Sunday, July 06, 2008

60 years of NHS- time for a rethink

The past week has seen the BBC and the UK, celebrating the 60th anniversary of the founding of the nationalised health service - the NHS. The system based on the openly socialist philosophy that the state should provide health care free at the point of use to all.

The reality of the risks of that system was largely ignored by the Labour Party at the time it was introduced. Britain was bankrupt from World War 2 and the Atlee Labour government used ample funds from the Marshall Plan supplied by the USA (and the UK got more than any other country in post war Europe) to fund its socialist plans of the NHS, iron/steel, coal, railway, bus, truck, airline etc nationalisations. The point that the NHS would result in over demand (with some going to doctors when they had little wrong with them), few incentives for healthy living (you pay the same regardless if you smoke, exercise and eat fatty foods or not), and a lack of accountability for any failure to perform as promised

Now the NHS is probably the UK's biggest sacred cow - it shouldn't be. For years the argument was that it needed more money - Labour did that, increasing NHS spending by 80% in 11 years. Improvements are difficult to see, as most of the extra spending has been sucked up by increased demands and increased pay. Another argument was that there needed to be administrative tinkering, which also has sucked in more money.

The Sunday Telegraph's editorial rather boldly proposes something else - an insurance based model which includes the private sector.

It states that the original vision of the NHS was that it would require less money over time as people became healthier, but ignored that people would expect more over time:

"It was assumed that, as the nation's health improved, so demand for medical treatment would diminish.

But the opposite has proved true. Increasing life expectancy means more people live to an age where they contract diseases that are expensive to treat. People are also less inclined to queue than they were in the austere days of the 1950s.

In a consumerist age, people compare their healthcare with the provision of other services and expect to have the same choice and speed of delivery.

Yet, while the NHS has evolved over the years, its structure and the way it is financed still owe more to a 1940s belief in the efficacy of state monopoly than to the realities of the modern world."

The paper continues, pointing out that both Germany and France have insurance based models with larger private sectors:

"Insurance schemes that let people decide how much of their own money to spend on healthcare and top up what they contribute in taxes are the way to bring greater investment into the system. Politicians must prepare the country for the realities that need to be faced; yet the totemic power of the NHS to stifle debate seems undiminished."

Indeed, the incentives of insurance could assist in encouraging people to look after themselves, and manage the costs of healthcare, in particular exposing people to the costs of what they expect. However, it is difficult to see the Tories (much like National in NZ) making any worthwhile change.

"Proposed Conservative reforms risk replacing Labour top-down targets with their own. The party must be willing to take on producer interests in the NHS and give greater choice to patients by embracing new ideas such as easier access to specialist doctors.

People no longer see the NHS as the property of its practitioners, but of those who pay for it. The NHS must respond to that mood - or voters will want to put their money into something that delivers the care they expect"

People will complain and moan about public health care and fail to recognise the simple truths, that the price of socialised healthcare is queuing, not always getting what you want, and paying the same regardless of your good or bad behaviour. It is time to put healthcare in the hands of those paying for it, by moving towards insurance, private provision and competition. The status quo has failed, and will fail more as the population ages and biotechnology pushes the cost of the best treatment beyond a socialised system. People will simply not tolerate ever increasing taxes for a system that produces ever increasing queues.

1 comment:

Anonymous said...

Ive had many problems with the nhs myself, the government can't ever seem to sort it out, you don't realise how bad it is til you need it, i'm going to get my own insurance for private healthcare