Saturday, 15 January 2011

Some random thoughts about the NHS

I am sure that my last couple of tweets about the NHS are going to get me some stick.

But I think it's important to divorce the business of healthcare from the organisational woes of the NHS. People who defend the NHS's virtues are the same people who complain about postcode lotteries or government interference in the niceties of healthcare.Or, indeed, low front-line staffing or excessive bureaucracy.

These really are two sides of the same social healthcare coin. As soon as the state is involved in the provision healthcare, it becomes subject to the decisions made by bureaucrats who are chasing statistics or "The Thick of It" soundbites, rather than caring for patients. If you want the "safety net" idea of a means of providing healthcare for all, free at the point of delivery, which has to be funded out of general taxation, then you have to accept the downsides of this approach, which is that the safety net is under the control of people who have no idea of the issues and consequences of their decisions and initiatives.

I don't think that opening the NHS up into thousands of competing hospitals and small practices, paid for by individual consumers, will have any bad effect that will not be outweighed by lower costs, better service and fewer needless fatalities.


bnzss said...

Problem is these people have a dogmatic approach. 'Public is good, private is bad' is the general mantra. The NHS should not be remotely private as a matter of principle, not as a matter of good decision making, or outcome, or even morals (as you and I might argue).

I try to get them to understand the downsides to the NHS and discuss ways to mitigate it (adopting a Singapore-style system, for instance) but this is rejected as a matter of course.

What needs to change is the idea that the NHS is immune from economic reality AND that healthcare somehow exists on a moral plane separate from everything else. Too many people seem to think that if they say it's so, then it is so.

S. Weasel said...

The US system actually worked pretty well, back when you purchased insurance with a very high excess to deal with catastrophic health problems and paid the day-to-day costs out of pocket. Ordinary checkups and office visits aren't expensive and insurance was reasonably affordable. I paid a lot less for maintaining me than I did my car.

Then everyone got sold on the idea of preventive medicine and having insurance that covered every little medical transaction. Twenty years ago, maybe. That's when health insurance became unfeasibly expensive.

I have been healthy since I moved to the UK, so my contacts with the NHS have been limited (and entirely satisfactory). But when everyone expects everything to be paid for -- yeah, that's going to be expensive.

Mr Eugenides said...

A propos of nothing: this.

Phil said...

You wouldn't think it that difficult to separate the provision of care from the receipt of care, but a recent Polly Toynbee article (full of concern for those working in the NHS, not so much for the patients) proved me wrong.

Mark Wadsworth said...

Obo, broadly agreed, and this is where Obama went wrong.

Let's agree that health is a 'public good' and even poor people should be entitled to a certain minimum standard. There is no need for the state to get involved in provision, the simplest way to do this is to give everybody a bit more money (aka 'health vouchers' like in most other civilised countries apart from the USA, which is not civilised, it is a kleptocracy) and tell them to take out insurance.

I've checked on a price comparison website, and you could take out private medical insurance for the whole of the UK for half what it costs to run the NHS, and that's before haggling a bulk discount.

Obnoxio The Clown said...

I've checked on a price comparison website, and you could take out private medical insurance for the whole of the UK for half what it costs to run the NHS, and that's before haggling a bulk discount.

My only reservation with this is that medical insurance assumes there is an NHS that will pick up at least some of the healthcare costs. I suspect that more comprehensive healthcare insurance would cost more than current quotes.

Bayard said...

A schoolkid with a computer and the internet could probably produce in a week a fairly decent report answering the question: "How do countries other than the UK fund their healthcare, what does it cost and how well do the recipients think it works?" This exercise seems to be beyond the powers of anyone in Westminster for all their "researchers" and access to information.