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.