Mix of both, neither can be left to markets alone to solve, because while that might produce the most efficient delivery, the resultant outcomes don’t meet other tests. Both probably have to be state-funded, but both could have some degree of privately run. Single-payer systems seem to work fairly well. In education, you have the particular problem that private schools could conceivably deliver better education for the same price by excluding difficult/poor/disabled kids, so you have to put boundaries on any market system. But every public school board I have ever seen could sorely benefit with having to deal with parents as a client with a choice to go elsewhere.
As a simple example here in Ontario for healthcare, we dogmatically compare our system with the US system in order to insist that service delivery must be public, or we will have the US system. Many other developed countries have extensive private delivery in their systems, better functioning overall systems, and can easily meet tests of equity and fairness. Canada’s healthcare system should be something of an embarrassment if we looked at it as a league table, but we only compare ourselves to the US, using the metric that makes us look good.
The Tory party no longer has conservative values. They are clearly populists. We live in a post truth world. They may trade off their image as being fiscally responsible, the party of low taxes and business, tough on crime. But all evidence points to the opposite. The systematic dismantling of the checks and balances (from media to courts), corruption, and association with foreign regimes for me makes them dangerous. On top of a general incompetence.
Labour too are no longer the party of the left, primarily because what the left use to be and what it is today is different. The party has failed to evolve. Dockers, coal miners, and flat caps are a thing of the past. Unions represent teachers and doctors. If you grew up on a council estate, you still had a good chance to go to uni. Lots of people working on universal credit. Most migrants part of their core base. Labour has a stigma of good values but incompetence when it comes to economics. The infighting of old vs new labour, views of nationalisation and Brexit only emphasise this.
Problem we have is voters of these parties are associated with tribalism, historical values and entrenchment. The historical perceptions don’t match reality.
The best illustration of this, is despite both parties being at various ends of the shit spectrum. Less than 20% of population will vote lib dems or greens.
Imagine how many people would vote for other parties if they thought they had a chance of getting into government. The electoral system is broken in the UK and doesn’t produce governments reflective of the electorate.
This is the basic flaw.
I’ve struggled to see how a privately funded health system could function in the UK. Contractually I see it being a nightmare, cost more than it should and service remaining poor. And with the model that the UK is likely to adopt initially, the patient is not the client. They are just some pawn that is at the mercy of what is in the contract. For the record that could work both ways.
Same with education. So much wrong with it which is in no small part down to the funding mechanisms. Mechanisms that really shouldn’t exist. The idea of a school having to cut teaching staff because they don’t have enough budget is abhorrent but has just happened 2 years running at my little one’s school.
You would make a good Canadian. In the study below, the three top systems are Norway, Netherlands, and Australia. All three have more extensive private delivery than the UK, to varying degrees. To be fair, the UK is ranked in 4th, but is actually a higher % of GDP than two of them (0.2% lower than Norway). In measuring performance versus expenditure, the UK is upper-middle of the pack. Not the disaster that some make it out to be, but not without scope for improvement. Way the hell better than Canada (see Exhibit 4).
The truly striking thing about the analysis is just how dire the performance of the US system is. Smith’s invisible hand definitely has a lot of work to do in fixing US healthcare.
Education is inherently very difficult to address with a market institution, because the externalities are enormous. The semi-literate 11-year old that is enormously expensive to catch up with her peers just might be the young woman who develops the Moderna vaccine. But I assume your school is publicly funded, so it isn’t a problem that goes away by relying on public delivery.
Part of the issue I think with the NHS in particular is that it has zero contingency. The bed count is shockingly low against other EU nations and certain services (Ambulance) are in a complete mess. Throw in things like mental health and other side services that have now been thrown under the NHS’s wing and it’s groaning. Too much of it is relying on the good will of those that work in it.
I dont see how throwing that out into the private sector fixes that. The number of hospital beds doesn’t change because the sign on the front door has changed. Plus you’ve just handed a sizable lump of your budget into overheads and profit.
Schools again I just see resourcing issues. It’s just crazy that one teacher is being asked to cover students spread over 3 years. Ok class size is small but 3 different curriculum’s to deliver is just stupid. The work teachers have to do now is a crime.
So many issues and the common theme is the governments that have been driving this for the last 10 years, maybe more.
That is the critical flaw of public systems. They are managed toward occupancy targets, with a percentage safety margin. If a bed is not occupied 80% of the time (different systems might have different numbers) and the system never reaches 80% occupancy as a whole, the public system is going to cut that bed.
By contrast, American hospitals don’t really care much about occupancy. They want the last profitable bed. If marginal revenue exceeds marginal cost, the bed is kept. Throw in outlandish charges, and the system inherently builds out what we see as excess capacity, but that works well as contigency.
As an example, the state of North Carolina had 3514 ICU beds in March 2020, for a population of about 10 million. Ontario, with a population of almost 15M, had 2012 in March 2020. Had we seen anything like the infection rates they have had in NC, our system collapses - not even their spikes, just some of their sustained rates. UK capacity is somewhere between those two poles, but closer in logic to the Ontario one.
What I experienced in the UK was massive variation in the NHS depending on where you lived and what service you needed.
I lived in Edinburgh till about 2013, the NHS was excellent. Could usually see a GP within 3-5 days, had a cancer scare and within 12 hours I was having an operation. Hospitals were generally overloaded (say 3-5 hour wait) but you felt like it was highly qualified staff, hospitals clean, and seen in a reasonable time frame.
Moved to the North East of England between 2013 and 2019 and it was a totally different picture. GP in my village could not be seen for 2-3weeks. My wife was on waiting list for 18 months for an operation, 2 years for fertility treatment. I injured my balls (young daughter gave them a kick) and specialist I saw told me it would take 6 months to have an OP and 30% chance I would be in permanent pain. I ended up instead going to London to paying to go private to see a specialist who could do it the following day, and said not one of his patients has ever had such side effects.
In Liverpool the hospitals are shit. Ended up in A&E and it resembled a third world country. Dirty is what best summed it up. In the last 3 years, 4 family members have had operations. 3 have had mistakes occur during surgery. 2 have died of those mistakes. I dont blame the doctors, but in parts of the UK the hospitals are at breaking point.
Its a bit of a postcode lottery, and luck depending on what is wrong with you. Parts of the UK, and certain aspects of treatment the NHS is excellent. Others it is shockingly poor.
In my defence I’m not saying that to make perjorative point. Believing that everyone is better when people look after themselves and the benefit cascades through society, is a perfectly reasonable thing to thing. I think it’s wrong, but I don’t think it’s evil.
My personal position is that natural monopoly’s and essential services should be in the hands of the state, run for the benefit of the public, with profits being returned to the public purse. Everything else can be left to the markets.
Interestingly, research shows when you blind test policies without attaching a party name to them, the Green’s come out on top. If we had to vote for policies or manifestos without being aware of the party the Greens would be the natural party of government. The Tories are nowhere.
When you slap party names on them, people do a 180 and the Tories come out on top.
If that doesn’t speak to the act of mass witchcraft the Tory have put upon the country I don’t know what does.
I wonder how much of it is also due to first-past-the-post. I know that my voting strategy would be different if we had something more akin to what Germany or New Zealand have…
