Tuesday, 19 November 2013

Mo Money Mo Health Problems

Oh, for Gods' sakes.  The only thing Reform are independent of is basic logic and political history.
PATIENTS should be charged £10 to see their doctor and a £10 "hotel charge" to stay the night in hospital, a leading think-tank has said... Reform added that charges should not be applied to people on low incomes, although it states not all pensioners would necessarily be exempt... Proposing a series of options, Reform claimed that an increase in prescriptions charges from the current £7.85 up to £10, and in the cost of an annual Prescription Prepayment Certificate from £104 to £120, would raise an additional £130million annually. 
Reform can insist they're an "independent think tank" (frankly I wonder if a large armoured vehicle isn't the least inapplicable of those three words here) all they want, but George Osborn just got a chubby that won't subside until he touches a homeless person.

First of all, pointing out other European countries use this system completely fails to take account of the wider picture. Sweden may charge you to see your doctor, but it also has an array of social safe-guards in place to make sure you're looked after in a way David Cameron will swallow his golden lectern before he allows to happen to those of us in the UK.  At first glance, France might be a better comparison, but there's still a huge difference, which is this: France pays a far higher amount per capita into their health system than we do, and gets better results because of it (one of the reasons the NHS gets us so high up the list of countries in terms of healthcare is because it manages so well despite it's lack of funding; we're a surprisingly palatable budget meal amongst haute cuisine). Front-ending a small cost in order to gain access to a far more well-funded system is therefore less unreasonable. 

More to the point, this is the established system in France.  That's a very different kettle of fish to the idea of introducing charges to see a doctor at the same time as trying to strangle the NHS everywhere else. It's one thing to charge an entrance fee on the door.  It's quite another to introduce that fee the same week you're removing half the chairs.

In a political climate where introducing the bedroom tax is considered a reasonable plan but maintaining tax rates on the filthy rich isn't (this might be the Express' problem and not Reform's, but I'd like to know on what basis they state tax increases can't help), this kind of fiddling with the superstructure becomes grotesquely irresponsible.  It's also not clear it would even have the desired effect. Having slammed the Express above for lazy comparisons to other countries, I offer my own comparison guardedly, but it's at least worth pointing out that in the US (which, yes, has a very different healthcare system to the UK and France) this kind of charge is desperately counter-productive.  By charging patients to see a doctor and to pick up medication (under the proposal above, that's £20) you encourage people to avoid seeing the doctor until things get so bad that they have no choice.  By this point symptoms have often grown to the point where more medicine is required - which means even more money has to be spent - or even means a visit to the ER, where the state is then forced to pick up the bill in any case.

So much for basic logic; onto political context.  The counter-argument to everything I've said above - and it's less an argument than it is a smoke-screen - is that the changes would exclude people on low incomes.  To that, I give a hearty "pull the other one".  There are precisely two steps to the dance by which the powerful strip the powerless of their basic rights.  The first is to suggest those rights are more properly services which should be paid for by those who can afford it.  The second is to pretend everyone can afford it.  The first step is always, always the hardest.  No-one should be foolish enough to let a striker get into the box unopposed because the ball isn't yet over the goal line.

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