Thursday, August 20, 2009

A Few Thoughts On The NHS "Debate"..

Daniel Hannan is again grabbing the political headlines by giving some talks in America about the drawbacks to Socialised Medicine, and dispelling some of the myths there about how the NHS really is over here.

The most annoying and depressing aspect of this is the immediate attempts by the British left to smear Hannan and shut down a debate before it has even happened. Andy Burnham even went so far as to suggest that Daniel Hannan is “unpatriotic”… I know few people Andy Burnham seriously, but still he is a Minister, and to make such a suggestion is not just comically inaccurate, but a calculated insult.

Here’s what I want to add to the debate. Firstly I am like most people in the UK, my family and I have had good experiences of the NHS and we have had dreadful experiences, but I have not experienced to any degree healthcare in any other country first hand. So, my experiences and opinions stem from a bubble of prescribed ignorance.

If we can have the debate, it needs to be wider than offering the US system as the alternative, there are others. Dan has pointed this out already but he and Douglas Carswell’s preferred alternative is that of the model used in Singapore, and this is the alternative that they set out in their book, The Plan, published last year. [In contrast to another smear, this time allegedly from Tom Watson, who claimed Dan Hannan was going abroad casting assertions that he would not make at home.] I have read The Plan, and from memory their healthcare idea is to have citizens save through health schemes their own money to pay for healthcare to be drawn upon as it is needed, additionally people will need insurance to pay for more expensive healthcare should it be required. The poorest in society will be provided for by the State, as and when it is needed. The system itself becomes open to price influence and consumer pressures and will naturally seek ways to compete for custom by improving service and offering competitive pricing. Medical staff will naturally seek to be better so that they can themselves do better. When the system fails, individuals can seek recompense openly and fairly.

This may not be exactly as was written in “The Plan” but is the motion at a high level.

The well off do have the advantage of being able to pay for better doctors and facilities; but in contrast to the UK system now this will be more widely available than is currently available to the smaller, but wealthier who can still buck the system. Perversely the less than 10% who can afford to do so in the UK now, simply buy their way to the front of the queue and will likely end up in the same operating theatre, with the same doctor using the same tools, the other 90% or so have to wait their turn for a slot to open for their treatments.

So, what troubles me is; why exactly is it so offensive to the British Left that alternatives systems are discussed that may actually improve the state of health in the people of this country? There is compelling evidence that there are other systems employed in the developed world where a UK equivalent could save more lives; so it cannot be a body count issue.

It is of course because the NHS is the bedrock of the Socialist argument in the UK; it is held up as universally popular and universally acknowledged as being a success. But away from the Government and out of the mainstream press that is not entirely how everybody views the NHS. If you tug at the threads of the NHS and show that things can actually be done better, cheaper and more efficiently then the whole of the Labour Parties core beliefs can come into question. The criticism and attacks we hear from Labour come from a position of fear, rather than of confidence.

I gave it some, but not really a lot of thought over the last week, and I am personally in no hurry to bring down the NHS. Firstly, there has been no debate and no consensus that an alternative should be sought. This however I would like to contribute to. Secondly, as with all change the fear of change clouds the uncertainty of the potential of improvement. Without more cheerleaders and an inspired vision it is hard to have confidence that a change would be successful… but that can change.

The fear stems from the certainty of what almost certainly will go wrong. Though I am not convinced the whole of the NHS is behind the notion that the State must run all, there would be enough organised opposition to ensure that any moves to change will be fiercely opposed. We can be sure of this fact because we have the benefit of history on our side. Also, no matter what changes are made, and no matter how good things get, we can only move from an imperfect system into a different imperfect system, and it is there that those who are ill served and neglected will be held up as the victims of what I would assume will fast be referred to as corporate healthcare.

So, as is probably evident, I am personally clearer on the fact that I think we should just be open and allow ourselves the luxury of talking about how we could make things better, than I am on how I personally would advocate how we can really make improvements. But the more everyone talks, the clearer these positions and alternative will become. That is the benefit of living in a free society, power and change can emanate from public debate, rather than from those who prescribe how they think we should governed.

If you are still convinced we can do no better than to allow the State to run the Health Service, I invite you to imagine for one moment a contrasting example. In your mind’s eye, look at how the State has taken more and more control in the past 40 years of Education. Think about how things were in all terms, does the money the rich have buy more or less of an advantage today compared to 40 years ago? What standard of service do the poorest get? Are the standards better or worse than 40 years ago? Now ask yourselves the same questions of your food supply?

Perhaps a bizarre example, but what I am trying to illustrate is that in 40 years, through private enterprise, Supermarkets like Tesco’s & Sainsbury’s, as well as your local stores and restaurants have done more for food and diet equality to the people of the UK than the State has done for education equality. For the few of you who scoff, I invite you to now image the reverse scenario, if food supply was a ring fenced competence for Government? Would it be cheaper, or as widely available? Try to imagine how that would affect yours and everyone standard of living. In that bizzarro world, you would be hard pushed to imagine how the free enterprise system could be providing food much more easily and cheaply, but we know it to be possible.

Hopefully, such an example illustrates that it is not unpatriotic to simply aspire to live our lives free from State control. Also, just because we don’t yet have all of the answers to how we can make things better, the first step is to talk openly and to include everyone in those discussions, because everyone is affected. Then hopefully, down the line and with popular consensus try some new ideas out for real giving them a real chance to succeed or fail.

Finally, and just because I think it is important to mention something that is sometimes, strangely ignored and occasionally spun inaccurately. The NHS is free at the point of use, in that an ambulance driver no more needs a credit card than does your GP’s receptionist; but the NHS is not free. It is in fact very expensive and consumes a big chunk of the taxes we pay.

1 comment:

Tarquin said...

Good stuff, Dan - you're a lot more thoughtful than me

For what it's worth I think the opposition to criticism of the NHS is mostly fear - yes those on the left want, and love, state control - but that's not the average voter, I think they fear that if you take away free healthcare, which despite all its flaws is a very nice thing to have to reassure you, they might end up with a system where they are bankrupted by illness, like in america

Now it's unlikely we'd go anywhere near the model of the US, but it's well known and can you trust politicians to properly change something? I wouldn't blame people for thinking a change to their doctor or hospital could stop them ever being free again

It definitely needs addressing (I remember the BBC show where that bloke was sent to fix the NHS) - and we need to coolly and raionally do that, unfortunately the screaming banshees of the left start shouting 'unpatriotic' (and how can a true leftie be patriotic, that's nationalistic) - we need someone to stand up and guarantee that healthcare will remain free at the point of use, and that any financial contribution will be fair, and then reform the system

Unfortunately politics is never rational