Hospital Waiting Lists

You know how it works: proposals to use the public spending fund to help the general population are met with cries that ‘the country can’t afford it’, while public spending proposals intended to help the owners of the country sail through fine.

A good example would be hospital waiting lists. Proposals to reduce waiting lists are often countered by the old ‘the country can’t afford it’ argument.

Two Types of Waiting List

Waiting lists fall into two types:

temporary delays, such as those that occur when a surgeon phones in sick, or when a vital piece of machinery goes wrong, or when bubonic plague breaks out;
built–in delays, which are due to policy decisions.

In practice, almost all waiting lists belong to the second category.

Deliberate Policy

There is, of course, no magic. Public spending isn’t a supernatural force, beyond human control. It is entirely a matter of deliberate policy. There is a fund of revenue, and how that revenue is distributed is decided entirely by state policy.

So a certain amount goes to support the military, a certain amount goes to support the secret police, a certain amount goes to the NHS, and so on. And within the NHS’s share, policy decisions determine how much goes towards medical treatment, how much goes to train medical staff, how much gets handed straight over to the wealthy through Private Finance Initiative scams, and so on.

The medical treatment budget, likewise, is entirely a matter of deliberate policy: this much goes to treat this type of illness, disease or injury, and that much goes to that type.

It is not that the details are decided from on high. There’s no–one in an office in Whitehall who specifies that this surgeon at this hospital should treat this patient before that patient. As in any complex social organisation, general policy is decided at one level, and detailed policy is decided further down the line. But all are matters of deliberate policy.

Thank Goodness for Private Medicine

What’s the first thing you notice about hospital waiting lists? In most cases, there is a private contractor ready to step into the gap and provide the treatment that the NHS fails to provide. Isn’t that nice of them?

Medical treatment falls into two categories:

Treatment that can’t be provided profitably, such as accident and emergency treatment.
Treatment that can be provided profitably, such as dentistry.

Health spending is deliberately allocated so that waiting lists occur in those areas of medical treatment that can be provided profitably.

What If?

Imagine that sufficient funds were allocated to dentistry, which has been largely taken over by private practitioners, so that all demand for dentistry was met by the NHS. The private dental industry would collapse; it couldn’t possibly compete against a properly funded alternative.

Allocating sufficient funds to, in this example, dentistry, is entirely possible. Because the state has full control over the allocation of its resources, those funds could come from anywhere. The funds could easily come from some other area of health spending, such as accident and emergency treatment. So the waiting list would be transferred from dental treatment to accident and emergency treatment.

Of course, because there wouldn’t be enough profit in providing accident and emergency treatment for all, and because the general population is sufficiently organised, there would probably be riots. That’s why accident and emergency treatment is reasonably well funded.

Or those funds could come from, let’s say, the military budget, or the secret police budget. Perhaps the country can’t afford those. Wherever the funds come from, it’s due to deliberate policy.

Public Subsidy, Private Profit

Hospital waiting lists do not indicate that the NHS is an inefficient provider of health care. Quite the opposite: they exist because a properly funded health service would be by far the most efficient provider of health care. Without waiting lists, no–one would use private medicine.