MINISTER, MINISTER, back to the wall, which is the fairest health system of all?
Last Wednesday Patricia Hewitt told the Royal College of Nursing that it is Britain’s NHS. And when she described it as the “fairest” she did not mean prettiest. Among health systems in the West, the NHS is more ugly sister than sleeping beauty. She meant fair as in just. Foreigners may enjoy higher standards of healthcare — better, faster and now often cheaper — but we should not envy them. They partake of injustice.
What makes the NHS so fair? You already know the official answer. The NHS is fair because it conforms to the Marxist principle: from each according to his ability, to each according to his need. NHS services are free, and funded from general taxation.
Of course, this is precisely what makes the NHS such a shambles. Fixing consumer prices to zero inevitably results in waste, state rationing and low-quality services. Patricia Hewitt, David Cameron and all the other politicians who favour the current system know this. That is why they never suggest extending it to food, electricity, cars or anything else.
They are generally happy to see efficient, “user pays” injustice prevail. But not in healthcare and education. Here the demands of justice are absolute.
I doubt they are. But that is irrelevant, because Marx and Hewitt are wrong about justice. Privatising healthcare and education would improve not only efficiency but also justice. For, as Aristotle said, justice requires that we treat equals equally and unequals unequally. And equal treatment requires that users pay.
Compare my sister’s household and mine. We keep the house warmer and take longer showers. The situation would be quite unequal, except for one fact. My electricity bill is bigger than my sister’s. Or consider my brother-in-law’s Mercedes. It is a much better car than mine. I might complain of unequal treatment, but for the difference in the prices we paid.
As with electricity and cars, so with healthcare and education. Jack smokes, drinks and overeats. Jill does not. Jack’s behaviour means he consumes more healthcare than Jill.
It would be unfair if healthcare cost Jack and Jill the same. Yet this injustice is precisely what the NHS guarantees. With privatisation justice would prevail; Jack would be charged higher health insurance premiums than Jill.
Or consider a town with two secondary schools: Snodbury High and Snodbury College. One is sure to be at least slightly better than the other (Snodbury High, let’s say). Under the state system this creates injustice. All pupils pay the same, yet those at Snodbury College receive an inferior education.
How can this injustice be remedied? Not by the Labour and Tory policy of increasing choice within tax-funded public services. While schools remain free, all Snodburians will choose the superior Snodbury High, and half are guaranteed to be disappointed.
Ruth Kelly recognises the problem. On the Today programme last year she admitted that “we will have real choice only when the school down the road is as good as the school two miles away”. But how does she propose to make all schools equally good? No amount of new Labour micromanagement will achieve it.
If these schools were privatised, however, the inequality would be eliminated almost overnight. Demand for places at Snodbury High would bid up its fees, while the lack of interest in Snodbury College would force it to offer a discount. This process would continue until the price difference between the schools was equal to the value parents placed on Snodbury High’s superiority. Parents who make the average trade-off between price and quality would no longer prefer one school to the other.
Of course, few parents will be exactly average in this respect. And that is what makes having a choice between priced schools worthwhile. Those who are willing to spend more than average on education will prefer Snodbury High; the rest will prefer Snodbury College. A good expensive school versus a bad cheap school: that is a real choice. A good free school versus a bad free school: that is not.
Some car lovers with modest incomes own Mercedes. And some poor, education-loving Snodburians would pay Snodbury High’s higher fees. But, in general, it would be the children of wealthy Snodburians who attend this school. This is the outcome of privatisation that most offends the left-wing sense of justice. No one should suffer an educational disadvantage on account of their wealth.
This is an absurd principle and an absurd objection to privatisation. Under the current system the wealthy can send their children to private schools, hire tutors and pay inflated house prices in the zones of good state schools. Short of totalitarianism, it is impossible to remove the educational and healthcare advantages enjoyed by the wealthy.
Nor would removing them be fair. If Jack had more money than Jill but could not buy superior goods and services — be they food, cars or healthcare — then Jack’s extra money would be worthless. Removing the advantages of wealth simply removes the wealth. Which is fair only if the wealth is ill-gotten. But why should we assume it is? Do our leaders subscribe to that Marxist idea too?
No one should be denied decent healthcare and education. That is a reasonable principle. And it favours privatisation, which would soon improve the healthcare and education received by the poor. Ford and Asda, as much as Mercedes and Harrods, are creatures of the private sector. Soviet-era Ladas and illiterate school leavers are creatures of the system favoured by Hewitt and company.
It is scandalous that we should still suffer Marxism in any part of our economy. Inanities about fairness cannot excuse it.
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