Almost everything else in this country is delivered via the market. Essential items such as bread, or milk, or tax services or... well... anything is delivered via the mechanism of the market. So, what makes health provision so very special?
What makes health care so special, my dear Devil, is firstly that the patient has no way of telling good health care from bad health care, and secondly un-necessary health interventions are bad for patients in an occult way.
Other examples of such 'special' services are policing, the armed forces, and intelligence services.
Even education is not a 'special' service because it is usually pretty obvious to the end user whether the education system being provided is actually any good.
How, exactly, can a market function when the customer has absolutely no way of knowing if the product is life-saving, useless, or potentially lethal?
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9 comments:
Almost everything else in this country is delivered via the market
(can't be bothered to go to his blog to say this) this is just crass.
One of NHS achievements is to restrain the commercial activity of doctors, and the quack fringe.
Once doctors go commercial then rampant "patent medicine" "special tests" "scareoscopies" and "nuciform sac removals" will come back into fashion.
Doctors could easily medicalise every activity of life and make work (and money) for themselves. Some (too many) of press and public would buy into it.
"It is the first duty of the doctor to educate the public not to take medicines" said Napoleon. Open medicine up to the market and we'll teach you to take all sort of things to our profit. In best medical parlance it won't hurt us at all.
If you're lucky such processes will only hurt your bank balance.
In the meanwhile just think you could have a cancer growing anywhere inside you. Wouldn't you like the reassurance of a scan to be sure your safe?
"..firstly that the patient has no way of telling good health care from bad health care, and secondly un-necessary health interventions are bad for patients in an occult way"
Fair point, if the patient were to be the customer. However, I think that the model he suggests is that health care would be purchased by the patient's insurance company which one would hope would be making more informed decisions, although there are other potential problems
The decision the insurance company will be looking for will be purely based on finance. The best quality health care won't get a look-in. Just look at how they behave in the US.
DK may mean insurance companies (and he probably does), but the question stands.
How exactly, can the market help when the insurance companies can't tell what is good health care and what is bad health care.
However, they can tell the difference between cheap health care and expensive health care.
See the problem?
My dear doctors,
For starters, right now it doesn't matter if the patient can tell good healthcare from bad: they get what the politicians tell them that they will get, regardless.
Second, can you tell what good medicine is? Yes? Good. Then you will, presumably, be able to advise your patients, won't you?
Or do you not see any kind of future for GPs in a private system?
"In the meanwhile just think you could have a cancer growing anywhere inside you. Wouldn't you like the reassurance of a scan to be sure your safe?"
Absolutely. What is the total waiting time for a scan on the NHS these days?
"The decision the insurance company will be looking for will be purely based on finance. The best quality health care won't get a look-in. Just look at how they behave in the US."
Or, alternatively, let's look at other systems based on insurance, shall we? How about Switzerland? Or France? Or Germany or the Netherlands or, basically, anywhere in the world that isn't Britain. Even in Canada, where the state funds the majority of healthcare, the provision is still private.
Anyone who wheels out the US as a recent for not going for a private system is, I am sad to say, an ignorant wanker.
There are many degrees of "private" and there are many systems of insurance; to point at the US and whine about their system (which is nowhere near as bad as most make it out to be anyway) is just stupid.
DK
P.S. I know that doctors like to think that they have a monopoly on knowledge, but let's put it another way: given the recent troubles, given a choice, how many people do you think would choose to be treated at the Kent and Snuffit Hospital.
Now, how many people currently have no choice?
DK
DK
Thanks for responding.
You are failing to distinguish wants from needs.
Health needs are diseases that need treating. If they are not treated the results will be bad in terms of mortality (death) or morbidity.(dysfunction, handicap, pain, discomfort, incapacity benefit etc) NHS is currently far from meeting all health needs.
Health wants are silly things. They are operations that are done for vanity (laser eye surgery, most cosmetic work.) wants are the consumer demand end of medicine and if patients want to pay for these they are welcome to do so. We'd say "caveat emptor" to them, but fools and their money are soon parted.
It is too easy for doctors to generate health wants eg scans and blood tests "just in case, to be safe" etc. Even worse you get VOMITs (Victims of Medical Imaging Technologies)and sufferers of incidentalomas. Hence restraining medical commercialism is probably a good move...and prevents iatrogenic disease...even though it may disadvantage doctors.
Where we'd agree with you is that NHS is an unmanageable monolith and the more mangers there are the less well it gets managed.
An insurance system along European lines could well be sensible, with compulsory coverage of whole population. Having several different insurers competing for patients could liven things up a bit.
An American model (See blog Deny, Diminish, Deny and Blame) would be appalling.
Sadly Labour seems more focused on USA model than UK.
My dear Devil,
For starters, right now it doesn't matter if the patient can tell good healthcare from bad: they get what the politicians tell them that they will get, regardless.
No, they don't. They get what NHS staff give them. Doctors and nurses, who don't have a financial interest in whether the patient gets treatment A or B provide the care. We spend so much of our time bypassing the government bullshit, which is why the government spends so much of it's time trying to bring us to heel.
Increasingly, of course, the NHS is being corrupted by targets and more and more financial incentives. This is not a problem with the NHS, but with fuckwits who think private is better trying to apply private solutions to the NHS. When this does not work, they then blame the NHS!
Second, can you tell what good medicine is? Yes? Good. Then you will, presumably, be able to advise your patients, won't you?
No! No! No!
I have fuck all idea what good medicine is. I know what I THINK is best for the patient in front of me. But, when I had my hernia operation recently do you think I KNEW what the best option was for me? Did I fuck! I was terrified, and had to trust the consultant treating me. He could have been a ham fisted moron, and I would have little idea.
Of course, there are obvious duffers out there. The system protects them, which is criminal. But no more so than Canada, or France, or Germany, or the US.
Do you really think private providers care about the patients? They care about the cost. Insurance companies in the US have been shown to routinely deny 10% of requests for care AT RANDOM because they know the savings outweigh any costs of being caught.
Or do you not see any kind of future for GPs in a private system?
For me? Fuck yes. But is that good? I've worked in fee-for-service systems. I know that despite my belief in professionalism and patient-centered care, I probably did stuff because it made me more money. Did I bring patient back perhaps more often than they needed to overbill? How would I know? The variation, if it was there, could just be chance.
That's the problem. Don't you see? Medicine is so complex, and so many bad results happen due to chance, that spotting butchers and con men is almost impossible.
"In the meanwhile just think you could have a cancer growing anywhere inside you. Wouldn't you like the reassurance of a scan to be sure your safe?"
Absolutely. What is the total waiting time for a scan on the NHS these days?
Then you are a stupid cunt, and your chances of dying will go up. Read the previous fucking post about tests for fuck's sake. You will get a FALSE POSITIVE result and end up on chemo that you don't need.
Give me strength!
"The decision the insurance company will be looking for will be purely based on finance. The best quality health care won't get a look-in. Just look at how they behave in the US."
Or, alternatively, let's look at other systems based on insurance, shall we? How about Switzerland? Or France? Or Germany or the Netherlands or, basically, anywhere in the world that isn't Britain. Even in Canada, where the state funds the majority of healthcare, the provision is still private.
No, Canada has no private provision. It has not-for-profit providers that are owned privately. That is not the same thing (see posts passim about death rates being higher in profit vs not-for-profit hospitals).
I mean, DK, for someone who is clearly a clever chap, you're pretty stupid when it comes to the evidence vs dogma thing.
Anyone who wheels out the US as a recent for not going for a private system is, I am sad to say, an ignorant wanker.
Why? It is the most private system in the world (or was). I thought you said the market is good for bread so it's good for health care? I don't see you saying that Tescos should be on a Social Insurance model. So what is so special about health care?
Good grief, DK, even you are saying that Health does need a SPECIAL system - a Social Insurance model such as the one in Germany.
I agree, the US is a bad example, but you brought the whole 'private good, public bad' thing up.
There are many degrees of "private" and there are many systems of insurance; to point at the US and whine about their system (which is nowhere near as bad as most make it out to be anyway) is just stupid.
The US system is much, much, worse than people make out. Why do you think the Kings of Capitalism are all talking about reform?
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