Steve Richards’ proposal for a referendum on whether to tax more to invest in the NHS (Opinion, 3 January) is interesting. But his first “drawback” – that “the Treasury hates any form of earmarked taxation” – is not quite right. What the Treasury objects to (stating awkward facts, as usual) is that hypothecating an existing tax to a particular programme will put an unacknowledged extra burden on other programmes (actually or potentially). The problem with this proposal, as with any referendum, is that a “vote for change” lands the government with the further question: what change? In this case, what new tax? Indirect tax (VAT) is regressive. A straight proportionate increase in income tax looks unfair to low earners and harms incentives to work; but a steep increase in direct tax on rich individuals, or companies, will drive them to base their money, or themselves, abroad. This leaves a progressive tax on the value of fixed assets (land and buildings) – for example a reformed council tax; but how much would a government dare to tax “ordinary” property owners when house prices are already so high?
Alan Bailey
London
• As this winter is indisputably showing, the NHS is slowly dying, and no doctor or nurse can save it. The cure can only be ministered by the British people. As the year turns they must decide whether or not they believe, as they did in 1948, that “illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community” (Aneurin Bevan). If they do, they should indicate through their elected representatives that they are willing to open their wallets and pay the cost through increased taxation. If they do not, they should accept that our health system, the envy of the world, will perish, leaving behind the country’s poorest and most vulnerable.
Dr Nicolas Suarez
Bristol
• At 2pm on New Year’s Eve I phoned Shropdoc, the out-of-hours GP service in Shropshire. I was staying near Clun and my grandson had a severe cold and agonising ear ache. I was told to expect a call from a GP within three hours. In fact they didn’t call until nearly midnight – far too late for anything to be done. Compared with how it once was, the GP service is frighteningly inaccessible and unreliable. The government’s seven-day proposals are completely unachievable without the appointment of thousands of GPs, but these are needed right now to make the current service effective.
Chris Hardy
London
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