Okay, well, firstly for non-UKers, the NHS is pretty much universally popular in the UK as an institution and the thought of privatising it is tantamount to political suicide for any party; nonetheless my doctor friends testify that it is a monolithical, bureaucratic behemoth that needs a shakedown, and a lot less ministerial interference.
This is an idea one of my friends has proposed as a means of reforming the NHS. Now, he is a Thatcherite, but his idea does seem to have some reason to it, even to someone such as I who is on the whole hostile to undermining the basic tenets of the NHS, that of universal healthcare.
His idea - dismantling the British Department of Health, but creating a ‘BBC-like’ NHS, responsible to Parliament but autonomous and independent of direct ministerial interference, looks like a good means to eliminate the micro-management that currently takes place in the NHS, and potentially reduce administrative burden on doctors enormously. This in itself would free up time and money for them to save lives.
The BBC is another broadly popular institution that works pretty well and holds it own against competition.
Now I don’t know too much about economics, but this idea appeals, but your good selves might know reasons why it would be bad, or lead to privatisation or collapse in the long run. What do you all think?
How are you going to pay for it? The BBC is funded by the licence fee. I don’t think a health licence fee would go down very well. If you keep funding it from general Treasury funds, ministerial interference is pretty much required.
Well, the Bank of England also has a Royal Charter, as do various universities and professional institutions…but I guess their funding is at least in part sourced from private donations and business. Hmm.
The NHS is currently supplied through National Insurance though, and I suppose that would remain?
The article doesn’t mention a single instance of “ministerial interference” causing a problem, but he’s pretty sure we need to protect the NHS from it. Why?, well healthcares expensive*, maybe it will help with that. No real reason, but hey, you never know. (Indeed, oddly the only example in the article of ministerial interference is a program created by Tony Blair, which the author approves of).
Plus, even if you disregard the US*, the UK’s system is cheap by first world country standards. It seems odd to complain about how expensive it is
**(fun fact, here in the States our public spending on healthcare is larger as a fraction of GDP then the UK’s, even though our public spending only covers a small part of the population, while the UK’s covers almost everything).
Believe it or not, but a lot of people go on in the UK as if the NHS is the most expensive and least efficient healthcare system in the world. It’s bonkers of course, but there you are.
To me this sounds like turning into it into a Medicaid-like program for covering medical care for the very poor, and requiring everyone else to buy health insurance. Or… maybe not even requiring it, maybe allowing people to go uninsured.
I think it would be useful to compare this scenario to the ‘privatisation’ of the UK rail network.
British rail was an incompetent, bloated, expensive organisation. It was sliced up into a number of competing, notionally-private business, because* The Market Will Fix Everything*.
What happened is that it turned into a slightly-less-bloated, more-expensive, more-incompetent system, offering fewer and largely inferior services. The need to make profits to pay shareholder dividends drove up the cost to customers and diverted funds away from essential maintenance, as a result of which, trains crashed and people died. It never turned a profit and continually requires government intervention and funding.
Instead of being a sinkhole for public funds, it turned into a conduit for public funding to siphon directly into the wallets of shareholders.
I’m not saying I have a better idea - in fact, I’m not sure improvement is even possible. Public Sector organisations waste a massive chunk of their resources and funds just continually trying to restructure themselves - the next restructure will always fix everything, but inevitably, it never does.
The bits that most desperately need fixing turn out to be hard to fix, and just get additional layers of management plastered over them, and the ‘power players’ find ways to hijack the restructuring process to create their own little kingdoms. Big organisations are essential, but don’t work very well.
I’m knowledgeable enough on British politics or economics to really offer a specific opinion.
But I will say, as a general observation, that a doctor’s viewpoint might not be the best perspective on this issue. Doctors and other health care professionals are obviously a significant portion of the health care system. But the system isn’t supposed to be designed for them.
There’s a natural instinct in any organization for the people who are inside the organization to begin thinking that the purpose of the organization is to meet their needs. But in virtually all cases, the real purpose of an organization is to produce a product or service for people who are outside of the organization.
I’m not sure how useful the comparison is - the rail network has certain “natural monopoly” characteristics that, as far as I can see, healthcare does not.
Not that I’m advocating privatising the NHS or anything. Just saying.
Not really. It’s cheaper than the French or Swiss systems, which are often trotted out as examples of how to do socialized medicine properly. This despite the fact that the UK population has a higher median age than France (though not Switzerland).
Really, the only place healthcare is done better in terms of cost-effectiveness is Japan, which uses a mixed public/private coverage model where patients pay 30% of the cost of care. Of course, Japan has draconian immigration controls, which is a big benefit in terms of cost.
Well, sure, the destinations are fixed (and so’s the track), but any number of different carriage companies could offer competing services on the same or similar routes, or part thereof (in fact, that’s pretty much how it was supposed to work when it went ‘private’).
Hospital services aren’t so very different - a city is probably not going to have an unlimited number of hospitals and when you accidentally sever your own foot in a freak golfing accident, you’re probably not in the mood for shopping around. Maybe that’s not so true for non-emergency cases, but at the moment, we already have choices if you don’t like the standard service (in the same way that, if you don’t like the train options, you can fly, drive, bus, cycle, etc instead).
E.g.if you want to go from Leeds to Edinburgh by train, you don’t have any real choice about whose track you travel over. No competing company can spring up and realistically build its own track between those destinations.
True, but that’s a fairly trivial factor. I also don’t have any choice in the question of where Edinburgh is sited, but multiple operators can run trains on the same tracks.
There will be parts of even a privatised health service that are also a virtual monopoly. The thing that makes me most uncomfortable about the notion is that competition and choice implies that we will allow some of them to be cheap and shitty, and allow those to fail - if the commodity was knitted hats, it wouldn’t matter so much if the market contained cheap and shitty offerings, but this is a commodity where people’s lives and wellbeing are at stake - we should invest what we can, and try to design the system so that as much as possible of that investment is delivered in the form of end user services.
