Wednesday, 13 January 2016

The Junior Doctor Dispute Slightly Resembles An Argument About The Buffet On The Titanic

Just as, in the study of epidemiology, symptoms (increased thirst, tiredness and hunger) are not the same as the disease (diabetes), the same is true in politics - the symptoms are not the same as the diseases. In the NHS the symptoms of this junior doctor controversy are demands for increased hours at undesirable pay, but the disease is the structure of the NHS itself, and the fact that the government simply cannot keep generating enough funds to pay for the service – a problem that’s getting increasingly worse as the ratio of workers to pensioners keeps narrowing.

Because of the quasi-religious fervour attached to Britain’s NHS, most people just can’t entertain the notion of a more competitive health system, based on free market principles, in the way that they can with, say, food and clothes shopping. But while no one is arguing for the erosion of the ability for any sick person to be treated, nor for the welfare elements to be compromised, a system in which most health care was run independently by private operators, where providers would compete with other providers for patients based on price and quality of service, would be much better for people than the current outdated and unaffordable system.

Under these conditions, some providers would be part of big corporations, whereas others would be large cooperatives, and others still smaller businesses specialising in particular practices. There probably would even be many charitable organisations funded by benefactors. This would also open the market for insurance companies to offer incentive based premiums for a diverse range of people with diverse lifestyle choices (and no, I don't mean like the cost inflation-inducing American insurance system).

The vision I have for a future health system is rather like that of a shopping mall, where doctors, dentists, pharmacists and opticians are linked together by a nexus of industry and efficiency, where prices, supply, demand, value and incentives are more coterminous in their relations. Unless we plug the round peg of market efficiency into the round hole of NHS need, we will always be skirting around the main issues, and arguing about how to treat symptoms when we should be arguing about how to cure diseases.
And if the picture I've painted is something you cannot realistically conceive, then stick with me for a few decades and mark my words you'll see that what I've envisaged will be pretty commonplace by then. For more on the problems of the NHS as things are, see my blog post -  Crisis Coming: What Politicians Are Afraid To Tell Us About The NHS and this little blast from the past - If The Government Had Our Best Interests At Heart, They Would Make Most Of Us Pay For Our Health Care