The raison d’etre for the welfare state is to promote equal outcomes for all citizens. Proponents justify the redistributive state as a means of furthering some arbitrary idea of a ‘fair’ distribution of resources and securing that at least some outcomes are independent of wealth, ability, application and heritage. This may sound beguiling to some and appeal to a sense of justice and civility but it leaves the obvious questions of what services should be prioritized and how to secure and measure acceptable outcomes.
Take health care. In the UK, the National Health Service is a quasi-religion. Free at the point of use, the behemoth gobbles up almost £125bn of taxpayer money each year. Still, this is only around 80% of the total spend on health care services in the country. Despite free access to the NHS, the British public spends around £30bn on private provisions. Now, few people use private alternatives to public services for ideological reasons. They do it because they cannot access the service they require in the public system or because they expect better outcomes by purchasing services from the private sector.
The left has two main arguments against private health care. Firstly, under the naïve slogan ‘no to profit before patients’ they argue that any profit made by private providers are a ‘tax’ on patients, excess value extracted at the cost of the NHS. This betrays a fundamental misunderstanding of the role of profit (as we explain here). Secondly, they argue that it offers those with deep pockets access to care that is unavailable to others, thereby increasing inequality. But this argument of course reveals that the left understands that the private sector offers something more than the NHS – whether that be better, alternative or more expedient treatment.
A public service like the NHS lacks the metric by which a private enterprise measures whether its efforts add value to the customer: the profit/loss statement. Quality is difficult to measure in the public sector because of the absence of a price mechanism. The market price for any good and service is normally how we can determine what is good quality in the eyes of the consumer. A better, more attractive product can command a higher price. Without a price system, prioritization becomes a job for bureaucrats. In the NHS, those bureaucrats sit in NICE, the health quango which pontificates about what procedures and treatments should be available in the UK. Patients requiring care that does not make it through NICE’s approval procedure have few alternatives. They can try their luck in Britain’s somewhat neutered private sector, but most don’t carry private health insurance as this is supposed to be included in the non-negotiable tax-for-services deal the government compels you to accept.
Universal healthcare is viewed by many as a panacea which removes from the individual the burden of worrying about health care provision. But it not only those who fall through the cracks in the system who find the NHS lacking. A fifth of UK health care spending is voluntarily spent by people who already have access to what we are repeatedly told is the best health care system in the world. Instead of demonizing the private sector, the NHS apologist should ask themselves why.