The nonsense factor
Ian Bickle lets off steam about people voting with their
wallets
How many times have you been in the pub and heard people complaining
about the NHS or been waiting for a ward round and heard patients
and their relatives whingeing about the care they are receiving?
Probably quite often, but I am sure you have also had to hear and
read many people in the United Kingdom having a right old moan about
how much tax they pay. Let's have a look into the mind of one of
these people - name is Mr Average - more of him later. By the way,
Mr Average is married, with one son, and has a pet poodle called
Lucky, whom you will also meet.
The NHS is a unique, but rather dear, luxury for the people of
the United Kingdom. Established in 1948 following the NHS Act of
1946, it materialised out of a wartime document - the Beveridge
Report in 1942. The post-war Labour government decided that the
people of the United Kingdom deserved a comprehensive health service
free at the point of access for all regardless of race, colour,
status, or wealth. It was the responsibility of the then secretary
of state for health, Aneurin Bevan, a well respected Welsh MP, to
introduce the service against the wishes of many in the medical
profession.
At its conception it was hailed as a service that in the long term
would bring economic benefits through clearing the backlog of ill
health and putting people back into work. Not only would it mean
that the Treasury would get it hands on more income tax and reduce
benefits payments in the long term but it was promised that as more
people were treated, fewer would be ill, and so spending on the
NHS would fall - this has to be one of the most naive political
judgments ever.
NHS expenditure in the United Kingdom rises above inflation year
on year, rising at 3.9% in 19991 against a headline rate
of just 2.2%.2 This means that to pump in a "real" increase
the government has to spend over and above "healthcare inflation."
Additional funding has been commonplace in recent years with governments
of all political hues, yet the NHS continues to struggle from one
year to the next like a Lucky and his limp.
The government spent £61bn on the NHS in 1999, which represented
over 17% of all public spending in the country.3 A huge
sum of money but not enough - in fact, nowhere near enough to meet
the spiralling expectations of the public and to keep pace with
the technological advancements and ageing population.
This £61bn equates to 6.7% of gross domestic product (GDP) - this
is kind of the amount of money per head of the British population
each year. The European average for healthcare spending is 8.7%
of GDP, in Germany it is 10.7%, and in the USA it is a massive 13.9%.4
In real cash terms, for example, the USA spends three times more
than the United Kingdom. It is not surprising therefore that they
can afford new equipment, get treated quicker, and have lovely hospitals
that, of course, Mr Average and others look to with envy and complain
about why they haven't got a service like that at their local hospital.
This is where the British "nonsense factor" factor comes in.
The average stereotypical voter - and they are all potential patients
- follows an ideology of "I want a better NHS and lower taxes."
Mr Average is one of these very people.
On the splendid sunny day that was polling day Mr Average and Lucky
trundle off to the local primary school polling station in fine
fettle - on the way he bumps into Mrs Flower who tells him that
Mrs Button from Number 10 is poorly and in hospital. This makes
him think how fortunate he has been - he last went to the general
practitioner three years ago with a spot of backache after falling
from a ladder while cleaning out the gutters, and his only hospital
experience was 35 years ago when he had his grommets done. He gets
into the polling booth, looks around, and feels secure - he votes
with his wallet for the tax cutting promises.
A month later his beloved little son decides to have a fight with
a BMW while out on his new bike and ends up in accident and emergency.
Mr Average goes with him and waits for three hours. He doesn't like
the seats, thinks there are not enough nurses, and, when his son
is transferred to a ward, is appalled at the lack of new equipment.
He is vocal with anger and complains about the standards to his
mate: "I pay my bloody taxes don't I!"
But wait - didn't Mr Average vote with his wallet, you are asking?
Yes - it's the "nonsense factor." He wants the best but doesn't
think he should have to pay for it-how often do you get a Rolex
watch in the Mr Pound shop?
It might be funny, but this is reality, and it's the reason why
an honest and open debate is warranted on the future of the NHS.
A debate that should involve the people who use its services - the
public.
For the government it is a magic wand as it offers the opportunity
to end once and for all the continuous bickering and uncertainty
over the future of a comprehensive, fair NHS without electoral repercussions.
It's simple, and whatever the result they WIN. Governments are scared
to raise taxes for fear of losing power, so why not offer a referendum.
The question could be something like, "Are you prepared to pay 2
pence on your basic income tax for a better quality NHS?"
The public votes yes, and the government gets additional resources
that can make a real difference, without accusations of raising
taxes unfairly. The public votes no and then cannot blame the government
for a dwindling level of NHS services. Magic!
No method of securing the future of our NHS is going to suit everyone,
and none will be without its disadvantages, but a debate needs to
begin, with the public on board, to ensure we have a healthy NHS
in the years ahead. Have you met Mr Average before? I think you
have, and he's been Lucky for too long.
Ian Bickle, third year medical student, Queen's University of Belfast
Email: email
studentBMJ 2000;08:89-130 April ISSN 0966-6494
- Towse A, Susse J. Getting UK healthcare expenditure up to the European Union mean - what does that mean? BMJ 2000;320:640-2.
- Office for National Statistics. Consumer price indices 1999. Briefing notes 25 January 2000. (www.statistics.gov.uk/pdfdir/cp0100/pdf)
- Treasury. Pre-budget report. Stability and steady growth for Britain. London: Stationery Office, 1999.
- Organisation for Economic Cooperation and Development. OECD health data 99: a comparative analysis for 29 countries. Paris: OECD, CREDES, 1999.
