Is state-funded healthcare the best we can hope for?
Digital governance has revolutionised the NHS. While progress has been slow and very expensive, underpinning the progress is the ease with which feedback can be gathered and processed into a target.
While early targets caused confusion and chaos (in one hospital patients were sent home still recovering from surgery to make beds available), their re-evaluation and adjustment based upon patient requirements has led to medical staff delivering better services. Effective feedback has allowed weak staff to be flagged and has made other staff work harder – although the difficult bureaucracy needed to fire employees has inhibited progress.
As well as this, competing NHS trusts enable underperforming hospitals to be identified and closed down, and good hospitals to become independent foundations. So, although the “right” targets are still developing, Labour’s NHS legacy is in the hands of technocrats reading off spreadsheets and the NHS is no longer directly run by the central state. To some extent the target culture simulates the effect of competition, without actually privatising NHS funding.
Of course the incremental and expensive improvements we currently see in the NHS could be speeded up by the de facto privatisation of healthcare – for example, the coalition could sell hospitals to private firms and surgeries to GPs. The profit motive would undoubtedly lead to better results. However, while the doomsayers who compare planning the NHS to the impossible job of organising the whole Soviet economy were right 13 years ago, their viewpoint is arguably less valid today. Local managers, accountable for local results, mean the so-called monolithic NHS is actually a fragmented umbrella body.
Ludwig von Mises demonstrated that only the free market reveals people’s preferences, and any deviation from it leads to economic inefficiency, as well as the moral conundrum of why one person should subsidise another. But – and here’s the rub – there are important reasons voters turn away from any politician who airs the idea of scrapping or privatising the NHS. Voters fear that some people wouldn’t get healthcare, maybe because they could not afford it or just decided to opt out – and for many people health is too vital an issue to take risks with. Indeed, a common perception is that accident victims with no insurance would be left to die on the street. While it may be possible to convince academics that healthcare needs radical reform, ordinary Britons strongly support the welfare state now and recoil from the risks they associate with market-based systems.