I'm pretty sure that this will draw a lot of emotional response, but in a truly Libertarian world, there is no place for state-controlled provision of medical care. The NHS would be dismantled and individual people would be able to interact with individual care providers and move between them freely. Unfortunately we do not live in a Libertarian Britain, we live in an Authoritarian and centrally managed one.
Oh, and before anybody starts: the NHS is not free. It's funded by taxpayers. There is a vast majority who will have paid more into the NHS this month than a fully self-funded medical insurance package would cost. That's without the queues; the rude, nosey receptionists; the appalling service and the outrageous parking costs.
There are no plans by LPUK to close any Hospitals, Clinics or Doctor surgeries. There are no plans by LPUK to diminish any health related medical or clinical facilities currently providing front line services.
Where the initial changes will occur are the methods of funding for each of those facilities.
Primarily this will mean reform of the National Insurance scheme, taking it back to the original scheme as proposed by Bevin all those years ago before it was mutated into a monolith that tries to be all things to all men.
Today we have the 4 main layers of NHS.
1. is the fund raising, based upon a percentage of income using the NI scheme.
2. is the DoH. Bloated, expensive and adding little if any value to health care.
3. are the regional setups - RHA's, SHA's and PCT's.
4. the health care delivery points themselves - Hospitals, Clinics, Surgeries Dentists etc.
At present any funds collected via NI deductions end up in the General Fund, we are proposing that National Insurance be set aside as a self contained financial unit, that will directly fund those layer 4 Hospitals, clinics etc. What will change in this is that the vast number of agencies, quangos, taxpayer funded 'charities' and Area Health Trusts will no longer be funded from this source of revenue, unless and until they can justify and prove that they add value to the clinical services offered to the public.
The majority of those NHS funded Agencies, quangos and fake charities are self evident. The obvious ones can go straight away, reducing the NHS budget almost immediately, but for those which are not quite so obvious then I would envisage a commission made up of MP's, commercial medical advisor's and NHS clinicians to report on which should remain, which should be pared back and those for which funding would cease. I would be inclined to purposely exclude the regional bodies from this commission if only for the reason that they have a vested interest in maintaining a gravy train.
If we take a look at just some of the
'partner' organisations of NICE (National Institute for Health and Clinical Excellence), all of which receive all or part of their funding from the NHS (including NICE) ask yourself which ones are essential to the NHS and which would better serve a slimmed down service if they stood outside of a monolithic NHS and were funded from elsewhere.
In the interim, layers 2 & 3 will continue to be funded from the General fund, but as we review them they will either be moved to the NI scheme, sold off to provide private input to level 4 delivery points or closed down. In all cases funding from the General Fund will eventually cease, thereby removing from the general taxation system the cost of the NHS in favour of a ring fenced NI.
For the public, paying into the NI scheme, healthcare will still be 'free' at the point of delivery, but decisions about how those services will be delivered in each locality will be decided and run by clinicians, not business managers, administrators or politicians.
Given that the government would also not be micro-managing their every objective, I'd expect a massive refocusing of resources away from management and perception and back into primary care. Where we currently have a system that sees each Hospital having twice as many managers as doctors, and three times as many administrators as beds, there is clearly something wrong, and it is this mismatch that we will initially be addressing.
We must also ensure that any NHS services are secular. Religious groups in hospitals
now costs £40m p.a, a cost that should not be borne by taxpayers. If people and religious bodies considered these services so vital, they should be prepared to fund them themselves
We are talking about a National Insurance scheme that will pay for medical treatment, not lifestyle choices. Hospitals, clinics, doctors will get paid for what they do, not just for being. No more massive budgets to spend on whatever, it becomes income based upon treatment served. Out of that income, each hospital, clinic or doctor surgery then has to maintain its buildings, pay its staff and its running costs. Just like a private doctor or hospital does.
I think you will be surprised how quickly each hospital reviews its overpaid Chief Executives, perhaps 2 out of every 3 administrators and management tiers with the mass of bureaucracy will simply disappear, and it is important to understand that it is the bureaucracy that ramps up the NHS costs. Unburdened of the huge overheads and targets, Hospitals will be free to start delivering real medical services again.
Beyond that initial reform, we will then invite the commercial insurance industry to compete with the National Insurance scheme, offering alternative ways for the public to obtain medical cover, with an optional opt-out of the NI scheme or the ability to co-fund treatments. We feel that this competition will force a reduction in individual cost to the public, and will generate new sources of funds for the Hospitals. Contrary to popular belief, private medical insurance costs on average one quarter the cost of the median wage NI contributions. Private health insurance is not just for the rich, and will become even more accessable as the competition increases.
At the same time Doctors will be permitted to compete with each other and allow them to provide specialist services if they wish, again giving the public further choice, and increasing the service levels provided by Doctors.
There will be no forced closures nor will there be a fire sale of NHS assets. Any Hospital that would rather operate being entirely funded by commercial insurance would be able to do so, but a strict set of criteria would have to be met in order for that to happen.
Firstly, that they would not be able to refuse treatment in emergency cases, and that National Insurance cover would have to be accepted on an equal footing to commercial insurance. Further, any assets of that Hospital would be covered by covenants, to ensure that private asset stripping could not occur.
All the NHS assets would remain in the ownership of the National Insurance Scheme until such agreements are made to transfer that ownership to a Charitable Trust, an Insurance Company, a Management buy out, a Community scheme or a Private investor, but the same criteria as above would apply to whoever decided to invest in the Asset. At that point, they would be able to operate free from government control, and compete in the marketplace with any other hospital.
It may be decided over time that the prudent course of action should be that the NI scheme be privatised as well, thereby ending any government involvement, but that is open to debate and clarification when the circumstances of reality are available to us.
From the bottom up view, ie public looking for medical or health care, the scenario would look like this.
Member of Public goes to doctor with medical problem. Patient is asked which insurance they have. All schemes will have to have a basic level as a minimum, just like car insurance.
Doctor will see patient and perhaps requires X-Ray as suspects that there is a fracture. This particular doctor may offer that service themselves, or may have to refer to a hospital.
Doctor does the referral, Hospital takes insurance details from doctor and accepts patient. X-Ray done and returned to doctor.
Hospital will bill the doctor for the service.
Doctor prescribes treatment of whatever kind.
Bill including hospital service sent to insurance company.
Doctor paid, Hospital paid. Happy patient.
If patient does not like the service provided either by the doctor or the hospital, then they have the choice to go to another doctor, or if referred refuse a hospital and suggest to doctor another one. The choice now belongs to the patient, and the Medical records will also belong to the patient.
Before too long, clinics will spring up offering just specialist services. Blood testing, X-Rays, scans etc and will earn their money from doctors referrals.
Over a period of time, the system will shake out the poor quality service delivery and the competition will increase the level of service and keep costs down. This shows medical service commitment to the public rather than the institution or politicians.
Remember, we are talking about a National Insurance scheme that will pay for medical treatment. Hospitals, clinics, doctors will get paid for what they do, not just for being. With tiers 2 & 3 of my plan largely gone, the NHS is not going to be expensive, as the hospitals will be paid direct from the scheme so it will be costed at £ for £ value, rather than filtering through tiers 2 & 3 as it does at present where only about 40p in each £ of tax money gets to a hospital or clinic.
If we are to have a debate about the NHS at all we have to get past the current all or nothing view of the NHS, where the slightest whiff of cost cutting invokes screams of doctors and nurses being thrown away. I certainly don't have all the answers, but these are my thoughts on a practical solution and would welcome the debate.
However, as
Devils Kitchen quite rightly pointed out:
As the hysteria over Dan Hannan's comments shows, no debate can be had about socialised healthcare in this country beyond the spastic yelp of how we should pay nurses more money and refuse treatment to people we don't like.
There are of course many people who believe, because they have been led to believe, that Income Tax is the only source of revenue for the Government and is essential for the NHS. This is not true.
[1] Income Tax raised £156 billion in 2007/8 and accounts for approximately one third of Government income. Current annual spending on quangos (alone) is running at around £167 billion. We do need to remember that some quangos are actually integral -- currently -- with genuine service provision; but huge amounts of NHS money taken by fake charities such as Alcohol Concern, ASH and many others are not, and this area remains a prime candidate for recovery of taxpayer funds.
[2] The main sources of income -- as things stand today, and in order of value -- would then be National Insurance Contributions, VAT, Corporation Tax, and Fuel Duty. Other items like Stamp Duty, Tobacco Duty, CGT, and duty on wine, beer and spirits etc. also draw substantial income into government.
Source for the above.
As we reduce the spending, cutting out the unnecessary bureaucracy, cutting out the waste, the quangos, fake charities, funded special interest groups and the plethora of costly projects such as ID Cards, NIR, NPfIT and many of the government sponsored databases, the dependence on Income Tax will become ever less. As this occurs, incremental steps would be taken by the Libertarian Party to firstly raise the tax threshold to remove more of the lower paid from income tax, then a low flat rate of income tax for the rest until we are in a position to remove it altogether.
