Why can’t the NHS be run like Tesco?

Came across an excellent post from the Adam Smith Institute the other day that’s definitely worth sharing:

We’re lucky there’s no such thing as the National Food Service [NFS], modelled on the National Health Service, to ensure equal access to affordable food supplies.

[…] It’s not hard to imagine the disaster befalling our kitchens and restaurants if the industry was organised into an NFS in pursuit of an equality agenda. GPs (Grocery Practitioners) would be the gatekeepers to food supplies, assessing everyone’s basic dietary requirements and issuing coupons according to guidelines from Whitehall under budgets set by the Treasury. PCTs (Primary Comestible Trusts) would oversee the distribution of food parcels, adopting best practices as judged by NICE (National Institute for Cuisine Excellence). There’d be nationally set waiting-list targets to see consultants on wine and cheese.

Fortunately, nobody is seriously proposing a National Food Service – yet. But, equally, nobody is seeking lessons from the supermarkets on delivering efficient health care in rapid response to changing consumer demands. Which is too bad.

I think this article makes its central point very clearly: that there is absolutely no credible reason why the NHS needs to be organised the way it is, i.e. through central government dictat and controlled by all-powerful vested interests. The equally important grocery industry is as near to free-market capitalism as you can get in this country, and yet somehow the less well off have plenty of options on where to shop and have not starved en masse.

The time for a free-market health service that truly reflects the needs of the customer – not the producers – is now. Will anyone do anything to bring this about before the current system collapses under its ever-increasing burden…?

I’m not holding my breath…


Greenpeace in our time

2011-06-19 4 comments

Current green energy policy is a complete farce

The cartoon above is just one of many amusing items I’ve just discovered on the Cartoons by Josh website. I’ve been trying to keep my sense of humour about AGW, although when I read that electricity and gas prices are going to go up by 20% and 10%, respectively, in the next months mainly due to feed-in tariffs, and that we will soon be at risk of rolling black-outs because our cretinous politicians think windmills and solar cells can adequately replace our existing coal, gas and nuclear power plants, I’ve felt my blood pressure rising to dangerous levels.

Our energy policy is written by vested interests

Based on the above, you will be not surprised to learn that I was not impressed by the revelation this week that a key author of the IPCC report into climate change was in fact on Greenpeace’s pay-roll. That’s right: someone paid by a lobby group that campaigns on behalf of vested industry interests was a key player in a document which, when implemented by our paid-for politicians, will divert billions (if not trillions) of dollars from customers into said vested industry interests. Then again, this comes after numerous IPCC claims have already be shown to be made up or based on ridiculous assumptions. It’s already be found out that one ‘expert’ report author had not even completed her PhD at the time.

Obviously, we all want to live sustainably and leave our environment in a good state for our children; however, I completely and utterly disagree with those who advocate the dismantling of our economy and lowering of our quality of life to achieve it – all justified on now-thoroughly-discredited computer models.

Nuclear fusion power cannot come soon enough, since it would have so many advantages:

  • No carbon emissions. The only by-products of fusion reactions are small amounts of helium, which is an inert gas that will not add to atmospheric pollution
  • Abundant fuels. Deuterium can be extracted from water and tritium is produced from lithium, which is found in the earth’s crust. Fuel supplies will therefore last for millions of years
  • Energy efficiency. One kilogram of fusion fuel can provide the same amount of energy as 10 million kilograms of fossil fuel
  • No long-lived radioactive waste. Only plant components become radioactive and these will be safe to recycle or dispose of conventionally within 100 years
  • Safety. The small amounts of fuel used in fusion devices (about the weight of a postage stamp at any one time) means that a large-scale nuclear accident is not possible
  • Reliable power. Fusion power plants should provide a baseload supply of large amounts of electricity, at costs that are estimated to be broadly similar to other energy sources

What price sanity in energy policy?

A tale of two drugs: why we all pay (more) for socialised care

I came across a really interesting article on the US healthcare system on the Mises Institute website yesterday, which puts forward the argument that rather than help, Government intervention in the healthcare market only makes things worse – most obviously by raising prices and costs way higher than they otherwise would be. Quite frankly, this article is completely relevant to the UK’s NHS as well.

Below is a key section of the article where the author uses a simple example to demonstrate the inherent flaw in socialised systems:

The following is an example of a real and very popular drug that I use on a routine basis that I will call drug X. Drug X works by inhibiting blood clot formation (when a blood clot forms in a vessel in the heart, one can have a heart attack). Drug X and drug Y work together by acting on different substrates of the clot-formation process to ultimately effect the same outcome — stopping clots from forming. Drug X costs on average $141.82 per month. Drug Y costs a couple of dollars per month over the counter at your local drug store. What does the data tell us about the two?

Multiple studies have been performed to answer the question: Does drug X improve cardiovascular outcomes compared to drug Y alone after a patient has had a major cardiovascular event or a stroke? The answer, unequivocally, is yes. By how much? The answer is a few percentage points, give or take.[2] Does it eliminate the risk all together? The answer, unequivocally, is no. It should also be noted that drug X in addition to drug Y confers a minor increase in the risk of having a major bleeding event. So the question is: How many people, in the appropriate clinical setting, knowing this information, would buy drug X for $140 per month? Probably not nearly as many who take it now for nothing or for a small copay. Leaving aside the issue of brand names and patents, under conditions of market competition, do you think the company who makes drug X would lower the price to entice more buyers? If they did not lower the price, or simply could not lower the price due to production costs, I would venture to guess that drug X would not be marketable outside of a small niche of patients.

Now ask yourself, is the doctor who recommends drug X the bad guy? Of course not: drug X does provide a benefit beyond drug Y itself, and furthermore, if he didn’t offer it and the patient had a heart attack (which could happen despite being on drug X) the doctor could be at risk of losing his medical license. After all, drug X is part of the standard of care. Is the patient the bad guy? Of course not: if you were offered the chance to take a drug that had a defined benefit and wouldn’t cost you that much, you’d be silly to reject it. Is the pharmaceutical company the bad guy? No, they have a responsibility to their shareholders to make a profit, so they should sell their product at the highest price possible.

So who’s to blame? The answer: a system that has been developed by government intervention to interfere with consumer sovereignty and make every individual pay for every other individual’s medical expenses so that the individual consuming the care does not bear the full price at the point of utilization.

For me, this is pretty much self-evident. Amongst all of the wailing and gnashing of teeth that we have all been subjected to recently on the subject of reform – from the unions, the myriad vested interests, the politicians (from all parties) and our unbiased (hah!) media – where is the voice of the actual, put-upon consumer?

Manu elsewhere…

Posted on my employer’s blog: First impressions count: why you must do more to manage your medical communications

Our approach is that you need to be pro-actively communicating with your audience all of the time – not just whenever you have some data to present or an issue to manage. If you or your advocates don’t make the first impression, someone else will do it for you, and you may well not like the long-term outcome…

Stop tinkering with the NHS – it needs a complete overhaul

It seems that I have a new addition to my ‘Do Not Read!!’ list of London Evening Standard commentators: Andrew Neather. The article from Neather that caught my eye on the train home yesterday evening was “I’ve seen the real cost of tinkering with the NHS

Neather begins his piece by trotting out the age-old red herring used by those who defend the current NHS setup – conflating the system with some of the people who work in it:

Down in the West Country for an aunt’s funeral, I was struck afresh by the oddness of people’s attitude to the health service. By the time my mother’s kid sister went to the doctor, it was far too late to treat her cancer. But for the remaining couple of months of her life, she received excellent care. “The nurses were so good,” said my mother.

And while, for sure, we read some healthcare horror stories in a nation of 60million, most of us say the same thing. In opinion polls, people consistently tend to rate their own care highly – especially their GP. But ask them what state they think the NHS is in, and half or more tell pollsters that it’s a basket case.

So your mother had a great nurse. How is that of any relevance at all to how the NHS is run? Presumably said nurse would continue to be a great nurse whether she worked in a state-run or a private hospital? It’s the same story with our GPs – in terms of the overall NHS system, we as customers at least retain some degree of control over whom we go and see in primary care. If we do not like our allocated GP, then we can usually ask to see a different one in future. Unfortunately, once we need specialist consultation and care, those of us needing NHS care pretty much have to take what we are given.

[Cameron] feels the need to do so because while the planned changes are complex, most people instinctively realise that NHS privatisation – companies profiting directly from their illness – is a scary thing. And they haven’t even lived in the US, as I have, and seen how rubbish such healthcare is in practice for all but those with gold-plated insurance policies.

Neather demonstrates his complete lack of understanding of economics here (although to be fair, none of our politicians apparently has a clue either). In a completely free market, i.e. with unfettered competition with no state interference in the form of barriers to new entrants, and with no regulations and tariffs favouring vested interests, profit is the deserved reward for entrepreneurs risking their own capital to provide goods and services to society. There is NOTHING wrong with profit – in healthcare as in any other industry – if it comes from voluntary transactions that benefit both parties.

Neather also throws in the obligatory red herring of the comparison to the US healthcare industry, as the bogey man to scare away people from even thinking about NHS reform. Of course the US is not the gold standard that we should be trying to emulate! As I wrote about previously, there are numerous other national healthcare systems with much better outcomes that we should be looking at for inspiration.

As a friend who is a head of service in mental health asks: “What if a private sector provider goes out of business -what happens to their patients? A decommissioned NHS service will not be there waiting.”

In a truly free healthcare market, there would be a multitude of private sector providers all competing for your business. If one provider went out of business (presumably due to incompetence or losing customers due to poor service), then there would be many others who could step in and would gladly take you on. If Ford went bust, would we suddenly not be able to buy a car? Would your lights go out at home if your electricity provider went into administration? Is Apple an international pariah because it makes stupendous profits from the sale of its highly desirable products? Of course not!

It would be perfectly possible to construct a fully privatised healthcare service in the UK, that would remain free at the point of use, and which would still provide cover for those who genuinely could not support themselves (e.g. the elderly & infirm, the mentally ill, etc). The problem is – and this is why I doubt that I will ever see it happen – that to create such a system would necessarily entail the dismantling of a system which serves the needs of the providers, rather than us the customers.

Perhaps the saddest thing about all this is that useful idiots like Neather don’t realise just how effectively they are being used by the same vested interests that perpetuate the NHS ‘basket case’ we all know is there…

Manu elsewhere…

Posted on my employer’s blog: Groundhog Day!!

In the 1993 film ‘Groundhog Day‘, a washed-up reporter played by Bill Murray goes to an annual meeting and ends up replaying the same events on that day over and over again for what seems like infinity. For any readers just coming back from, or planning to go to, a major medical congress – does this sound at all familiar…?

Keynesian cretinism at the London Evening Standard

Like many thousands of other people, I pick up a free copy of the London Evening Standard to try and help minimize the pain of the daily commute home coutesy of South East Trains. Normally, the LES is a good read and time passes quickly. However, every now and again I come across an article that is so completely wrong that I can feel my blood pressure rising while reading it.

There are a few of the regular writers that I can now expect to be highly annoyed by whatever they write (e.g. James Fenton, Chris Blackhurst, Jenni Russell), but one of them stands out: Anthony Hilton, the City Columnist. One of his latest articles appeared last week, “Debt isn’t always bad. We may even learn to love it

Here a few of the (many) paragraphs that got my blood boiling:

In fact, the whole saga shows up our politicians at their worst. Listen to Chancellor George Osborne and you could easily believe government debt was invented by Gordon Brown. In fact, he made a pretty big reduction in the debt levels he inherited from his Conservative predecessor John Major – fixing the roof while the sun was shining, to coin a phrase – until he was knocked hopelessly off course by the financial crisis and the need to bail out banks.

Of course, it is unfair to blame Gordon Brown alone for our current problems – our fiat currency, the policy of the US and most other ‘developed’ countries’ governments to finance ever-increasing state debt via the printing press and permanent inflation (i.e. currency devaluation), and rampant crony capitalism are just some of the systemic Keynesian problems that no UK government has done anything to address for the last century.

However, the major cause of our current problems in the UK at the moment is the structural budget deficit – in other words the amount by which state spending oustrips tax revenue. Far from ‘fixing the roof while the sun was shining’, Gordon Brown spent our money like there was no tomorrow and built up the public sector of the economy to the point where it is now larger than the productive private sector. This is Gordon Brown’s legacy to the nation – had there been no financial crisis or bank bailouts the deficit would still be the same.

On current projections, debt is expected to stabilise at around 70 per cent of GDP or, shedding the jargon, it will be the equivalent of just over two- thirds of all the output generated by the entire nation in one year.

However, if things turned out much worse than that and debt rose to 100 per cent of GDP, the interest would still only be about five per cent or 5p for every £1 earned in the country. Eminently affordable, so why the panic?

Hilton appears to be talking about the UK’s “official” state debt, which helpfully excludes most of our pension liabilities as well as a tranche of other items (e.g. public-private partnerships) that are kept “off the books”. In fact, the UK’s total debt has been forecast to hit £10 trillion by 2015. For an even more frightening example of how much trouble we are all in thanks to Brown et al, have a look at this video – the total US debt is greater than the combined GDP of the whole world economy:

One more paragraph:

It would be wrong to say debt does not matter but we need a sense of proportion – and having made the point, the Government must move on. Talking tough on cuts may keep financial markets onside, but the Government’s priority should be to restore economic growth, not fixate about the deficit. Get growth right and the deficit will take care of itself; but a government which defines itself by cuts stands a very good chance of making things worse.

At the risk of repeating what many independent bloggers have pointed out ad nauseam already, what cuts?? The result of the ‘biggest cuts in a generation’ – you know, the ones that are proceeding “too far, too fast” – is simply a reduction in the rate of increase of our debt. Worth repeating: these cuts constituting the “final solution against the poor” will not even sort out our deficit, let alone start paying off the debt itself.

Hilton would do well to cold turkey himself off his big-state Keynesian theories and perhaps school himself on Austrian free-market economics. Who exactly is going to fuel this growth when those same people are slowly being strangled by red tape and de-incentivised by ever-higher taxes? Once again, who was in power over the last 13 years and did more than any other Chancellor to put these things into place?

Anyway, rant over. Hilton and the legion of others like him is the reason why I – like many others – no longer get my news from the mainstream media. If you want to start thinking for yourself then type ‘libertarian’ or ‘Austrian school of economics’ (or, for any US-based readers, ‘Ron Paul’) into your browser and see where it takes you.

In the meantime, note to self: stop reading Hilton’s articles. He’s not worth it.