Friday, April 28, 2006

DK reforms the NHS

I have been doing a wee bit of thinking about the NHS recently, Fucking Retard Patricia's problems having brought the topic to the foreground amongst my regularly-read bloggers and real-life cronies. The NHS deperately needs reforming; few, I think would dispute that.

But what really needs to happen is that the NHS needs to be completely abolished. Now, I know that this might have caused some gasps, in much the same way as Bill Hicks' suggestion that we use terminally ill people as disposable stuntmen and women, although given my general readership I suspect that there will be a certain amount of agreement.

The ones gasping will, of course, whine about the hundreds of billions of poor people, who are splashed across newspapers daily throughout the world, who die unnecessarily in the US because the poor dears cannot afford the private medical insurance (and who seem to think that Medicaid, which consumes an average of a quarter of each state's budget is just a figment of George Bush's fucking imagination). "What about the poor?" they will shriek.

Now, despite my being a filthy libertarian who believes in a teeny, tiny government (preferably small enough to join those angels dancing on those pinheads) I am not actually interested in stamping on the poor; contrary to popular opinion, I have done some literally shitty jobs, I have been extremely poor (and continue to be so) and I don't wear a top hat, chomp on a large cigar, rest my feet on my slave manservant gainfully employed domestic labourer and eat the children of the downtrodden workers for breakfast. I am not interested in doing down the poor, rather the reverse; I want them to better themselves and their families through hard work, and obtain satisfaction by having control over their lives. For many, it will be a bitter medicine but, like any medicine, in the end they will be happier for having taken it.

Inspired by Right For Scotland, I decided to have a look at private Health Insurance. I was astonished by what I found. Let us bear in mind that I still smoke and drink quite heavily, but the highest that I could get my premiums was £58 a month. Now, I didn't read the policies in hair-fine detail, although I did check that they were fairly comprehensive (there was one which offered as many free consultation as needed and offered 240 procedures that the NHS did not cover, but (obviously) did not cover those that the NHS considered priorities, which was £18 a month). Whatever, it all seemed like a bit of a bargain, frankly.

And it is eminently affordable. I'm seriously considering getting a policy (as soon as my income becomes a little more regular). After all, it's not much more than a month's worth of Sky TV, and which one would you say is more important? (Anyone who answers "Sky" actually deserves to die for lack of medical care.)

Back when I originally assembled the "blogger cabinet", Andrew was assigned to the Department of Health and came up with a good way of privatising all of the hospitals. Essentially, all hospitals would be spun off as Limited Companies; however, I would also be tempted to make them not-for-profit organisations with charitable status. They could then engage in fund-raising and solicit charitable donations (which is how hospitals used to obtain the greater part of their funds).

The point is that central planning simply doesn't work, either in terms of cost efficiency or in delivery of the services. What I think that we would eventually see is more smaller, local hospitals; the re-emergance of the cottage hospital, if you like. This is because a smaller facility would require far less capital expenditure to build, would be easier to manage and would be more responsive to local needs. But this is in the future.

Treatment would be paid for by private medical insurance. Most working people can afford £50 a month (especially if NICs were totally abolished, which it should be, and if my commensurate plan of bringing in a £12,000 Personal Allowance were also implemented).

"But what about the poor?" I hear you scream, "will they die like rats for want of a credit card?" No, for this is where we look at the alternatives. As part of unemployment benefits, the government will pay your health insurance premiums for you (as NI was essentially supposed to do). They will not pay it to themselves, they will pay to a private company, who will be chosen by you (or your existing supplier if you had one) so that you know that your premiums will actually go towards providing healthcare rather than fat, fucking MPs' over-generous pensions.

If someone should be left without medical insurance, then the solution is simple. If they need medical treatment, they will simply pay back the charges over x years, paying a monthly amount until the debt is paid off. If you can get free credit with a new sofa, then I see no reason why the same thing should not be the case with medical care.

There we go, sorted. Any questions?

13 comments:

The Gorse Fox said...

It is interesting that whenever someone says "abolish the NHS" or that the Tories are "abolishing/dismantling the NHS" there is a wave of complaints... but most of these come from a) people working for the NHS; or b) people in the Labour party. The shouting is so loud that no sensible debate can ever be held.

What does the consumer of healthcare want?
a) speedy treatment in emergencies;
b) timely treatment of non-emergency health problems;
c) access to preventative care and medicines if required;
d) clean hospitals that help to cure rather than add to the health problems;
e) excellent doctors, and nurses
f) treatment that is "free" at the point of delivery

None of these is exclusive to the NHS; none requires armies of Managers. It does require reasoned and adult debate... but that won't happen.

Gorse Fox would love to know what proportion of his taxes and NIC actually go to sustain this behemoth of mediocrity and what it would cost to have the sort of system you suggest instead. Methinks it would save a fortune... but of course there'd be less people employed by the state and therefore likely to vote for the current incompetent, sleazy cretins.

Blognor Regis said...

"What about the poor?" they will shriek.

Stefan Molyneux notes that this reaction virtually proves your case. People are by default concerned about, big quotes, "THE POOR". This is when they can prove their concern doesn't soley consist of "the government should do something about it".

Serf said...

and eat the children of the downtrodden workers for breakfast.

I find them best lightly toated with Marmalade.

Devil's Kitchen said...

Gorse Fox,

Look at it this way: when I was last full-time salary employed, 11% of my salary would have been about £175 per month. This is then also matched by the employer, so the total NICs is £350.

Private health insurance: £50
Private unemployment insurance: £23
Private pension to get the same as a state pension of roughly £5,000 a year, retiring at 65: £100
Total: £173

So, rather less than half of what it costs through the government.

DK

Anonymous said...

I've blogged a flippant response, but just to note me and t'lass pay £85 a month for health insurance, which then reduces our gym fees by about £45 a month. Anything unused in one years gets rolled over to put against next year's fees. I reckon they'll end up paying us if we stay moderately healthy. Didn't tell em about my mainline lagavulin habit though.

Anonymous said...

Great idea, I mean just look at how the private sector sorted out the transport system, the speedy trains, the timely treatment of repairs, the great reduction in prices. The fully functioning market forces.

When I finially have a heart attack, when asked to fork out yet another pay 120 quid to go the 100 miles by train to Bristol, I'm sure the privatised ambulance service won't use it's nice new monopoly to prise the last few pence from my death grip.

Devil's Kitchen said...

The privitisation has been a disaster, that much is true. The trouble with the railway is that it is not really subject to market forces. No one is going, for instance, to go to the capital expense of building another line from London to Edinburgh in order to offer a cheaper service.

However, what should have been done was to make the train operators responsible for the track as well as the trains (which is, after all, how the railways started). Furthermore, the tender process is ludicrous: since only one operator is allowed to run each service, there is not even any competition there. The tender times are too short, so operators are not going to invest in more rolling stock, as they may lose the franchise (but not their debts) within 7 years.

Furthermore, someone like GNER, which runs a good service is forced to pay the government £3.5 billion over the next ten years whilst Virgin, and any number of other crap operators, are actually paid by the government. The total rail subsidy now is double what it was under BR.

Once again, it is government interference that has done the lion's share of cocking things up. It does not allow the market to operate, by disallowing any competition. It just shows that governments should never try to run anything.

DK

Katy Newton said...

Surprisingly, given that you say you can't currently stretch to it yourself, I think you underestimate how much £50 represents for most working people (even if you take only single people without dependants, as you must be if using a figure of £50), even if NICs were abolished, given that most people struggle to make ends meet on what they earn and probably desperately need an extra £50 a month just to meet their current expenses more easily.

Katy Newton said...

Overlong sentence. Sorry.

Anonymous said...

Katy,

£50 a month may represent a lot of money for some. So it should. Health care is the second most important commodity they will ever buy in their lives.

Most CAN afford it.

10 cigarettes a day
One pint of beer a day.
Two tanks of petrol

I could go on.

The point is, because it is perceived to be free (it is not really) it is not valued.

Abolishing the NHS does not mean abolishing health care. It means rationalising it. All it really means is abolishing the nonesensical mantra of "free at the point of entry"


John

Jim said...

One of the best outlines of health reform I've read. Interestingly enough, I heard from a Canadian free-marketer that healthcare worked in Europe because they allowed public and private sources to compete with each other. Over-regulation and monopolies are the two extremes, and in between is the happy medium.

chris said...

That Canadian was probably thinking more of the multiple payer multiple provider systems in place in Continental Europe such as Germany and France, rather than the last bastion of Socialism that is the NHS. The continental systems being rather closer to what DK is proposing than the current one.

Perhaps your proposal to cover premiums of the unemployed could be a hypthocated Citizens Basic Income. So everybody gets a certain number of vouchers to spend on heathcare with whichever insurer they choose.

Anonymous said...

Dk,

Your 173 to 350 quid private to state ratio seems about right. I remember reading somewhere that for the government (any government) to do 1 quid's worth of good deeds actually requires them to levy 2 sovs in taxes.

There's a technical terms for this which I'm sure Tim Worstall could tell us, but the amazing thing is that this "fiscal stickiness ratio" varies very little between governments. Strangely as soon as you get into the private sector the ratio drops from 1:2 to less than 1:1.2 or lower.

To answer Katy, not only could the poor afford private insurance if they cut down on smokes booze etc. Since the state wouldn't be spending the money any more, they could stop taking it away from people. Quite frankly, if the government stopped taking 350 quid off me I'd be quite happy to spend 173 on replacing those services they no longer provided. I could spend the balance on all sorts of things more likely to make me need my health insurance for one thing.

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