THE LAST DITCH

The Conservative Party | News | The Blue Blog | We are proud of the NHS.

David Cameron sent me an email today. Click the link above to read it in full. He wrote;

One of the wonderful things about
living in this country is that the moment you're injured or fall ill –
no matter who you are, where you are from, or how much money you've got
– you know that the NHS will look after you.

Why does the leader of the Conservative Party praise the world's largest socialist institution? Why did he denounce Conservative MEP Dan Hannan for the interview he gave on Fox News recently? If Conservatives really believe the NHS is an efficient way to organise the provision of healthcare, why do they not advocate the same system for the provision of food, transport or housing?

Look for the #welovethenhs "hashtag" on Twitter, and you will enter an alternate universe of sentimentality and denial. If a single state provider of healthcare from general taxation were the only alternative to the American system,  the NHS would not be the second largest employer in the world. Not only is it not the best alternative to the American system, it is not even a better one. If it were, cancer survival rates in Britain would be better than in America, not worse.

Why won't the British open their eyes? Why won't they compare their system with those of healthier countries? Why is support for the NHS so widespread? Why are politicians of the right so in favour of it?

In truth, they are probably not. The employees of the second largest organisation on Earth are too big a bloc vote to take on. Labour has engineered a political deadlock, which only it can break. At one point it looked like Tony Blair might have the nerve to do it, but Gordon Brown prevented him. So we continue with the worst of all possible models for universal healthcare.

As Dr. Eamonn Butler, Director of the Adam Smith Institute, said;

If a privatised health service had made many of its patients wait for
18 months for their operations, put them on trolleys in corridors when
they arrived, given more than a quarter of them an illness which they
did not have when they arrived, and confiscated the organs of their
dead babies without bothering to seek their permission, or even to tell
them, people would have blamed privatisation. For that matter if one of
its practitioners had murdered 150 of his patients, or one of its
surgeons had removed healthy kidneys instead of diseased ones, or one
of its teams had conducted smear tests so incompetently that operable
disease was not treated, while healthy women were unnecessarily
subjected to distressing operations, all this would somehow have been
put down to the reckless pursuit of profit, or to putting shareholders
ahead of patients

Dan Hannan is right. Americans would be mad to base their system on anything that resembled the NHS. They don't need to create a producer collective to ensure healthcare for all. A better system would involve no state hospitals or public-employee doctors or nurses. Provision of healthcare would be private from the hospitals to the local general practitioners. There would be a compulsory system of private insurance from qualified, competing companies. Policies would be provided under a regulated system which prohibited, for example, exclusions for pre-existing illnesses or differential premiums based on age. They would simply have to price their premiums accordingly. The government's only role would be to provide, from taxation, the means to pay the premiums of those too poor to pay. This is essentially the system in France and many other countries in the civilized world which enjoy better health than Britain or America.

If we changed there would be problems, but not the ones we fear. Our medical professionals have been entirely trained in the NHS for 60 years. They are generally not of the calibre needed to run a private system. Businesslike people in Britain currently don't choose to go into medicine. The few who train in the NHS without realising its nature from the outset, tend to leave the country when their training is done. It would take time for the culture to change. New generations of doctors would be more like other professionals; not just technically competent, but capable (as their distant predecessors were) of running a business. Those who didn't make that grade would be employed, as is right and proper, by those who did. Just like the less worldly or energetic lawyers, surveyors or engineers.

There would be transition problems. Socialists would point the finger and say it proved the NHS was right. But steadily things would improve. Fewer people would die prematurely. Patients would be treated with respect. Standards of health would rise. Cancer survival rates would pass those in the United States.

No, I certainly don't love the NHS. Neither should you.

18 responses to “Proud of the NHS?”

  1. Fay Levoir Avatar
    Fay Levoir

    IMO the only people this would serve are the ones who can already pay for health insurance and would prefer not to pay NI contributions as well.

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  2. Colin Campbell Avatar

    The US system is good for the people who are in the system. The others are stuffed if something happens.

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  3. Moggsy Avatar

    Well here I can basically agree. “What Tom Said”… Despite you accusing me of being a lefty ^_^
    I guess the evidence clearly shows the state is not really competent to run a health service effectively and certainly not the best solution to providing it.
    Equally I think there are good reasons for a ‘universal’ healthcare system free at the point of delivery, especially for modern heavily populated societies.
    I can see how this might work by regulation a bit like zoning and building codes ensure safe properly built construction.
    I do wonder tho’ how you see the coordinated provision of inoculation programs working under this system.
    Fay and Colin, Be fair, those are reflexive comments surely. It looked like he dealt with that…
    “There would be a compulsory system of private insurance from qualified, competing companies. Policies would be provided under a regulated system which prohibited, for example, exclusions for pre-existing illnesses or differential premiums based on age. They would simply have to price their premiums accordingly. The government’s only role would be to provide, from taxation, the means to pay the premiums of those too poor to pay.”
    See the last few words especially.

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  4. Fay Levoir Avatar
    Fay Levoir

    Moggsy I was holding back 🙂
    I did not feel his argument held up to any scrutiny at all.

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  5. Tom Paine Avatar

    Thank you, Moggsy. Sorry again for calling you a lefty. B^) Really I am suggesting nothing much more radical than the system in France, which I have personally experienced and found impressive. But then anything’s impressive compared to the Dickensian horror of the NHS. The French system requires everyone to make the initial payment themselves (so it’s not free at point of use) but the government re-payment system is so efficient you can guarantee to get the money back in 14 days.
    Not being free at point of use, means that the financial relationship between doctor and patient is not broken – which is very important. The doctor understands that the patient in front of him has chosen him (and has other choices). If a provider of any service thinks otherwise, that service will degenerate precisely in the way the NHS has, which gives the lie to those sentimental folk who think health is “too important” to be run as a business. Not being free at point of use has the incidental benefit that people don’t go to the doctor frivolously which, if you read the NHS Blog Doctor’s posts (strongly recommended, though he is in my terms a lefty) leads to a huge waste of time and money. He does not think routine doctors’ appointments should even be covered by the NHS, let alone be free at point of use. He insists that single change would solve much that is wrong with the NHS (which is the point where he and I part company).
    Where the French and I part company is that their basic health insurance is a government scheme, though you can “top it up” with private cover (and most do). I don’t think the British government is any more likely to be good at running a health insurance company than an hospital (or post office or army for that matter). The British government, let’s face it, is unutterably crap at everything it does. I would not personally employ it to shine my shoes, still less have sole charge of my health in a crisis.

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  6. JMB Avatar

    Ah, everyone is an expert on the many problems of the NHS. 🙂 In actual fact the NHS behemoth is probably too large to dismantle now, even though it is obviously not working to do the job it was designed to do.
    You know business like people never did go into medicine. But the one thing I know is that extremely bright people do. The OS could go into his Chemistry classes at the beginning, many of which were premed requirements, and hazard a pretty accurate guess as to who the med school applicants would be and over the course of the year it would become even clearer. He wrote hundreds of letters of recommendation for applicants and he would tell you that only the brightest got into med school. It’s a very competitive business, at least here, where we too have socialized medicine, which works well enough for the most part in my experience although it has its share of horror stories too.
    So assuming the same in the UK, under your model, they could learn/be taught those skills. One of my US medblog doctor pals often goes around the country teaching other doctors how to run their practices more efficiently as Primary Care Physicians find their costs increasing and their incomes decreasing. Consequently more doctors are specializing but the PCP is the cornerstone of any healthcare system, the only one who has the whole picture of the patient and their shrinking numbers is of great concern there.
    One problem I see under your scheme is those who fall just outside those whose premiums are subsidized and would find the high premiums (and they will be high) a great burden. Perhaps you need to add a sliding scale based on income for the state subsidizing the premiums and maybe that is implied but not stated by you. Even that is a problem as people’s incomes wax and wane over time, especially recessionary times and subsidies are usually bureaucratic nightmares to administer. So another government monster would be created.
    The truth of the matter is that no matter what healthcare scheme any country uses there will always be monetary problems. We have an increasing population, an ever enlarging aging population and costly advances in medicine that move from experimental into the normal treatment area all too quickly. Treatments that everyone expects to be available to them if needed. Providing the ultimate level of care to every individual is simply beyond the economies of even the wealthiest countries even assuming an adequate number of medical personnel are available in all fields which of course is not true.
    Random thoughts on this post from across the pond.

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  7. JMB Avatar

    One more point.
    There would be a compulsory system of private insurance from qualified, competing companies. Policies would be provided under a regulated system which prohibited, for example, exclusions for pre-existing illnesses or differential premiums based on age.
    Now there’s a loaded statement if ever there was one. These benevolent qualified competing insurance companies do not exist. They are profit making entities which are ultimately responsible to their shareholders and that is their bottom line. In the States they do everything to deny coverage of treatments where possible and disallow this or that drug because it is too expensive, such that they end up driving the treatment plan as physicians try to ensure their patients are covered by their particular provider. Any US physician will tell you that it is a nightmare for them. I mean they pay bonuses to their employees based on how much money they save and no that is not an urban legend.
    A regulated system? By whom and overseen by whom? The Government? Who else? More bureaucracy. More costly little tin gods.:)

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  8. Tom Paine Avatar

    The Rosa Luxemburg of Vancouver is coming around to our point of view! If the “costly little tin gods” are incapable of regulating a branch of the insurance industry by setting fair rules for them to compete, how much less capable must they be of running the entire healthcare system?

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  9. Kevyn Bodman Avatar
    Kevyn Bodman

    Thanks to Tom and the commenters for treating this subject with the seriousness it deserves instead of sloganeering.
    ‘There would be a compulsory system of private insurance from qualified, competing companies. Policies would be provided under a regulated system which prohibited, for example, exclusions for pre-existing illnesses or differential premiums based on age.’
    I have known for some time, and admitted here I think, that I am not 100% Libertarian. I find this idea appealing, but you are advocating compulsion.
    I’m guessing that you are faced with a number of options,all of them flawed, and are choosing the least bad one?
    So you are rejecting a completely unrestricted private system, with charity to pick up the worst problems?
    I completely agree that the financial relationship between doctor and patient is important and should not be broken. And this point should be made firmly and repeatedly because it is so very different from the initial reaction of nearly everyone in the UK. But it’s rational.Consideration of costs,incentives and value helps in decision-making.
    I’m going to give this subject more thought, it merits much more than ‘tweets.’
    And so far this is the best blog page I’ve found on it.

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  10. Kevyn Bodman Avatar
    Kevyn Bodman

    I hope this is not a breach of netiquette, but I’ve just been over to Coffee House where there is a thread about a debate on the ‘national religion’ that is the NHS.
    The thread itself is less a debate than a whinge that we are not having a debate. But I would like to recommend a comment put up by Ed Hoskins which explains in some detail the way the French system works.

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  11. JMB Avatar

    Not only have I been called a leftie but now a Communist! Had to google her, mind. And I thought good, well meaning person was a putdown! Is there no end to the name calling I am subjected to? Sigh.
    Anyway I was being ironic, but it obviously fell flat. You suggesting a regulated system, obviously government level, amused me, thus the comment.
    But my point is that, in the US, those qualified competing healthcare insurance companies are not working out especially well. So I don’t see why they would be any better/different in the UK.
    I don’t have the answers but I see lots of potential problems with your solution. It sounds good stated baldly but reality is something so different.
    Just looking at your explanation of the French system, immediately causes me to think, but what if you don’t have the money to pay upfront, even if you are reimbursed for it speedily. Do you get your treatment anyway and the doctor waits? Or do you have to submit a paid receipt for reimbursement. I should look into their system before making any comments but that was a first thought.
    My daughter had minor daycare surgery when she was a grad student at Stanford. She had health insurance with 80% coverage from the University but I had to pay US$4000 to cover the balance. What would it have been for something more serious? What if we couldn’t have afforded it? Well that has nothing to do with the topic at hand. Just another one of my many healthcare anecdotes. LOL.
    I’m afraid on the topic of health care I deal with my heart not my head so once again it just as well I am not in charge. Mind you I am a good steward of money and would run a much tighter ship than I often saw in my years in the healthcare industry. Waste was rampant. Why don’t people treat taxpayers’ money as if it were their own hard earned money? Why do normally sane people turn into profligate spenders when dealing with public money? Shakes her head.

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  12. jameshigham Avatar

    I currently have a survey on this issue because of ridiculous things said in the comments section of a post that the NHS is working fine.

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  13. Young Mr. Brown Avatar

    Tom, you make the point, which others also make, that there is a huge political problem here. The NHS is a sacred cow, and David Cameron is scared that Daniel Hannan, in having a go at it, is going to damage the electoral prospects of the Conservative Party at the next election.
    Even though there is a prima facie case that the system is broken, politicians are hesitant about mentioning, and loath to do something about it.
    In some ways, the situation is similar to that in the early 1930s, when many politicians believed that there was a need for Britain to rearm, but were reluctant to say so because rearmament was unpopular with the electorate.

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  14. Tom Paine Avatar

    You are right and I am surprised Rosa didn’t pick me up on it. B^)
    My proposed approach is not only not fully libertarian, it’s not even that far from Obama’s proposal. Rightists in the US are using the NHS as a straw man in their attacks on his proposals, because it’s so obviously rubbish and it’s run by government. The Left in Britain are equally stupidly appealing to injured national pride (which didn’t save British Leyland, won’t save British Airways and in the end won’t save the NHS, thank goodness).
    I would personally be prepared to “go for” a fully libertarian approach (and to donate everything I saved in taxation to medical charities) but there are probably less than 10,000 people in Britain who would vote for that. Therefore, I simply propose moving away from the present statist approach to a solution that anyone can see is better.

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  15. Tom Paine Avatar

    Ed Hoskins’ summary is a good one and I would reproduce it here if I had a way to ask him for permission. It accords with my own experience (admittedly limited) of the French system.

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  16. Tom Paine Avatar

    I think you are too kind. David Cameron is being a political coward and is letting down his country in the process. There was a time when one could hope for better from Conservative leaders.

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  17. Tom Paine Avatar

    Rosa, you almost deserve your jokey new nickname by using “…profit making entities…” as a derogatory expression. I have never had satisfactory dealings with any service-provider that did not aspire to be profit-making (except a genuine – not state sponsored – charity with which I am involved). I confidently never expect to. Therefore, I regard it as a good thing that service providers make profit. Don’t you, comrade?

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  18. JMB Avatar

    Well a profit is certainly better than a loss.
    especially if I own shares in them. 🙂 Mind you the one insurance company I do own, which has now frankly morphed into a “bank”, despite very healthy profits/earnings, announced the very same day to add insult to injury, has halved its dividend as it shores up its reserves without increasing its debt load. Well that’s their excuse. No doubt bonuses for the top dogs are increasing as a result of this. Sigh!
    Service provider and profit, mmm. I guess I consider health care a basic necessity like food. True, the food industry makes a profit but has very narrow margins. Hopefully healthcare insurance service providers under your scheme would be satisfied with the same. How likely is that I wonder.
    Sticks and stones………

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Tom is a retired international lawyer. He was a partner in a City of London law firm and spent almost twenty years abroad serving clients from all over the world.

Returning to London on retirement in 2011, he was dismayed to discover how much liberty had been lost in the UK while he was away.

He’s a classical liberal (libertarian, if you must) who, like his illustrious namesake, considers that

“…government even in its best state is but a necessary evil; in its worst state an intolerable one.”

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