Tuesday, January 01, 2008

If the NHS becomes a conditional service then it should be privatised

What would you think if a burglar broke into your home, took all your valuables and then came knocking on the door and said you could have them back but only if you promised never to eat beef on a Friday? Perhaps you'd make the promise anyway, but how would you feel about the situation?

That is what Gordon Brown wants to do with the NHS it seems. According to the Daily Mail (which is well placed to know Gordon Brown's plans thanks to it's editor's friendship with the PM) there are plans to make NHS services conditional upon lifestyle. So, if you're fat, or you smoke, or you drink, then the NHS will be able to refuse treatment.

The social authoritarian plans appear to now be that they will take your money in National Insurance contributions which you have no choice about, and then they will only provide you with services back if you follow their rules about how you ought to live. In other words, the Government will now not only reserve the legal right to take part of your earnings, but it will also reserve the right to give you bugger all back for the money as well.

Well excuse me for a moment, but that really does make my taxes closer to theft than ever before. No one particularly likes paying tax, but in the current NHS system at least there is a trade-off when you do it. You know that you have access to services because you are one of the people that is paying for them through your taxes.

Whilst you don't have a choice about whether you pay tax or not you do at least there is a principle at play that means you are "buying" something with it. However, if you're a smoker, what is now being proposed is that you're buying insurance that you have no choice about and being told that conditions of that insurance are being changed and that it's just "tough shit".

Don't get me wrong, I don't have a problem with the policy per se. Insurance always comes with conditions, but the crucial problems is that I cannot choose not to pay National Insurance. As such we're back to the burglar analogy. My money is being stolen from me and then the Government has the cheek to offer it me back with conditions.

If the Gordon Brown wants the NHS to act like a private medical system that has graduated insurance policies defining what is and what is not covered, then he might as well go the whole hog and privatise the whole thing and move to a genuine insurance based state system that people can be in or out by virtue of choice.


Unsworth said...

'Conditional' is an interesting term. What's proposed is actually more 'contractual' - with potentially fatal outcomes.

As I read this, the principle is that treatment(s) will not be provided to those who do not comply with a contract imposed upon individuals. That in turn raises the question as to who will apply the contract and what their responsibilities and powers may be. Naturally the legal profession will be thrilled at this splendid new opportunity for expensive and pioneering litigation.

Now what about the reverse? Let's take an individual who fully complies with the strictures of these contracts, but the treatment proves ineffective or worse. What happens in this case? Is there reciprocity in the contract? If so, what legal remedies will be available?

Maybe the answer would be to fully privatise this 'National Health Service' - a complete misnomer, of course. It is so driven by targets and accountants that there would be little requirement for change, apart from taking that proportion of our NI contributions which relates to 'Health Care' and handing it over to favoured private companies. Come to think of it isn't that what happens now?

dizzy said...

Not so sure it is contractual as such, as you won't be entering into a contract as such, although the Government may see it as such I guess.

Anonymous said...

You're forgetting that care in an emergency and access to medical advice will still be offered, thus providing quite a lot for your NI contributions.

I think what they're getting at here is a sense of 'we won't invest our time/money/skills in you if you don't take care of that investement.'

IE: what's the point in giving someone inhalers for their asthma if they still smoke? Why do a knee replacement (which has to be revised in about 10 years anyway) if you're morbidly obese and will reduce the prosthetic's life to half that - meaning twice as many operations and a ruined knee.

Afterall, it's the taxpayer subsidising your operation - it's only fair that you should do what little you can to make it a sound investment.

dizzy said...

"it's the taxpayer subsidising your operation"

What am I?

Anonymous said...

I declare an interest - I smoke and enjoy doing so.

This 'plan' is even crazier than it appears at first. Why treat drivers injured in motor accidents caused by their poor driving or consumption of alcohol - even if within legal limits?

Why treat moutain climbers, hill-walkers or pot-holers or other participants in sport injured in pursuit of their activity?

Why should pregnency - a self-inflicted condition (you know what I mean even if my early New Year brain is still asleep) - attract treatment paid for by non-participants?

Why should older people be treated for broken hips/wrists or whatever? The sole reason they suffer the injury is a result of their life-style. And don't for a moment suggest that growing older will not be declared a 'choice' under such a plan.

In short - whatever you do or don't do, there will be an identified causal link between your 'bad' habit and current need for treatment thus you don't get treated on the NHS.

Word verification QEDefxyb

Happy New Year!

Rich Tee said...

Absolutely right. I have just taken out PMI for the first time ever. I have had a private dentist for years. I always have to pay for my prescriptions on the rare occasions that I visit the doctor. And I'm not exactly wealthy - I'm only on an average salary.

OK, so you do get the emergency service and advice as hollowgodric suggests, but I can't help getting the feeling that I'm being cheated.

BrianSJ said...

NI was a misnomer; from the outset it was a tax; money in that FY was used to fund treatment that FY. It wasn't an insurance scheme, and this is why it has been so inequitable for so long.
Handing the money to private companies direct would be different; the customer would be me not GB.

Anonymous said...

I have always said that is significant that the government have always said that "the NHS will remain free at the point of treatment" (or something similar). This leaves it open to sending out a bill later but not refuse emergency treatment at the time brought in on the ambulance.

What they need to do first is address the huge amount of time that the NHS has to spend on the results of drunkenness which has increased since this government made drink more accessible. It must be really depressing to work overnight in the NHS at the weekend and spend most of your time on cases caused by heavy drinking. These are the people who need charging the full cost of their treatment.

Anonymous said...

I don't quite get the logic of someone who is as secretly fat* as Gordon Brown telling us the NHS isn't going to treat fat people. It's a bit like David Blunkett giving us a lecture on ethics and how not to abuse your ministerial perks.

* Gord is a fatter man than he appears; he hides it well with loose suits and has improved his posture since he became PM.

Phil said...

Don't worry, Dizzy, Brown would prefer to privatise the whole thing. How else can you explain the government's love-in with PFI, contracting out of services, etc etc?

Anonymous said...

Doctors are obligated to respect the Hippocratic Oath and must treat all people who are sick and need help.

We all pay into the NHS and you have no right to refuse treatment to any British citizen. It is the most unethical proposal I have ever heard of (and probably illegal).

This proposal is morally bankrupt. The government is happy to make huge amounts of tax money from selling cigarettes and then it refuses to treat smokers on the NHS who need treatment?

To refuse treatment on the NHS is wrong on so many different levels.

Selective medical care is a very slippery slope ...

David Cameron has said: "Our position is clear. As has always been the case in the NHS, NHS treatment must be judged by medical professionals on the basis of the clinical need and the best interests of the patient. The NHS will always be universally available to all based on medical need – we will never bring in any kind of blanket ban denying people routine treatments solely based on their lifestyle."

Anonymous said...

It's odd that the contractual obligations which they would wish to apply hit the people who have probably contributed more in taxes and national insurance than the rest of us (smokers, drinkers, fat obese motorists).

Besides, what is to become of the Hippocratic oath?

Happy New Year!

Anonymous said...

Just say I have pains in my chest and am admitted to hospital I am a heavy smoker. First question are you a smoker, answer no, I stopped three weeks ago
Get real Gordon

Anonymous said...

"Contracts" are by mutual agreement. Gordon Brown is declaring that everyone has a contract with the NHS, which is a bold faced lie.

As I've said elsewhere, the only solution to the mare's nest of the socialist-driven NHS is to privatise NI contributions. In other words, the contribution would still be mandatory and still be deducted at source. But the wage/salary-earner would be able to nominate the healthcare insurer of his choice. The NHS would be just one of the choices among companies that enter the field.

This way, everyone would have access to private medical care if they chose it. All insurance companies have terms and conditions. As one of the healthcare insurers, the NHS would have the same requirement to provide a legal (ie, not a notional contract dragged out of the swamp of Gordon Brown's "brain") and people would have to sign the contract with their insurer of choice, as with any contract.

This would have the effect of vastly deflating the grossly bloated NHS. Like the other insurers, it would have to operate within its means. This would mean that "the largest employer in the EU" would be reduced to around 15% or 20% of its current gross self. And it would have to perform against the private insurers in the field.

I have no respect whatever for the communist NHS, but I can see the appeal when it first started back in those days of much simpler medicine with much less expensive equipment and fewer drugs. It is anchored in the socialism of the last century.

Newmania said...

Interesting post Dizzy , one of your best.. You commenter says , well whats the point of helping you with your asthma if you continue to smoke . Helping you with your asthma would include helping you not to smoke not denying your treatment . By the former logic anyone who is old may expect less help and less treatment on the basis of fewer health/year returns to the tax payer. The old would, rightly say , as you do, “ I am the fucking tax payer and I want what I have paid for ? “

Although you say , by the way , that Insurance polices always come with conditions there are many strategies for ensuring the market copes with difficult areas like catastrophe or slum dwellings. Furthermore the conditions are always subject to a consensus ad idem ie they must offer what was broadly to be expected at the time off purchase . Insurance does not impose the sort of unfair conditions you might imagine it is heavily regulated , governed by a fluid market and subject to the law and specifically Consumer protection statute law. No Insurance company would dream of trying it on the way the NHS do.

paul ilc said...

Good post, Dizzy.

"National Insurance" is not a hypothecated tax: it is a redistributive tax on jobs.

The sclerotic, stalinist NHS should be abolished ASAP and replaced with a compulsory insurance scheme with a choice of providers.

Anonymous said...

So if gibbering browns eyesight fails,he goes to hospital and they say"shouldn't have played rugby should you bye!!" I can live with that.

Anonymous said...

Paul ilc - that's what I said above. NI contributions should continue to be mandatory, but the wage/salary earner would nominate the health insurance provider he wishes to patronise.

Anonymous said...

This is classic Mr. Bean half-baked nonsense. The government has had to come out and correct all the reports by saying there will be "no two-tier NHS" and that no-one will be refused treatment. So basically 'our policy in no way bears any relation to the statement we released in the morning.' Another super fast U-turn in a matter of hours. Government scrawled on the back of a New Labour pledge card (fag packets being too covered in health warning to write on).

Anonymous said...

National Insurance - value for money.

I am approaching 60 and my private health insurance costs me just over £1,000pa. Let's double that to allow for GP and A&E services that are not covered and reasonable private costs would be about £2,000 pa. ( a GP gets about £120 pa per patient and the drugs bill is about £180 per head - total NHS spend per head is just under £1,800 pa - so thats a very generous assumption)

For the basic state pension assuming an average life expectancy to 82, 5% investment income and inflation at 2% it will need a funding pot of about £60k at age 65. With a real interest rate of 2.5% pa building such a pot (in 2007 money) would require contributions of about £900 pa.

Throw in a bit for job seekers allowance and some catastrophe insurance and the total annual cost is unlikely to be more than £3,500 pa. On an income of about £40K next year's contributions will be £3,803. Thats before the employers contribution of 12.8% of everything I earn.

Even if one took the socially responsible position that someone on 1.6 time national average earning should be prepared to pay double to cover for the cost of someone who can't afford to pay, it still looks like a bloody crap deal.

And then they want to refuse to deliver what has been paid for!!!!

Anonymous said...

Exactly right Dizzy.

This sort of thing has been going on in the NHS for a while now anyway.

Labour claims to be the torch bearers for the NHS but ultimately they're content to betray everything it was supposed to be about.

It's about time we started offering an opt out for the NHS.

If I'm not using it (i.e. I've gone private) then why should I pay for it?

BrianSJ said...

The NHS has always operated a rationing system. This has got more noticeable as medical advances increase the potential expenditure. In a sense, 'conditional' treatment is fairer than a post code lottery or the arbitrary outcomes of the NICE decisions. An insurance policy sets out what you pay and what you get - this seems better than the NHS could achieve.

Anonymous said...

All rather righteous and legalistic.
BUT some treatments produce no benefit in the obese.
In others the side effects increase to outweigh any putative benefits.
BUT you "know yer rights innit"

flashgordonnz said...

What a clown, Gordon Brown.

Grumblestiltskin said...

Asking around, one of the interesting things is that doctors are already refusing elective treatment to those who drink and smoke.

The justification is that it is a doctor's duty not to carry out a procedure where the risks outweigh the benefits. If you are obese and/or smoke, the benefits are greatly reduced and the risks become higher. You can debate this bit all you like, but would you, as a human being, do something to another when you know it would probably do them great harm?

GB is simply turning this practice into formal government policy so he can look like he's doing something.

Anonymous said...

I wasn't going to comment on this because we are all sick of "reform" of our fundamental institutions. Lunch over the holidays with distant members of the extended family fired me up again. This couple are very senior members of the health industry in the UK, a consultant in the NHS & a senior manager in a regulatory body. Very very committed to their profession and us, the patients. A gentle enquiry elicited an explosive reaction "The NHS is being destroyed". Only two reasons could be uncovered in the time available 1) The NHS job placement system which has succeeded in completely random placement of hospital doctors - a sort of anti-meritocracy - such that the person recruiting finds that they often have to refuse to interview candidates who are in no way qualified for the job they are applying for. Meanwhile many of the very best doctors cannot get any interview at all. This system is STILL in place and, entirely on its own, will totally destroy the NHS as a compentent medical organisation. Who is prosectuting this fantastic dogma? 2) Excessive immigration: there is no way, in a service which has been set up to provide a service for the whole population, of checking if you have a "right" to the service. Uncontrolled and excessive immigration is overloading the service. We are compounding this by paying for translators! This is a double or even triple whammy. we have the cost of an immigrant who has not paid for his/her "national" insurance, the translation service, PLUS the medical tourisme practised by the extended members of their overseas family.

Truly fantastic.
No doubt even thinking these thoughts leads me open to prosecution for a thought crime. Having written them down & published them on the internet then I calmly await my fate & the knock on the door

I try and keep quiet about my concerns, I don't want to be labled grumpy old man (far too late I am afraid!, but it is fascinating to find these comitted members of the health industry so embittered by what Nulabour is doing.

tgf ukip said...

Same story in the Telegraph which, under this Editor and this Political Editor, is now even more up Brown's arse than The Mail. While there's a jockocracy, Andrew Neil plainly is after a title.

Liz said...

Ensuring that the NHS doesn't have any patients is a novel way to solve the cash crisis, I suppose.

BBC News 24 is running some horribly politicised thing called 'Obesity Week' at the moment. Yesterday I found myself forced to turn over when a skinny Scottish doctor started getting terribly excited on camera and telling us that it is the duty of government to save us from ourselves by raising the prices of fattening foods.

I'd love to know what Gordon's BMI is.