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I think we in the UK do not pay nearly enough tax
According to a lady from the IFS on this week's more or less the UK is a 'middling' taxed country when comparing taxation vs. GDP. Apparently we're higher taxed than any other country in the oecd.
Del - that is nonsense. gawd knows what definition they are using to come up with that.
We are much lower taxed than most european countries. Thats why we have crap public services.
I heard the same interview as Del. N.B. it is calculated as total tax take (so direct, indirect, corporation taxes etc) as a proportion of GDP.
This is the link to the show.
https://www.bbc.co.uk/programmes/p09vyy6h
Wealth taxes are expensive to collect and distort efficient allocation of capital. Seriously dumb policy.
Not necessarily, depends on how it's implemented and collected. Norway, Spain and Switzerland all operate them (with varying levels of capital gains property taxes and inheritance taxes). Look at the WTC (wealth tax commission) report Nov last year, it's recommendations are pretty level headed and the return on a one off tax is staggering (hundreds of billions of pounds) and pretty popular, I doubt it could be done without reform to capital gains and inheritance though Given that Sunak's room for maneuver is limited, I can see this being an option, although I could understand why many wealthy folk in the S.E. would squeal about it.
Look at the WTC (wealth tax commission) report Nov last year, it’s recommendations are pretty level headed
They don't recommend an annual wealth tax because they don't really work very well, instead they recommended a once off unannounced raid on people's wealth, I think that is the very opposite of level headed.
To me a couple with a niceish £500k semi in the southern ‘burbs of Manchester and £250k in each of their pension pots are not millionaires in any useful definition of the term
Depends whether you see the hike in NI as directly funding social care or, in reality, protecting elderly Tory voters' homes from taxation.
instead they recommended a once off unannounced raid on people’s wealth
They say nothing of the sort. Daft thing to write
instead they recommended a once off unannounced raid on people’s wealth
They say nothing of the sort. Daft thing to write
Really?
Seems to be reported a lot.
https://www.withersworldwide.com/en-gb/insight/uk-wealth-tax-commission-publishes-report
"The self-appointed ‘Wealth Tax Commission’ has published a report recommending a one-off wealth tax on total wealth"
https://home.kpmg/uk/en/home/insights/2020/12/tmd-wealth-tax-commission-final-report-recommends-a-one-off-wealth-tax.html
"The Wealth Tax Commission has published its final report and concludes the UK could benefit from a one-off wealth tax on all assets."
Depends whether you see the hike in NI as directly funding social care or, in reality, protecting elderly Tory voters’ homes from taxation.
That is exactly what it is. Not sure what measurements will be used to evidence improved social care but I will be amazed to see any improvement at all.
People having to use up their assets to fund their own care home bills is not even part of the social care problem.
All I debating was the strict definition of a millionaire.
Its an arbitrary level. Maybe replace "millionaire" with "wealthy". All of those people are wealthy by pretty much any definition so are a reasonable target for a little more tax
on using the house to pay for care.
If you do not do this a large tax increase would be needed.
The only people to benefit from not selling a house to pay for care are the children of middle class parents who still get their inheritance.
Why should my taxes pay for someone else to inherit?
its one of those situations that seems unfair however you look at it
To prevent avoidance through forestalling, the tax must not be pre-announced.
Conclusions and Recommendations Section 6.1
They recommend that it's not pre-announced. ie. don't tell people in 2021 that there's going to be a wealth tax in 2025. As that will encourage avoidance measures by those wealthy enough to implement them. They recommend decision of an assessment date on or before announcement date.
It's not an un-announced raid on people's wealth at all.
I don't think people should need to fund their own care. They are in care because they are ill, i.e. having dementia is an illness and needs caring for just as any other medical conditions does. Should all be within NHS.
Whether wealthier people are taxed more to pay for improved NHS is separate to that but this change seems to be focused on protection of wealthy peoples houses more than anything.
They recommend that it’s not pre-announced. ie. don’t tell people in 2021 that there’s going to be a wealth tax in 2025. As that will encourage avoidance measures by those wealthy enough to implement them. They recommend decision of an assessment date on or before announcement date.
It’s not an un-announced raid on people’s wealth at all.
Eh? Makes no sense.
I don’t think people should need to fund their own care. They are in care because they are ill, i.e. having dementia is an illness and needs caring for just as any other medical conditions does. Should all be within NHS.
So that argument initially seems to make sense, but:
- not everyone in a care home has dementia
- not everyone with dementia ends up in a care home
- whether they are in a care home or their own house there are costs for the building, heating, lighting, food etc. Why should the state be covering those basic costs for some people whilst others have to pay their own?
- is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house - so that the elderly person's children will inherit £0.5M when the time comes?
Eh? Makes no sense.
If you tell people that there is going to be a wealth tax calculation in 3 years time (for instance) you give some folk the head start they need to minimize their exposure. So a one off wealth tax needs to be announced and then either quickly assessed or (more likely) the assessment date is in the past...ie what was your wealth on "x" date.
You can have all the mitigation you may need to acct for "asset rich and cash poor" and deferred or installment payment etc set up within the mechanism.
"i.e. having dementia" means for example.
Full social care means that people have care in their own home via health service just as those in a care home would be. It is all care and should all be part of the health service.
– is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?
Yes, that is reasonable just as she is paying NI/tax today. That is how the NHS works and is funded. The rich elderly person gets exactly the same care and treatment.
If you think the rich elderly person should be made less rich then great, do that via taxes that impact them and not the single mum, i.e. very high inheritance tax, high taxes on their shares
whether they are in a care home or their own house there are costs for the building, heating, lighting, food etc. Why should the state be covering those basic costs for some people whilst others have to pay their own?
the same applies if you go to hospital - should people in hospital pay for the lighting, heating etc when some other healthy people do not?
– is it reasonable for a single mum of two earning £28K a year, living in a rented house with no assets to pay more tax to fund the care of someone with £300K in the bank/shares, a £30k a year pension and a £250K house – so that the elderly person’s children will inherit £0.5M when the time comes?
yes, they're paying more tax now, but the person with a 30k pension has paid more tax whilst accumulating their pension. THe single mum will also get a load of benefits the old person won't.
but the person with a 30k pension has paid more tax whilst accumulating their pension
Not on their pension they didn’t! Also that’s not how it works. It doesn’t matter how much you’ve paid in the past that money is spent. Might net being spent now needs to be raised now (ish).
If yoyu want free care homes for all then you need a big tax increase - and I really do not see why my taxes should be used so middle class children get to inherit.
So you are using care home payment as a means of stopping middle class children (More like 50 years olds) having any inheritance. Clearly that only impacts those that require care and those dying of other things don't have their inheritance affected as their treatment is covered by NHS. Odd way of looking at things.
If people require health care of any kind it should be covered by the NHS.
If you don't want people to inherit large amount then increase inheritance tax which would be a consistent and fair way of handling it.
Social care costs are huge - dwarfing anything else. Are you prepared for a 20% rise in taxation to pay for all care to be free at the point of use when the only difference it makes is not to the people in care but their children who inherit?
Taxpayers money being used to allow the rich to inherit?
I don't think many of you realise the sums needed.
If you think the rich elderly person should be made less rich then great
I don't think the old lady should be less rich, but certainly the children that inherit should or could be, as they've done little or nothing to earn the wealth.
Social care costs are huge
And are only going to get bigger. Those above working age/retirement is set to be something like 20% of the population in the coming decades...we need some way of paying for it.
At current rates all social care including home care etc if fully taxpayer funded would add something like 20 billion to the spending
NHS is 180 billion or so. In comparison. Its a lot of money to find and will only increase with the aging population
Apologies. I listened again to 'more or less' and I need to correct my statement. We tax above the average of the oecd countries.
Still, if you think we are a low taxation country you agree with Sajid javid who claimed the same on Today the other day, so there's that. 👍
The piece begins at about 8 mins 30s in.
At current rates all social care including home care etc if fully taxpayer funded would add something like 20 billion to the spending
NHS is 180 billion or so.
Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?
but the person with a 30k pension has paid more tax whilst accumulating their pension
Not on their pension they didn’t!
Doesn't matter, they still paid more, unless they put all the extra 2k into pension, which they probably didn't.
Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?
Hospitals suck up too much resource of the NHS already and arguably (from a primary and community care perspective) are already badly and inefficiently run. They can barely cope now. Adding Social care to their portfolio would be a recipe for disaster IMO. I think I'd cut it all to pieces, separate out Mental Health, pretty much all children's services, pretty much all outpatient care, and leave only acute/emergency and planned surgery care with hospitals. All chronic conditions and elderly care looked after by separate arm.
About the only bit the works anything like it should is primary care.
My wife works in social care. Her employer is NHS Scotland.
don’t think the old lady should be less rich, but certainly the children that inherit should or could be, as they’ve done little or nothing to earn the wealth.
Well 100% inheritance tax (which severe penalties for dodging it) would get my vote.
That should find the 20 billion (TJ figure) which in the big scheme of things is not very much anyway
Serious question: Could there be cost savings by having them both run by the same organisation? I mean, if care could be integrated across both hospitals and care homes?
Nope
Indeed integrating it into the NHS would increase costs massively because 60+% of the cost is staff costs and NHS employees are paid about 50% more ( if you include holidays and pensions) than care home workers and home care workers.
Nickc - really?
and leave only acute/emergency and planned surgery care with hospitals.
What about rehab? what about imaging? what about diagnostics like catheter labs / MRI scans etc
Where are you going to do outpatients? remember that outpatient consultants will also be working in the hospitals on the same day they are in OPD. making staff move locations several times a day is unutterably daft.
BTW - as is well proven UK hospitals are amongst the most efficient in the world - even in england where admins costs are twice Scotland because of the stupid fake internal market.
as is well proven UK hospitals are amongst the most efficient in the world
yep, don't disagree, and they still suck up huuuuge amounts of cash just to run them. There's really no reason why outpatient stuff like audiology or ophthalmology should be in the hospital. There's no reason why cataracts aren't being done at all the (largely) unused ops rooms in most of the lift buildings that also house 2 GP surgeries and dentists. I ran a very successful cataract community ops pilot that saw 16 people every day working from essentially a GP surgery with no adverse side effects at all.
the Dutch have long separated their medical needs into Acute and Chronic and Mental Health, and it's high time we stopped thinking that we can't learn from places like Spain who've had some success devolving their care to regional "total care" packages. Even the US have things to teach us about getting the pat and doc together in the most effective and cheapest way (as they do with Medi-care and Medi-aid)
making staff move locations several times a day is unutterably daft.
But making them move in locality once a day isn't really that daft, lets move the fewest people, and that's always going to be the docs and nurses. We spent huge amounts of cash in the nighties and naughties building tremendously capacious and capable buildings in every town, let's use them properly.
Oh dear.
A senior registrar or a consultant will be working 7 30 - 5 usually. OPD is usually 2x 3 hr sessions. You really want to waste their highly valuable time moving locations 3 or 4 times a day?
Even the US have things to teach us about getting the pat and doc together in the most effective and cheapest way (as they do with Medi-care and Medi-aid)
twice as expensive as the UK
Cateract ops in the way you describe are much more expensive than done in hospitals and require far more equipment as each piece of equi[pment has to be duplicated multiple times for reach clinic
the only way you could do it is because the fake market in england is totally distorted in favour of private providers
so under your plan for OPD we would be having the senior medical staff having to change locations 3 or 4 times a day wasting valuable time
they would be working in the hospital - then have to leave to other premises, then return to the hospital, then return to opd, then return to the hospital wasting maybe 15% of their time that day
also sometimes the OPD doc is also on the crash team
absurd
Indeed integrating it into the NHS would increase costs massively because 60+% of the cost is staff costs and NHS employees are paid about 50% more ( if you include holidays and pensions) than care home workers and home care workers.
An interesting angle.
It's only a matter of time until euthanasia shall be a health care option
An interesting angle.
Its something many people do not understand. the privatisation of elderly care under thatcher was for one reason only - to enable the employers to be able to pay less than NHS or council staff.
Of course I would want everyone working in care to be properly paid - but is just an aspect that many folk will not realise. to bring all elder care into the NHS would have a huge cost because of the utterly wretched pay terms and conditions that the privatised workforce have and to bring them up to NHS standards would add significantly to costs
You really want to waste their highly valuable time moving locations 3 or 4 times a day?
That's not what I said, go back and read it properly. There's no reason why they can't gp to a different location once a day, is there?
so under your plan for OPD we would be having the senior medical staff having to change locations 3 or 4 times a day wasting valuable time
Not what I said. stop making shit up just because you can't read properly
twice as expensive as the UK
some of the insurance companies running medi-care in some states are very very efficient at getting patients and docs together as cheaply as possible, their profit-margin depends on it!
Nickc - if you are moving senior doctors out of hospitals for OPD then thats what would happen - at the moment they work in the hospital outside OPD for a part of the day and in opd for a part of the day - doing what you suggest would mean them moving sites 3 or 4 times a day.
"That’s not what I said, go back and read it properly. There’s no reason why they can’t gp to a different location once a day, is there?
Yes - because thats not how they work. the docs are doing ward work before. after and in between OPD sessions.
At the moment the senior docs will be doing ward work before and after OPD sessions. so taking OPD out of hospitals means they would be moving between units 3 or 4 times a day and wasting hours a day doing so
so yes - your idea is absurd, would waste huge amounts of time, reduce the amount of patient contact the doctors have
Once again you show your total lack of understanding of how hospitals work
As for the idea that american systems are cheaper - laughable
Cateract ops in the way you describe are much more expensive than done in hospitals and require far more equipment as each piece of equi[pment has to be duplicated multiple times for reach clinic
Oh, you really have no idea. Cataract ops costs the same rate regardless of where they're carried out, the only difference is the overheads which are always more expensive in the big white building filled with expensive staff, and not the partially empty building with just GPs in it.
You may have been a good ward nurse, but you've no idea what you're talking about.
doing what you suggest would mean them moving sites 3 or 4 times a day.
Again go back and look at what I said:There's no reason why they can't do to another location ONCE a day, jeasus pointless discussing this with you if you're just going to ignore what I wrote
Shame for you that is categorically not true
Lots of research showing that hospitals are much cheaper
yes NHS commissioners pay the same amount - but the actual costs are much higher done the way you suggest. gpo check the kings fund reserarch. Up to twice as much per op