I am reposting this post from two and a half years ago (Feb 2011).
It's prompted by the Chief Exec of NHS England on BBC Radio 4 this morning saying - after praising the Government - that the NHS is unaffordable (massive funding shortfall 30bn in next decade).
This prompted a BBC Radio 5 Live phone discussion on "What Should be Cut to Save the NHS?" Various top ups and additional charges were then mentioned by callers.
My Plan to Destroy The NHS
Suppose I am very very rich, and very very selfish. The NHS annoys me
intensely. It costs lots in tax revenue to run, and being very rich, I
pay proportionately more of my income on it, and of course far more in
terms of hard cash, than almost anyone else. I also resent the fact that
my business empire is unable to cash in on providing the services that
people would buy from my private businesses if the NHS was not there.
BUT,
the public loves the NHS, even many Tories are fond of it, and to
propose scrapping it would provoke howls of outrage. Plus there's no
evidence I can marshal that the public would get a better service if it
were provided by the private sector - rather the opposite in fact.
What would I do? Here's what I would do.
First,
I'd ensure a team of expert PR run the Tory party - people adept at
twisting facts, spinning, and indeed telling bare face lies and getting
away with it. And I'd have my private health companies etc. fund them
generously.
Next, once elected, I'd get them to introduce
phase one:
the introduction of a market system in which GPs buy services from NHS
hospitals, or anyone else, based on variable price, etc. This can still
be called "NHS" because it's still free at the point of use. This would
all be justified by lies about how the evidence shows it's more
efficient, etc.
This new system allows e.g. my private pharma and
health care companies to cherry pick the services that are lucrative
and compete with existing hospitals without having to provide the
expensive back up necessary when things go wrong (that's all dumped on
the old hospitals), offer loss leaders to pull in the more lucrative
patients, etc.
What next? At this point I'd get the Tory spinners
to start talking about how the NHS is "increasingly unaffordable" (what
with the aging population, advances in expensive medical treatment,
etc.). I'd have this phrase repeated endlessly in the media, in a mantra
like way, until it becomes part of the zeitgeist. It will take time.
Eventually, this "problem" will be felt to require a "radical solution".
Once
the Tories are back in power, I'd have my PR men talk about the
"unfairness" of preventing people from adding their own funds towards
what the state is providing to buy a service they would prefer. After
all, this increases "choice" and "freedom" and so must be a good thing.
And it would bring increased funds into the health care system as a
whole. Surely a good thing. Then - the all-important
phase two
- top ups would be introduced (despite not being on the Tory manifesto
on which they were elected). For any ailment you can now choose from a
range of treatments at different cost, only some of which the state will
fully fund (the cheaper ones). It's your option to make up the
shortfall and go for the more expensive treatment among those offered
you by your GP. You have that "freedom". Lucky you.
If it's felt
this sudden introduction of across the board top ups won't wash with the
public, top ups could instead be introduced gradually (the policy
already exist for some cancer drugs and could be e.g. extended to more
drugs, then all drugs, then to some medical procedures, and so on))
Of
course, the plebs will be told the NHS is still, and will always be,
there providing necessary services for all. But the "increasing
unaffordability" point will be used to justify a "necessary realism"
about what, precisely, the state can ultimately fund. This will be used
to justify the growing top up system.
Phase three:
state funding is then reduced more and more. Topping up becomes more
and more unavoidable if you want half decent medical treatment. More and
more people take out health insurance to cover differing levels of top
up, and so more and more have less and less of an emotional stake in
protecting what's left of state-funded treatment. There's less and less
resistance to further cuts.
Rich people like me cash in on the
boom in health insurance. I'm now making enormous profits on both sides
of the equation - supplying pharma and medical services, and supplying
insurance services. And I am now paying less and less tax too.
Eventually,
state funded treatment will be a third-world-level rump relied on by
perhaps just the poorest third of the population. Fuck 'em. My wealth has
increased astronomically.
Well, that's what I would do. Of
course it couldn't be done in one go. It would require several Tory
terms, probably with some Labour periods intervening, so I'd have to
make sure that whatever is achieved at each stage is very hard to undo.
Of
course this is a nightmare scenario. Hopefully it's not the path on
which we are actually embarked. I'm probably just being paranoid. But
every now and then it crosses my mind. After all, what I called
phase one is just being completed.
If
this is really where we are headed, then expect to hear lots more about
the "problem" of "increasing unaffordability" that requires "tough" and
"radical" solutions. Then, later - probably not in this parliament, and
probably not from mainstream Tories to begin with, but from e.g.
self-styled mavericks writing in
The Spectator
- some hints that a general top up policy might be part of the
solution. At the very least, expect recommendations that top ups be
introduced for a wider range of drugs, etc. But you won't hear this from
ministers until phase one is complete, as that might give the game
away.
POST SCRIPT. I just googled "NHS top up payments" and found
quite a lot on the Labour introduced cancer drug top up policy.
Including this from Janet Daley at The Telegraph - go
here. Daley is
exactly the sort of person I had in mind when I mentioned "self-styled mavericks".
Follow up piece
here.
to watch the show: