What would happen here?
My wife’s Uncle has just undergone major surgery to remove a cancer from his face. Being in the US and being lucky enough to have health insurance despite being unemployed he is having excellent treatment and care.
The first estimate he got was of a 36 hour operation, but given the choice in health care afforded to him he could get various other estimates and someone else estimated a 12 hour operation. Still a long time, but considerably safer for an elderly man and probably less worry for his family.
I am left wondering what would have happened under the NHS. My guess is that the operation may not have even been possible, it is close to the cutting edge, if it was then he’d have had no option to switch surgeons like that as far as I know.
There are certainly cases in the NHS, although usually in less serious cases, where treatments are not available due to a decision by NICE that the improvement in quality of life of the patient is less that the expense - that is inhumane, but a necessary constraint of the central planning of the NHS. I fail to see how local control will improve matters much either.
What I want to see from a health care system is that everyone can get this level of care if they need it, and that everyone can decide how to spend the limited resources available for health care for themselves.
I want to do away with the necessity of NICE and quality of life assessments. Only the individual can do that so the individual needs the power to make those choices.
The NHS fails at this. The US system also fails. Both have systematic failures (as the opponents of universal health care in the US will tell you, they advocate reform of the US system too).
Thankfully there are many other systems out there in use, and even more possible systems. We need to move towards a fairer and freer system. A more liberal system.
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November 13th, 2007 at 10:48 am
Many people in the US who comment on the NHS seem to believe that having it means private health care is banned. Of course it is not, people in the UK may have just the same sort of private health insurance as people in the US. We do indeed seem to be moving slowly towards a system where this is regarded as the norm, and the NHS is only a fallback for those who can’t afford it.
You want everyone to get the highest level of care possible, but that just can’t be done unless everyone is prepared to pay whatever it requires in taxes and/or insurance to achieve that. And that means those who are wealthy paying more than whatever it requires in order to subsidise those who cannot pay whatever it requires.
Furthermore, as medicine develops, new and more expensive ways of treating illness are discovered. So someone who a few years ago would have been left to die as their case was hopeless can now be cured - at a cost. Then they might live to a ripe old age, but we all have to die sometime, and if we live to a ripe old age often we die in a prolonged way requiring expensive care as we do it.
Consequence is, to appear to keep still on health and social care, we actually have to take more in taxation/insurance. Most people don’t seem to understand this, and so put down rises in tax/insurance as due just to evil politicians/bureaucrats who are “inefficient” or who take a delight in increasing taxes or costs to make a profit.
November 13th, 2007 at 11:20 am
Single payer systems like the NHS effectively ban private health insurance for the majority. People simply cannot afford it after taxation. It forces the less wealthy to put up with the bog standard treatment, it sharpens the divide between the rich and the poor.
If we go down the route you suggest we are then we will end up with the unsatifactory US system with the better off/in work having access to better healthcare with the poor having to put up with the NHS.
You actually aid my argument - we all have to die, but surely it should not be some functionary of the state who decides whether you get treatment and live or don’t and die?
Give people the power to decide what they spend their own money on. Those who don’t have the resources to spend enough to cover healthcare you can give some aid to through direct payments.
A side point, the insurance system in the US actually increases the costs of health care. When people are not paying for services directly they have no interest in keeping the price down. This leads to the situation of the $36 glass of orange juice..
November 13th, 2007 at 11:29 am
Matthew, a couple of good points there.
I agree that people don’t generally trust that extra taxes will go straight to public services. Equally they don’t generally trust that cuts in public services will translate into tax cuts. There is an expectation, both times, and partly justified that the money will go somewhere else.
And you are right that healthcare needs ever increasing funding to stand still. Perhaps in 50 years we will be spending 50% of GDP on healthcare. Higher taxes and more efficient delivery are only temporary fixes. How do you propose to judge where the point is where the tax rises should stop?
November 13th, 2007 at 12:41 pm
Tristan, I would question your contention that the NHS sharpens the divide between rich and poor - okay, everyone has to pay tax to fund the NHS, but it is disproportionately the rich who are paying for the treatment of the poor. That, I would have thought, brings equality, not inequality.
November 13th, 2007 at 12:49 pm
sanbikinoraion:
No. Because as we can see, the rich can still afford superior care, whereas the middle classes and the poorest cannot afford it because more money has been taken by tax.
Perhaps if we had a system whereby the rich were taxed truly punitively and the poorest weren’t taxed at all then you’d get no inequality there, but that is not feasible (as the rich would just leave, because they can and the economy would basically go down the drain…)
Also, what equality there is (amongst the non-rich) is not equality in excellence, its equality in poor standards.
Its a lowering of the middle ranks (admittedly whilst raising the lowest).
What I want is to raise the lowest and the middle ranks up. True, the very rich will always be able to afford better care, but that drives innovation and new treatments which then become available to all.
November 13th, 2007 at 2:29 pm
Tristan, when you say “Give people the power to decide what they spend their own money on”, they already have that power. As I said, private health care isn’t banned in this country, if people wish to spend their own money on whatever health care they need, they are free to do so.
The question is, what to do about people who can’t afford to pay for the health care they need. You say “you can give some aid to them through direct payments”, but you fail to answer the point I was making which is that requires other people to be willing to pay tax or excessive insurance in order to give them that aid.
If people aren’t willing to pay enough to help others live, and others don’t have enough money themselves, then someone has to decide who dies. You can’t get out of that.
In any case, I think what you are actually saying is that the direct payments only go to those too poor to pay for their own health care. So you’re really saying is “make the rich pay for their own health care, tough if they get a serious illness which costs a lot”. They can, of course, buy insurance to spread the risk. But then, do you give these direct payments to people who haven’t paid the insurance though they could have afforded to and suddenly find they have fallen to some expensive to cure disease? Or do you say “tough luck sucker, you could have paid for insurance but you didn’t, so die”?
Now you say that insurance causes costs to boom, yes, we are all aware of the nod and the wink “put it in insurance”. But isn’t the free market supposed to drive costs down, so any insurance company which allows such things ought to be driven to the wall because of competition from companies which are more careful so can charge lower premiums?
November 13th, 2007 at 2:47 pm
Matthew, you are failing to understand my argument and willfully ignore the nature of things:
Only the rich have the power to spend money on health care today. That is wrong. Everyone should have that power. The high tax burden the NHS entails prevents that.
If someone wants to spend their money on other things rather than health insurance, the let them. That is liberalism, it is liberty. We should not be forcing people to live their lives as we wish. I’m sure plenty of people will step in to help anyway, what with the massively lower taxes they have/ Or do you think only government can do good?
Someone’s own good is not sufficient reason to force them to do something. That is a fundamental tenet of liberalism.
Where is this mythical free market in health care? Certainly not in the US where the government meddles with it, starting with tax breaks for companies who provide insurance to employees (but not offering the same breaks to individuals, pricing individual insurance too high for most people), continuing with massive regulation of the pharmaceutical industry to the extent of denying people treatment which might help them and condemning them to death to the medicaid and medicare programs.
In some states they now mandate buying insurance, but also mandate that you cannot be refused and you must have particular cover, whether you want it or not. That has driven the costs of insurance sky high. All well meaning, all economically illiterate and immensely damaging to people’s well being.
As for these rising costs of health care, firstly these are mostly taken up in rare or very new treatments.
Secondly why need the whole cost be born by the tax payer?
Catastrophy insurance with a high premium is not expensive because the events are rare. That can be provided at far lower cost.
I fail to understand what you are actually proposing. Is it more of the same NHS with the rich being able to opt out?
November 14th, 2007 at 10:16 am
No, I am saying however health care is paid for, it still has to be paid for. Whether it’s paid for by taxes or private insurance, it still has to be paid for. In what I’ve posted above, I’m not arguing for either system, just pointing out what I think is obvious.
Given that it has to be paid for, if the money is not there to pay for it, people have to die who might otherwise not have done so. And there will have to be some bureaucrat there, whether a state official or a private insurance or hospital official saying “Sorry, you die because the money isn’t there”. You seemed to be arguing that’s something which happens under the NHS, but not under other systems. There you are wrong.