[graemep]

The UK tax system (like many others) is not as fair or progressive as it is presented to be.

1. NI means that the real standard rate on earned income is substantially higher than the "income tax" rate. it is also not fair that unearned income is exempt from it. 2. Lots of purchase taxes, which are disproportionately paid by people with moderate incomes. People on low incomes spend a higher proportion in necessities which are (rightly) subject to lower levels. The more money you have (beyond a certain point) the less you spend on things subject to these taxes. 3. Too many loopholes.

> so we are being forced to pay for a system that doesn't work and end up having to go private (and thus pay again) when we do need timely healthcare.

Some of the NHS is good. NHS dentists can be very hard to find and waiting lists are long. Waiting times can be long too. Reform is prevented by the fear of a US type system and I think many people think that is the only alternative (and seem not to realise how things operate in most other developed countries).

[Nextgrid]

> seem not to realise how things operate in most other developed countries

Genuine question, what do other countries do differently? The way I see it (and described in my original comment) is that the underlying factors behind the decline of government services (no accountability, no incentive to use tax money efficiently) are common across many countries.

Some countries may get away with it for now because they're still "early", but if there is no pressure to do well it's just a matter of time before they too suffer the same fate?

[cycomanic]

I'd argue that the decline in quality of services as been a phenomenon across many western countries and to significant degree been caused by a economic idiology and a deliberate campaign with a goal of privatisation of many public goods, started in the 1980s.

Essentially funding to services are being reduced to pay for tax reductions, until at some point the quality declines significantly, which is taken as the argument that private enterprise would deliver a much better service at lower cost. Services/infrastructure are then sold and a low price and after a short while costs for services go up, but because they are now private enterprises raising prices it is "the market".

The reason why the UK is worse I believe it's due to the political system which results in essentially 2 dominant parties with very little differences.

[graemep]

Look at most continental European systems, or developed Asia - some form of government backed insurance is usual:

https://en.wikipedia.org/wiki/National_health_insurance

Singapore has an individual fund system if I understand it correctly, and that provides extremely good value for money.

One big difference is that these systems are less centralised and therefore less bureaucratic, less prone to political tinkering, and they reduce the problems of lack of accountability and incentives for efficiency.