As Jeremy Hunt and Simon Stevens appear before the Health Select Committee in an emergency session on NHS finances, Paul Hobday explains why 'where's the money coming from' is the wrong question.
Whenever NHS funding is debated – as it will be this afternoon when health secretary Jeremy Hunt and NHS boss Simon Stevens appear before the Health Select Committee - the first question asked is “where is the money coming from”? That seems to be the only NHS question new Prime Minister Theresa May is interested in – and it is rumoured she has already made it clear the answer is “not from government”.
“Where is the money coming from” is an understandable and obvious question to ask - but it is also the wrong one.
Political debate about the NHS at the 2015 General Election was pathetically superficial. All the main parties tried to outdo each other by claiming they would “spend more”. The waste of the “market” system wasn’t mentioned, as all had colluded in its conception. Rather than intelligent offerings, the public was offered unexplained slogans – notably, “a seven day NHS” without any explanation of how it would cost or how it would be staffed.
Curiously, few in the media asked where the money for this was coming from. Not before the election, anyway!
Only the Government thinks the NHS is adequately funded. Everyone else lives on Planet Earth. So the Liberal Democrats revive the corpse of a hypothecated tax, while enemies of Bevan’s NHS want to get ‘co-payments’ on the agenda, saying we have too many elderly for the NHS to cope and “we” can no longer afford a comprehensive and universal service.
Strange where all these “elderly” have suddenly appeared from , and that it seems to be unique to England.
What does it mean to say “we can’t afford it”? And who exactly can’t afford it ?
If the NHS is “unaffordable” to Britain as a whole then the claim is that the sixth richest country in the world cannot look after the health of its citizens.
If the claim is that the NHS is unaffordable to the Exchequer, then this merely exposes its political priorities as to what is and isn’t publicly funded (in over-simplistic terms, what our taxes are spent on).
Other systems are even less “affordable”. Public funding of healthcare is the fairest, most efficient and cheapest way of paying for it. Moving towards an alternative system is a political choice – and a neoliberal one.
After all, if the State “can’t afford” healthcare for all, the cost must be devolved down to the individual citizen. Assuming the Government leaves us with a basic core safety-net NHS for the poor, then top-up or full health insurance would be needed for good healthcare provision.
It probably won’t bother the super-rich who would pay direct. They wouldn’t trouble themselves with insurance, although even they are in for a nasty shock when it comes to emergency care.
The rest of us would be paying from one pocket some general taxation towards what is left of a decimated NHS, like Medicaid in the USA, and from the other pocket insurance premiums. But the money all comes from the same pair of trousers. And both pockets would have to fund bloated administration costs of this inefficient system.
Those without money in their pocket would go without. And even those lucky enough to be able to pay for the best insurance possible would soon learn that they need a third pocket - to fund the insurance companies “excesses” and the claims they reject.
So rather than healthcare being delivered based on clinical need rather than ability to pay—one tier—we will end up with three tiers. The elite would just spend their wealth and bonuses directly on healthcare for themselves – but not for anyone else. The next tier would get their care through insurance, and the third poor tier would rely on the new Medicaid NHS.
Add all that up and the nation’s total expenditure on health would be much more for a worse, more inefficient and wasteful system where people at the top end will get things done that aren’t even necessary, but the poor folk at the bottom will die through lack of care.
Those who have never liked the NHS , have peddled this “we can’t afford it” nonsense since 1948. What they really mean is they don’t want to pay for it. But it’s worse than that. They don’t want to help others in a time of need. This argument has prevented, from chronic underfunding through its entire history, the NHS from blossoming from the struggling duckling that many tried to strangle at birth into the wonderful healthy swan it should be.
When politicians want to sell us an idea like HS2 Railway, the Millennium Dome or new airport runways they bang on about the economic benefits of such projects outweighing the costs and always dodge the question “Where will the money come from?”
But every £1 spent on healthcare actually benefits the Nation’s economy by a return of more than £3. Why don’t we hear this more often? It seems some politicians have another agenda, simply to get rid of the NHS. After 68 years they argue more forcefully than ever we can’t afford an NHS.
But they are wrong.
The right question is “Can we afford not to have an NHS?”
And the answer is undoubtedly no.