Thoughts on Privatisation

by David Webb

Privatisation of services – which is basically what libertarians are calling for, along with an elimination of personal taxation – suffers from the key flaw that the bureaucratisation of our society extends to the private sector too: just because they are privatised, services do not have to be efficiently run, with lean management teams.

US healthcare is a prime example: as a percentage of GDP, expenditure on healthcare in the US is very high, and although health outcomes are better than in the UK, it is still true that relative to the low expenditure as a percentage of GDP, healthcare in the UK is relatively productive compared with the US system.

Why is that? Well, ambulance-chasing laws and compensation payments account for a good deal of that. Even privatised services are infested by the same managerial culture as in the public sector, with health-and-safety and the compensation culture taking a big toll. Telephone number salaries for healthcare professionals are another factor, pushing up the ultimate cost, although we have found that even under the state-funded NHS, we are funding extremely lavish pensions for bog-standard GPs.

I am convinced that some kind of law limiting the compensation culture has to be part of the privatisation of healthcare package. After all, the managerial culture in healthcare, and the fact that healthcare is an essential service that operates like a cartel even in privatised systems, means that all hospitals and surgeries do is to take out insurance against compensation suits – passing the bill to their patients in a privatised system. This is part of the reason the US system is so expensive. A “rip-off Britain” privatised healthcare system is not really what I want to see.

I am toying in my mind with the idea of not having any compensation payments at all for healthcare misinterventions. That means no insurance for doctors or hospitals, and no increase in the medical bills as a result. I basically tend to believe that most doctors are not going to try to kill off  their patients, and that we have to trust them to do their best. There is a considerable body of anecdotal evidence that doctors from the Indian subcontinent operate in a more careless cultural framework, and they are much more frequently involved in newspaper reports of medical mishaps. I would like to see all medical personnel in the UK eventually chosen from the native British community: I am convinced that medical mishaps would decrease greatly in proportion as a result.

But where mishaps occur, there should be no lottery-style wins. If your baby dies because of mistakes by the doctors, there need be no multi-million-pound payments. People always claim that it is not the money they are after, but the principle, but when offered a smaller sum, say “are you saying my baby is only worth X?”, showing that it is not the principle, but the money, that they are after. Instead of money, they should be able to sue the doctors – take the decision themselves to sue, without intervention of the Crown Prosecution Service – with the courts liable to cancel the doctor’s medical practice licence as a result of mishaps. That solves the “principle” without offering any money: a doctor who causes the death of  a baby is simply barred for life from practising. No money changes hand. If some smaller compensation payments were thought necessary, they should be limited to the doctor’s private assets (his house, pension fund, etc), with the hospital never having to pay compensation. Manslaughter charges and other criminal charges could also be brought against doctors, but in no cases leading to financial rewards.

We could possibly refine this approach by allowing compensation in the relatively small number of cases where someone has been paralysed for life and relies on life-long care as a result, but in general there would be no payouts. Having an operation go wrong would not be like winning the lottery, and patients would not have to pay astronomical sums as the doctors cynically passed the bill for their negligence onto other patients. My approach contains a strong presumption that failing doctors be struck off in every case. This is the only way to pressure the doctors into performing well.

This approach could be more widely adopted. For example, we hear regularly of how the Metropolitan Police use taxpayers’ money, ostensibly being made available to fund crime prevention, to pay compensation for various types of police malpractice – including politically motivated “compensation” cases, such as the award of a telephone number payout to Doreen Lawrence for their failure to solve the murder of her son. I would like to see the right to any type of compensation payout from public bodies abolished: if the Met behave badly, the police officers involved should be sacked, and could be pursued through civil courts for their own private assets, but in no case should public money be wasted on compensation.

By extending this principle to privatised semi-monopoly services, such as healthcare, we could gain cheaper and better healthcare. Why should libertarians be aiming to enrich lawyers, after all? We need a debate on this.

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8 responses to “Thoughts on Privatisation

  1. Your ideas on the compensation culture are sensible. It is highly corrupting as well as having perverse consequences of limited services at higher prices. Of doctors and surgeons refusing to treat patients for fear of the legal consequences.

    Just another example of the State being used by a special interest group, in this case ambulance chasing ‘respectable’ lawyers and all the ‘compensation’ industry that has grown up around them.

  2. The best healthcare I’ve received from the NHS for a long while (not that I use it much) was from an African doctor in Accident And Emergency where I turned up in agony after no help at all from the 24 hour phone thing; after waiting all night for a reply, I was eventually advised by the telephone doc, who sounded very English, to take some painkillers. When I suggested that pain is not actually caused by a lack of Ibuprofen and pain so great as this normally means something is wrong with the human body, he said that if I was still in agony in a few days, phone back. So I got my dad to drive me to Casualty.

    The doctor I got was very African, in the sense of his accent, and I initially worried about communications problems. But his English was very good, he listened attentively, ran every check he could on me; heart, X-rays, the lot, and eventually diagnosed gall bladder with the pain transferring up to my left shoulder; he then went off to check whether it was hospital policy to notify my GP, since he was only a temporary rather than on the permanent staff. It wasn’t. He wrote her a letter anyway. I wouldn’t support an “English only” policy. Doctors should be chosen on merit. He was the best doctor I’ve seen in years.

  3. I had hoped to start a debate on the role of compensation payments in making privatised systems more expensive.

  4. From personal experience I know that doctors and surgeons will now refuse to carry out procedures on very ill patients which previously they would have performed. Instead they regretfully tell the patient that nothing can be done.

    This is purely because if the doctor tires to help the patient and the patient still dies then the doctor is at great risk of being sued and losing everything, whereas if the patient is untreated and left to die there is no legal consequence.

    People in Britain today, right now, are dying because of the perverse compensation culture that is embedding itself in the wider culture.

  5. And as an aside to Ian B, I don’t support an ‘English only’ policy for medical staff, but I do support a policy of making sure that foreign staff are trained to the same standards as British staff. Unfortunately, a large number of staff recruited from the 3rd world are not trained to as high standards as we train our own people. I am very glad the doctor treating you was not one of those.

  6. Well as a general comment, the problem with compensation payments is a generally problem with the court system, juries, the judiciary, etc, and not limited to payments from public bodies. As with most of our worst innovations, it appears to have been inherited from the Americans.

    Compensation is a problem, in terms of calculation. Imagine a hypothetical. Most of you know that I am an artist of a kind, so my hands are crucial to my work. Imagine that Sean is foolish enough to invite me to address a libertarian gathering. Imagine also that he is filiming my mad rant, and has rigged lights above me to facilitate that. During my presentation, one of the lights falls and permanently injures my right hand, so that I cannot draw again, and thus my entire career is ruined. Subsequent investigation reveals that Sean had not followed the manufacturer’s safety instructions, and that is why the lamp fell from its rigging.

    Under libertarian principle, I am surely entitled to sue him for compensation. But how would you calculate the amount which I am due?

  7. The reason we inherit bad stuff from the Americans, is that the GramscoFabiaNazis are trying to corrupt, and thus of course destroy, America, first. The greatest part of their wicked and iniquitous effort, therefore, is being strategically-focussed on undoing America first.

    Hence the visceral hyperhatred of anything that is popularly and culturally American (as is normally-inculcated into new and young British teachers otherwise they cannot graduate) such as nice prepared food that tastes of something like Burgers and Fries, and the best drink in the Universe when you’re really really parched, such as a Pepsi or Coke (it even outdoes a whole Tennent’s or a Special Brew, for you can still stand up afterwards.)

    Therefore, anything bad coming from America, has been put there to infect us by the ObamaNazi’s friends. It’s quite simple really, if only you can see.

  8. They can’t forgive us in the West, for undoing their first really grand experiment to destroy humanity utterly at last, after hundreds of years of trying, which was the Soviet Empire. They know, too, that although Thatcher provded the spirit and will, Reagan deployed the money and the space-weapons, even if they didn’t quite exist: the threat was enough to de-trouser the f*****g leftist bastards.on the Nazi side.

    They won’t and can’t forgive us, and they will never, ever say sorry, and will never, ever give up, until their meme is gone. I rest my case.

    And they have interfered with man-woman-sex so badly, so deeply and so irrevocably, that it is hard actually to see how things can be repaired, ever, between human men and human women, so that (a) there’s no fuss and bother, (if you like her very much and she likes you very much too, then you f*** her, which is very nice and thrilling) and (b) the woman is delighted if the man “releases sperm in her vagina” in under 10 seconds, “‘coz that shows he really really REALLY likes her….really rather a (very big) lot..”….it’s really quite simple. You can’t destroy an idea, even by book-burning, in the age of the internet, which is very sad in this case actually: when we are trying to deal with the bad effects of GramscoFemiNazis, who have muddied the waters evilly.

    Oh,and 100,000 years ago, it would have been an advantage to f*** a female quickly and without fuss. There wold have been predators, lurking, in the forest, like “Giant Short-Arsed-Bears” (don’t meet one any time soon), and Sabre-Tooth-Tigers. They would bite both your bums off and worse, if they caught you f*****g your woman, and “releasing sperm into her vagina” in a too tardy way, like more than a half minute, while your “backs were turned”.

    Never fly straight and level for more than ten seconds…..