Chemo didn't change my mind about the NHS

Lots of people think that I ought to be grateful for the fact that we have the NHS, because that's how I got my chemo treatment. I am seriously grateful for a whole long list of things. The doctors and nurses involved, Guys hospital, modern medicine, the vast improvements in survival due to the use of platinum treatment pioneered by a researcher in America, medical technology, the administrative staff in the cancer centre. And so on.

None of this exists because of the NHS. If you think that it does, you are going to have a hard time explaining how all of those things turned up in all those other countries where medicine wasn't socialised.

And no, I am not talking about America. Spending 20% of GDP on healthcare is insane. And it's not even clear Obamacare worked as well as it was thought to do:

we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals.

If you honestly believe that full socialised health insurance is profoundly better, why not nationalise car insurance too? This isn't a flippant question. It gets to the heart of the discussion: we are talking about how the money works, not whether people ought to have access to the best possible healthcare.

Perhaps my biggest objection to the NHS is the way it encourages the sort of puritanism that leads to sugar taxes and other initiatives to improve public health. Ministers are forever talking about the burden some lifestyles places on the NHS. It's creepy to have that sort of social coercion, starting with the government.

And it calls into question what "free" means. Part of the trade off, other than the taxes, is a government that is more active in policy and rhetoric terms about telling you what you can and cannot enjoy.

This erodes the idea that people can make sensible decisions for themselves. And it's not entirely sensible to create a system of rules and incentives about consumption because the NHS exists. Especially because the NHS is not actually particularly good at preventing people from dying, according to the Nuffield Foundation:

The UK’s NHS performs worse than the average in the treatment of eight out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years

It is the third-poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’)

It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): seven in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries

There are other factors in the report, such as the lower rate of doctors, nursers and scanning machines in the NHS, relative to other countries. This is despite the fact that we spent a similar level of GDP on healthcare to other countries.

And that's my point. Nationalised industries tend to underperform. This is what you would expect from socialised medicine. It happened with the railways and energy and airlines and BT and all the other things that were later privatised.

Some people will scream about the spending gap. But we spent 9.7% of GDP compared to an average of 10.2%.

There's no reason to think that we couldn't do some of the things France and others do to move from public money, public provision towards public money, private provision. Did you know that the French government covers 77% of expenditures? Or that in Germany healthcare insurance is not free, but it is mandatory, which gives them a huge amount of patient choice about what coverage and treatments to use? Germany, of course, has more doctors and nurses than us, but not always better outcomes.

And there's always Singapore. Not easily scaleable, and not compatible with British politics, but providing excellent outcomes at historically much lower levels of spending.

There's also the horrible politicisation of the NHS, which needs to end. Perhaps that is the only reform we should aim for. Here is an excellent thread on that topic.