Who’d have thought it? The UK Department of Health has said ID cards are the best way for removing health tourism from the UK government’s dreadful National Health Service (NHS). What a coincidence that the Home Office, which has been struggling for decades to find a problem necessitating an ID card solution, are trying to introduce just the very thing. And at this exact moment in time? Fancy that.
And here’s the best part. State-subsidised UK family doctors already refuse people access rights to their medical lists, if they don’t have the correct UK citizenship qualifications or residency permissions. Yes, the very people whom the ID card is supposed to prevent abusing the glorious wonders of the NHS, are already prevented from abusing it, at least up to the point the government is prepared to stop them. And whatever happens, the Department of Health have said, nobody will ever be refused emergency treatment, whatever their circumstances.
So currently, without ID cards in place, all those whom the state deems invalid for NHS treatment must go to Accident and Emergency departments, which will treat everyone who turns up regardless of status. And in the envisaged ID card NHS future, all those whom the state deems invalid for NHS treatment must go to Accident and Emergency departments, which will treat everyone who turns up regardless of status. Err…Doh?
The only solution to stop ‘health tourism’, where hapless British taxpayers are forced to subsidise the health needs of various global parasites, is to abolish the NHS. Immediately.
That way, everyone pays for what they need, or insures themselves against what they might need. And Britain can start becoming a welcoming place again, which people only come to for its wet Welsh weather and its fine Breakspear ales, rather than trying to sponge off our coerced goodwill after fighting their way through malevolent Blunkettesque security, at the ports of entry, before finding the nearest organised crime ID card forger.
Is this solution too simple, or should I be strung from the nearest lamp-post for daring to suggest that the great white elephant of our wondrous National Health Service should be slaughtered right here, and right now? String me up, baby. It can’t come a moment too soon.
How I’d personally dump the NHS:
phase 1: dump “entitlement” for anyone who could concievably pay – even if it means they must sell their house, car, etc.
phase 2: spin-off the remainder as a charity, and let it sink or swim.
Oh and also, if this ID shit passes, I plan to equip myself with these: http://www.phunkyshop.com/product.asp?prodID=10
Nobody scany my iris without my permission.
Some idiot was bleating on the “Today” programme (UK BBC Radio 4 morning news & comment – kind of like NPR’s “Morning Edition”) about the usefulness of ID cards in the prevention of “child trafficing” (today’s Evil of the Moment…)
Two problems, though. “Child trafficing” isn’t illegal; and ID cards (as proposed) would only be issued to over 16s.
I was thinking along the same lines as Julian, especially phase 2. I see charity as a kind of privatised welfare system. Being private, it would be more efficient than anything the government could run, and charities will compete. People will give to those charities they see as being most effective.
One of my favourite quotes comes from Eric Raymond: “The kind of charity you can force out of people nourishes about as much as the kind of love you can buy — and spreads even nastier diseases.”
My quick (and therefor probably ill-thought out) solution to the NHS is to sell every hospital to its staff for £1. Let them choose a management board, give them two years running money and then let them survive how they can.
Yes, yes, there will probably be all sorts of bad effects but one good one would be the rapid establisment of true price information so that for the first time in its history the health service would actually no the cost of everything.
Tax payers would (or at least, should!) enjoy a huge tax cut out of which they will have to provide medical cover for themselves. The truly poor would have to apply for an annual Health Voucher of, say, £500. If they require treatment in excess of this the hospital would have to bill the Health Dept who at least will be able to check the price against what other hospitals charge.
All of us, including the poor with their vouchers, would be empowered by the re-establisment of the customer/supplier relationship. Of course, some smart operators currently employed in the NHS would become exceedingly rich as their hospital expands and buys out other hospitals. Who cares? Not me! Also, my guess is that roughly 1/3rd of NHS employees would eventually be laid off. I don’t care about that either because they would be the unproductive ones that I’m currently paying for.
Oh well, I can dream , can’t I?
David Duff
Oooops! Typo in the 2nd para – should be “Know” not “no”. Sorry.
David Duff
Those with long enough memories might recall the Thatcher privatisations. In particular, the government owned and run Skill Centres. The result was bankruptcy and anarchy within about 18 months. Why? Because in the brave new world, the managers used to civil service treasury rules regarding finance hadn’t a clue about how to manage when faced with the harsh reality of having to find work and cut one’s cloth to one’s income.
A tough lesson – but unfortunately a lot of ordinary folk got burned along the way.
David Duff writes:
My quick (and therefor probably ill-thought out) solution to the NHS is to sell every hospital to its staff for £1. Let them choose a management board, give them two years running money and then let them survive how they can.
No, I don’t think we can do that. We’ll get the same corruption we had when British Rail was franchised off by HMG, with numerous civil service rail managers, who knew the assets they “managed” were woefully undervalued.
They cashed-in big time by buying their bit of British Rail, one week, for five pence, and selling it the next week for £500 million smackeroonies (was John Major’s government the stupidest ever, or am I an Aardvark? 🙂
I, you, and every other voter in the country theoretically owns the NHS, under its communist ownership model. And I’ll be damned if my bit is given away to some parasitic friend of Gordon, who sells all the scanners the next day, for shed-loads of cash.
Going on that basic gut feeling, here’s my own back-of-a-fag-packet plan:
The NHS would be declared to be a private company, overnight; the Private Health Service, or PHS. And slapped up on the stock exchange.
Using the last electoral roll register collected, before this plan was announced, let’s assume there are 40 million UK citizens entitled to vote. Forty million PHS (Private Health Service) shares would be allocated, one to each voter.
You could then do with this share, as you wished; sell it on the open market, or keep it, to claim future dividend income, and decide the direction of the company, mostly asset-stripping all the useless bits I should imagine, and cashing in the bureaucrats, useless sods that they are.
What we must not do is “privatize” the NHS, then use the cash to pay off government borrowing. This will just let the thieving bastards rack up their borrowing again, funded from their unfortunate ability to tax us in the future, and then waste it all.
Maybe there are some clever merchant bankers out there who could come up with some other scheme, written on the back of an even bigger fag packet? 🙂
But I want MY money back.
Oh yes, and as the NHS accounts for (approx) 25% of government spending, I want a 25% (approx) cut in tax, immediately. Scrap VAT, and then scrap some other taxes, until AT LEAST 25% is cut off government tax theft.
Oh, and while you’re at it, scrap every other tax too, privatise the schools, abolish the welfare state, and make Tony Blair pay for his own holidays! 😎
Oh yes, I’ve not started yet…(that’s enough raving. Ed.)
One would still need an A&E (ER, for American readers) that treats those who’ve been careless enough to have a heart attack without their credit cards on them. However, a benefit of having a privatised (or even part-privatised) system might be that a triage nurse could say “go away, you aren’t an emergency” to little Johnny’s sniffles or someone presenting a mild chronic disorder that should be under a GP. I’m told the wide prevalence of entitlement psychosis means this most useful procedure has been abandoned for health and safety reasons under the NHS.
***
Rob’s plan has worked in the past: a large proportion of Britain’s hospitals were charities before 1948, and there’s nothing to prevent a charity charging, though it would be common for one to give some free treatment to those who can’t pay.
Mark Elliott’s point is a very strong one. Getting from here to there is not very straightforward in institutions of any size. The Sam-Brittain-ic approach offered by Andy and David Duff’s hand-’em-over-to-the-staff formula both fall flat on this. Almost all NHS management techniques are likely to be worse than useless in a private context, and the thing has to be approached gradually.
This doesn’t mean it can’t be done quickly, but it couldn’t be instant. My suspicion is that charging should come first allied with genuine patient choice over treatment. Followed by local staffing and other local management of resources. All targets would then be superfluous. Then the unnecessary NHS agencies and bureaucracy could go, scrapped or privatized as appropriate.
Selling-off, or liberating, the medical components of the behemoth would be the last and actually the least important thing to do. As long as state hospitals ceased to be subsidised preferentially and managed from the Whitehall, nominal ownership eventually wouldn’t matter.
(To quote the devil–in the shape of the LibDems–“ownership is not an issue”. If that phrase can support nationalization-by-regulation, it can also sustain effective privatization by excising the Civil Service.)
Breakspears Ales aren’t as good as they used to be. I can still remember when they sold “Strong Ale” in bottles. Mind you I can remember when breakspears had a brewery in Henley and “Tarzan” was our MP…
…ah those were the days. Then George Harrison had to go and spoil it all.
Well said, Julian! Just imagine how law-abiding, scaredy-cat please-Mr-State-don’t spank-my-bottom iris-scanned folk will feel the first time a cashpoint is robbed by thugs carrying an eyeball they’ve just cut out of someone’s face. [It will happen somewhere, citizens.]
On the topic of NHS freeloading, I think Britain is well overpriced for visitors and residents alike [see this article in the UK Spectator], and while the NHS exists, I’m actually quite happy to see foreigners who can afford an air ticket or a train/boat ticket to turn up in Britain for operations at my expense.
I think it is almost certainly a very small percentage of freeloaders, akin to the miniscule costs of benefit scroungers compared to the large cost of tax evaders [forgetting for a moment whether we agree with tax and benefit in the first place – I’m trying to be a little objective here].
And people visiting Britain for free, unfussy medical care is about the best PR this country could have, and we need some good publicity. Being ill, even on the point of death, and asked for your papers is a world away from being ill and getting treated at once no questions asked.
Call me a softy, samizdataists, but I like this aspect of the current British freedom/burden mix, and like all freedoms/burdens it involves some freeloaders. So what, the costs are minute compared to the other problems people here rightly target, such as administrative silliness.
On which topic, restoring some of the old-world power of the feared Matron, abbess of a hospital’s nuns/nurses, and kicking out the administrators would do a lot in my view to restore morale among health workers. I’ve taught management ‘science’, and it has some virtues, but in the case of health, I’m well happy to leave a lot more decisions up to the good sense of doctors and especially nurses. They may be pompous types at times, but they do care about curing people and they understand that curing a few people expensively can endanger their ability to cure a lot more people of something else cheaply. That’s as complex a utility function as we need in public medicine, I reckon.
Perhaps we want to change the NHS into something else, agreed. But let’s not get diverted from more urgent to less. First, kill identity cards and Blunkett’s career in politics stone dead. Then we can talk about health care.
You will have to work really hard to get an extracted eyeball to pass a retina scan since the scan reads the blood pumping through the capilliaries (or something). Good old menacing the eyeball and the rest of the victim would be much easier.
NHS costs could be cut by refusing treatment to criminals. Ditto dole. Why subsidise and repair burglars?
And housing the sods.
Guy Herbert writes:
One would still need an A&E (ER, for American readers) that treats those who’ve been careless enough to have a heart attack without their credit cards on them.
Anyone stupid enough to go through life without health insurance, or strolling down to the beach without a credit card, would still get treatment in any beach-side private hospital I ran, if they fell down unconscious outside. And when they recovered, if they were willing, and not insured with a company which recognised my hospital, I would charge them for it. If they weren’t willing, and remember, I forced my medical team upon them, I’d let it go and put it down to community good will. If they were ungrateful enough to sue me for my having impressed my medical team upon them, without their permission, despite my team having saved their life, I would be happy to let a common law judge, or appeals court, decide the matter, and allocate any fees due or compensation, either way. This would be part of the risk of running a hospital. If I wasn’t up to this risk, I would get out of the hospital business.
Though I can’t imagine there’d be that many people stupid enough to be without health insurance, falling down with heart attacks outside my door, and I would make sure my hospital had agreements with all reputable insurance companies to provide health care to all of their members.
As for those too poverty-stricken to even afford basic emergency-cover health care insurance, despite wanting to, but needing to eat first (because of the tax-induced poverty inflicted upon them by generations of socialist, and conservative, statist governments), or those stupid enough to have wasted all of their resources on heroin and alcohol, or gameboy cartridges, I’m sure the privatisation of welfare, and its application by private charities determined to get them to stand on their own two feet, would keep them covered, until the benefits of a liberty-based society got them out of this severe real poverty, as opposed to the insane relative poverty of the Guardianistas, which guarantees we’ll always have poverty in the UK until everyone earns exactly the same wage in the communistic society they desire (as long as they’re in the aristocratic elite, of course, where the much larger incomes aren’t used in compiling the relative poverty figures 🙂
And I’m also sure most hospitals would have a major charitable input anyway, as you say, or even get bought by charities, which would only charge to those who could afford it.
Your case is a hard one, I’ll agree, but not that hard, not in the real world of normal people who won’t be prepared to walk on by, on the other side. And certainly not hard enough to prop up £90 billion pounds of coerced tax-fed incompetence on stilts, aka, the National Health Service.
Mark Elliott’s point is a very strong one. Getting from here to there is not very straightforward in institutions of any size. The Sam-Brittain-ic approach offered by Andy and David Duff’s hand-’em-over-to-the-staff formula both fall flat on this. Almost all NHS management techniques are likely to be worse than useless in a private context, and the thing has to be approached gradually.
Well, my solution was not to gift it to the staff, but to hand it over to HMG’s voters. And I’m sure some cleverer heads than I, such as Sam Brittain, would have a much bigger fag packet than I used, to work out a more realistic plan, but, let’s step through even mine, written on a pack of 10 B&H:
Once handed over to the voters, as new private shareholders, HMG would simply stop sending cheques to GP surgeries, hospitals, or any other part of the NHS. The GPs, nominally private businesses anyway, would immediately cope, by charging for appointments and services, indeed they would start doing this the moment the plan was announced, before the shares were sorted out, to build up their assets. The hospitals would also cope easily for a few months. They would also immediately start charging people and GPs for operations, bed care, and so on, sack useless staff, and sell off unnecessary assets, or land. Any short-falls, the shareholders would be obliged to meet. Though I can’t imagine there would be many banks, who wouldn’t lend sufficient funds to a hospital, to tide them over till they’d sorted themselves out. No, the big bang is the way to go. Anything less keeps the statists in control, and you’ll find nothing will actually change as piece-meal reform will get swallowed up by the Leviathan. And remember the tax changes. With VAT abolished, stamp duty, capital gains tax, and whatever else takes us up and over 25% of the annual tax take, the subsequent river of wealth washing out of the government waste machine, will seal any cracks.
If any NHS managers can’t cope with this, and let’s face it, they can’t cope with anything currently, except the Guardian quick crossword, sack them. Replace them with people who can.
I’m sure that’s what the insurance companies will do, when they start buying up all the hospitals, from the shareholders who want to sell up, from the privatised holding company which owns all of the hospitals.
And if even any of that stacks up, after precisely three minutes of me making up the initial plan, just think what the Von Mises institute could come up with! 🙂
(To quote the devil–in the shape of the LibDems–“ownership is not an issue”.
Sounds more like communism to me. Ownership is everything.
mark writes:
I’m actually quite happy to see foreigners who can afford an air ticket or a train/boat ticket to turn up in Britain for operations at my expense.
But this is the nub of the problem, isn’t it?
Even forgetting all the other related issues of massive NHS incompetence, you may be happy to have Gordon Brown lift cash from your back pocket, to give it to other people in the form of free health treatment, but I am not.
And even if everyone in the UK, except me, think it’s Ok, what gives any of you the right to help yourself to my money, to satisfy your happiness?
In my book: Nothing
Perhaps we want to change the NHS into something else, agreed. But let’s not get diverted from more urgent to less. First, kill identity cards and Blunkett’s career in politics stone dead. Then we can talk about health care.
Well, yes, and no. My personal fetish is education. We’ve got to get the state out of education, the BBC, and all other statist propaganda organs, and their generational brainwashing that the state is the font of all goodness. But it all hangs together. Education, health, ID cards, welfare, John Prescott, it all has to go.
The ID card issue is a Rubicon, I’ll grant you, but we mustn’t just concentrate on that bridge over the Rubicon. We’ve got to look a Caesar and his Gaulish armies, and all of his friends in the senate, too. And Egypt, and Mark Antony, and Octavian. We must attack all of them, all of the time.
Just look at the NHS itself. Once they nationalised it, this gave them the excuse to make everyone wear car seat-belts, to stop costing the NHS money, it gave the Health and Safety executive innumerable excuses to regulate British life, to stop costing the NHS money, and it will give the health fascists the excuse to ban smoking, outside of a small shed near Slough, to stop costing the NHS money (witness the current waste of our money, on anti-smoking NHS adverts, to pre-empt this inevitable move).
If it helps, think of privatising the NHS right now, as an indirect though highly effective way of stopping ID cards in their tracks. Because the mantra has become, we must introduce ID cards, to stop costing the NHS money. So get rid of the NHS, and this major prop under ID cards disappears instantaneously, and ID card “health entitlement” proponents, like Oliver Letwin, will be left spluttering.
There’s always more than one way to skin a statist! 🙂
mad dog barker writes:
…and “Tarzan” was our MP…
I stood at the door of Gillots school, once, collecting money for the Tory party at their South Oxfordshire AGM, and Michael Heseltine stepped up. He looked me right in the eye, and I looked him right back, and neither of us said a word.
We’d both spotted the enemy.
This went on for some time, and then he broke away to jump into his limousine back to the Northhamptonshire arboretum.
Never seen him since. Let’s hope we never see, or hear from him, again, or any other Heathite.
BTW, I accidentally burned that Ken Clarke’s mouth with a scalding cup of tea, once, too. In retrospect, it was my finest hour! 🙂
Whoops, there goes my Wiltshire safe seat 🙂
For “Breakspear” (doubleplusungood) substitute “Boddington” or “John Smith Bitter” (doubleplusgood).
Did I get the IngSoc NewSpeak right?
It is pertinent to recall how effective the health service was before the NHS. In the 40’s and into the 50’s it was practical for consultants to donate their time pro-bono to the NHS because there wasn’t all that much they could do about certain things.
Entering hospital expecting to get better of heart attacks, cancer, spinal cord injuries and so forth is all relatively new.
I have a friend who entered nursing the in the early 60’s – he has worked through a revolution in the nature of effective health care. This is what presents the NHS with its real problems. If we had a 1940’s NHS, it wouldn’t be a problem.