Thursday, 17 March 2011
Privatising the NHS isn't as bad as it sounds
I'll shortly describe the system I grew up with (not in England). Basically, all doctors, including GP's, specialists, and some complementary therapists are self-employed. They are paid by each patient they see. Apart from a small set fee (which can vary depending on the service), the patient can recover the cost immediately by sending the receipt to their health insurance provider. For large bills (like hospital stays) you do not have to pay up front. You get a bill afterwards, which you pass on to your insurer. The health insurance providers are private companies but the minimum cover and its price are controlled by law and every person is required by law to have health insurance. There are no restrictions or higher fees for covering people with chronic conditions or high risk. The insurers are supported by government subsidy but they are in real competition with each other, so they offer very good basic and extra cover for quite low prices.
With this system, every patient can access any level of healthcare whenever they like. They are free to choose whichever doctor they wish to see, and can self-refer to a specialist if they desire although the fee is lower when referred. As the doctors get paid by patients, they have an interest in seeing as many of them as possible and treating them as well as possible. The money comes from subsidized health insurance, but the patient decides who gets paid! You'll find you're not rushed out the door because if you're not happy with their bedside manner and/or clinical outcomes, you are completely free to go elsewhere. You do not have to be registered with a GP and most doctors have open surgeries so appointments aren't required. But they are readily available when wanted, because that's good service. There's usually a slight surplus of doctors so the bad ones lose out.
The NHS is believed by the English to be a noble institution that provides healthcare to all, regardless of ability to pay, a bastion of equality, well worth the tax money spent on it. Except it's not. Everybody pays a lot of tax to run the NHS, which treats anyone and everyone for free, badly. If you want to be treated well, you pay extra to go private, in essence paying twice to get the care that you were supposed to get on the NHS but didn't. In reality, England has a two-tier health system where good care is only available to the rich. How exactly would using a private but state-supported system such as I described be a bad thing? With that system, everybody has access to the best doctors because they earn the same set fee from seeing and treating any patient, rich or poor.