That?s not how it works at the moment, making healthcare unlike almost any other form of consumption, where the buyer simply votes with his feet if he thinks he?s getting poor value for money. In Britain, you get what you?re given. On any politically impartial analysis, therefore, the problem with the Bill is not that it is too radical, but that it is not nearly radical enough.
No system of universal healthcare is perfect. All have their pros and cons. But by common agreement, the best and most effective tend to be those that combine public provision with some form of co-payment or compulsory health insurance. Many of the best healthcare systems also allow for extensive private sector involvement.
Yet in the UK, anything that could be construed as partial ?privatisation? remains strictly off limits. Similarly, any discussion of co-payment that goes beyond simple prescription charges, dental care and so on, is taboo. Debate about the future of the NHS remains largely frozen in a miasma of post-war nostalgia. On healthcare reform, as on much else, Britain is firmly stuck in the past.
Even Sweden, spiritual home of the high-tax, social market economy, enthusiastically embraces both co-payment and private sector participation. You won?t pay less than 15 euros to see a doctor in Sweden. Admittedly, the amounts raised by this method are small relative to health spending as a whole, but it does help defray the costs a little.
Perhaps more significantly, it brings about behavioural changes that limit demand, with no discernible impact on standards of health.
Last week, I attended a presentation by the Swedish finance minister, Anders Borg, to the Ifo Institute?s Munich Economic Summit. Though he was plainly putting Sweden?s best foot forward, it was hard not to be impressed. Many of the things Britain has been getting wrong, Sweden is getting right. The economy is growing strongly, labour market participation is at record levels, poverty rates are some of the lowest in Europe, and despite tax cutting, the public finances are comfortably in surplus.
Mr Borg attributed these successes to the enduring strengths of the Nordic model, yet the most striking thing about his presentation was quite how much of the best bits of the Anglo-Saxon way of doing things this model now incorporates ? labour market reform, fiscal conservatism, tax cutting, and so on. Believe it or not, government spending in Sweden is now lower as a share of GDP than in the UK. The country has adopted an approach to economic management which is both pragmatic and ideologically agnostic, and it?s plainly working. We should be learning from this success.
I don?t dispute the need to get the deficit down as quickly as possible, but it does seem to me ever more obvious that the Government is setting about it in the wrong way. It is often said that providing for the old and sick is the mark of a civilised society, and so it is. But if maintaining spending on healthcare and pensioners is at the expense of investment in future competitiveness ? infrastructure, training and education ? then it condemns the country to long-term decline.
The idea of co-payment is thought perfectly acceptable for education ? higher tuition fees are just that. But when it comes to healthcare, it?s not to be discussed. The policy choices seem ever more dictated by the demographics of an ageing society. Britain prefers to spend wastefully on its past than invest in its future.
Upholding the ?free at the point of use? principle for healthcare will eventually bankrupt the country if nothing is done. Equally absurd, from a strictly economic perspective, is restoring the earnings link for state pensions or, when spending on defence and capital investment is being cut to the bone, universal entitlements such as the winter fuel allowance.
The Government is still borrowing, taxing and spending far too much. Protecting healthcare, one of the biggest spenders of the lot, from sensible forms of support such as co-payment only digs us further into the mire.
Dennis Kucinich Nelson Mandela Paul Martin John McCain Evo Morales
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