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The Lib Dems' Health spokesperson took a lot of space and words in the Western Mail on Monday to fulminate against the policy of Free Prescriptions, but she actually said very little. (The Tories' Assembly leader was making similar noises just a week or so ago as well.) Specifically, she once again totally failed to explain why Lib Dems and Tories believe prescriptions should be singled out for charging, whilst other aspects of the Health Service remain free.
Their main lines of argument seem to be:
• We should not have to refuse some treatments on cost grounds when there are other people who could pay for their prescriptions and don't;
• Providing free prescriptions diverts funds from other areas of the health service;
• People don't appreciate something (such as prescriptions) which they get for free.
But suppose we substitute 'appointments with the doctor', or 'minor surgery', or 'hospital accommodation' for prescriptions in those three points? The statements all remain just as 'true'. There is no particular rationale for picking on prescriptions other than the fact that people have been accustomed to paying for them; but the fact that something has been so for a period of years is never in itself an adequate justification for it to continue.
I suspect that the Tories and Lib Dems actually believe that a wide range of health services should be means-tested; with those who can afford to pay being charged for the services they receive. Prescriptions is just the tip of the iceberg for them. Just think of all the money that that would free up for other parts of the health service (or would it just go on tax cuts, I wonder?).
Actually, I welcome the way in which the Tories and Lib Dems won't let go on this one, because it helps to draw a clear distinction between those of us who believe in a free health service, and those who have simply never understood the underlying principle of 'free health care for all'.
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5 comments:
A good argument. I have one further point to make in support.
It is my understanding (albeit gleaned from a nameless WAG official) that if prescription charges from the chronically ill - however defined - were abolished the cost of administering charges for the remainder of patients would exceed the revenue.
And since abolishing prescription charges for the chronically ill is Lib Dem policy (and indeed was supported by the Assembly) they have effectively made the charging regime non-viable.
In other words, Lib Dems should support the abolition of all prescription charges.
I actually think we should consider charging a nominal fee to visit the GP. It would create a culture of self-discipline among patients and also strengthen the patient's hand. At the moment many GPs give the impression of seeing patients as fodder, barely giving them 10 minutes. Psychologically, a patient would feel entitled to a better service and the GP would feel more obliged to give a better service if there was an over the counter fee involved, something like £2 a visit.
Plaid don't seem credible in saying that the NHS should be free for ever when we have a massively aging population, or rather, population on pensions, and a population which is more informed and expect more.
I think Plaid (and Welsh Labour) are playing class jingoism and making short term points but in the end will bankrupt the system ... and people won't pay more taxes to fund the NHS.
What's the incentive to keep yourself fit and healthy when you pay the same taxes as someone who doesn't and get less back for your taxes?
Anon 1,
It always struck me as inevitable that there is a point where the number of paid-for prescriptions becomes so low that the cost of collecting charges outweighs the income received, but I wasn't sure where that point would be. Thanks for the answer to that question.
Anon 2,
"I actually think we should consider charging a nominal fee to visit the GP"
I'm not at all surprised that you think that. I think it sort of supports my point - i.e. that thee is no obvious logical distinction between prescriptions and a range of other aspects of health care. For those who support prescription charges to also support charging for other aspects is an entirely consistent position to adopt. I just disagree with it.
"... and people won't pay more taxes to fund the NHS"
A sweeping statement, which can neither be proved or disproved. But isn't the point of politics that parties offer different options and the people choose through the ballot box? At its simplest, the support at the last Assembly elections for parties which included free prescriptions as part of their package greatly outweighed the support for those parties which did not. It's complicated by the fact that, under the Assembly's present powers, the election was only on the spending, not the tax-raising proposals of the parties, so I won't attempt to argue that it disproves your point. But it does give an indication of the sort of priorities which people in Wales have, surely?
"What's the incentive to keep yourself fit and healthy when you pay the same taxes as someone who doesn't and get less back for your taxes?"
Are you really suggesting that people will deliberately become unfit and unhealthy in order to get their fair share out of the NHS? Or that healthy people should pay less for the NHS than unhealthy ones? The whole point of any sort of 'insurance' system (and that's ultimately what the NHS is) is that it's there 'in case', not that you should always aim to get back what you put in.
"... [on taxes] A sweeping statement, which can neither be proved or disproved."
Erm, no John. One reason New Labour won three elections was because they promised to keep Tory tax plans. Not one party advocating to raise taxes has won a general election in 30 years (if not more). So, the theory is proven positive.
I'm a Plaid person, but don't believe voters who tell pollsters that they'd vote for a party which raised taxes. Plaid would see a fall in its vote if it went into an election promising to raise taxes and were in a position to implement that promise. Do you seriously think you'd win Carmarthen West on a ticket of raising taxes. In the end people will think' 'I'd prefere my possible £30 a year to park my car in a hospital, or have a perscription once in a while' than pay 1.5% p.a. more taxes. I've sat in community council meetings where Plaid councillors voted against raising £3 a more a month on the council tax because they were afraid of losing their seats and being seen to be wasteful with money.
The more 'free-bees' Plaid gives off the less money to real treatments ... or new railway lines or Welsh language daily papers.
" ....The whole point of any sort of 'insurance' system (and that's ultimately what the NHS is) is that it's there 'in case', not that you should always aim to get back what you put in."
Yes, but if you join any other insurance system, lets say car insurance there are differences. You're obliged to use some common sense or self-control. If you drive too fast, drink drive, crash, drive a dangerous car or are a young male, then your insurance will be more. If you don't use common sense or self-discipline then you'll:
a) pay a higher contribution to your insurance or
b) could lose your insurance (and so, maybe job altogether) for negligence.
If you don't use any common sense or self-discipline in respect to the NHS health insurance as you advocate John, then there is no comeback. In fact you and Plaid Cymru members will campaign and make heroic speaches about your right to be totally negligent and not have to pay anything for it.
"... Are you really suggesting that people will deliberately become unfit and unhealthy in order to get their fair share out of the NHS?"
Well, lets put it this way. What do you think all the self-inflicted injuries and health issues from accidents induced by stupidly over drinking, obeseity, or smoking are. What's the insentive not to do these things. The fact is, money speaks louder than words. We're now using our cars more carefully because the price of petrol has increased, nothing to do with concern about the environment. Likewise, maybe we'd take more care of our bodies if there was a small charge for services we use.
I'd much prefere to pay my parking fee or for a 'free' percription and see the money the NHS saves from that go towards a proper treatment from eye surgery to cancer which what an 'insurance' plan should finance and support.
The depressing thing is, I know in 10 years time when Plaid are in power and the cold light of day hits them in the face; they'll say that people will have to pay for some NHS services. Why not be honest now, stop treating the NHS as an icon and treat it just as a service. There's a definitive pot of money, freebees means less money for other (more pressing) treatments.
PS
I enjoy the blog by the way.
Anon,
Actually, I don't think that I said that I was in favour of raising taxes. I was supporting the Assembly Government's position on free prescriptions - a move which has been accomplished without tax rises and within the Assembly's overall budget. However, since I also advocate independence for Wales, it is entirely valid to raise the broader question of how services should and would be paid for.
When any proper government (i.e. one with responsibility for both spending and tax-raising) decides to spend more money on A, it has a choice. It can do one of three things – cut spending elsewhere, raise taxes, or borrow. In practice, all governments do a combination of all three. Wales would be no different.
I just wanted to set that as the context for my responses on your specific points, because I don't accept that anything that I said in the post or in the comments necessarily implies that I'm suggesting increases in tax at this point. But taking the more general point, if we believed that a tax rise was necessary in order to fund our spending programme, then I think we should be prepared to say so, openly and honestly. And if that were the case, then we would have to deal with the political implications, and I'm happy to respond on that basis.
"Not one party advocating to raise taxes has won a general election in 30 years (if not more). So, the theory is proven positive."
But on many occasions, a party which promised additional spending has gone on to win an election, and has then raised taxes to pay for their programme. (In fact I think that, despite the rhetoric, governments generally have raised taxes. Tax 'cuts' are very often just a switching of the tax burden from the obvious to the less-so). So, effectively, people have voted for parties where there was an obvious implication that overall taxation had to rise, even if that wasn't explicitly stated. I accept that isn't quite as black and white as proving that people would actually vote for tax rises; but neither does it prove that they would not. It merely proves that parties sometimes put forward manifestos which are less than entirely honest. I think we all knew that anyway. People don't vote for or against specific proposals – the system doesn't allow for that – they vote for a package.
"…don't believe voters who tell pollsters that they'd vote for a party which raised taxes."
If the sole premise of the election was 'vote for us and we'll raise taxes', I'd agree. And I share some of your doubt about how honest people are when they respond to opinion polls on this question – there is certainly a degree of mismatch between what people tell the pollsters and the way they cast their votes.
The Tories won elections in the 1980's on the basis of an overall platform which included tax cuts. I don't remember them actually saying at the time, 'oh and by the way, we're going to dismember the NHS to pay for it'. Cuts in the more visible taxes might be said to have worked for them in the short term; the consequential damage they did to services and communities doomed them in the longer term.
In the interests of political honesty, I believe that we have to propose what we believe to be the right level and type of services, in the sort of society in which we wish to live, and then be honest about the cost of doing that and how it should be paid for.
"The more 'free-bees' Plaid gives off the less money to real treatments ... or new railway lines or Welsh language daily papers."
I think this goes to the heart of the difference of opinion between us. Where do we draw the line between 'essential services' which should be provided from the tax pool and those things which people should provide and pay for themselves outside any provision made by the state? One person's 'freebie' is another person's 'essential service' isn't it? Perhaps there's a simple test here that we can apply to any and every item of government spending. Let's call it the 'Essential Service or Freebie' test. So:
Prescriptions - Essential Service or Freebie?
Major surgery - Essential Service or Freebie?
Doctors' appointments - Essential Service or Freebie?
Dentistry - Essential Service or Freebie?
Not charging tolls on new roads - Essential Service or Freebie?
Providing books in schools - Essential Service or Freebie?
The list could be endless of course. In every case, there will be some who would argue that those who can afford to pay should do so; or even put forward the more general argument that people should always make a contribution to the costs. But isn't it the case that one way of distinguishing the programmes of the parties is to look at what they regard as essential and what they regard as freebies? And that which of the descriptions they use for each of the items tells us something about the sort of society that they want to see?
"I know in 10 years time when Plaid are in power and the cold light of day hits them in the face; they'll say that people will have to pay for some NHS services."
I don't believe so. But I'm planning to still be around in 10 years' time (and to make as little use of the NHS as I can in the interim!), so perhaps we can debate the question again then?
"PS I enjoy the blog by the way."
Thank you – even if we have to agree to disagree on some issues!
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