Plain packaging - a new Adam Smith Institute report
Today sees the launch of the Adam Smith Institute's latest report, Plain packaging: Commercial expression, anti-smoking extremism and the risks of hyper-regulation. Its author, Christopher Snowdon, is the author of books including The Spirit Level Delusion, Velvet Glove, Iron Fist, and The Art of Supression. We reproduce the report's executive summary in this post, but the whole report is available to download for free here:
1. The UK government is considering the policy of ‘plain packaging’ for tobacco products. If such a law is passed, all cigarettes, cigars and smokeless tobacco will be sold in generic packs without branding or trademarks. All packs will be the same size and colour (to be decided by the government) and the only permitted images will be large graphic warnings, such as photos of tumours and corpses. Consumers will be able to distinguish between products only by the brand name, which will appear in a small, standardised font.
2. As plain packaging has yet to be tried anywhere in the world, there is no solid evidence of its efficacy or unintended consequences.
3. Focus groups and opinion polls have repeatedly shown that the public does not believe that plain packaging will stop people smoking. Even ardent antismoking campaigners do not make such a claim. Instead, activists assert that nonsmokers take up the habit as a result of seeing “glitzy” tobacco packaging. This claim lacks plausibility and is bereft of empirical evidence.
4. One in nine cigarettes smoked around the world is counterfeit or smuggled. The illicit market lowers prices, fuels underage consumption, deprives the treasury of tax revenue and makes an unhealthy habit still more hazardous. It is hard to think of a policy that could delight counterfeiters more than standardising the design, shape and colour of cigarette packs.
5. The wholesale confiscation of an industry’s brands and trademarks represents an unprecedented assault on commercial expression. It not only tramples on the principles of a free market, but it may also be illegal. Expert opinion, including that of the European Communities Trade Mark Association, the British Brands Group and the International Trademark Association, says that plain packaging is an infringement of intellectual property rights and a violation of international free trade agreements to which the UK is a signatory.
6. Anti-smoking lobbyists claim that plain packaging will not be imposed on other industries in the future, but this is a hollow reassurance in the light of the accelerating war on alcohol, sugar, salt and fat. What happens to tobacco tends to happen to other products sooner or later. Public health organisations around the world have been applying the blueprint of antitobacco regulation to other products for years. Sin taxes and advertising bans are increasingly common for certain types of food and drink, and various campaigners have called for graphic warnings to be placed on bottles of alcohol. It should be no surprise that in Australia, where a plain packaging law was passed in 2011, activists are already demanding that ‘junk food’ be sold in generic packaging. Australian anti-smoking lobbyists, meanwhile, say that the next step after plain packaging is to force the tobacco industry to make cigarettes “foul-tasting”.
7. Plain packaging is not a health policy is any recognisable sense. It neither informs nor educates. On the contrary, it limits information and restricts choice. It will serve only to inconvenience retailers, stigmatise consumers and encourage counterfeiters. Wholesale expropriation of private property to make way for public propaganda represents an unacceptable intrusion into an already over-regulated marketplace which will set a dangerous precedent for other products.
What turns doctors into tyrants?
The British Medical Association has called for the government to ban all smoking in cars. This follows a similar call from the Royal College of Physicians a few years ago.
The British medical lobby has had an epiphany. Why should they have to worry about adapting to the shifting nature of Britain’s healthcare needs – which reeks of the unwelcome prospect of change – when they can instead simply demand that the government outlaw things that are making us ill?
Allowing people the freedom to do harmful things, and thus to contribute to ‘preventable death’ statistics, is anathema. I mean, if the entire nation were the prisoners of good doctors we would all live much longer.
That very phrase, ‘preventable death’, is symbolic of the problem. It reeks of a ‘something must be done!’ attitude towards people’s lifestyle choices that indicates a widespread disregard on the part of the medical authorities and much of the commentariat for the capacity of ordinary people to make their own decisions.
Of course, nobody will own up to this sort of old-fashioned, paternalist elitism. After all, progressives are meant to respect the working man and woman. Looking down on the ‘great unwashed’ and making moralistic judgements about them is what Tories are meant to do.
So instead, other reasons are found. Sometimes they are small and particular – for example, the car smoking ban is supposed to be about protecting children, even though advocates want to apply it to single drivers as well – and all this on the basis of an almost certainly apocryphal ’26 times the death’ statistic.
More often the reasons are big and sweeping, and none comes bigger than ‘cost to the NHS’. It’s pretty perverse: on the one hand, we insist that our social conscience will not permit anybody, for any reason, to fall beyond the safety net of the state; while on the other we try to claw back as much money as we can by stripping them of freedoms which may weigh heavily on our social treasury.
I’ve written at length about how a certain species of leftist will turn a safety net into a straightjacket and use the NHS as a highly effective basis for authoritarian government. Yet this is really just the logical outworking of the fact that the freedom-minded have almost totally lost the cultural battle about whether or not adult citizens of a country should be respected as such.
That’s the real battle. Important as the individual policy struggles for liberty are, they’ll continue to resemble endless rematches of Canute vs. the Tide unless public perceptions on personal liberty can be fundamentally shifted. Otherwise, each and every state-cutting measure will come with a ‘preventable death’ toll, and progressives will continue to paint liberty as murder-by-omission.
Healthcare reform must tackle funding
The coalition government's healthcare reforms are in the news once again. My take on the proposals hasn't changed a great deal since I wrote the following for The Spectator last year:
They might help a little here and there, they might be an improvement on the status quo, but they are probably not going to prove worth the effort. To put it bluntly, they don’t go far enough. They won’t help cost control in any meaningful way, because they don’t allow competition on price or abolish collective pay bargaining. They won’t do much to encourage choice or innovation, because they leave the public sector dominant and perpetuate onerous, central regulation. And crucially, they fail to put the patient in charge of their own care in any meaningful way, which is surely the key to delivering a tangible change in the patient experience.
Today, former health secretary Alan Milburn weighs into the debate with an article in The Times (£). He writes:
The Health and Social Care Bill is a patchwork quilt of complexity, compromise and confusion. It is incapable of giving the NHS the clarity and direction it needs. It is a roadblock to meaningful reform.
He goes on to make a number of points that I more or less agree with. Health and social care should be better integrated, rather than being forced into artificial silos that suit planners instead of patients. Control should be decentralised. Payment should be by results. The private sector should play a greater role. And patients should become active participants in their healthcare, rather than mere passive recipients.
All good stuff. But Milburn's final point exposes a contradiction in his thinking. Early in his article, he rules out demand-side reform of the way British healthcare is funded. Later, he says: "Studies in both the US and the UK show that where people have direct financial control over their own health budgets levels of patient satisfaction rise and levels of public spending fall." Milburn suggests that hundreds of thousands of patients should get their own personal budgets, "so that they can buy the services that are right for them". But why stop there? Why not extend the same logic to all patients?
This, ultimately, is the key to successful health reforms: put patients in charge of the money. Not bureaucrats, not doctors, but patients. Once you do that, the door is open to genuine choice and competition, which will raise up standards and drive down costs - as well as instilling a much-enhanced sense of personal responsibility. No amount of supply-side tinkering - however worthy or well-intentioned - can have anything like the same effect.
We need this principle to be spread as far and wide in the healthcare system as possible. As long as NHS funding comes from the top down, it will necessarily remain a centrally-planned, command and control institution, with all of the inherent defects that entails.
I've outlined my own, radical vision for the future of healthcare here.
Sugar: the new monster under the bed
In their ongoing campaign for plain packaging of cigarettes, Action on Smoking and Health have dismissed fears of a slippery slope, saying:
Tobacco is not like any other product, it is the only legal product on the market which is lethal when used as intended... Plain packs for tobacco would not set a precedent for other products.
This is the same mantra we hear from self-described health campaigners every time the Trojan horse of tobacco is to used to expand state interference in lifestyle choices. Meanwhile, back in the real world, the latest issue of Nature provides the most shameless indication yet that policies once seen as unique to cigarettes will be applied to food and drink. In an article entitled 'The Toxic Truth about Sugar', three San Francisco-based public health advocates argue that sugar is a poisonous substance of abuse which is too readily cheap and too available. 75 per cent of all US healthcare expenditure is, they claim, spent on treating sugar-related diseases.
The seriousness of the journal precludes the possibility that it is a spoof, but one can still enjoy the moments of unintentional hilarity, as when the authors make this appeal to nature:
Evolutionarily, sugar was available to our ancestors as fruit for only a few months a year (at harvest time), or as honey, which was guarded by bees.
"Nature," they add, "made sugar hard to get; man made it easy." The millions of people who live in sugarcane-growing regions—for whom nature made wurzels hard to get—may raise a quizzical eyebrow at this, but even if it were true, anyone who understands medicine, as opposed to the nebulous and debased concept of 'public health', knows that nature is to be feared and defeated. Mother Nature brings us disease, malnutrition and infant mortality; mankind bring us vaccines, cures and plenty. Few doctors would recommend abstaining from fruit for months on end because Gaia has willed it, and even the most primitive religions do not regard bees as gatekeepers of unhealthy vices.
The authors note that infectious diseases now kill fewer people than "non-communicable diseases" and that more people are obese than are undernourished. Man's triumph over starvation and parasitic killers is a jolly good thing, but in the glass-half-empty world of public health, it only serves to show that government action is more urgent than ever. "Non-communicable disease"—what we die of if malaria and tuberculosis don't get us first—is set to be the medical establishment's buzzword of the 2010s. It covers all the ailments that have traditionally been beyond the remit of public health and it is so broadly defined as to allow almost any intrusion into our private lives.
Denmark already has a fat tax and many US states have some form of soda tax, but these are usually set so low as to be stealth taxes by any other name. Public health crusaders would like to go much further. The authors of the Nature article suggest banning the sale of sugary drinks to the under-17s, banning the advertising of sugary products on television, banning vending machines, removing sugar from the Food and Drug Administration's list of products which are Generally Regarded as Safe (GRAS), doubling the price of soda drinks, reducing opening times of shops that sell sugar-containing products and limiting the number of fast-food restaurants and confectioners that can operate in a district. "We’re not talking about prohibition," says Dr Laura Schmidt, one of the authors, "We're not advocating a major imposition of the government into people’s lives." One wonders how heavy the government's hand would have to be for Dr Schmidt to recognise a major imposition.
Libertarian objections to one side, fat taxes and soda taxes are phenomenally ineffective. A recent study found that a penny-per-ounce soda tax, as proposed in the Nature article, would reduce consumption by just nine calories a day. A 10% fat tax on milk and fizzy drinks, as proposed in the British Journal of Nutrition recently, would have even less effect.
Sin taxes of whatever variety are useless when set at low levels and spawn a host of unpleasant, unintended consequences when set at high levels. The repeated failure of such neo-prohibitionist policies will not be enough to deter the rampaging public health industry from taking an ever more draconian line on what we eat and drink. Governments, meanwhile, are so desperate for cash that the unholy alliance between taxman and puritan is only likely to get stronger.
Don't ban adverts for boob jobs
In the wake of the fuss about some people being fitted with dodgy breast implants, the British Association of Aesthetic Plastic Surgeons (BAAPS) wants advertisements for cosmetic surgery to be banned and 'cowboy' plastic surgeons regulated out of existence.
It's a bad idea. For a start, the faulty implants, made by the French company Poly Implant Prostheses (PIP), were approved by the UK authorities when they were fitted, and many of them were fitted by NHS surgeons. It's not a 'cowboy' problem. And sadly, the call to ban 'cowboys' through regulation is the first resort of any interest group that feels its business threatened by competition. As Adam Smith knew 250 years ago, such appeals should be listened to "not only with the most scrupulous, but with the most suspicious attention".
Banning advertisements (for any good or service), meanwhile, robs the public of information. And people need information in order to make informed judgements about what they should choose. Many of us have spent hours on the internet, checking out the various features, quality and ratings of household appliances or cars or wristwatches. Shouldn't people be able to check out their surgeons? Advertisements convey useful information on just such decisions. Sure, you need to apply a bit of 'suspicious attention' to them: but in the UK at least, advertisements are required by law to be truthful.
It is actually rather difficult to draw a line between 'advertising' and 'information', because one of the main functions of advertising is to inform people – to alert them to options that they might never otherwise have discovered. Not just goods and services that they might have been unaware of, but suppliers, options, quality and price information that they may not have known. The sort of information, in fact, that established 'insider' suppliers definitely do not want people to know because it represents a threat to their cosy monopoly. And monopoly is never in the public interest. As Milton Friedman showed long ago, professionals' restrictions lead to higher prices and worse service.
Intellectuals and professional people invariably condemn advertising as crass and distasteful, with things like their 'limited time only' offers. Some surgeons have even expressed worry about 'buy one, get one free' offers with breast implants (which makes me wonder how many women would want a single, unless they had suffered mastectomy or some disfigurement). But such offers simply demonstrate that some suppliers have found ways to use up spare capacity in slack periods, or found ways to provide their service at half the cost of the establishment providers.
And is the 'advice' of the professionals, with their interest in keeping the business to themselves, any better or more reliable than the claims of advertisers, with their interest in breaking in to the market, and bound by the 'truth' condition as they are? Far fewer of us these days follow the advice of professionals without at least asking around, or checking things out on the web. And people do not make decisions on the strength of an advertisement alone. The advertisement alerts them to the options, then they root out the information they need.
So we should not ban breast-implant advertisements on the basis of what the establishment professionals of the British Association of Aesthetic Plastic Surgeons happen to think, any more than we should ban all those ads of cars racing round alpine bends on the grounds that the wise folk at the Society of Motor Manufacturers and Traders probably know what's best for us. We should let people discover all the options, and make up their own minds.
Let them eat steak
I don’t usually bother with New Year’s Resolutions, but waiting until after the Christmas orgy of eating was over seemed like a good idea to start watching what I eat. Discipline has been surprisingly easy, but what’s been hard is to actually decide what to eat. As anybody who’s ever looked into eating healthily will know, there are more diets than there are religions. Low-fat or low-carb? Paleo or South Beach? Cookie or cabbage soup? (Ok, so that last choice sounds easy enough. Sadly, the cookies are mostly made of newspaper.) It makes me wonder how government can hope to improve people’s eating habits, when there’s no consensus about the “right” diet at all.
The NHS’s Healthy Eating site goes for the mainstream, low-fat approach. Less meat and butter, more pasta and bread. Sounds reasonable, but this could be completely wrong, if people like Gary Taubes are to be believed:
There are plenty of reasons to suggest that the low-fat-is-good-health hypothesis has now effectively failed the test of time. In particular, that we are in the midst of an obesity epidemic that started around the early 1980's, and that this was coincident with the rise of the low-fat dogma. (Type 2 diabetes, the most common form of the disease, also rose significantly through this period.)
…Public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat, and we did. We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease.
Are Taubes and the other low-carb people like Atkins right? The whole piece is worth reading. I don’t know the answer, but there’s clearly no obvious position the government should take in advising people about what to eat. If the low-fat people are right, then the government-recommended diet of wholegrains and fruit might be precisely what is making people get fat. Even a seemingly-innocuous (if annoyingly preachy) campaign like the “five a day” idea could be steering people in the wrong direction. Is it good to eat five bananas a day (equal to 70g of sugar, or a sixth of a bag of sugar)? Probably not.
I’m sure most of the paternalists in government and the medical profession think that they are being helpful in providing state-mandated dietary advice. They probably think of "civilians", especially poor ones, as being a lot stupider than they are, child-like and in need of a nanny to help them live healthy (and thus worthwhile) lives. But most state efforts to improve people’s lives cause some nasty unintended consequences – in this case, it seems as if the obesity epidemic might be, in part, a direct consequence of governments seizing upon bad dietary advice. Another part of this is the cheapness of the high fructose corn syrup that now sweetens soft drinks like Coca-Cola, incredibly fattening and unusually cheap thanks to corn subsidies paid by the US government.
Rather than a "healthy" diet of oatmeal, bread, rice, bananas and the odd lean chicken breast, the best way to eat healthily might be to emulate the diets we evolved to eat: no grains, some plants and a lot of meat. Maybe that's wrong too — it's hard to know. The obvious solution is for government to get out of the diet advice business altogether. “First, do no harm” is a good rule of thumb. In reality, they want to tax and regulate food even more. It's a pity — people should be able to do what they want no matter how harmful it is to themselves, of course, but it's even worse when the government's nannying makes people fatter. A little bit of humility would go a long way.
Hands off!
Whilst most of the coverage of the PIP breast implants story has been rather puerile – if they had been in men or a rather less exciting body part I doubt the story would have gained much traction – there are some serious issues at stake.
There has been much criticism of the private cosmetic clinics for refusing to replace implants. Their refusal is quite correct, however. As the clinics point out, the costs of removing all the PIP implants and replacing them would be enormous and unnecessary. The quango responsible, the Medicines and Healthcare Products Regulatory Agency (MHRA), had declared the implants safe to use and had given them a CE mark. Subsequently, the MHRA has stated that it is not recommending removal. This makes Andrew Lansley’s accusation that clinics have a ‘moral duty’ to remove implants even more of a nonsense; what about the clinics’ moral duty to their other customers and employees not to bankrupt themselves for no reason? Further, the government statement that the NHS would remove any implants which clinics refuse to remove means that clinics are incentivised to do just that, as clinics are well aware that the state will do it for them.
Most idiotic, however, has been commentary regarding regulation of the cosmetic surgery industry. Unsurprisingly, the Observer led the charge to call for regulation. This particular article is a litany of contradiction and misunderstanding. It is quite obvious, however, that the cosmetic surgery industry is already heavily regulated, as the existence of the MHRA shows, and this regulation helped to cause the problem. The cosmetic surgery industry is already covered by general laws and regulations relating to any business, but also to specific medical regulations and institutions as this DoH report shows. By approving the implants the regulator encouraged clinics to use them and customers to buy them whether they were safe or not (which is unclear). In a free market, it is in the interests of producers to protect their reputations and supply good quality products. Under a regulated market, suppliers can hide behind the protection of regulatory approval. In short, the regulator created moral hazard.
The calls of the industry’s own professional bodies to be regulated should be treated with the contempt they deserve. The Observer’s ignorance of the function of professional bodies is laughable, although commonplace. It is in the interest of professional associations to create mechanisms by which they can reduce competition and erect barriers to entry so that they can increase market share and raise prices, hence the BMA supports the NHS and so forth. Under a free market, there may be a number of competing agencies and outsiders who may be able to offer a cheaper or more innovative service. In a regulated market, a state agency will set an arbitrary standard and create compliance costs to achieve it, thus reducing competition and innovation and driving up prices. It is no wonder that established market players are calling for regulation but it will not serve to protect consumers who will be exploited by monopolists and will suffer regulator-induced health problems such as this one.
Existing regulations notwithstanding, the success of the cosmetic surgery industry in the UK has occurred because it has been freer of regulation than many other areas of health. Costs have been kept down by competition and innovative products have been brought to market offering new and better treatments. Levels of complaint and dissatisfaction are low – it would be interesting to compare these to general medical standards in private and in nationalised medicine. Whilst some feminists and those who think they know better scoff at cosmetic surgery, for patients there are enormous benefits. Further regulation of the industry would only serve bureaucrats and producer interests, it would not serve the interests of consumers or potential consumers.
(One commentator pointed out that many breast implants were funded by women on relatively low incomes using cheap credit as a means to fund surgery and that the cosmetic surgery industry was hit hard by the credit crunch. Clearly, this may be a classic case for Austrian Business Cycle theory to show how credit manipulation by Central Banks led to inflation of assets!)
Genome genie
Same old problems got you down in this new year? Budget deficits, euro crisis, immigration? Ed Milliband’s promise of fairness in tough times doesn’t stir the soul? Thirty minutes quicker by train to Birmingham on HS2 a big yawn? Well, here’s something brand new to start worrying about.
Life Technologies of San Francisco unveiled on Tuesday its new benchtop Ion Proton Sequencer that is designed to sequence the human genome in a day for $1,000. That’s quicker (and maybe cheaper) than your average NHS cholesterol test. The gadget costs only $149,000 compared with current sequencers costing $500,000 to $750,000 but which take several weeks to complete the sequencing at a cost of up to $10,000.
As is the way of these things, costs will come down quickly and soon the whole process will be cheap enough to install at your local Tesco pharmacy. Before then, of course, the trendy will be getting these genome sequences on their way to a breast or hair implant clinic. No doubt, the Americans will be way ahead on this as UK and European politicians wrangle about its morality, regulation and accessibility.
This is going to be big, very big - far bigger than the current kerfuffle about removing faulty breast implants - and for good reason. Insurance companies and employers would love to get their hands on such information. Governments, too, will be keen to either suppress genomic information so as not to interfere with equality agendas or to demand such information in the pursuit of any number of other objectives.
In effect, the genome sequence is a scientific crystal ball, significantly enhancing the ability to predict the likely course of an individual’s life: predisposition to disease, physical characteristics and mental aptitude. That’s what will make the issue so big - and scary or hopeful, depending on your point of view.
But the inevitable is hurtling towards us. Once the genie is out of the bottle, there’s no putting it back. As with the first mainframe computers, then the PC, then the internet, then social media and smartphones, the more that information is rapidly and transparently disseminated, the better. It’ll be noisy, perplexing and disturbing so get ready – widespread genome sequencing is upon us.
Whistling in the wind
Andrew Lansley has provided a new, from 1st January, independent helpline for NHS staff with concerns about malpractice. The line (08000 724725) is operated under the auspices of Mencap and is already very busy. The questions though are whether the whistleblowing needed to improve the NHS will take place and the NHS be any more transparent as a result.
Any large organisation hates to have its faults brought to public attention. Counter to policy as it may be, whistleblowers can be victimised, or fear they may be victimised. Yet we need the sunlight, the best disinfectant of engrained malpractice.
The NHS management organisation has posted, in line with the new helpline the admirable policy “NHS Employers supports NHS organisations to promote a climate of openness, in which staff feel free to raise concerns in a reasonable and responsible way, without fear of victimisation.” Note that NHS organisations are free to set their own rules; “NHS Employers” is advisory. As part of that they promote a booklet written for them by the independent charity Public Concern at Work which was set up to help whistleblowing in 1993. The booklet “Speak up for a healthy NHS” is entirely admirable.
The questions, though, are the extent to which NHS organisations follow those guidelines at the policy level and whether they do so in practice. Some use the term “whistleblowing” purely to mean internal reporting of concerns. External publicity is not even considered. Taking three hospital trusts at random, the Norfolk and Norwich Hospital lays out an admirable set of policies on its website whereas searching the Basingstoke and North Hampshire Foundation Trust for “whistleblowing” or “speaking out” produced nothing at all. St George’s Hospital also appears to have nothing about whistleblowing on its website beyond a concern that the whistleblowing policy should be observed so far as fraud is concerned.
These are just three hospitals. A full study would require a formal survey and maybe that of itself would help best practice. Using websites is valid because that it where an employee thinking of blowing the whistle would be likely first to go.
The original trigger for this blog is concern that problems will still be covered up rather than exposed to sunlight. Yes, it is better that they are dealt with internally, if they are, but serious unchecked malpractice should be exposed.
Chatting with a Mencap helpline responder, it became clear that their advice would never include talking with the media. They see their more as counselling, including raising the matter with regulators or other helplines if the NHS employee is not satisfied. But this could simply enmesh the potential whistleblower in a bureaucratic spider’s web.
Lansley’s initiative is the third in recent years: 1993 saw the creation of “Public Concern at Work” and then the Public Interest Disclosure Act 10 years later. The recent string of cover-ups and the need for the new helpline indicate that the earlier responses did not work. It is not obvious that the new one will work any better.
The government now needs to get tougher, for example, by requiring Mencap to publish statistics on the calls they receive and the outcomes as well as concerns that need public attention. Mencap should obviously provide anonymity for whistleblowers that are concerned about possible victimisation whatever their employers’ policy documents may say. Whistleblowers need to be heard.
The NHS needs radical reform
- The NHS is a monopoly that does not provide comprehensive or high quality healthcare.
- A social insurance scheme needs to be introduced, funded by employer and employee contributions along with co-payments from patients
- Hospitals should be removed from government ownership and sold to private groups to create genuine competition and choice for patients
In a report released today, the Adam Smith Institute calls for radical reform of the NHS. The government’s current plans are trying to introduce competition to improve health care quality, but seek to do so only in a limited and overly bureaucratic way.
Instead, our report proposes the gradual selling off of all hospitals to multiple private groups, in order to introduce real competition and drive up standards. The sales receipts from this would be used to establish a health insurance fund.
The fund would be entirely self-financed through employer and employee contributions and co-payments from patients. With the NHS no longer needing the £105bn in government funding the treasury could afford to cut direct and indirect taxes to offset the additional contributions individuals would make to the health fund scheme.
The report also argues that co-payments are essential for any health care system to be viable in the long term. Without them, costs will keep spiralling upwards uncontrollably. Introducing co-payments would move English health care towards a European-style social insurance system (with proven better performance than the NHS). It is proposed that these co-payments should be set at around 20% of treatment costs, but limited to a maximum of £6000 per patient per year.
To ensure costs are not onerous for patients, private insurers should be encouraged to enter this secondary market on a needs-blind basis. As the maximum insured risk is only £6000, insurance cover should be available for around £250 per annum.
The report’s author, Chris Davies, has experienced over 45 years of NHS care and writes candidly about the many ways the service has failed him. Many of the health conditions he has experienced were caused by incorrect and inadequate past NHS protocols, forcing him to spend large amounts on private healthcare or on going abroad for treatments to fix problems caused by the NHS.
After being failed repeatedly by the NHS, which he sees as a fifties-style nationalized service that does “time wasting and inconvenience on a monumental scale”, he has written ‘Reforming the National Health Service: Reflections on four and a half decades of NHS care’ to argue that the NHS cannot continue failing patients and should be radically reformed.
Tom Clougherty, Executive Director of the Adam Smith Institute, adds:
“Britain’s anachronistic healthcare system is failing its patients and the government’s proposed reforms will do little to change this. The NHS continues to consume a large amount of the government’s budget but does not deliver the quality of service that is to be expected in a wealthy, developed nation.
“As our author points out, we urgently need to reform the NHS and seek out alternatives to a one-size-fits-all nationalised service. Adopting a European-style social insurance model, and transferring England’s hospitals into diverse private ownership, will inject real choice and competition into healthcare provision and give us the patient-centred system we desperately need.
“We must not let nostalgia about the founding of the National Health Service get in the way of the desperately-needed reform of this sector.”
