Our authorised icon - the National Health Service

I promised my e-pal, Dom, a few words on our NHS - "the envy of the world" even if no-one else copies it!  Like most Brits I just take it for granted because it is an institution with which I have grown up and lived with all my life.  Again, like most Brits, I enjoy good health and only have need of it on an occasional basis and sometimes on the even more occasional emergency basis.  I think it is fair to say that most people using the NHS find the experience positive but there is a minority, and, I think, a growing minority, who are disappointed and even outraged at their treatment.  As always with giant institutions, the faults and weaknesses are slow to build up pressure but when eventually they burst the results are cataclysmic - as the recent North Staffs Hospital outrage showed.  That deeply shocking affair has led to a far more jaundiced view of the NHS and its workings, not only by the public but also - and long overdue - the authorities.  It is now obvious that things need to change.

First of all, I think it is entirely right and proper that in a sophisticated western society everyone who earns a wage or enjoys an income should contribute to a universal health service.  I think the charge for this should be seperate from general taxation so that people can see how much they are paying for the service.  Also I think everyone in receipt of an income, even those on minimum wages or state pensions, should have a small amount deducted so that they, too, can see that they are contributing.  Obviously those on higher wages will pay more in line with the relevant tax rate that applies to their income.  My reason for insisting on as many people as possible paying directly into the NHS fund is to restore the sense of customer/supplier which has been sadly lacking in the NHS for decades.

Second, I would, in effect, privatise the hospitals and let them operate in a true market place.  Thus, if you are ill you go to your General Practitioner who, in effect, gives you a voucher for treatment of your condition.  You then 'spend' that voucher at a hospital of your choice.  Of course, your GP will recommend certain hospitals or clinics and they, in turn, will be keen to impress, first, your GP with their good service, and second, you, as the final customer.  The GP practice, in turn, will earn according to the number of patients they attract.

What I think is essential is that the customer/supplier relationship is re-instated in medical matters.  I often use the comparison of the supermarkets who supply that other essential requirement for life and health - food!  There you see, for the most part, big organisations vying for your custom with good produce and good service.

There are two riders - probably a lot more but time is pressing - which need to be considered.  Whilst I think a universal health service is a proper part of a modern state it need not, and should not, be more than basic.  A lot of what is provided these days under the NHS is not basic - cosmetic operations, fat reduction, IVF, abortion, etc - and if people want those sorts of things they should pay for it themselves.  Finally, I think that people should be encouraged to opt out of the NHS by taking private health insurance and that should be reflected in a reduction to their NHS contribution.

There, pick the hole sinthat  - shouldn't be too difficult!

 

 

Comments

[backofanenvelope]

Like you, my experience of the NHS has been OK. However, I think the government should get out of the health business. There is no reason why hospitals should be owned and operated by the state; over half of German hospitals are privately owned. The government should be in the business of seeing that citizens get the treatment they are entitled to. Not providing the treatment. The GPs are already in this position.

We should connect the people with the cost of things by adopting the French system; you pay up front and get a rebate from the state, with a top up from your private insurance.

Foreign nationals should pay upfront and not get the rebate. On entering the country they should be asked to show that they have health insurance. When they use the health system, then proof of identity and residence should be asked for. This would mean that British citizens should have to do the same. When I got my concessionary bus pass I had to do this and have my picture taken. Does anyone have a problem with this?

[dearieme]

An NHS tax wouldn't work as either it would be too high, and therefore looted for other purposes, or too low and therefore would need endless additions from general funds.

Better to look at the systems in France, Singapore, Iceland, NZ, Oz, etc, and see whether any would - after adaption - suit us well.

We all know one country whose system is not a candidate for adapting, but given the readership here it would be impolite to mention it.

[Michael Adams]

There would be a small wrinkle in BoE's plan, which could certainly be ironed out, but it would be there. In two years I shall be eligible for Medicare, and, AFAIK can no longer buy private health insurance. I do not know whether Medicare would work outside the US. There could be an insurance policy that foreigner visitors could by, right there in the airport, if they had not made an arrangement before departing these shores. It would be something like the automobile insurance we buy at the border. OTOH, Medicare would be well advised to cover anything we geezers need in Britain, since your doctors and hospitals are paid at a lower rate. There'd still be medical tourism, but without cheating anyone. These economics work pretty well for the expensive stuff made by the BBC, at lower cost, and resold in the entire Anglosphere, so our British cousins have a net cost of zero.

I have always felt uncomfortable with the present set-up. The idea of mooching off the honest taxpayers of Britain, if I should get sick there, was really troubling. The thought of a free vacation in Britain, paid for under Medicare, at a lower cost to Medicare,which was on the hook for the knee replacement or the whatever, sounds too good to be true, so I suppose it is not true. Still worth exploring, though. These knees won't last forever, and the BSU does love to travel.

[Antisthenes]

Much of what you are advocating is similar to that of the French healthcare system and having used that system know how excellent it is compared to the NHS. My experiences of the NHS which have been many tells me that it is not fit for purpose and is in many ways dysfunctional. I have used or seen many healthcare services around the world and even those of so called third world countries sometimes are miles better than the NHS. The NHS is a monopoly and as such will not like all monopolies have to take into consideration the customer as they are a captive audience so will always look to satisfy it's employees in preference to patients.

[Lawrence Duff]

The GP's are one of the main problems. Wtf should a GP hand me a voucher? Most of the GP's I've dealt with are negligent, careless, jobsworths, who attempt to do as little as possible for their £100k plus per annum.

Around £1800 per annum goes into the NHS for each of us. Just give us back that money as a voucher and let us insure ourselves in a market that is regulated so that the insurers are not allowed to ask medical history questions. I once had a bad mark on my drivers licence that meant I couldn't get insurance at my age for the car I wanted. When I joined a company I got exactly that car on the insurance policy of the company. The insurers had set an average value for the insurance per employee, taking into account all the angels and devils they'd get in the thousand or so company car drivers.

Just define an SLA, legislate for "no medical history questions", and let the market set the price. I bet you'd get change out of £1800 per annum.

I mean, if you phone BUPA and said: "My SLA is that of the NHS: days or weeks to see a GP, weeks or months to see a consultant, and months or years to get an operation, and I don't mind MRSA or abuse; I'm an averagely healthy person and I want cover for even the average conditions I might have; and I've £1800 per annum spend", they'd reply: "Even the worst policy we have isn't as bad as that SLA, and even our most expensive, Rolls Royce, stub your toe and we'll send you to Barbados for a massage, policy isn't as expensive as that".

The only overarching problem is the medical profession itself. You can privatize the service providers, and that is a step in the right direction, but until you break the medical profession's closed shop you'll just get privately ripped off and abused, instead of public-sectorily ripped off and abused. Look at lawyers, for example.

And who's gonna have the balls to square up to the doctors and nurses unions and professional bodies and open up the UK to the medical professionals of the global, liberalized world, like they do for IT people? Cameron, Clegg, Miliband?

SoD

[Dom]

As I see it, these are the problems in pre-Obama US health insurance:

1. We insure everything, not just the big stuff. This is like car insurance that insures gas, tire rotation, oil change, etc.

2. Insurance companies do not work nation-wide. States restrict which insurance can be offered.

3. The Amer. Med. Assoc. restricts the number of doctors. Even doctors educated in the UK can not get a license easily. They openly do this to keep a doctor's salary high.

4. Anti Patient-Dumping laws, which force a hospital to treat everyone, and make up the expense elsewhere if that is needed.

5. The American habit of suing hospitals and doctors.

What bothered me from the start is that nothing in Obama's bill addressed any of this. In other words, the forces that make health-care expensive are still at work. The only difference is the usual socialist trick. Hide it by making others pay for it.

[Michael Adams]

DM, you have discovered politeness? That's wonderful, but I personally do not mind rudeness in this discussion. What's really irritating is that comments from outside the US reflect the propaganda from Leftie US media, (There really are non-leftists, but they are harder to find.)and so are fact-deficient.

However, the NHS is your problem, or your solution, not mine. What is instructive for me in reading your discussion is the parallels with debates about other problems here on this side of the pond. Lawrence, for example, offers a voucher solution for health care finance, that we hear proposed here, for education. I used to advocate it, myself, but I have begun to think about it in larger terms. That L. 1,800 cited by Lawrence, is actually about what we pay, in all, for each member of my family's health insurance. My wife's employer picks up part of that tab for us, but we have paid it in full at various times, on a nurse's wages, and paid for education for both kids, also without government assistance. It was not easy, but freedom is not cheap. Half of my income, in some years, went for health insurance and schooling.

I do not know how London does it, but over here, the US Ag. Dept knows how much of known nutrients is required to prevent obvious deficiency diseases, like scurvy, beriberi, kwashiokor, etc., and how much it costs to eat the diet that will supply those nutrients, adjusted for local variations in food prices. That's the cost of the "Basic Diet." Three times that is the official poverty level. Many eleemosynary programs define eligibility as "poverty level," "twice poverty level", or whatever. If we decide that everyone should be able to have the minimum hundred and fifty square meters of living space, and the basic diet, and safe transportation, basic clothing, etc, we have a way of verifying that the poverty level calculation is on target. Then, everyone below that level gets a government-financed health care plan, and free schooling, as needed, with a sliding scale above poverty level also covered. Everyone else could pay his or her own way, in a manner of his or her own choosing. I repeat, own choosing. One of the things that has most galled Americans about Obamacare has been that bureaucrats fifteen hundred to three thousand miles away are allowed to decide what coverage we need. So, a sixty three year-old man like me is required to carry obstetric coverage. What I much prefer is a high-deductible plan and a tax-free Health Savings Account, and to be able to raise the deductible as the HSA grows. This would meet Obama's definition of "inadequate health plan."

So, returning to Lawrence's point, it seems fine to me, but it has the weakness of assuming that only government can take care of us, and that we are unable, and therefore not free, to take care of ourselves. In my own life, this has proven to be untrue.I know that I am not alone.

[dearieme]

Dom, I've never understood how number 2 can be constitutional.

[Dom]

It dates back to Franklin. Insurance is considered a utility, like water or gas or electricity. So states can regulate it. I assume it is the usual story -- first it was meant to protect consumers, now it just protects the companies. It's impossible to change. There are too many layers of state employees who draw their salaries from this racket.

[backofanenvelope]

Perhaps what we need is an end to constant fiddling by politicians and a determination to make the system work.

Take the Nth Staffs hospital mess you mention. Just imagine if dozens of doctors and nurses had been struck off and sacked. Followed by lots of bureaucrats who didn't get payoffs or pensions, and who could not work for the NHS again.