Sunday, 16 August 2009

National Health?

The debate on Twitter and elsewhere about the merits and demerits of the UK's National Health Service and whether Mr Obama wants to impose it on the US is certainly attracting a wide range of opinions. I am a critic of the NHS. It is expensive, overly bureaucratic, run by Civil Servants (Which is, in itself, enough to make me skeptical of its ever achieving "value for money" or efficiency) and very selective. That said, I do believe that some form of "social" health service is needed.

The myth that the NHS is "Free at the point of delivery" is just that. A myth. It is an expensive myth too, and the older you get the more of a lottery it becomes, though one advantage of being over 60 is I now get my prescribed medicines (I suffer from Hayfever) free. The downside is that many expensive treatments are "rationed" and the older you are the less likely you are to be given them. The hospitals are an expensive part of the whole and used to be run by fearsome Matrons whose iron rule kept them spotlessly clean and efficient. Now they are run by "managers", frequently non-medical personnel who may have a "qualification" in some nebulous "Management" course whose focus is on some target set in that Palace of Waste, Whitehall, or on "cost", also determined in a Boardroom somewhere. The bulk of the money thrown at the NHS, some £70 billion last I heard, goes in paying the medical staff and the army of civil servants that "manage" them. Our hospitals are filthy, you have long waiting lists for appointments to see specialists and then you have to sit in filthy waiting rooms and if you are unlucky enough to need to spend time in hospital you have a good chance of having to stay in a mixed sex ward and of catching an antibiotic resistant bug. And it is most definitely NOT free.

OK, so you don't pay at the point of delivery, but you pay a premium every month out of your taxes and you also pay a "fee" for every prescription. If you need a dentist you have a job finding one on the NHS contract who will treat you on the NHS, so many of us have "Dental Insurance". Need glasses? Go private and pay for them yourself. Need an appointment with your GP? If you're lucky you might get one this month. Need an ambulance? We used to have the best service in the South West, but since that was merged with two other failing services you're lucky if there is one in the County - but the bureaucrats reckon that's an improvement. Of course, it does save money for the NHS, you're probably dead or past being resussitated when it finally reaches you.

Personally I believe that the NHS is generally a good idea but one that needs major reform and restructure. I believe that it could be made far more efficient and effective by being reshaped on the German model which has some "insurance" and some state provision. As the US debate hots up the one thing I would say is that the last model you want to adopt is the UK one. Look to Europe and particularly the German model and you'll probably find a better solution which will give fair and reasonable access to medicine to everyone in the US at the level and standard you are used to - assuming you can afford it on the present system in operation there!

The old Irish joke about the tourist lost in the west asking for directions applies. "If you want to go there, you can't start from here."

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