Visiting my GP recently, I asked about having my hearing checked. Tests over past years have indicated a modest loss in hearing. I wanted an update. The GP replied that the NHS only tests people over 65 unless there is a distinct problem. My previous tests were conducted in Switzerland. Had I paid for them, the GP asked. Well yes, although it was covered by my insurance. I came away from that appointment knowing I had less control over my health than I once did. I do not have an update on my hearing.
This episode begs the question: Is it better to pay for the services of your doctor, or to receive those services courtesy of the state?
This is particularly a question for the British, whose National Health Service is the quintessential model of state-run services. Formed by socialist instincts at the end of the Second World War, it tests the management capacities of government to the extreme. Funded by tax receipts, it renders invisible the costs of service to the individual. It provides physicians freedom to practice without commercial pressure. And it assures a dependent public that their medical needs will always be met, no matter their circumstances.
Conscious of this mix of characteristics, the British public has a paradoxical attitude towards the NHS. We are wary of disrupting what we know, but at the same time, we want to shift the balance of power of state and medical profession to focus better on our individual needs.
Paying your doctor does not necessarily empower you. They can be influenced by commercial pressures to prescribe particular medicine or procedures, or to seek more fees by over-treating you. But the paternalistic tendencies of a state-run health system do not empower the individual to take greater control of their health. So we are in a bind.
Health policy reforms tend to take aim at making the supply side more efficient. The gaping hole is to promote demand for health – to encourage people to take more responsibility and initiative. From this point of view, state management of the health of its people may not be the optimal choice.