Tag: market

NHS Funding – Calls to introduce charges

The Kings Fund have been looking at the future of the NHS and how it will be funded. One of those invited to discuss the issue with Kings is the right wing think tank ‘Reform‘.
Roy Lilley stated that Professor Alan Maynard tweeted about Reform’s message to King’s:
Alan Maynard (@ProfAlanMaynard)   25/08/2014 04:35 pm
NHS funding: “can we ignore pricing any longer” in KF weekly bulletin. Answer: YES! Taxation is fairer, easier to collect & opposed by cretins!!
King’s concern is about the issue of  demand for health services outstripping the country’s ability to pay. The suggestion is that the  NHS is facing a funding crisis so big that that the only solution is co-payments, top ups and insurance. This challenges the NHS principle of ‘free at the point of delivery’. I have argued in a previous post that care costs and so we have to consider who pays, but my view is that we should socialise the risk and spread the cost across society.
Roy Lilley asks: “Are top-up or insurance based systems with their overheads, actuarial hocus-pocus, running costs, surpluses, cost of collections, regulations, appeals systems and palaver cheaper and more efficient than a tax based system?”
He goes onto make the point that insurers “have to lay-off risk, reduce exposure and break even on their book. And, ten pounds to see a GP is £10 that has to be collected, administered, audited and in extremis, debt-collected. Taxes must be cheaper to administer and easier to collect”.
Kings,  in listening to Reform , are lending credence to the neoliberal dogma that wishes to shrink the state, individualise costs and encouraging private sector involvement.
The Tories used to say that the NHS is safe in their hands. The Kings bulletin will be music to their ears. Don’t expect Miliband’s Labour to challenge this.

The Corporate University, Health as commodity and the citizen as customer.

 “As universities mirror the increasingly unequal nature of English society … their role in advancing social equality, or minimising embedded disadvantage, will be traduced in a ‘meritocratic’ game of spotting talent and ensuring that it is slotted into the appropriate tier.” So writes Andrew McGettigan on the the discoversociety.org website in 2014. This comment on the ‘corporate university’ indicates that universities have functions that go beyond only meeting the needs of student consumers in their quest for a job, that indeed Universities should address aims beyond producing  ‘cognitive capitalism‘.

Should we care at all about this, or should we encourage even more market discipline?

For some, education is a commodity which should be bought and sold in a free market.  If a student wishes to borrow money to study literature or sociology then that is their choice, the State has no business in supporting study that has little direct economic benefit for individuals or society. So goes the free market apologists who places trust in the individual rational action of the student/consumer when buying the commodity of education. This is not new. Logan et al in 1989 argued in the context of the provision of health care that

“…services should be treated just like any other commodity that can be efficiently produced and consumed under market conditions”.

David  Willetts, Minister for Universities and Science, told a fringe event at the most recent Conservative party conference: unleashing the forces of consumerism is the single best means of improving the quality of undergraduate provision.

Student tuition fees have turned students into customers. This is seen as a ‘good thing’. Students will vote with their money and desert courses and institutions that they feel will not fulfill their hopes and aspirations. Competition for Elite universities will thus increase and only the best survive – a bit like the Premier League. Since its inception we have seen the loss of 50 football clubs as well as a sense of the club representing the local community values. Does that matter? Not if you are the winner – a Manchester City/Utd or a Chelsea – or a winner’s fans.

A clearer statement of the ideology of free market capitalism you will find hard to beat. Consider that this thinking has, not as yet, boldly reared its head for health. How would you feel upon hearing:

“unleashing the forces of consumerism is the single best means of improving the quality of health care provision”.

What do you think about  this:  Individuals should pay for their own health and social care needs at the point of delivery, as they are best placed to know what their needs are and how much they value health and social care. If they value beer and fags more, then that is their choice and the state should not intervene in that decision.  Individuals and families could pay for insurance for that ‘rainy day’ of dementia, cataracts or a broken leg. Hospitals and GP practices would be forced to compete for customers and those with poor reputations would have to close. Public Health England could be disbanded as a wasteful state cost base and instead individuals could be nudged to take responsibility for their health.

Well, if you have swallowed market ideology wholesale, that might sound like nirvana.

If universities are turning into warehouses for the production of cognitive capitalism in which education is a commodity to be bought and sold for instrumental purposes (“its the economy, stupid”), then their social role diminishes. Likewise, is health care a commodity to be bought and sold or does society also need a health sector that addresses the social and political determinants of health as well?

Individual rights and liberties balanced with social solidarity?

At root this is the difference between a social democratic political philosophy and a market driven neoliberal agenda. Its your choice, but remember ‘some animals are more equal than others‘ and they have the clout to ensure they stay ‘more equal’.

Health, Education and buying shoes

Now,  this f**king (excuse my Cornish) Tory gov’t cannot see beyond its own ideology and its disappointing that ‘two brains’ Willets is caught up in this. Let’s be clear: students are not customers, ill people are not customers, health is not a commodity, Education is not a commodity. They are not shoes. Creating markets in health and education is not a good idea. The Economist recently argued similarly for health: see http://tinyurl.com/healthreforms and see this for what is happening in education http://tinyurl.com/educationreformss.  Now here is the point about markets in health and education:

 

 

“Most people aren’t qualified to determine which medical procedure/product is the optimal product to treat their ailment”. (from a comment by Heimdall) . In the same vein most students are not qualified to determine which University or course is the optimal product to further their careers. In  addition markets cannot serve health protection, education or the social determinants of health.

When you buy a car, you know roughly how much power you want, how much storage, etc. You can look to Consumer Reports to gather reliability data and dealer cost. You can negotiate with the dealer based on this information. Similar story with most consumer goods.

When you have a dread disease (one of a bazillion maladies, not a few dozen as with most purchasing decisions), there might be uncertainty among doctors whether it is indeed disease X, or maybe Y or Z.

Once you (kinda maybe) know what the problem is, which treatment is best? Even among doctors who agree on the disease, they may think that treatment A, B, or C is most effective based on their research, year of graduation, etc.

Thus, even if all doctors and practitioners were equally adept, you would still need to navigate the diagnosis/treatment thicket. But they’re not equally adept, and there’s no Consumer Reports to provide data on reliability, outcomes per thousand operations with doctor X in hospital Y.

In short, consumers are ill-equipped to treat medical care as if it was any “normal” market. We just don’t have the expertise to do it. And thus we are even more susceptible to the recommendations of the “experts” as to what to do than we are with a pair of sneakers.

 

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