The road to hell, says DK (of the excellent Devil’s Kitchen), is paved with good intentions. And he’s right. The NHS is a stinking tax vacuum which, if left in the hands of the socialists, will one-day become the largest employer in the world (rather than just in Europe).
But in a previous post I also criticised the US’s can’t-pay-then-die system which is, to put it simply, wrong. In a civilised country it is right that provision of healthcare for those who cannot afford to pay is made from general taxation. If that makes me an impure libertarian then so be it.
But this system does not have to be the NHS. It doesn’t even have to be in place somewhere else. So here’s what I propose:
The railways in the UK were privatised by the last government in the most awful way. Ticket prices are not set by individual operators and so if I buy a ticket from Brighton to London it effectively does not matter which company’s trains I use. This ruins the point of privatisation — competition.
Oops, I just lost some of my audience by talking about privatisation; well come back will you?
The NHS needs genuine competition. The way I propose to introduce that is to allow half of all hospitals in each area to be run privately. Whatever the state spends per patient, the private hospital in the same area would get the same money. The incentive, then, would be to attract patients to your private hospital in order to receive some of that funding. Money that is not required to provide patient care is then made available to the private hospital’s shareholders. The drive for efficiency to create profits would be balanced by the need to attract patients and so be better than the NHS hospital.
The private hospital would be free at the point of use (because it receives matching funding from the state) and would be heavily regulated in the same effective way the financial services sector in the UK is (and which is clearly not working in the US).
Alongside this revolutionary healthcare system would be a change in incentives for drugs companies. Currently there is a clear conflict of interests whereby drugs companies can make more money from treating illnesses than from curing them. So the drug companies need an incentive to attempt to cure ailments. This should be done by using a competitive prize system where prizes are larger than the likely profits from symptom-relievers. I challenge some philanthropist to start up a charitable foundation to fund these prizes — I would happily contribute to that fund!
And finally, let’s be clear, Sicko is not even as unbiased as the BBC; it is a propaganda work which sits on a body of fact and then changes aspects to suit the maker’s own ends. I enjoyed Sicko, I found aspects of it (that are true) disturbing and I found aspects of it laughable. The reactions of British patients and doctors was clearly genuine — Brits do tend to laugh at that sort of question in a way that Americans do not.
January 21st, 2008 at 12:59 pm
Great Idea Gav, but why stop there, why not give the entire NHS budget to the private sector to allow them to provide free care for all? Surely competition within the Private sector would solve all the NHS problems, don’t you agree?
A couple of questions for you based on your proposal.
1) How do you allocate which hospital deals with which treatment? Each hospital would chase the cheapest patient? Would the patient chose?
2) You are aware that the Private hospitals consultants are NHS trained and work part time for the NHS/Private hospital. Would you force Consultants to continue this or have to chose NHS or Private - works well for dental treatment!
By all means, let the Private sector take on the costs of patients requiring long term care A&E (especailly the drunks on a Friday night!), community services, etc. I have feeling that the private sector wouldn’t want this or impose a short term period of care after which the NHS pick up the cost (again).
What I would like to know is why somebody with breast cancer and private medical insurance can be seen by a consultant, operated on, and on going treatment prescribed but under the NHS would still be on the waiting list to see a cionsultant, especially when it was the same NHS consultant (working part time for a private hospital) who treated my friend.
January 23rd, 2008 at 6:08 pm
Dental treatment fails because dentists believe (and they’re the ones to know) that they cannot provide a decent service and make enough money with NHS funding. With my suggestion the NHS is free at the point of use and so the question of whether more could be charged is avoided.
I wouldn’t wish this to be the only option, though. Bupa and the other independent and/or private companies have their place.
In answer to your first question, this would be a complex issue, but I believe that careful regulation of the private NHS companies would ensure that the state hospitals did not remain the ones burdening the more complex procedures.
Perhaps NICE (or a more fair all-Britain equivalent) could agree reasonable costs per procedure and ensure that funding is given to the hospitals on an equitable basis that way or maybe the regulator would insist that particular procedures and treatments were provided in given areas by the private provider?