Liam Murray tries to look at healthcase provision according to some basic principles, and is unimpressed with the idea that the state back out:

If you can’t afford healthcare then you have no such personal liberty. In a rich, developed country like the US it offends decency for anyone to go without decent healthcare because of their social background. Also, there’s strong precedent for doing things collectively via taxes and public spending (policing, military, education etc.) so the idea that public healthcare crosses some sort of philosophical rubicon is just daft.

But the article got me thinking. We Britons have our own hang-ups about healthcare and they’re related to the issues Prell raises in his piece…

Here is a different view from Keith Hennessey:

The right kind of health care reform is not a free lunch.  It carries obligations as well.  While others offer you the hollow promise of government-provided and underfunded health care security, I’m telling you that you’re going to have to take more responsibility for decisions about your own health. 

A well-functioning system will offer financial incentives to keep yourself healthy, and to avoid risky behaviors that are the source of so much of the costs in today’s system.  You will have to spend more time talking with your doctor and making hard choices yourself, although that’s far preferable to spending that time fighting with your insurer or with a government bureaucracy. 

You will have to shop intelligently for health insurance and decide what tradeoffs make sense for your family situation.  You will have lower insurance premiums but more financially responsibility for relatively minor medical costs, and you can have a tax-free reserve fund that you can spend wisely on everyday non-critical medical expenses. 

It means more personal responsibility and control, and less dependence on the government.  It means your health security comes from you buying insurance to protect your family against catastrophe, rather than hoping the government won’t ration your care when it’s needed. 

Others want to tell you that you have the right to have someone else pay for your health insurance.  I think you have the responsibility to provide for your family’s health security, and that it’s government’s job to set rules so that you have affordable options, and to subsidize the poorest who cannot afford basic catastrophic protection.

Personal responsibility? The very thought of it.

The hard fact is that every system involves some form of incentivising and rationing, either obviously or not-so obviously.

In the UK the NHS buys some life-saving drugs and top-end pieces of equipment, but not others which are too expensive or ‘not a priority’. People who need the latter have to buy the procedures themselves or perish, as happens every day round the world.

In the USA some people are not insured and so risk losing out. This fact creates all sorts of anomalies, including grisly manoeuvres between hospitals with some uninsured patients quietly being shipped from private hospitals to publicly funded facilities.

The UK NHS does nothing seriously to discourage unhealthy lifestyles other than endless expensive ‘awareness campaigns’. However stupidly you behave, including by filling your bottom with all sorts of household articles to see what happens, you get free treatment.

An insurance-based system in principle forces people who eg smoke to pay higher premiums. Is that fair?

One point seems (sic) clear to me.

Namely that any purported healthcare reform here or in the USA which does not address the uncontrollable costs element of tort litigation and massive ‘negligence’ damages is essentially dishonest. 

That tort element forces up insurance and/or NHS costs endlessly in a random and ridiculous way, piling on costs and creating all sorts of new contortions and disincentives across the board.

And tort reform is not going to happen soon.

One last point. The US system has its weaknesses and distortions, but it does generate all sorts of new discoveries and procedures. European ‘social’ systems benefit from those innovations without contributing to them.

What happens to healthcare outcomes round the world if one effect of Obamacare-style reforms in the USA is to depress that motor of innovation?

Back to Liam Murray:

So why are British voters so distinctly uncomfortable with ‘safety-net’ provision in healthcare? Why can’t the focus of our debate be the adequacy of that minimum level to which everyone is entitled regardless of their means? Instead our debate (and the language we conduct it in) is focused on the ‘top end’ of healthcare provision and discussions around why everyone can’t have the best available treatment.

Even committing that sentence ‘to paper’ illustrates the difficulty with this because I can immediately hear the counter that such an egalitarian and noble outcome should be beyond question – why CAN’T everyone have the best available?

For much the same reason that not everyone can run fast? Or live in a big house?

Any minimum healthcare provision does not help if your illness is not a minimum illness.

Plus some people have more ability to contribute to a common pot, and some people have a greater propensity to contribute to a common pot. Some people are lazy freeloaders, living off the hard work of others for as long as that behaviour is allowed.

In any case, there is somewhere an absolute limit to the resources we as a society can put into this sector or any other. Plus slabs of such resources go on bureaucracy and lawyers’ fees, not sharp-end healthcare.

One step beyond that limit is a sick person needing a treatment which is available but not paid for by ‘the system’.

So, who decides what to do then?

An unelected and effectively unaccountable NHS Committee? Or something less obvious which does involve an element of private choice, such as ‘market forces’?