The repetitiveness of this debate eventually led me to write this:
Government should have no role in healthcare whatsoever, and most of America's problems with healthcare come from government involvement. There are pragmatic arguments for this, namely that you get more choice in the private system; you aren't treated as a supplicant but as a customer in a private system, with the rights that go with that; you generally get better quality of care in the private system; and the private system is far more cost effective.
In the United Kingdom, the government bureaucracy NICE (national institute for clinical excellence) decides centrally which treatments the NHS will and will not fund. Now, given that the private system is so small to be near-monopoly, you have very little choice, unless you are exceedingly wealthy, but to use the NHS. The result of this is that, if you are unfortunate enough to have a disease that won’t be treated, or happen to be too old for it to be deemed worth treating you, you die. Furthermore, if you have a disease, you cannot choose a different treatment to those that are agreed upon by NICE. It is clearly absurd that a centralised government body can better decide what healthcare you should have than you, but at the same time, if any government tries to improve healthcare services, by the nature of government, they will have to do it from the centre.
In a private system, you are paying for what you are getting, and have corresponding rights. If your insurer or your hospital or anyone else fails you, as inevitably happens in any system, you and your family have every right to sue them. This is not the case in the UK, where you would be trying to sue the government. In truth, you just accept what you’re given. The distinction here isn’t just that you get reparations in a private system, but also that you encourage the private companies to provide a higher standard of care, to avoid litigation. Ultimately, no doctor in the NHS really needs to fear for his job if he is somewhat substandard- take a look at the case of Shipman, who murdered his patients for years without being caught. Systems are in place now to stop that kind of thing happening, but you still have surgeons who use general anaesthetics when local ones would be safer, and so on, and again, the patient has no means to avoid the bad doctors.
To support the claim that you get better care, I shall compare the American and the UK systems, however it is important to note that America hasn’t got a private system, but rather a part-private and part-socialised system. The effects of this are most severe, as I shall move onto later on. We cannot compare the life expectancies of two countries, as there are many things, in particular the lifestyle of the citizens, which will have an effect to invalidate the results. What matters is the likelihood, when you get sick, that you are treated, and the amount of preventative care you receive too.
In the US, relative survival rates for cancer, stroke and heart disease are higher than in the UK. These are among the biggest killers in the Western World, responsible for half of the deaths. Concerning the preventative care, where many claim that America falls behind, we see that in America 93% of one year olds are immunised with MCV compared to 86% in the UK, 96% with three doses of diphtheria, tetanus, toxoid and pertussis compared to 92% and 94% with the Hib3 vaccine compared to 92%.
Finally, the cost of private care is lower than the cost of public care, when private care is universalised. To support this claim, I would like to point out that per capita costs of private care in America are more or less the same as per capita costs of the NHS. The NHS costs the UK $3200 per capita. The US private system has very uneven costs, but if we look at all but the top 5% (rich people to whom the money matters very little, and so it is distorting to consider the costs), for the other 55% of Americans who use private care, the average cost is $3300. Given that the costs would go down without any Medicare and Medicaid, without lobbies, and without such overburdening regulation, this shows that private care would be somewhat cheaper than public care.
Of course, the American system at present is not a free market healthcare system, the lobbies exercise a great deal of control over the government, encouraging regulation that keeps new and small companies out. If the government were to scale back its involvement to purely the maintenance of contract law, trade descriptions regulation etc. this would cease to be the case. They should relax licensing legislation that causes prices to rise due to artificial scarcity, abolish import tariffs on drugs to lower costs, lower taxation substantially, as will be possible, to give people more money to buy healthcare. Also, they should permit insurance to be sold across state lines. We can see the benefits of the free market approach in cosmetic surgery, where customer care and costs are consistently improving.
A case in point of the government acting to spoil the free market in favour of doctors can be found towards the start of the 20th century, when, of course, free market healthcare was at its height. At that time, it was common for groups of relatively impoverished Americans to come together in a fraternal society, a voluntary mutual aid association, and employ a doctor on a permanent basis. Because of the permanent nature of the employment, the doctor’s pay was somewhat lower than it would be if he were paid on a treatment-by-treatment basis, costing each member as little as only a day’s pay each year, however many doctors took up this option because it offered more certain employment and because demand for treatment-by-treatment care was lower, with many choosing to go for the group-based model. Now, at the end of every year, the members would discuss the performance of their doctor, and either extend his contract, or not, depending on whether or not they were satisfied. The response of the medical trade was wholly negative: they resented the fact that non-professional ignoramouses, i.e. the customers, would analyse their performance and they disliked the lower pays that they got. Their response? To get laws passed to prohibit this sort of collective forming, to the great detriment of the health of Americans.
Now I could continue to attack the NHS and other socialised systems, pointing out that the Patients’ Association identified 1 million different cases of “Cruel and neglectful” treatment over the past six years, that the victims were largely elderly, and had no recourse. I could add that one NHS trust threatened the Patients’ Association with legal action for publishing this data. I could draw your attention to Mid-Staffordshire NHS Foundation Trust - where up to 1,200 people died through failings in urgent care. I could add that the UK government withdraws all care if you so much as buy a painkiller privately to supplement your NHS care, keeping you wholly stuck within the system, and that the average waiting periods for hip and knee replacements extend to a year. However, to do so alone would be disingenuous of me when I haven’t myself similar statistics about the alternative, just as pointing out that many get poor treatment in the US is disingenuous, since it doesn’t involve comparison between the two, and that, since man is fallen, you can always find horror stories in any system, just as you can always find good examples of care in any system. It would amout to little more than an appeal to emotion, when what matters is the objective comparison of the two systems, as I have given already. It must surely conclude that the best way to improve healthcare is by the free market, just as the best way to improve everything else was by the free market.