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?

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.

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.

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.

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

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?).

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!

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.

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.

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.

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.

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.

“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.

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.

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.

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?

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.

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.

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.