The cost of the welfare state - challenges posed and solutions

[Bletchleyite]

Continuing the non-bus part of the discussion from here: https://www.railforums.co.uk/thread...n-to-be-in-england.302597/page-3#post-7907912

When the welfare state was created, there was suddenly a load of people who had never "paid in" or had a shortish working life. That was ok because the average life expectancy was 68. The ratio of workers to welfare claimants (i.e. pensions or sick) was 5:1. Now it is 3.5:1 for two reasons - the success of the NHS means average life expectancy is 82, and that there are many more sickness related benefits. You are right (and it annoys me when folks say it) that there is no pot of money that people pay into. Essentially the two generations that follow pay for the pensioners of today.

Roger French has done a very good article on his blog today. You may not agree with him but I think he raises some very valid points.

One of the issues here is that the system in a way is contributory. That is, if you haven't paid in NICs you don't get a pension, or if you've paid fewer you get a smaller one. This creates an illusion of it being contributory. That doesn't change that current workers pay for current pensioners, of course, but it creates an illusion of expectation.

It would be better if we got rid of that so everyone gets a state pension (which also recognises that being a full time carer or even a housewife/husband has value) but that would of course itself come with a massive cost. So it's a difficult one.

 

[brad465]

I think we're going through a very rough couple of decades where the baby boomer generation is going through receiving the state pension and having more health problems by virtue of being near life expectancy. If this period is weatherable, then further down the line I suspect this will be easier to manage, as later generations are less numerous so the ratio would improve, though this will rely on a level of skilled immigration to support.

 

[Bletchleyite]

I think we're going through a very rough couple of decades where the baby boomer generation is going through receiving the state pension and having more health problems by virtue of being near life expectancy. If this period is weatherable, then further down the line I suspect this will be easier to manage, as later generations are less numerous so the ratio would improve, though this will rely on a level of skilled immigration to support.

Said immigration however will result in people needing pensions etc. Unless you propose they "go home" when they retire, but this seems unlikely.

 

[brad465]

Said immigration however will result in people needing pensions etc. Unless you propose they "go home" when they retire, but this seems unlikely.

Well the whole economy is essentially a pyramid scheme: more people are required at the bottom of the pyramid (workers) to support the top of the pyramid (corporate bosses, property portfolios/developers and the retired). When it comes crashing down, the Great Depression will look like a stock market dip.

 

[Bletchleyite]

Well the whole economy is essentially a pyramid scheme: more people are required at the bottom of the pyramid (workers) to support the top of the pyramid (corporate bosses, property portfolios/developers and the retired). When it comes crashing down, the Great Depression will look like a stock market dip.

I don't disagree, I've described the State pension as a ponzi scheme before, and still believe it in effect is. However my point was that switching from births to immigration doesn't change the situation, those people are still going to need pensions and healthcare.

 

[Merle Haggard]

Continuing the non-bus part of the discussion from here: https://www.railforums.co.uk/thread...n-to-be-in-england.302597/page-3#post-7907912



One of the issues here is that the system in a way is contributory. That is, if you haven't paid in NICs you don't get a pension, or if you've paid fewer you get a smaller one. This creates an illusion of it being contributory. That doesn't change that current workers pay for current pensioners, of course, but it creates an illusion of expectation.

It would be better if we got rid of that so everyone gets a state pension (which also recognises that being a full time carer or even a housewife/husband has value) but that would of course itself come with a massive cost. So it's a difficult one.

The state pension payment is indeed based on the years of NI contribution (though not its value)
However, is it not the case that people above retirement age who, as a result of these calculations, receive little or no state pension then receive a benefit of about equal value?
If my surmise is true we already have what you suggest.

 

[Yew]

I do feel that the change in demographics is something to be concerned about, I know it's often a bit of a right-wing thing to be concerned about the birth rate, but it does place the burden of paying for the pensions of an increasingly large group of retirees, by a much smaller number of working-age people.

Whislt the right-wing view is probably something like a "patriotic duty to procreate", I think we need to look at the economic factors that drive this. Wages have stagnated despite a rising cost of living, and lot of people have to move away from their families to secure work, often to cities and hubs with expensive rents. This furthermore creates an added cost as they are often away from their families, and have to pay for childcare. Coupled with lots of little factors that no-doubt parents will know better than me (e.g. it's a lot more difficult to take a child out-of-school to avoid peak-time holiday pricing than when I was growing up), I don't think any of the thinking behind the decision to have children is unreasonable.

Unfortunately, the solution to this, reindustrialisation of the regions, and efforts to reduce the centralisation of well-paid jobs in the south east, are likely to not be short term fixes. Even once they are fixed, the impacts of an increased birth rate don't really start to show in the exchecquer for around two decades.

 

[Bantamzen]

Continuing the non-bus part of the discussion from here: https://www.railforums.co.uk/thread...n-to-be-in-england.302597/page-3#post-7907912



One of the issues here is that the system in a way is contributory. That is, if you haven't paid in NICs you don't get a pension, or if you've paid fewer you get a smaller one. This creates an illusion of it being contributory. That doesn't change that current workers pay for current pensioners, of course, but it creates an illusion of expectation.

It would be better if we got rid of that so everyone gets a state pension (which also recognises that being a full time carer or even a housewife/husband has value) but that would of course itself come with a massive cost. So it's a difficult one.

Hmm, so you're proposing to make Retirement Pension (RP) means tested? In all honesty it's not the worst idea in the world going forward, and I'm speaking as someone who is not all that far away from retirement age myself. The question is though, what would be a reasonable threshold to cut it off, and would it be a cliff face or tapered as you approach the threshold? This would be a highly political issue, because at some point you're going to have to ask some of the future generations to effectively have considerably less than they've been planning for all their careers. That is going to be a very difficult sell, and risks targeting completely the wrong people in the first place.

As far as administering it this would be costly, although much of that cost would be in the development of a software platform that could handle the complexity of means testing it. But it would be a very complex system, if the ceiling were based on assets / capital / income, it would involve a lot of verification and monitoring of these. So you'd need a lot of legislation to go in to support such as system, which in itself could take years and even decades.

Perhaps this issue requires some out-of-the-box thinking, and some that may be as equally unpopular to means testing RP. But perhaps it's time for other people, or more importantly organisations that make significant amounts of money thanks to the working people of this country to also contribute. The cost of pensions sits at around £153 billion pa currently, but whilst sounding like a huge amount of money, it still pales compared to the amount of money that is made here. So there are probably ways to to tap into enough of this to cover the shortfall at the very least. And for the corporate world it would be barely a pinprick.

 

[ainsworth74]

(which also recognises that being a full time carer or even a housewife/husband has value)

In fairness a carer should be claiming Carers Allowance which gives them NI credits and a housewife/husband if the reason for being at home is to bring up children should be claiming Child Benefit which also gives NI credits. These credits could give entitlement to a full or partial State Pension (depending on how many other credits or contributions you get over your life).

However, is it not the case that people above retirement age who, as a result of these calculations, receive little or no state pension then receive a benefit of about equal value?

It is indeed. If you do not get a full State Pension and have no other income (or a small amount of extra income) and/or don't have significant savings/investments/capital/etc and either don't have a partner or your partner is in the same boat then you could access Pension Credit to top your income up. At the moment the full State Pension is £241.30 per week and the minimum guarantee amount of Pension Credit for a single person is £238.00 per week. So lets say you only made some NI contributions and so get a reduced pension of perhaps £100.00 per week. Assuming no other income/savings (and no partner) you'd get a top of up a further £138.00 per week to take you to the guarantee amount of £238.00 per week.

 

[Merle Haggard]

Hmm, so you're proposing to make Retirement Pension (RP) means tested? In all honesty it's not the worst idea in the world going forward, and I'm speaking as someone who is not all that far away from retirement age myself. The question is though, what would be a reasonable threshold to cut it off, and would it be a cliff face or tapered as you approach the threshold? This would be a highly political issue, because at some point you're going to have to ask some of the future generations to effectively have considerably less than they've been planning for all their careers. That is going to be a very difficult sell, and risks targeting completely the wrong people in the first place.

As far as administering it this would be costly, although much of that cost would be in the development of a software platform that could handle the complexity of means testing it. But it would be a very complex system, if the ceiling were based on assets / capital / income, it would involve a lot of verification and monitoring of these. So you'd need a lot of legislation to go in to support such as system, which in itself could take years and even decades.

Perhaps this issue requires some out-of-the-box thinking, and some that may be as equally unpopular to means testing RP. But perhaps it's time for other people, or more importantly organisations that make significant amounts of money thanks to the working people of this country to also contribute. The cost of pensions sits at around £153 billion pa currently, but whilst sounding like a huge amount of money, it still pales compared to the amount of money that is made here. So there are probably ways to to tap into enough of this to cover the shortfall at the very least. And for the corporate world it would be barely a pinprick.

A means tested state pension would sabotage any attempt to increase the take-up of private and company pensions.
Why would anyone make working lifelong contributions to a private pension when it just results in you losing your state one?

 

[andrewgs]

If this period is weatherable, then further down the line I suspect this will be easier to manage, as later generations are less numerous so the ratio would improve, though this will rely on a level of skilled immigration to support.

This was true when the fertility rate was near replacement levels. However the TFR has fallen from a peak of 1.94 in 2010 to 1.39 in 2025, -28%, so the population pyramid is becoming smaller at bottom due to fewer births, in addition to getting larger at the top. Outside of immigration, the ratio cannot improve unless fertility rates increase significantly, pension age increases or life expetency decreases.

A TFR of 1.4 is 2/3s of the 2.1 replacement rate, so every generation will be a third smaller than the last. A class of 30 children in the 90s is now giving birth to 20 children. At current rates that drops to 13 in the next generation.

The thought that this is a weatherable period is wrong as it will continue to worsen throughout our lifetimes. It takes a lifetime for the effects of a low birth rate to fully play out. Japan still has another 15 years or so before its old age dependency ratio stabilizes.

 

[Bletchleyite]

Hmm, so you're proposing to make Retirement Pension (RP) means tested? In all honesty it's not the worst idea in the world going forward, and I'm speaking as someone who is not all that far away from retirement age myself. The question is though, what would be a reasonable threshold to cut it off, and would it be a cliff face or tapered as you approach the threshold? This would be a highly political issue, because at some point you're going to have to ask some of the future generations to effectively have considerably less than they've been planning for all their careers. That is going to be a very difficult sell, and risks targeting completely the wrong people in the first place.

It would be possible to play with taxation to effectively do this with less of the adverse publicity, as one option? But we might have to go that way. It's simply not possible to continue with a system designed for 5-10 year retirements into a situation where 20-30 year retirements are increasingly common. The sums just don't work.

The other option is to up the pension age further, but of course that means there are more people for the same number of jobs so may up unemployment.

Perhaps this issue requires some out-of-the-box thinking, and some that may be as equally unpopular to means testing RP. But perhaps it's time for other people, or more importantly organisations that make significant amounts of money thanks to the working people of this country to also contribute. The cost of pensions sits at around £153 billion pa currently, but whilst sounding like a huge amount of money, it still pales compared to the amount of money that is made here. So there are probably ways to to tap into enough of this to cover the shortfall at the very least. And for the corporate world it would be barely a pinprick.

They do. Is not the mandatory employer pension contributions to a private pension not exactly that?

A means tested state pension would sabotage any attempt to increase the take-up of private and company pensions.
Why would anyone make working lifelong contributions to a private pension when it just results in you losing your state one?

This depends on whether means testing simply reduces it rather than wipes it out. Also, morally, one should provide for oneself before resorting to benefits when one simply cannot, though sadly that view isn't universal.

== Doublepost prevention - post automatically merged: 18 Aug 2026 ==

This was true when the fertility rate was near replacement levels. However the TFR has fallen from a peak of 1.94 in 2010 to 1.39 in 2025, -28%, so the population pyramid is becoming smaller at bottom due to fewer births, in addition to getting larger at the top. Outside of immigration, the ratio cannot improve unless fertility rates increase significantly, pension age increases or life expetency decreases.

A TFR of 1.4 is 2/3s of the 2.1 replacement rate, so every generation will be a third smaller than the last. A class of 30 children in the 90s is now giving birth to 20 children. At current rates that drops to 13 in the next generation.

The thought that this is a weatherable period is wrong as it will continue to worsen throughout our lifetimes. It takes a lifetime for the effects of a low birth rate to fully play out. Japan still has another 15 years or so before its old age dependency ratio stabilizes.

This is a massive issue for pensions and is precisely why immigration issues aren't really being addressed - because the issues that would be caused by addressing them are worse, basically. Reform etc unfortunately disregard this.

An interesting wider question is how we might provide for population decrease without economic collapse - as if it wasn't for this I think a lot of people - me included - would consider that a drop in population (simply through natural deaths and non-replacement with babies, not via any of the racist methods) back to about 50-60 million would make the UK a nicer place. But there is this massive financial issue it causes as you say.

 

[Bantamzen]

It would be possible to play with taxation to effectively do this with less of the adverse publicity, as one option? But we might have to go that way. It's simply not possible to continue with a system designed for 5-10 year retirements into a situation where 20-30 year retirements are increasingly common. The sums just don't work.

The other option is to up the pension age further, but of course that means there are more people for the same number of jobs so may up unemployment.

Frankly given the state of youth unemployment as things are, pushing back the retirement age would be insanity. But so would shunting more current & future pensioners into more poverty by removing the state pension net. Which leads neatly into the next quote:

They do. Is not the mandatory employer pension contributions to a private pension not exactly that?

It has no effect on the funding of Retirement Pension, so not really.

So the question lies, how do we a) Increase revenue to cover the cost, or b) Move away from state funding and lean more into private pensions?

You probably don't have to spend a lot of time working out which one would be worse in the long term. Private pensions aren't exactly cheap, and come with the additional issue that the pension funds expect returns for their investors. Plus they are potentially more at risk, be it through stock markets tanking, bad investment choices by fund managers, or even total collapse. It's why so many Americans are far more interested in the stock markets, their 401Ks (the US version of RP) literally depend on them. If the markets tank, so do their pensions.

Given the state of our economy, could we really risks millions of future pensioners arriving at retirement age with private funds that won't cover the cost of living, and therefore have to support them regardless? I think these risks far outweigh those of finding future funding for Retirement Pension. The question is now, how do we go about that? There's no easy answer is the truth. I honestly don't think pushing retirement age further back will help, and will cause problems at the other end of the generational jobs market. Not funding it further will only lead to more poverty, which in turn takes more money out of the economy and puts more pressure on the NHS as poverty always does. And leaning more into the private markets comes with more risks than rewards.

Therefore, until we can find a better way, we may need to lean into bringing in more revenue. There's plenty of money sploshing about out there, much off the back off this country's efforts, some of it even avoiding taxation. Is it really a stretch to seek a little more revenue to assist the people making companies successful?

 

[Bletchleyite]

It has no effect on the funding of Retirement Pension, so not really.

It would probably mean the Triple Lock couid more viably be removed because it would take on some of its role, to be fair.

Certainly I do believe that needs removing. It's brought pensions back up in real terms as they had gone backwards, but now that's been achieved a single lock (either based on average earnings or RPI) would be sufficient. Arguably it should have been timebound or effect-bound, but we are where we are.

 

[andrewgs]

This is a massive issue for pensions and is precisely why immigration issues aren't really being addressed - because the issues that would be caused by addressing them are worse, basically. Reform etc unfortunately disregard this.

An interesting wider question is how we might provide for population decrease without economic collapse - as if it wasn't for this I think a lot of people - me included - would consider that a drop in population (simply through natural deaths and non-replacement with babies, not via any of the racist methods) back to about 50-60 million would make the UK a nicer place. But there is this massive financial issue it causes as you say.

Low fertility has benefits in the short term (lower child benefits and school costs) but significant effects in the long term as there's fewer workers. Politicians elected on 5 year cycles have no incentive to address this within their term.

The difficulty labour had with the winter fuel allowance, a small benefit, is illustrative of the other side of the issue. The triple lock and state pension are are much bigger and important. A voter base that is skewed towards the elderly means politicians will never address the issues of ever increasing pension costs as they will not be elected. It's not just pensions. Adult social care and health are major spending items and increase with an aging population.

There are many issues population decline causes that aren't in public consciousness. A population decline to 50-60m would mean many homes become near worthless outside of major cities/towns. Young people move out of small towns towards cities and don't come back. In Japan the population of the cities are rising while the total population is falling, and you can buy houses in rural areas for 0 yen.

 

[Bletchleyite]

There are many issues population decline causes that aren't in public consciousness. A population decline to 50-60m would mean many homes become near worthless outside of major cities/towns. Young people move out of small towns towards cities and don't come back. In Japan the population of the cities are rising while the total population is falling, and you can buy houses in rural areas for 0 yen.

Lower house prices are a benefit of reducing population, not a downside. We need to stop thinking about houses as investments and start thinking of them as somewhere to live. If you don't intend to sell your house its value is irrelevant.

Free houses is an extreme effect, more likely a slow decrease would ensue. Negative equity is a problem with selling to move house but legislation could require mortgages to still be transferrable between homes even if in negative equity.

Also the flight of young people to cities does tend to reverse a bit in middle age, certainly in the South East where families like to move out of London into leafy Surrey and the likes. I accept it isn't true everywhere, but Manchester is starting to look a bit like that too, as is Bristol...

 

[Broucek]

One of the issues here is that the system in a way is contributory. That is, if you haven't paid in NICs you don't get a pension, or if you've paid fewer you get a smaller one. This creates an illusion of it being contributory. [snip]

The fact that there is an explicit link between contributions and pension makes it even harder to change it quickly

== Doublepost prevention - post automatically merged: 18 Aug 2026 ==

Lower house prices are a benefit of reducing population, not a downside. We need to stop thinking about houses as investments and start thinking of them as somewhere to live. If you don't intend to sell your house its value is irrelevant.

Free houses is an extreme effect, more likely a slow decrease would ensue. Negative equity is a problem with selling to move house but legislation could require mortgages to still be transferrable between homes even if in negative equity.

Yes, the whole "my house is valuable" is a bit bonkers unless you are selling for cash or downsizing. We could release money when we retire by moving away from London/SE but this is where our community and friends are...

A slow decrease in house prices would probably be beneficial at the societal level. A fast decrease will have all sorts of negative secondary impacts on mobility, rate of home construction etc.

 

[TheSmiths82]

So much of the welfare state bill will be reduced if we build more social housing. A huge part of the problem is we sold a lot of the housing stock off with the idea of letting tenants buy the house they have lived in for years. When those tenants die or sell up the houses often end up in private landlords. These houses are often then rented out to people who need to claim housing benefits for their rent and it becomes a vicious circle.

Then there is the issue of entry level jobs, these are becoming harder and harder to find which means a huge amount of young people become unemployed. If we stop giving benefits to these people then crime will increase. We can't talk about cutting the benefits bill while not acknowledge the severe lack of jobs which will only get worse with AI.

 

[Bletchleyite]

Then there is the issue of entry level jobs, these are becoming harder and harder to find which means a huge amount of young people become unemployed. If we stop giving benefits to these people then crime will increase. We can't talk about cutting the benefits bill while not acknowledge the severe lack of jobs which will only get worse with AI.

I can't help but think that I'd rather see us run subsidised job creation schemes at the low end rather than just pay benefits. It would be great, for instance, to see more street cleaning and toilet attendants, and both of those presences would reduce antisocial behaviour. It's not policing, no, but the presence of someone in a peaked cap* tends to improve behaviour even if they lack any real power. People who go on benefits tend to stay on benefits, whereas an entry level job is a route into other jobs, and even if they stay in it for life it's still doing something fundamentally useful, which also boosts mental health.

* I'm just being traditional there, more likely they'd be in a polo shirt and hi-vis.

 

[Farigiraf]

Wages have stagnated despite a rising cost of living, and lot of people have to move away from their families to secure work, often to cities and hubs with expensive rents. This furthermore creates an added cost as they are often away from their families, and have to pay for childcare. Coupled with lots of little factors that no-doubt parents will know better than me (e.g. it's a lot more difficult to take a child out-of-school to avoid peak-time holiday pricing than when I was growing up), I don't think any of the thinking behind the decision to have children is unreasonable.

Unfortunately, the solution to this, reindustrialisation of the regions, and efforts to reduce the centralisation of well-paid jobs in the south east, are likely to not be short term fixes. Even once they are fixed, the impacts of an increased birth rate don't really start to show in the exchecquer for around two decades.

This isn't a railway thread but I'll still try to tie this to a railway-related topic; it's these factors that you mention which really show how badly society has been affected by the decline of transportation outside the urban Southeast from 1960 to now. Naturally deregulation is by no means the sole reason (the complete lack of any plan post-deindustrialisation won't have helped), as there have been a good few decades of state-run lack of regional investment as well (we might be in one of those decades, unless Burnham can perform some miracles), but I can't help but imagine that if we hadn't cut over half the rural bus and rail routes in the country then actually living a fulfilling life in a rural town (within commuting distance of a regional centre, which applies to about 95% of the country) would be a lot more feasible.

== Doublepost prevention - post automatically merged: 18 Aug 2026 ==

I can't help but think that I'd rather see us run subsidised job creation schemes at the low end rather than just pay benefits. It would be great, for instance, to see more street cleaning and toilet attendants, and both of those presences would reduce antisocial behaviour. It's not policing, no, but the presence of someone in a peaked cap* tends to improve behaviour even if they lack any real power. People who go on benefits tend to stay on benefits, whereas an entry level job is a route into other jobs, and even if they stay in it for life it's still doing something fundamentally useful, which also boosts mental health.

Replacing welfare / unemployment benefits with low-level 'just get out and do something' jobs has been tried by a number of governments around the world in the past and I can't think of a single case where it's actually resulted in any meaningful change, usually just making things worse. The proportion of people out of work long-term that have a "I'll take any job, I just can't find anything" mindset is diminishingly small - and in a modern country it's not a great idea to push people without that mindset into a job they have no intention of making an effort in.

You can improve the problem by making it easier to find (or providing more) jobs that are long-term, meaningful and can lead to a proper career - litter picking and toilet cleaning jobs rarely fall into this category. I appreciate that you can't just pass around free vocational/academic classes to the unemployed, as it'd cost a fortune, but that's the avenue that results in the most progress. Providing better mental support for the people who can't/won't work due to mental problems (a fairly large proportion, more so if you count those without a diagnosis yet) also goes a long way.

 

[Bletchleyite]

Providing better mental support for the people who can't/won't work due to mental problems (a fairly large proportion, more so if you count those without a diagnosis yet) also goes a long way.

Generally I take the line that benefits that are paid to people who genuinely cannot do any job should be generous and enable a good quality of life, but that we'd be better funding changes of career for people whose disability takes them out of a given job than just paying them benefits forever. The railway notably does this quite well but it has a wide range of job roles, the Government probably would need to step in for e.g. a builder who ends up in a wheelchair and needs to move to a job they can do.

 

[ainsworth74]

Providing better mental support for the people who can't/won't work due to mental problems (a fairly large proportion, more so if you count those without a diagnosis yet) also goes a long way.

This does always seem to be the missing piece in conversations like this. A lot of the media, commentators, politicians and similar like to pretend that the issue is just shirkers, the workshy and fakers. And sure, there is some of that going on but it isn't as much as the people like to pretend. A bigger issue is that accessing treatment is now much harder and takes much longer thanks to the NHS being in a slow running crisis of care. There's always been a bit of an issue with the NHS that if you rock-up with cancer or with bits of bone sticking out of you you'll get excellent treatment and get it quickly whilst chronic conditions or those slightly more niggly conditions can end up taking months or years to resolve.

So now people who would have been able to remain in work are dropping out of work due to not being able to keep up with the work anymore. Say for instance you work on the shop floor at Tesco and end up with a dodgy knee you might battle through but if it takes two to three years to get and recover from a knee replacement (once you factor in time to get a GP appointment, scans, the wait to access a none surgical intervention like physio, and then the wait to actually have the procedure as well as recovery time afterwards) you might struggle to keep that job. Similarly for mental health treatment. As wait times go up more people are simply going to end up falling out of the workforce by simple virtue of not being up to the job they once did.

Young people on the other side face a similar problem getting into the workforce. Child, adolescent and young people's mental health treatment is a complete disaster zone in large parts of the country. Quite apart from whatever damage was done to them by Covid lockdowns along with the damage that social media might well still be doing to them. It's not very surprising to me that the number of young people accessing disability benefits is rising when it can take years from referral to treatment.

You want to reduce the number of people on PIP? Make it so that they can access treatment in a reasonable period of time. After all PIP has what's known as a required period condition which, if I simplify somewhat, means that the needs you have need to have been present for three months and are expected to last for a further nine months. If we lived in a world where people could reliably get their knees sorted out within twelve months or could get mental health treatment within twelve months we'd have far fewer people qualifying because they'd never meet the required period condition...

 

[Broucek]

... accessing treatment is now much harder and takes much longer thanks to the NHS being in a slow running crisis of care. There's always been a bit of an issue with the NHS that if you rock-up with cancer or with bits of bone sticking out of you you'll get excellent treatment and get it quickly whilst chronic conditions or those slightly more niggly conditions can end up taking months or years to resolve.

This is a big problem. One reason most private sector employers have private medical cover is so employees (and often their partners) can get treatment and get back to work which is good for the employer, the employee and society as a whole.

There are huge economic and quality of life issues attached to how slow the NHS is, even with relatively inexpensive treatments like physio

 

[styles]

To be perfectly honest, I think we're just not as good at preventative healthcare as we should be; and investing in that would save money (and more importantly, make people healthier and happier) in the medium to long term.

The example I always think of is obesity. Some of this we have started to get right, thanks to the likes of Jamie Oliver campaigning to improve the nutrition of school dinners (contrary to popular belief, turkey twizzlers are not actually banned, they just need to form part of a balanced menu now rather than being served with only chips all the time!). But we do have an obesity crisis, and if you go to your GP about it, they're often not very helpful, though I'm sure there's some pockets of excellence dotted around. I've a family member who has been to the GP multiple times about their weight, and the first two times they went they were given advice which the vast majority of people already know - eat more fruit and veg and protein, less saturated fatty foods, exercise more, and ultimately - calories in, calories out. But we all know that it predominantly boils down to calories in, calories out; getting another leaflet stating that isn't much value. A lot of people have obesity because of the psychology, not because they don't understand the physiology. In this particular person's case, when they were growing up, their siblings would steal food off each other's plates, so they (all) got into the habit of eating as quickly as possible, rather than eating slowly and letting the body digest and recognise when it's full. Similarly, and this would've been handed down in particular by those who were told the same during rationing times, they were told they need to finish what's on their plate to save it going to waste, even if they said they were full. So they have ingrained behaviour to eat quickly and always finish what's on their plate. Their body doesn't get a chance to communicate that it's had enough. To get to the bottom of these things and work on changing behaviours, a lot of people actually need talking therapies like REBT or CBT. And ideally, they need it before their weight reaches obesity, not after going to their GP multiple times over the years and being given leaflets on calorie counting.

To that end, I'd personally like to see everybody in the UK offered say 12x1hr sessions of talking therapy. They can use it however they like - to talk about their weight, or their sadness, or their smoking, or just chat about life and see what comes out of it.

For the cost, I reckon it would make significant savings on welfare spending.

 

[Bletchleyite]

With regard to obesity there are lots of causes. You sometimes for instance see two kids in a family and one is skinny and one is fat. From personal experience "food noise" i.e. being effectively permanently hungry can be an issue, and as it's innate it is surprisingly hard to resist at times. Thus the GLP1 medications will also fulfil a role. Injections were a barrier to adoption but pills won't be.

Assuming no major issues are found with them, once they go generic I think that will be the end of obesity and its associated health issues - those with "food noise" will just take them long term at a low dose to keep it manageable. How long is a patent, 25 years?

 

[Merle Haggard]

This depends on whether means testing simply reduces it rather than wipes it out. Also, morally, one should provide for oneself before resorting to benefits when one simply cannot, though sadly that view isn't universal.

== Doublepost prevention - post automatically merged: 18 Aug 2026 ==



This is a massive issue for pensions and is precisely why immigration issues aren't really being addressed - because the issues that would be caused by addressing them are worse, basically. Reform etc unfortunately disregard this.

Means testing seems to be at different levels for different benefits. For instance, in another thread, it was said that earning £100,000 pa results in losing child benefit. The effect on private pensions would entirely be based around what level was a chosen although I assumed that it would be much lower than £100,000..

I concur with your moral suggestion. However, imo, there will need to be a change of attitude towards the state pension in that, at the moment, some see it as the country's reward for being a member of the community who has worked - and thereby contributed - to it since leaving education. It must in future be regarded as a safety net, similar to Pension Credit.

//

The State Pension is taxable in that it is treated as income, however it is treated as the first source of income. Because it is only just short of the Personal Allowance it means that any other pension, or PAYE work, is taxed at 25% on almost all of the payment. Is this a unique feature of the SP or are all benefits (for instance the Child one I mentioned above) also taking into account when taxed? If one's only income is benefits and the total exceeds the Personal Allowance, are they similarly taxed?

One penalty against private pensions already exists. One of my - unfortunately now late - friends had a small private pension (from a bus operator) that pushed his income just above PA. The increase in the private one each year was swallowed up by extra taxation because of the freezing of the PA, although of course he did receive an increase in his SP..

 

[styles]

With regard to obesity there are lots of causes. You sometimes for instance see two kids in a family and one is skinny and one is fat. From personal experience "food noise" i.e. being effectively permanently hungry can be an issue, and as it's innate it is surprisingly hard to resist at times. Thus the GLP1 medications will also fulfil a role. Injections were a barrier to adoption but pills won't be.

Assuming no major issues are found with them, once they go generic I think that will be the end of obesity and its associated health issues - those with "food noise" will just take them long term at a low dose to keep it manageable. How long is a patent, 25 years?

Yes I do think there's a place for genuine weight loss medications like GLP1 as well, but it is worth noting that when prescribed on the NHS, they are only provided for weight loss when wraparound care includes behavioural therapy. Private prescriptions usually don't include this, and unsurprisingly when people stop taking them, their weight increases again, so I think I'd like to see the long-term studies on the medication-only approach before I sing their praise.

 

[Broucek]

The State Pension is taxable in that it is treated as income, however it is treated as the first source of income. Because it is only just short of the Personal Allowance it means that any other pension, or PAYE work, is taxed at 25% on almost all of the payment.

To me that makes sense. Tax should be levied on your total income - in other words if two pensioners get £20k a year with one getting c. half of that from the state and the other getting nothing from the state then they should pay the same tax

 

[styles]

To me that makes sense. Tax should be levied on your total income - in other words if two pensioners get £20k a year with one getting c. half of that from the state and the other getting nothing from the state then they should pay the same tax

To an extent, I agree with the principle. But because of the scenario @Merle Haggard describes, with pretty much all private pension drawdown after 66 being taxable on the way out, the benefit of tax relief on the way in is effectively lost (there will be some weird edge cases where people have large private pensions but much less than the full state pension but they really will be unusual cases). At that point, you might as well stick it in an ISA instead, then you don't have to wait until the government tells you you're old enough to draw it down. The main private pension advantage is reduced to plugging the gap between private pension and state pension age for those wanting to retire earlier than the state pension age.

Of course, if you're a higher rate earner during working life, aiming to retire on a lower income, there's an advantage still.

 

[Merle Haggard]

To me that makes sense. Tax should be levied on your total income - in other words if two pensioners get £20k a year with one getting c. half of that from the state and the other getting nothing from the state then they should pay the same tax

Yes of course it does, but I was asking whether that applies also to other benefits (particularly if they're the sole income) where the benefit payment is above the PA.