Negative Proposals from Outside Government
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There is plenty of information about what is wrong with the National Health Service. Not all solutions offered by political parties would be moves in the right direction. Any proposals need to be judged against the following criteria.
Proposals based on insurance either voluntarily or through employers score well against item 2, and may not cause anybody immediate disadvantage (item 3). They weaken accountability to the patient (item 1) by adding a layer of administration in insurance companies that may be difficult to bring to account, and by making hospitals the clients of the insurance companies rather than the patients. Longer term, a two-tier system, with people in well paid regular jobs likely to get better health care than people who are low paid, unemployed, chronically sick or disabled, or retired, would undermine public support for the level of taxes needed to provide a good quality universal health service. This is why any growth in private health insurance is a bad move, and any voluntary reduction in take-up of private insurance policies may be a sign that the Health Service is significantly improving. But rejection of a two-tier system should not be extended to a denial of choice. Choice of alternative hospitals is a way round local staff shortages. Choice of alternative doctors, including access to a second opinion, is a way round prejudice, based on age or unrelated medical conditions, or substandard treatment. Although choice is easier for people with more resources, especially transport, that is not, despite Roy Hattersley's objections, good reason to reject choice. The Conservative proposal to subsidise part of the cost of private treatment would be damaging as it would inevitably extend the two tier system and would reduce articulate pressure against low NHS standards, as it would be too easy for people with middling incomes to opt for higher standards. |
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Sheila
Porter-Williams |