In the row over Daniel Hannan’s comments on the NHS, David Cameron said: “Millions of people are grateful for the care they have received from the NHS – including my own family.” I suppose that I am too, in the sense that the NHS was the only available provider of healthcare when I had a life threatening emergency condition. If I went out into a desert unprepared, I am sure I would be grateful if I came across a water hole when I was dying of thirst. That does not mean that going out into the desert unprepared is a good idea – there are better ways of doing things.
Cameron, as with most of our politicians who wish to make us grateful for what we are given, forgets the notion of “opportunity cost”. Every NHS bureaucrat has an opportunity cost. Every time I am offered a treatment or course of action that is supplier driven it uses resources that could be used to meet my real demands. Most families I speak to have personal experience of something that their children really need not being provided by the NHS. At the same time there is chronic waste – not necessarily of the sort caused by bureaucrats pushing pieces of paper round but of the sort caused by nobody having the foggiest idea what should be provided and how because, in the absence of price and cost signals, nobody can possibly know.
Cameron further said: “One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.” Well, it depends what you mean by “look after”, I suppose. Again, much personal experience and many discussions with others suggest that in a model that ignores price signals it is “voice” that counts. The articulate and the knowledgeable get what they need. My wife, for example, would not have received her periodic mammograms – which she needed as a breast cancer patient - unless she had telephoned to petition for them to be reinstated. They were quietly dropped because the three radiographers at the hospital had left, gone on maternity leave and gone on sick leave. I could cite many other depressing examples. Perhaps that is why the articulate and the knowledgeable like the NHS – they can get what they want, and get it quite cheaply.
Lib Dem health spokesman Norman Lamb said that Hannan was not a maverick and that his views were shared by many people in the Conservative party. The good news is that they are shared by many people in the Lib Dems too; and by some in the Labour Party. Many in the Lib Dems admire models where the state, one way or another, puts purchasing power – or at least the power of decision – into the hands of the people and takes it out of the hands of the politicians.
Why is nobody in the Conservative Party in parliament willing to spell out the objectives of government intervention in health care and have an honest debate about how those should be achieved?