Hannan: a partial defence

Daniel Hannan is copping some stick for his criticism of the NHS. But there’s one thing he said which seems defensible. It’s this:

If the Americans came to me and said, ‘Would you recommend us taking up a system just like the British NHS?’, I think I would have to say ‘No.

The thing is, it’s perfectly possible to believe this whilst believing that the NHS works well in the UK. I say so for two reasons.
1. The NHS works as well as it does because it is underpinned by a system of gift exchange. Patients accept waiting a few weeks for operations; do not demand expensive treatments of dubious value; and do not often sue doctors. And doctors and nurses, in exchange, often do more than they are contractually obliged to.
In a society in which this culture of non-market exchange is weaker, an NHS system would not work as well. So it’s quite possible to believe that the NHS is OK for the UK, but would fail in the US.
2. In moving from one system to another, there are adjustment costs. These aren’t just the administrative costs of setting up new systems or the PR costs of educating suppliers and users about it. They also include the costs of frustrating some expectations, as people who had expected expensive treatments on demand find them refused or delayed.
Even if the UK system is somehow better overall than the US system, it’s quite possible that - given the endowment effect and status quo bias - these costs are large enough to rule out sifting from the latter to the former.
I say this not to support Hannan, who went further than the quote I’ve used. I only want to say that the question: is the British healthcare system better than the US? is very different from the question: should the Americans adopt a British-style system? I fear, though, that this is not an issue in which subtle distinctions are relevant.

Comments

[Morten]

I think you are right in dismissing this subtle distinction as not relevant. The debate is if the US should move in the direction of European style healhcare, and how much. Not that they should completely adopt the UK or, say, French system wholesale. But Fox and its like are claiming that the US system is already the best one, so any move in 'our' direction is a move for the worse.

And, watch Jon Stewart's smackdown of Glenn Beck last Thursday. Pure gold.

http://www.thedailyshow.com/watch/thu-august-13-2009/glenn-beck-s-operation

[Massive Profits]

I always believed in accepting that what works the best. If I do something and in due course of doing it I find out better way of doing the same thing, I immediately accept the way that is better and improved. I think that should be the general principle. I always teach my clients: 'never steal from yourself'.

Best regards,

Velibor

[John Terry's Mum]

I thought vulcans had pointy ears.

[jameshigham]

Chris, I'm currently running a poll which says it's not working well. I think we're arguing cross-purposes here.

As it's the ONLY system, then it will, by definition, include good doctors and good treatment. The argument is that the government abandoned the GP system and poured money into worthless things like supporting a raft of executives when they could have put the money into doctors, nurses and medicine - you know - the things we actually need form the NHS.

[ortega]

Maybe, in a more general sense, it is about wich society is more willing to trade freedon for security.

[Tom Addison]

A large part of it is about who's willing to foot the bill for other peoples illnesses. Americans aren't, Europeans are (they call it socialism and burn it at the stake, we call it progressive.)

I know people don't like him because by doing so it makes them seem like an intellectual, but Michael Moore's "Sicko" (which I can't believe nobody has mentioned yet) clearly shows the flaws in America's system (although he conveniently ignores the flaws in everybody else's healthcare systems, but that doesn't matter here, because he clearly shows what's wrong with America's private, insurance based healthcare system.) It's all about incentives, and the incentive for doctors over there is to refuse people treatment.

[Bishop Hill]

Tom Addison

I haven't seen the Moore film. Why would doctors in the US refuse patients treatment? Presumably this means they wouldn't get paid? Sounds a bit odd to me.

[Guano]

Yes, the UK and the USA are different. So es, what works in the UK may not work in the USA. However the argument works the other way around as well: what works in the USA may not work in the UK, though were often encouraged to adopt USA practices without regard to this problem.

[Neil]

@Bishop Hill - ever watched 'House'?

[Stu]

The idea that Americans aren't paying for other people's treatment is bizarre in the extreme. That's what the insurance premiums are for. If everyone got more healthcare than they'd paid for in insurance premiums the insurance companies would go bust. It's just a different, less fair and clearly vastly more expensive method of achieving essentially the same thing as our National Insurance.

The key flaw in the NHS is the state as monopoly provider, not the state as default health insurance scheme.

[georges]

UK voters believe in the NHS for religious reasons, because it's virtuous. They'll vote against any party that looks unsafe on the NHS. But the same voters refuse to vote for the higher taxes needed to make the NHS work really well. After all, most of us will only use the NHS extensively in the last few weeks of our lives, and we'd rather not think about that most of the time. In a way, we're no different from those Americans who think "I won't get sick" and skimp on life insurance.

[rockinred]

Chris, you're far too soft on that repugnant, self-promoting, intellectually dishonest tosspot Hannan. I think using his spurious Fox-pleasing outpourings as the basis for a gentle academic discussion is an uncharacteristic lapse in good taste, if not political judgement.
You're right that the question is not 'is the UK system better than US?' but nor is it 'should the US move towards a UK-style system?' - the current proposals go nowhere near doing that. But the unholy alliance of insurance and pharmaceutical companies (both of whom would see some decline in revenue) and the loony wing of the broken Republican party have decided to scare the bejasus out of America with lies that the Commies are coming. In fact, for the Republicans, it's not really to do with healthcare at all - they sniff an opportunity to inflict a defeat on the hated Obama, and they'll do and say anything to achieve that.

[zorro]

Does the NHS work well? That's news to me. Have you actually used it recently?

Note I'm not saying it's worse/better than the US or any other system around the world. Just saying does it work well?

My experience says no it doesn't. So does the experience of the several people close to me who use the NHS on a regular basis. It SUCKS. Like everything run by the public sector it is (literally) painfully innefficient.

rockinred In what way is Hannan dishonest. Please address the point he made in the comments about the NHS which is not accurate?

[SC]

I read somewhere recently that a trip to a doctor in the US can cost $1,000 for a half hour appointment. Does anybody know why this is so and who ends up with the cash (insurer, doctor, administrators etc)?

The level of costs shocks me because I gave up on the NHS in 1996 and have had an independent GP since then. I currently pay £95 for a 1/2 hour surgery appointment, £115 for a home visit during hours and £150 for a home visit after hours, all appointments guaranteed within 3 hours of telephoning.

I can't for the life of me see how $1,000 for a 1/2 hour can be justified. To me it looks like taking advantage of the patient and/or insurance company just because it can be done. Somebody, somewhere must be raking it in. Maybe a little government regulation is required to rein in costs to a more reasonable level.

[rolex submariner]

And a lot of it reflects a switch from bank deposits to securities; foreigners “other investments” in the UK, http://www.watchgy.com/ mostly bank deposits, fell by £143.2bn in Q1. And of course there’s no guarantee such buying will continue.
http://www.watchgy.com/tag-heuer-c-24.html
http://www.watchgy.com/rolex-submariner-c-8.html

[Coach Factory Outlet]

sharp mental division between what is 'on the table' and the reserve left at home which you can fall back on. If that is so, the only financial disincentive that would be expected to change the behaviour of financial bosses is something that bites on their reserves. My hunch is that the liability of the responsible bosses of a regulated financial corporation needs to become much less limited should the corporation fail or be taken into administration by its regulator.

[vibram five fingers]

rockinred In what way is Hannan dishonest. Please address the point he made in the comments about the NHS which is not accurate?

[Five finger shoes]

I read somewhere recently that a trip to a doctor in the US can cost $1,000 for a half hour appointment. Does anybody know why this is so and who ends up with the cash (insurer, doctor, administrators etc)?

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