When I was recently in the UK there was the usual, ubiquitous, ad nauseam, debate about hospital queues. In this particular incarnation it was about people being kept in ambulances for hours outside hospital emergency rooms until there was space to treat them. Some hospitals sensibly stick these patients in corridors so that ambulances can go about their business. But whether people are kept waiting in ambulances or in hospital corridors, the hand wringers will be out and the government, whatever government, will pledge to see that it is all improved. Ten years ago, last year, this year, next year, next decade; it has and will be ever thus.
The reason is clear. When a zero amount is charged for a valuable service demand, almost inevitably, outstrips supply. It’s called economics. You might notice the relative absence of queues at private hospitals. One ‘imaginative’ solution announced by the UK government was to trial the opening up of numbers of GP surgeries at weekends to give people an option to visiting their local hospital emergency departments.
A spokesman for the British Medical Association (BMA) was interviewed by the BBC. He said something like: hold on where are the extra doctors coming from and if a doctor works on Sunday and has Monday off how is that a gain? At this point, the interviewer took the moralising high ground, familiar territory to BBC personnel. Surely, he intimated, you’re not opposed to this life-saving initiative? What could the spokesman say? It was like being asked in Shanghai during the Cultural Revolution whether you supported an initiative of Chairman Mao.
Of course, at this point he had to put away his common sense and express his support for the trial in principle; and we’d just have to see how it worked. He knows how it will work. We all know how it will work. It won’t work. Economics will not be trifled with despite the extreme inconvenience this gives to socialist dreamers who have the utopian objective of providing free medicine to all who need it. Free medicine! Now that’s a concept to appeal to the Greens.
Inevitably then, the Greens are opposed to the proposal, to be considered by Hockey’s and Cormann’s National Commission of Audit, to charge patients a $5 co-payment fee for GP consultations.
Acting Greens leader Richard Di Natale (a medical doctor) was reported as saying that “to balance the books on the back of the health care of ordinary Australians would be a big mistake”. So there we have it. Ordinary Australians should be absolved from paying for their healthcare; presumably leaving only extraordinary Australians to pick up the tab for everyone.
According to Dr Di Natale putting a barrier in front of people to access a doctor is not the way to achieve efficiencies in health care. Apparently we have to reduce health expenditure by treating more people in the community. “We treat people in hospitals, often the worst places for somebody who’s sick who doesn’t need to be there, when we could be treating them in the community…We could be investing in the greater use of antibiotics, for example, in the community; greater supports for people in the community so that they’re not in hospitals being exposed to the risk of infection.”
First, to barriers – we don’t live in nirvana. There are too many people with too many ailments to treat with first quality medical care. There will be barriers; it is simply a case of what kind. We can have queues and dispense rushed medicine for a common derisory fee as of now or we can have a default position where people are charged for their medical care. Most people can afford it with appropriate insurance and with a prioritisation which puts their medical expenditure ahead of any and all spending beyond meeting essential needs. You can’t (or shouldn’t) expect someone else to pay for your visit to a doctor if you are spending money on holidays or on fashionable shoes. Let us get grounded and end this medical merry-go-round.
Second, to treating people in the community – what this means in any practical and feasible sense I have no idea; and I suspect that the Greens have no idea beyond a delusional thought bubble. Maybe they are thinking of the UK trial mentioned above. If so, they need to listen to the representative of the BMA when he is not being badgered by the BBC.
Mind you, I think a $5 co-payment is a waste of time. There will be so many exceptions and exclusions that more bureaucrats will have to be hired to administer it and for what gain exactly? Some years ago I was earning a princely salary; even if, unfortunately, I was short of being a one-percenter. I was on holiday south of Sydney and was jogging in the darkening evening. My foot went into a small indentation in the pavement (I should have sued the council) and I turned my ankle badly.
Though my wife downplayed my discomfort she took me into the local hospital. They treated me for no cost. How in the world was that sensible? I had the means to pay. It was my fault for jogging in the dark and not minding my step; yet someone else paid. Well, perhaps, I paid because I was paying a lot of tax then, but you get my point.
Free treatment is a misnomer. There is no such thing. Someone has to pay for medical care and it is best if a proper and adequate charge is made at the point of service. Economics tells you that this will cut down on unnecessary procedures; and will provide an incentive for the medical professional to provide responsive care. How worried would you be about the state of your pipes if your plumber was paid a scheduled fee of $35 to fix them? Sure doctors have their Hippocratic Oath but they are human and respond to economic signals as do the rest of us.
Finally, and importantly, in a compassionate society; if those who can afford it pay, those who genuinely can’t have a much better chance of getting good and timely medical care. Medical care is not an inalienable right or entitlement. It sits alongside other things that people need and want and which can only be afforded out of earnings. Most people have to, or should, understand that as much as they understand that the cost of food, clothing, shelter, and transport comes out of their earnings. To give an impression that medical care is a free good is equivalent to putting LSD in the water supply. It creates an artificial world; remote from the real world. One fit for delusional addicts, for Greens perhaps but not for normal functioning human beings.
Peter Smith, a frequent Quadrant Online contributor, is the author of Bad Economics