Tuesday, 18 May 2010

What is the NHS for?

I think it's time somebody asked the question. And it's not an easy one.

My take on this is that anything outside A&E can't really be a "common good".

You could argue that care for chronic (i.e., long-term) illnesses should be nationalised because of the potential of financially ruinous bills. I wouldn't argue that, but it could be argued.

So, would you support the NHS providing for chronic illnesses and what else would you want the state to provide in healthcare? (Or not, as the case might be!)


Bristol Dave said...

As a fatty myself, I can say with utter certainty that it should not be for gastric bypass surgery for fat chavs.

How's this for surgery - STOP FUCKING EATING SO MUCH.

Why in the name of fuck we should be expected to pay for some fat cunt's lack of self-control is just beyond me.

I think this should go for any self-inflicted illnesses.

Lung Cancer? Oh, but you smoke? Tough fucking shit, that's a choice you made knowing the risks.

Chronic liver disease? Oh, but you're a heavy drinker? Ditto.

Obsidian said...

It's also a useful network for identifying epidemics and any potential biological attacks (however unlikely).

You only really need the A+E's and GPs to be funded nationally though to achieve those ends.

Of course it's as embedded in the nations psyche as fish'n'chips, so any attempt at reducing will be met by the unwashed masses rage...

Obnoxio The Clown said...

GP's do not need to be funded nationally for that purpose.

John R said...

We really need the NHS to be doing a lot less, but do it better.

For starters all the elective or self inflicted crap should go asap - cosmetic surgery (unless to correct accident injuries e.g. fires etc), boob jobs, sex change ops, tattoo removal, tummy tucks, gastric belts etc. If you want it, fine. But pay for it yourself.

Get some decent buyers in there as well. Why are we paying top dollar for substandard kit when the state is spending billions with suppliers?

Then just bin 50% of the paperwork, I cannot believe it's all really needed. Focus on patients/treatments not on feeding the system.

I'd move the whole thing to an insurance funded system anyway rather than state funded. (France has this, seems to work well.) That way there is a brake on accelerating hospital costs and demands for more freebies from the public. Also there's an element of competition to keep standards up. Not sure about the fully privatised US version now being dismantled by Obamacare. The results are good but the costs seem excessive for everyone.

Ed P said...

Just cut out all the "lifestyle" crap - stomach tucks, breast +/-, cosmetic surgery (some of which, incredibly, IS done by the NHS).

I think Bristol Dave is wrong about so-called self-inflicted illnesses, as defining what's in & out would require so much background information it would lead to more state interference in our lives.

Anonymous said...

I can remember us having arguments about this when deciding upon policy for LPUK. As far as I remember, most of us thought that A&E, maternity and mental health were about the limits of what the state ought to be looking at providing (safety net stuff). That subsequently got watered down to the current vague statement in their manifesto.

AntiCitizenOne said...

What's the NHS for?

The staff.

Kingbingo said...

I’m fine with universal healthcare paid from the state. I’m just against the state then actually attempting to provide the service as well.

Just give everyone healthcare vouchers of £Xk a year. Leave it up to them how they spend them. If they contract something like pregnancy or Cancer give them a lump sum voucher to spend as they see fit.

People can make their own decisions as to what drugs they really need, and how to source them and let the market compete to provide.

We live in a country which has accepted as core the notion redistribution. The point for free-market libertarians (not you anarcho capitalist spillters! *spits*) to argue for the method of redistribution that least distorts the market and most improves outcomes for the majority, these will be by their nature those with the least state involvement.

AntiCitizenOne said...


Any extortion funded solution that subsidises above the cost of insuring a healthy person financially incentivises people to ignore their own health.

TDK said...

To Bristol Dave

The are two basic model of health redistribution.
1. Contributory Model - my entitlement arises because I've paid in. This was the original model for the NHS
2. Rights Model - my entitlement arises because I have a right. This is the way the NHS (and the welfare state) has gone

The contributory model is similar to the private insurance alternative except that there are no surcharges for pre-existing conditions. It is blind to the fact that some people are more likely to be ill than others. An insurance model might well charge more to smokers and the overweight, but having done so they gain full entitlement. The smoker might well argue that since tax money is fungible, they already pay more than others and so they remain entitled. An overweight person might equally argue that with their reduced mortality they contribute a disproportionate amount of taxes before they die young.

In contrast the rights model is in conflict with the basic fact that health care demand is virtually infinite. ie Health Care must be rationed. That means that choosing to treat certain people more must mean that others are treated less. It is inevitable in such a situation that some method must be used to triage the patients. One such method is to weight the rights of smokers and the overweight below that of approved citizens.

In other words, a state system will inevitably lead to abuses such as denying smokers health care, overriding the fact that they contribute more. Your demand is already being fulfilled by the state system and it will get progressively worse as the state gets poorer.

Kingbingo said...

AC1: I grew up very poor and in poor health. I appreciate the value of universal healthcare I may well have been be deaf by 20 otherwise, perhaps I could have turned to the vagaries of charity, perhaps not.

Now older and wealthier I can afford my own healthcare if I need it, and I would definitely be able to with the NHS crowding-out the market alternatives. But I still believe in the principle of universal healthcare. But I think it should be voucher based, of course with the option to top-up with insurance to personal taste.

I also believe in a citizens income of about £50pw to all as a replacement for welfare. And schools vouchers for education.

You can make a good anarcho-capitalist case for none of the above. But the difference between me and you is that mine stand a very slim chance of actually being implemented in my lifetime, witness Gove’s education policy as step 1.

Both our methods would make the state very much smaller, and improve outcomes. So why not champion what can actually work.

AntiCitizenOne said...

Healthcare is personal, not collective. That's why as an idea it's a fail.

High Citizens Dividend (from LVT and IPVT) and let people buy their own Catastrophic insurance and pay for regular GP visits.

Obsidian said...

"GP's do not need to be funded nationally for that purpose."

GPs tend to be first point of contact, so I disagree. Being able to detect an epidemic or an attack is as vital as aspect of national defence as a military.

Of course you could entirely replace the GP system with something like the Saturday Funds, but that'd be years down the line.

Obnoxio The Clown said...

Obsidian, it's quite possible for a privately-funded GP to report an incidence of some communicable disease. I'm really not sure what the funding of the GP has to do with it???

bayard said...

"National Insurance" should be just that - an health insurance policy run by the state, not a tax. It should have nothing to do with pensions and it should give no claims bonuses. That would encourage people to look after their health. (Why run by the state? because I'd sooner trust a civil servant than an insurance company.)

Anonymous said...

"What's the NHS for?" - I thought it was supposed to make people better.

Our neighbours 40 year old only son died yesterday. He was suffering from cancer, and had recently had a bone marrow transplant, which had, apparently, been successful. Then he caught an infection in the hospital.

So that's not only the tragic waste of a life, it's also the waste of money spent trying to prolong it....

How about shooting all the fucking pen pushers and employing some good cleaners who are given the time and equipment to do a proper job. Then, maybe, hospitals could become places that make people better, not killing zones.

AntiCitizenOne said...

I keep telling people this.

On the NHS you are a COST, not a customer and costs are minimised.

It fails all the same ways the Soviet Union failed, and for all the same reasons.