Charging for healthcare: a deadly prescription

“That’ll be £22,451 for that heart bypass surgery then, please.” A phrase like this has no place in our National Health Service. Yet this is the spectre raised in Jordan Bishop’s comment piece in the last issue of this paper, where he argued for a service charged rather than provided according to an individual’s need. He claimed his plan was “literally flawless”, but I’d like to take some of Bishop’s “flawless” points and explain where the flaws are.

The first point in his article I take issue with is the assertion that we should automatically resent paying tax if we have not (yet) had to use the NHS. “Make the sick people pay instead,” he seems to argue. Aside from the obvious selfishness and questionable morality here, there are a number of other issues as well. First of all, the cost of £2,000 per year per person cited by Bishop is relatively small. The UK spends slightly less than the European average for healthcare, and yet health outcomes in this country are as good or better on many indicators than other similar countries. The NHS is, according to a major longitudinal study comparing the health systems of industrialised nations, one of the most efficient health systems in the Western world – £2,000 a year is actually not a lot, considering the quality and effectiveness of the NHS.

Bishop argues that those who live a healthy lifestyle should contribute less to the NHS. However, it is ridiculous to assume that simply because people make healthy lifestyle choices they will never have need for the health service, or to assume, as Bishop says, that the majority of people go their entire lives without needing healthcare.

It makes perfect sense for everyone to contribute what they are able to for the health service regardless of current need, because there is no way of predicting future need. And if we are going to go down the route of charging more for certain lifestyle choices, where will the line be drawn? Charging someone who has had too much to drink might be relatively acceptable, but what about someone who drives for a living and is thus more likely to be in car accident? Also, people are already charged more for unhealthy lifestyle choices – ever heard of cigarette or alcohol tax? And finally, the bureaucracy associated with determining each individual’s rate of contribution would be enormous and costly and likely negate any potential savings.

The final flaw in the flawless plan is the fact that unhealthy lifestyle choices – smoking, heavy drinking, etc. – are far more prevalent amongst lower income groups. This would mean that those who are most likely to be charged under his plan would be those least able to afford it.

Bishop’s plan sounds very similar to American healthcare, where payments are linked to lifestyle, medical conditions and ability to pay. The more money you have, the better your healthcare. Although Bishop argues his plan would help solve the financial crisis and help the government spend less money, data shows this would not be the case. America spends more on its healthcare (around 17 percent of GDP compared to the UK’s 9 percent) than any other industrialised nation, has appalling levels of inequality and has one of the most inefficient systems in the world. Making people in the UK pay when they get sick would do nothing other than to send millions of people into bankruptcy and shatter the very bedrock of the British health system.

The NHS’s founding principles are that it meet the needs of everyone, is free at the point of delivery and that it be based on clinical need, not ability to pay. These principles form the basis of everything that is good about our health service, and altering them risks demolishing an organisation relied upon by tens of millions of people and that serves as a shining example of how nationalised medicine should operate. The current government’s proposals to reform the NHS do, in fact, go some way towards achieving Bishop’s horrifying vision for healthcare in the UK – indeed, he argues the reforms are a step in the right direction.

I get the feeling Bishop wrote his article more to be controversial than to propose a serious plan for the NHS. Whatever the rationale, though, his plan doesn’t deserve the light of day. It would leave the poor dying on the streets while the wealthy pay for whatever world-class treatments they choose. This is no vision for the future of healthcare in Britain.