On the day after Boxing Day the government announced new proposals representing the slow and inevitable privatisation of the health service. These proposals took the form of a rise in the current cap on the number of beds and the amount of theatre time that may be dedicated to private patients in NHS hospitals, from its current level of 2% to 49%.
The government claims this will be good for the NHS, bringing in more money that will go to supporting the hospitals and increasing the quality of health care for all through the positive influence of competition. This may be so and competition maybe the key to lowering costs in the short terms, but is a two-tier system, in which those able to pay are first in line whilst the patients not able to afford these benefits are left with affectively second-rate care a reasonable solution?
The appeal of private health care is obvious. By paying for your service you can ensure quicker care and assumedly better quality with a private room (or at the least in a private) wing and arguments that by doing so whilst continuing to contribute to the NHS are not without merit. For the government it represents a large saving in health bills.
The appeal of the NHS is more obvious for patients, it’s free but represents a huge dedication of funds from our national budget in a time when employment is low and there is little to spare. This difference is key when we continue the pros and cons of both system and this goes further than simply government cost.
With the NHS paid for by taxation (a baseline of £103.8 billion for 2010-11) they have a natural incentive to ensure our population is healthy as a pre-emptive measure. Cost cutting, especially in times of economic downturn, is always a priority and by ensuring our population is healthy reduces the level of care, procedures, and time needed to deal with ill health. As opposed to this the alternative is simply cutting services and relying on private health care. Taking up the first opportunity would increase the nation’s economy by making our work force happier, have a longer work life and be more productive.
Private health care has no such incentive. Firstly the providers make their money through procedures. With this in mind we cannot deny that the health care providers are reliant on a population ravaged by ill health and reliant on procedures, operations, and care. Although we would like to believe business will act honestly in their activities, from experience we know this is not so, with many attempts to create a false demand. In this instance it’s likely to be in the form of tests, procedures, and care but taken by the exploitation of the trust patients have in their doctors. As Roger Strube said, “we should not consider patients “wise consumers” of medical care’.
This fear is not unheard of and may be witnessed in the current investigation by the Fair Trade’s Competition Commission into the practises of the these health care providers in not providing patients, GPs, and insurers enough choice and putting into the question the nature of the competitive health industry and government claims these measures are intended to create.
Secondly, the private health insurer has the same lack of incentive. Unlike the providers their income comes from regular payments with the promise to pay for an agreed amount of treatment when needed (treatment provided by the previously mentioned health care provider). Although they may have the same intention to ensure their clients remain healthy to cut down on expenses, by ensuring that the populations health is at risk they can increase premiums in order to cover greater apparent risk. Just like the health care provider, the insurer also has an interest in the undertaking of unneeded and unwarranted tests and procedures in order to justify the higher premium rates to cover the greater risk in insuring the people.
We can largely see this by studying health care insurers in the United States. A country that is famously reliant on privatised health care to a much larger extent then our own, many claims of the greater efficiency of this system proven wrong with private health care insurance prices rising 700% between 1969 to 2009 and changes to the cost of Medicare (the government funded health care program for over 65s and the disabled) having risen only 400% in the same time.
So what does this mean for the British health care system?
It is not the case that the NHS will be abolished in a favour of complete free market health system but these proposals are pushing people in to the arms of private health and away from the NHS. By doing so they are extending the market share of the health sector and are likely to draw the best personnel, and therefore the best potential for care as people will always be drawn towards high pay and better work environments. This ultimately harms the NHS as they may be left doctors and nurses less able to deliver the same level of care as private providers subsequently creating a positive feedback loop, furthering the lack of faith in the NHS and increasing the cause of the free-market believes.
Privatisation has for thirty years become the free-market followers aims for all industry. Their beliefs that markets can lead people, and free people from the tyranny of government has seen us fall to economic ruin and social divides. We must consider the long-term impacts of such decisions rather then just the short-term savings for these things do not happen overnight but represent the slow erosion of the pillars of society.
Originally published on The Grapevine