Tories of the left
Aug 16, 2009
Bishop Hill in Health

In which I dip my feet into the swamp of the NHS 'debate' that is currently exercising the minds of those blogs still functioning during the dog days of August.

The manufactured outrage over Daniel Hannan's suggestion that maybe that NHS wasn't the best thing since motherhood and apple pie is thoroughly tedious, with the left wing of the media falling over themselves to create a narrative that reduces us to just two options: American style insurance schemes or a centrally planned state monopoly that is identical to the NHS vintage 1978.

You may have a DeLorean or a Trabant, but nothing else. If you fancy a common or garden Ford Fiesta, well that's just too bad.

I pointed out to some of the excitable masses at Liberal Conspiracy that all the invective they were directing at the US system was maybe somewhat misdirected, Hannan actually favouring Singapore-style private healthcare accounts. Whether this was taken on board by Sunny et al, I don't know, but fairly shortly afterwards there was a full-on Unitypost. For those of you who don't know, this means lots and lots of words - although by Unity's standards it was actually a bit brief, being only ten times as long as the average blog post. I don't mean this as criticism, Unity being one of the best bloggers on the other side of the fence in terms of researching what he's writing about, but it's true to say that his ruminations were not up to his usual standards.

Unity starts out with the standard mouthful of abuse at Hannan (`a complete and utter twat') and goes on to outline why he thinks so:

the full extent of Hannan’s outright twattery only becomes fully apparent when you examine the background to his assertion that the NHS should be replaced with a Singapore-style system of personal health accounts because...

"The Singapore system produces better outcomes than ours for half the price."

Taken at face value on a comparison of key health indicators and taking into account the relative proportion of GDP spent on healthcare in the UK and Singapore that’s perfectly true but it rather ignores a very important and somewhat unusual feature of the Singaporean system, one that makes it very different from healthcare systems in both Britain and the US.

When it comes to providing healthcare to its citizens, both the supply and the price of healthcare in Singapore is actively regulation by the Singaporean government, in both the public and the private sector in order to control costs and avoid the kind of significant inflationary pressures that pretty much every other healthcare system in the world has had to deal with.


 This was news to me, so I decided to take a look.

Among the other "outright twats" who have written in favour of the Singapore healthcare system is Tim Harford of Undercover Economist fame.  (In passing I should note what he says about the problems of discussing changes to the healthcare system:

Policy debates get stuck with one side claiming that we should rely on the market and the other side asserting that the government would do a better job.


What is striking about the section of the Undercover Economist covering Singapore is that there is absolutely no mention of controls over prices or supply. In fact, some further digging throws up very little by way of evidence to back up Unity's claim. There are basically one source (which is the one cited by Unity). This is an article by John Tucci, which, after extolling the virtues of healthcare in Singapore says:

Another key focus of the Government has been to ensure that overall health expenditure does not fall victim to the significant inflationary pressures that have been evident throughout the world. This has been achieved by actively regulating the supply and prices of healthcare services in the country. 

Case proven then? Far from it. Here is another article on the subject from the Hong Kong Policy Research Institute

health expenditures rose faster following introduction of Medisave. Singapore did not institute provider-side price controls, instead depending upon competition to bring down costs. 

 Bryan Caplan has also written on the subject

"The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available."

Private healthcare providers are required to publish price lists to encourage comparison shopping. 

Caplan also hints at what is meant by "control of supply"

The price mechanism and keen attention to incentives facing individuals are relied upon to discourage excessive consumption and to keep waste and costs in check by requiring co-payment by users.  

There are a few other academic references to a lack of price controls, but the Tucci reference apart, there are only left-wing campaign sites claiming that there are.

It does look rather as if Unity has got the wrong end of the stick here.

But there's more. Unity spends a great deal of time discussing how authoritarian Singapore is - and he may well be right. But he then points us back to the Tucci article, which reports as follows:

Although the Singapore health system has been very successful, it is a very difficult system to replicate in many other countries for several reasons:


We then get a truly remarkable non-sequitur from Unity:

Even those who commend Singapore’s health care system as a model from which other governments could learn concede that it would be very difficult to replicate elsewhere in the world because its a system that has been developed concurrently with the development of the country over a significant period of years against a backdrop of political ’stability’ which is derived, in the main, from a culture of enforced political and social conformity to a degree that would be unthinkable in a Western liberal democracy such as the UK.

Clearly the thought has been lifted pretty much wholesale from the Tucci piece. But look carefully. Notice how those scare quotes have appeared around the word "stability", with a seamless transition back to the subject of political authoritarianism. Suddenly, Tucci's caveat of the need for political stability becomes Unity's caveat of something along the lines of "you need authoritarianism to make this work".

Tut, tut.

But this twisting of the meaning is not really what I find so depressing. Everybody, but everybody, Unity included, seems to recognise that the Singapore system works very, very well. Far better than the NHS. Far better than insurance-based systems. And yet for suggesting that this would be a good system to look at, Daniel Hannan is told that he is an "outright twat" and "a complete and utter twat".

Really, what does this say about the mindset of Unity, together with his cheerleaders on the pages of LibCon, who yell "SMACKDOWN" when someone yells abuse at Hannan?

And then the thought struck me. They are conservatives. A closed-minded as any bufton-tufton from the shires. Change is what they fear. They are Tories, plain and simple, but without the brogues and corduroy trousers. Tories of the left.


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