Why government intervention in the health service?
Contrary to what many people might think, I’m not going to advocate a complete laissez-faire system here, actually I’m not going to advocate any system. What I want to do is look at what is wanted from intervention in health care by liberals, hopefully to serve as a starting point for looking at what a liberal health policy might look like.
If I were to suggest a laissez-faire system, I think the liberal objection would be that some people would be unable to afford health care at all (the socialist would argue about profit and how the state could run things better, the authoritarian or Tory radical would say that some people would spend their money on other things, neither of which are objections from a liberal viewpoint).
Given the liberal world view - that monopoly is bad and markets should be used where possible and that state intervention should be minimal and as a last resort, along with the freedom of the individual to pursue their own aims as they wish without interference (excepting where it comes into conflict to other’s equal rights) and the desire to ensure that everyone is given the opportunities to pursue those aims - there is one clear aim of liberal intervention in health care - to ensure the poor can access it (or economic and personal freedom plus social justice)
Once the poor can access health care, and the same health care market as others, the aims of liberal intervention will have succeeded, and intervention should not proceed any further - the final aim would actually be to eliminate any need for intervention, if nobody is too poor to access the health care market then what need is there for intervention?
This means that liberals should be supporting raising the poor into the market which they otherwise would have been absent from, a policy of raising opportunity for the disadvantaged whilst keeping the benefits of freedom for everyone - something which I think exemplifies the broader liberal approach.
How a liberal system might work is another matter, but this should provide the basis for developing models for health care intervention.
You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
October 31st, 2007 at 2:49 pm
I can see how a market in the supply of treatments might work. But a market in the supply of diagnoses? If I could tell a good diagnosis from a bad one, I could do it myself!
Of course I could look for a diagnostician with a good reputation, but a reputation will be based on other patients’ vague impressions and guesswork. Harold Shipman probably had a good reputation before he was found out.
There is an information problem here, that is a barrier to competition. And I would rather get my diagnosis from someone who is insulated from the commercial consequences of his or her judgement.
October 31st, 2007 at 6:09 pm
Like Harold Shipman?
October 31st, 2007 at 9:31 pm
Joe, forgive, me, but that makes no sense to me…
As Bishop Hill says, Shipman was “insulated from…” and so was the cardiac firm at the JR in Oxford and look at their record. Yet the protectionism inherent in the system made them pretty well unimpeachable until it was too late for too many people.
It is the “vague impressions” as you put it that would drive such a market. Those “vague impressions” would make sufficient number of people (or even their insurance companies) seek second opinions, that clinicians that made regular mistakes by others’ professional second opinions would be spotted sooner.
It seems to me that elected local health boards have the *potential* to entrench that culture of “vague impressions” and inexpert opinions, whereas it is arguably possible that competing insurance companies wanting to ensure they get the best treatment for their money, with their actuaries studying clinicians’ records to determine whether or not they should get accreditation in one of the hospitals they use would do better in determining whether an objectively good job was being done.
November 1st, 2007 at 11:33 am
Bishop, Jock, the choice is between professional oversight and amateur (i.e. non-clinical) oversight. Shipman had neither, but he illustrates how reputations, vague impressions, can lead one completely in the wrong direction.
Yes, second opinions are good, this is professional oversight, an insurance company actuary cannot do this. And few would be interested in funding a doubling of the diagnostic workload, under any purchasing model.
Where is the incentive for insurance companies to get the best treatment for their money? There is none - their incentive is to prefer the cheapest treatments and encourage the corresponding diagnoses. Ditto health boards.
The problem here is information. One prerequisite of a market is that the customer knows what they are buying. But for a diagnosis, the product is the same as the information about the product. The only competent buyer is one capable of making the diagnosis themselves.
Historically professional oversight has also been a joke. It is getting better, perhaps not fast enough.
The solution will have to find the right information as well as the right incentives, and the question elected health boards or social insurance is far too simplistic to get heated about.
November 4th, 2007 at 7:58 pm
I agree with your comments about insurance. So what we need is a non-insurance-based scheme - something like Singapore?
November 4th, 2007 at 11:32 pm
Singapore has some interesting features. I don’t see that it particularly addresses the issues I mentioned, but it seems to address some others quite well.
November 5th, 2007 at 8:44 am
Could you expand on that a bit. From my perspective Singapore exactly addresses the information issue and the incentive for insurers to get the cheapest treatment rather than the one offering the best value.