Profiting from patients

I don’t often write about the NHS. I don’t ever complain about it: my local GP and hospital are both excellent (and have been, unfortunately, well-used by my family). I figure if they can get it right here, in one of Britain’s poorest boroughs, it can be done anywhere. The NHS surgeon that saved my daughter’s life, in Georgeous‘s constituency next door, is no more salubriously sited.

But the best blog post I’ve read all year has given me a nudge. Specifically, this:

… to voice my entrenched views questioning the morality of making a profit from the provision of healthcare…

I guess this feeling is common. It probably forms the backbone of public opposition to “privatizing” the NHS. But why? Why do so many of us instinctively feel that profiting from healthcare is plain wrong?

We don’t have the same hostility to profiting from chocolate (rots teeth) or brewing (cirrhosis) or skateboard-making (broken wrists). But the people who put the ultimate impact of these right, we expect to work for love. It’s not an argument about funding limits: public healthcare expenditure per capita in France is higher than the UK, within a national insurance system part-provided by private contractors. It’s not, either, about healthcare being “free at the point of delivery” or involving co-payment. Both are compatible with wholly private, wholly public or neither-Arthur-nor-Martha provision.

And the finite-pot argument (that profit subtracts from the total available for patient care) is a fallacy, if multiple providers increase competition and therefore efficiency. When only one airline flew to Paris, nobody could afford to go. Now most of us can. Nobody seriously argues for a National Supermarket Service. And so on. This economic line of reasoning, the finite-pot argument, whether accurate or not, seems too instrumental anyway: the objection appears to be one people just feel.

But yet, in my experience, people working and being treated inside the NHS don’t just feel part of a giant civic institution, as they do in state education. There are no civic side-benefits, not any more. I just wanted the surgeon to make my daughter well. I didn’t care who paid her. The institutions that impacted daily on staff were teams, groups of colleagues, wards, units.

And we don’t just feel that doctors and nurses ought to work for board and lodging and no more. They are quite rightly allowed to make a profit from their labour. Yet companies involved in the business of making people better aren’t?

First published at The Sharpener.