European commentators on US healthcare are often misguided in their description of the American system as a ‘free market’ model – when that system involves significant levels of government regulation and funding. Equally, American commentators are often misguided in their accounts of ‘socialist’ healthcare in Europe. Europe contains a diversity of healthcare systems. Some, such as Switzerland are based predominantly on private insurance while others such as Germany and France combine elements of public and private funding and supply. The one European healthcare system that might genuinely be described as socialist is that of the United Kingdom. In the UK system of compulsory ‘free’ health provision, competition and the price system have been almost entirely eliminated from the patient-provider relationship, and even co-payment schemes which allow citizens to ‘top-up’ public funding with their own savings of the sort that are widespread in continental Europe, are prohibited.
Both European and American citizens have got much to fear from any move away from their current ‘mixed’ systems to anything approaching the UK model. The following extract comes from a report by an independent ombudsman charged with examining the quality of care for the elderly under the UK’s ‘National Health Service’. Having catalogued an appalling number of cases where patients were regularly starved of food and pain-killers, she concludes in the following vein:
“The findings of my investigations reveal an attitude- both personal and institutional-which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.
The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.”
This parlous state of affairs, it should be noted, follows a ten year period which has seen real expenditure on health care in the UK more than double. Where, one might ask, will Michael Moore choose to spend his retirement?
PILEUS 
I’ve long held the view that, where the state arrogates to itself the role of (virtual) monopoly provider, and then protects that status by legislative barriers to entry and restriction on competition, then producer capture is the inevitable result, to the gross detriment of the consumers.
This seems to be the case irrespective of sphere, ie seems to apply just as equally to education provision as to healthcare provision.
Often thought that an interesting field for research would be (1) the differing degree of producer capture according to industry (where is it greater – education or healthcare?), and (2) length of time needed to achieve producer capture related to industry and extent of state’s monopoly position.
One for the retirement PPE, perhaps.
PS. MP – thoroughly enjoying working through “Robust Political Economy”
Thanks Michael – not sure how to operationalise your research proposal, but it sounds like a good idea. Glad you are enjoying the book. MP.
Of course, there are lots of horror stories about the care of the elderly under the US system, so I’m not sure what you’re proving here.
Bill, the reason I drew attention to this was because it is not simply the usual anecdote about horror stories that we hear about virtually all health care systems – rather it is based on a systematic report on elderly provision by an independent ombudsman, ie. not the usual ‘right wing suspects’. It achieved some media coverage in the UK, but then disappeared without trace. This is conjecture on my part, but I think this reflects the fact that after 60 years of state monopoly provision people in the UK simply can’t conceive of another way of providing health care and they just accept such outcomes as inevitable. I can’t ‘prove it’ but I think reaction to these kind of findings in the US and in continental Europe would not have been so accepting. The report also gives the lie to the claim of many in the UK and of Michael Moore types more generally that people who work for the NHS are selfless ‘public servants’ who always sacrifice their own interests to those of whom they ‘care’ for. Mark
I’m not sure who claims that people who work for the NHS are always selfless saints–bitching about the NHS is practically a national sport in the UK, and although I saw sicko I remember Moore praising the system, not the character of the people running it. Few serious liberal health reformers in the US put forth the NHS as a model–what’s usually viewed as the gold standard is the French system.
Bill, I disagree about public attitudes to the NHS – people do bitch about the service, but usually on the grounds of ‘under-funding’ and ‘too much management’ – not with respect to the attitudes of nurses and other staff. The point of my post was to attack the UK system with respect to ‘mixed’ systems such as the US and many European systems. It is, of course, another matter in terms of what criteria we might use to choose between these mixed systems – US versus France etc. That is something I might comment on in a future post. Best wishes. Mark