Monday, 20 December 2010

Part 2. Does having the NHS give the government the right to tell us what to eat, drink and smoke?

In my post about whether or not having the NHS gives the government the right to tell us what to eat, drink and smoke, unfortunately in the final reckoning I had to conclude that it did.

This really got to me, because as I said at the time, I am a left-libertarian and I don't like the government telling me what to do. The knowledge that I had written a piece legitimising its presumption to tell me what I can or can't put in my own body disturbed me immensely.

However, in my defence I did include a very important caveat in that conclusion. I said that "faced with the two choices we have in society as it stands" I would rather allow the government to have a say in our lifestyle choices in order to protect the NHS from collapse, than leave the freedom to choose entirely up to the individual and let the free market take over in the ensuing meltdown and price millions of people out of the health care system all together - like what happens in America for example.

I also explained that there was a third option that would mean fundamentally changing the way society is structured and that this blog would be covering it in some detail. This is the first article introducing the topic of social cooperatives and in this case how universal health care doesn't have to go hand in hand with an authoritarian 'nanny state' telling us what to do!

First of all some housekeeping. In the previous article I basically cited America as an example of how to run your health care system if you want people to die prematurely. Although this is an accurate reflection of the American system (which is born out statistically), I should point out that America also has examples of the kind of health care system we should be employing over here.

In 1937 the Farm Security Administration (FSA) was part of Franklin D. Roosevelt's New Deal to provide help for America's poorest farmers who had been thoroughly fucked over in the Great Depression. One of the more innovative policies the FSA oversaw was the implementation of health insurance cooperatives.

The idea is simple. Instead of paying a health insurance premium to a private insurance company who will pay out in the event you need treatment, or paying for a government run scheme like the NHS through taxation, you pay your insurance premium to a health insurance cooperative, which is a kind of mutual insurance company. In other words the cooperative is owned entirely by the policy holders themselves.

Because the cooperative is run as a not for profit organisation and is owned entirely by the policy holders (in other words the patients who use the health care system) it's ultimate concern is patient care; not commercial profit like a private insurance company. This has obvious benefits in terms of keeping premiums low and ensuring it will pay out on the best treatment for the patient, not the cheapest treatment for the insurance company!

Also because the cooperative is owned by the patients it has a vested interest in negotiating the best deals with providers in terms of price AND service. This has advantages over a government run system that draws a steady stream of public money and has no imperative to increase efficiency or get value for money. If anyone is in any doubt about how profligate and inefficient a government run scheme can be because of this have a look at how the NHS spanked £110 billion last year!

So what about cost? At the time of writing this, Bupa's average premium is around £400 a year. As we've already seen though, because a cooperative doesn't have to make a profit, the premiums are likely to be lower than a those of a private company like Bupa.

What about the NHS? As we know in 2009 they spent £110 billion. That's £1174.20 a year each we have to pay for the current scheme through taxation

Ironically although we have long taken the piss out of the American system for being elitist, non egalitarian and generally backward, it is thanks in general to President Obama's health care reform bill and specifically U.S. Senator for Montana, Max Baucus's proposed "America’s Healthy Future Act" that they may well get a system like this before we do.

If only we would implement a similar system here, I wouldn't have to sacrifice my leftism (I still get universal health care) or my libertarianism (no government telling me to eat my bloody greens!!!) by having to choose one of the two thoroughly unsatisfactory health care options we have in this country today.

There are many examples of how taking both government AND private enterprise out of the equation makes society better. Some will throw up their hands in horror and say you can't have anarchy (the absence of government) because it will be chaos. In reality an anarchic society is highly organised as we see in this example. As for the NHS, the government run alternative, I would even go as far as to suggest that it is by far the more chaotic option!

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