Revealed: Cameron meets NHS ‘advisors’ who want to completely undermine it


9:00 am - December 29th 2009

by Darrell Goodliffe    


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David Cameron spent some time in a House of Commons private office with Nurses for Reform earlier this month seeking inspiration to remodel the National Health Service.

We are told he wanted to discuss NFR’s ideas on the future of health policy and have them present a range of ideas.

We already know what Daniel Hannan thinks of the ’60 year mistake’ but what does Cameron think? He would have us believe he ‘loves the NHS’ and it is ‘safe in his hands’ and surely consulting nurses proves this? However it’s worth examing the people associated with Nurses for Reform, which is:

growing pan-European network of nurses dedicated to consumer-led reform of British, European and other healthcare systems around the world.


First-up is Stewart Browning; no details on his biography on NFR, however, ‘Free Market Cure’; the linked-to site is more forthcoming:

Stuart Browning is a film director, entrepreneur and health care policy commentator.

Next-up is Dr Eamonn Butler who we are told is a director of the Adam Smith Institute. Again we have an American connection as we are told by his website;

Having graduated from the University of St Andrews in the 1970s, Dr Butler worked on pensions and welfare issues for the US House of Representatives in Washington DC. Returning to the UK, he served as editor of The British Insurance Broker monthly before devoting himself full-time to the Adam Smith Institute, which he helped found.

The American connection is significant because as we all know the right and the Republicans are vociferously opposing President Obama’s healthcare reform proposals.

Dr Tim Evans links to the Libertarian Alliance from his profile, an organisation which he helps run. Among other things he also campaigns against the regulation of the sale of firearms and talks about ‘The Englishmans right to own and carry firearms‘.

There is also Mr John Wilden, a businessman although he does have a background in health. Interestingly, we are told that this connects him to Dr Evans as Dr Evans is Chairman of Global Health Futures which is;

the brain child of John Wilden, a former specialist and consultant neurosurgeon. GHF is developing and promoting software products for “Time to Cure” and “Cost to Cure” Common Diseases based on the advances of molecular biology and other technologies which will underpin the fast looming world of curative global healthcare, thereby ushering in a new age of diminishing healthcare costs across the developed and developing world.

The board also includes Shane Frith of the libertarian Progressive Vision – MEP Dan Hannan’s “favourite” think-tank. Nurses for Reform itself recently held a shared event with Shane Frith to discuss: ‘Alternatives to Government Run Healthcare‘ – sounds like Dan Hannan rhetoric, no?

So, no vested interest in breaking-up the NHS there then?

We can also see how the right is insidious in weaving through various ‘campaign groups’, designed purely to protect the interests of business.

The dominant interests here seek to undermine the NHS as it stands. They would completely undermine its current state. They are not those of public servants but of ideologues opposed to it or business figures who would profit from it.

I think its fair to say that the above illustrates just how unsafe the NHS would be in Cameron & Co’s hands.

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About the author
Darrell Goodliffe is regular contributor and writes for several blogs including his own: Moments of Clarity.
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Story Filed Under: Blog ,Conservative Party ,Health ,Westminster

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Reader comments


A meeting is held.

The people hosting the meeting have Opinion X, ergo you come to the conclusion that attendees will automatically leave the room supporting Opinion X.

I have no doubt that some, if not all of the views of the nurses group will find support within some members of the Conservative party – just as I am equally sure some views of the Communists will find equal sympathy within the Labour party.

Would I presume that if Gordon Brown met some Communists that he is a Communist? Not really.

Would I attack Gordon Brown for meeting Communists and listening to their opinions? Equally, not really.

In politics, it is vital that people listen to views from all sides of the debate – and if you are claiming that one meeting will lead to a complete change in political direction for the listener, then I can finally understand why lobbyists are paid so much money.

They must all be hypnotists on the side.

And the NHS works perfectly delivering the best possible heathcare with great efficiency? If the answer to that was yes then there is no need to look for ways to improve the delivery of healthcare. The answer however is we have an inefficient monopoly delivering politically directed services with the worst cost-effectiveness in the developed world.

The crime would be if Cameron was not looking at a wide range of alternative approaches. He may choose not to take all the advice that these people are proferring, but he has every need to listen and consider alternatives.

The answer however is we have an inefficient monopoly delivering politically directed services with the worst cost-effectiveness in the developed world.

The UK has lower healthcare costs as % GDP than Germany, France or the US. The old saw, which is still reasonably accurate, is that the NHS provides a second-rate service for the price of a third-rate one.

You clearly think that the NHS is perfect and we shouldn’t investigate alternatives?

It is this sort of dogma that has left Britain with one of the worse healthcare systems in the developed world.

Progressive Vision agues that Britain should adopt the Singaporean system of health savings accounts. Such a system remains universal, but provides Singapore with better health outcomes than Britain, at less than half the price.

As for vested interests, I would gain noting but better healthcare if such a system were introduced. On the contrary, I know of medical professionals who would like to speak out about the NHS but fear the consequences of doing so.

As a statist, you clearly have a vested interest in keeping a centralised system of healthcare that provides jobs for your friends and control for your union buddies.

The state of Britain’s healthcare system is poor and requires serious debate about the issues and possible solutions. Not alarm about who politicians are only talking to or cheap claims that some of us are in this debate for profit. Maybe you are? The people you have accused are involved in the health debate motivated by a desire to improve an inadequate system.

I’d say more, but I’m off to a much cancelled NHS appointment for a knee injury – I’d hate to be late! I’m lucky, because the delay has merely stopped me from exercising. I have friends and family who would have been off work for six months with the same injury.

Read more here; http://www.progressive-vision.org/policies/health.htm

“… an inefficient monopoly delivering politically directed services with the worst cost-effectiveness in the developed world.”

Huh? Tell that to Americans paying 16% of GDP on healthcare with much worse statistics on a range of outcomes. The NHS has provided healthcare on the cheap for decades. Ironically, it is the creeping privatisation of services, contracting out, PFI and private consultancy costs which is eroding the efficiency of the system.

I’m interested to know how the provision of my mother’s hip operation was ‘politically directed’? Is that another way of saying democratically directed?

Disclosure: I’m at the ASI along with Eamonn Butler. But dredging back to the 70s for an “American connection” is pretty weak.

We’re talking about the sort of student internship/first job out of uni that Will Straw had as a Fulbright Scholar.

Labour are finally introducing a Libertarian NHS policy

http://bastardoldholborn.blogspot.com/2009/12/libertarian-policy-at-last.html

I have to ask, why are some people so opposed to the idea of even discussing NHS reform? Even if Cameron meets those wanting reform he’s not going to suddenly decide to scrap taxpayer funded healthcare for the poor. That’s not going anywhere (if you read hannan he also supports this). So why the opposition to even discussing reform?

As a statist, you clearly have a vested interest in keeping a centralised system of healthcare that provides jobs for your friends and control for your union buddies.

Oh dear oh dear. And the argument can be quite easily turned towards you – you clearly have an interest in helping your buddies in the healthcare industry make lots of money.

Would I attack Gordon Brown for meeting Communists and listening to their opinions? Equally, not really.

Actually, plenty of people do.

So much to reply too lol. Briefly.

Ian Visits,

Is that what Cameron is doing; listening to all sides of the debate. If it is when has he met the people who support an NHS that is free to all at the point of use? When has he met trade unions representing nurses and other workers in the medical profession? If he has I havent heard about it.

Robert D and others;

The argument is not that the NHS is perfect; the principle is that there should be a health service that is free at the point of use avalible to all. Saying something isnt perfect isnt really an argument at all; its dodging the issue.

Shane,

You might have no personal business interest in dismantling the current system but others on this board clearly do. As for your lauding of the Singoporean system it beggars belfe that people still argue this way. I remember the classic example of this being the promise of Japanese style high-speed wonder rail with the advent of privitisation; look how that turned out.

You also avoid the point that once an element of insurance in the way you talk about (as opposed to National Insurance, which isnt insurance in the proper sense of the word) a judgement on things like risk and premium becomes involved at somewhere along the line. At some stage ability to pay will effect the quality of care you receive.

Also, as with the Japanese example, you can not artifically transplant one model from one country to the next because socities are structured in different ways. You can for example, take a principle, like the principle of ‘free health care for all at point of use regardless of ability to pay’ and implement it in subtly different ways but what you cant do is transplant a system like an organ.

“Free at the point of entry”

So is BUPA. At half the price.

I’m just amazed Cameron is meeting some genuine radicals. We could yet see some reform from the Tories after all.

Darrell,

“Available to all” and “free at the poiint of use” are part of the problem. There is no incentive in the system to be responsible and careful in the use of healthcare or of ones own health status. Free at the point of use is meaningless if you are paying a huge bill through general taxation. These maxims are actually part of the problem. Until people understand directly what elements of healthcare cost, and bear some direct responsibility for the way they use it, then there is no lever for improvement.

That does not mean that I am against risk sharing and an element of social subsidy. It just that these elements need to be identified and debated, not hidden in a pile marked UNTOUCHABLE.

Robert,

At least you honestly admit it is a problem which is more than can be said for Cameron who continues with the pretence of supporting the idea. I would have thought not wanting to be ill is a pretty good incentive myself but there you go. Your way will leave billions of people with no access to healthcare or access but to substandard care and the state failing in its fundemental duty to those it governs to protect them.

The reason they are UNTOUCHABLE is quite simply because its a slippery slope and no matter what intention you actually start with you get the same result in the end; the one cited above.

“the state failing in its fundemental duty to those it governs to protect them.”

from toothache?

Does the State cut your hair as well? If not, why not?

Old,

Quite simple really; your haircut (or lack of) is a matter of personal taste or style. Unless it is so long you trip over it (unlikely) its not going to damage your health is it?

Toothache on the other hand does and can.

@10 Darrell

the principle is that there should be a health service that is free at the point of use avalible to all

But even those despised by this site (such as Daniel Hannan) propose services that are free at the point of use and available to all. No-one wants to see a system in which those without money receive no healthcare.

The argument, as I see it, is about equality of service. On one side you have those saying that everyone should receive the same quality of service regardless of their wealth. The other side argues that if you allow wealth to buy a better service then the quality of service experienced by everybody improves i.e. the rich man might receive better treatment than the poor man, but the poor man receives better treatment than he otherwise would if the rich man could not put his money in.

Darrell,

There is no need for a revised system to leave people without essential care. What is required is to understand the balance between society’s interest and the individual interest. It breaks down into four main tiers.

Firstly there are illnesses (such as infectious diseases or serious mental health problems) where effective treatment prevents social harm, and everyone has an incentive to contribute to making sure that immediate treatment is always available. State funding through taxation essential.

Secondly there are some individuals who through genetic inheritence or other events beyond their control have health impairments that make it difficult for them to participate fully in the economy and society without, or even despite, major healthcare interventions. I would argue that a civilised society sould provide the resource to provide for their needs out of collective resources. Collective funding though taxation or social insurance essential

Thirdly there are the routine medical maintenance for people who are economically active. There I would argue the greater the linkage between contribution and payment the more the consumer can express their preferences and hold providers to account for the quality of treatment provided. That does not rule out some subsidy for the poor or unemployed from the better off. Just that there needs to be a financial link that encourages healthy choices by consumers and imposes an economic discipline on providers. A mix of private and social insurance, with maximum choice by the consumer of funder and provider.

The final area is the degenerative and terminal diseases commonly experienced after an individual has ceased to be economically active. Under the current NHS regime people have an expectation that their 40+ years of contributions entitles them to good treatment. In paractice the (unaccountable) NHS spent all of those contribution in the year they got them. There is a massive unfunded liability ( I estimate of the order of £800 billion) for future heathcare to be provided to people who are no longer economically active. Since the NHS / government has spent the money, this group is increasingly being told that they can’t have the best treatment because it is too expensive. This is FRAUD. It would be better if individual were able to keep control over some part of the funding for their care in retirement. The essential and catastropic elements should remain covered by collective insurance, but people should be encourage to to put money into a healthcare fund alongside their pension so that they have control over how it is spent. If people make a choice in their life to spend all of their money and take no care of their health then they should not expect those who are careful and thoughtful to subsidise them. Collective insurance for catastrophic illness provided for by prior contributions plus personal controlled health saving funds / self payment.

Many of these elements are already being put into action is countries around the world. Only the UK seeks to remain ossified in the pre-antibiotic world.

Mark M,

The problem is that they may say this but as you rightly go onto point out there becomes graduation in the quality of care received and the fact is that the kind of care becomes determined not by medical need or any other factor than somebodies ability to pay or how much they have been able to put in a health pot (something those on lower incomes will naturally be able to put less into). Also, in practice you would get people who start to slip through the net so that principle would end up being violated no matter what the intent of the schemes proposers.

So the determainent of care is not the provision of the care but the ability of the person in question to consume. So yes i agree wealth should not determine the quality of care you receive. Ah yes; the trickle down argument! So, if rich people keep buying Jaguars then eventually the price of Mercedes will fall so far that even the poorest Skoda driver will be able to afford one? Thats simply not how the market works and it isnt how it would in healthcare….

20. Richard Blogger

Thanks for posting this and thanks to Shane Frith for being honest. We now know what Cameron’s real plans are for the NHS.

Singaporean system of health savings accounts

This is the scheme (The Plan) that Dan Hannan has for the NHS. Except, of course, that his scheme cannot work. He suggests that NI contributions should go into a savings scheme. He ignores that, firstly NI is supposed to be for pensions and unemployment benefits as well as healthcare, and that currently NI contributions in total only cover 85% of the NHS costs (NI is about £91bn, the NHS costs £108bn). So if we ignore pensions and other benefits covered by NI, the Singaporean system would have at least a shortfall of 15%. So the lauded ring fence means at least 15% cuts, eh?

Of course, as someone with a chronic condition (type 1 diabetes) I will not be able to earn enough for my NI to pay for my treatment. But let’s do the calculations.

For the record, a recent study at my local hospital showed that a diabetic clinic appointment costs £149. I have two such appointments a year. I also have two appointments a year at the eye hospital (they have saved my sight at least once). In a year I inject almost £2500 worth of insulin (5 x 3ml cartridges of human insulin costs £50 – I am on the cheaper insulins – one cartridge lasts me 3 days and I take two such insulins: you do the calculations). I am supposed to test my blood sugar regularly, let’s say that I do it three times a day (if my doctor is reading this then, yes, of course I do it that regularly!): a pack of 50 strips costs £30, a pack will last 17 days so the cost is another thousand pounds per year. Then there are the ACE inhibitors and statins that national guidelines say I should take to reduce the likelihood of complications: these are generic drugs and are quite cheap.

So before I have any other diabetes related illness I cost the NHS £4000 a year. Let’s assume that NI is 8% (I am self employed). So for me to earn enough to pay £4000 NI I have to be on £50K, that is, twice the median income. (It assumes that my wife and kids don’t need any medical treatment.) Remember that type 1 diabetes is not a lifestyle condition, it is genetic: if you have the genes you may or may not get it.

For what its worth, I earn less than the national median so therefore it is clear that under the NFR (or Dan Hannan) plan I would have to use less insulin (since that is the major cost in my treatment). That will lead to diabetes complications, pain and discomfort to me and an earlier death. Before you dismiss this as scaremongering, note that this is exactly what happens in the US: the poor cannot afford to be diabetic.

It may sound nasty to say this, but I wish Dan Hannan and the entire NFR board develop a chronic condition. That way they would appreciate the NHS and would be a little less keen on privatising it and applying punitive charges for people who are ill.

Sunny H: I was being sarcastic against accusations of bias. “the argument can be quite easily turned towards you”. The argument *was* used against me.
As for Gordon Brown or any Labour politicians meeting with communists, you have no comparison. Communism is a vile ideology responsible for killing more people in the 20th Century than any other. I’m not aware that liberals are responsible for any deaths. If Cameron was meeting with Castro, the BNP or other national socialists, your comparison would be valid.
Darrell: I argue that Singapore offers the best example of a healthcare system and the best you can manage is Japanese trains??? Singapore is a wealthy, English-speaking, commonwealth nation. It achieves better healthcare outcomes at less than half the cost of Britain’s system. If Britain could achieved the same result, we *almost* wouldn’t have a deficit this year! I doubt we can achieve an expenditure of less that 4 per cent of GDP, but adopting such a system would make significant improvements over the current system.
Do you think that the NHS is the best system in the world? If not, do you not believe that Britain deserves the best?
The Singapore system involves catastrophic insurance, but the secret to its success is a compulsory (I know, not very liberal) health savings scheme. Freed from the bureaucracy of either a state funded or insurance based system great innovation and price sensitivity can be achieved.

Robert,

Well that depends on an entirely subjective definition of what is essential care; something of course which you have pre-determined and therefore are happy to hive off into different areas.

This is glaring in your first example. What do you define as a ‘serious mental illness’ and therefore worthy of state funding? Who knows? Regardless of what you define as ‘serious’ the principle you are enshrining is different tiers of care determined by the source and level of funding. You sit as judge and jury of who gets this state money and that is fundementally unfair because people will start slipping through the cracks.

You also determine the level of care through the prism of economic (and therefore in your eyes social) usefullness. So, the economically useless will be left with scraps from the table;

“That does not rule out some subsidy for the poor or unemployed from the better off.”

However, it doesnt exactly gurantee it either does it? Your view is also predicated on a rather rose-tinted view of choice in our society seeing it as being no way inhibitied by structure and factors external to the individual when it clearly is; everything is down to an individuals ‘thoughtfullness’. So seprated from reality you maybe to convince yourself of the validity of your claim at the start of your point but its really not that convincing when seen in the above light.

Richard Blogger:

I don’t know about the people you hang out with, but I make a habit of being honest as does the board of NFR.

I only wish Cameron would be adopting The Plan, but if you are citing his meeting with Helen Evan as evidence he is, you have got to be kidding. Gordon Brown met the Dali Lama recently (in a cowardly manner), but I don’t expect he is planning to create a theocracy (I seem to remember the previous PM meeting the pope!).

Part of how a health savings account system works is that it contains catastrophic insurance to cover payments that exceed what the out of pocket or savings accounts can reasonable manage. Diabetics are treated in Singapore!
Once again, a defender of the NHS resorts to lazy comparisons with the US. There are more health systems in the world than Britain’s and America’s.

However, what a vile shit you are to be wishing illness on people simply for advocating polices you disagree with.

“Ah yes; the trickle down argument! So, if rich people keep buying Jaguars then eventually the price of Mercedes will fall so far that even the poorest Skoda driver will be able to afford one? Thats simply not how the market works and it isnt how it would in healthcare….”

Erm, actually, that is exactly how the market works. New technologies are introduced, they’re hugely and grossly expensive and only the richest can afford them. Fast forward a couple of decades and every chav in the land now has an example of the basic technology: hugely cheaper than the very expensive original and better too. Think cars, mobile phones, fridges, freezers….

Richard Blogger: you’ve missed a crucial part of the Singapore system. There’s a cap on total payments by any individual. Once you’ve exceeded that limit then the catastrophic part of the health insurance system kicks in.

The key to controlling health care costs isn’t denying those with chronic illnesses like Type 1 diabetes treatment. Far from it actually, not just better for you but far cheaper to provide you with the insulin and the strips than it is to treat the complications: to say nothing of the obvious benefit to your lifestyle and life.

The key is in the incentives people face to control their own low level treatment costs.Got a sniffle? Go to the GP for free to get it checked out? Or wait and see if it develops with a Lemsip? If it cost you £10 to see the GP? If it cost your health savings account £10?

I’m afraid you’ve got entirely the wrong end of the stick if you think that Singapore denioes diabetics treatment, or those with other expensive problems (cancer, scraping people up after a traffic acident, whatever) treatment. By making people responsible for their own trivial and routine treatment actually it opens up more resources for the treatment of those serious things.

Darrell,

The problem is that these sorts of value judgements are inherent in any resource constrained heathcare system, as all of them are and will continue to be. The problem is that under the current NHS these value judgements are made in private by unidentifed and unaccountable people. The critieria are not public nor subject to debate. The application of these criteria is opaque and rarely capable of review.

The poor and the weak are still being shafted by the system. The prudent and thoughtful are being exploited by the indolent and irresponsible. Its just that the illusion of equality given by the “available to all free at the point of use” mantra hides the reality from them. It is an unacceptable CON. All I, and many others, are demanding is that the Wizard of NHS is recognised as the myth it is, incapable of delivering what it promises. Lets have some honest and rational debate on better alternatives

Glasses used to be so expensive, the NHS had to pay the bill. Now we have specsavers.

Anyone who can afford their own mobile phone, sky TV, 42″ Plasma and microwave can afford to buy their own glasses.

Shane,

It was a comparison with how advocates of change promise the world but suspiciously never seem to dealiver which isnt really shocking if your grounded in reality as opposed to a privatising ideology.

I think its the fundementally correct system for Britain, im not claiming for it perfection but then again nothing is perfect. Richard has done quite a good demolition job of the notion your peddling that the Singapore system is the ‘best for Britain’….

Tim,

But it doesnt really does it because the new technologies are always superceding the cheaper models which are invalidated by the new technologies. However, I think as a human being its rather bad of you to argue that healthcare should be dished out on this basis. The poor get yesterdays models and standards of care and the rich get the very best in everything just by virture of being rich not their need.

Robert,

That maybe true but you make them the fundemental basis of your system. Im not claiming the NHS makes these processes perfect but I do have to say that there is more democratic accountability in a representative democracy to the government than there is corporate boards which is where ultimate power would lie at the end of these reforms, not in fact, in the hands of paitents at all.

Incidentally, you really cant have it both ways you know;

“The poor and the weak are still being shafted by the system. The prudent and thoughtful are being exploited by the indolent and irresponsible.”

Express faux sympathy for a set of people in one sentence and in the next imply they are some kind of social parasite.

When are the voters going to wake up and see that Cameron is a fake, lying piece of shit. He is far right wing nut who will turn over his govt to all the right wing fruit nuts from both England and America.

It is no secret that the American private health care business ,have been trying to destroy both the Canadian and UK health care systems. The way they have bribed and bought off most politicians in Washington should act as a warning to allowing them to take over the National health care system.

“Anyone who can afford their own mobile phone, sky TV, 42? Plasma and microwave can afford to buy their own glasses.”

You can pay for a heart by pass operation can you?

Darrell

You choice of high speed rail is good example of a transferred policy as a failure, but this was because high speed rail is uneconomic, not because it was transferred. Airline privatisations, pioneered by Britain were a success and have been successfully replicated around the world. Politicians of all stripes use international examples as inspiration – are you seriously arguing that if it wasn’t invented in Britain we shouldn’t copy it? Argue the example, not the concept of following an international example.

On most international ratings the NHS is rated poorly compared the rest of the developing world and you think this is the best that can be achieved? Is your ambition for Britain that low?

The NHS charges every man, woman and child in the UK £1803 per year.

Bupa could do it for half.

Sally:

I don’t see anyone in this forum arguing for the US system. Do you? Maybe you have NHS glasses?

I can’t afford to replace my car if is stolen, which is why I have insurance…

Tim Rand

“Erm, actually, that is exactly how the market works. ”

Oh yea, Like you know how the free market works.

You just spout theory that you have pulled out of your arse. I have told you before you must not confuse your own weird opinions with fact.

Still, it is very interesting how many Tory trolls can’t wait to destroy the national Health care system.. They really hate poor people getting well.

Conservatives really are the most selfish species of low life you will ever find.

When faced with political issues, ask yourselves

“What would the Swiss do”?

http://en.wikipedia.org/wiki/Healthcare_in_Switzerland

“Bupa could do it for half.”

Not if you had a pre existing condition they could not. And certainly not when you pass 55. And how do you pay that if you have no work?

Run along troll

UK 12% of GDP. The highest in the World. We can’t afford it and poor people REALLY can’t afford it.. End of story.

http://www.reform.co.uk/Research/Health/HealthArticles/tabid/80/smid/378/ArticleID/598/reftab/69/t/The%20NHS%20in%202010/Default.aspx

Shane,

No its an example of a promise made and predicated on the market being ‘the solution’ which failed to deliver because put simply the market mechanism failed to deliver which is exactly the same as saying its uneconomic. I suspect the relative success or lack of airline privitisation depends on ones perspective; however that is something of a sidetrack. I’m saying that there are societal differences which need to be taken account of in any copying.

I hate these kind of comparisons they are so false and are precisely produced to serve ideological agendas. Do they take account of contexual factors? I doubt they do.

“However, I think as a human being its rather bad of you to argue that healthcare should be dished out on this basis. The poor get yesterdays models and standards of care and the rich get the very best in everything just by virture of being rich not their need.”

I’m not arguing that this is the way that health care “should be dished out”. I’m arguing that markets are very good at taking experimental, very expensive, things and making them vastly cheaper over the course of a couple of decades.

We do want medical care to get better, don’t we? We do want our children to be better off than we are? What is the best method of achieving this?

I would and do argue that market mechanisms in the deployment of new technologies (and I’ve got impeccable evidence from serious economists like William Baumol to back me up) (please note, deployment, not creation of) do this best.

As to the poor getting the last generation, the rich getting this, what do you think happens with NICE? Over £30k for a QUALY you don’t get the treatment on the NHS. The rich can still pay if they wish to…..

““Erm, actually, that is exactly how the market works. ”

Oh yea, Like you know how the free market works.

You just spout theory that you have pulled out of your arse. I have told you before you must not confuse your own weird opinions with fact. ”

Pots and kettles Sally, pots and kettles. I base my observations of markets and their alternatives on the empirical observation of the world around me. West Germany or East? Noth Korea or South? We’ve had that 50 year experiment in whether markets work better than planning and markets won.

Or didn’ty you notice that?

39. Richard Blogger

@23 Shane

I am very glad that you are being honest, and as you can see from my post I, too, like to present things as they are. Your reply is the first time that I have seen such honesty and I commend you for it. Unfortunately all we get from Cameron, Lansley and Co are vague statements.

I wanted to give you an example of the cost of my treatment to show you how unworkable The Plan is. I gave you the figures for me, but I am not unique, there are a quarter of a million type 1 diabetics in the country, the vast majority of whom will not be on twice media salary, so it is fair to say that The Plan will not work for them either. You say that there will be “catastrophic insurance”, but I am not talking about catastrophes, I am talking about the mundane action of staying alive. Under your plan, me, and all the other type 1 diabetics (type 2 diabetics are a different case) will never be able to pay their medical bills from their NI contributions. The plain fact is that The Plan is badly thought out by innumerate incompetents: it does not add up!

But let us explore this “catastrophic insurance” further. You say this is “to cover payments that exceed what the out of pocket or savings accounts can reasonable manage”. But what is the point? You are saying that I will get the treatment regardless of whether there is money in the savings account. If that is the case then why have the account, you may as well pay for all the treatment regardless. There are two reasons why you may want the account. The first is the idea that if you do not spend it then that is your money to spend on something else. This is arrant nonsense because, as I mentioned in my other comment the plan is underfunded anyway, and by allowing people to take yet more money out would make it so underfunded it would not work at all. So let us dismiss that silly idea for what it is: nonsense. The other way to make this work is to have a two tier system: you get the gold service when you pay with your savings account, and you get the easyNHS service when you cannot pay. Of course, for people like me with a chronic condition all of my treatment will be on easyNHS, the second class citizen that the plan thinks I am.

My comparison with the US was deliberate and accurate. If you study the situation there (and please do, you may learn something) they have gold service for those who pay on the nail – this is equivalent to your “savings account” idea. For those who pay by insurance.they have to get the permission of the insurance companies, a process which can take months. I will give you the benefit of the doubt here to you and say that this is not applicable to your plan. However, since the 60s US hospitals have not been allowed to refuse emergency treatment. This is equivalent to your “catastrophic insurance”. In the US this cover is paid for by Medicaid from general taxation and is almost half the income of healthcare in the US. The problem is that poor people (the equivalent in your plan are people with no savings account) wait until they are sick enough to get emergency treatment, at that point Medicaid pays the bloated prices of the hospital. There is a direct comparison with your plan. The system fails in the US and it will fail here too.

Finally, I accept it as a badge of honour that you call me a “vile shit”. You have already told me that you want me to have an early death through your unworkable healthcare plan, and wishing that upon you too is poetic justice!

@3 comes closest to the truth of this: “The UK has lower healthcare costs as % GDP than Germany, France or the US. The old saw, which is still reasonably accurate, is that the NHS provides a second-rate service for the price of a third-rate one.”

With all the high-flown rhetoric on markets and healthcare, why not compare what happens in other west European countries, as this Swedish think-tank does?

The Netherlands win the 2009 Euro Health Consumer Index (EHCI), for the second year in a row – the first time this happens since the EHCI started in 2005 – and with an outstanding margin. Nevertheless, Denmark keeps its runner-up position from last year. Besides the Dutch and Danish system there is a small group of strong performers: Iceland, Austria and Switzerland. Luxembourg leaves the top league, losing 5 positions. Estonia, “the wonder boy” of the EHCI, drops significantly but anyhow delivers value for money healthcare.

The NHS in the UK ranked at 14 out of 33 countries covered:
http://www.healthpowerhouse.com/files/EHCI-2009-general-Press-release-final.pdf

Results matrix:
http://www.healthpowerhouse.com/files/Index-matrix-EHCI-2009-090917-final-A3-sheet-substrate-5.pdf

Is this Shane Frith the guy who met Dave-boy?

If so get this thread out to the MSM – he couldn’t debate without insulting people.

The “Libertarian” nutters see the UK recession as something God sent. As an example above:

The NHS charges every man, woman and child in the UK £1803 per year.

Bupa could do it for half.

Utter bullshit! Trains, privatised – costs the train users a mint! Add to that thy go back to government for hand outs. Gas, water, leccy – privatised, granny can’t keep warm because of the cost of turning up the heat, leccy and gas companies subsidised via winter fuel payments. Plus making billions of profit to boot.

BA, BT, privatised – how cheap have they become?

Next the Royal Mail and the NHS? How many people live in Singapore? How can tweaking it t fit into a British system work?

One word for Dan Hannan – Iceland. The man is a tit and other “libertarians” follow him like he is some Prophet. All because he gave it large to Brown.

RE-nationalise the NHS, get rid of the vast majority of bureaucrats, stop all the for-profit spending and you will save billions.

Tim, remember Adam Smith was all about redistribution. ASI wouldn’t know the free market if it twatted them with a cold fish.

42. Richard Blogger

@38 Tim Worstall

what do you think happens with NICE? Over £30k for a QUALY you don’t get the treatment on the NHS.

Do you actually understand what that means? I think not.

NICE look at the benefits of a treatment in comparison to the existing alternative and they quantify the benefits in QALY units which measure not only the extra years of life, but also the quality of life (one QALY is one extra year of life). So If a new treatment keeps you alive just as long as the old treatment but gives you a better quality of life then the new treatment will get a positive QALY score. But note that it is a comparison, so therefore the QALY that is used is the difference between the QALY for the new treatment and the QALY for the old treatment. At this point, if the cost per additional QALY is less than £30K then the treatment is approved.

It does not take a maths genius to note that because the cost is applied to the difference between the new and old rather than the total cost of the treatment, very few treatments will go over the £30K limit. All of this is explained (along with an example) on the NICE web site. I suggest you have a read of the actual process.

Unfortunately this obsession with the NICE £30K per QALY limit was started by Sarah Palin, who as we know was not the brightest beauty queen on the stage.

Darrell,

The poor and weak are not necessarily (or indeed very often) the same people as the indolent and irresposible. Your merging of the two is unacceptable. The poor and weak get shafted because they don’t have the knowlege and connections to game the system. More than any other group they need the power to say, “I am not paying for inferior service and I am going to another doctor / hospital”. The NHS refuses them this opportunity. The indolent and irresponsible are those who take no care of their health and then bleat loudly about their “rights” to priority treatment while minimising any contribution that they make and without regard for those whose needs remain unmet.

@27 Darrell

However, I think as a human being its rather bad of you to argue that healthcare should be dished out on this basis. The poor get yesterdays models and standards of care and the rich get the very best in everything just by virture of being rich not their need.

From a purely theoretical point of view, what if it turns out that “yesterday’s standards” given to the poor in a ‘trickle-down’ health model are better than the standards they (and everyone else) would receive from an NHS-type model?

Can you accept inequality if that inequality results in better standards for all?

NB – I’m not saying a market health system would definitely achieve this, I’m asking from a purely hypothetical point of view – if there are 3 health standards A, B and C, with C > B and B > A, which system would you go with? One in which everyone receives A (the lower level), or one where the rich receive C while the poor receive B?

Also, would you accept a system in which the rich get standard B while the poor got standard A?

@Robert 43

Ok, I am not merging the two but rather suspect somewhere along the line they will come together in your thoughts. However, do you not accept their ability to pay is hampered more than any group so, in a ‘consumer-driven NHS’ they will lose power because their ability to say what you want them too is naturally limited by their ability to consume.

A consumer-driven NHS will not divide on the basis of ‘indolence and irresponsibility’ but on how big your wallet is so the rich can be as indolent as irresponsible as they like and still get the best treatment because they have the money. Thus your position is logically self-defeating.

@MarkM 44

I doubt very much that situation would arrive but then, purely theoretically, should the onus not be on proponents of the idea to prove that beyond reasonable doubt that this would be the case?

In this area because inequality could have a direct bearing on the chances of somebody living or dying. Just as in education it affects their life chances. To think some people think we live in a meritocracy hey. The point is provision of care should be on the basis of need not ability to pay; money is not even a factor here because of the nature of the situation what is neccessary is what should be done.

@Tim Worstall 38

“I’m not arguing that this is the way that health care “should be dished out”. I’m arguing that markets are very good at taking experimental, very expensive, things and making them vastly cheaper over the course of a couple of decades.”

As if people who are seriously ill should be expected too or should have too wait a couple of decades while the ‘market mechanism’ works its magic….i mean come on….

“Pots and kettles Sally, pots and kettles. I base my observations of markets and their alternatives on the empirical observation of the world around me. West Germany or East? Noth Korea or South? We’ve had that 50 year experiment in whether markets work better than planning and markets won.”

Various libertarians will tell you they didnt because even the ‘free’ market is never entirely free. I love this argument too because some of the most highly centralised (and least democratic) organisations are actually corporations who do plan to the nth degree after a fashion. Besides the NHS has been standing alot longer than 50 years as have other elements of welfare provision.

You lot need an aspirin. Saves hundreds of millions of lives a year

Created by Bayer, a free market German company. 50 for a £1 from Superdrug. Or £7 each from the NHS.

If you want to live beyond retirement, don’t look to the State. It has no interest in keeping you alive.

Tim Rand…………………. “Pots and kettles Sally, pots and kettles. I base my observations of markets and their alternatives on the empirical observation of the world around me. West Germany or East? Noth Korea or South? We’ve had that 50 year experiment in whether markets work better than planning and markets won.”

So the market with a top rate of tax at 60 % as we had in the UK in the 80’s was just fine with you. So we will have no more clap trap about how taxes must be cut more.

Of course you compare apples and oranges, and then conclude with some half based cider bullshit. You compare ultra communism with a rigged , market economy which still has a big safety net. I realise that you wanabee Rand’s will never be happy until we remove all safety nets, but then that will just re- create the conditions that lead to both the French revolution and the Russian revolution. What you Rand’s always end up with is the very thing you claim you hate.

It would be nice to be able to debate this area with clear eyes and ditch some of the emotional content, but it won’t happen.

Because, for some reason, the NHS is promoted and perceived as a much-loved British institution that it is unpatriotic to criticise. Even the usually frothing commenters on Old Holborns blog gave him an ear bashing for calling its worth into question.

And that is why we find it so surprising when research shows that medical services abroad are generally superior to ours. And although some begin to suspect that this emperor actually has no clothes they dare not say so because they fear that their political opponents would hurt them by tapping into the cosy emotional attachment of the British people to the myth.

To be analogous, a dispassionate assessment of Bruce Forsyth might conclude that he is an old lech in an ill fitting rug who has been around for a long time making third rate TV shows and that he never had much talent for anything in the first place.

But I bet even Dan Hannan would think twice before saying it.

“Tim, remember Adam Smith was all about redistribution. ASI wouldn’t know the free market if it twatted them with a cold fish.”

Actually, there’s not all that much about redistribution in Smith. There’s a whole heck of a lot about how wealth is created (division of labour, specialisation and the subsequent trade), you can find arguments for progressive taxation, even arguments for not taxing overseas incomes. Plus warnings about rent seeking and the dangers of producer collaboration and corporatism. But “redistribution” per se, not so much.

Yes, I do understand what a Qualy is and means. It’s a form of rationing of new treatment by cost.

“You say that there will be “catastrophic insurance”, but I am not talking about catastrophes, I am talking about the mundane action of staying alive. Under your plan, me, and all the other type 1 diabetics (type 2 diabetics are a different case) will never be able to pay their medical bills from their NI contributions.”

You’re missing the meaning of “catastrophic insurance” here. It applies to any and all treatments that cannot be paid for from the health savings accounts. The “catastrophe” is not one event (say, a car crash): it’s any series of or single illness that exhausts such savings. The “catastrophe” is being catastrophically ill. That’s what the insurance applies to.

Another way of putting this is the difference between assurance and insurance. Assurance is for things that are highly likely to happen. It’s really a way of saving for what is expected to happen. We all have minor medical costs and we all know they’re going to happen. Reasonable enough that we save to meet them (through say our NI contributions going into a separate account) and that we control them. Insurance is the spreading across a group of things that are unlikely to happen. The car crash, cancer, Type I diabetes. We’re all acepting that these should be covered and that a form of social insurance is probably the best way to cover them. We know that they will happen to some in the group but not to which ones: thus we pool and share the financial risks. That’s insurance.

The NHS currently gives us both assurance and insurance. The Plan, the Singapore system (and even in the US a high deductible private insurance plan) separate the two. Assurance is dealt with one way, insurance another.

“As if people who are seriously ill should be expected too or should have too wait a couple of decades while the ‘market mechanism’ works its magic….i mean come on….”

Under any and every system the seriously ill die because we don’t have treatments for this or that *yet*. Catastrophic heart falure, many cancers etc. My comments about markets are that they encourage the discovery and creation of those new treatments faster than not market systems. The go to economist on this subject is William Baumol. I recommend you read some of his material. The invention of new treatments can come under many different systems. The spread of the new treatment across the population and the making the treatment cheaper more quickly come better under market based systems than not market based. One example would be Lasix eye surgery: perfected in the Soviet Union but made mass market and affordable in the market economies.

“Various libertarians will tell you they didnt because even the ‘free’ market is never entirely free.”

I make that point myself all the time. The distinction though is between who regulates the market and how free is the market. Not *free* market but *freer* market.

“I realise that you wanabee Rand’s will never be happy until we remove all safety nets,”

Straw man alert. I’ve never argued for the abolition of the safety net. I’ve only ever wondered whether the one we have now is the best we could have and whether we might consider changing it to make it better. For example, we might look around the world and see whether others have a better health care system than we do and if they do how have they done it? Singapore does have a better system so it’s worth looking at how and why they do, no? Sweden and Denmark have both better unemployment and labour law systems than we do. Worth checking them out (they also have better corporation and captial taxation systems). The US is better at innovation…..there are some 192 different economies and governmental structures around the world. Worth looking at the results of all those different experiments and seeing which of them do things better than we do, no?

Which do things worse is also a good idea as in what not to do of course. Italy might be a good example of not politicising all large scale industry perhaps. Greece of borrowing too much, Ireland or Spain of being in the euro etc.

52. the a&e charge nurse

[50] does Angola count as ‘abroad’?
http://www.aneki.com/mortality.html

Some of you Libertarians need education – try this

http://www.youtube.com/watch?v=eHhCpQPJzXY
Then …….
http://www.youtube.com/watch?v=FOnValBetpI&feature=related

Remember Hart’s axiom;
“Those most likely to need good healthcare are the least likely to receive it”.
JT Hart, The inverse care law, Lancet 1 (1971), pp. 405–412.

Simple fact is a market system neither drives up quality nor keeps cost under control.
Look at ‘ISTCs’, ‘Out of hours Primary Care’, and ‘PFIs’, and Hospital domestic, or telephone services, all market driven disasters, I’,m afraid.

NFR claims “Robert McIndoe, British Nurse” to be an advisor

He is also managing director of a Marketing Company

http://www.themarketinghouse.org/team/index.html

with links to Hedra, a SERCO clone

I also like “Robert LeFever, Blogger” as advisor. So very coy!

@46 Darrell

I agree the onus would be on the market-reformer to prove that their system of “rich get C, poor get B” is better than “all get A”, but my question was purely hypothetical. Can you accept the inequality if that inequality means everybody gets better treatment than in an equal system?

Also, why do you assume that a person with more money is somehow less deserving of that money? That somehow all those with money would no longer have it if we awarded our currency on merit? Many of the people at my place of work who earn more than me do so because they are better at their job than I would be. I may dislike the pay my CEO gets but if I’m honest and ask myself’ could I do any better?’ the answer is probably no. But then, the point about market NHS isn’t about the super-rich, they get all the best doctors anyway (think about professional footballers who gets seriously injured on the pitch – do they wait at A&E or does their club have a doctor on hand for immediate treatment?).

Gilbert,

Thanks for that nugget of information. Says alot i’d say….

@54 MarkM

Thank you. In all honesty i’d lean towards saying no purely on the grounds of that I think its unacceptable in my eyes to have someones life chances determined by their income. However, I can also see the virture counterarguement that in the hypothetical scenario everybodies life chances are improved by the virtue of that inequality. Having said that the people in question are denied the active agent of choice in whether they want to make that sacrifice and that again makes me question its fairness. In general a choice between evils lesser or otherwise is usually a false counterposition and is a bit metaphysical for my tastes. Id like to think id concretly come down on the side which did improve things for people eventually. This probably hasnt answered your question decisively but then again I hope its given an insight into how I would respond.

Because they often (though I concede not always) are and also I dont see them as wealth creators. My answer to that is simply your CEO doesnt perform a socially useful or necessary function; he certainly does not perform a function that the combined powers of your workforce couldnt. Even if you do not feel confident yourself I would wager a dollar to a dime there are collegues you have who would feel they could and not be wrong. I agree that the market already undermines the NHS; the question is whether we are going to allow it to destroy it totally.

However, despite Smith’s warnings about the malign effect of government intervention it is wrong to portray him as an unflinching advocate of laissez-faire. He can even be regarded as a prophet of the ‘mixed economy’ found in many developed nations after World War II, since he acknowledged that some vital goods and services were unlikely to be provided by the free market. Smith’s work can also be used to justify the redistribution of wealth through taxation; rather than defining poverty as an absolute measure based on access to basic food and shelter, he understood that it was related to the general level of prosperity in a given society.

http://www.oup.com/uk/orc/bin/9780199231331/01student/keythinkers/smith/

Now me being me, Tim – I normally don’t argue with those in the know and can write a good piece on Dear old Adam – however “libertarian” and toxic asset justificationalist you wish to be, that’s good and fair. Even the canard of one being a ‘classical’ liberal.

But when we look at Adam Smith he certainly was a Scot who believed in the involvement of government in many ways, and many tiers to help the poor from poverty.

The ASI may have his esteemed name in it – but they only use what they feel he wrote to justify their argument, a bit like Thatcher with monetarism. Through progressive taxation redistribution of wealth from the rich to the poor he certainly did believe in. Your enlightened take on it would make him think twice methinks – but, as always, I could be wrong.

Some even use the argument that the old Soviet Union was a Communist state. Though we both know that really wasn’t the case.

“The ASI may have his esteemed name in it – but they only use what they feel he wrote to justify their argument,”

Not entirely convinced you know. We were (at least as far as I know) the only think tank considered to be “right wing” who welcomed the J Rowntree Trust definition of poverty. You know, that £13,400 a year one?

And we justified it entirely from Smith. His comments about a linen shirt not being a necessity of life but in a society which considers a linen shirt to be a necessity then a man who cannot afford one can rightly be considered to be poor.

Thus when Rowntree goes around and asks lots of people what you need to be able to do/buy in order not to be poor we welcomed this as giving us that standard of what society thinks it is to be poor/not poor.

Of course, we then rather spoiled our progressive copybook by insisting that this was an argument in favour of one of our pet causes: we shouldn’t be taxing the incomes of the poor. The personal allowance should be raised, as we have been shouting for years, to around £12,000 a year. (12 k post tax is around 13.4k pre tax and the Rowntree number was pre tax). Interestingly that’s also about the minimum wage for full time full year. So we also argued that the minimum wage shouldn’t be raised either: for if you work on minimum wage then you’re not, by the definitions of this society, poor.

But we most certainly started with Smith’s own expressed views on poverty.

As for government intervention: you do know we supported (even, to an extent, devised) the London congestion charge, yes? We really do support intervetions: just that we’re selective about those we do.

59. Blank Xavier

I pray that the NHS is broken up.

It is expensive, delivers terrible service and is profoundly unfree.

It is a blight, a cause of massive human suffering, both by the vast amount of healthcare it does *not* provide, by spending money so badly, and by the terrible quality of what healthcare it does provide.

There is no way in a billion years I would buy health insurance from the NHS. My experiences with them have been uniformly awful. On what basis am I *forced, against my will, by the State*, to buy health insurance from the NHS?


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