Two tier, one life

The government’s visceral hatred of co-payment for health is as absurd as it is dangerous. Practically everyone who uses the NHS practises co-payment. The very system Labour set up more than half a century ago soon required co-payment in the form of prescription charges. It always allowed private sector pharmacies to offer over the counter drugs to people for self treatment, or for treatment under the advice of the pharmacist. NHS Doctors have been known to tell people to buy an over the counter drug rather than a prescription one where this could be cheaper or better for them.

The discovery that the Health Secretary now thinks that if someone buys some drugs that are not available on the NHS from a private Doctor they should be banned from all NHS treatment for that condition is bad and mad. Logically on this Labour view if I try to treat myself for an ailment at home using over the counter medicines, and then have to go the GP because it is not working, he should say I have no right to free treatment for that as I have been spending my own money directly on the condition. Co-payment and alternative systems are fundamental to meeting the real pressures on health care in this country. The NHS could not manage without a flourishing pharmacy sector alongside it to handle many of the day to day and smaller items. Ending prescription charges and charges for eyes and teeth would leave a big hole in the accounts.

This looks like more evidence that this government is reverting to class war as its main reason for being. The so called humour of the Crewe by-election clearly has a greater significance. If even more consumer friendly and sometimes rational politicians like Alan Johnson are now declaring war on those who have earned or saved so they can supplement the medicines available on the NHS we are in for more of a hard pounding. The bad news is we may have two more years of this. The good news is that the assault on Middle England is now so severe that it just means even more Labour MPs will lose their seats when the day of reckoning can be stalled no longer.

This measure is mean minded. It is also politically incompetent. Don’t they even read the polls I thought they believed in? Most people see nothing wrong with people being able to supplement NHS care from their own funds. Most people understand that if you tried to ban co payment comprehensively it would just drive private medicine offshore, limiting it more to the rich.


  1. Steve Garner
    June 1, 2008

    Well said John. And to think that some people think Johnson should take over as PM. His political judgement, prejudice and dislike for middle Britain are as bad as Brown’s. They truly are nasty!

    He’s also weak witness his pathetic cave in over public sector pensions. As you say, the chickens are flocking home to roost, it’s a real pity we’ll probably have to wait another 2 years to condemn this awful Government to the dustbin of history.

  2. Stuart Fairney
    June 1, 2008

    JR I would be more than happy to be prohibited from using the NHS and any and all other government 'services' they may care to mention.

    But as I would be banned from using them, it would seem logical to me that my obligation to pay for them also lapses.

    I don't usually find myself agreeing with former communist postmen ( as the arguments tend to be a bit "pub-bore, class-war, wannabe Stalin" but in this case, if he takes the policy through to its logical conclusion, I'm happy to keep my own money and buy decent, timely, clean treatment from someone I choose.

  3. Neil Craig
    June 1, 2008

    Mean minded & politically & economically incompetent (it will discourage people from not bothering the NHS for something minor). This does feel like the wheels coming off.

    (The Tories did start off by hiring a man in a kilt to follow Brown around to prove that he was Scots which isn't any better than turning up in a top hat – on the other hand they did stop)

  4. Adrian Peirson
    June 1, 2008

    A little bit of Socialism is a Good thing but I can't help but feel the good intention has been subverted and is now a Cancer throttling the life out our Nation.

  5. mikestallard
    June 1, 2008

    I can understand where the Labour people are coming from. If you are in hospital and are a member of the chippy "working class" and you are given water to drink, while the person (same sex??) in the bed next to you buys champers; if you are treated like muck, while the person next door is called"Sir/Madam", then I can see that isn't "fair".
    At school, trips are like this. "Anyone for skiing?" "My Dad bought me this Lamborghini". It isn't "fair" either as the real world out there comes seeping in.

    Nevertheless, you are (as ever) right. It is OK to be Labour until it is you that gets cancer. Shirley Williams broke her leg in London and was transferred immediately after a speech extolling the NHS to – a Private Hospital bed.
    Ed Balls, that egalitarian Schools Minister, of course, went through Public School to Oxbridge.

    But you aren't supposed to mention it.

  6. John
    June 1, 2008

    I would liken Gordon Brown to an owl.
    No he is not wise, but the more light you shine on him, the less he sees.

  7. DBC Reed
    June 1, 2008

    As someone who has worked in the public sector , I would say that a lot of people in the sector are only too aware of the intensity of this kind of criticism. (It is noticeable that the examples of good practice given are entirely from production management : not only does this country no longer have any public-sector production [nationalised industries they were called], the unplanned evolution of the private sector has tended to favour financial services over producing things, with the consequences that are only too apparent.
    Efforts to make some public services more business-like were in my time totally inappropriate. Giving promotion to teachers for responsibilities outside the classroom led to people taking on mindless admin and refusing to share it. Only nowadays is a classroom teacher (strange expression: what other kinds are there?) able to earn a decent wage "staying in the classroom" (This expression was current : even now headteachers may not teach at all).
    The forcing of a hierarchical structure (modelled on industry / possibly the army) onto public services is by no means always beneficial. A rough-and-ready democracy among teachers , university lecturers (who often practise it apres les evennements of '68 ) , and medics is more the way forward than business methods that create a culture of over- mangement making skilled practioners feel they are being checked up on all the time and measures everything but the knowledge that is their professional raison d'etre.
    I am not sure that professionalism is compatible with business organisation.
    Neither is business practice obviously superior even on its own terms of cost-effectiveness. Private-sector consultants , IT experts and full-time quango persons (who exist like permanent students never actually working) appear to waste more money than old-fashoned civil servants.
    N.B. hospitals got dangerous after ward-cleaning was privatised.

    Reply: Things have moved on from top down time and motion studies! Modern manufacturing is about empowering people and improving their skills, making them resposnsible for delivering total quality. I quite agree we need to trust teachers and doctors more – we also need a way of ensuring they want to deliver a high quality service. Client choice would help deliver that, within the framework of free at the point of use.

  8. emma2000
    June 2, 2008

    Just a minor example of the way this government never thinks things through. I have a skin condition that causes brown facial marks, for twenty years I bought a cream called Fade Out which used regularly kept the condition at bay. This contained 2%hydroquinine. Then a few years ago there was a lot of publicity about African and Asian women using a skin lightening cream which was causing damage, these creams contained 20% – 30% of the active ingredient hydroquinine. Anything containing this was banned, I have an excellent dermatologist who managed to get me a cream with 3% which works perfectly well, this however is very expensive and is imported from America and is only available on named patient basis. So instead of buying a commercially available cream myself I now cost the NHS money. The biggest joke is the dangerous creams are available in any big city or on the internet so my Asian friends tell me. If they had thought it through they could simply have banned anything containing say more than 4%, but no, like everything else it is just not thought through and the law serves no useful purpose.

  9. William B.
    June 2, 2008

    Let us not forget that there is still a large part of Labour which wishes to outlaw private medicine altogether. The view they seem to take is that health care is too important a matter for any inequality to be permitted. I await with bated breath the arrival of NHS ambulances on football fields to take the place of the man with the cold wet sponge and the freeze-spray.

    It has always seemed to me that if I am in a queue at a bus stop and someone in the queue hails a taxi it can only improve the position. If he is ahead of me in the queue I advance one place, if he is behind me it makes no difference to me but advances those behind him and those still to come. The approach of the left is to condemn the fact that he arrives at his destination sooner than me; but I don't care about where he goes or when, because it does not impede my progress by my chosen means of carriage.

    Quite apart from the practical good sense of relieving the burden on the NHS there is a more fundamental point. The NHS was set-up as an insurance-based scheme. Spreading the collection of premiums throughout the country by way of National Insurance contributions was intended to ensure that everyone who did not have the means to pay the full cost of health care themselves would be assisted.

    The system was not set-up to replace private health care but to supplement it. Yet it was set up quite deliberately as an insurance-based model so that everyone could see the level of contribution they were required to make. One reason for this was to ensure, so far as possible, that people would not make unreasonable demands on the service for fear that their contributions would have to rise in the same way that insurance premiums rise when large numbers of claims have to be paid.

    Once the NHS became a political football as well as a medical service it was inevitable that those taking a populist approach would cite limitless "free" healthcare as a right. And once something is labelled a "right" the demand for it expands endlessly unless there are mechanisms in place to control demand.

    Perhaps it is time to revert to the original model and create a category of National Insurance contributions specifically for the NHS (one could say the same about the state pension but that is another issue with different considerations). A clear link between what everyone pays by way of NI and the level of NHS health care provision will bring back into the equation a question which should always be a central plank of all economic and social policy, namely "what can we afford?"

  10. DiscoveredJoys
    June 2, 2008

    Arrange private tutoring to get your child through exams? – You can't send your child to state run school, even though you pay taxes!

    Use a private dentist? – You can't have your impacted wisdom teeth extracted in hospital, even though you pay National Insurance!

    Watch ITV? – You can't watch BBC, even though you pay the licence fee!

    Doesn't make any sense does it?

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  12. Ron Forrest
    June 3, 2008

    The maximum publicity must be given to this nonsense. Is the Conservative leadership doing this ? If so, I have missed it. David Cameron made much of his NHYES policy some time ago. Now he should condemn the government for excluding patients from NHS treatment if they dare to obtain private treatment.
    Isn't this matter actionable in the courts ? Maybe Stuart Wheeler could again come to our aid.

  13. Michael Taylor
    June 4, 2008

    I wonder what happened to the Hippocratic oath? I don't remember anything about refusing to help people because they are political enemies. Given that the denial of treatment has now actually helped kill someone, is there no way of dragging the moral pygmies who ok'd this before a human rights court? Just wondered.

  14. Tim Almond
    June 5, 2008

    Can you tell us what Conservative Party policy is on this?

    Reply: I support co-payment

  15. Andy Hooper
    June 6, 2008

    I think about this issue and my blood starts to boil. Maybe I am becoming a 'grumpy old(ish) man'.

    I just cannot in any of my wildest nightmares imagine the thought processes that go into making policy decisions like this. Applied large, we are bankrupting ourselves with this mania for government controlled top-down spending.

    An environment seems to be emerging that will allow us to dismantle much of this nonsense over the next 10 or 15 years. Let's pray as much, at least.

    John – I hope that Cameron's reticence in announcing more public spending cuts and replacing them with price driven free market approaches is only a calculated measure aimed at ensuring he wins the next election. If the Conservatives don't make meaningful reductions in the amount of public spending then you won't last long in power. I don't like to think about what will replace you, either.

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