Provision does not require ownership.
Topic: Politics
Remember the last time that you had a really lousy time in a restaurant; rude service, poor food, dirty tables, unhygienic lavatories and over-priced drinks? Remember how you swore that you would go there again and give their accountant more money, cross your fingers and blithely hope that things would get better for your next visit?

Didn't you? OK, please yourself then. Perhaps you're one of those normal people who decided to take their business elsewhere. Like anyone would actually.

Well that's the problem with the NHS in a nutshell. You don't need to know anything about fundholding, waiting lists, citizens' charters or brain surgery. You just need to know that you pay for it in a way that’s totally different to the way you pay for everything else in life. That’s enough to make you realise that it’s doomed. It was poor under the Tories and after nearly nine years of a Labour government it’s still poor. And that’s after huge increases in tax. Why is this?

Well dare I say it, but maybe it’s got something to do with the fact that you can’t take your money away if you’re dissatisfied? Not if, like most people, you can’t afford private care. You have no threat. Targets can come and go, but the poor punter doesn’t have a choice.

I know that many people reading this will argue that the NHS was underfunded under the Tories. Maybe it was. I have no idea what the ‘correct’ budget should have been. Neither do you. Perhaps you think it would improve with more money now. Maybe it would. I don't know. But if you’ve followed the newspapers or just looked at their Jobs sections, you’ll realise that there has been a big increase in hospital administration. Was this really what the voters wanted when they booted out Major in 1997?

When health is politicised, but not privatised, politicians will still attempt to improve it. But without a free market, the mechanism to ensure that the money is well spent is very indirect. If you don’t like what the politicians are doing to the Health Service on which your life depends you can vote them out at the next election in up to five years time, but wouldn’t you rather have the option to take your business to a better performing service now?

Many Britons are proud of the NHS, believing that it’s right and proper that everyone should be able to get treatment that’s free at the point-of-service. I can understand that. So it’s fine by me if you want to make it free for everyone. But that doesn’t mean that the government needs to own the hospitals or employ any of the doctors and nurses. Provision doesn't require ownership. They are totally different concepts.

Anyone who’s travelled to the US knows this intuitively anyway. The last time I went there I had a travel insurance policy that I'd bought at the Post Office. It covered me for potential medical costs up to $10m. That is what I needed. I was under no illusion that the British Post Office actually owned any hospitals in the US, nor that it employed any doctors there. I just knew that it had made arrangements to pay for its policyholders to receive treatment should they need it. Why can't the NHS work like that either? Why can't I have insurance coverage guaranteed by the government, but with me having the choice of various competing insurance companies to select from? Hospitals that employed too many administrators and too few nurses would slowly lose custom to those who did the opposite. And this would give the health providers the incentive to cut paperwork and focus on hiring those who actually roll up their sleeves and care for the sick, instead of paper pushers. That’s what I’m interested in paying for.

It’s hard to discuss the NHS. Over the years it’s gone beyond rational discussion. But discussion is need if we’re to change it so that it saves more lives than it does. Don't take my word for it if you don't want to. See what the Observer's Health Editor said in 2001.

Why the NHS is bad for us, by Anthony Browne – Observer Health Editor 2001

In the meantime, I must weep for the opportunity that the Tories have wasted to promote this philosophy. Hague had no chance of winning the 2001 election. The voters were clearly in a mood to punish the Tories for the Major era for years to come. That was the ideal time to promote the idea of reform. It takes years for voters to consider radical change. So it’s tragic that the opposition party didn’t make the case years ago.