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Beginning of the end for England’s NHS? Yes. Defending the NHS with poorly reasoned rhetoric won’t save it

Steve Black

British Medical Journal

24 April 2013

The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition to reform is ineffective because it appeals to emotions and doesn’t draw on credible evidence.

For example, rather than discuss the evidence about whether competition among providers is good for patients, Hunter goes straight to the easy rhetorical point that this will lead to a system governed by “naked greed,” as in the US.

Moreover, he misses the vital point that it is more important who pays for healthcare than who provides it. There is clear evidence that a single payer system where government acts as the insurer is fairer and cheaper than the alternatives. This is the most important characteristic of the NHS and the one most worth defending.

In this era of rich, incompetent, and greedy bankers, it is easy to characterise markets as red in tooth and claw, as Hunter does. But most markets are not like that. In reality, markets offer better responsiveness to need, faster improvements in productivity, and higher rates of innovation than monolithic systems run by governments (at least when well regulated).

In fact, much of the anti-market argument is based on the naive assumption that the means of production must be controlled by the state to ensure efficiency and the public good. If that were true, communist central planning of the economy would long since have crushed the chaos of capitalist markets. In case anyone needs reminding, that didn’t happen.

The NHS has many serious challenges to deal with, most of which will not be overcome by Lansley’s reforms. But alleging that it is all a conspiracy and failing to address important sources of evidence won’t convince me or many others to join the campaign.

Steve Black is a health management expert at PA Consulting Group


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