Sunday 31 August 2014

Five arguments for public healthcare

In response to the creeping privatisation of the National Health Service, a group of women from Darlington have organised a 22-day 300-mile march from county Durham to Westminster following the route of the 1936 Jarrow March. You can read about it here: More on this later. Meanwhile some general thoughts on healthcare provision.

Access to healthcare is a fairly basic human need. So is having food to eat and clothes to wear. In fact you might consider these even more basic. But nationalising the allocation of food or clothing would be soviet-style lunacy – much better for people to sort this stuff out for themselves. This is what private enterprise is good at. So why entrust healthcare to the government?

First because sickness is so unpredictable and potentially expensive that only the exceptionally wealthy could budget for it. To solve this problem capitalism provides insurance companies, which are motivated by profit to do three things: sell policies, deny claims and steer clear of sick people.

Secondly because although choice is a good thing, and simple enough when it comes to shoes or sausages, options for treatment can be so complicated, so finely balanced and of such uncertain outcome that they can be baffling not only to the individual patient but to the individual practitioner. We don’t need competing stallholders crying their wares and hiding their ingredients and processes from each other, but a marketplace of ideas and information.

Thirdly because new drugs are constantly being developed and sold by multinational companies with huge budgets for sales and advertising. We need whoever’s passing them on to us to have some bargaining clout and the means and motivation to conduct their own research on what works and what doesn’t.  

Fourthly because ill-health is sometimes catching, and its causes, consequences and cures often have a social dimension. The profit motive doesn’t offer much encouragement for competing providers to look beyond their own potential markets and consider the larger picture.

And because, in the end, healthcare isn’t about selling stuff. Pile it high and sell it cheap might be a recipe for success in the grocery business, but it shouldn’t apply to antibiotics. It’s not about selling services either. In his preface to The Doctor’s Dilemma, George Bernard Shaw expresses despair at the thought that ‘any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg.’


  1. Thanks, Joe, for expressing all this for such clarity. The arguments, as you will guess, are not new to me, but it's rare to find them laid out with such concision.

  2. 'With' such clarity, that should have been...