4 thoughts on “Universal healthcare without the NHS: a preface of sorts”

  1. Posted 12/12/2016 at 08:19 | Permalink

    Kristian, be our Siegfried!

  2. Posted 12/12/2016 at 08:57 | Permalink

    I work in the NHS as a nurse, and I could agree with you more! Is so frustrating having to ration care due to the rigdit funding system we have!
    Let’s have a really conversation about better alternatives

  3. Posted 14/12/2016 at 17:35 | Permalink

    Dr. Niemietz, thank you for your interesting publication. I notice you did not mention the Singapore approach in your paper; is that because you were focused on the West, or is it insufficiently different from the countries you selected to highlight?

  4. Posted 22/12/2016 at 14:16 | Permalink

    I look forward to reading this Kristian. It may be that you address these issues in the book, but I have a short list of points I’d love to hear your thoughts on, if and when you have the time. Overall, and this is hopefully constructive criticism, you seem to put out a lot of ideas about improving healthcare in the U.K. (and I don’t disagree with them) but your pieces don’t often feature insight into the pitfalls your solutions may fall victim to (and do in other countries), with potential fixes.

    And so, specifically:
    1) Over investigation and over treatment. Private medicine in the UK already suffers from this, as do many other privatised health systems around the world. It is human nature to want “something to be done”, and this combined with the ability of a private provider to charge the state leads to over-intervention. If you are bound to nationally recognised guidelines (including what tests/treatments should not be offered), as is increasingly the case, it’s hard to see how much patient preference can have a significant effect on the market beyond doctor personality and decoration in the waiting room. If not, patients will surely flock to whoever will perform their whole body health scan, prescribe antibiotics for a cold etc, which will be detrimental both for physical health, mental health and the public purse.

    2) This point is similar – patient preference over good clinical decisions. I agree care should be patient centred, but I disagree that healthcare professionals simply exist to do anything a patient wants. Sometimes, patients do really just need to lose weight – trying to give them a pill for something is a sticking plaster and will only encourage them to look for an intervention rather than make a lifestyle change.
    If a patient wishes to pay extra out of their own pocket for something that ultimately won’t do them any good, fine. But it shouldn’t be paid for by the state, nor should it be included in insurance schemes that will put up the premiums of others. Again, what you seem to be left with is either very regimented, nationally approved care (in which case, the argument for diversity of providers seems to get slimmer), or a much more expensive system as the state is forced to fund placebos for patients now playing the all powerful consumer.

    3) How do you deal with struggling hospitals, and the injustice of patients – who will pay the same in taxes or premiums – having to travel unacceptable distances because their local hospital “went under” for not being competitive enough? Such hospitals are likely to need investment, not the harsh divestment that the market tends to provide. You simply can’t say “tough – there’s a hospital 2 hours away that is more efficient.”

    4) Means-testing – isn’t this very frequently found to be more costly in the bureaucracy involved than efficient in what is saved? Isn’t this why even libertarian bodies are suggesting basic universal income rather than means-tested welfare? Given that everyone accesses healthcare at some time or other, how is this any different?

    5) Finally, not a potential pitfall but a tactically obvious point: Despite all your criticisms, you admit that we don’t spend as much on healthcare as we do other countries. How do you answer the suggestion that we at least start by matching their funding levels with the current system, remove the ability of zealots to say “it’a desperately underfunded”, give it 10-20 years and then make the case on the basis of the results? Changing the system totally when we *are* arguably underspending on the NHS (even if most would recognise that many failings are not funding related) seems a very hard sell.

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