Stakes in the Heart

Limitations of Public Health Exposed

A debate is taking place in the UK about public health.  The cold hard reality is that the UK government has run out of money and its debt levels are worrying.  It has consequently put the squeeze on the public health system.  It now has a duty to raise more money by providing health services to the more wealthy, to those who can pay for medical services and procedures. 

This from The Guardian:

Hospitals are seeking a radical increase in revenue from the treatment of private patients as their budgets come under pressure from the needs of an ageing population, according to new figures obtained under the Freedom of Information Act.  Great Ormond Street children's hospital has budgeted for an extra £11m from treating private patients in the financial year ending in 2013 compared with 2010 – a 34% increase. The Imperial College Healthcare NHS Trust is also expecting to boost revenues by £9m over the same period – a 42% rise. The Royal Marsden is expecting an extra 28% increase on 2010 revenues, equating to about £12.7m. Across all trusts an 8% increase in revenues from private patients is expected to be posted for 2012-13 compared with 2010-11.

Previously, successive governments have decried and rejected the idea that state funded health services should generate any money from the more wealthy.  It was a rationing system that was a bridge too far for socialists.
  Now the government has no choice.  Socialism, as the Thatcherite adage has it, eventually runs out of other people's money.

The increase in revenues (from private patients) follows the government's controversial decision to allow foundation trusts to earn 49% of their income from treating private patients. They were previously capped at earning about 2% from private sources. 

The Achilles heel of all public health systems is that, as one NZ Treasury official put it, they are a fiscal black hole.  You can never have enough of other people's money to satisfy the its demands.  Aging demographics and shrinking population bases are one thing.  But equally relentless is the wonderful expansion of health care itself.  As medical science and technology advances the number of cures and medical procedures rises exponentially.  All these new, wonderful procedures and treatments cost money to provide.

Critics of the new policy warn that a two-tier system will develop in the public health system.

Ministers, who want trusts to act more like businesses, will celebrate the latest figures. However, critics fear that NHS resources are being disproportionately directed at patients with money and that a two-tier system is emerging. Gareth Thomas MP, who obtained the figures, said: "The huge expected rise in income from private patients is a further sign of an underfunded NHS. These figures confirm that the NHS under David Cameron is increasingly offering a two-tier service: pay privately and you'll be seen quickly; don't pay privately and join an increasingly long waiting list."

The retort is that all the private patient income is directed back into the public health system.  But the cavil over a preferential priority for paying patients remains.  The critics will be proven right.

To our mind the only fundamental solution is one which is even more of an anathema to socialist ideology: the encouragement of charity.  Socialists hate charity with a passion.  Welfare is a right, a demand right in socialist dogma.  Charity is an anathema because it drives a stake into the ideological status of public health demand rights.  That aside, it remains the only viable solution to the withering of public health under fiscal constraints.

Charities raise a great deal of money for the needy and the indigent.  They would raise a great deal more if the government were more up front and honest about the inadequacy of its socialist welfare services.  It's long past due for the state to acknowledge its severe limitations and to welcome participation from charities.  We have one qualification: what the UK, nor NZ needs, is more charities which are really a front for government funded welfare.  Many charities have turned to government funding to support their operations.  Governments have agreed: the fee for service model in delivering welfare can work well up to a point.  But it does not plug the gap in public funding.  It merely shift services from one provider to another, both alike publicly funded.  The crisis we are talking of is a fiscal crisis due to socialist money running out.  That is the fundamental issue.

We expect that this UK initiative will continue to be opposed by socialist ideologues.  The introduction of charitable funds into the public system will be even more resisted. It represents a strike at the very heart of socialist dogma.  But it remains the only viable way forward.