Good sense again from Jamie Whyte

If they think this is a good method for rationing GP visits, perhaps they will like this idea for rationing food. Nationalise supermarkets, set the price of all food to zero, then eliminate the problem of wasteful overconsumption by educating people that they should take only the food they need rather than what they want.

The proposal is obviously absurd. No such education could possibly have the desired effect; no one could sensibly specify which food is really needed as opposed to merely wanted; and, even if they could, why should people be allowed to eat only what they need? All the same goes for visiting a GP.

Simples stuffs.

Visiting a GP is free. Therefore too many people visit a GP when they don\’t need to.

Charge a fee.

Of course, then we get the howling cries of the NHS is supposed to be free at the point of use. But there are myriad health care systems around the world, ones which work much better than the NHS, which do charge a low user fee.

Do note that this is like a Pigou Tax. The money raised is an irrelevance. It\’s the change in behaviour as a result of the tax which is the important point.

The only reason this eminently sensible proposal will go nowhere is that it is indeed sensible: and we don\’t do sensible where the NHS is concerned.

19 thoughts on “Good sense again from Jamie Whyte”

  1. On the other hand, it’s quite possible that a small fee would simply give the hypochondriacs a perceived license to go whenever they wanted [*]. And we know that a large fee would deter people with low incomes from seeking medical help when genuinely ill. So no, like most economic problems, not simples at all.

    [*] true story: an economist I knew at university was stopped by the police pushing two shopping trolleys of music equipment to a gig (he was also a drummer). He told the police, “they’re my trolleys, I paid my gbp1 for them”. This general attitude, approximately, is why supermarket trolleys in the UK no longer take a deposit.

  2. This would not be a tax. It is a fee. A fee for a service rendered, i.e. a Doctor’s time.

    What we see now is a typical Leftist “we broke it now we want to fix it” mentality, totally in denial about any responsibility for the failures and dysfunction they have caused. No. More control. More State is Always The Answer.

    The idea of Health Savings Accounts are a good thing. Catastrophic cover via insurance and sniffles and snuffles via the savings account or cash.

    Those on welfare could have a modest sum put in the HSA, I suppose, but one wonders at the amount, the split between daily necessities etc. and that you could end up (yet again) with another area of life where those not working are “better off” than the employed poor.

  3. This would not be a tax. It is a fee. A fee for a service rendered, i.e. a Doctor’s time.

    No it isn’t, unless it gets set at a level comparable to private practice (ie about gbp70 for a 10-15 minute consultation).

    If, empirically, this turns out to be a situation where a nominal charge (note to middle-class IT contractors: trivial to an old lady on the state pension, not trivial to you) has the Pigovian impact described in A-level economics, then it’s a good idea. If it has the counterintuitive impact that Levitt found in Haifa, then it isn’t.

    But either way, it has absolutely naff-all to do with the cost of the service rendered. Unless you think a GP consultation should cost GBP70 to everyone, of course…

  4. There is some hope. At the start the NHS provided drugs free. Within a short time the cost became unsustainable, so a prescription charge was introduced. That was under Attlee- and I seem to recall Bevan resigned over it.
    Since HMG is rather stretched at the moment, there must be some hope that sense will prevail.
    Of course not until after the election- they’re all afraid of frightening the voters.
    Somehow this got posted on the wrong thread before- sorry.

  5. The Pedant-General

    I really hate to say it 🙂 but I’m with John B to a certain degree here.

    There are plenty of examples of similar behaviour.
    e.g. nursery is fed up with parents being late to collect children, so decides to charge £10 for each 30mins you’re late to collect.

    Result: massive INCREASE in parents being late.

    Parents moved from moral/altruistic behaviour (I owe it to my child and the staff not to be late) to economic behaviour (£10 for 30 mins is pretty cheap – I’ll buy some of that).

    I suspect that the same is true of GP visits. You would have to see the fee at realistic price in order to engender the correct economic behaviour and I don’t think that that is what we are trying to do: we would simply price little old ladies out of the market whilst not having the correct impact on the hordes of hypochondriac middle class IT contractors.

  6. The other problem is that there’s going to be exemptions – for pregnant women, the elderly, those with chronic illnesses, those on income support (in other words the current exemption from prescription charges) and after all that one wonders what advantage it’ll really give, except for pissing off people who are already pissed off at paying a lot of taxes and not getting enough in return.

  7. My GP used to run a drop-in only service which worked, on balance, really well. Sure, you had to wait for an hour or two to see a doctor but at least you were guaranteed to see a doctor on that day. And because you knew you had to wait around in their surgery for a fair amount of time, this concentrated the mind as to whether you really needed to see them. Then the PCT announced that this was unacceptable and they were forced to introduce an appointment system. Net result: average wait of two weeks to see a GP (and they generally run late so you have to wait anyway), and in my family one A&E admission already and counting because of the inability to get a GP appointment…

    I can only assume that by imposing the cost of time, they were able to manage demand down. Of course, they also didn’t have any DNAs to deal with…

  8. On the other hand, it’s quite possible that a small fee would simply give the hypochondriacs a perceived license to go whenever they wanted [*]. And we know that a large fee would deter people with low incomes from seeking medical help when genuinely ill. So no, like most economic problems, not simples at all.

    Except it works elsewhere. How so?

  9. Visiting a GP is not free, it costs the patient time as well as the doctor. I would confidently predict that people who waste the doctor’s time are all people whose own time has no value, pensioners, welfare claimants or government employees.

    The self-employed can’t afford it and private sector employers will not give endless afternoons off for doctor’s appointments.

    So any charge levied will deter the genuinely sick and probably have no effect at all on people popping in to their doctor’s surgery for a chat and sympathy.

    When I was an IT consultant, I used to see a private GP. It was cheaper than seeing a NHS GP because I didn’t loose half a day’s pay for a 15 minute consult.

  10. “Except it works elsewhere. How so?”

    Well it works in the UK as well. ‘Works’ is a very elastic concept.

  11. Roue Le Jour

    When I was an IT consultant, I used to see a private GP. It was cheaper than seeing a NHS GP because I didn’t loose half a day’s pay for a 15 minute consult.

    Where do you find out about these?

  12. Somewhat missing the point: they should nationalise the supermarkets and make the manufacturers and producers compete on
    fixed RPM prices and no distorting discounts.
    Now,carry on talking among yourselves.

  13. But some of us are already paying a fee to visit our GP, clinic, or hospital.

    About £3.00 for every hour that your car spends in the car park. And on one occasion I was there for nearly ten hours, waiting for my frail elderly relative to be assessed by a doctor, and finally admitted to a ward. Then it was about £6 per day when I was visiting her.

    Having said that, I would probably still pay a fee, to be forfeit if an appointment is missed. But my local NHS would have to get their e-mail act together so we would all be able to confirm our appointments. Right now, they rely on snail mail, and they don’t always put sufficient postage on the mail.

  14. The charge should be the same as a 20 pack of cigs, around about £5 – free for under 18’s and those with a chronic condition. People on benefits are rational, on the whole they value their health more than their addiction, besides most of them I know are hypochondriacs – having to much too much time to worry about their percieved ailments.

  15. And what happens if I make an appointment for 11.00, not to be seen until 11.50? Note, this happened to me on 28th August 2009. Do I get to charge them a fee for not seeing me when they should?

    Ideologically sound, Tim, but one that won’t run in the real world.

  16. “There is a charge to visit GPs in the UK?!!”

    No most GPs are free in the UK (at point of use, blah blah). My point is that “it works”, most people are happy with the GP service.

    As they are in other countries which do levy a tax. But the point is that noting it works in other countries doesn’t mean the criticisms aren’t valid (just as noting it works in the UK doesn’t answer criticisms of the free approach).

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