News from the New Party

The sacred cow

Willem Buiter and Anne Sibert make a powerful argument against the National Health Service in the Daily Telegraph:

Among the rich industrial countries, only the United States has a healthcare system that is less fair and less accessible, and (at least as judged by admittedly imperfect quantitative health indicators) offers poorer value for money than the UK. The bureaucratic monster that is the NHS has few incentives to encourage efficient use of resources; it is dominated by producer interests and used as a political football by national party politics. Patients have very limited choice of providers and virtually no recourse if they are unhappy with their quality of care.

Healthcare should be available to all, regardless of ability to pay. However, the principles on which the NHS is based, universal healthcare financed entirely out of tax revenues and free provision at the point of delivery, no longer make sense. Research and development has created effective, but expensive, treatments that are not affordable for all - and this makes free universal access at the point of delivery impossible.

Currently, what determines your quality of care in the NHS is your education, intelligence and connections. While the "aristocracy of pull" (in Ayn Rand's wonderful words) receive their cancer treatment in the Royal Marsden, the inarticulate and less-well-connected may never see an oncologist. We need to find more fair and more efficient ways of allocating healthcare. Rationing by queuing works for taxis - it is fair and efficient. But, when your place in the health queue is determined by unaccountable bureaucrats, luck and pull, it is inefficient and unfair.

The NHS is the sacred cow of UK politics. Being perceived as hostile to its principles is the kiss of death for a politician. Better, therefore, to have unelected academics point out that the emperor has no clothes and to propose alternatives.

The NHS must go. It should be replaced with a system that guarantees good quality healthcare to all, but one which is - at least to a much greater degree - financed through payments for service. A system of mandatory health insurance of the kind found in the Netherlands would provide an attractive alternative, but there are good systems all over the Continent that might serve as examples.

Buiter and Sibert go on to make some interesting recommendations for an insurance based health system, based not on the American healthcare system (which is the NHS advocate's favourite bogeyman), but similar to systems in place throughout continental Europe.  It is encouraging to see this issue seriously debated in the press, at a time when the major parties are reluctant to rock the boat on the issue of public service reform.  It is time to put Britain's favourite sacred cow out of our misery.