Daily Archives: February 1, 2011

So you think private healthcare would beat the NHS…

Anyone who has ever had private medical insurance will know how incomplete the cover is. Common exemption clauses are a two year waiting period for existing complaints to be covered, a complete exclusion of psychiatric treatment and severe restrictions on aftercare, which is frequently excluded when active medical treatment ends.

Those who have had chronic and serious illness soon discover that the amount of private active treatment and aftercare they can obtain is considerably less than they imagined. Many enter  courses of treatment which end before the utility of a treatment is exhausted. They then transfer to NHS care. Frequently operations are funded by their insurance but not the subsequent nursing which is undertaken by the NHS.

Those in Britain who laud the idea of private insurance as a substitute for taxpayer funded health service should examine the effects of such a system in the richest country in the world, the USA. Around 40% of the population have no health insurance. Even those with insurance find themselves left high and dry more often than not. Here are the words of a British journalist and novelist living in New York, Zoe Heller, from the Daily Telegraph London 6/5/2000:

One of my best friends was short of cash one month and let her insurance lapse. That same month, she was diagnosed with breast cancer. Seven years later, she is still paying off the credit card debts. Another uninsured friend was rushed to hospital for emergency intestinal surgery. She will be paying her bill on an instalment plan. She counts herself lucky that the hospital has a relatively liberal policy about treating uninsured patients…

A recent study established that one in four of every American declaring bankruptcy in 1999 cited illness or injury as the main reason for his financial problems and that of that group, roughly half were insured. In other words, paying extortionate sums to the insurance companies doesn’t protect you from financial ruin if you happen to fall ill with something serious and expensive enough.

Even the rich in the US find healthcare beyond their means if the treatment is long and serious. The Superman actor, Christopher Reeve, one of the highest paid Hollywood actors, had exhausted his savings within two years of the terrible injury which left him paralysed. Private medicine will guarantee virtually any treatment – if you can afford to pay for it. That is the long and short of it. The NHS provides a remarkably wide range of healthcare free at the point of use. It mitigates strongly against “unfairness”.

As far as private medicine in Britain is concerned,  it currently enjoys a great deal of unacknowledged  public subsidy. Private medicine in Britain is notoriously prone to pushing any bungled private treatments back on the NHS without compensation. It also makes little investment in private sector facilities because it can rent NHS facilities for more complicated treatments, facilities which are purchased at well below any realistic cost. Private medicine also makes no contribution towards the cost of training medical staff. In short, private medicine in the UK lives off the back of the NHS and the taxpayer.

The media which is only too willing to feed the public with NHS “horror stories”. A good example is one from the Sunday Telegraph. On 27 August 2006 their front page ran ‘Blunders by NHS kill thousands of patients a year”. Does anyone seriously imagine that any healthcare system in the advanced world does not suffer such casualties or that private medicine is generally more efficient or safer? Of course the NHS makes many mistakes and these add up to a sizeable bald global figure but when you are catering for a population of 60 million that is scarcely surprising.  As a public body the NHS also records its mistakes so that its overall perfomance can be measured. That does not happen with the private sector.   A public audit of the safety and efficiency of private medicine  would make interesting reading.  I would be willing to bet that it would show two things:  (1)  that clinical outcomes for similar treatment in the NHS and private medicine are poor l more often in private medicine than the NHS and  (2) that the range of treatment offered by private medicine would be both much narrower and less demanding than that undertaken by the NHS. It would also be interesting to know how many patients had to be treated by the NHS after private medicine had bodged treatments, procedures  or aftercare, the ailments  of the patients whose treatments had failed and the cost to the NHS of picking up the pieces.

The harmful effects of private medicine on the NHS go beyond inadequate payyment for NHS facilities, medical training, the rectification of bodged treatments and the cherry-picking of treatments and patients.  Even  if private medicine  paid for NHS resources in full, it does not follow that would be a good thing for the NHS because the money received might  not adequately compensate for the loss of the NHS facility during the time it is in private use. This is particularly the case where complex treatments, especially surgery, are concerned because the number of NHS facilities able to offer the treatment will be very limited. It is worth mentioning that a sizeable proportion of private medical treatments in the UK, especially the more demanding cases such as those of serious heart disease, involve the treatment of foreigners. It is morally indefensible to allow NHS resources to be hired to be used on a foreigner rather than used to treat a British citizen on the NHS. Where there is genuine spare capacity in the NHS, private medical providers should be charged a realistic price for it. In cases where private medical treatment goes wrong, the private medical provider should pay for the remedial NHS treatment.

It is vital that the NHS survives because even with present life expectancies, there are going to be an awful lot of people who will need intensive medical support in their extreme old age. The cost of that will almost certainly exhaust the resources of even those who have made seemingly substantial private provision for their old age.

The NHS has many faults, but for most of the population, it is a better and more complete supplier of medicine than private medicine will ever be or could be.

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