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Nurses supping with a long spoon

Helen Evans, who runs Nurses for Reform, a campaigning organisation dedicated to free-market options for healthcare in the UK, got to meet Conservative Party leader David Cameron a couple of weeks ago. The Daily Mirror [here, here and here] and the Daily Telegraph found out about the meeting and offered their own take on it.

Broadly, I agree that the proposals are in the right direction, although I have concerns about some of the tactics suggested and their formulation, which I deal with later. The bit that was not previously familiar to me was the idea that a barrier to entry should be at least lowered, by amending local planning rules to make it easier to open a new healthcare facility. I’m told the Conservative Party already favours this for schools, so the extension to clinics should not be difficult.

Having read the briefing document presented to the Leader of the Opposition, I disagree with one element of the strategy being proposed, specifically this passage: “the [National Health Service] NHS should be renamed the National Health SYSTEM and that under its auspices patients should benefit from a universal right to independent hospital care and treatment.”

A “universal right” is something that a government could be justified in declaring war to defend, like “freedom from slavery” or freedom from the use of confessions extracted under torture in criminal trials. It could certainly be a pretext for new taxes, a new bureaucracy, more regulations, and the restriction of other “non-universal” rights. Sadly, this call for declaring that privately-provided healthcare is a right could become the very instrument for imposing regulations (such as US Medicare-style price controls, or French-style government control on where doctors can practise [link in French]) that violate patient and physician freedom. To give a specific example: could a private clinic be fined for not providing 24-hour accident and emergency access? I would expect a government agency to do just that. Meanwhile, of course, government facilities which operate “in the public interest” would be excused.

A second concern comes in a later paragraph: “health censorship must be outlawed and patients must be empowered with greater access to information.” Outlawed? Must be empowered? By what agency, regulation, funded by what taxes or levies, with what powers of inspection and control?

These may seem like quibbles, but the law of intended consequences suggests that the wording of reforms can be as important as their spirit. Consider the US Constitution’s First Amendment:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Does it say that Congress cannot give money to the Food and Drug Administration to hunt down anyone making claims about the alleged benefits to cancer patients of drinking grapefruit juice? No it does not. It means it, I think, but can I prove it to the US Supreme Court? Probably not.

It might be more boring to do, but the best way to remove censorship would be to revoke the clauses of those laws and regulations that allow it. As for “empowerment,” if this comes from the government it will mean a Department of Truth in Advertising demand for a quarterly report from all private providers as to how they inform the public, with fines for not reaching a wide enough audience.

On the positive side, Nurses for Reform finds that the ownership by a government department of most of the UK’s hospitals is a potential conflict of interest. There is the temptation to hide problems, to restrict information about alternative (often newer) treatments, the cozy relationship between the government employees in the NHS and those of the Department of Health who are supposed to watch them.

Dr Evans is therefore absolutely right to suggest the immediate transfer of ownership of NHS hospitals out of “public ownership,” and she is also correct that the “Secretary of State for Health must no longer have any say over when or where hospitals are built, opened or closed.”

On the issue of advertising, or freedom to communicate with the public in general, the major benefit would be that people could get an idea of which were the better brands (either cheapest, or best quality, or best balance between the two). If we think of how Aldi and Lidl can co-exist with ASDA, Tesco, Sainsbury, Waitrose and independent grocers, we can see how variety of branding can lead to beneficial competition: new treatments, more options and probably less queues.

Personally, I see no point whatsoever in delaying the reform of NHS funding: it merely prolongs unnecessary suffering and provides more opportunities for opponents of change to mobilise, like Gorbachev’s “perestroika” versus the liquidation of the soviet system. Having little expectation of any progress under a new Conservative Party government this coming year, it would be a pleasant surprise if Dr Evans’ proposals came to fruition. But at least no one can now claim that the case was not made.

[UPDATE: corrected link for Daily Telegraph article]

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7 comments to Nurses supping with a long spoon

  • Johnathan Pearce

    I have said it before and I have said it again: the idea that I or anyone else has a “right” to healtcare is a nonsense. Such “rights” are not the rights not to be interfered with as a sovereign individual – which is the definition known to classical liberalism. No, these bogus “rights” are claims on others, and can only be realised in practice by coercing people into providing services. For instance, does any politician, of any party, who thinks there is a “right” to healthcare believe that some people, who have the ability, should be forced to work as doctors, nurses or lab technicians? Unless they say yes to that question, all talk of rights in this sense is vacuous BS.

  • newrouter

    i have a right = i should be allowed to steal from other people

  • Note: the Telegraph link directs to a Mirror rant instead.

    There is a sense in which the word ‘right’ is justified here. No even slightly hopeful runner at the next election is talking about fully, or even substantially, privatelly funded healthcare. We are all going to be taxed for the NHService/System come what may, and it is going to be a lot.

    When someone grabs all the money I would otherwise be spending on healthcare, and does the spending on my behalf in the alleged public interest, I nearly think I have a right to at least receive actual healthcare for it instead of three Cat Obesity Strategies and a London Olympics.

  • Hugo

    I’ve been reading Fabian Tassano’s book, “The Power of Life and Death”.

    Obviously the NHS monopoly needs to be broken. Another monopoly that needs to be broken is that of doctors.

    And lawyers too, come to think of it.

  • Hugo, there is only one monopoly that needs to be broken: that of violence. All the others will follow naturally.

  • Paul Marks

    The stealing of the hospitals in 1948 was a terrible thing – sometimes centuries old charitable trusts were just taken by the whim of Act of Parliament.

    I remember (some years ago) guarding University College Hospital. On my searches I found many things (including a once fine chapel) lost in decay – and I found histories of the hospital with all the lifetimes of work by ordinary people to build an institution, now left to rot.

    Even the large grand buildings built to house nurses were totally empty and left to decay.

    By the way this was not an abandoned hospital – no, people were taken into the place for treatment ever day.

    As for the small “cottage” hospitals founded in villages and towns all over this land – well they have mostly just been closed down.

    The government ran hospitals before the NHS (the Poor Law establishments), but they were considered vile places – the poor much preferred treatment in the free wards of the independent hospitals (although, even in 1911 the vast majority of working class people were covered by fraternities, mutual socieites, and so had not need of free wards).

    But then all the hospitals became Poor Law hospitals.

    Since then some new private hospitals (both charitable and commercial have been built), but 1948 was a hammer blow – although the effects were slow to be seen (at first the hospitals went on as before with the same people in charge, but over time……..).

    A similar thing is being done by another route in the United States.

    There are already government hospitals – lots of them.

    However, the remaining private hospitals (mostly charitable) are being undermined by endless regulations.

    For example, one under passed in the time of Reagan that an Emergency Room can turn no one away. Sound nice and humane – till one finds out that many people use ERs for any medical problem they get, knowing that many of the bills for ER treatment are never paid – and that indeed the hospitals write them off.

    Private hospitals with no control of their own costs – because anyone can just walk in off the street and demand treatment. And the bill is passed on in higher prices to the people who do pay – the honest people (or the dumb – depending on how one looks at it).

    This is only one of many ways that American health care is made wildly expensive (so the demand goes up for government to do more and more – the very interventions that cause the increase in costs in the first place) – and yet the hosptials are (at the same time) going bankrupt.

    Total state control in the end – but by another route.

    If state provided health care is so good – a “right” indeed, then let the state just stick to hospitals it has built.

    Let it not steal hospitals (as in Britain) or regulate them into collapse (as in the United States).

    As a libertarian I object to government hosptials – but why should statist object to them?

    Why should they demand that nongovernment hospitals be taken over – when there is a “free” “county” hospital (or whatever) just down the road?

    And why should they demand that nongovernment hospitals have a vast spider’s web of regulations placed upon them – that vastly increase costs, and the prices these hospitals charge.

    Why? Again when there is a “free” government hospital only a little way away.

    The only logical replies to such questions are “paranoid” ones.

  • Paul Marks

    As for the government paying for private treatment – it simply does not work, not in the longer term.

    For example, Medicare and Medicaid together cost 5 billion Dollars when they started out (five).

    How many HUNDREDS OF BILLIONS OF DOLLARS do they cost now (which also pushes up non government health care costs – just as the subsidies for higher education push up tuition fees).

    Yet more and more doctors refuse to have anything to do with Medicare and so on – because, in spite of the vast sums spent, very little money actually finds its way to the doctor per treatment (actually Medicare and so on pay the doctor LESS than his costs – the doctor tend to make a loss on every person who seeks aid on the standard version of Medicare, although not on some special types of the scheme).

    Even hospitals specially pointed to as a role model by President Barack Obama report the above.

    For example the Mayo Cancer clinics in Arizonia (pointed to by President Obama as a wonderful example of both cost control and good treatment) have formally announced that they will no longer take Medicare people. Because, again in spite of the vast sums of taxpayers money spent, very little of it actually reaches the hospital per person treated – and the hospital can sustain the losses.

    All the above is due to get WORSE under the Health Care Reform Bill.

    “But it would be different in Britain”.

    In the end – it would not be.