Polly on competition in the NHS

Cancer networks are the template, as they caused survival rates to soar by joint working: one hospital does the best diagnostics, another the best surgery and a third the best chemo and radiology, collaborating not competing.

That is the heart of a market economy. The division and specialisation of labour. And the only way of getting to the collaboration part that we know of is a market.

As for the competition: it\’s the diagnostics departments of hospitals two and three, the surgery departments of one and three and the chemo and radiology departments of one and two which are the competition.

Why do people find this so difficult to understand? This \”collaboration\” that the left are cheering on is a market economy. It\’s the whole damn point of having one.

56 comments on “Polly on competition in the NHS

  1. In a competitive market, providers seek not to help their competitors – in such a market, if I discover a better way to treat cancer, it’s in my interests to keep it secret so that everyone has to come to me. (Or I might be able to use intellectual property laws to make other providers pay me to be allowed to use the improved treatment.)

    In a co-operative market, providers seek to help one another to improve. That’s what the Cancer Networks do.

    Doctors and nurses respond to economic incentives like anyone else, but they are also very willing to act altruistically to help patients. Wholesale introduction of competition for its own sake is therefore unlikely to be optimal for the NHS.

    In this instance, Polly Toynbee is right.

  2. @ PaulB

    If Polly Toynbee is ever right about anything, then I’m a goldfish with a bicycle…

  3. What’s the difference between this “good NHS co-operation” and “evil capitalist outsourcing”?

    Efficient businesses generally concentrate on what they do best, and get other businesses (even potential competitors) to do other bits for them. That division of labour thing.

    But the left’s view of “competition” seems to be “crush your enemies beneath your chariot wheels, take their cattle and women and sow their land with salt”. It says something very worrying about their mentality.

  4. “Doctors and nurses respond to economic incentives like anyone else, but they are also very willing to act altruistically to help patients. ”
    And this is unique to the medical fraternity? Oh & Guardian journalists & socialists, by default, of course.

    “In a competitive market, providers seek not to help their competitors”

    Where ever did you get that idea? Yes the players will keep schtum where they can obtain competitive advantage. But that still leaves extensive areas where cooperation can be more important. And that cooperation doesn’t mean to the detriment of the consumer. It’s in all our interests the consumer benefits.
    You’re looking at it as a zero sum game. It isn’t.

  5. You can get cancer survival rates to soar just by getting earlier diagnosis and making no further change. It is – or can be – a bogus measure of merit. In fact, if your change to diagnosis finds small slow-growing tumours that are not going to kill the patient anyway, earlier diagnosis then becomes even more bogus – but, by God, the survival rate will soar.

  6. It will amusing watching her reaction when this collabaration and specialisation reaches its logical conclusion: mergers of health trusts and the funelling of specific procedures to a single hospital in that enlarged trust. Probably in 6 months or so in the case of London.

  7. & incidentally, all the problems I’ve had with the NHS & most of the ones that hit the news papers – in essence they’re caused by lack of cooperation & indifference.
    How do patients end up lying on trolleys for days in their own piss & shit? Because no-ones passed the paperwork & dozens of altruistic medical staff have repeatedly passed without enquiring why they’re still there. And what happens when there’s an enquiry? It’s all finger pointing. No-one with a mea culpa, very sorry. “It’s all the fault of the system.” But they are the fucking system.

  8. …..In a competitive market, providers seek not to help their competitors ….

    Every big company in the world has scores of partnerships with companies that are at the same time competitors.

    The most successful concentrate on what they do best and buy everything else in.

  9. My friends are mostly social democrats (Yes I know, but what can I do? I move among the relatively well off and mid and high level state employees/politicians).

    They have the warped idea about ‘companies’ put forward by bloke in spain & richard; only interested in rape, death and mayhem generally.

    I was sat round a table (loaded with seafood and rather good cold white wine, they know how to live, but then so do I) last weekend with a bunch of woolly lefties (they would definitely dribble all over the Guardian) coming up with all the data-free prejudices on the crisis, the euro, the solution and me doing my best to shoot the balloons down. Mind you 14 against 1 (the wife keeps quiet at these times) is really hard work. It gets wearing but somebody has to do it.

    I came to the conclusion that they hate ‘business’ without even understanding it. It’s knee-jerk. Our motives are naturally and inevitably evil or at a minimum suspect.

    We open up, turn the handle on the till and then off to the bank to stash the profits (which we won’t have paid tax on) before ripping someone else off. Actually, I usually shoot a couple of workers before lunch too. It does give one an appetite. No effing idea.

    They seem to think that the profit motive is the one and only motive. Tremendously one-dimensional view of what business people do. Helps understand their inability to stop saying good things about Castro.

    Funny thing is that those who have occupied positions of power all end up on boards (for inflated sums) or open consultancies funded by work from public administrations. The parties here also collaborate, not sacking second tier politicos until the gold-plated pension comes round even when their party is out. Scratch backs and all that.

    Oh they also like entrepreneurs until they are successful.

    I can see Polly thinking that rogue docs would be running round competitors’ hospitals giving death injections to patients to ruin their competitors’ figures. Hmm, thinking about it…?

  10. PaulB,

    Doctors and nurses respond to economic incentives like anyone else, but they are also very willing to act altruistically to help patients. Wholesale introduction of competition for its own sake is therefore unlikely to be optimal for the NHS.

    This is the big mistake people make about the public sector – the assumption that workers in it do so out of altruistic interest. Some do, absolutely. There are teachers that work tirelessly for the kids. I’ll give a lot of credit to the Oxford Eye Hospital for being very well run and full of dedicated people.

    But there are definitely a lot of people not doing their job in the public sector and the problem is that failure is frequently not dealt with properly, and that failure costs a lot.

  11. Too many simply do not understand ‘business’. The fact I’m selling items for more than I paid for them, that I’m buying products made in China, that I’m not working for someone else makes me very suspect in the eyes of some people I’ve come across. Even my own bank’s loan staff don’t seem to understand that turnover is not profit.

  12. “But there are definitely a lot of people not doing their job in the public sector and the problem is that failure is frequently not dealt with properly, and that failure costs a lot.”

    There is something which I’ve been dealing with & have mentioned here before. It’s regarding a doctor’s failure to arrange a home visit over a period of 3 months. We have now come to point of a hand written entry on an appointment card, indicating: “called at ,,,,,,,,,,,, no reply”. (The only 4 hour period this would be true in the entire time & conveniently, possible to establish from the patient records.) There is, however, no evidence of an appointment notice. & the surgery has spent over 2 months denying the visit was requested. Their records are either unavailable or ‘confidential’.
    OK, it’s anecdotal & no doubt the lost_nurse from A&E will be along in a minute, blue lights flashing, but I cannot think of a single company I’ve dealt with would try this with a straight face.

  13. @Bilbaoboy: This is why the BBC’s bias matters.

    The bias, in this case, is the refusal to report on the private sector. There is not a single TV show on the BBC which reports or depicts the private sector.

    There are only 2 gameshows, the Apprentice and Dragons’ Den. Both are Marxist pastiches of business (evil men in suits shouting at poor people).

    Compare to the saturation coverage of the public sector (fly on the wall documentaries, fictional drama such as Holby City and police shows).

    Ps: One of my favourite Fry & Laurie sketches is the “Dammit John” series. Stephen Fry said they wrote it because they’d never worked in a business, and it reflected their ideas of what working in an office must be like.

    http://www.youtube.com/watch?v=Y7o8FbGCR9U&feature=player_detailpage#t=5s

  14. OK, so you’re unanimous that there are a lot of lefties who have unrealistic ideas about how business works. I’m not one of them. Banks, about which I know rather a lot, are very happy to trade with one another – that’s co-operation – but if one of them discovers a profitable trading algorithm, it does everything it can to keep it secret – that’s competition. And that sort of competition would be bad for the NHS.

    This is the big mistake people make about the public sector – the assumption that workers in it do so out of altruistic interest.

    I was talking about the medical staff in the NHS, not the public sector in general. As the example you give demonstrates, it is not a mistake to think that altruism is an important factor there.

    There is not a single TV show on the BBC which reports or depicts the private sector.

    I looked at today’s BBC1 listings. In among the tennis, soap operas, and current affairs, there are three programmes which could be categorized in this way. They are Fake Britain, which is about allegedly dishonest dealings in the private sector, and the efforts of the public sector to stop them, New Tricks, which is about an entirely fictional corner of the public sector, and White Van Man which is set firmly in the private sector. It would seem that your claim is based on prejudice not fact.

  15. PaulB,

    I was talking about the medical staff in the NHS, not the public sector in general. As the example you give demonstrates, it is not a mistake to think that altruism is an important factor there.

    I gave one example of one service that’s well run. Now, I do think that teaching and medicine do, in general, bring out more of someone than being a quality co-ordinator. And while I’ve met a few clinical staff that I considered to be not very good, my bigger problems with the NHS is the management (including the politicians).

  16. “They are Fake Britain, which is about allegedly dishonest dealings in the private sector, and the efforts of the public sector to stop them, New Tricks, which is about an entirely fictional corner of the public sector, and White Van Man which is set firmly in the private sector. ”
    Can’t say I’ve seen any of them, but from the titles & your descriptions, your point is?

    (Isn’t “White Van Man” © Yasmin Alibhai-Brown? Does she know?)

  17. My point is that Charles’ claim that “There is not a single TV show on the BBC which reports or depicts the private sector” is provably false by reference to today’s listings.

    According to wikipedia, the phrase “White Van Man” was first used in the press by Jonathan Leake.

  18. So what you’ve given us is:
    1 A show “about allegedly dishonest dealings in the private sector, and the efforts of the public sector to stop them,”
    2 A drama series about the Met Police.
    3 A comedy depicting “Darren displays little enthusiasm or interest in working whilst Ollie is desperate to make his father proud whilst failing to bring in enough money. “(Wiki)

    And this is supposed to reflect the deep interest of the BBC in the world of business?
    And your point was, again?

  19. No it doesn’t reflect deep interest in the world of business, any more than Casualty reflects deep interest in the NHS.

    My point, again, for the third time, is that the claim I’ve twice quoted is untrue. Can you not read?

  20. Read very well thanks. Through the tears of laughter.
    Are we including alleged crooks amongst the private sector now? In which case I suppose we could always pop Today In Parliament in for good measure. “White Van Man”? “Open All Hours” as a faithful depiction of small retailers?

  21. Good grief! Shows how out of touch I am! Holby City & Casualty! Is the BBC a department of the NHS now or the other way round? And a Holby Blue spinoff? Nothing like a bit of public sector navel gazing. Have they done a series set in a council Health & Safety Dept yet?

  22. along in a minute, blue lights flashing

    Only to say that TW’s definition of the “market” seems to be a very movable feast. These three theoretical hospitals competing in cancer services – each dazzling in 1 out of 3 major specialties – are they all within the same area, or what? What a convenient configuration…

    We send serious neuro stuff (including, but not limited to, operable head injuries) to our neighbours (another major city hospital, but in a different Trust), because that is what they specialise in. In other words: we don’t have that capacity, but we know somebody who does – and we co-operate with ’em. Ditto: certain kinds of surgery. But we are not in specific competition with them, as such.

    Again, if this kind of thing is a market economy, how would Tim characterise existing working relationships between specialties? If somebody from the Cardiac wing (i.e. Medicine) comes over to give an opinion on an elderly patient with a fractured hip (Surgery) and AF (for which read: potentially tricky heart), is this the market in action? And if (as is likely) we have hived off all profitable procedures to Cut N’ Shut Inc, thus leaving us with reduced theatre capacity and surgical cover to manage said elderly patient, is this “collaboration”? Words having, y’know, specific meanings & all that.

    Other than that, I’m not getting involved – except to say that if TV shows were hospitals, I’d be choosing C4’s 24 Hours in A&E over Holby. Better acting, for starters.

  23. Paul B. 10:54 AM

    Your point illustrates what I believe is an incorrect assumption as to who a healthcare system operates on behalf of. It’s only purpose is to make people better. It is not provide employment. It is hard to see in the example you provide how the patient loses out.

    In a competitive market, if company A creates a better way to treat cancer; a way that is demonstrably better than the NHS treatment of cancer, why should the health care system pay (or even allow) companies B, C, D et al to continue providing paid for treatment? How is this competition evil?

    If company A can provide the treatment at a reasonable cost then there is nothing more to be spoken of. The other companies are simply diverting resources, or worse, doing damage.

    If company A’s treatment puts fifty thousand cancer specialists out of work that is a GOOD thing. Those fifty thousand people can now do something else that will benefit themselves or society. The Universe doesn’t care if your skillset is no longer needed. Where are the tears for Linotype operators, Beaver trappers or stone-nappers?

    The Guardian’s view of the world is that being a teacher, nurse, doctor, social worker is inherently a good thing. It forgets that these occupations are simply providing a service. If the service is no longer needed because someone invents a better way of educating, healing or eliminating social deprivation, then those occupations simply become parasites.

  24. Be inclined to agree with the lost_nurse here. What Tim’s describing isn’t really a market. If it was the private sector, it’d be 3 companies conspiring to carve out 3 nice little monopolies for themselves. Which hospital does which speciality isn’t the result of choice amongst receiving the service. You don’t even really know which is best at which. Whatever information is available is filtered through the suppliers themselves.
    But where lost_nurse gets it wrong is the presumption there’s a shortage of resources. Of course you can’t have a proper market operating if resources are constrained. However markets produce limitless resources. That’s the principle behind any market, isn’t it? If there’s a demand then someone will seek to satisfy it. There’s no reason why you can’t have the Cut’nShut as well as the careful care for the elderly. They’re not the same thing in the same way that a Fiat Punto isn’t the same thing as a Range Rover, although they’re both cars. If it costs more to look after the elderly than the Cut’nShut why try & lose the cost in the paperwork? Be honest about it. There is a need for expensive intensive treatment. It costs this amount. In the end, you are doing the same amount of medicine. There’s no intrinsic reason why knowing what it costs through a price system should make it more expensive. We hope less.

  25. Stuck-Record: I entirely agree that the purpose of the health service is to improve people’s health: when did I say anything else?

    However, your comment illustrates a common blind spot of the right: you’re unable to grasp the point that sharing information is good, and restricting access to or use of “intellectual property” is damaging. In some circumstances, the damage caused by the restriction may be justified by the incentive to innovation, but that should not be allowed to obscure the fact that the restriction in itself makes us poorer.

    In the Cancer Network as it now is, hospital A would demonstrate its techniques to hospitals B, C, and D, and the best treatment would be available everywhere. In the competitive world you would like to see, company A would keep its knowledge to itself, even if that meant that some patients would get inferior treatment.

    bloke in spain: You seem to be watching the television through one teary eye. Never having seen the programme I am happy to accept your contention that White Van Man is not an accurate portrayal of a small business in operation. But I have seen Casualty, and I’m gobsmacked that you imagine that it bears some resemblance to the NHS.

  26. Guys, the programmes on television are entertainment. They may give you a small view of certain things, but nothing like reality. Even documentries will push a particular idea, point out a particular scandal, a particular entertaining point. Not the boring bits, the hard work necessary to get to a particular point, the problems.
    The NHS buys in particular services already. You don’t come across many NHS run pharmacutical companies, NHS run equipment suppliers, even NHS hospices. Our local NHS trust I know has paid for outside services such as hospice, detox, GP services etc.

  27. PaulB – re Casualty and White Van Man

    One is a drama that generally portrays its characters in a good(ish) light. The other is a caricature doing the opposite. I’m assuming that you can distinguish which is which.

  28. Going from diagnostic to surgery to chemo etc sounds dandy.
    But suppose the diseases fluctuates or goes backwards or the customer breaks a leg.
    Will it all still be smooth sailing.
    And will you be a number or a person during it.

  29. Charles ventured a digression alleging BBC bias, and I demonstrated that he was trivially mistaken by referring to the facts (I realise that many righties prefer to refer to their own prejudices). Since then, nearly half the comments, excluding my own, have sought to lecture me on the wholly irrelevant question of the deficiencies of the programme I cited. Guys, I’m never going to watch the thing, I don’t care if it’s any good, and if you manage to read what Charles wrote and I disagreed with you’ll see that the degree of realism of the programme makes no difference to the point.

    Could it be that you’re pursuing the digression because of the cognitive dissonance of finding that Toynbee has got a point on the competition issue?

  30. Paul B

    I agree that sharing information is good. However I’m afraid your distaste for intellectual property is typical. It goes hand in hand with a distaste for private property, and is one of the most destructive aspects of leftist thought. I know you don’t see it but it is the very bar to innovation that almost always destroys societies built on socialism. It almost inevitably lead to developmental stagnation, apathy and, inevitably, state coercion.

    However, there is a problem with the example you quote.
    “In the Cancer Network as it now is, hospital A would demonstrate its techniques to hospitals B, C, and D, and the best treatment would be available everywhere. “

    You fail to see that, in the example I provided (of companies), the best treatment IS available everywhere. It is provided by company A to everyone. The matter of who the provider is becomes irrelevant. As long, as I said earlier, the price is acceptable and the govt pay.

    If company A exploit this monopoly unfairly then government regulation can intervene. This is the very point of government: to create a ‘fair’ or level playing field. Providing that company A treats everybody at a reasonable price everybody gets treated. The patient benefits. The fact that they are making money is irrelevant.

    If company B (who are now pushed out of the field by having an inferior product) create a treatment which is demonstrably better than company A’s, then company A becomes worthless. Their monopoly is broken. And they go the way of Linotype setters and Beaver hunters.

    This is how we get progress. It’s why we have iPhones instead of Minitel.

    However, if the government, by force, takes the treatment away from company A and gives it to everybody else, they have now created a state administered monopoly.

    This monopoly cannot be broken. Except by the will of unelected quango. The other way people vote with their feet based on clinical success.

    In the state-owned scenario Company B now have no incentive to create a better treatment as they are making money from Treatment A Licence (which was handed to them by the Govt). And even if they did they are now up against a state medical monopoly. Imagine the headlines in the Guardian: ‘Company B lobby government to close down cancer treatment program. Fifty thousand jobs to go’.

    This, unfortunately is where we are now.

  31. Can’t see Charles’ “digression” wasn’t relevant or even particularly a digression. La Toynbee’s a pundit not a politician. That her position on competition is supported by a large & influential portion of the media by painting the existing NHS in generally glowing terms is extremely relevant. As is the contention the same media paints a very different picture of the private sector. It was just ironic that the shows you mentioned illustrated the point so well.
    There’s two levels to this discussion. One is whether competition in the NHS would improve it. But you can’t get competition if you can’t get the opportunity to discuss it. And the opposition have a neat way of shutting down the debate by trying to make the status quo sacrosanct. And largely succeeding.

  32. Stuck-Record: you seem to have lost track, we’re talking about hospitals not companies. We want hospitals to co-operate to provide the best possible health care.

  33. PT touts the benefits of co-operation but, as with most on the left, refuses to see the outcome. As she rightly points out, each hospital has a ‘Best’ area, and by using all three in sequence the customer gets the ‘Best’ outcome. What she won’t countenance is the closure of the ‘Not Best’ departments, this results in only the few who wriggle through the ‘Best’ path get the Best treatment. Those who fail to wriggle correctly get the ‘Not Best’ treatment. The answer? close the second Bests, boost the Bests to handle all the trade. They will become inter-dependant as each needs the other. But, as the Biggest and Best, they will be able to help a wider area and enable a wider area to close its Second Best departments.
    And your problem with ending up with a non-competitive central Cancer unit turning out the Best outcomes in all events is…?
    As is plain to see, it only works for one discipline, hence we end up with a mish-mash, post code health system where every one sighs that, ‘Things ought to be better, but we don’t have the money to pay ourselves what we think we’re worth.’

  34. “we’re talking about hospitals not companies.”
    Now you’ve lost me altogether. Hospitals are by definition a company. People coming together in a joint endeavour to produce a good or service. At the moment it’s a large, badly managed monopoly set up in such away that it’s hard to discern how each division of the company is performing. All that’s being proposed is it more resembles the rather successful model that works outside. That each speciality is it’s own entity. What’s the big problem with competition? Where’s the competition? Companies that make screws aren’t in competition with companies that make washers. Their complimentary. But we are interested who makes the best screws so that we can use them with the best washers.

  35. In the state-owned scenario Company B now have no incentive to create a better treatment

    Company B is actually Hospital B. And Hospital B is staffed by doctors who want to help sick people. Not because it will make them rich, partly because it earns them the esteem of their peers and the gratitude of their patients, and largely because helping the sick makes them feel good about themselves.

    Not all incentives are economic. We should organize the health service on the basis that its medical staff are living, breathing doctors and nurses, not desiccated libertarians.

  36. How are libertarians dessicated?

    Given the recent strike by doctors, it seems a bit rich to be claiming that doctors are any less likely to be driven by money than non-doctors.

  37. ChrisM: I find that the best way is to trim off the fat, cut them into strips, salt liberally, and put them in the oven for a few hours at about 70C.

  38. Given initially you were using the adjective, not the verb, my question relates to the adjective, not the verb.

  39. I can’t honestly think of any doctors or nurses who would do the job without pay. Many are well paid – and do a lot for that pay. There can be people who are dedicated to helping others in most professions and jobs. NHS staff do not have a monopoly on that. I suspect the idea of going into the medical profession as a calling is decades in the past – seems to be more common that there is a job paying good money in this field, you need this qualification to get that job, therefore get that qualification and apply for the job.

  40. Paul B

    Your statement about not all incentives being economic actually applies to many of us in the private sector as well (I’m sure you may not believe that)

  41. Well, the contention medical personnel aren’t motivated by money doesn’t really survive walking into a hospital, does it? It wouldn’t be largely staffed by people from the developing world, would it? Or did they travel half way round the world, driven by a philanthropic desire to minister to sick Brits?

  42. bloke in spain: whose contention is that?

    Emil: it was a general statement. What does it mean that be sure that something may not to true?

    Stuck-Record: since you mention iPhones: do you think the patent trolling that now pervades the industry is in the best interests of consumers?

    ChrisM: so you believe that if A is less motivated by money by B, there can be no unilateral reduction in compensation which will provoke A into going on strike. Curious.

  43. No PaulB, I don’t believe that A is less motivated by money than B. I believe that A, B and C are equally motivated by money.

  44. “And Hospital B is staffed by doctors who want to help sick people. Not because it will make them rich, partly because it earns them the esteem of their peers and the gratitude of their patients, and largely because helping the sick makes them feel good about themselves.”
    PaulB
    “bloke in spain: whose contention is that?”

    Er, your’s Paul.

  45. PaulB
    “whose contention is that?”

    Yours.“Hospital B is staffed by doctors who want to help sick people. Not because it will make them rich, partly because it earns them the esteem of their peers and the gratitude of their patients, and largely because helping the sick makes them feel good about themselves.”

    So doctors and nurses will work for free? For the love of it? They’ll be excited to hear that. Which is why their unions are always so happy if govt threatens to cut their pay.

    Re company v Hospital.
    You’ve lost me. Really. Shall we agree call them organisations instead then? Successful hospitals around the world are businesses. Good practice should drive out bad. This can happen in a market, patient-centric, model. I explained why (above) it cannot in a state-controlled one. States are bureaucratically opposed to any change that weakens the power of the status quo.

    Re iPhone/patent trolling. This is a bad thing BECAUSE it stifles free markets. I’m glad you think stifling free trade is a bad thing. It is also a bad thing when govts like the EU stick their fingers into tech areas. Lawyers are generally evil whether they work for corporations, NGO’s, the EPA (CO2 bill lunacy), or Govts.

  46. Paul B,

    No it wasn’t a general statement. It was a statement in which you quite explicitly (in post #15) made very clear that this applies more to medical staff than to others…

  47. Doctors and nurses in the NHS want to be paid for their labour, they want to be treated fairly, and they prefer more money to less. But for the most part they do not need financial incentives to do their best to help the sick.

    I apologize for not making this clearer: I fell into the error of supposing that this meaning would be obvious, even to libertarians.

  48. “But for the most part they do not need financial incentives to do their best to help the sick.”
    The NHS gets a high proportion of its staff from less developed countries. This is an acknowledged problem. They are needed in their own countries. It’s not, they come here for training. They come here qualified. In the absence of responding to financial inducement, how would you account for this. British cooking?

  49. Regrettable this thread has now dropped of the bottom but one closing comment.
    Perhaps Paul would get a better response to his argument if it wasn’t for some of the contributors here living in places where the system he’s telling us won’t work, is the one they find works quite well thanks. Better than the NHS, in truth.

  50. Thanks, that would have been a good starting point for an intelligent discussion. I loath and despise arguments of the form “competition produces better paper clips so we should privatize the NHS”. But I welcome evidence of how various setups actually work. Perhaps on another thread…

  51. PaulB, I don’t think the argument is of the form “competition produces better paper clips so we should privatize the NHS”.

    The argument is competition – not privatisation- in general produces better outcomes so the default position should be that there should be competition, unless there is some compelling evidence that in a given situation it would not produce a better outcome.

  52. (And I loath and despise arguments of the form “state enterprises don’t make profits therefore state employees are selfless altruists who do what they do out of love for their fellow citizens” 😉 )

  53. “The argument is competition – not privatisation – in general produces better outcomes so the default position should be that there should be competition”

    And it’s a very poor argument if the generalization is taken from particular cases quite unlike healthcare.

    “state enterprises don’t make profits therefore state employees are selfless altruists who do what they do out of love for their fellow citizens”

    That would indeed be an absurd view. Arguments about what motivates people should be based on empirical observation, not dogma of either the left or the right.

    In matters of how best to run things I’m a pragmatist. I got involved in this discussion in defence of Toynbee’s pragmatical argument that we shouldn’t break something that works in pursuit of competitive dogma. And the arguments against me have been almost entirely dogmatic. Which is why I welcomed bloke_in_spain’s reference to his evaluation of how healthcare systems actually work in practice.

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