Public versus private
I was reading the interesting NHS Blog Doctor and was struck by the latest round of debate about the various merits of private healthcare as opposed to "socialised" healthcare a la the NHS.
Readers of this blog might not be in need of any justification themselves for publically funded health care, but we should all be equipped with some facts and figures becauseincreasingly this argument is coming up, and is gaining currency even within circles that twenty years ago would not have dreamed of suggesting that profit should be anywhere near health care. This is the legacy of New Labour - now privatising the NHS isn't anathema.
"You are promoting an ideology!" say the privatisers, "But our system actually works. That's more important than your socialistic notions of fairness. Look at prostate cancer. In the US almost 100% five year survival rate whereas in the NHS its only 70%. This proves that private is better."
Firstly, I don't think this is comparing like with like. The US health system spends a vastly greater amount of money than the NHS - OECD figures for 2006 show that the UK spent 8.4% of GDP on health whereas the US spent 15.3%. That's clearly going to have a big impact on the amount of resources available.
(But, despite all that extra money the NHS still provides more hospital beds!)
Secondly, if you break down the prostate cancer stats in the UK a bit more you will see that five year survival does hit 99% for all those who present and are diagnosed prior to the cancer metastasizing. The issue then is one about the difference between routine standardised PSA screening and not rather than the funding mechanism.
Finally, looking at the bigger picture, say, life expectancy rates in the two countries, the UK actually comes out on top.
Cherry picking the statistics which fit your argument doesn't stop you being an ideologue ;-)
Private healthcare also rations the provision of healthcare - it just does it based on how rich people are instead of the various (admittedly sometimes bizarre) methods that the NHS uses. I'm not suggesting the NHS is perfect. Far from it. But I can see no evidence at all to suggest that privatising it would improve it one iota.
It's private already.
The point you are missing is that primary care is effectively in private hands, since GPs are private contractors to the NHS. They are small businesses.
So, what you ought to be arguing for, is the nationalisation of the NHS (or at least that part of it). That's something Bevan didn't manage because it was politically impossible. GPs like to use the fact they are part of the NHS to protect their interests when under threat from competitors, but don't kid yourself they want to employees of the NHS. That is still politically impossible. In fact, the whole furore about so-called privatisation is the same battle that Bevan fought, which is the protection of GPs interests and autonomy.
The founding principles of the NHS did not include employing everybody involved in healthcare. They were:
1. Services were provided entirely free of charge at the point of use.
2. Central taxation funded the services.
3. Everyone was eligible for care.
So long as the three principles above continue, I don't see the problem (in principle) with so-called privatisation of the NHS by the state paying businesses to provide services. We already pay the pharmaceutical industry to provide our drugs (and there is no viable nationalised alternative to that model in prospect). I have practical concerns about how this is managed, but they are distinct from ideology. And as I've said, we already accept the principle of private providers in the form of the current set of GPs. So long as that works, then fine, but there is space for other models. In fact, the state have greater control over a employee doctor profession working for private companies, than over independent businessmen.
Arguments over the desirability of GPs maintaining professional autonomy carry much more weight, than worries about privatising something which is already privatised.
See here.
http://www.blacktriangle.org/blog/?p=1177