Tuesday, 10 October 2023
NHS reform and the incompetence of the state
Kristian Niemietz has a pointed CAPX piece on fixing the NHS.
If there was a way to fix the NHS, we would probably have found it by now
Last week, I spoke at a panel at Think Tent 2023, a series of fringe events jointly organised by the Institute of Economic Affairs and the Taxpayers’ Alliance which was running alongside the Conservative Party Conference. The panel was on the question of ‘How can we improve Britain’s health service?’, and my take was that we probably cannot, fundamentally. The NHS has been reorganised more times than anyone can count. If there was a way to fix it, we would probably have found it by now.
The whole piece is short but well worth reading because of his key point. The known incompetence of the state is an obvious obstacle in switching from the NHS to, for example, a ‘Social Health Insurance’ (SHI) system.
One of my fellow panellists, Toby Brown from the King’s Fund, made a reasonable case against a switch to an SHI system. His issue, though, was not with the destination, but with the way to get there. He accepted that SHI was ‘a great healthcare system for many countries across the world’. But he also cautioned:
‘We’re talking about a state that is failing to build a railway from London to Manchester. Are we going to trust it to completely rewire the health service?’
That is an entirely fair point. One could have added the chaotic Brexit process, and the messed-up, endlessly delayed rollout of Universal Credit, as further cautionary tales.
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8 comments:
We’re talking about a state that is failing to build a railway from London to Manchester.
Yup, the state is a blithering nincompoop so we must leave the health service in its hands.
Near where we live a relatively nice bungalow became unoccupied. I don't know what happened to the old gent that lived there.
The bungalow didn't appear for sale but instead was demolished and rebuilt on a larger footprint with a different layout.
The new owners didn't spend a fortune doing up the kitchen and bathrooms and redecorating throughout - they pulled it down and started again because they didn't want to be limited by what had gone before.
So yes, "If there was a way to fix the NHS, we would probably have found it by now". Tear it down and start again.
There's another important reason why we don't get rid of the NHS, and that's because of a political application of the "sunk costs" fallacy. Imagine if we got rid of it, and replaced it with a Dutch-style system that actually worked. All those people who had been praising it as an unsurpassable success would look like complete tits. All that bloviation and hype, and preparedness to die in a ditch over the "jewel in the crown of our welfare state": it taints most politicians, and huge swathes of the general voting and opinion-forming public. If they had been so wrong on that, then what wouldn't they also be wrong on?
We've gone too far. It's easier to let the queues lengthen and have people die, than it is for them to admit they were so fundamentally wrong. So nothing will get done. It's like Victorian Christians who had sung so many hymns and prayed so fervently in public and pontificated on the duties of Christians: they could not allow themselves to doubt.
With the NHS, as with all our State employers, we are lumbered with a load of pensions which we cannot shake off.
As with H2S we should just accept that as lost money and start from scratch. All those very talented and experienced management will have no problem finding employment. John Lewis? All the doctors can go full time Private rather than wasting time with NHS. The huge number of outstanding malpractice legal cases......?
Give the customer an allowance to be spent on insurance.
Then the hospitals can sort themselves out. Maybe back to local small hospitals rather than packing patients into huge, distant, recirculating-air infection incubators.
And Matrons.
But it will be driven by the customer. Not the jobsworths.
Then the BBC.
Ah well. One can dream.
dearieme - yet chances are that voters will elect the party which has no intention of taking the health service away from the nincompoops.
DJ - I don't think there is the political will to do anything but feed it with more money. Imagine the screeching if anything radical were to be proposed.
Sam - I agree, it can't happen until there is a major reduction in number of people politically invested in the NHS. That's the immoral aspect of it - it's easier to let the queues lengthen and have people die. Appalling but they do it and must know they are doing it.
Doonhamer - it may be that some system such as giving the customer an allowance to be spent on insurance could wean us off the NHS. A system where the money follows the patient perhaps. Optional and running in parallel with the NHS.
"Are we going to trust it to completely rewire the health service?"
It appears that the argument is that the State is so incompetent that we cannot possibly let it devise a replacement for the NHS, so instead healthcare must continue to be run by the incompetent State......talk about cognitive dissonance!
Anyway the way to reform the NHS is not to allow the State to design anything at all. Just divert the money, away from the NHS and to the patient. Give the patient the funding that would have gone direct to the NHS for their care and let them spend it where they like, often with their own money added on top (or insurance money). Then private sector healthcare suppliers will increase over time, and the NHS provision will reduce over time. Similarly insurers will provide policies that take into account the State funding that is available, thus making private healthcare insurance far more affordable. In not too long a time a completely different healthcare system would organically emerge, as people made decisions using their own money in their own best interest. One that had both State provision and widespread private sector provision. Absolutely no need for State design of anything.
Sobers - if the funding follows the patient it certainly ought to work, but I'd expect the the Labour party, NHS, medical establishment, media and permanent administration to sabotage it. All for the best possible reasons of course, but the political will to do it would have to be formidable.
State education could be reformed in a roughly similar way, but Starmer already seems intent on making it even more difficult by attacking private education.
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