Privatised Healthcare: What Would We Lose?


Contrasting the different challenges facing British and American healthcare, Janet Daley attacks the “anachronistic and unsatisfactory” arrangement of a “state-owned-and-run monopoly of medical provision”. This throws up a number of obvious issues around the equity, efficiency and sustainability of these different models. But even aside from the questions of whether state run healthcare is cheaper, more equal or produces better health outcomes, I think Daley accidentally touches upon a couple of underappreciated benefits of the NHS style system: the limitation of unpleasant choice, and avoidance of the distrust of the market.

“Note to politicians: there is a new generation of adults out there who buy their holidays and their electronic equipment on the internet, who purchase their insurance on price-comparison websites”

Daley makes the automatic assumption that because they live in a consumerist society and are constantly making consumer choices, people must desire and enjoy these choices. We do live in an era where most people purchase their insurance on the internet. But that doesn’t mean that they like doing so – in fact, the majority of people see it as an unpleasant chore. The ubiquitous adverts for price comparison websites are intended a) to motivate people to exercise their consumer choice and b) to convince people that acting the consumer is less unpleasant than they expect.

So why then does Daley assume that the NHS deprives people options they want to take, rather than preserving them from having to go through tedious and time consuming decisions? I can’t be the only one to look at the process of Obamacare and be extremely grateful that I don’t have to worry about health insurance, don’t have to sit down on my hard-earned weekend and run through the different plans, however nicely they are laid out. I can’t be the only one grateful that I don’t need to worry about anything, and can still know I will receive care when I need it.

“A system that is absolutely, unconditionally free at the point of use with no questions asked and no exceptions made”

Daley sees this as an outdated principle which can only cause problems. But one benefit this principle brings is obvious. It means that the unwell and their families never need to worry about money at a stressful and difficult time. Even if the money can be claimed back, even if the excess is small, the fact of needing to have money free to pay for care just adds another potential headache at a difficult time.

But, more subtly, the fact of money changing hands alters the social dynamic between doctor and patient. For example, psychologists have shown that ‘priming’ people with the idea of money alters their outlook: it makes them more individualistic and less socially-oriented, a worrying trait to encourage in doctors.

Moreover, the exchange of money creates a more ‘transactional’ relationship between doctor and patient, and potentially erodes trust between doctor and patient. The doctor’s job is no longer to make me better, but to get the most money out of me. How do I know they are prescribing that drug because it is the most effective and not because it is the most expensive?

Now I’m sure Daley would respond that those willing to take the time and effort to work out their optimal health insurance plan will receive better care at a lower cost. And she would probably say that a bit more mistrust between doctor and patient might make doctors less complacent, and force them to improve standards to meet the challenges of their patients. I have my doubts, but they are not implausible claims, However, she cannot deny that something has been lost, that people would be in these ways worse off, without the NHS. And so a lot depends on showing that cost and effectiveness would be clearly higher with greater privatisation.

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