The NHS - a marvel of the modern world

I had a frustrating NHS experience recently. I am moving and starting a new job at the end of May and don't hear very well in one ear, so around the middle of March I thought I'd ask about getting a hearing aid (I've previously been offered an operation to correct it but (a) it's just one ear, it doesn't make enough of a difference to warrant taking 6 weeks off work and (b) they've already done this particular op twice and it hasn't worked twice).

I got an appointment with my GP towards the end of March and he agreed to refer me to a consultant. I get a call from an NHS place to book a time to see the consultant. Great - it's a month away, but that's not so bad, I guess - I can justify taking a morning off work to deal with it.

Next week I get another call from the same place - can I book a hearing test? They can't do the same day I'm seeing the consultant, so I'm looking at two mornings off work now - great! Still, it's not so bad, and at least if that gets it done it'll be worth it.

I go in for the hearing test. Next week I go back for the consultant visit. "So, you're hear to get your ear cleaned then?"
"No - I want to get a hearing aid." I explain the situation.
"Oh, ok. We can probably do that - let me just get you booked in for a hearing test and we can see you again to talk about it."
"I've already had the hearing test - here. Last week."
He checks his notes. "Oh yes, so you have. Well I don't see any reason why you can't have a hearing aid - we'll give it a try and see if that helps."
"Great - where do I pick it up?"
"Oh no - I can't give you it here, you need to go to the hospital and talk to someone there. I'll refer you, you should hear from them in a few weeks."
"But I'm moving house and starting a new job in 3 weeks - can you refer me to a hospital near Leeds?"
"No, but if you want to speak to your GP there, they can get the ball rolling for you."
I've already been trying to get this down for a month and a half at this point - I can always come back for a hospital visit. "No, that's ok thanks. I'll proceed down here."
"Seeing as you're hear, I can give that ear a clean anyway."

So I'm now nearly two months from when I spoke to my GP and I've had a hearing test (which showed the same as the last one I had) and have had my ear vacuumed out (which made no difference to my hearing), at the cost of two mornings off work. I'm still waiting to hear from a hospital which won't be any where near where I live by then, and I'm starting to lose the will to live.

If you had to have anything urgent done, I hate to think about how it would be dealt with.

Don't get me wrong - when my mum had an aneurysm, the NHS were not bad. They did keep postponing the operation to fix things, and it was hard to get anyone to actually tell us what was happening, but they did it and kept her alive, so that's a great outcome. There's a lot that could be better though.

Taking kids out of school in term time

Doesn't affect me, but I saw this

And when the case was heard at the Supreme Court earlier this year, the local authority argued that an unauthorised absence "for even a single day, or even half a day" could be unlawful.

Back when I was in school, there was a lot of truancy. If they've cracked down on this then fine, but if we have kids bunking off once a week and no prosecutions, and then we have kids with 90+% whose parents are prosecuted for a week out then we're doing it wrong.

Who pays?

Saw this article about maternity pay on the BBC

Statutory maternity pay for UK mothers is among the worst in Europe, according to an analysis by the TUC.

Well the fact that the TUC is behind it is a bad sign to start with.

The trade union body says only Ireland and Slovakia have worse "decently paid" entitlements.
It defines decently paid as two-thirds of a woman's salary or more than £840 a month.

This is a little unclear - the £840 a month figure is apparently 2/3 of the UK average. They don't compare with absolutes anywhere in the source or the TUC's analysis so the mention is a little misleading - not least because no other country is being measured against £840 a month.

Croatia comes top, with six months

Would you rather have 6 months of 2/3 the average Croatian pay, or the current UK system?

Average pay in Croatia is around 750 euros per month, meaning 6 months at 2/3 would be around 3,000 Euros. In the UK you get 90% of your average pay for 6 weeks then around £140 per week for the next 33 weeks. So it would be approx (6 x 25000 / 52) + (33 x 140) = ~ £7,500

Although, the UK system pays out over 9 months - if we pro-rate we get 3,000 Euros vs £5,000 for 6 months. I know which I'd prefer.

Don't get me wrong - I get that this is an issue, but we need to consider the costs of increasing maternity pay. Do we really need more kids being born? If so, encourage it. If not, don't. As far as I know, no-one has done any analysis of whether we want to increase or decrease the birth rate, and without that it's hard to know which way we should incentivise behaviour.

Trump's new healthcare bill

I don't have much of an opinion on Trump either way - I figure we wait and see how he does, it's a bit early to judge so far. That said, I saw this story on the BBC and the graph at the bottom is very misleading:



The scale on the left jumps from 0 to 10 so a quick glance will appear as if the fall under the ACA was significantly greater than it was. Looking at the numbers, it seems to have fallen from a high of 18% to 10% (a drop of 44%) but looking at the positions on the graph it appears more like a drop of 80%.

The prediction under the new republican plan appears to be heading back to where it was before the ACA, but I do note the little uptick they've added at the end (suggesting it will be worse?).

Anyway, let's have a look at what they're doing (and I've cross checked with PolitiFact - no idea if they're any good, but they come across as relatively unbiased)

Key elements of the new bill:
Cuts the Medicaid programme for low earners

This is one of the key things in America, from what I can gather. The Democrats want more support for the poor and the Republicans want less (or at least don't want to have to pay for it). There are a couple of parts of the new act that this could refer to, but probably the biggest one is that the the rollback of the provision under ACA that allowed states to expand their Medicaid provision to those earning up to 138% of the official poverty level (with the federal government paying 90% of the cost), whereas previously it had been limited to 100%. This option has only been taken up by 31 states, so it seems like another one of those odd cases where you get different levels of federal support depending on which state you live in.

Provides tax credits to help people pay medical bills, but reduced compared to Obamacare

Still higher than before the ACA, from the sounds of it, but I can see why some people are unhappy about it being lower.

Ends penalties on those who do not buy health coverage

Definitely a good move - I'm against forcing anyone to buy anything - although there is a risk that young healthy people won't buy healthcare and that will mean the insurance companies can't afford to provide cover for the less healthy.

Allows insurers to raise premiums for older people

This looks fairly big. I do think it's misleading for the BBC not to mention that this is already the case under the ACA, but the limit is going from 3x to 5x the premiums expected from a younger person. In addition, the new act will reduce the subsidies available (for everyone, but this has a bigger impact on the older people).

Blocks federal payments to women's healthcare provider Planned Parenthood for a year

That's a policy thing. The Republicans don't agree with abortion, so they're banning payments to a group that carry them out.


Looks to me like people will still be better off than they were before the ACA. To be entirely honest, the healthcare system in America is a bit worrying - they should look to somewhere like Singapore for a good example of how it can be done.

Real Tax Rates 2017/18

Six and a half years ago, I posted a summary of how much tax is actually paid at the various earnings levels. I thought it might be time to update it.

Summary:

Earnings	Marginal rate 2017/18	inc Employer's NI
up to £8,060	0%	0%
£8,061-£8,112	12.00%	12.00%
£8,113-£11,000	12.00%	22.67%
£11,001-£43,000	32.00%	40.25%
£43,001-£43,004	52.00%	57.82%
£43,005-£100,000	42.00%	49.03%
£100,001-£122,000	62.00%	66.61%
£122,001-£150,000	42.00%	49.03%
£150,001+	47%	53.43%

There's a big bump between £100k and £122k as the personal allowance is withdrawn, and the slightly different banding between NI and Income Tax makes for a few oddities. Overall the levels are higher than you might think.

Note: This was calculated using the weekly NI limits, and it is worth noting that if your income is not spread evenly over all of the weeks of the year, you may wind up paying additional NI. Also those with low incomes may face severe benefit withdrawal rates taking their effective tax rate up a lot higher than indicated here.