7. In terms of wealth, in 2010 (the latest year for which data is available), 45% of all wealth in the UK was held by the richest 10%. The poorest 10% held only 1%.

It depends which bits you choose to quote.

It does - especially if you confuse "earnings" with "income". Something ONS doesn't do but many others, with a lobbying agenda, will choose to do.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[tanglewood]

Come on - even Gordon Brown now admits that raising the higher income tax rate to 50% reduced the amount of tax collected. It's called the Laffer Curve.

The Laffer Curve isn't THE TRUTH written in stone. It's an idea that works to some degree, but not all that well in a complex world.
....

I thought the problem with raising then dropping the higher tax rate (the problem that caused lower tax revenue) was that when it was announced lots of bonuses, etc. were brought forward so they were counted as income before the higher rate was introduced (meaning then lower incomes after the higher rate and thus lower tax revenue). As the rate did not stay in place for that long, once it was announced it was dropping again more pay rises, bonuses, etc. were delayed until the new lower rate was effective, further reducing the tax revenue during the 50% rate time.

As to that effect causing the reduced tax income ... who can say with certainty who much pay rises/bonuses/etc. were "re-scheduled". Certainly a lot were reported as having been moved but I'd imagine that the true effect of the tax revenue must be something of a guess. However, it seems a reasonable contributing factor.

Also, if somebody is offered a pay rise or bonus, I expect they would still be happy even if it took them into the higher tax bracket (they still get more money in they bank each month). So if you are on £60k a year and happen to get given a choice of a $200k bonus or a £300k bonus would the 50% tax rate stop you choosing the £300k bonus ? and how many employers would get away with saying "50p bonus this year which wont affect you thanks to the 50% tax rate" (employees are not that daft).

Ian

Anecdote, but my wife runs a business that very carefully pays her just enough to reach the higher rate threshold and not a penny more. The business then puts the rest of its operating surplus into her pension. It then makes a profit of £1, pays no corporation tax, and my wife minimises her tax bill and maximises her pension.

Ok, maybe she is morally bankrupt (but I wouldn't say that to her on Valentine's Day). But it is rational behaviour, and shows how higher tax rates do not translate to higher tax revenues.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[Vorpal]

Wrong. The gap between rich and poor is narrowing in the UK, and it widening in most other developed nations. It has been narrowing for a while now and at a rate faster than any other developed country :

OECD :

"Income inequality in the UK grew steadily from the mid-1970s and only dipped briefly in the mid-1990s, the OECD said.

"We found it starts narrowing from the year 2000," said Mark Pearson, the head of the OECD's social policy division. "It is really quite a remarkable reduction since then - the largest fall in all developed countries, at a time when inequality has been rising in most developed countries."

I'm not sure where this came from, but if you look at the data on OECD's website, that quote is not born out.
http://stats.oecd.org/index.aspx?queryid=66670

seems to have latest data at 2013 (same areas have 2014 data), and it shows that while inequality in terms of Gini has gone down slightly since the financial crash in 2008, that it was higher in 2013 than in 2003. It is possible that it has gone down further from 2013 levels, and that's what the quote refers to, but honestly, unless it's a huge a decline, in just a couple of years, it's hard to understand the conclusion.

Also, it's worth noting that of the OECD countries, the UK has the 7th highest income inequality, behind the likes of Mexico and the USA, and well ahead of most Eastern European countries.

It is also worth noting that

Over the past few years, income inequality levels have remained at historically high levels. Across OECD countries, the average Gini coefficient of disposable household income reached 0.318 in 2014, compared to 0.315 in 2010. This is the highest value on record, since the mid-1980s.

The UK's coefficient is well above the average at 0.358
from http://www.oecd.org/social/income-distr ... tabase.htm

(and I see that whilst I was writing this several others have posted)

[tanglewood]

Tanglewood
http://www.independent.co.uk/news/uk/ho ... 97038.html

That's wealth, not income.

Wealth inequality is very different. It is of course massively affected by house prices, and therefore whether you own a house. Pension assets too.

But these wealth assets are not very liquid. So income is more relevant to how people live their lives than wealth. Living in a house worth a million doesn't put food on the table.

My father doesn't feel rich at all, although his wealth is high - way, way higher than my debt! But his income is much lower. His lifestyle is not as comfortable as mine. He would say he is on the wrong side of equality compared to me, despite having considerably more wealth.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[tanglewood]

So you're asserting that NHS inflation for basic goods and services is greater than that in the economy at large.

This is mere assertion, unless you can provide evidence.

I'm sceptical. A link, please?

Sure:

https://www.gov.uk/government/publicati ... -to-202021

Looks like excessive inflation in unit costs is a safe future assumption.

But the link shows the exact opposite of your claim.

Other operating costs 1.7% 1.8% 2.1% 1.9% 2.0%

These are low figures, very much in line with general inflation.

Figures above inflation (drugs) is a reflection of improved technology (new expensive drugs), exactly as I wrote.

Selective quoting of just part of the table. The projected NHS inflation for this year is 3.1%, against a background 1.8%.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels

[reohn2]

That's wealth, not income.

You don't get the wealth without the income as a rule.OK some can fall off the Co oP and land in the Divi,but not that many.

But these wealth assets are not very liquid. So income is more relevant to how people live their lives than wealth. Living in a house worth a million doesn't put food on the table.

If I lived in a house worth a million and couldn't eat I'd be a fool not to do something with the house to enable me to.

[Psamathe]

That's wealth, not income.

You don't get the wealth without the income as a rule.OK some can fall off the Co oP and land in the Divi,but not that many.

But these wealth assets are not very liquid. So income is more relevant to how people live their lives than wealth. Living in a house worth a million doesn't put food on the table.

If I lived in a house worth a million and couldn't eat I'd be a fool not to do something with the house to enable me to too.

Wealth vs income is complex. If you are wealthy enough to own your own house they you don't pay rent so your income requirements/income to live are significantly lower. But once you own your house then more wealth (more valuable house) can act in the opposite way (more expensive to run, higher Council Tax, etc.). Same with other assets - a newer car is less likely to need significant work to replace worn out parts, etc.

And as you say, many at the higher end asset wealth wise can often chose to liquidate their assets to provide cash and lower their "running costs" whereas the less wealthy don't have that option.

Ian

[tanglewood]

That's wealth, not income.

You don't get the wealth without the income as a rule.OK some can fall off the Co oP and land in the Divi,but not that many.

But these wealth assets are not very liquid. So income is more relevant to how people live their lives than wealth. Living in a house worth a million doesn't put food on the table.

If I lived in a house worth a million and couldn't eat I'd be a fool not to do something with the house to enable me to too.

The growth in wealth that many have experienced is not directly linked to income of the owners. House prices in the south east and London is a great example.

As for selling up the house and garden you have owned for 50 years and nurtured, and that allows you to have your grandchildren come and stay, and moving into a one room flat - well, it's not easy, and no wonder most resist it as long as they can.

I think those of us with income but low wealth should buy our parents' house a month at a time while they still live in it. They get more income and we get more wealth. That way we reduce two inequalities at once.


I'm a trendy consumer. Just look at my wobbly bog brush using hovercraft full of eels