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.
Living In A Madhouse 
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“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.”
The NHS as we know it, and in my case, knew it, has a mighty problem now. It is funded by state taxes but creamed off by private ‘enterprises’; through contracting out services both medical and general services, and through draconian and plutocratic attitudes within its bureaucratic structure. Control and assessment has been given away to a bureaucratic business mentality, with many departmental and middle line managers having no concept of medical, clinical and health care related issues,the focus of how much can we save rather than what can we provide. Short term measurements and cost saving decisions have led to the state the NHS is in, ward closure then open again, operating theatre closures then open again, yet somehow a whole level of bureaucratic administrative staff were and are still employed; thus way the NHS was envisioned is no longer applicable. What can be done?
I think private healthcare could be better than a National Health Service if we had a true free market capitalist system, and here’s why:
Once the NHS was removed along side large government and a centralist administration two improvements would be felt; 1) There would be negligible ways for corporations to “bribe” politicians in order to pave way for corporate cartels 2) Public sector workers removed from the equation would not be able to contribute to waste and therefore high prices for treatments/drugs/machinery etc.
In addition to smaller government we would have less tax and thus individuals would have more disposable income.
What would result?
Applying the same principle to the banking sector (keeping gov out) banks would have to compete for those savings and savers would receive a fairer rate of interest on their savings.
The removal of a Federal system would create competition in all sectors; finance, education and of course healthcare, therefore costs would reduce and more competition with less cartels would also benefit the public with lower insurance costs.
Poorly run states would be allowed to fail, allowing better companies to move in and restructure. Over time people would move to states that offer better health systems bringing an increase in revenue and improved salaries for medical staff, which would in turn attract more people to the profession and with government out of the way, private hospitals could dismiss staff creating a higher standard of service and less waste. Higher salaries and pride would also make the possibility of pro bono easier not to mention a good platform for training.
So yes, if we had an honest and true free market system the overall picture would be far improved.
Why does anyone want to be involved in healthcare? Yes they want to earn a good living and why shouldn’t they, but more importantly any individual that gives up their time freely to study medicine wants to feel better about them self by healing people. Allow them to do this and let the system work itself out.
If we changed the system tomorrow there is such a mess to clear up the improvements will not be immediate, perhaps it’ll even take a generation or two, but really, what’s the alternative?
If you don’t hold the belief that individuals wish to be able to do good things then we’re all lost and no amount of intervention will repair that.
Hi Clive
You stated,” Once the NHS was removed along side large government and a centralist administration two improvements would be felt; 1) There would be negligible ways for corporations to “bribe” politicians in order to pave way for corporate cartels 2) Public sector workers removed from the equation would not be able to contribute to waste and therefore high prices for treatments/drugs/machinery etc”.
It is not a case of (1) ‘removing’ as to remove one would be at liberty to ensure there is a replacement. The structure of management, consultant and GP consortium’s would all need to be coherent and cooperative in transitional movement from State run, funded and provided to free lance run, funded and provision of services. They of course all be self-employed directly to the private conglomerates. Tesco or Asda Health for instance – or of course they could be funded by wage by such conglomerates; which could lead to a bribing back hand scenario of providers (2).
As Robert made clear: ” 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”.
What would be different with a private conglomerate? Competition of course, but competition does not always lead to efficient use or resources – medical science and research is a very costly and necessary thing. I doubt that any one private conglomerate or group of cartels could fund such an expensive and on going research base. Not impossible just improbable.
Then there is the health insurance / saving scheme to amend first. Again as Robert made clear:
“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”.
(3) You said, “Public sector workers removed from the equation would not be able to contribute to waste and therefore high prices for treatments/drugs/machinery etc”. What does contribute to the waste mean? Define waste. I guess you might mean wages. Monkeys and peanuts come to mind. As for drugs and machinery these are not produced by public sector workers it is produced by private companies ‘used at service level’ by public sector workers. The cost of an incubator, for instance, is the cost a private not public sector worker firm states it is.
I would envisage a US style managed heath system [Tesco or Adsa Health Services] with board of directors / share holders dictating where money goes for what facilities. This leaves mine fields all over for profit orientated / bribe maintained health care and not patient [they are not clients as most do not choose to be in such situations and many are too ill or poor to make such choices] oriented health care. Human nature will not change after all.
I do not think you have answered Roberts main points. The cost to the individual in finance and peace of mind. Nor do you address what I stated:
“Control and assessment has been given away to a bureaucratic business mentality, with many departmental and middle line managers having no concept of medical, clinical and health care related issues,the focus of how much can we save rather than what can we provide. Short term measurements and cost saving decisions have led to the state the NHS is in, ward closure then open again, operating theatre closures then open again, yet somehow a whole level of bureaucratic administrative staff were and are still employed; thus way the NHS was envisioned is no longer applicable”. Could private be even more bureaucratic? Could managers and of board of directors be even less medically facilitated? Profit vs patient provision of care at all costs? Short term measurements at all costs?
Thank you Clive, though, for getting me to think, and to Robert for being so articulate and producing well thought out articles in his blogs.
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