Debating the NHS: A Rejoinder
I’ve had some interesting replies to my last post on this, so I thought I’d put down a bit more here. Just from the outset, though: I wrote the original piece out of bemusement that everyone had given up whinging about the NHS for a day. I was hoping to strike my usual balance of being critical of something while still supporting it overall.
The estimable Shiro Ota wrote this:
Perhaps the NHS does constitute some semi lack of freedom (to be as detrimental to your own health as you like, although most people who live in such a way don’t seem to worry too much about their moral responsibility not to strain the system); but surely that’s more than offset (by a long way) by the benefits of aiding those who are genuinely, unavoidably, unhealthy; and those who are upstanding; hard-working citizens who could, nevertheless, not afford equivalent private care.
Randian objectivism is an understandable system that would oppose an NHS. But without subscribing to that (which I don’t), I can’t see a case for opposing its institution. In post-war Britain; or at present.
The question of the balancing act returns, of course - do we derive a greater value (of freedom or whatever else is at stake here) from the existence of the NHS as we do from the potential state of its non-existence?
It’s hard to prove anything from a counterfactual (and I should know). I suppose that all I can say in reply to this is that I don’t feel the only alternative to socialised health-care is its polar opposite. This is reflected in the fact that a Labour government has been spending the last decade and more tying the NHS to private interests, partnerships, and investment. I don’t think it’s working – actually I think it’s disastrously half-arsed.
Coming from another world, though, where we never had an NHS, I think that state intervention would be perfectly acceptable in a system that is, for the most part, operated in terms of a free market of health-care. So I don’t think that Randian Objectivism is the only recourse, or that, indeed, it could be any sort of improvement.
Obamacare may be basically the right synthesis, in the end – I’m sure we’ll find out.
My sainted mother, Dani Kaye, wrote this:
And why don’t you mention what you would put in its place, given the relative poverty of such a massive proportion of the British population compared to, say, Switzerland, where we have mandatory health insurance?
Well I think I made clear that I wouldn’t do anything like remove the nhs… it’s too well-established. But if I was starting from scratch?
Subsidies delivered to essential, first-level health services and medicines, mandatory insurance with certain benchmarks of assistance based on personal income, anti-monopoly laws for hospital ownership and licensing permissions so there wouldn’t be too much geographical overlap… basically a really, really well-regulated market scenario. Rather than the current approach, which is to try to de-regulate, localise and set up PFIs etc. over the top of a state monopoly. No NICE, either: individual health establishments make their own decisions about their services, above a certain level. They compete, improved services are incentivised, and thus we’re hardly dealing with some anarchistic nightmare realm.
Another particular friend asks:
Is it just me or are the Daniel Hannan NHS comments pretty reasonable?
Well, Hannan clearly thinks the whole project was misguided, though he seems to agree that people have always meant well in instituting the NHS. I don’t actually have a problem with this guy. He’s mainly saying things that most people say every day: we spend too much money on it, it’s over-regulated, and it has crazy little breakdowns in its own special ways. It’s a perfectly reasonable point of view.
A few points about the general Fox coverage, though: Doctors over here are paid PLENTY. There’s no argument to be found on that. I truly believe that. Could they be paid more? Sure! But I don’t think their pay levels are in any way part of any of the problems that our system has.









Recent Comments