Column

Health without commandments

In celebration of healthmatters’ half-century, Seedhouse Says… presents a commemorative cut-out-and-keep guide to the perpetual battle over the NHS

The five commandments of the private NHS

1. Consumer choice shalt be worshipped above all things;

2. The state shalt not offer hand-outs to citizens under any circumstances whatsoever;

3. Thou shalt covet your neighbour’s health insurance;

4. Thou shalt pay for visiting your GP;

5. Private companies shalt have unrestricted access to all parts of the NHS.

…and their consequences

1. If your neighbour is willing to pay more than you, he will get his operation first;

2. If you want to be a doctor, you must to pay for your education: that includes the training of your teachers, the upkeep of the medical school, the administration of your courses – well, all of it (no freebies, remember?);

2. Prudent patients will take out sufficient insurance to guarantee the health care they anticipate they will need. If they spend too much, the insurance company wins. If they don’t spend enough, see Commandment 1);

4. Your GP will decide whether to see you or not. The GP will charge whatever she or he reckons you’ll pay;

5. Your doctor will favour the products of those companies that most favour him or her.

The five commandments of the socialist NHS

1. Thou shalt maximise health at every opportunity;

2. Verily thou shalt receive (and be grateful for) the Health for All targets delivered unto you from Mount Geneva;

3. Health experts shalt plan everything, for theirs is the wisdom and the right;

4. The health system shalt be wholly funded through compulsory taxation;

5. Thou shalt exercise moderation in all health matters.

…and their consequences

1. Health planners’ interpretations of health will be maximised. Alternative views of health will count for nothing;

2. Do not worry if Health for All targets are not achieved. Hardly anyone will notice. And is there anyone to complain to?;

3. Health problems and solutions will be defined exclusively by health experts (Caution: technical expertise is no guarantee of moral expertise.);

4. Health systems paid for by money coerced from individual citizens will no longer permit private practitioners to profit from them (if you work in both the public and private health systems, recalculate those mortgage repayments and school fees);

5. Health experts will have unquestionable authority to exercise their clinical judgement as gatekeepers of the public system (when you want an operation, stub out, dry out, work out or watch out).

The ideological squabble between the right and the left over the direction the NHS takes goes on forever. But it is a pointless debate. We have heard it all before. Everyone knows that unfettered freedom creates big winners and small losers. Everyone knows that unfettered oligarchy breeds stubborn unaccountability. And everyone knows that social reality hardly ever bends far enough to allow the one-eyed commandments of either wing to have their full logical effect.

So how about concentrating on health instead? If we could agree that creating health means creating autonomy, and that all human beings have equal rights to good health, then we could save our flags for political rallies. Spouting commandments repeatedly is the easiest thing in the world to do, and has little to do with morality.

Our real and historical moral challenge is to see beyond doctrine of whatever kind, even more so beyond our own. If we are to find ways to bring about the greatest autonomy for all, we must see past our prejudices.