A slippery slope for health?
- 12 Dec 07, 07:06 AM
Left-wing Labour MPs are girding themselves for a rebellion over which they say could spell the end of
will publish its health directive next week and it is meant to make it easier for people to travel to get specific medical treatment in another EU country.
British diplomats say this is NOT the same as making sure that if you or have an you can get treatment straight away.
It is what some people call and both critics and fans say it will allow people to shop around for health care.
The British Government is at pains to stress its going to be pretty limited in its impact. No wonder.
But is claiming that it would mean that patients could pay for private medicine in one country and claim the money back in Britain, and that could eventually destroy the NHS.
They've got 33 MPs to sign a motion condemning the plan which they say could be the beginning of the end for the NHS.
says it will be "catastrophic" for the NHS if this directive goes through.
"The Commission either has no idea what damage this will cause to our NHS, or they simply don't care," he says.
"It will allow the rich to 'top up' NHS costs to get better treatment. MPs and trade unions will do all they can to avoid this Brussels directive becoming law here."
βNonsense,β says Labourβs health spokesperson in the European Parliament.
βIf it was like that weβd chuck it out,β told me.
She says that the aim is not to promote people moving around seeking health care, but to clear up the current situation, where people get treatment, then have to go to the European courts to force their country to cough up for the cost.
βWe need to have a law," she says. "At the moment it ends up in the courts. Nobody knows their rights.β
Both Linda McAvan and British diplomats stress that your local national health trust would have to approve both the treatment and its cost before you go abroad. And the decision has to be taken on medical grounds.
This story is interesting for another reason : just how will it be portrayed ? β¨At one time I would have bet it would have been seen in certain newspapers as a threat that the Good Old NHS could be overwhelmed by a horde of sick foreigners.
Now its more likely to be "a savage indictment" (F8 on any good hack's keyboard) of the state of the NHS.
That aside, are the left wing MPs right that itβs the top of a slippery slope? Do you believe the reassurances? Or, for that matter, what on earth is wrong with health tourism?
Do tell me.
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Comments Post your comment
These may well be the same 'reassurances' that only a few people from the EU Accession countries would turn up here looking for work, oh, and the benefits of living in a country with an NHS...
"It will allow the rich to top up NHS costs to get better treatment" says Frank Dobson. First time I've heard Mr Dobson admit that treatment abroad is better than what the NHS provides in Britain! Pretty soon he'll be agreeing that we should organise our health services more like they do...
Surely, the whole point of the EU is that it should be possible for citizens of any EU member state to travel to or even live in any member state as if it was one's own home. An essential part of that is the right to be able to access health care without the need for expensive insurances - and indeed to be able to access treatments that may be denied in one's own home state.
Anything that the EU can do to facilitate this should surely be welcomed by everyone.
According to general knowledge, the NHS is one of the worst systems of its kind in Europe. Thus it makes sense that people go somewhere else. This would also take pressure of the NHS and they can even do more with the money they get.
A few years ago when travelling in Vietnam I met two locals β a brother & sister in their 20βs. The guy worked for a major French motor manufacturer that had sponsored the 1998 World Cup and he had been based in Paris at that time with access to tickets. His sister visited him during the tournament, saw some games, and had some laser eye surgery performed during her trip. Unfortunately they operated on the wrong eye. Unable to read from either eye she later had to abandon her university course in Saigon. The French doctor offered her $100 compensation. This is of course just one anecdotal story of what can happen with international health tourism, but it is obvious that more can go wrong when there are language barriers and that it will be harder to put right afterwards.
In practice what people want is local healthcare; Local doctors that speak their language who can establish a long-term understanding of their condition; Hospitals close enough to home that friends and relatives can visit. This is why people complain about a lack of local NHS dentists or whenever a local hospital or medial facility is threatened with closure. This move by the EU Commission does not therefore address any true problem. Once again we see that real-world problem-solving is a distant secondary concern, even an accidental by-product, for the EU Commission whose primary goal when formulating policy is always the transfer of more powers to itself.
Supra-national organisations should not be able to mandate spending programs onto their member states because this removes a basic decision over how tax revenues are spent from the democratic arena. Without the strong solidarities of an pan-European βdemosβ (or people), taxpayers will not stomach the closure of local hospitals while being told that their taxes are required - by a force of supranational law that their votes cannot touch β to be spent on subsidising the healthcare of peoples in other countries.
Since there is no βdemosβ at supranational level one must always make a fundamental distinction between supranational law that removes harmful restrictive barriers between countries (which is a win-win situation for all parties and therefore relatively uncontroversial) and supra-national spending programs which are a zero-sum redistribution of money in which each country will always support whatever policy results in it benefiting from the most financially. It is no accident that when the EU addresses the former (e.g. common market) it is popular, and that all of its most unpopular policies (CAP, etc.) fall into the second category. The weakness of pan-European solidarity is such that the EUβs agricultural spending program (which consumes ~0.4% of GDP) is widely regarded as illegitimate. It is inconceivable that the EU Commission play any role in the βbig ticketβ spending areas of healthcare or social security that consume the bulk of 40+% of GDP raised by taxation. These areas must always be determined by democratic politics which can only ever exist within the context of the nation-state.
Once upon a time it was "bloody foreigners taking British healthcare". How times have changed! Now it's "bloody Brits, taking foreigners' healthcare"! The EU is parliamentary itching powder; blow it into a piece of legislation and someone will object. From what I know of the proposal it seems quite reasonable, and could be quite good at matching spare capacity in one country with shortages in others.
Mark, what was the position of the MPs objecting to this proposal, when the government (and the opposition) were talking about putting more choice in the NHS?
Patient Mobility is a real hot potato.
It can be argued β with some justification β that this is a route by which the European Commission can get power over an area where they have limited influence, namely national healthcare expenditure. Now, how the Member States set and spends their budgets is up to them. However, this does mean that countries can and do use rationing of services through waiting lists, etc., to restrict expenditure. For obvious reasons, most Member States want to keep hold of this power
However, with patients allowed to travel for treatment, governments will lose the ability control of their healthcare costs through waiting lists and the like. As your blog says, it is not clear who will pay for what.
The consequence of such a lack of control and lack of clarity would be a cry to centralise standards of healthcare provision, which would put the Commission at the forefront. Proponents of the scheme say this is not the case, but it is obvious that where treatment is restricted in one place and available in another, there will be an inevitable follow, and the rationing of access will no longer be effective.
Whether this is a bad thing or not is another debate, but be under no illusion of the changes it will bring. The implications for where these healthcare services will be centred β to match supply and demand β are anyoneβs guess. However as we use more services as we get older, look to the Med, where people retire to, to become centres for conditions such as heart bypass, hip replacements and so forth. Talent and resources will concentrate there, drawing it away from other countries
In addition, of course, once you have central coordination for healthcare, you will need similar controls for social services, pensions, etc. Basically, this will become a European competency by default. Whether you think this is a bad thing is up to the individual, as someone who has lived outside the UK and seen a better healthcare system in operation, it worries me not a jot. However, do not believe governments who say, βitβs going to be pretty limited in its impact.β If they believe it, they are fools, if they tell citizens that, they take them for fools.
I for one would be more than happy for the EU to bring in changes, as stated in your article. In fact, the one thing guaranteed to make me positively a europhile would be moving to a continental health system as practiced in Germany, Holland and France. Time people, political parties of all persuasions got their heads out of the sand over the NHS, a leftover of Stalinist proportions. No one from the developed world would suggest imposing a NHS style service on their populations because of the rationing of health care that comes with it. Social insurance is the only way forward to ensure a decent health care system, one thats see operations carried out within 4 week, not the 18 weeks the government keeps banging on about, let alone access to various drugs readily available in Europe but not here, unless you pay privately or have private medical insurance.