Thursday, July 10, 2008

Adam Smith On Publicly Funded Health Treatment

Emmett Tyrrell, Jr, founder and editor in chief of The American Spectator and co-author of Madame Hillary: The Dark Road to the White House writes (10 July): “Health Care From Adam Smith” in (HERE):

I am back from travels in old Europe and have survived in the pink. Readers of this column will recall that during the past three weeks, I have been traveling through France and England. Add Scotland to the pilgrimage. In Edinburgh last weekend, I participated in the unveiling of an Adam Smith statue, prominently placed near the top of the famous city's Royal Mile. Smith now overlooks much of this city, in which he -- along with other members of the Scottish Enlightenment -- thrived. He is referred to often as the founder of economics. He certainly is the first advocate of free markets and one of the most famous. Now a heroic statue of him overlooks one of the great tourist spots in Europe. Thousands of tourists will confront him as they parade up to Edinburgh Castle. While there, I witnessed dozens of individuals having their pictures taken at the great man's feet.”

Raising that statue would have been unthinkable a generation ago. The Edinburgh city council would not have heard of it. Smith and his ideas were supposedly passe. Now, of course, market economics has swept the world. Even old socialists, such as the Chinese and the Indians, believe in markets and allocate their capital and their energies according to the markets' demands. Marx and Engels are has-beens. The only Marx we admire today is Groucho.

I say I survived my travels in the pink because while in France and the U.K., I never had to avail myself to any aspect of their health care systems. Doing so remains perilous. Their systems remain socialist, or -- to use modern American liberals' euphemism -- "single-payer.

I met Emmett Tyrrell during the day’s events – he came up and introduced himself to me – and we exchanged a few words. Clearly, he is an enthusiast for Adam Smith and his ideas.

It’s his last paragraph that slightly bothers me. I live in Scotland and also for parts of the year in France, and I have experiences of both state-run Health Services, though I do not shake with the fears than Emmett Tyrrell reveals in his piece linked to the unveiling of Adam Smith’s statue.

Is it really true that his trip to Europe can be described as a case of his ‘survival’? Is he some kind of ultra-nervous hypochondriac? Was he genuinely at severe risk of ill-health and ill-treatment? Is true that ‘doing so is perilous’?

I would suggest that this kind of alarmism undermines the excellent case for opening up the health care systems of France and the UK to private health competition and service, if only because his attitude is far too shrill and contrary to the experiences of most people who live in both countries. That alone discredits those who purvey such extreme views.

There are many things wrong with the National Health Service in the UK and think tanks like the Adam Smith Institute has done much to highlight them and to propose workable remedies. All of which I support. But persuasion is not helped by extremist comments. In democracies we have to persuade legislators to legislate for change, not berate those hesitant to take the risks of change.

In all parts of the UK, private health care services are available – even in ‘socialist’ minded Scotland with its massive public sector. I have used, recently, the excellent health care services of the UK private insurance firm, BUPA, for a knee operation. I have also used the NHS care service over several years for regular screening in its Edinburgh cancer clinic, and, of course, for regular visits to my local GP doctors.

No pressure, no crisis, no feelings of being in peril and about to be dumped in a large queue. Similarly, in France, I have had two ‘emergency’ procedures (picked up by their famous pompiers from a street and a train, respectively) and treated in their clean hospitals, complete with scans and intensive care services. These experiences were more re-assuring than ‘perilous’.

Emmett Tyrrell had little to worry about if he needed rapid medical assistance.

He might want to reflect on what Adam Smith actually said about health in Wealth Of Nations. In Book V, when discussing the government’s role in Public Works and institutions for facilitating Commerce and on the Expence of the Institutions for the Education of Youth, he added to a discussion of the need for the public funding of part of the costs for educating youth with a ‘little school in every parish’ and for maintaining ‘the martial spirit’ necessary for defence, he added this sentence asserting the need for the ‘most serious attention of government:

in the same manner as it would deserve its most serious attention to prevent a leprosy or any other loathsome and offence disease, though neither mortal nor dangerous, from spreading itself among them, though, perhaps, no other publick good might result from such attention beside the prevention of so great a publick evil’ (WN V.i.f.60: p 788).

There is much to do to reform the state-managed health services in the UK and France, in particular overcoming the prejudice against private care services. It is widely accepted that health care services should be free at the point where people use them, but that in no way should restrict the provision of such services solely to publicly-funded institutions. Private institutions should be permitted to sell their services to the National Health Service, which would schedule individuals to receive such services at their (i.e., the individual’s) convenience, and individuals should be allowed and encouraged to fund their care services through private markets should they desire and be willing to pay for them.

These reforms do not break the provision of care services free to patients at the point of use, nor do they limit the voluntarily consumption of private services for those able and willing to pay. Dual provision would introduce healthy competition and over time raise standards in both private and public sectors.

Adam Smith was always pragmatic and not ideological. It might be better if those who claim they admire him (and his statue) would adopt this stance too.


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