Daily Archives: June 13, 2011


Cheap Medicine and Nasty

There is a coalition lovefest going on over the new reformed NHS reforms, which have suddenly gone from being the worst think since the plague to the greatest thing since sliced bread, all with a few tweaks.

The problem is, it is the entire principle on which the reforms are based, not the mechanisms operating on that principle, which is fundamentally wrong. The underlying principle is that the NHS will work better if it operates on competition between healthcare providers, both existing NHS hospitals and clinics, and private and charitable hospitals and clinics which will have new access to NHS patients and cash.

Both Sky and the BBC have been telling us all day that competition drives up efficiency and quality.

But this is not true. If financial profit is the motive, then competition does indeed increase efficiency, in terms of maximising profit by minimising costs. But the natural tendency is for this to be at the expense of quality, except in certain specific areas of luxury good provision. Competition and profit drives the producer to give just as much quality as required to provide something the consumer will still take, while undercutting rival sellers. Where there are a limited number of providers, (and in most parts of the country there are obvious limits to the number of possible clinics and hospitals), this increasingly becomes a race to the bottom in quality, with the added temptaitons of cartelisation on price.

For a brilliant demonstration of the effect competition between providers has in real life, read “Cheap Clothes and Nasty” by Charles Kingsley.

It is hard to believe that anybody could for one moment accept the premiss that something done for love and care, will always be of less quality than something done for private profit. Yet that is precisely the hogwash promoted by Thatcherism and which New Labour under Blair signed up to completely.

Not only will a large percentage of the NHS budget now go as profit into the pockets of large business (as though Southern Cross were not sufficient warning), but there will be a whole new and still bigger infrastructure of accountants and paper shufflers regulating and processing the entirely artifical NHS “Market mechanism”.

It also worries me that so much attention is paid to the desires of the medical profession. I don’t much care what doctors think. Remember, doctors were strongly against the creation of the NHS in the first place. Remember, the medical students you knew at university are doctors now. Remember the guy at your local surgery who pulls in over £100,000 and won’t see you out of hours or at weekends, and normally has a Polish locum see you while he’s off in Corfu? Why do you care what he thinks about it? If you wanted to find a wealthy right wing nutter, you would have an easier chance in a group of doctors than among the general population.

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