I was at a party yesterday and got in to conversation with someone about the NHS and healthcare provision and funding in the UK. What was most interesting was that, although they admitted that the NHS was a system that failed people, they still thought that the Government would be able to put things right. The idea that given government has made such a mess of things should mean that it should stay out of healthcare in the future was not something that had been considered.
Entries tagged with “NFR”.
Mon 7 Jun 2010
Mon 31 May 2010
With the election out of the way and a new Conservative-Liberal Democrat Government it will be interesting to see how the NHS actually fares given the size of the burgeoning national debt.
While Conservatives are often thought of as free marketeers and Lib-Dems are often thought of as being a bit lefty the rise of the so-called Orange Book Crowd in the Lib-Dems over recent years could make for interesting politics. For the Orange Bookers are often not only more socially liberal than the most libertarian of Tories but they are more free-market than many Thatcherites. While the NHS will suffer some cuts over the course of this parliament NFR believes that more complimentary private funding schemes could well come on to the radar screen of both the Conservatives and the Lib-Dems over the next five to ten years.
Watch this space…
Thu 15 Apr 2010
Today I am off to speak to the fast-track graduates at the Department of Health.
I am participating in a debate and proposing the motion “This house believes that the founding principals of the NHS are no longer sustainable and that medically necessary services should and will be chargeable by 2010″
I will let you know how I get on!
Tue 9 Feb 2010
Ladies and Gentlemen, in 1948 the British government put a leaflet through the door of every household. It said, in black and white, that: “the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”
Today, we live in a country where our political class is seemingly proud of the target that: “the longest you should wait after being referred by your GP until you start your treatment is 18 weeks”. More than 4 months. There is even a web site called:
Today, there are tens of thousands of people trying to get onto these waiting lists. Many are delayed so that the official 18 week clock does not start to tick.
According to Professor Julian LeGrand of the LSE, people from professional and managerial backgrounds access – on average – more than 40% more NHS resources per illness episode than those in lower social groupings. Today, 1 in 10 people in NHS hospitals pick up infections and illnesses that they did not have prior to being admitted. Over the last five years, more than 30,000 people have died from Healthcare Acquired Infections related to NHS care.
Indeed, things are now so bad in our state health service, that even basic nutrition has become an issue. According to the National Patients Safety Agency, NHS malnutrition incidents rose from 15,473 in 2005 to 29,138 in 2007. Overall, during this period, almost 70,000 NHS malnutrition and starvation “patient incidents” were reported.
Today, as students at this fine university, you are residing in a country that is a long way from the politicians’ promises of 1948. You are now in a country were where some 7 million people have private medical insurance. Where 6 million people have private health cash plans – many of them are members of trade unions. This year, 8 million will pay towards private complementary treatments. And many, many, tens of thousands of others will chose to self-fund for private surgery and treatment.
More than a quarter of all people in nursing and residential care homes now pay privately. Spectacles went private back in the 1980s. Dentistry is now going – as many of you will know – the same way.
Today, in 2010, the NHS is not doing all medical, dental and nursing care. Far from it.
Sometimes, the NHS does get things right. But, all too often, it does things badly. As my good friend Dr. Eamonn Butler put it a few years back:
““If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients.
Now, given the side of the debate I am on this evening, I wish I could tell you that America has got it right. It has not. I wish I could tell you that America is a genuine free market system. But it is not. Instead, away from all the propaganda and all the statements of those greedy vote-motivated politicians, America has much more of a mixed economy than most on this side of the pond realise.
Today, the US taxpayer spends a fortune on its Federal healthcare programs: Medicare, Medicaid and S-Chip. Who do you think has the larger budget? The Pentagon; or US government healthcare programs? The Answer, is US government healthcare.
I ask you: historically, which government do you think has spent a greater proportion of its GDP on its government healthcare programs: Britain or America? Well, averaging the last thirty years, the answer is America.
We hear a lot in Britain about the poor in America. We hear a lot about the 45 million uninsured. But who are they? 17m of the 45m live in households with incomes above $50,000. That is 38% of the uninsured in America. 9 million – or 20% of the uninsured – live in households bringing in more than $75,000 a year. And then there are the young-invincibles. These are the 18m Americans aged between 18 and 34 who chose to spend 4 times as much on alcohol, tobacco, entertainment and dining out, than they do on out of pocket spending on healthcare. They represent 40% of the uninsured in America.
Today, US federal law dictates that American hospitals have to treat – irrespective of ability or willingness to pay – anyone who comes within 250 yards of their Accident and Emergency department. That, my friends, is why so many Americans don’t bother with insurance. Many know that the government will already be there for them.
Now, there are probably 9 million people in America who are genuinely outside the system. But they refuse assistance and help from all sectors: be it public, private or charitable. We have those people here too: the homeless, the dispossessed, the mentally ill. For whatever reason, they want to operate on the edge of the mainstream and tonight they will probably be looked after by the Salvation Army or a myriad other good people in the independent charitable sector.
I could have talked tonight about how an American cannot buy insurance from another state. Or how the government skews the whole US insurance system so it rests with employers. I could have talked about the need for tort law reform. But, I don’t have the time to touch on these matters.
Instead, I simply want you to understand the size of US government intervention in healthcare, and to understand that like our own system, it has precious little to do with a free market.
However, I still believe that the US system is generally, better than ours in the UK. Overall it provides better rounded, more timely care for patients of all backgrounds. This not only means that in America patients have better access to the most up to date medicines, medical and surgical procedures. It also means that if they need a hip replacement or cardiac surgery they are not left for months, or years waiting in pain or unable to leave their homes, as happens in the UK.
Indeed, I believe both systems would be better if they were more open, diverse and competitive. In short, if they were more free market.
I am not a politician. I am not an eminent medical doctor. I am a nurse. I have worked in and around the NHS for more than 25 years. And my concern his high quality patient care.
Away from Westminster, the Royal College of Surgeons and all the other vested interests, it is people like me, day and night, at ward level, who know and can talk about, the harsh realities of the NHS.
What I know, is that in this country today, most families have a horror story about the care, they or a loved one, has received in the NHS. Today, I know people find it difficult to get GP appointments. People are not able to register with NHS dentists. Increasingly, they are not always able to get the ambulances they need… When they do get one, they sometimes wait outside accident and emergency departments because the hospitals are full. If they were let in, the hospital would fall fowl of government targets on length of wait.
More than 4 months waits to get treatment? MS patients denied Beta Interferon? Patients with Kidney Cancer unable to get drugs that could prolong their lives? Women with Breast cancer not able to get Herceptin? 1 in 10 patients picking up healthcare acquired infections? 30,000 dead in 5 years? 70,000 malnourished or starved? All this, on this little Island?
You take it from me; someone who really knows; someone who cares, on the frontline; tonight you would rather be unwell in America than here in our nationalized, vote-motivated, health system.
Mon 8 Feb 2010
Now this could be a really interesting opportunity to get some meaningful and sound reform of US healthcare along much freer market lines. When recently asked if inviting Republican Party leaders to the White House meant that President Obama was going to start from scratch, he responded:
“I think that what I want to do is to look at the Republican ideas that are out there, and I want to be very specific, how do you guys want to lower costs, how do [you] guys intend to reform the insurance markets so people with pre-existing conditions for example can get health care…and if we can [go] step-by-step through a series of these issues and arrive at some agreements, then procedurally there’s no reason why we can’t do it a lot faster than the process took last year”.
In truth, US libertarians at places like the CATO Institute, the Independent Institute and the Competitive Enterprise Institute have invested huge amounts of time, energy and resources over recent years in developing and honing free market solutions to correct the state failures of American healthcare.
What makes Obama’s statement so interesting is not just that it is an admission that Obamacare One has effectively died, but perhaps to save his and his administration’s reputation, the White House appears to be casting around for viable and practical reforms rooted in the real world and not the quasi-Marxian crack pottery we saw during this administration’s first year in office.
This is all good news in as far as there is now a chance (albeit a very slim one) that the term ‘health reform’ might just become associated with the ideas of a freer market. As I have said many times before, in America the word reform has to be rescued from meaning more of the top-down statism beloved by the political class and its friends in the big anti-competitive corporates. Today, there might just be a chance that Obama is starting to understand this. Only, time will tell.
Mon 8 Feb 2010
Last week, I spoke against the NHS and whole idea of socialised medicine at an Oxford Union debate. Against me were the usual political class types including Andrew Lansley MP (Conservative Shadow Secretary of State for Health), Kevin Barron MP (Labour), Norman Lamb MP (Liberal Democrat) and that doyen of producer power and legislative favour, the President of the British Medical Association, Professor Averil Mansfield.
It was a great evening and everyone enjoyed themselves hugely. I certainly did and was delighted to have on my side the top cancer specialist Dr. Karol Sikora. He has long demanded changes to the ‘Stalinist NHS Quango’ and all in all we had immense fun together.
Sun 31 Jan 2010
As this fabulous paper against the medical monopoly makes clear, state monopolies initially set up to protect standards in the name of public interest invariably degenerate into the total and utter reputational shambles that they pretend to oppose.
It is with this in mind that I recently noted this story . You cannot make it up really. If only the Competition Commission would intervene to end the General Medical Council’s monopoly then perhaps things might start to turn around for doctors’ reputations.
For if allowed to chose, consumers would finally be free to decide between different brands, schools and philosophies of doctor. In such a world I would not chose a GMC doctor. Like millions of others, I would go out of my way to avoid members of an organisation that has consistently given the impression it exists to administer clubbable cover-ups for the benefit of its relatively well-healed members.
Come to think of it, why doesn’t the government allow a rival Competition Commission? Oh, no, silly me! That would be far too much like a market. Yes, it is much better to have one monopolist in the name of the ‘public interest’!
Serious point: to truly break state healthcare you have to sweep aside the medical monopoly. In the UK, that means removing the legislation that surrounds protected groups like the GMC. Like all other moral outfits they should stand or fall by their reputation in open, diverse and honorable competition. NFR says, let the people decide.
Tue 26 Jan 2010
While it has long been apparent that vast swathes of the trade union movement promote private healthcare as a benefit of membership – remember this – and indeed many of the movement’s leaders have long avoided state healthcare, NFR passionately believes that trade unions are important in civil society.
As voluntary associations, trade union aligned friendly societies, mutuals and co-operatives have glorious histories and ones that we can learn from today. Born of the market and representing a wide range of diverse ownership philosophies one can actually make a good case that with its mutualist and charitable roots, Britain’s historic independent sector owes more of its history to workers, the labour movement and a worthy concern for the poor than to any political tribe of the so-called right.
This is a serious point. For NFR believes that to become more relevant and useful in the twenty first century, trade unions should consider using their large memberships and economies of scale to forge even better strategic alliances for the benefit of members. Indeed, politicians should stop penalizing trade union aligned, or for that matter, any other sort of independent healthcare. Instead, these good things should receive a much friendlier treatment in the taxation and legal spheres.
Tue 3 Nov 2009
I am off to Oxford University tonight to speak to the Oxford Libertarian Society. I will be giving a joint talk with Shane Frith, Director of Progressive Vision. This is how we have been billed:
Alternatives to Government-Run Healthcare’
The ubiquitous assumption in British political discourse is that state control of healthcare is a necessary policy to ensure universal access to high quality care, free from profit-motivated decision making. Our speakers challenge this assumption, arguing that evidence from voluntary schemes around the world present a compelling case for rejecting the deference to state-run systems of healthcare. Arguing from her experience as a senior nurse in the NHS, Helen Evans will tackle the reform of healthcare provision, criticising the rationing and bureacracy of NICE, and the special interests served by the state’s position as a monopolist in healthcare.
Mon 2 Nov 2009
This is a great analysis of the healthcare bill presented to the US Congress last week by Speaker Pelosi. Grace-Marie Turner of the Galen Institute explains all that is wrong with it and why it breaks promises that President Obama made to the American people.
How can President Obama possibly endorse the bill that Speaker Pelosi unveiled to such great fanfare on Thursday? The House bill breaks major promises he has made to the American people about his goals for health reform. To name just a few:
Cost: The president has assured us that health reform would lower health costs. But the House bill would bend the federal cost curve UP, not down, according to the Congressional Budget Office’s preliminary analysis.
And only by using budget gimmicks were House leaders able to get the reported cost to $894 billion over 10 years, just barely under the president’s somehow magic $900 billion number. But that’s not the real cost. Robert Pear of The New York Times reports today, “By the most commonly used yardstick, the bill would cost $1.05 trillion over 10 years, roughly $150 billion more than President Obama had said he wanted to spend on the legislation.”
So the real cost will be over $1 trillion — and that doesn’t include the “Doc Fix.” The Speaker had the audacity to introduce that bill separately so the $245 billion price tag wouldn’t get counted in the total cost of the bill. Senate Majority Leader Harry Reid tried that trick last week, and went down in flames. Can the AMA possibly still stay on board with the House bill, since its deal has now been broken?
And health insurance premiums will soar, especially for younger families because the insurance regulations in the House bill allow only a 2 to 1 premium variation between the youngest and healthiest policy holders and the oldest and sickest.
And this doesn’t even count the huge economic distortions, cost-shifting, and new taxes that surely will be passed along to consumers.
Middle-class taxes: The president promised no tax increases on the middle class, but they surely will be paying the lion’s share of the $500 billion in new taxes to finance the bill. Americans for Tax Reform posted a listing of the new taxes in the House bill which violate the president’s pledge.
And add to that the estimated $33 billion in taxes the CBO says will be collected from individuals who don’t buy the expensive, government-mandated health insurance.
Keeping health insurance: A coalition of major business groups late Thursday sent a letter to Speaker Pelosi and Republican Leader John Boehner saying the House bill falls short of the bipartisan goal of controlling costs and could jeopardize group health insurance provided by employers to 160 million workers.
These are people who should know because they represent the companies that provide health coverage to the majority of Americans: The American Benefits Council, Business Roundtable, Corporate Health Care Coalition, the ERISA Industry Committee, National Association of Manufacturers, National Association of Wholesaler-Distributors, National Business Group on Health, National Coalition on Benefits, National Retail Federation and U.S. Chamber of Commerce.
No savings from the public plan: CBO concludes that the government insurance option would typically charge higher premiums than private plans available in the new Health Insurance Exchange. “That surprising conclusion raises doubts about Democratic promises that a government-run insurance plan would provide a lower-cost alternative to consumers,” Politico reports. And it adds, “At the same time, it calls into question Republican charges that the plan amounts to government takeover of health insurance — because only 6 million people would enroll in the plan, according to the CBO.”
The 400,000-word House health reform bill is absolutely astonishing in the level of government intrusion it would shove into the lives of every American, every business, and every health care professional. I won’t bore you here with the legislative jargon, but pick a page, any page, and you will see what I mean. Here is a link to the bill and a much more reader-friendly section-by-section analysis. You will see that all power and control vests to the government.
Hitting small business hard: Don’t miss the new analysis by WellPoint that mined its own actuarial data to model the basics of the plan incorporated in the House bill, using data from 14 states where it runs Blue Cross plans.
In all 14, it found that the legislation would drive up premiums for small businesses and individuals. Young and healthy consumers would see the largest increases, with premiums more than tripling in some states.
The head of the National Federation of Independent Business, Dan Danner, said the huge cost of the health reform bill “will ultimately come out of small business owners’ pockets and prohibit them from growing, investing in their business and hiring new employees.”
The bill requires detailed recordkeeping on employee health insurance, imposes new taxes and new civil penalties for not complying with the barrage of new federal health insurance laws, and puts burdens on virtually every company to pay for this expensive insurance, in perpetuity. See my article, linked below, in Tuesday’s Wall Street Journal for a report on how this is (not) working in Massachusetts.
Lock out: Speaker Pelosi’s announcement of the House bill had all the trappings of a major campaign rally. The only problem was that the public was locked out. Big chain link fences surrounded the West Front of the Capitol — usually a very open, public space — to make sure only supporters of the bill were allowed in.
This is so symbolic of the whole process: The American people are being shut out of the debate. All congressional recesses have been cancelled since August to keep members away from their constituents as much as possible, doors are locked while negotiations over the bills are taking place (breaking another presidential promise of an open and public process), and now, the public was even shut out of the public space outside the Capitol for the announcement rally.
This legislation is going to have an impact on the economic and health care freedom of Americans for decades to come. It is beyond irresponsible for Congress to be on the verge of passing these bills with this kind of disregard for the will of the people.
Politico carried a full-page ad yesterday with the pictures of 36 former members of Congress defeated in the 1994 elections in the aftermath of HillaryCare. It could happen again unless members open up this process to heed the fears of their constituents about a government take-over of the health sector.
The Independent Women’s Forum conducted its own poll that found women want to make their own choices and decisions about their and their family’s health care and they do not want politicians intruding.