Sunday, 16 August 2009

An idiot writes

Stick to dispensing the drugs:

The healthcare will be as expensive as you make it. If you are paying for it you will start to scrutinize your therapeutic interventions more closely. You will have to eliminate waste. Ask your healthcare professionals. They know where the wastes are in the system. They will save you money without compromising your quality of health. With strong leadership, you can start to spend your healthcare budget on interventions that makes real difference to people's lives.

Doesn't that make your soul wither? Let's start with the "if you are paying for it": we are paying for it, but there's no connection between what you pay and what you get. The NHS, by making things free at the point of delivery is actually the worst possible mechanism for pricing. There is no incentive (or even possibility) of you shopping around to get the combination of price and service that suits you best. Your service provider has no incentive to innovate or differentiate or improve anything, because he has complete monopoly. So, you're paying a set amount irrespective of your personal health, your risk appetite, your desires, etc. and in exchange for that you get whatever health care a committee feels they can afford or, even better, whatever health care the government dictates you can get.

I'm sure that Americans scrutinize their therapeutic interventions much more closely than we do, already. I mean, right now, who cares if we do an operation or not? Apart from the guy getting operated on. Who hasn't heard of operations being rescheduled at the last minute because of some bogus issue which hides either incompetence or the fact that the trust needs to save the money for the operation this month so that they can operate within their budget?

And isn't it amusing that there is a presumption of significant waste within the system? I mean, any business has waste, which is why redundancies are a feature of modern business life. Redundancies are a way of allowing a business to re-optimise itself and do more (or the same) with fewer people (and fewer assets, as a consequence.) When was the last time you heard of a program of redundancies in the NHS? Does that make you wonder how much inefficiency is in the NHS?

And strong leadership? Is that what you really, really want? I mean, Mao, Franco, Stalin, Hitler and Mussolini were all strong leaders, but they didn't really do much for their countries, did they?

And it gets even better:

I am personally encouraged by what is coming out of the big pharmaceutical companies. They are beginning to understand that they have a social responsibility. It is not all about profits to shareholders. A number of them are now consolidating their positions. They want to be part of the solution not the problem. They now know what they have to do. And if they want to innovate and they ask you for help, it is within your rights (and power) to develop a system which will provide the pharmaceutical companies with opportunities to innovate. It can be done and it is being done. What will you rather have your pharmaceutical companies doing? Supplying drugs to you on the strength of an effective marketing campaign or on the strength of a great product? It is in everyone's interest for the pharmaceutical companies to develop new innovative drugs.

Oh dear. I think your faith in big pharma is entirely charming, but oh so very misguided. What has happened is that big pharma has decided that rent-seeking, by sucking up to government, is easier than doing what they used to do. Why bother going through all that fol-de-rol of creating new drugs when you can make as much money or more for your shareholders by sucking up taxpayer money?

Given the amount of drug regulation that goes on, is this man really saying to us that we buy drugs because they're well-marketed rather than because they work? Isn't that a rather damning indictment of drug regulation, which is, let's remember, an adjunct of the wonderful NHS? Or is he perhaps just talking out of his arse? I couldn't say, but either way it's not a ringing endorsement of statist health care, is it?

I'm fucking amused by the shameless hypocrisy of this Labourite, economically illiterate cock-sucker at the end of all this, endorsing The One's principles of health care. Because the very first of these is:

  1. Guarantee Choice
The NHS offers the population of the UK a fantastic choice: take it or leave it, but you're fucking paying for it either way. If you want lubrication with that, you're going to have to buy it yourself - sucker!


Chalcedon said...

There is also no incentive to take the most expensive option either. they do in the states, either because of fear of litigation if they don't give you 'the best' or because they see insurance as a bottomless pit. Here they do, on average, try to do what is best for the patient. In the US , doing the most expensive means more money in the wallet.

Ian B said...

The world's first ever nationalisation was the telegraph system. It was confidently predicted that there would be economies of scale, staffing levels would fall due to eradication of the wasteful duplications of competing companies who care for nothing but profits, and the whole system would be more efficient.

Immediately after nationalisation, staff levels went up enormously, pay rates rose due to a strike, and efficiency plummetted, resulting in the telegraph service never making a profit. Then when the telephone arrived, that had to be nationalised too, to prevent competition harming the state telegraph system.

People never learn.

Dick Puddlecote said...

Great article Obo. I think I'm on the same page.