pumpkinstrokemarrow

This morning's thoughts are prompted by being reminded last night that the old Etonians who now run our country are out to turn our national health service over to their mates in the insurance industry, one effect of which would be something like the spike in the image.

First thought was that it was self evident that health has to be rationed. There was far more of it about than we can possibly afford to give, ad libitum, to everybody who might want it - something which is, I suspect, a lot more true now than it was when the national health service was invented; in the teeth I might say, of many of the health professionals of the day, many of whom seemed to think that national health amounted to getting into bed with Uncle Joe, an uncle who was by then shedding his image as the saviour of the free world. Plenty of folk in that other saviour of the free world, the US of A, still think along the same lines more than fifty years after his demise.

Second thought was that this was maybe not so self evident after all. We could spend more than we do - say 10% of GDP. If we pushed that up to an unrealistic 20% with no loss of efficiency (rather unlikely. Think what a fist New labour made of a much more modest spending hike), would everyone be able to have as much health as they wanted? Possibly. So I settle down on the thought that it is unlikely that we will be able to take health off rationing any time soon.

After which the question is, how does one accomplish the rationing? One way it to have everybody pay for health at the time and place of delivery. Fine for the very rich and the very careful, not so fine for the rest of us. Some of the rest of us would take out insurance. But that would still leave a large chunk of people at the bottom of the heap who made no provision. The improvident. Not decent to have them pegging out in the street or in squalor at home so we would have to do something. In the way that many decent doctors gave their services to the poor gratis before the health service was invented.

Then we observe that the insurance model seems to be very expensive. The US does not get all that much bang for its very large number of bucks. National health services, for all their many faults, much more efficient. So where in the service do we do the rationing?

Do we get GPs to do it?

Do we do it by long queues? With those with no stomach for queueing not getting too much health.

Do we get NICE to lay down guidelines for GPs to follow? Would this be so different from the guidelines that insurance companies lay down? Would the fact that NICE is not a profit making corporation make a difference? Although it is, presumably, an important target for various sorts of corporate lobbying by entertainment and favour.

Sadly, I suspect that some sort of tiered system is going to be the outcome. The dream of everyone getting the same health care has not turned out to be workable. If some people want to spend more than others - either absolutely or as a proportion of their income - a preference for health over beer and skittles - and get more health care than others as a result, I guess we have to let them. A bit unsavoury if a rich man with an unpleasant disease can afford to be cured while a poor man has to put up with it; but that is where I believe progress has taken us.

And then there are the lawyers. Are we getting so legalised that whatever we do with health systems, we will be covered in lawyers making a tidy living out of the inevitable nooks and crannies? I wonder if Muslims go in for suing as much as Christians? I rather think not, that they are more content to go along with the will of Allah, without making so much fuss. But it would be interesting to hear the story from someone who knows. Maybe when they are as sophisticated as us, they will be just as bad, Allah notwithstanding.

To be continued.