Thursday, 10 October 2013

Doesn't follow.

From The Metro:

COPYING ideas from poorer countries such as India and Ghana is key to saving the NHS, a watchdog says.

Adopting 'industrial engineering' techniques used to carry out cataract surgery in Aravind, India, could save £1.1 billion a year, Monitor claims.

Another £800 million could be recouped if Britain copies Mexico, where two-thirds of patients sort out their problems in a phone call with a nurse...

All good stuff, health spending is a question of diminishing returns to scale, some things are worth every penny, other things aren't and somebody has to draw a line somewhere.

But shadow health minister Andy Burnham said: "This will send a shiver down many a spine.

"It confirms the suspicion many people have that David Cameron is softening up the NHS for privatisation."

How on earth did he work that out? How does he get from "the NHS saving a few bob" to "the NHS being privatised"?

I am really am sick and tired of this false dichotomy that Tories want to privatise everything and Labour want to nationalise everything, it's a bit more nuanced than that.

If you think about it, everything is ultimately privatised at the bottom level. Police officers are private individuals who receive payment from the government for maintaining law and order. Firms who supply the police with stationery, computers or cars are private businesses. But "the police" in the wider sense is quite certainly a national thing.

So it all depends on what level of the organisation is being "privatised".

If Cameron went mad and handed over the keys to the entire NHS to some large corporate and gave them £100 billion a year for doing whatever it is they feel like doing, such as leveraging up on the land and buildings, taking massive bonuses, providing a catastrophically bad service and then disappearing, that'd clearly be a bad move.

But we already have this at a low level with GPs, they get given random amounts of money for doing whatever it is they feel like doing. Are they still an integrated part of the NHS? I would say "yes". Are their salaries and housing subsidies justified or value for money? I would say "no".

What if the NHS realises that procedure XYZ costs them £10,000 but they can send patients to a hospital in Eastern Europe who can do it just as well for £5,000? That's still NHS, isn't it?

So it's all a question of degree.


Kj said...


What if the NHS realises that procedure XYZ costs them £10,000 but they can send patients to a hospital in Eastern Europe who can do it just as well for £5,000? That's still NHS, isn't it?

Public sector unions and other defenders of a proper public NHS would say "sure you can let the private sector cream off all the "profitable" surgeries, and leave the NHS with all the difficult stuff, those who have multiple health issues, complex cases." To which my reply would be, well, yes. But you have all the complex, expensive stuff now, in addition to those surgeries who some surgery mill can do for a pittance and save us all a whole lot of green.

Lola said...

Broadly, you could scrap the NHS (for example) and start again. Without it what would people do? Well experience elsewhere (where there isn't rampant cronyism and protectionism and unionisation) indicates that people self fund most routine medical stuff and buy catastrophe insurance for the truly ghastly. So, by that reasoning the NHS could just be a 'catastrophe service'.

Mark Wadsworth said...

Kj: "sure you can let the private sector cream off all the profitable surgeries"

That's the sad thing, isn't it, that people get away with spouting this crap.

The NHS can (and does) offer some patients the alternative of going abroad and getting operation done quicker/cheaper, and many accept it gladly.

So seeing as we've halved the cost of that surgery (to the taxpayer), actually they are getting rid of the loss making surgeries, aren't they?

And nobody says the £5,000 saved can't be spent on something more useful closer to home.

Kj said...

That's the sad thing, isn't it, that people get away with spouting this crap.

Oh they can, if noone thinks about the logic. In one way, they are right in that current practices with "internal markets", partial DRG payment is given, and the hospitals, be they public or not, may actually subsidise the "difficult stuff" with "easy stuff".

john b said...

Lola: you're talking experience from the country which is universally known to have the most wasteful healthcare system in the world, presumably? (the US spends more as a % of GDP on government healthcare than the UK spends on all healthcare).

Because *every other developed nation* has government-funded healthcare. They don't have a mythology of total state provision (as Mark notes, in the NHS this is also a myth, as GPs have always been private), but they do have government funding.

Lola said...

JohnB. No, not just the USA, but other places. And I agree that the US healthcare is wasteful and expensive. But that's a result of cronyism/corporatism/protectionism and a mad over zealous claims culture motivated by a no win no fee it's always somebody else's fault culture. In fact even pre Obamacare the US operated Medicare (for working age people of low means) and Medicaid for retired people ditto.

It is not 'government funded healthcare'. It is taxpayer funded healthcare. Government just rations it.

Yes, GP's have really got it sorted. (And as I have posted elsewhere I met the BMA's chief negotiator...) They have the ludicrous deal they have because of state (mis)managment not despite it.

Personally I reckon you make it all private, and reserve taxpayer funding transfer payments for uninsureable chronic conditions, like say asthma (which I have).

Mark Wadsworth said...

JB, L, we aer getting off the actual topic which was HTF does Burnham go from "the NHS trying to save a few bob" to "the NHS being privatised".

Apart from that, most European countries split provision (competing providers, even if nominally run by different parts of the state with a few truly private ones as well) and taxpayer-subsidised insurance.

Basically, the government might be a bit crap at most things, but insurance companies are even worse, so having compulsory and universal basic health insurance coverage (i.e. funded out of taxation) is far from the worst option, it's certainly the cheapest.

paulc156 said...

I see a real likelihood that as the more routine surgery gets outsourced to specialist private clinics who can readily make a profit on such surgery/treatment that we are then told the rump of services still remaining directly under the NHS are simply 'too expensive' due to demographics and the success of 'specialist clinics' in treating more solvable ailments, thus leaving a huge per capita cost for those who still need the NHS. ...ergo co-pays for complex/ongoing treatments ala dentistry, will become a fait accompli.

Dinero said...

What if people all went private and just sent the bills to the treasury -would that still be the NHS.

Mark Wadsworth said...

Din: "What if people all went private and just sent the bills to the treasury -would that still be the NHS."

That would be more like the European systems. The NHS would just be the department of the treasury which approves treatments, agrees prices with hospitals/doctors and handles payments.

DBC Reed said...

You are ignoring the ticking time bomb: people are becoming increasingly fed up with privatisations. Miliband has only to tap in on this feeling a little more.

Mark Wadsworth said...

PC, I think you are forgetting the "grey vote".

DBC, come now, yes, some privatisations/outsourcing didn't quite live up to expectations - like PFI, A4E, G4S, anything to do with Capita, energy companies, NHS Spine, Railtrack/railways, the TSB, most defence spending etc.

But think of all the successes!

ageing man said...

I'm all in favour of privatising the Government... maybe we would could have a fighting chance of getting better value for money, better accountability and a more open and honest balance sheet. We could see much easier then, exactly which wall they are pissing our money up.

Kj said...

PaulC: Co-payments aren´t the end of the world. And looking at the population as either the healthy ones who´ll go to private facilities now and then vs. the indigent who will forever be a drain of resources, ignores that most people are a bit of both at some point of their lives.

JimS said...

DBC Reed: people are becoming increasingly fed up with privatisations

How long will it be before the EU imposes a single health market?

The plebs bleat about the privatisation of Royal Mail/Post Office Counters, (they can't tell the difference), and assume that Miliband will put an end to it, foregetting that Labour started the process and are fully signed-up to the 'ever closer' union with its Single Market directives which inexorably drives the sell-offs.

paulc156 said...

@Kj "Co-payments aren´t the end of the world."

Counterproductive. Ref.dentistry. Though instead of just having people walking round with rotten teeth/no teeth due to cost avoidance, we'd have people with chronic health conditions for the same reasons.

Lola said...

MW - Apologies. Just answering another commenter.

As to the thrust of your post, ultimately we are all 'private citizens'. It's just that (IMHO) far to many of us are paid out of tax transfer payments without any 'price signal' setting our wages. And the GP's thing is just a bloody try on.

Intringuingly there are more 'private police' protecting property then there are 'real police'. Not sure what that proves really.

Mark Wadsworth said...

AM, the largest areas of government waste are when they get private companies involved.

It is quite simply that there are some things which the government should do and some things which private businesses or individuals should do.

JS, we can blame the EU for a lot of terrible things, but the health system in most countries is firmly entrenched and the EU probably wouldn't dare much about with it too much.

L, yes, the police protect "public" areas like streets, investigate serious crimes and actually pursue and punish baddies, while private guards look after individual buildings or people and can do very little apart from act as a deterrent. They don't actually investigate crimes or take people to court, and what they do is not particularly for the benefit of the wider public.

DBC Reed said...

JS As a pleb I also bleat about the EU services directive that enforces privatisation; the European court of justice that always rules against collective bargaining agreements; the stability and growth pact that rules out Keynesian demand stimulus and the EU competition policy that stops state aid to strategic industries. I am not keen on the EU's absolute prohibition of freely contracted Resale Price Maintenance contracts, legalised in the USA in 2007, and which were once the UK's traditional method of doing business, by which small retailers were protected from predatory discounters and small manufacturers from big firms offering loss-leader discounts.
Its a pity that the Left, which was very anti in the Common Market referendum, has let right -wing headbangers take over a radical cause and make it a laughing-stock.

Mark Wadsworth said...

DBC, this is what's known as going round the clock.

The right wing nutters don't like the EU because they say it is socialist. The left wing nutters don't like the EU because they say it is arch capitalist.

Truth of the matter is, the EU is (nowadays) primarily corporatist, which is like the worst of both worlds.

Graeme said...

MW - it seems that DBC is a fan of the corporatist mind-set...another turn around the block for those policies that worked so well between 1945 and 1967....picking winners...a national plan....strategic is almost as if he has forgotten about stagflation