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Health Again

6.04.2005

I have been thinking further on the idea of a mandatory national insurance as a measure which can totally reform our health system, it is a topic I am sure I shall dip in and out of regularly when stuck for other posting fodder. However my point of contention this time is the source of our insurance schemes. I am under the impression that no one is so inclined as to advocate that it it’s the state which provides the policy.
This means that we leave the provision of our national health insurance open and solely available to the private sector. I am always willing to consider these arguments on opening up to the private sector but for the majority of the time I remain unconvinced. This time it am dubious about two major points, though I am sure there may be more later on.
1. I am aware that labour are advocating this policy and have done much of the running in research terms. What I am unsure of is how exactly the policies are laid out. Is the mandatory state policy to be set out by the state as covering a basic minimum of care, then insurers are allowed to compete in terms of premia and included add ons? This system means that roughly 50% on the states scheme would be receiving the bare minimum of cover. Or are we going to lay out a rather more generous scheme which incorporates elements of elective surgery which may become necessary for the likes of the elderly and disabled? For it is precisely these sections of our society that will be most reliant on the state for their insurance. If the state follows the latter plan and introduces such a scheme of mixed cover then it will erode the profitability of the private sector that now only have approx 40% of the population to chase with a reduced set of coverages available to make a profit on. This system will possible discourage a vibrant and diverse insurance sector and may if improperly regulated lead to a cartel of premia guaranteeing a minimum level of profitability at the expense of cost effective health care provision. I support completely the idea of minimum national health which eradicates the divide between private and public but it is this divide that allows the present cost structures to operate.
Will physio be covered under the scheme? Or will it only be offered to those who can afford coverage? I understand that this is nit picking in an under developed policy but I am writing these as they occur to me. In introducing such a far ranging scheme the government ahs the chance to make certain treatments covered as part of some need weighted basis, or it can cut its losses and make services like these available to all. The basic mandatory insurance is a fine idea but we must consider its impact on secondary care and the coverage of those who need it most. Those who can afford insurance should pay, most people would agree with that however those who cant must be looked after. Where will the state draw the line? It is a tough and potentially emotive question. However I think that this also offers an opportunity to give the disabled a much better chance of attainting the care they so badly need and deserve but are starved of. Who gets what and who is in, or out, will pose a major headache to this project. We must look after those who need it most, first.
2. The other thing that concerns me is the degree to which funding will become liquid and dynamic. The likelihood is that because of patient empowerment and choice becoming a major operating principle we are likely to see hospitals abandoned because of bad standards but starved of funds to improve. This is an area of government responsibility and they must be able to sanction state intervention to protect vital health infrastructure form becoming swallowed up by market forces. Of course it cannot subsidise failure but it must have a turn around possibility. We are also likely to see vast sums made by private operators in profit from this system. I believe that all labour standards must be guaranteed from the off to preserve the public provision ethos of our system and to make patients feel like people not euros in a back pocket. I also believe that we must be able to temper the private sectors profitability by ensuring redistribution of excess funding throughout the health service at large. By creaming off the top to finance capital investment in training, university places and hospitals the new initiative can be made to work. We want the private sector behoven to us not vice versa in an area as socially sensitive as health.
Red Rover

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