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Matthew Whitfield

'the profit seeking behaviour of private firms, constrained by the law, by their reputation, and by their rivals, is the best means to do so'

It is certainly one way to provide healthcare, and it is obvious that commercial pressures make private providers up their game and provide the best possible care. My concern (yes, you won't be surprised to hear I have one) is that the limited human resources of doctors, nurses and other health specialists are simply canibalised when two systems - public and private - exist in tandem. A case study: my father recently needed medical tests for which the potential NHS waiting time was 2 weeks. If he made use of his mutual society health insurance he could have the test done the very next day - with the same doctor who would carry out the procedure on the NHS. So, because there was only one specialist doctor qualified to carry out this test in a particular geographical area, he took on private as well as NHS patients and, naturally, the waiting time for his NHS patients was longer than it would have been if he wasn't showing preference for his private work. As it turned out, the NHS waiting time was short enough not to make the effort to use the insurance, but the case stands.

You've demonstrated the advantages of both systems, but I say that the NHS is more equitable for everyone, it is the existing system, and should not be further compromised by incursions from the private sector. I can't see how an equalibrium between public and private can ever be reached without the NHS being eventually weakened to the point of virtual extinction.

AJE

Ah, the old "equity" line...

Better that we all have poor service, then some have "good" and some have "excellent".

My Grandfather recently required a pretty serious operation, one that would have taken several weeks to wait for an NHS appointment. Seeing an advert in the Daily Telegraph he paid a few thousand pounds to visit a private clinic just outside London. Even though a humble pensioner, it was affordable, and meant he didn't have to deal with the lack of dignity a hospital often requires (sleeping in a ward, rather than having your own room in a Travel Tavern...)

My response was good on him. I guess yours would be that it was a shame the NHS was being undermined.
But if pensioners would rather fork out for private care, deeming it a better quality, then please tell me just who would benefit from you desire to force pensioners into the NHS.

Note that I'm not trying to exercise my values here. All i'm saying is that the best system is one that individuals prefer: one that increases choice, and opportunity. If my Grandfather has an alternative to the NHS, and he exercises that, and is glad that he did... then I think it's a 'good' thing.

How the hell can anyone claim it's 'bad', and that we'd be better off with a system where we all suffer equally as much.

Equity my arse.

Matthew Whitfield

Firstly, your Grandfather may well be a 'humble pensioner', but he remains able to pay what you describe as a 'few thousand pounds' for his private operation. Indeed, good for him if he can afford it - there are plenty who couldn't, not even able to raise a loan - I'd never criticise any individual who chose to exercise such a right, health is invaluable. I think, though, that you have to accept that the NHS exists for the overwhelming number of people who don't have the means to pay for private care.

Secondly, you're quite right to identify that my argument is about equity. However, where you are fundamentally wrong and rather unimaginative is in extrapolating from my comments that I would like to see a poor level or service for all. Contrary to your statement that you're not exercising your values, I would argue that your blithe assumption that a universally public healthcare system leads inevitably to poor standards is about as clear an expostion of your values as it's possible to have. It appears that you have missed or ignored my original point about resources.

When people in your Grandfather's position are faced with a choice between the NHS and a private facility, is it not obvious that the NHS will never be allowed the advantage of shorter waiting times whilst private hospitals use their financial clout to pay medical staff a premium to work there? You talk of patients making a fair choice in favour of higher quality, but the NHS is not granted the ability to compete in such a marketplace. Indeed, there is no marketplace - there is a public service and there are private firms operating on its fringes by selling the illusion of choice.

As I believe that healthcare should be a public service, well funded by the public to serve the public, it follows that I believe that, by wont of a finite number of medical professionals in the UK, private healthcare undermines this system. You, I think, believe the exact opposite of this. You may imagine that public funding leads to uniformly poor levels of service, but I am certain that your active desire for inequity in healthcare provision would leave those least able to pay (you and I, as low income students, included) in a far worse position.

AJE

1) "I think, though, that you have to accept that the NHS exists for the overwhelming number of people who don't have the means to pay for private care."

No. These hoards of destitute pensioners is a myth. Private care is affordable for most pensioners, and would be even more so if a. the promise of unlimited, costless care didn't provide an incentive to not save, and b. council tax wasn't bleeding them dry.

Remember, a private healthcare system would mean that all the money pensioners paid in taxation over their lifetime would be available to spend in private care. Compared to how much he's paid the NHS, £2k is nothing.

In this regard, my Grandfather is unremarkable.

2) "I would argue that your blithe assumption that a universally public healthcare system leads inevitably to poor standards"

Of course I don't think you want poor service for all, you want utopia. Lets not argue about what utopia looks like, lets discuss which means are consistant with achieving it.
My point is that publicly funded and coerced healthcare does lead to poor service. It's not an assumption - the assumptions are that centrally planned bureaucracies are less able to process dispersed information than local networks, that profit is a major impulse for innovation, that people spend their own money with greater care than they spend other peoples.... etc.... the result of those assumptions is that the only way to have an equal service it to have a universally poor one.

In other words, in the USSR everyone had a Datcha. In the UK, some people have Mercedes, some have second hand VW Golfs. But a second hand VW Golf is a better car than a Datcha, and over time the quality of a second hand car improves. I think the unequal system is more equitable, and better, than the equal one. I think healthcare is no different.

3) "but the NHS is not granted the ability to compete in such a marketplace"

Are you kidding? The fact that any private clinic can entice customers away from a behemoth that has a legally protected monopoly position and almost limitless funding is remarkable. Private clinics can only raise money from providing a good service, and so any "financial clout" they have is richly deserved.

4) "your active desire for inequity in healthcare provision would leave those least able to pay (you and I, as low income students, included) in a far worse position."

Lets stop using the term "equity", since we both think our respective system is the fairest. Rather, we disagree on whether the system should be "equal". The idea of an NHS run to fund students is abhorent, though. Taxing the relatively poor in order to subsidise the alcoholism of the soon-to-be-rich? For that's what the NHS does - by picking up the tab of those Saturday nights in A&E.

As students, we are a transient group. We shall soon be reaping the awards of higher education, and are perfectly capable of using financial markets to bring some of those gains forward.

Also, i've raised a new point in a seperate post.

Matthew Whitfield

I give up, your points are just too strong. You're right that there aren't really any poor people, it's just that people don't save because they're feckless and rely on the state for everything. You're right that we should compare social democratic policies in the UK to the systemic failures of the vicious, Communist dictatorships of the former USSR. You're right that cars and healthcare are pretty much the same - just products, like any other. You're right that the NHS has an unfair monopoly position that should be undercut - I mean, they're probably making millions in profit and providing shit levels of care when there are independent clinics out there going to the wall. You're right that students are all alcoholics who will one day be rich enough to pay for a drying out clinic before their next bender. You're just so, so right about it all. I've seen the error of my ways. I'm off for a drink now, I'm nowhere near drunk enough.

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