Tuesday, November 04, 2008

It's Life Which Matters, Not a Socialist Utopia

The news that co-payments may now be allowed in the NHS should be welcomed by all those for whom medical care is the only priority. The move will, of course, be panned by those for whom the class war is important and adopt the attitude of, well if I can't have it no one can.

At the moment, if a particular cancer drug can save your life but your local healhcare trust won't pay for it, you're stuffed. You can of course pay for it yourself but then the Trust can withdraw all other NHS treatment. What a byzantine system.

I have a problem with my right shoulder. I am paying for physiotherapy. That doesn't affect my rights to further NHS treatment. Why should it when drugs are involved?

We already have a so-called two tier health service. All today's announcement does is recognise that and allow people, if they have to, to spend their own money to prolong a life. How on earth can that be wrong?

Those arguing that it is wrong need to examine their own motivations very carefully. For they are rarely motivated by clinical excellence. More often it is pure class envy and a hankering for a socialist utopia that never was.

24 comments:

Roger Thornhill said...

A problem with co-payments is that it delays the inevitable overhaul/scrapping/reengineering of the NHS. Noisier middle classes will have a safety valve.

The real problem here is that because the NHS is a de facto monopoly, a single wrong decision cannot be bypassed. Now people can pay twice to avoid it, but that is hardly ideal.

We need plurality in heathcare provision just as we need plurality in educational provision. The State has to get out of provision and lay the foundations for withdrawal from universal funding and establish a safety net.

Alas, the Tory educational "voucher" idea is half-baked as it still requires "permission" from the centre. Wrong wrong wrong.

Anonymous said...

This sounds great at first hearing - BUT: PCTs will be under less pressure to fund high cost drugs, hell - they have an ideal get-out clause now! The list of high cost drugs they already fund will shrink due to ever-increasing budgetary pressures. I suspect many in the middle classes may live to regret this decision.

Raedwald said...

Demand for a free good such as the NHS is unconstrained without rationing. Once you accept that fact, the argument becomes about where you set the ration level.

And it's not life in itself that matters. There's a popular obsession about quantity of life rather than quality, but in setting the ration level both are relevant - thus QALYs or Quality Adjusted Life Years are a transparent and objective method of rationing NHS resources.

The principle in determining whether co-payments are useful is whether they affect the level of rationed services; in the case of drugs, this will have next to no effect, but in respect of use of much more finite resources such as some medical equipment or expertise, private demand will diminish the availability of the rationed good and should not be available. In such cases it should be totally private or totally NHS.

As Roger has said, the sharp elbows of the articulate middle class will tend to ensure they have greater access to rationed services anyway, but if a relative of mine couldn't get rapid access to a NHS scanner because some wealthy BBC executive had bought the time, I'd be furious. If they remortgaged their house to buy expensive but readily available drugs to keep their partner alive for another three months, I wouldn't care.

Anonymous said...

About time.

Those arguing that it is wrong need to examine their own motivations very carefully

Dead right. Tony Benn was arguing this case on Any Questions back in September. However Benn, like far too many Socialists, is not motivated by compassion but by building Utopia (and the sound of his own voice, of course) - a Utopia where inconvenient people who did not want to be hugged by The State were cast out. One would have thought that most people of his age would have grown out of such facile mirages.

Man in a Shed said...

This move is another clear sign that Labour are clearing the decks for an early election fuelled by massive debt and borrowing.

If they win that - they will be able to enforce the pain and suffering they think the English middle classes deserve at their leisure.

Anonymous said...

As somebody who is now involved with the care of a terminally ill mother I can honestly say that if a super-drug was available that I could pay for yet not sacfrice the essential other treatment and services I would take that option in a moment, and so would any other family in the same position as mine.

One thing I would add is that it should be possible to get financial assistance for these drugs if the NHS won't pay and the person in need can't pay. For example, my mother receives state benefits that barely look after her as it is. If a drug came along that could help her then it should be possible for a loan of some kind to be taken out to pay for it. Of course, the simplest method would be for a family member to take out a personal loan with a bank, however, as yet, you can't take a loan out for these purposes so far as I understand it, but could be wrong there. I'd certainly take out a loan if it would help.

Anonymous said...

The problem with topping up your drug treatments is that it's not just the drug that costs more - there's additional testing, increased monitoring and more docotors appointments, each one costing even more money. Just paying a bit extra for more pills (as I assume these people are doing) ends up costing the taxpayer a lot more than it would otherwise be spending on other patients.

Anonymous said...

The other thing to watch here, Iain is insurance companies moving in to offer policies to fund "top-up" drugs. In effect you move to a backdoor reform of the NHS where to get the best health care you need to take out an insurance policy.

Anonymous said...

I think Nick Clegg deserves some credit for pushing this issue.

Anonymous said...

It seems to me that this may be a convenient excuse for the NHS to NOT bring new drugs into the service. Why should they when people are paying for them privately?

In any other organisation this wouldn't be a problem, but the NHS under Labour?

rob's uncle said...

The drugs for which this is relevant do not 'save your life': if they did they would be on the NHS; what they do is prolong the lives of some [sometimes only a few] of the terminally ill patients who take them.

Anonymous said...

This is just tinkering. it's time for a real debate on the future of the NHS.
The idea was great in 1948, but it's time for a review as it doesn't work 60 years on.

Anonymous said...

Anon @ 9.24

So what are you suggesting - these people are not tax payers, and never have been? You are wrong you know - it's their taxes which funded your free access to health treatment before you became a tax payer yourself (if of course you are)

Are you suggested that we leave them to die, because it may cost money - Just precisely are you suggesting?

Anonymous said...

Two similar national anachronisms: monolithic State-organised health care provision, compulsorily funded by taxation (national insurance contributions); and monolithic public service broadcasting, heavily influenced by the State, and compulsorily funded by a poll tax on the possession of electronic devices (the TV licence fee).

Why, in the 21st century, should we tolerate either of these extraordinary aberrations? Time to sweep both of them aside.

Anonymous said...

only applies to England.

The old idea of a universal BRITISH NHS is long gone , there are four NHS's now and the other three are all massively better funded than the English NHS on a per head per annum basis

this is gigantic and targeted discrimination against the English by the British

why don't you mention this Iain?

hatfield girl said...

How does the NHS know if someone using NHS facilities also uses other, more appropriate services from the private sector?

Chris Paul said...

The issue is more complex Iain. The drugs people are willing to pay for have to be administered by someone in some facilities or other, any bad consequences have to be dealt with. It's not just the cost of the drugs, it's the personnel time and facility and the consequences. The simpleton pro-mix lobby have just been calling for extra drugs to be paid for and neglecting the people and places required to allow this to happen. Once a formula is available to cover this then we're cooking with gas whether we are essentially socialist or essentially reactionary.

Denis Healey paid for his mum to go private many years ago. Scarcely anyone batted an eyelid. But the point is to not penalise the NHS and take money from mainstream services by allowing extras with a hidden cost.

Anonymous said...

While it makes sense for people to be able to buy expensive and experimental drugs for things like cancer without losing their basic health care, it might just be opening up a whole can of worms. It could be the first step towards reducing the services the NHS provides until only the most basic emergency care is available to all for free and everything else has to be paid for. That's not necessarily a bad thing, but if it's going to happen there should be a proper debate about first. If someday old age pensioners are going to have to pay for hip replacements themselves if they want them then it must be a national decision, not merely the result of a drip-drip effect...

Anonymous said...

need life saving drugs? cant get them in England? come to Scotland and get all the drugs you need, all paid for by the stupid English :D

(offer only applies to scots)

Anonymous said...

Why "byzantine"?

Anonymous said...

I listened to some member of the Pox Doctors Trades Union on Radio 4 at Lunch time telling us that co-payment is evil, wrong and a sin. The principles of solidarity should apply and everyone treated equally. I have news for her I’m not a member of her trades union and I’m not prepared to die for her utopian principles.

Anonymous said...

What would be handy is a Royal Commission into health care. No instant answers as it would take years to report, but it could help to settle the debate about social/private provision.

Clearly, Broon's doubling of spending has been a huge flop and a scandal: we have to look hard at the NHS's propensity for waste and excess. Equally, anyone who has seen the US system cannot feel comfortable at moving unthinkingly to an insurance-driven approach. Hence the idea of a careful look at the whole of health care - which Broon will never offer, but which Cameron could promise.

Anonymous said...

Chris Paul:
"Denis Healey paid for his mum to go private many years ago. Scarcely anyone batted an eyelid"

I remember in 1980s when Denis (who went cap in hand to the IMF as the Chancellor , stupid man) as Windbag Kinnock's Deputy was commenting in TV AM that Thatcher will privatise NHS (I wish she had done both BBC and NHS), Anne Diamond the TV AM presenter reminded him that he went private
for an Orthopaedic problem of his wife, jumping the queue. Denis, the bully he ever was, was visibly angry towards Ms Diamond, for letting the world know of his secret.
It is not true to say ' Scarcely anyone batted an eyelid'. many commented on Dennis the bully about his accusation of Thatcher but hiding his own selfish act which is the norm for Labour leaders always (just as they send their kids to grammar and independent schools preaching comprehensive schools for the rest of us). Words like 'selfish, pontification Labour' was mentioned in the papers, it was talking point in media.

John Pickworth said...

Norman is correct... Denis Healey was positively livid when Anne Diamond (heavily pregnant at the time) raised the issue. In fact he famously stormed off the program during its live broadcast (circa 1987).

I've been looking for the video but no success so far.

I did find Mr Healey on old BBC Question Time speaking about the current hot topic of sex education. How times have changed!

;)