At the End of the Day

You will only understand the complexity of the public/private health provision dilemma once you’ve experienced both for yourself. Yelling Lefties and bellicose Righties will pontificate forever on the subject, but only the experience of being a patient (and carer of the patient) will give any citizen the complete and honest picture of the task facing whatever real reformers come after the robotic idiot Lansley.

The key dimensions are these:

1. Both services contain hospitals, and hospital doctors. The former are Kafkaesque prisons, and the latter suffer from mild to acute idiot savantism. 

2. Both services have woefully undertrained nursing staff, and organisational communications so hopeless as to be black holes into which vital information is sucked and then never seen again.

3. In the NHS, you will be patronised at primary care level, and forgotten once in hospital. In the private sector, you will be admitted to hospital with difficulty from primary care, treated like royalty while you are in hospital, and forgotten once you leave.

4. The NHS provides affordable health care which, with luck, won’t kill and might cure. The private sector offers affordable health care to the super-rich 3%, top corporates, and those who can afford private health cover on account of rarely if ever being ill. The flaws in both systems should be obvious to any pre-pubertal teenager, but represent a baffling enigma for all civil servants, politicians, and health provision managers.

5. Healthcare demand is infinite, but cannot be rationed. Nobody in public life has yet fessed up to this reality, let alone tried to deal with it.

6. The answer at five is to switch from trying to do everything (up to and including the secret of Eternal Life) over instead to a system designed – within strict limits – to improve quality of life during our allotted span.

7. Expenditure priorities as set by civil servants, hospital/practice managers and medical staff are job-creatingly complex, insane and Utopian respectively. Giving all three groups a say results in car parks with impenetrable payment machines, pay TV for every bed, and IVF on the National Health.

8. Government pussy-foots around poor diet, without baring its teeth at the sociopaths who sell double-size Mars Bars and megacheap 37.5% white spirits.

The answer is twofold:

a. Take the problem away from the Sir Humphreys and the Ed Milibands – and forever out of insurer/profit-driven hands – by mutualising health services on a regionally mutualised basis…complete with savings provision, like the old building societies.

b. Make food manufacturer levies part of the funding model.

That’s it. Thank you, goodnight, and enjoy the weekend.

14 thoughts on “At the End of the Day

  1. Last weekend I had a stabbing pain near my heart all of Saturday. I thought it would pass. All of Sunday I had a stabbing pain near near my heart. I thought that it would pass. Bank holiday Monday the stabbing pain had not passed. I did not go to A & E at the hospital because I did not want to wait for 6 hours to see a doctor!

    My son insisted I went to the drop-in NHS general practice at the local railway station, which I did not know existed! Charming receptionist asked me to complete a form of my personal details and explain what my problem was. They apologised for the fact that I may have to wait an hour to see a doctor as it was a Bank Holiday and they were very busy. I took a seat.

    After 10 minutes a young lady called me into her office and explained that she was a nursing medical assistant. She questioned me fully and at full speed typed my answers onto a computer. She said she wanted an EGC which she performed there and then. After she had finished she said she wanted to talk to the doctor and left the room. She returned to say the doctor would see me immediately and she showed me into his room.

    The doctor examined me and said the ECG was ok but there were a number of things it could be and he wanted me to go to hospital. He picked up the phone and phoned the hopital to arrange an immediate appointment.

    When I arrived at the hospital a receptionist had already printed off my file with my name in large black print on the cover. A nurse came to see me to take blood for various heart/lung related tests and carried out another ECG. She said the doctor would see me when the tests were complete.

    When the doctor called me she carried out a thorough examination and went to talk to the heart consultant. She said he wanted an x-ray and for me to stay in overnight. The x-ray was carried out immediately.

    I spent the night in the hospital and in the morning the Consultant came to see me, explained what the problem was, said it was nothing to worry about and would go within a week, and sent me home!

    Friday night i am fit and well and just come back from the pub!

    The NHS service I received was as good as you could wish for.

  2. The fundamental problem is the “infinite demand and inability to ration”.

    However, people who are lucky enough/talented enough/hard-working enough to be rich, should be entitled to spend their money however they wish, including on healthcare not available on the NHS, If this kind of healthcare is available at all (and why wouldn’t it be, even if you have to go abroad for it), it could be made available to (some of) the rest of the population through insurance.

    My point being, that even if the NHS becomes “a system designed – within strict limits – to improve quality of life during our allotted span.” it won’t stop a “two-tier” system from existing, as now.

    The requirement is for a stricly-defined limit on NHS activity, and that’s the political nettle that no-one wants to grasp, because it represents a curb on the infinite demand, and a rationing of the non-NHS care.

    • ‘However, people who are lucky enough/talented enough/hard-working enough to be rich, should be entitled to spend their money however they wish, including on healthcare not available on the NHS, If this kind of healthcare is available at all (and why wouldn’t it be, even if you have to go abroad for it), it could be made available to (some of) the rest of the population through insurance.’

      It all sounds so terribly, neo-liberally plausible doesn’t it?

      However it is based on the false assumption that all of your wealth is due uniquely to your own luck.talent/hard work.
      Sadly there is no such thing as the lone genius/individual wealth creator/ambitious striver.
      Ones wealth is derived from profiting from others or exploiting ideas previously elucidated – the collected wisdom and labour of humanity. Either way your success is from standing on the shoulders of others, living or dead.
      So whilst your private income after taxation may be spent as you wish (and that has never been restricted under the NHS) your level of taxation should exceed your needs from the state in order to give back that which you have crystallised in personal wealth.
      The idea that healthcare can be provided by private insurance is risible – one need only look across the Atlantic to see how badly that works.
      The rich get overdiagnosed and overtreated, the poor get nothing at all and the middle class get driven into bankruptcy by chronic health problems.

      • I’m not sure what your point is.

        I am glad that you agree that, regardless of whether one’s wealth is totally or partially due to luck/talent/hard work, one is still entitled to spend whatever is left after tax, however one wishes.

        I don’t think I commented anywhere on the level of tax that one is obliged to pay. That “my level of taxation should exceed my needs from the state in order to give back that which I have crystallised in personal wealth” is moot (does it apply to poor people?) but is not incompatible with my buying elsewhere, healthcare that is not available on the NHS.

        In the USA, healthcare is provided by private insurance. And while this system has its faults, so does the NHS. I don’t think my comments advocated a system such as that found in the USA, nor did I intend them to.

        I’ve looked hard, but I can’t find your point.

      • @DE Indeed, no-one lives or prospers in isolation from what is or has gone before. So your point that “your level of taxation should exceed your needs from the state in order to give back that which you have crystallised in personal wealth” is not only valid, it’s fundamental to a civilized society.

        That of course should not preclude those with the means from having private health insurance or choosing private treatment. I’ve done it myself, either because I didnt want to wait 18months for some ‘non-urgent’ NHS treatment or because the treatment wasnt available on the NHS.
        Nevertheless throughout my life I’ve had several occasions to be thankful for the existence of the NHS, without which I’d definitely be dead by now.

  3. Your excellent essay omits the interesting point that for the most part the hospital clinicians in both secotrs are the same people, in one sector moonlighting on a very nice earner, and for that reason behaving much better.

    • @JA As I understand it, far from ‘moonlighting’, NHS consultant contracts specify how many hours of private practice are permissible.

  4. JW mutualising health services regionally might lead to a lack of financially demanding specialised hospitals. I wonder if we’d be back to the local cottage hospital scenario which, though it has its place, cannot provide the degree of specialisation which is the signature of 21st century medical treatment. Presumably each region would aim to have one major teaching hospital to which people would need to be willing to travel for specialist therapies. The Department of Education, the Royal Colleges and Higher Education Funding Council would also have to be involved. So it’s quite a tall order. Howevah…..food manufacturer levies would certainly be one way to offset the costs. Nice one.

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