{"id":7071,"date":"2018-07-05T14:27:04","date_gmt":"2018-07-05T14:27:04","guid":{"rendered":"https:\/\/sceptical.scot\/staging\/?p=7071"},"modified":"2026-04-18T19:34:32","modified_gmt":"2026-04-18T19:34:32","slug":"private-alternatives-nhs-cost-much","status":"publish","type":"post","link":"https:\/\/sceptical.scot\/staging\/2018\/07\/private-alternatives-nhs-cost-much\/","title":{"rendered":"Why private alternatives to NHS cost so much more"},"content":{"rendered":"\n

The NHS has survived to the age of 70<\/a> and now costs<\/a> the UK just over \u00a3120 billion per annum. Many advanced economies spend even more on healthcare per head of population. Why do fully paid-up capitalist nations persist with this Stalinist approach to healthcare?<\/p>\n\n\n\n

Instinctively we might cite humanitarian and political reasons. But is this enough? Arguably access to food is a more fundamental human right, yet we don\u2019t have a National Food Service.<\/p>\n\n\n\n

Governments do intervene in food markets, providing social security to poorer people to feed themselves \u2013 and we can debate<\/a> whether it\u2019s adequate<\/a>. Generally, however, food is left to the market. In contrast, healthcare spending comes mainly from the public purse \u2013 see below.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

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In the 1960s, the eminent economists Alan Williams<\/a> and Dennis Lees<\/a> held a correspondence about who should fund healthcare. Lees thought there was nothing to distinguish healthcare from other commodities, and thus prevent it being provided mainly via the free market. Williams drew on the analogy of the duck-billed platypus to disagree:<\/p>\n\n\n\n

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The argument you employ would run as follows \u2026 Many birds have duck-type bills, and lots of animals have furry bodies, and as for laying eggs, this is common in birds and reptiles, and all mammals suckle their young, therefore the duck-billed platypus, \u2018would appear to have no characteristics which differentiate it sharply from other \u2026\u2019 etc. I hope my point is clear.<\/em><\/p>\n<\/blockquote>\n\n\n\n

In other words, healthcare is unique, despite sharing individual characteristics with other types of expenditure. It\u2019s this unique combination that makes it so problematic to provide via the market. Let me explain.<\/p>\n\n\n\n

Because we as a society care that these healthcare needs are met, we see this as a market failure that justifies government intervention. The government intervenes in food markets for similarly altruistic reasons, though the failures are not comprehensive enough to warrant going further \u2013 food needs are more predictable and people know what they like.<\/p>\n\n\n\n

Some countries try to care for their needy without a full publicly funded system. One option is a system of voluntary contributions, where anyone who pays an agreed regular amount can rely on it for medical cover \u2013 such as the Medicare<\/a> and Medicaid<\/a> systems for vulnerable groups in the US.<\/p>\n\n\n\n

Yet before Obamacare<\/a>, around<\/a> at least one in six Americans were still inadequately insured. This subsequently dropped to more like<\/a> one in eight, but has since been rising<\/a> as the Trump administration attempts<\/a> to unpick the reforms. The US has still not learned that taxation is the most effective way to ensure 100% coverage \u2013 leaving it as the only advanced economy in the world unable to do so.<\/p>\n\n\n\n

Finally, markets work properly when consumers are well informed, which isn\u2019t the case in healthcare. Since it\u2019s so specialised, consumers instead rely on the fact that medics must attain certain qualifications before they receive a licence to practice. Once granted, the danger is that this literally becomes a licence to print money. To combat this requires what the great Canadian health economist Robert Evans once referred to<\/a> as the \u201ccountervailing power\u201d of government to negotiate with the professionals over pay and levels of provision.<\/p>\n\n\n\n

The great survivor<\/strong><\/h2>\n\n\n\n

As early as 1953, the UK Conservative government requested<\/a> an inquiry into the cost of the NHS with a view to dismantling it. This backfired when the Guillebaud report<\/a> of 1956 declared the NHS value for money. There are still many in government today who, as with other goods once thought the preserve of public provision, would still divest the NHS if they could. They cannot precisely because of how healthcare operates as a commodity.<\/p>\n\n\n\n

I don\u2019t mean to paint the NHS picture as rosy but, in reality, publicly funded healthcare is more efficient and more equitable. The UK is heading for a total health bill of \u00a3200bn per annum, but even that is actually great value for money.<\/p>\n\n\n\n

The US highlights the alternative \u2013 spend twice as much and fail to provide access for the whole population. Perhaps recognising healthcare as the duck-billed platypus of commodities, even Margaret Thatcher declared<\/a> in 1989 that \u201cthe NHS will continue to be available to all \u2026 and to be financed mainly out of general taxation\u201d.<\/p>\n\n\n\n

With Theresa May\u2019s recent early birthday present<\/a> to the NHS, it is a case of d\u00e9j\u00e0 vu. It\u2019s a reminder that health spending is as much a policy choice as a question of affordability.<\/p>\n\n\n\n

First published by The Conversation<\/a><\/em><\/p>\n\n\n\n

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 <\/p>\n","protected":false},"excerpt":{"rendered":"

‘I don\u2019t mean to paint the NHS picture as rosy but, in reality, publicly funded healthcare is more efficient and more equ’itable. The UK is heading for a total health bill of \u00a3200bn per annum, but even that is actually great value for money.<\/p>\n","protected":false},"author":215,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[706],"tags":[74],"class_list":["post-7071","post","type-post","status-publish","format-standard","hentry","category-society","tag-health-spending"],"_links":{"self":[{"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/posts\/7071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/users\/215"}],"replies":[{"embeddable":true,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/comments?post=7071"}],"version-history":[{"count":2,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/posts\/7071\/revisions"}],"predecessor-version":[{"id":18832,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/posts\/7071\/revisions\/18832"}],"wp:attachment":[{"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/media?parent=7071"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/categories?post=7071"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sceptical.scot\/staging\/wp-json\/wp\/v2\/tags?post=7071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}