Wednesday, August 05, 2009

Attitudes to public healthcare

Liam quotes Michael Prell, a US right-winger, on public healthcare:

You should manage your health. You should have the power to choose whichever option serves you best. The power over your health -- your very self -- should be in your hands. … What we desire is liberty. The freedom to choose. Domain over our own bodies. Ourselves.

Liam doesn’t share this view, but he does wonder about the dominant UK attitude to healthcare:

I know lots of people who have bigger houses than I do. Nicer clothes, better cars and more exotic holidays. … I also know some who do considerably worse on all these things. As a society we’re largely comfortable with those disparities. …
The reason for that comfort, it seems, is that on all these fronts some sort of acceptable minimum is in place. … We’re comfortable with the lottery of life provided nobody falls too far…
So why are British voters so distinctly uncomfortable with ‘safety-net’ provision in healthcare? Why can’t the focus of our debate be the adequacy of that minimum level to which everyone is entitled regardless of their means? Instead our debate (and the language we conduct it in) is focused on the ‘top end’ of healthcare provision and discussions around why everyone can’t have the best available treatment.

Two thoughts: first, I think we all do actually accept that resource constraints mean that the NHS can never provide the very best care to everyone. In fact, it falls a good way short of that. Yes, there’s political rhetoric that suggests perfectibility (as there is in most policy areas), but that’s hard to take seriously other than as a gesture towards ongoing improvement.

Second, Liam does have a point. Nigel Lawson wasn’t far wrong when he called the NHS Britain’s “national religion”. The thought of a ‘basic minimum’ level of healthcare makes us fearful of how low that might be in a way that the thought of having a basic minimum level of material possessions doesn’t.

The reason can actually be found in the quote from Prell: your health is about “your very self”, so poor healthcare is an existential threat while relative material poverty, however damaging, typically isn’t seen that way. It’s not about what we have, it’s about who we are, and I think that explains a lot of the resistance to treating healthcare as a commodity. The British public are likelier than Prell to favour the state over the market in this case.


Liam Murray said...

Might seem bizarre but I see some similarities between UK attitudes to the NHS and US attitudes to gun ownership - it's kind of not about the facts or the substance of what's being said, it's more to do with national identity and the sort of existential thing you highlight.

Americans know that high gun ownership rates probably makes them less safe as a society but at an individual level that doesn't matter - they can arm themselves and so they completely 'own' the problem and that autonomy is like a drug. With the NHS I think most thinking peole know that at some point in the next 20/30 years the model will just collapse (tax revenues needed to support it will be unsustainable) but in the here & now it's still the most palatable option for most people.

Hughes Views said...

Perhaps you both underestimate the good sense of the Great British Public.

Maybe they've noted that the UK has a pretty good health service but spends a pretty low proportion of its GDP on it.

By comparison most western European countries spend a slightly higher percentage to get comparable services whilst the US spends a whole lot more to get a generally inferior overall service.

Or maybe none of us is as rational as we'd like to believe. If we were why would we be content with GPs and dentists earning more, for example, than teachers or public health inspectors (the latter probably do more to keep us healthy) to say nothing of MPs?

It's a shame that it's impossible to admit that we can never all get the health service that, for example, the late Queen Mother enjoyed or have a sensible debate about, say, the relative merits of keeping cancer sufferers alive versus mending broken legs quickly - but politics is tough...

Liam Murray said...

"Maybe they've noted that the UK has a pretty good health service but spends a pretty low proportion of its GDP on it."

That's true Brian but the question is the sustainability of that - from what I've read (by no means exhaustive of course) there's almost unanimity that the tax-funded, free @ point of delivery model has a shelf-life and we'll need to revisit somehow.

chris said...

Isn't this a good example of endogenous preferences and the status quo bias/endowment effect?
Maybe Brits love the NHS because it's what we've got, whilst Americans love private healthcare because it's what they've got.
The merits or demerits of each system are secondary to our tendency to value what we have and fear change.

anticant said...

"With the NHS I think most thinking people know that at some point in the next 20/30 years the model will just collapse (tax revenues needed to support it will be unsustainable) but in the here & now it's still the most palatable option for most people."

This applies to almost everything - the environment, global fuel resources, transport, population growth, social services, 'defence' spending, etc. etc.

We all do know that in the medium term if not the short term our current way of life is unsustainable. But very few of us are prepared to take the likely personal consequences for ourselves and our children on board and seek new solutions which are politically acceptable.

21st century human beings as a whole have an ostrich-like "apres moi le deluge" mentality. As I'm in my 80s, there's no point in MY worrying about it - which proves the point!

Hughes Views said...

Chris - Americans increasingly are coming to hate their health-care system. That's why the new president put its reformation at the top of his campaign pledges.

They're learning to resent the huge sums soaked up by the bureaucratic nightmare that the system has become. The ratio of administration costs to medical spend in the US is massively higher than anywhere in western Europe.

All those health-care insurance companies and hospital finance departments have to paid for somehow.

As people live longer and/or acquire elderly parents, they're realising that the bargain basement health insurance costs the middle-aged (or their employers) can enjoy, rapidly turn into unaffordable nightmares once you reach retirement age...

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ADRE_A said...

I am utterly convinced that public healthcare leaves to wish for better in most countries. Personally, I don't use it. If I face health problems, I try to solve them by myself. For example, when I faced erectile dysfunction, I needed to see it here to know what to do.