Polly addresses the "problem" of people topping up their NHS treatment with their own money and thereby risking being denied any further NHS treatment.
There\’s a glaring hole in her reasoning:
The National Institute for Clinical Excellence (Nice), one of Labour\’s best inventions, scrutinises all available evidence to decide what the NHS should provide once new drugs have EU licences. But Nice has been under siege from the drug companies, claiming their products are turned down because of cost. However, Nice is independent, and not primarily a rationing mechanism: it sanctions any drug with good evidence for effectiveness. It has only refused 5% of drugs – those that offer perhaps a few weeks\’ more painful end of life at huge cost. It makes the same decisions any wise family should make before paying privately, if only they knew the evidence.
Now, perhaps a tad unfashionably, I\’m a supporter of the essential idea of NICE. At root it\’s a form of cost benefit analysis . From taxpayers\’ dosh, we should only provide those drugs and services which are indeed cost effective. This is true whether we\’re talking about cancer drugs and it\’s also true out there in the wider world. We should only invest in, say, train safety up to the point where the costs of doing so are balanced by the benefits done. Similarly with the environment and climate change: we should only pay to mitigate climate change to the extent that such mitigation is cheaper than adaptation.
Cost benefit analysis is good for society, certainly. However, the error comes here:
same decisions any wise family should make
Ah, no. We\’re all well aware that there are things which benefit individuals but which do not benefit the wider society: all too aware. But we also need to understand that there are things which might make sense at a societal level which do not, necessarily, at an individual level.
The cost benefit analysis which society faces over the funding of drugs is rather different from the one an individual does. For society is asking the question "how much of other peoples\’ money should be spent to save or extend this life?" The individual is asking a very different question. "How much of my money should I spend to extend my life?"
The two are entirely different questions. By analogy: we do indeed have a welfare safety net, rightly so. There is an amount which it is righteous that I pay into society that the poor do not starve (leave aside whether it is State driven or charitable here). But the diet that the poor receives from that zakat? A reasonable and nutritious one? Or filet steak and caviar? And would it be immoral that the societal minimum diet guaranteed to all would be less sumptuous than the one that I might purchase for myself out of my own remaining resources?
There are those who would and have argued that yes, such would be immoral. Old JC got nailed to a cross for, amongst other things, suggesting that the correct reaction to a cold beggar was to divide your cloak into two and to bed down with him, asking if you might share his cold.
You might have noticed that we don\’t in fact run society along such lines and that we have in fact rejected this idea that the spending of our collective resources "should" be the same as we spend our private ones.
In other words, Nice is not refusing drugs any doctor should be suggesting it\’s wise for individuals to buy.
The NHS makes the same cost decisions individuals should make,
And there again is the mistake. The cost benefit analysis of how society deploys its limited resources is an entirely different one to that of an individual facing the same situation. And that is the problem with Polly\’s analysis. She\’s insisting that the micro and the macro are the same, when they clearly are not.