We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.
Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]
|
Direct health care: register your interest Recently I wrote about Simon Gibbs’ idea to find doctors willing to offer direct health care, providing better care at good value to customers and making a profit at it. Now his site Libertarian Home is gathering a list of people in the UK interested in such a service.
Register to express your interest in purchasing, for your own needs, a monthly subscription for GP services such as check-ups, disease management, minor treatments, obstetrics, and advice.
Simon explained to me that he wants to find a cluster of people who make a potentially viable business for someone, and put them in touch. You will be signing up to be notified of opportunities.
I hope he can help make this work. For the right price I would welcome such a service: it would be valuable to just have access to a doctor who I could chat with at leisure for general advice and not feel like I was being a nuisance.
|
Who Are We? The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.
We are also a varied group made up of social individualists, classical liberals, whigs, libertarians, extropians, futurists, ‘Porcupines’, Karl Popper fetishists, recovering neo-conservatives, crazed Ayn Rand worshipers, over-caffeinated Virginia Postrel devotees, witty Frédéric Bastiat wannabes, cypherpunks, minarchists, kritarchists and wild-eyed anarcho-capitalists from Britain, North America, Australia and Europe.
|
I can receive private gp services as a company benefit. How is that different?
From which provider? I’ve Googled, called people, asked around and spoken to a GP about it. All I found was a guy in the cotswolds doing it only for out-of-hours, and a new company in Wandsworth.
BUPA sales people, for example, have told me this is not done, at least not by BUPA.
I do not mind being wrong. It would be great if this WAS available, we should then proceed to use it and work to ensure there is more of it.
I’m not sure I share the optimistic view of GPs. Many I have encountered (or their staff at least) seem to relish their role as the front-line in the state surveillance mechanism.
In one case I was brow-beaten by a practice nurse for not bringing my son in for over 2 years. “He hasn’t been sick!” I replied. “Yes well, we just like to keep an eye on them…” before wistfully sighing “Oh, it’s so much easier with children who go to state nurseries….”. She said this while looking at his records, and she was annoyed that he’d had no contact with anyone who could update those records in some time.
The medical records system is the defacto “government database” on everyone who isn’t a criminal, and these days it contains info even the Stasi could only dream of. It has all sorts of non-medical stuff in there, and all manner of government employees (many who have nothing to do with medicine) can access and edit them at will.
I’ve long thought that GPs complicity in informing on their patients was a fundamental breach of trust which undermined their role as a provider of care. If I stay away from my GP because I’m concerned he’s going to tell on me (for whatever), and then I get sick, who is to blame? This is very common in psychiatric care. Many people who get “a little bit depressed” would love it if they could talk to their GP about it, but don’t want it going in their records for all and sundry to see. They want a genuinely private conversation with someone who isn’t a government informant.
The extreme form of this can be seen in those who make calls for compulsory vaccination. Like a lot of Christians (and religious people in general) we do not give our children vaccinations we consider to be “unethical” (that is, they are manufactured using material gleaned from an abortion). There are ethical alternatives available, but not on the NHS. It is their way or nothing. Many are campaigning to remove “nothing” as an alternative.
If such a law were passed, people like my family would simply take to avoiding doctors altogether.
I’m sure I’m missing something here. A Google search for “private GP” comes up with thousands of results. I personally go to one near Harley Street — not cheap, about £80 for half an hour. But he can normally give an appointment on the day you book it, or at least the next day. And you’re guaranteed half an hour rather than being rushed through by an NHS GP who’s been forced by the economics of the state healthcare system to jam everyone’s appointments together.
In the interest of my own privacy I won’t link to the GP I use, but here’s a link to a company in London that I did use once and who seemed very professional, helpful, and effective: http://www.samedaydoctor.co.uk/
I have private health insurance that doesn’t include GP visits, via my partner’s job, and they say that they’re happy for private GPs to refer me for treatment through their plan if necessary, though they want him to have full access to my medical records over a number of years to do that (I think simply to ensure that I don’t use them for conditions that pre-dated my insurance cover from them).
TBH I’m not sure I’d want to use a subscription service — pay-to-play feels like it keeps incentives aligned better. You have to ration visits for hypochondriacs somehow. (As a hypochondriac I’m entirely sure of that 🙂
@Giles: you are not missing anything, but I think there is a qualitative difference with pay monthly plans that you are not focused on. That difference is that a low monthly commitment is less scary for many people.
Most private GPs charge a visitation fee and most insurance plans require a GP referral before their specialist services kick in, so in any case the GP is a gateway. Some insurance companies do offer a GP telephone helpline, which I would look on as the minimum viable direct care product.
Extreme hypochondriacs could, ultimately, be declined a contract (as in any good honest trade between consenting adults, neither party is obligated) but I would expect both sides would want a minimum commitment and doctors, having basic empathy, would probably want to work with the patient to sort out the root of the problem.
Disclaimer: I do not know much about the condition.
So, surrender to the state. Pay your taxes and thereby pay for the NHS and also pay a doctor privately.
Not exactly Fred. Everyone enjoying fully private medicine is a member of a put upon interest group. Politics is good at pandering to interest groups. If an opt-out was secured then that would be progress.
That’s rather uncharitable, Fred. Simon is concerned with creating the foundations of a liberal society before the illiberal one collapses. And, incidentally, his proposed Direct Care initiative doesn’t require you to pay your taxes.
@Simon agreed re: the lower scariness of a low monthly commitment.
The problem, as I see it, is that if you have a subscription fee then some portion of the plan’s customers are paying more than they would if they paid per use, and another portion are paying less. For the customers are paying extra, the predictability of their payments is obviously a benefit, but (hypothesis) for at least some of them, the value of that benefit is lower than the extra that they are paying. So they would leave and start using a pay-per-use system. Because those were the lowest-usage customers, then that pushes up the average visits/customer, so the service has to raise prices — which in turn pushes out another tranche of low-usage customers.
It’s a similar problem as the one with insurance for likely events (I forget the technical term) — customers who are likely to make claims will get insurance, and those who expect that they’re unlikely to make claims will not (and will save money against a rainy day or whatever). So you’d wind up having to use the same kinds of complexities that one sees in the insurance market — some kind of deductible (£10 per GP visit on top of your fees?), an equivalent of a no-claims bonus, that kind of thing. Or, FSM help us, government-mandated subscription to these plans like we see in the car insurance market.
Subscriptions for unrestricted usage do work in some markets — mobile phone plans and Internet access seem to be heading in that direction — but it seems to make most sense in markets where the marginal cost of providing extra services to an existing customer is small, which obviously isn’t the case with GP visits!
Still, I may be totally wrong about all of the above. The great thing about the free market is that it can be tested by someone setting up a subscription service, and let the best product win… Though whether the current healthcare services market is free enough for it to be a fair test right now is an open question.
I’m reassured to have learnt (via Andy Bolton, thanks Andy) that there are people trying this already, also one of the meetup members is an actuary.
I’ll ask them about these issues and feedback via Libertarian Home. In the meantime, I think it’s important to produce evidence that there is commercial demand. In fact, evidence of demand may help to get access to people with experience and knowledge to bring to bear.
Simon are there any interest groups that would lose if your idea became reality? Might GPs feel threatened enough to petition against it in some way? And how would all this affect Scottish Healthcare, if Scotland succeeded in seceding?
Simon, sorry for the tardy response.
The company is called ‘roodlane medical’. This is the blurb from my company benefits website.
When you’re unwell, the sooner you’re treated the sooner you feel better. Same-day appointments are offered from our locations based in the City and Central London. Roodlane Medical offer ‘continuity of care’ from its established doctor team and membership gives you access to its clinicians, as often as you need. This clinician team has strong links with a wide range of specialists, enabling faster access to the right consultant for you when investigations are required.
When you need to see a doctor or nurse, simply call to make an appointment. On your first visit, you’ll be asked to complete a registration form. You will be allocated a minimum 15 minutes for the consultation, giving you time to talk and the doctor time to listen. You also benefit from a range of procedures at no extra cost with the practice nurse such as simple dressings and changes and removal of stitches and family planning services.
Your membership funds your consultations and no further payments are required for your appointments. If the doctor thinks you require any tests, you’ll be advised of the costs and can make the decision to proceed. Preferential rates have been negotiated with laboratories & imaging centres.
You must give 24 hours notice of cancellation. If you fail to do so or do not turn up for your appointment then you will not be charged a fee for a first occurrence. Should it happen again though, you will be charged £70 for each instance.
Great. Thanks.
I feel a list coming on.