2 thoughts on “How, and how not, to disagree on healthcare”

  1. Posted 07/08/2019 at 10:07 | Permalink

    Having benefited from the NHS recently , I am probably inclined to defend it . As an older citizen , my fear is that a private system would render people with pre- existing conditions vulnerable to higher charges.
    However on a less personal note , is there any information to indicate how much the average person’s life expectancy is influenced by the type of health system his country has ? If so , does it vary by age ?
    I think that any answer has to taken into account low hanging fruit such as clean drinking water , adequate food and childhood vaccinations which are presumably prevalent in all first world countries . I would be interested in your views .

  2. Posted 11/08/2019 at 10:22 | Permalink

    The NHS is a relic of the brief period during which socialist (as opposed social-democratic) ideals were put into practice in the UK. Hand in hand with a variety of nationalizations.

    State intervention is only legitimate in order to address market failure, according to economic liberalism (maybe a strict liberal would not even consider market failure as something tha should cencern the state). For communautarians (socialists, communists, certain types of conservatives) the role of the state can be (or must be in the case of marxism-derived ideologies) much wider.

    The Dutch system is one whereby the chief role of the state is to regulate, in order to mitigate abuse of power, ensure quality and mimimize the cost of health care to society as a whole.

    One cannot seet the Dutch system as separate from its origins as a mixed socialized/private system. Helath care providers were always (since the German occupation at least) regulated and “private practice” in the English sense only existed hand in hand with equally “private” health insurance. The social/state component was a means tested free insurance system that would pay for a basic level of service (private patirnts could pay more for more luxury, not for better treatment) . The state system did not have a deductible.

    That system was becoming too much of a burden for the state and a major reform took place whereby there would be a single level of service, a single type of compulsory insurance (with some ability to add packages for treatments not condidered part of the basic package and a supplement that would allow the insured to select their own providers) , explicit insurance premiums and an explicit deductible (the higher the deductible the lower the premium) and a subsidy to those who in the past would have enjoyed a premium-free scheme.

    Helth providers like hospitals may have an operating surplus but are not allowed to distribute earnings. The same applies to health insurance companies.

    Finally, rates and pharma prices are negotiated between the state, insurance providers and care providers.

    The state has two incentives to keep costs low: (1) the level of subsidy and (2) the fact that the government/public sector is the country’s largest employer hence also the largest provider of employer-subsidies.

    All in all this scheme functions pretty well, despite complaints from pharma (especially the providers of expensive, exotic medicines that tend to be kept uninsured for a while) and certain specialists. One indicator is patient satisfaction (a bad indicator inn this area) and a much better indicator, the number of patients that seek treatment in (very nearby) neighbouring countries where waitinglists may be shorter or exotic treatments more readily available.

    My expectation is that this system will not appeal to the Uk’s next trade patron, the US because it has an enormous institutional bias against expensiveness hence a consumers’ paradise, the exact opposite to the US system, a suppliers paradise. The more likely trajectory for the UK would be to keep the NHS as a single payer/insurer, have a separate regulator and let the provision of services become more private, but for profit private, a critical difference.

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