Alternative Medicine
If we want decent healthcare, we need to stop banging pans together, and start banging heads together.
The late Queen was 96 when she died. The President of the United States, Joe Biden is an admittedly doddery, 80. His rival in next year’s presidential election is likely to be Worst Man in the World Ever, Donald Trump, 76. The last Speaker of the House Nancy Pelosi has only just retired, she is 83. Succession star Rupert Murdoch is getting married again at 92. The same age as Clint Eastwood, and he’s still making movies.
Clearly being super rich and having access to top class medical care does wonders for your health. I have no doubt the aging celebrities and politicians listed above, receive almost daily attention from a team of health specialists, alert to every twinge, flutter, pang and ache.
Unfortunately most of us aren’t super rich and so don’t have access to top class medical care. We have access to the NHS instead. And maybe not much access, and that’s a shame.
Not least because removing the link between access to wealth and access to good healthcare was pretty much the main reason The NHS was set up in the first place.
You don’t need me to tell you there is a lot of love for the NHS. Of course there is. For a start, it’s universal healthcare. Everyone gets equal access to the resources. At least in theory. It’s a foundational value, and incredibly popular with British people who care a lot about fairness.
And of course the NHS is what they call ‘free at the point of use’ which is a fancy way of saying it’s paid for by the state, which of course, is a fancy way of saying it’s paid for by me and you, out of our taxes. And that is also a popular feature. Don’t underestimate for instance, how reassuring it is for old people, to know that they can get their medicines, and see a doctor, without worrying they’re about to be handed a great big bill.
So universal access is great. And people like the fact that they don’t get charged by their doctor, at least directly.
But when it comes to outcomes, the NHS is less impressive. Rather than bombard you with a load of statistics I’ll just quote the Commonwealth Fund, the left leaning foundation which rates the NHS as the best ever in the world at a lot of things
"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency,"
Great stuff. But then goes on to say
‘The only serious black mark against the NHS was its poor record on keeping people alive’.
Which if I was being cynical, rather than open minded and fair like normal, I would suggest is a bit like reviewing Wing Stop as
‘An excellent fast food restuarant, which only falls down on the quality and availability of its chicken limb based snacks.’
(Just to be clear, I’m not saying actually that about Wing Stop, it’s great. And I fully support universal access to low cost, Louisiana Rub, chicken wings.)
So there are clearly problems, as anyone who has tried to see their GP, called an ambulance or is currently one of the 7 million people languishing (they’re always ‘languishing’) on a waiting list would attest.
We are usually encouraged to put these failings down to a lack of money.
OK. Fair enough. So how much do we spend?
We spend a bit more than most western countries on healthcare, but nowhere near the most, that’s actually the USA, which surprises a lot of people.
The USA spends 17.8% of GDP, we spend 11.7%, a tiny bit more than Switzerland, a little bit less (about 1% less) than France and Germany.
Which translated to £152.6 bn in 2019-2020 before COVID.
That’s a lot of cash. 18.5% of the government’s overall budget.
So that should be enough right? Maybe.
I watched a comedian perform on stage recently. No one famous, but he was very good. He was funny and likeable, an everyman. His stuff was domestic, not political at all. And yet he earned his biggest cheer of the night with an off hand remark. It wasn’t even a joke.
He just mentioned how we’d all be much better off if the NHS wasn’t being starved of funds by the greedy Tories. The room went wild. But that reaction made me sad.
Now I’m no fan of this Conservative government. Just to be clear-I think they are rubbish.
They have betrayed the people who voted for them, wasted Brexit, abandoned the principle of Free Speech, trashed the economy through lockdowns, and pretty much every other means at their disposal, waged war on motorists, stopped policing real crimes while cracking down on imaginary offences, pushed ahead with HS2, and abandoned the idea of helping disadvantaged people and communities through ‘levelling up’. Also, they gave us Matt Hancock.
But starving the NHS of funds? That’s simply not true.
We started off in 2010, under David Cameron, (a Tory for younger readers), spending almost £130 bn a year.
The Kings Fund projects we’ll be spending £184.5 bn in the year 2024-2025 and the last time I checked 184 is bigger than 130. A lot bigger. Even when you factor in that transitory-nothing to worry about- inflation.
The reason the crowd’s reaction made me sad wasn’t that they were being horrible to the Tories, it was because if voters genuinely believe that the only real problem with the NHS is that it is being deliberately starved of funds by the main party of government, then they will never seriously call for it to be reformed in a way which does eventually allow it to function as they’d wish.
They will only ever see the solution as more frequent injections of more and more cash.
Now I’m not saying we shouldn’t spend more on healthcare. Maybe that’s a good idea. I expect another big injection of money might be popular with the electorate. (Though maybe not as popular as it once was).
However if we spend about the same as other countries but get worse outcomes, then the logical non-ideological conclusion must be that the problem isn’t exclusively how much money we pump into the system, it’s how it is spent.
The NHS is a government run monopoly. This is problematic in two ways. Firstly the government is notoriously crap at running things.
And as Exhibit ‘A’ I give you, The Country.
And secondly, monopolies are very bad for consumers.
Having only one supplier for any commodity, product or service concentrates all the power within that supplier. And takes all the power away from the consumer or user of that service. It’s an unbalanced relationship. Which leads to inefficiency, bad service, poor quality goods, and generally a raw deal for the end user.
Which is why we have a Monopolies Commission. Its job is to stop that from happening.
No one wants craggy faced marriage mogul Rupert Murdoch owning all our newspapers. We don’t want creepy Mark Zuckerberg running all our internet services. You don’t want the Rockefeller family in charge of all the oil wells.
Yet when it comes to our healthcare, we’re encouraged to think a monopoly is perfectly ok.
Great news! It’s clumsy metaphor time.
Imagine a world where instead of Tescos, Lidl, Waitrose, and the rest, there is only one supermarket available. It is run by the state, and essentially has a monopoly.
You have to pay for all your shopping in advance. Directly out of your wages.
No so bad you think.
At least this way all my groceries will be guaranteed. Plus, with the economies of scale, all my shopping should be super cheap.
Happy days.
So, one day, feeling peckish you turn up at the monopoly supermarket and ask for some sausages. And the supermarket staff look at you like you are an idiot, and ask you if you really, really, really need sausages.
And then they tell you to go home and at some point over the next 48 hrs someone will contact you. You can make your case for wanting sausages over Zoom, and they will decide if you get them or not.
And you say yes ok, but point out ever so politely that actually you have already paid for your sausages. And they in turn point to a sign which says ’Abuse of our staff will not be tolerated’ and you feel bad and ashamed of yourself, and you shut up and leave.
So you go home and wait for the Zoom call, and then the nice lady from the cold meats counter comes on the screen and when, eventually, you do manage to convince her that your tummy is indeed rumbling she reluctantly agrees to put you on the sausages waiting list.
Six months later you get a letter which says you can come and collect your sausages between 11am and 11.15am the very next day. It’s a bit short notice. You did have a work commitment, but you ring your boss, and she’s very understanding and tells you that sausages are more important than silly old work. She’s super nice like that.
So next day you turn up at the monopoly supermarket to collect your sausages. But they’ve lost your shopping list and the shop staff are on strike anyway.
So they send you away again and tell you you’re going to have to wait another six months. At this point you are getting exasperated and think you might go elsewhere for sausages.
But the laws of supply and demand dictate that the only other shop which sells sausages charges a fortune for them, so only rich people tend to eat their sausages, and since you’re not rich, it’s not really an option. You do hear however, that the other shop’s sausages are very, very good. And that’s annoying.
So you decide to wait, and six months later you turn up at the supermarket, and guess what? They have your sausages!!!
The shop assistant is super nice and even gives you a couple of handy sausage recipes. The people in the shop are absolutely lovely and obviously care about sausages and trying to get them to as many customers, as cheaply and quickly as possible. You say thanks so much and walk out of that supermarket with the sausages under your arm, feeling like you are the luckiest shopper ever.
You go home and eat your sausages. They’re a bit stringy and you only actually got two when you paid for six. But never mind. Two sausages are better than none sausages right? And they were free at the point of service. No one in the actual supermarket charged you a penny! Amazing!!!
And then afterwards, with a tummy full of sausage, you go outside into the street and bang some pots and pans in praise of what a brilliant supermarket your supermarket is, and how you especially like all the super nice and dedicated people who work there.
And you wonder why no other country in the entire world is clever enough to adopt such a brilliant, fair and efficient system, for delivering people’s sausages.
We wouldn’t want a monopoly state supermarket to be in charge of delivering our sausages. So why do we accept a monopoly state system for our healthcare? After all, healthcare is much more important than sausages.
Now obviously, I’m obliged to say at this point. That no. I do not want an ‘American healthcare system’ which ‘kills poor people’. Or an unfair system where they won’t even look at you in A&E unless you hand over your pets and credit cards.
I don’t want a free for all market based approach. I’m not ideological driven on the issue at all.
But ever since I can remember, and I can remember quite a bit. The NHS has always been ‘in crisis’. First every Christmas. And then it was like it was Christmas every day. And not in the good way.
Up until recently any criticism of the NHS received pretty much the same reception as JK Rowling would get, if she turned up to Nicola Strugeon’s leaving do, in a MAGA hat.
But fortunately things are beginning to change. Probably thanks to a combination of factors; more and more NHS users experiencing dissatisfaction with the long term after effects of shuttering most of the healthcare system during lockdown.
And secondly, what I call the ‘Love Island Effect’-the fact that increasing numbers of regular people are happy to pay for medical procedures like Botox and Brazilian bum lifts (whatever they are).
We’re obviously voting with our feet. More and more people are using private medicine . And thanks in part to Insta, going private doesn’t seem so outlandish any more.
When even that nice Wes Streeting, the Labour health spokesman, is calling for reform, not just another massive injection of cash, you know there’s a real potential for change.
I know this is a heresy, but would a system which at some level, used profit to incentivise putting the patient first really be so heinous? Maybe to some people yes it would be.
But the idea that The NHS is run on good will and rainbows is just another myth. There are plenty people making an absolute fortune from the NHS.
For instance most people don’t have a clue that GP surgeries are private businesses. They might only have one customer but they aren’t directly run by the NHS. Don’t believe me? This is on the British Medical Association website. And this can even lead to accusations of profiteering. Although in fairness, they don’t all make piles of cash.
For a centralised, broadly socialist system, The NHS is pretty good at making some people very, very rich. I’m trying to keep this statistics lite. But here’s the start of a rabbit hole if anyone is interested. And that’s before we even consider all the suppliers, drug companies, grievance lawyers, and what not.
One of the issues seems to be that the NHS has taken on too much. I think most of us would agree that the NHS should concentrate on spending money making sure poorly kids get their operations and nanas get their hips replaced, rather than on activities which clearly aren’t serving the core goal of making sick people better.
I’m not going to produce a long list of what the NHS is doing ‘wrong’. I’m not pretending to be some kind of arbiter, and clearly different people and groups have different priorities. My only point is that our healthcare system isn’t structured in a way it could possibly fulfil all the demands placed on it. And yet it seems to see its role as continually taking on more and more responsibility for more and more aspects of our lives in an effort to somehow ‘fix’ us.
For instance, instead of spending fortunes on endlessly hectoring grown ups to eat their veggies, I think most of those grown ups would prefer it if an ambulance turned up when their mum falls down the stairs.
Sure, prevention is better than cure, and improving the nation’s health is a laudable goal. But maybe not when our pinch faced, judgemental nanny state is on the one hand scolding us about ‘the obesity crisis’ and in the next breath warning us it’s a hate crime to notice that someone might be taking up a little more than their fair share of the lift.
I digress.
Why not at least look at incorporating aspects of other, dare I say better, healthcare systems?
The same people who love to constantly remind us how brilliant France and Germany are compared to this shitty country, never seem to extol the virtues of their healthcare systems.
Most European countries use a sort of hybrid system. Some state involvement, but health insurance too.
And yes, they nearly all include the guarantee that the poorest are covered, and in an emergency you don’t have to turn up to the hospital with a credit card sellotaped to your bleeding stumps before the doctors will agree to treat you.
If it works in Germany it might work in the UK. We could maybe even get the elites and vested interests onside by selling it as another kick in the nuts for Brexit.
I’m not saying privatise the NHS. I’m definitely not saying let’s burn it all down and start again. People like the NHS. A lot. It has even become a cornerstone of our cultural identity.
But we’re in a weird position, where anyone who seems happy to let things continue as they are, let the NHS fail, and simply blame a hugely complex set of issues on the venal Tories and their supposed ‘cuts’, is portrayed as a goodie.
While anyone who is open to any reform which might work for patients, even if that reform might involve a role for private care, insurance and markets, is portrayed as a baddie.
This isn’t yet another arena for ideological point scoring. It’s a nana in Rochdale with a dodgy hip who can’t get down the shops. It’s a bloke who’s fallen off a scaffold in Croydon who can’t get an ambulance. It’s real people
But only by acknowledging the NHS’s many failings can we hope to save it. Our healthcare system was already tottering on the edge before COVID but the lockdowns knocked its legs out from under it. Leaving us now with a health care system that doesn’t keep us healthy and for many, no longer seems to care.
Yes people care deeply about the NHS. But they care even more for the health of themselves, and their families.
I guess my point is. Until we have the courage to take off our ideological blinkers, the NHS is never going to get fixed. Patients are going to get sicker. People are going to get angrier. And if such a thing were possible, our politics is going to get even more polarised.
Surely it’s time for us, the patients to stop accepting the myth that the NHS is little more that a hospital based morality play, a never ending battle between goodies and baddies.
We need to stop banging pans together and to start banging our politicians heads together (metaphorically at least) until they stop simply blaming each other for the current situation, open their minds to new, potentially radical but genuinely workable solutions, and finally sit down together to come up with something that actually works for all us.
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PS: Of course there are the attempts to blame us, the NHS patients for some of its failings. We are too fat. Too lazy. Too boozy. Or too wilfully COVIDy to deserve treatment. I wrote a little about this trend here.
This kind of wrong think really must be stopped
Absolutely hilarious and absolutely correct! (how is this not bleedin' obvious to everyone??)