Healthcare should never be ‘national’ – still less nationalised
If you google “NHS best in world” you get 51 million hits. Nigel Lawson once said that the NHS is the nearest thing we have to a national religion. But he was wrong – he misunderstood religions. Religious belief is based on reason as well as faith. However, the belief that the NHS is the best in the world is based on faith alone.
Indeed, the vacuity of the case for the NHS is illustrated by the very first of those google hits. It is a Guardian article which has, as its first sentence, the statement that the NHS has been declared the best in the world by an international survey. Later on in that article, the author mentions, without any apparent sense of irony, that the only black mark against the NHS is its poor record in keeping people alive.
And it has a very poor record when it comes to keeping people alive. The UK ranks 20th out of 24 developed countries for cancer survival and 19th out of 23 for mortality amenable to healthcare – that is an overall measure of performance that looks at deaths that could be avoided by better health care. The UK consistently ranks close to the post-communist countries of Central and Eastern Europe rather than to Western European countries.
Until Jeremy Corbyn was elected leader of the Labour Party, it used to be argued that nobody believed in real socialism any more. When it comes to the revered NHS that was never true. The model replicates exactly the very worst features of centrally-planned economies: health care financed and centrally planned by government, more or less entirely. There are no prices to guide resource allocation decisions. The outcome is exactly what we would expect – very poor performance.
Of course, as soon as you mention the fact that the NHS is not the best model through which to provide healthcare, people immediately say that it is obvious that you must want the American model in which, it is alleged, there are people lying on the streets untreated for want of a credit card.
We can debate the alleged failings of the US model another time. However, there are alternatives to both the British and the US healthcare models. Indeed, every developed nation in the world except for former communist countries, Canada and Iceland have a model that is different from – and less statist than – ours.
So, what should we do?
The first stage of reform should be to finance the NHS by a hypothecated tax. National insurance would be a candidate for this purpose.
Secondly, we should allow people to opt out of the NHS and give them a refund of at least some of their national insurance contributions.
Then we should encourage co-payment so that people make can at least some financial contribution at the point of use of health services. We know from other countries that this leads to greater innovation and reduced costs.
Finally, we should encourage methods of paying for healthcare whereby people save throughout their lifetime. Pensions and healthcare costs may well bankrupt EU states over the coming generations and the UK is no exception. Healthcare costs tend to come at the end of life and, as with pensions, it makes sense to pre-fund those costs. Otherwise we might be imposing unbearable obligations on our children.
If the NHS is the best in the world, then let’s put it to the test. Allow people to leave on reasonable financial terms and make alternative provision. We often think that healthcare is a technical service with no differentiation. It is not. There are many ways of providing care. Some people may prefer more access to technology and less to personal care. Others may prefer much more care and monitoring in their own home even if they do not get access to the best treatments; and so on.
We must stop treating the population of this country like children. When it comes to healthcare, we need innovation and competition and we need to allow people to express their own preferences. Healthcare is very personal. Indeed, it is a matter of human dignity that people should be able to make choices in this field. Healthcare should never be ‘national’ – still less nationalised.
Prof Philip Booth is the IEA’s Editorial and Programme Director and Professor of Finance, Public Policy and Ethics at St. Mary’s University, Twickenham.