Thursday, August 13, 2009

In Defence of the NHS

Cousins sometimes fight, but it gets too personal if the beloved NHS looks 'evil and Orwellian' to politicians in America. Have the Americans not had enough of this myth about socialised medicine and still believe the stories that boards decide which medicine one can get? That's utter nonsense; for all the little disappointments I had with NHS in Britain - and I am an immigrant - I can't ever say it is evil, because it was mostly better than I expected.

Agreed, I come from India. But then I am not benchmarking against the state hospitals in India, but against the better run private ones, where one can get world class treatment if they can afford it. More like America, I would say. Or the ones in Thailand and in Dubai, which is no less expensive than anywhere else in the world and no less luxurious. True, our local Mayday hospital may not stand in comparison in terms of luxury, but I have met some of the best professional doctors there, who were really committed to patient welfare. Besides, the best thing about NHS is that you never have this feeling of getting mugged, which is precisely the feeling you get while visiting some of the privately run hospitals here.

Here is an example. Once I had a visitor from India who did have travel insurance, but not complete coverage. He fell sick after coming to Britain and it emerged that his pacemaker battery ran out. He was not entitled to the NHS treatment, being a tourist. However, I still rushed him to the local hospital and to the Accident and Emergency department which operates round the clock. I did disclose that he is a tourist but requested them to take him in as it is an emergency. They took him in, no questions asked, and told me that I may have to pay, but that could be discussed with the finance director once she comes to office on Monday.

The following day, Monday, we were duly met by the Finance Director, who asked us to fill out a form accepting the obligation to pay. I was a bit hesitant, as I was still trying to figure out whether the insurance company will pay. However, the operation was already due and I was still trying to get a pre-authorization from the insurance company. The Finance Director, to my surprise, said that I could take my time and see who will pay, but meanwhile they will go ahead with the operation. I was surprised and wanted to clarify - did she say that they would operate regardless. She indeed said that - she said human life is more important to them than money and while I figure out who pays, they have to go ahead with the operation.

This is exactly what happened thereafter. The patient was operated, batteries changed and was released. I meanwhile failed to get the authorization - as all insurance companies play with the fine print - but got the patient home. I realized that it is an inefficient system, and since I haven't signed anything, I can get away without that. But, at the same time, I was deeply grateful, given that I met some very efficient and sympathetic doctors and nurses and got great care for someone who is obviously important to me. I did sign the document and paid up. I would have felt terrible if I didn't.

Beside this one sterling example, I have met some great doctors and nurses in the NHS. I must also complement our GP, who will rarely go beyond OTC drugs but that actually ended up making us fitter and less dependent on drugs. I would rate the care as excellent, particularly for children and vulnerable people. There are indeed wait lists but that's okay if you are not paranoid about getting one extra test done. You can always jump the queue if you are in emergency and usually the care is excellent.

One of the great myths of our time is that private enterprise has always the best answer. I thought the myth was busted with so many banks messing it up so clearly. I can give other examples, like British Rail, where Private enterprise actually worsened the problem. Economically speaking, I think Private enterprise can do a good job in the areas where there is assured competition and in the buyers' market. Essentially, it does a very bad job in markets which become natural monopolies, or where it is easy to form a cartel, or where there is a great social cost to be accounted for apart from financial efficiencies. Railways fall in the first category, and health care in the third - and I do think private enterprise can not have the final answer and the state needs to have a role to play. Besides, I wonder why Americans can ever object to 'socialised medicine' when they are unable to find a better way than 'socialised banking' to keep their economy going. And, if they have to falsely accuse our beloved NHS for their failure of imagination or the fact some of their politicians have sold their souls to insurance companies, we have to stand up and show them what Britain can still teach America.

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