Thursday, 1 May 2014

The camshaft bribe

From Wikipedia
Computer animation of a camshaft operating valves

A well-worn issue this, but still worth asking in the interests of clarity.

Decades ago, someone I knew had a camshaft problem on his car a few days before he was due to get married. Specialist work was required and there was a backlog, but the car was essential for the honeymoon. What to do?

Well he simply went round to the workshop and offered twenty pounds to the guy in charge, which was a reasonable bribe in those days.

“You’re next,” was the response and all went well.

So if an NHS patient sees an NHS consultant and opts for private treatment by that same consultant, is that pretty much the same type of queue-jumping bribe? Legally it isn’t bribery and probably the camshaft issue wasn't either, but should we see both examples as bribery to the extent of calling them bribery?

Or are they merely examples of markets doing their stuff and paying for a better service is perfectly okay? 

To my mind, many forms of legal bribery are endemic in the UK, but so is evasive language. The NHS illustration is entirely legal of course, but in effect NHS consultants accept queue-jumping bribes. Why not say so?

It's good to be explicit isn't it? 

But would I use money to jump the queue if a loved happened to be faced with a long wait for an essential operation to resolve a painful or debilitating condition?


Does that make me corrupt? Maybe, or maybe it is only a rational response to an imperfect world. Yet I would not shy away from the word bribe if it came up. 

So does explicit language leave us with a better situation or a worse? 


Sobers said...

Firstly, whether the mechanic taking £20 was a bribe or not depends on whether it was his garage or not. If he was the owner then he's perfectly entitled to prioritise his customers work in whatever way he chooses, and that includes doing work quicker for people who pay more. If he was an employee, and was pocketing the money, then its wrong not because prioritising the work for extra cash is wrong, but because he was defrauding his employer of money that was rightfully his.

And in some ways if there was a formal system of such payments, it could help others as well - if you wanted your car fixed but were short of cash and could get the job done cheaper if you were prepared to wait, you'd be gaining from such a system too. Its no different to the Ryan Air booking system - people who are time rich, and can book months in advance, for the middle of the night, and be sure they don't need to change flights get a better deal than those who want a flight the next day. Trading money for time and convenience works both ways people with money can trade it for time, and vice versa.

As for the NHS, the only way you can see going private as a 'bribe' is if you assume that all health care must be controlled by the State, and no free exchange can take place for health care services.

And if one argues that 'The doctor was trained by the NHS' well, you've just made being a doctor (or indeed a nurse, physio, surgeon etc) a slave. They can no longer work anywhere else other than for the NHS. Can they even leave the country? Unless one wishes to argue that NHS trained staff 'have' to work for the NHS for X years of their working life, and mustn't do anything else in return for their training, then one has to accept that some NHS trained staff will want to do private work, and there is nothing you can do about it. And paying for such services are no more bribes than paying extra for other services that are provided for free by the State - is paying private school fees bribery, if the teachers used to work in the State sector?

A K Haart said...

Sobers - as I understood it, the mechanic was defrauding the owner and the Inland Revenue - as it was then.

As for the NHS, I'm not saying it is necessarily wrong to jump queues for money. However the covert aspect is wrong in that those pushed down the queue are not given the full story.

I'm mainly interested in behaviour and how we use and avoid certain words. I think queue-jumping behaviour in the NHS is as near bribery as makes no difference in a behavioural sense.

Whether this should be made explicit I'm not so sure, even though I'm generally in favour of being explicit. Hence the last sentence.

Sobers said...

You are falling for the 'fixed economic pie' fallacy - that economic matters are zero sum - if I use a private doctor that prevents someone else doing getting a free NHS one. That is not the case. The existence of private medical services means MORE health care is going on overall than if private medicine was abolished. Markets create extra capacity, not just alter the distribution of a fixed amount.

Mark Wadsworth said...

I'm with Sobers on this one (especially the distinction on who pockets the £20).

I see nothing wrong with wealthier/more desperate people paying more for NHS services to subsidise the worse off/less desperate.

By and large, everybody ends up better off from such a system. If you think it through, you could probably make the NHS self-funding if you did it properly.

Mark Wadsworth said...

Addressing Sobers' last paragraphs, this was the really sickening bit, under New Labour, they said that parents who send their kids to state schools (93% of parents) would somehow be penalised if they also used private tutors.

Well, f- me, that's between parents, their children and private tutors to sort out.

I personally see extra tuition as very unsporting, but a lot of parents do this to their kids (including, I hasten to add, Mrs W, although she and her equally pushy Mum friends had an unwritten agreement that none of them would ever admit to having their kids tutored on the side).

Graeme said...

forget these earnest debates about principles...did the mechanic have free time? If so, let him charge for it at his own price.

Anonymous said...

The explicitness - or otherwise - of the business is interesting. Imagine a single server queue for hospital access where those with extra cash could go to the front and everyone else shuffles back. If the service time is very short then no problem - or any point paying extra. If the service time is longish then irritation among those pushed back would soon tend to rise and in the end a punchup would break out. So, as a cunning administrator I separate the queues such that they can't see each other and everyone is more or less happy. I even get to shuffle servers back and forth between the queues. The overall service rates remain as before. A quiet life all round, people cannot stand too much truth or economic reality, evasive language keeps the peace, let's not be too explicit.

But is it bribery? No, the servers are not employed fulltime by me, they hang around at the 'pay' counter in their own time (or play golf), I sometimes choose to pay them extra to sort out the 'free' queue but funds are limited. In any event I charge them for using the tools etc. There is bribery about but this ain't it.

Woodsy42 said...

If I went to my local garage and was told that my work was running late because one of their customers had an emergency repair in those conditions I would not mind waiting. I suspect most other customers would understand too and the garage would gain because we would all understand that they would do the same for us. Taking a bribe was therefore wrong, honesty would have been more profitable.
NHS bribery is wrong, the system should not allow it when it is to the detriment of other needy patients. However, anyone wishing to make altenative private arrangements is and should be free to do so.

A K Haart said...

Sobers and Mark - I agree, but the post is about a single consultant. I'm interested in language and behaviour here, rather than the general function of public services.

Graeme - no free time, the place was full of work.

Roger - yes, I tend to agree with you about explicitness, even though a lack of it grates with me.

Woodsy - I'm sure the NHS runs into these difficulties because it isn't supposed to be a market, yet to some extent it is.

Sobers said...

Lets examine your single consultant then.

Are you saying he has no free agency in his career? That because he was trained by the NHS, and then employed by them, he cannot work elsewhere, either part-time or leave the NHS entirely for private practice? If so does this run for all NHS trained staff? Are they all in effect indentured labour - they must work for the NHS until the debt of their training has been erased? How does the training provided by the NHS differ from training provided by any employer - can they demand their employees cannot leave until the costs of said training are recouped?

A K Haart said...

Sobers - "Are you saying he has no free agency in his career?"

No, just the opposite. He/she has the freedom to accept what in similar circumstances would be called a bribe.

The NHS may make this inevitable, but all I'm pointing out is the similarity and the use of language.