Wednesday, May 6, 2015

We are getting there

I do not believe I have ever watched or experienced a more boring, stupid and content-less campaign in all the years (since my school days) that I have been interested in politics. As the last day of campaigning wears on I shall write about it some more but now I'd like to concentrate briefly on one subject that is supposed to be the political holy of holies: the NHS.

We all know what a lot of nonsense is spoken about it; we all know how ridiculous is the claim that without the NHS most people would not have access to healthcare because, it would seem, in all other developed countries sick people are simply dying in the streets; and we also know that there is a great deal of nonsense spoken about the NHS being untouchable because everyone adores it and would not have things any other way. People might (but only might as I don't trust the way hacks reinterpret things) say that but the number of British people who have some kind of a health insurance is growing all the time and most employers offer some form of it as part of the employment package.

A good many of my frustrations with people who seem unable to think straight about healthcare were summed up by an interesting briefing paper, recently produced by the Institute of Economic Affairs, entitled What Are We Afraid Of? and subtitled Universal healthcare in market-oriented health systems. It is not a long paper and well worth reading (the link takes you to the pdf version of it).

Kristian Niemietz, the author, says a couple of times that he is not producing solutions to the enormous problems all healthcare systems in the developed world face but he is advocating a more rational discussion that looks at systems that are not single-payer ones, like the NHS and not the US system, which, in his opinion (and I agree) "is singled out because its well-known flaws make it a relatively easy target to attack".

The three countries he does look at have various versions of social health insurance (SHI) systems and are none the worse for it. They are Germany, Netherlands and Switzerland, where the population as a whole has access to high level of medical care but where the funding system is complex and involves a great many private for profit and non profit organizations. Yet, this systems, which would be relatively easy to introduce in the UK and they may well improve the healthcare we have, are never discussed because that might destroy the myth of the NHS's uniqueness.

Two paragraphs from the Summary give a very good idea of the inadequate standard of discussion:
The UK is far from being the only country which has achieved universal access to healthcare. With the notable exception of the US, practically all developed countries (and plenty of developing countries) have managed to do so in one way or another. But Britain is probably the only country where universal healthcare coverage is still celebrated as if it was a very special achievement.

The NHS is often unduly eulogised for minor achievements, because it is being held to unrealistically low standards. The NHS should not be compared with the state of healthcare as it was prior to 1948, or with a hypothetical situation in which all healthcare costs had to be paid out of pocket. Rather, it should be compared with the most realistic alternative: the social health insurance (SHI) systems of Continental Europe, especially the Netherlands, Switzerland and Germany.
Curiously enough, soon after I finished reading the paper I came across one of those "you have one day in which to save the NHS" comments on another forum in which UK system was lauded more or less because it managed to save one person's life. Apparently, no other system could do anything of the kind.

Read the whole paper. The subject is not going to go away, not even after tomorrow.


  1. I see a parallel here with the BBC. Just as a lot of people now have private healthcare, a lot of people have Sky TV, and increasingly Netflix which are making their own programs etc.. But like the BBC, the NHS isn't going to go away, and for the same reason. It is a form of Government control over our lives. As the State increasingly seeks to control our consumption of certain things e.g. tobacco, alcohol and sugar amongst others they will need everyone to go through state health care. And they need the BBC for their propaganda. In fact there is a certain circularity here as the BBC could certainly do more to expose the failings of the BBC, and reveal the other choices that are available.

    This one, like all the other battles is going to be a long uphill struggle.

    1. At the very least, when it comes to healthcare, we should be looking at various alternatives to the NHS. With the BBC we know about them but with the NHS there is a myth that there are none worth discussing.