Monday, August 17, 2009

NHS and alternative health care systems

(Note: am having to start a new thread because of bloody Blogger comment length restrictions. I'm musing on moving our blog to Wordpress for that reason. But anyway, here's the older NHS thread).

--------------

NHS and alternative health care systems

Perhaps the most interesting chapter in Tim Harford's fascinating book The Undercover Economist was on health care systems. Astute readers, such as the ImpDec audience, will probably be unsurprised to learn that both Britain's NHS and America's bizarre public/private health care systems are extremely poorly designed and wasteful. After a discussion as to the characteristics of systems likely to do better, Singapore was held up as an example of how to do it.

This article gives a flavour of Singapore's system:

Singapore's Health Care System: A Free Lunch You Can Sink Your Teeth Into
Library of Economics and Liberty
JANUARY 13, 2008

All this is in the news because of comments from Daniel Hannan, a Tory MEP, disparaging the NHS. It turns out (this is a massively underreported in the discussion) that Hannan also favours the Singaporean model. Having read his comments below, I'm firmly on his side. And I can also say, having lived in Spain and Germany, that their systems worked a damn sight better than ours, and that anyone who thinks the health care argument is between the UK and US models needs to have his head examined. Preferably after a 6 month wait, and in an MRSA infested hell-hole.

The NHS row: my final word
Daniel Hannan's blog
August 14th, 2009

...

As far as I can tell, three separate charges ae being laid against me. First, that I have insulted NHS workers. Second, that I want to impose a US-style healthcare system on Britain. Third, that I have made criticisms overseas that I wouldn’t make in Britain.

Let’s take these in order. Start with how I insulted the 1.4 million NHS workers. Here’s what I said: “I don’t want to imply that, because we have a bad system, it doesn’t contain good people. A lot of very generous, very patriotic people become doctors, even though they’re working in a system that doesn’t maximise their utility, because they have a calling to help other people.” Pretty rude, eh? I suppose I should have learned manners from the NHS’s founding spirit, Nye Bevan, who described Conservatives as “lower than vermin”.

Nor do I believe - as Peter Mandelson seems fatuously to be claiming - that Britain should adopt a US-style insurance-based system. While in the States last week, I repeatedly emphasised that I thought their set-up could be improved, that costs were too high, that litigation drove up premiums and that powers could be shifted from big insurance companies to individuals. There is a difference between saying that the US shouldn’t adopt the British model and saying that Britain should adopt the American model. Think about it for a few seconds and you’ll see that it’s quite an obvious difference.

If you want to go in for shorthand categorisation by country, the model I’ve been pushing for is one of personal healthcare accounts, a system most closely approximated in Singapore, whose people enjoy a higher level of healthcare than Britons do while paying considerably less for it. Nor can it be repeated often enough that Singapore - like every developed country - pays for the healthcare of those citizens who can’t afford it. No one I know wants a system where the poor go untended. Nor will you find such a system outside the Third World: it really isn’t a British peculiarity. After ten years in the European Parliament, I have found that the only foreign admirers of the NHS are those on the serious Left. Mainstream social democrats on the Continent do not, as a rule, argue for a heathcare system funded wholly out of general taxation.

The third charge - that I should, as Labour’s Tom Watson puts it, “say it in Britain” - is the most asinine of all. I have been saying it in Britain for years. I’ve written a book all about how to shift power from bureaucracies to consumers. It’s called The Plan: Twelve Months to Renew Britain, it’s been in Amazon’s top 30 best sellers for nine months, it has become the best selling political tract in Britan and you can buy it here. In it is a lengthy chapter on healthcare which sets out how Britain compares with other countries in terms of survival rates, waiting times and so on, and proposes to replace the NHS with transferable savings acounts (which, to repeat, since some of my critics seem deliberately mulish on this point, would be met by the state for those who lacked the wherewithal).

Now you can agree or disagree with my views. But to ignore them for ten months, pick them up when they are attacked by John Prescott, and then - then - to complain that I haven’t expressed them in Britain, strikes me as a bit much. Of course, that isn’t how these rows work. Almost no one who has phoned me seems to have watched what I said in full. If they had, they would have seen that I conceded that there is majority suport for the NHS in Britain (although I believe this is partly based on the false premise that free treatment for the poor is a unique property of the British model), and that my views did not reflect those of my party leadership.

Still, I do wonder at the tone and nature of the criticism. It seems to be based on playing the man rather than the ball. My detractors say that I’m out on a limb, that I’m in the pay of the insurance companies, that I’m insulting those who have had successful treatment from the NHS. (What? How?) If supporters of the status quo were truly confident of their case, surely they would extend their logic. I mean, why shouldn’t the state allocate cars on the basis of need, with rationing by queue? Or housing? Or food? I am reminded of the debate over asylum ten years ago, or Europe ten years before that.

more...

4 comments:

Andy said...

I don't know, Andy Burnham would say that was very 'unpatriotic' of you to say so JP. As he said, "I would almost feel... it is unpatriotic because he is talking in foreign media and not representing, in my view, the views of the vast majority of British people and actually, I think giving an unfair impression of the National Health Service himself, a British representative on foreign media."

Really, you should feel ashamed of yourself for questioning the NHS!

JP said...

Well I've travelled the world a fair bit, and have never met anyone who envies (or, frankly, gives a damn about) the NHS, so I'm not sure what reputation Hannan is destroying.

I'd also refer our good friend Andy to Hannan's third point above.

Andy said...

JP I was indulging in a little irony (sorry, i should have used the smiley face, stupid of me really :) ). I don't think you are being unpatriotic and furthermore think that Doctor Johnson might have had Mr Burnham's number when he said 'patriotism was the last refuge of the scoundrel.' (thanks for the quote Dan)

Andy said...

Here is Oliver Kamm on Daniel Hannan's NHS comments:

"NHS "a mistake"

I commented a few days ago that a Tory MEP and Telegraph leader writer, Daniel Hannan, has what Jimmy Carter referred to in the case of President George H.W. Bush as a silliness problem. Pleasingly, Hannan has confirmed the observation independently. The Standard reports:

'[David] Cameron was also under pressure to slap down Tory MEP Daniel Hannan for claiming the NHS had been a "mistake for 60 years".

"Mr Hannan last night refused to back down, saying: "People can see for themselves that Britain has become a place where foreigners fear to fall ill. Yes, all three parties are committed to the NHS: I am a humble backbencher, and speak only for myself. But I wonder whether, as on tax and borrowing, public opinion hasn't overtaken the Westminster consensus."'

You have to feel sympathy with David Cameron on this. Writing leader columns is not real life. You can make a reasonable theoretical argument for an alternative to the National Health Service, but not in my view a practical one. And you can't make a plausible argument that the NHS is a mistake. The NHS is good value compared with the health services of other advanced economies; it is efficient, in the sense that doctors have no financial incentive to over-prescribe drugs; it contributes to trust between doctors and their patients; and it conforms to a widely-held principle of equity, that no one should be denied the right medical treatment owing to poverty.

After the 1997 election, Paddy Ashdown came up with a neat description of the Tory campaign: he described it as a decent man leading an appalling party. It would be absurdly sectarian to doubt that the Tories are a more civilised force now, and with a much better leader. But sometimes you gain a glimpse of that unappealing subculture, and wonder.'