Nobody now disputes the need for a significant and sustained increase in revenue for the NHS and social care (Household tax bills ‘must rise by £2,000 to fix crisis in NHS’, 24 May). Rather, there are two political battles to be settled: how significant an increase the country feels it can afford, and from whom it wishes the additional revenue to be raised.
The first question can only be answered through an ongoing “strategic welfare review”, conducted by the government along the lines of the present strategic defence review. Regular official long-term projections are required so that the country can be presented with a range of funding scenarios, based on different levels of service and accompanying outcomes it might expect from health and social care.
On the second point, the public have made clear that their preferred means of financing an increase in revenue is through the national insurance system. As a first move, therefore, the government should earmark an increase in contributions for health and social care. Crucially, the extra revenue should be collected on progressive lines so that those who earn most will pay most. This would lay the basis for an alternative longer-term model that gradually moves all health and social care funding to a new national insurance base, reformed along progressive lines.
Frank Field MP
Labour, Birkenhead
• It’s a no-brainer that the NHS needs more funding. Interestingly, if you plot satisfaction levels against the level of funding by different UK governments, it is no surprise that it was low under the Thatcher government when the annual real spending growth rate was 3.5%, but rose steeply when it was 6% under the Blair/Brown government, but has been going down since the 2010 coalition cut NHS spending growth to 1%. Everyone knows that if you want a good service, you have to pay a realistic price for it.
Sadly governments and the rightwing media have made a fetish about “cutting taxes”. They mean income tax in particular, which has forced governments to raise revenue by hikes in regressive taxation via VAT, insurance, flight and other taxes. Our whole tax system needs complete revision to make it not only simpler but fairer and more progressive, including introducing local income-based taxation to replace the arcane out-of-date council tax.
But the government could also do much more to reduce costs to the NHS by tackling obesity, and the consequent damage caused by diabetes, and by actually improving air quality instead of continually trying to avoid EU legislation requiring its improvement.
Michael Miller
Sheffield
• Amid general enthusiasm for extra health spending and some measure of support for hypothecated tax, a cautionary note should be considered. The argument for more funding is structured around shortages in treatment resources in the present and the likelihood of this worsening in response to demographic changes in the near future. While true, the allocation of extra funds to address these needs would entrench an incrementalism that has not served us well. More would be spent on existing service configurations and on treating illnesses rather than promoting health.
One argument for hypothecation is that it would take politics out of health spending. But those things that exacerbate the health inequalities that see poorer people doing increasingly badly on almost every measure are political: inequality in income and opportunity, environmental degradation and so on. A gradually rising hypothecated tax going to the NHS would undermine calls for upstream interventions that addressed the causes of the increased demand for medical care. It would be a status quo response to a challenge that requires radical thinking.
Neil Small
Bradford
• UK businesses benefit hugely from the NHS, by having a healthy and well workforce, helping to deliver on their corporate goals. They tell us rightly that they are an integral part of our social fabric. Why then, in all of the discussion of the tax increases required to return NHS funding to its past levels (let alone give it the capacity to cope in the context of the horrendous cuts to social care and other services supporting the vulnerable), has there been no discussion of significant rises in corporation tax?
The idea of hypothecation, whether soft or hard, could also be extended to the taxes paid by business. In that way, a significant and transparent percentage would be clearly seen to be going to pay for our national health and care services.
Such an arrangement would also throw into stark relief the impact of the various tax-avoidance schemes developed by the finance industry and big four accountancy firms. “Saving so many millions of tax charges” would then translate directly into “this is so much revenue we’ve removed from the NHS”.
Graham Head
London
• I am extremely concerned about the possible animosity that is going to be exacerbated between old and young. As things stand, older people use the NHS more, they get free TV licences, winter fuel allowance, free prescriptions, discounts here there and everywhere. Young people see rich old people with good pensions swanning about. Many of them have no prospects of owning their own home, getting a pension or being treated anywhere near as well as older people do nowadays.
And now the government is planning to charge people of working age £2,000 a year for the NHS while those who use it the most pay nothing. If this is not fodder for a revolution I do not know what is.
Kathleen O’Neill
Hayling Island, Hampshire
• How about the government creates a hostile environment for tax avoiders, tax evaders, money launderers and corporations using overseas jurisdictions to avoid paying their fair share of tax, in order to fully fund the NHS? This would mean the hardworking majority, who already pay their fair share of tax, would not have to shoulder this burden.
Ian Skelton
St Albans, Hertfordshire
• “Household tax bills must rise by £2,000 to fix crisis in NHS”. No, no, no. We just hasten to complete the privatising of it before Labour gets in, and then only the households who need treatment will pay for it. That’s fair isn’t it? The 1%, who already invest in the business, simply withdraw from their tax haven funds on the rare occasion they might have to.
John Airs
Liverpool
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