Spoiled for choice

Dalrymple writes in the Telegraph on the recent proposal by Andy Burnham, the British Secretary of State for Health, to allow patients the freedom to choose their General Practitioner:

The fundamental contradiction in our Government’s policy is that it wants to introduce the flexibility of the marketplace into a system that is fundamentally Leninist, and getting more so by the day. When you go to your doctor, he is more likely to do what the Government has told him to do to – or for – you than what, as a professional, he thinks he should do.

He does this because of targets and financial incentives. The Government has, paradoxically, de-professionalised the general practitioner by paying him so much. Few GPs have been able to resist the Queen’s, or rather the Government’s, shilling; and they have been foot soldiers ever since.

If we want real choice, there is no choice: we shall have to pay for it ourselves, and not through the intermediary of the Government or even of insurance companies, for wherever there is a third party involved there is less choice. Those who do not want choice, or cannot afford it, will have to settle for what the Sun Kings of the Department of Health grant them, once the salaries of the people working for the Department of Health have been paid, which is lack of choice.
For Americans like me, confronted with the possibility of more government involvement in healthcare, the real news here is: British citizens have been unable to choose their own doctor?! Is this what I should expect?!

20 thoughts on “Spoiled for choice

  1. Andrew JS

    90% of British people think they have a divine right to free healthcare. The problem is that they don’t show any appreciation for this free service. Everything Dalrymple says is correct. There is only one British politician who has stood up against the NHS, Daniel Hannan, and he is viewed as being a dangerous extremist by most British people as a result of his attack on the sacred NHS.

  2. Steve

    Yes, and hasn’t David Cameron said that he wants to poor more money into the NHS? There seems little hope of improvement in Britain, even under a new government.

  3. Steve

    I suppose they would say that the right exists even in the absence of God, but they don’t seem able to pinpoint or explain its philosophical source, do they?

  4. kate

    Steve, I’m wondering are you searching Dalrymples articles for proof that your fears of ‘socialist’ health care are true.

    British citizens have always been allowed to change doctors, all you need to do is apply. I’ve done it. The reason people go locally is for other provision of health care from your doctors surgery, like home visits, the district nurse etc.

    Infact I remember once watching a programme on tv, re American health care that showed some new born babies were harmed or died as new mothers did not know basic things, like keeping a baby hydriated. They didn’t know to give a new baby boiled water and the child was harmed as a result. The American programme pointed out that this would not happen or be less likely to happen under a system like Britains.
    New mothers and babies are monitored by the nurse in home visits, she examines both mother and baby, and advises in many small matters. Indespensible to a new mother for the first time. As well as that hospitals provide anti natal care, they will even demonstrate how to make the first bottle, tell you about breast feeding, how to wash baby, how to clean his eyes etc. This is provided to all, through taxation, probably one reason why most children now born in Britain a huge percentages are born to mothers who come from outside Britains borders.

    Stop fearing this, if you’ve money in abundance you will always be able to buy. For struggling families – this can be a god send.

    The republican party screaming ‘death panels’, and ‘health care to all citizens is socialism’, are doing so due to the interests of a huge medical insurance industry that stands to lose a lot of money.

    Never mind torturing yourself with the philosophical source, people in need of health care, ordinary working American families won’t think about that when they get hit by a car, or are diagnosed with cancer, or have a child born with defects.

    I can see my doctor, yes you must make an appointment, go to a walk in clinic, like you have in the US only NHS walk in clinics don’t charge an arm and a leg like in the states, I know that from experience. People here get 24 hr on call doctors by phoning the emergency doctor, and in an emergency dial 999 and help arrives usually quite pronto.

    Stop listening to screaming republicans acting in the interest of big business and not in the interests of the little fellow in the street, health care of citizens is not a bogey man. If Obama gets Snow’s vote I think his healthcare plans are on track, the changes are coming regardless of the smears they’re throwing Obamas way.

  5. Tayles

    The very existence of the welfare state encourages the belief that it is possible to live a kind of adolescent existence, whereby the state acts as a generous parent, doling out money and favours.

    People want to be able to do and think as they like, free from responsiblity, with the government protecting them from the consequences of their actions. And like spoilt children, they don’t concern themselves with where the parents get their money from. As far as they are concerned, it just exists like a natural resource. It never occurs to them that someone, somewhere must be doing productive, worthwhile work to generate this money. Nor does it occur to them that self-restraint or adherence to standards might be required to maintain the comfort and freedom they take for granted.

    That’s the problem with socialist thinking: it ignores the fact that freedom, knowledge and prosperity are not naturally-occuring phenomena. They require hard work, skill, knowledge and respect for others.

  6. Steve

    How nice of British politicians to allow you to apply to change your doctor. Do they sometimes even approve the application?

    I’m sure it is comforting to believe that Obama’s opponents are all either Republican pawns of big business out to crush “the little fellow” or morons like me who just ignorantly go along with them. Nurturing that belief saves one the effort of having to learn the arguments on both sides of the issue.

    To the extent that the American system does have problems, they are due to government policies that make responsible behavior self-defeating. Obama’s policies will make it even worse. The “little fellow” is hardly served by becoming increasingly dependent on big government. People are not the helpless fools you make them out to be.

    Government-run healthcare represents another nail in the coffin of a free and self-reliant citizenry. No thanks. We can look after ourselves.

  7. Tayles

    There may be an argument in favour of socialised medical care, but it doesn’t follow that the arguments against it are simply a pretext for supporting big business. That’s a false dichotomy if ever there was one.

    It is a trait of the Left that they look for a pretext behind every political view that opposes their own. I wonder if this is because their own views tend to have ulterior motives, leading them to assume that their opponents operate on the same basis.

    For instance, I’ve no doubt that global warming enthusiasts support the recommendations of environmentalists because they endorse their pre-existing grudges against wealth, capitalism and modernity. If global warming was disproved tomorrow, their bias wouldn’t simply evaporate; it would shift to some other issue, such as global poverty. Global warming is merely a convenient outlet for an underlying view of the world.

    Those on the Left seem to forget that big business is not big because it’s greedy, but because it enjoys the support of millions of ordinary people. And it enjoys this support because it provides something people are willing to spend their money on voluntarily. If you replace private goods and services with state-controlled alternatives you are taking away money that people would spend on things of their own choosing and forcing them to buy something they otherwise may not choose to pay for.

    A company that enjoys that kind of captive audience is free from the forces that drive efficiency, value for money and standards of service. The fact that employees of the state are not motivated by profit does not mean they will provide a better service. Experience tells us that quite the opposite is the case.

    People need to understand that the profit motive does not rely on greed for its success; it relies on giving ordinary men and women what they want. It’s when the forces of competition are removed in favour of a supposedly more virtuous system that greed, corruption and inefficiency prevail. And remember, the NHS isn’t free. We all pay for it.

  8. Kate

    Steve, for people who want total self reliance they can opt out of the NHS, theres never been force involved, they can opt out of state schooling, if they have the money to pay for self reliance without looking to the state. People could always change doctors if necessary, what is happening now is free market policies are being introduced into a system that isn’t geared for it, thats Daniels point.

    Steve, no one is arguing against self reliance. Dalrymples articles are not calling for a free market in health care, as he rightly quotes Shaw, that a man will cut off your leg if you pay him to, and points out Michael Jackson
    He is merely criticising Britains system from within. No system is perfect, he worked in it for a long time, he may criticise doctors being paid too much but that didn’t stop him lifting his paycheck, nor did he criticise levels of pay before he retired. He is merely pointing out some areas within that are causing huge problems, he isn’t advocating any method, he is pointing out problems associated with all types of healthcare systems throughout the western world, but especially Britain where most of his experience lies. That is fundamentally different to him proving a case against Obama.

    Tayles are you suggesting that the only way a man can be free is in a free market? I watched a programme on a working family in Drogheda Ireland, where the state is facing huge financial problems. This family living in a small house with a mortgage, living on a combined income of E50,000, both worked in hospitals. They have two small children, and cannot afford a car, due to the price of food in the Irish republic, hikes in electricity and fuel, they even had to ask for a reduction in their mortgage rates. Explain to me how this small self reliant family would benefit by having no health care provision through their taxation? It’s people like these, self reliant good people who will benefit in the states. Of course some stray immigrant may also benefit somewhere…..

  9. Steve

    Can you opt out of the taxes imposed on you to pay for those services? You are allowed to pay for your own healthcare, but you are still forced to pay for someone else’s.

    Do you still get healthcare if you act irresponsibly? You are allowed to be self-reliant, but you are encouraged not to be.

    As for Dalrymple, he has clearly argued against Obama’s policy: “The federal government should concern itself very little in health care arrangements, and leave it almost entirely to the states. I don’t want to provoke a new war of secession but surely this is a matter of states’ rights.”

    Taken as a whole, if there is one point that Dalrymple’s work makes on this subject, it is that, absent any legal or cultural incentives for self-reliance, people will become freeloaders. Do you not see any link between the government provision of all the basic needs of life and the loss of individual character? It is the main thrust of almost the last 20 years of Dalrymple’s work.

  10. Kate.

    “Do you not see any link between the government provision of all the basic needs of life and the loss of individual character”

    Yes I do Steve, absolutely . Thats welfarism you criticise, the social attitudes associated with the welfare state, that hardly equates with reform of health care. As for paying for someone elses health care, aren’t you already doing that – I read you Americans are providing emergency health care to the uninsured at the rate of something like one thousand dollars per person, and that the insurance industry is unregulated and over priced.

    Lower priced government funded insurance is hardly going to cost someone his character.

    “There may be an argument in favour of socialised medical care, but it doesn’t follow that the arguments against it are simply a pretext for supporting big business. That’s a false dichotomy if ever there was one.”

    Tayles you are right, there is an argument in favour of ‘socialised’ health care, and that is why instead of leaving things there you moved from health to the environment.

    “the NHS isn’t free. We all pay for it.”

    Thats right, we do, and its regulated and not over priced. It won’t cut off your leg if you pay them too. 😉

  11. Steve

    The $1,000 figure is per family, not individual, and that estimate comes from progressive interest groups like The Center for American Progress. The problem of deadbeats is a real one, and will never be completely solved by any system, but it does not stand to reason that any reform will improve it. Obama’s reform would actually make it worse. More on that below.

    Today’s market for healthcare in the U.S. is anything but unregulated. Government spends half of all healthcare dollars in the U.S., and it greatly influences how the other half is spent. States mandate the types of services that health insurance policies must cover, whether it’s chiropractic treatments, mental health services or coverage for morbid obesity. You don’t like to drink? You’re probably going to buy coverage for alcoholism, anyway. 45 states mandate it. Are you young and healthy or struggling to make ends meet, and you just want catastrophic coverage? It doesn’t exist, because it’s against the law. Shouldn’t people have the freedom to buy the coverage that best meets their needs? Sure, federal reform could solve this problem, but Republicans have tried to pass legislation to allow consumers to buy health insurance across state lines, and Democrats have shot it down.

    Obama has sought to address the problem of deadbeats by requiring every citizen to buy health insurance, a policy that is probably unconstitutional. It will also make the problem of mandated treatments much worse, as every healthcare provider would lobby the federal government to have their services included in the universal mandate. Premiums would rise for everyone, and more people would need subsidies from the public purse to pay their premiums, thus raising everyone’s costs.

    Under current tax law, employers can buy health insurance for their employees with pre-tax dollars, but individual consumers can not. Thus almost everyone gets their health insurance through their employer, and when the person that uses a service is not the person that pays for it, we all know what happens: people load up on “free” goodies and expect someone else to pay. Do you drink less at an open bar?

    Another significant factor in current high costs is a litigious American society whereby people (especially trial lawyers) get rich suing doctors on trumped-up malpractice claims to which sentimental juries are all too sympathetic. Doctors’ costs for malpractice insurance has skyrocketed, and they must pass those costs on to consumers. Even more costly is the impact of defensive medicine practiced by doctors who order a myriad of expensive tests to mitigate their risk of being sued. Republicans have fought for tort reform for years, but Democrats have always blocked it. Only in the last couple of weeks has Obama begun to express interest in tort reform, but even then it is only as a pilot project in a few states. Meanwhile, his radical restructuring of the entire American health system moves forward.

    All of this ignores the budgetary impact of Obama’s proposal, which is unprecedented. In short, government regulation has drastically raised the cost of healthcare in America, and as with every policy from the Left, its failure is only an argument for more of the same. Obama’s proposal will socialize and greatly increase the cost of healthcare. The only way to avoid this result would be to drastically ratchet down the level of services provided, so that the choice becomes either self-rationing by free citizens and their doctors, or rationing by Obama’s panel of “government experts”. I know which one I’ll choose.

  12. Tayles

    Your family in Drogheda surely need food more than they need a socialised health service, but no one would take their plight as proof that we require state-run supermarkets. It’s easy to imagine the queues, the shortages, the inefficiency and the dismal choice such a service would provide.

    We prefer supermarkets because they are well-run, offer good value and good choice. Competition ensures low costs, meaning that even those who survive on welfare payments don’t go hungry. If we’re happy to have our food supplied privately and paid for out of our own income, why should healthcare be any different?

    The point is that privately run enterprises always provide a better service, both in terms of quality and value. There’s simply no arguing that fact. If we want high quality, good value healthcare, it needs to be run privately. Of course, there will be some people who are so badly off that they cannot afford health insurance, but they will be able to claim cash payments from the government to spend on healthcare as they see fit.

    Of course, some might say that these people could be forced to spend that money on something other than health insurance, such is their terrible plight. But that’s not necessarily the case. And it is ultimately their decision. The fact that some people might fail to pay for health insurance is no reason for the rest of us to be burdened with the expense of a bloated, inefficient state-run service.

  13. Tayles

    Okay, Kate, let’s go back to the NHS then. The argument in favour of it is that every tax-payer contributes to its running, so it’s free at the point of use. That’s about all that’s going for it – and that’s only a good thing if you believe people’s income ultimately belongs to the state and it’s okay to confiscate a part of it to pay for stuff that other people use. Which I only believe when there is no alternative.

    The arguments against it are manifold and have been detailed elsewhere, but let’s consider the two points in its favour that you allude to: that it’s regulated and its not overpriced.

    Private medicine is also regulated. Anyone practicing without a licence or who ignores the regulations is breaking the law. What’s more, anyone who tries to get away with offering a shoddy or underhanded service would soon go out of business, since there will always be someone better to turn to. You cannot say this about state monopolies. The idea that private firms can get away with criminally bad, unregulated skullduggery is a fallacy.

    Then there’s the question of the NHS not being overpriced. You say it’s not, but how do you know? What is the going rate for a state-run health service exactly? I imagine what you mean is that the service is satisfactory for what you pay towards it. But there’s more to the issue than that.

    You might be happy paying what you do, but it’s possible – highly likely, in fact – that we could get a better service for a lot less money. We know that spending on the NHS has gone through the roof in recent years without a proportional increase in service. We also know that state-run enterprises are inherently inefficient. It follows then that we are unlikely to be getting the best service or value for money.

    You might think the extra we pay is a small price for universal healthcare, but the money saved by scrapping the NHS could be better spent by individuals on things of their own choosing. For starters, they could get better healthcare for less. But however they spent that money, it would be allocated according to people’s real wants and needs. It would mean more productive work being done, extra jobs and new wealth being created. These are the hidden costs of state provision: the things we lose out on because we’re pumping money into some Stalinesque relic that will ultimately suck us dry.

  14. TDK

    “It won’t cut off your leg if you pay them too.”

    Well leaving aside ‘pay them’, which is irrelevant in a “free at the point of use” system, we do in fact perform medically unnecessary surgery in cases involving Body integrity identity disorder.

    However, I’m more worried about your assumption that median income people will benefit from an NHS style system. I’m sure that advocates will claim that the system will be cheaper but that claim needs to be based upon some hard evidence. This is government after all and never has a state run “anything” offered a reduction in costs. The NHS was promised to be cheaper than the pre NHS system. Yet the reality was that costs were driven up by several factors including increased life expectation, costs associated with new technology and or treatments and increased expectations.

    The usual mantra is that insurance companies in the US drive up the cost dramatically but it’s hard to see how that will change in the future given that the basic insurance model will remain in place. If Obama wanted to reduce costs then the obvious solution is to increase competition by eliminating restrictions on out of state cover. Instead he seeks to increase the regulatory burden.

    The second complaint about insurance companies is that they refuse to cover pre-existing conditions. When I insure against fire I pay a premium that reflects the relative risk of my house burning down. Ask yourself yourself how much an insurance company should charge a householder whose house had already burnt to the ground. They would be moronic to charge a premium less than the cost of the house. Forcing insurance companies to pay for pre-existing conditions means that other people are forced to subsidise them. That may be morally right but it won’t reduce costs.

    It’s hard to see where your median income family will see a saving. They must pay taxes that exceed the equivalent medical bill. Only the poor will benefit and they are already covered by medicare/medicaid.

  15. TDK

    republican party screaming ‘death panels’

    A person who uses the word “screaming” in this context is not averse to a little hyperbole themselves. Perhaps you reserve the right to emotional blackmail to people who you agree with.

    In any case we know that ALL health systems ration care. Demand always exceeds supply. Notionally the US system is rationed by ability to pay (excepting Medicare/Medicaid and Emergency cover) whilst the NHS uses an informal equivalent to a QALY measurement. However there are inevitably injustices. There are many examples of health authorities restricting care such as Norwich Heath trust refusing operations to people who will not stop smoking. There may be rational grounds to ask the smoker to stop but the smoker has contributed more to the health budget than others. They were told that the tax was to pay for the additional health costs. Doesn’t that promise grant them some right. What about people who have been denied drugs on the NHS, scrimped and begged to get them privately then been told that they are now to be denied further NHS care. The people who sit on the panels that determine who gets this care and who doesn’t can be seen to have control of life extending medical procedures. These patients will die sooner because the panel determines they fail to qualify for care.

    What would you call these panels?

  16. kate

    What is your problem if all systems ration care? ‘Death panels’, is a US republican invention, the object of which is to alarm the public. It’s a scare tatic.

  17. kate

    Basically I agree with that, unless price fixing comes into it, and other dodgy business practices. When that happens either more regulation is needed, which interferes with the free market or if it is of great importance to the country it could be nationalised.

    I don’t want my taxes going to football (£40 million a year, or £70 to the rights industry, or to foreign wars,) I don’t want to pay for those things, I suspect most ordinary Americans don’t either, why should the family highlighted pay for them if they can’t afford it? We all contribute to things we don’t want to, or don’t believe we should via our taxes, at least this way ordinary US citizens are getting something necessary for their tax dollars this could be why they voted for Obama and his promise to reform health care.

  18. Tayles

    Kate, you’re making a very good case for LESS taxation and public sector spending. You’re right – we shouldn’t have to pay for things we don’t use or support. There are exceptions, of course, such as the armed forces, emergency services and so on, but as much as possible we should choose how we spend our own money.

    However, the fact that this ideal situation doesn’t currently exist doesn’t mean that we might as well give up and have the government do everything for us. We must utilise the free market as much as possible.

    The idea that tax revenue is some limitless pot of money to be spent as government ministers see fit is a dangerous fallacy. Every penny taken away in tax would be spent or saved by taxpayers on things they decide they want and need. As I said before, that tax money would otherwise be opening new markets and fresh opportunities, creating jobs, driving greater competition and efficiency, and benefiting society much more effectively than if it was being spent by a panel of ministers or ‘experts’, who must second-guess our needs and who are often motivated by ideological concerns very different to our own.

    Nationalisation is never a good idea. It is generally done when an industry is failing to satisfy the wants and needs of its customers. If the government props up a company, it becomes dependant upon subsidies rather than on its own performance, taking away the pressure to become more efficient and satisfy its customers. If the subsidies were ever taken away, it would be in no position to stand on its own two feet. It also gives it an unfair advantage over better-run companies, who may be put out of business as a result. The idea that nationalisation is a safeguard against job losses is a naive, short-term view. The tax money being pumped into propping up a failing industry won’t necessarily make it more viable and will divert cash away from the private sector, leading to job losses elsewhere.

    As for foreign wars, that’s a difficult one. As long as there are governments and shared national values, there will be wars. Short of having only those who support a war sign up to fight (which is obviously impractical) men and women will always have to fight for things they don’t believe in, and taxpayers will pay for them to do so, whether they like it or not.

    Many people disagree with the motives or morality behind wars, but that doesn’t mean that wars are wrong per se. Only an idiot would have advocated unarmed resistance to the Nazis. Even when our own interests are not at stake, there are sometimes occasions when we must face down evil to defend others and for the sake of a higher ideal.

  19. TDK

    I’ll ask again

    We have established that a panel of bureaucrats determined that a citizen who had privately purchased some drugs was ineligible for further NHS care. We know they do not have the means for further private care. We know the person would die earlier as a result.

    What do you want to call this panel?


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