Thursday, October 23, 2008

Can the poor afford BUPA?

Tristan Mills has a somewhat contentious post up attacking public-sector and pseudo public-sector employees as parasites. While I don't agree entirely with his taxonomy (I wouldn't call people providing front-line public services or line-managing people who do parasites) he has a good point. People who receive a salary from the government without providing a useful service in exchange (most managerial and policy-making roles, non-execs at quangos, all public relations types, etc.) are leeches on society and deserve no more respect than tax-dodgers and benefit cheats. Ditto the management consultants who get rich providing bad advice to them.

Unfortunately he provokes an attack in the comments from someone who says
Do we really want a society where the only people that get healthcare are the ones who can afford BUPA??
Well, lets look at what it takes to afford BUPA membership. I am "paying" (technically my employer pays, but the cost was taken into account when we negotiated my salary) £46 a month for a group BUPA policy which is available to anyone at my workplace under the age of 65, with no exclusions for pre-existing conditions. This isn't a special deal - it is available to any employer who sets up a group policy. That works out at £552 a year. The minimum wage is now £5.73 an hour. Someone working 40 hours a week and 52 weeks (less four weeks paid holiday, which is now a right) a year on this rate is earning £11918 a year. On this they pay £1177 in tax and £710 in employee's NIC's (for which they no longer get any useful benefit - contribution based benefits are not much more generous than means tested ones, and you no longer need a full NI record to get a full State Pension) and "pay" £827 in employer's NIC's. In other words, if they weren't supporting the parasitic class, the poor could afford BUPA almost five times over.


  • At 11:38 pm , Blogger Duncan Borrowman said...

    Remind me exactly how many doctors and nurses BUPA train every year. Now getting back to parasites.

  • At 11:45 pm , Anonymous Liberal Neil said...

    So if the NHS pays managers, or people to do publcity work, they are parasites, but if the private sector company employs them they are not?

    And what happens if something BUPA, or any other private provider does, goes wrong?

    They ring for an NHS ambulance.

    Or if you need something really expensive?

    They refer you to the NHS.

    There's also the fact that that person's taxes are also paying for a whole host of other services, not just the NHS.

  • At 11:46 pm , Blogger Andy said...

    In addition to Duncan's point, I might also point out that many people use the NHS for everyday stuff, even if they are insured, because it's easier than making a claim from BUPA and it doesn't increase their premiums. I think we can safely assume that if we abolished the NHS, that cost would go up markedly. A more enlightening back of an envelope calculation to do would be to look at the amount people pay in the US for healthcare coverage.

  • At 12:21 am , Anonymous John said...

    I think the blogger must have been asleep for the past month or so. A main feature of Obama's campaign (and something i hadn't heard of before) are people with terminal conditions having to negotiate down the phone with HMOs.

    I just think it's more efficient to have a properly run NHS and the peace of mind of knowing it's there when you need it is not only reassuring but can also be a spur to productivity as health isn't something you have at the back of your mind when you're healthy.

  • At 12:46 am , Blogger Miller 2.0 said...

    The question as to whether or not they can afford it must also fold in whether they would be incentivised to prioritise it.

    If they chose not to, would liberals simply ignore the sick and dying as they passed by in their portable private sphere?

    Secondly, given the premise of no NHS, don't you think BUPA's costs would be quite a bit higher, given the explosion in demand that they would face and the lack of infinite doctors and nurses?

    And why is the state able to be described as parasitic where BUPA does not suffer the same level of criticism? Isn't it true that the difference between state parasitism and BUPA parasitism is that the state forces you to be covered wheras the private sector is happy to let you assume your own risks?

  • At 12:56 am , Blogger Duncan Borrowman said...

    Thanks to Neil and Andy for picking up on my brief posting from my phone earlier. I will explain why BUPA is parasitic, and the state is not:

    Who pays the day-to-day salaries, including holidays, overheads etc for the consultants who do their few hours a week freelancing for BUPA. The NHS does.

    Who has to maintain A&E units able to deal with an unpredictable flow of patients with unknown problems 24 hours a day. With all the back up kit required. The NHS does.

    Who similarly has to maintain the major incident units to cover with train crashes, motorway pile ups, terrorist attacks, major fires etc. The NHS does.

    Who sits back and selects the cases it wants to deal with that make it the most profit without any of the overheads of a true health service. Well BUPA do.

    The finacial comparisons made in the original posting are kindergarten economics.

  • At 1:08 am , Blogger Hywel said...

    "all public relations types, etc. [are parasites]"

    Really. What about the people running campaigns to say encourage blood and organ donors, promote takeup of the HPV vaccine?

  • At 7:23 am , Blogger Femme de Resistance said...

    all public relations types, etc.) are leeches on society and deserve no more respect than tax-dodgers and benefit cheats. Ditto the management consultants who get rich providing bad advice to them.

    I disagree that all public relations and (all) management consultants are useless.

    People often become so involved in their organisation, they can't see the bigger picture.

    For example, I want to launch a new screening programme for housemaid's knee. The Government in its High Quality Health for All programme decided diagnosing housemaid's knee was important. To deliver the screening programme, I have to move some middle managers between departments.

    As the housemaid's knee screening guru, I create some leaflets to try to get patients to come for screening (a good thing). What do I put on the leaflets?

    Well, of course, I explain how the Government has launched a new initiative with various targets and objectives. To deliver a screening programme, I have moved some middle managers.

    Six months later, I don't understand why no patients have come for screening. So I employ a PR agency.

    They explain that patients don't care about the middle managers or the initiative. They just want to know that housemaid's knee causes swelling and pain. A new screening programme can catch it early.

    Why can they do something the guru can't? Because designing leaflets to communicate with patients is their day job. The guru's day job is creating a screening programme.

  • At 8:01 am , Blogger Femme de Resistance said...

    Not agreeing with LibertyCat here but:

    Remind me exactly how many doctors and nurses BUPA train every year.

    Don't doctors pay for their own training (see here about halfway down. This was why this was so much of a tragedy).

    So if the NHS pays managers, or people to do publcity work, they are parasites, but if the private sector company employs them they are not?

    LibertyCat has gone to the vet. However, knowing him as I do, he believes all PR people are parasites, regardless of who they work for.

    And what happens if something BUPA, or any other private provider does, goes wrong?

    The Cat tells me that the NHS sends them a big bill.

  • At 11:13 am , Blogger Duncan Borrowman said...

    Well as the father of a medical student, and the husband of a former senior NHS accountant (and my ex-wife was a nurse) I really wouldn't like to suggest I have any knowledge of this subject.
    The suggestion that doctors pay for their own training is as naive as comparing BUPA fees to NI payments/tax.
    To train doctors properly you need all that infrastructure I mentioned above. That doesn't coem cheap.
    Of course we could have BUPA trained doctors, who are just trained in BUP hospitals, adn could just deal with BUPA patients. And their trainig could be fast tracked so they only need the knowledge to deal with the things BUPA do. Of course we would need a good NHS hospital nearby with a fully trained doctor for when it all goes tits up.

  • At 2:22 pm , Blogger Tristan said...


    Are people really this thick?

    The state takes money by force. It takes away people's ability to spend their money as they see fit - because a bunch of (usually middle class) authoritarians claim to know best

    (Miller 2.0 falls perfectly into this)

    Duncan fails to understand that the state should not be paying to train anyone. Why should people be subsidised to earn money?
    If BUPA needs doctors and nurses it could then pay to train them. Business should not get any subsidy, be it training, infrastructure or direct funds.

    Duncan is probably correct in saying the state subsidises BUPA, in which case it should stop, but to be consistent the state must stop providing health care full stop.

    As for the infrastructure - it was far more extensive until the medical unions pursuaded the state to cartellise their profession so they could rent seek.

    My point about the parasitic classes is they have a vested interest in continuing to live off others.
    Doctors, nureses, teachers and those who do provide services can and should provide them on a freed market, not with protection and coddling from the state. It would actually serve people better (especially the poor) but the cartellised nature of the professions benefits enough people in the professions that they will not relinquish their position.

    (the obvious examples being teachers unions who reject improvements which will benefit students because it threatens their position - particularly prominent in parts of the US, but also occurs in the UK).

    Lastly, as I feel I have to say too often - this is not a case of eliminating the NHS and saying use BUPA or die, it is not a case of moving to the rigged market of the US.
    If I were in the US I'd be attacking many of the same things, they US just achieves them in different ways.
    What Obama says is of no relevence, because he is not talking about a free market system because the US does not have one.

    I make that point repeatedly, all I get in response is 'but without the NHS people will die!' without taking into account context (or the fact that the NHS kills people who might otherwise live anyway).

  • At 6:50 pm , Anonymous Squirrel Nutkin said...

    Poor, poor Tristan. Steadfastly, tirelessly proselytising for his faith, yet reduced to calling people thick!

    How naughty and headstrong these economic units are, not seeing the rationality of his faith. Which produces its magic wonderland because of their rational actions.

    Only a couple more steps now, Tristan, and you can wallow wholeheartedly in the warm bath of blaming "false consciousness" for the absence of mass popular support for your marketomania.

    And then you really will be the mirror image of all those marxist muppets who used to drone on at us in the 70s but could never understand why their abstracted theorising was about as popular as being in the Plymouth Brethren.


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