The National health Service is close to the hearts of the British public. As the service celebrated its 70’t birthday this summer, thousands marched in support. The banners were the same as always: ‘Save our NHS’ and ‘Patients, not profit’. The picture in most of the marchers minds were of a service starved of resources and increasingly being privatized, and to the naïve minds of the masses privatization means profit – and that must mean money being drained away from patient care.
But event the most ardent opponent of NHS privatization need not be a die-hard ideologue, but merely confused and indoctrinated by the quasi-religious reverence surrounding the NHS. Here are a few easy questions which could help them with straighten their thinking out on the matter.
Does privatization mean that only the rich get treated? This is an often heard argument, but the delivery and funding of a service are of course separate issues. There is currently no talk of transforming the NHS to an insurance based model neither one with an individual mandate (like for example Germany or Switzerland) or, heaven forbid, a true free market with individual responsibility for making provisions for health care.
Is the NHS really being privatized? Though public debate gives you a clear impression that ‘the Tories are privatizing the NHS to enrich their posh friends’, this sounds a little bit like an infantile conspiracy theory – and it is. As a share of total Department of Health expenditure, spending on private sector has remained flat for the last few years and actually decreased slightly in 2017/18. So no, the NHS is not being privatized, though around 7% of health spending does go to private providers. As a share of total health spending, the British spend far less on private providers than for example Germany and France.
If it was being privatized, would that mean worse service? No, most people seem to think not. A poll by Statista found that only 9% of Brits wanted only public hospitals to be included in the NHS framework and only 6% agreed that public hospitals always represented the best choice. That said, according to the Nuttfield Trust more than 40% prefer a NHS hospital, up significantly from only 20% a decade ago. But public opinion supports the rational notion that private hospitals can provide a good service.
Is profit a problem? Isn’t what matters not the profit, but the quality and cost of the service to the Department of Health? This is self-evident. A better service at a cheaper price should be preferable, even if someone is making a profit. Only the most die-hard left-wing ideologues would disagree.
Isn’t it true that the most profitable companies are often the ones providing the best product? Most Brits need look no further than their pocket, where their iPhone is the go-to example of innovative, cutting edge technology with broad appeal, which has bestowed on Apple years of blockbuster profits. We do not judge the value-for-money of a product or service by whether the provider makes a profit or not. If anything, a loss-making business often provides an inferior product – that’s why they’re losing money. Profit is how the free market rewards added-value economic activities, it is not a ‘tax’ on the consumer levied by fiendish capitalists.
Should the NHS produce its own toilet rolls? No matter if all health care was provided by NHS staff in NHS hospitals, the service would still procure services and products from the profit-seeking private sector. But few suggest that the NHS should do away with outsourcing altogether; establishing in-house alternatives to private providers of telephones, toilet paper, cars or windows to save money that could be put towards patient care. In many cases, most people recognise the ludicrous notion that paying someone a price above the cost of production automatically means that it’s more economical to produce that service inhouse. They just refuse to extend that thinking to front-line health services.
When the British public throw their proverbial toys out of the pram over the perceived back-door privatization of their beloved NHS, few have stopped for a second to ponder what they are protesting. The slogan-shouting masses are wedded to the idea of health service as a right, available free at the point of use. But the privatization debate has little if anything to do with the question of universal access to health care. Asking themselves a few questions would help the protesters sort their thinking out and avoid them making the same credulous placards for the 75th birthday coming up in 5 years time.