National or local

We have a national health service and socialised medicine. It is supposed to be our crowning glory, and woe betide anyone who criticises it, let alone suggests alternatives.

Is it really national? We hear regularly references to a post-code lottery, of treatments available in some areas but not others, of payments required for prescriptions in some areas but not in others and of services available in some and not in others. There may be national standards, but even these are failed, as witness the troubles at Mid Staffordshire recently, and in various other places, and there seem to be many cases of a service which is good generally on critical illness and poor at feeding and cleaning old people and maintaining hygiene.

The problem is that our service is government financed and controlled, and also government provided. It is not difficult to see many advantages which could accrue if one of these were no longer true, - either commercial and competitive supply, or privately financed. The latter may be seen in Germany, with an insurance based service for everyone, the former is virtually every other country in the world except Cuba and the UK.

A development was highlighted on the Institute of Economic Affairs website yesterday. Without any central direction but with agreement, liberalisation is happening in India. The poor are being increasingly offered provision of a low cost effective service, as others are also. There is experimentation in delivery and costing. The provision is not producer-orientated, but patient led, and there is no vast bureaucratic army trying to run things from the centre.

So why are the poor not being left behind, - the usual warning by left-wingers? The answer is that where is a demand, and there is also freedom to explore ways of satisfying it, then supply will step in. It happens in the case of most goods, so why not in health? There is no "one size fits all, take it or leave it".

Over a period with rising prescription charges, and services hived off such as dentistry, chiropody,and nursing the elderly, it has become obvious that a taxation-financed system will always be under provided. What the liberalised service is India is showing is that private finance will supplement government provision, so that all gain.

So why must we have a monopolistic, monolithic, centrally and bureaucratically driven service. "It's to offer everyone the same". Yes, but they are not getting the same, and they could all get more if we could throw away the dictum that supply must be financed and physically supplied by the government. If we had applied this to food production, or electronic goods, or cars, we would long ago have had rationing of food and electronics and much more walking.