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What free-at-the-point-of-use Health Care looks like in a Free-Market

By Sara Scarlett
June 23rd, 2013 at 11:48 am | Comments Off on What free-at-the-point-of-use Health Care looks like in a Free-Market | Posted in health, UK Politics

My fear of hospitals has been exacerbated lately with the latest stories of cover-ups and bribes. This behaviour may be shocking but it is typical of all socialist industries. The problems facing the NHS are the problems that always occur in industries structured this way so throwing money at the problems of the NHS is won’t help. No amount of money can cure problems of structure.

When talking about different health care systems everyone always says to me ‘Oh, but the American system is so much worse…’ (as if the NHS and the American system are the only two health care systems on Earth…) The answer to this is obviously – yes! The American health care system should be used in the ‘what not to do’ section of every public policy handbook. It is a 50% government funded mess of regulation, red tape and bizarre diktats left over from WWII meaning health care is tied to employment and other such nonsense. That said, individuals who have health care in America generally have better health care than individuals in the UK. A large amount of Americans do not have health insurance, however, and the difference between not having health insurance and having the NHS is a lot bigger than that between having the NHS and having American health insurance.

People seem to think that since the American system is capitalist it is free-market. This is obviously false. People also seems to think that the NHS is the only version of free-at-the-point-of-use health care. Tellingly, when the Soviet Union fell, none of the former Soviet states, or anyone else is Europe for that matter, chose to structure their health care like the NHS.

So, in light of all this, it was put to me that a lot of people struggle with visualising what health care in a free-market would look like. I’ve written this piece so that some of those who do not get how free-market health care would work can visualise the system.


First of all split health insurance and health coverage. These are two different sets of fiscal tools. Insurance is a fiscal tool used to pay for things that happen infrequently and, if you’re lucky, not at all. I think health insurance should be mandatory but every adult picks which private provider they insure with, just like car insurance (it doesn’t have to be mandatory but I think this would more pragmatic – depends if you want to go full voluntaryist or not). Ambulance and A&E services would be paid for with these funds.

Health coverage is the fiscal tool you use for paying for health care costs you know you are going to need at some point in the future e.g. general GP visits, minor operations. In a free-market you could rely on the following means to fund your coverage; individually, with a health coverage company, with a Health Savings Account (HSAs), by joining a friendly society, by private charity and I wouldn’t be opposed to government vouchers in certain circumstances but they probably wouldn’t be necessary.

All health care providers would be privately owned and compete with each other in terms of quality, price and the nature of their care. They could be non-profits or for profits; share-held, cooperatively held or run by charities.


Right now, our ‘Lords and Masters’ manage funds allocated for health care and if we don’t like how they are managed we can vote some of them out at the next election (or try to) apart from the Civil Servants that we cannot. In a free-market, were a greater number of us to join friendly societies, we would have direct democratic control over who manages our collective funds and the option to leave if we felt they were being mismanaged.​ A greater plurality of ways to fund health care means all of those ways get better and you would spend a lot less on health insurance and coverage than you currently do on taxes to pay for your health care.

Friendly societies self-police. Why? Because you have a closer relationship with the individuals who are responsible for your health care and who’s health care, in turn, you are responsible for. You would have a greater incentive not to waste those resources since you are more connected to your money and who spends it. You would have multilateral relationships with other human beings and not a unilateral relationship with the state.

Drugs will become higher quality and less expensive. Monopsolies are a bad idea if you want cheaper drugs. In order to drive down their own costs health care providers would now have an incentive to bargain and negotiate for cheaper drugs. Pharmaceutical companies would have more of an incentive to create better, cheaper drugs. With a monopsoly, there’s nothing stopping drug companies cooperating with each other to charge higher prices.

Health care will go up in quality and down in price. There is only one sector of the health care market that operates closest to a freer-market and that is the plastic surgery sector. Quality in the plastic surgery sector has gone up consistently and prices have gone down consistently in the last thirty years.

Health tourism, as a problem, would disappear altogether. Non-UK citizens would be billed just like everyone else.


You get sick. You go to a private GP/hospital. They send your bill to you, your private coverage provider, your HSA manager, your friendly society or a charity after.​

You get in a car crash. The ambulance you’ve already paid for through your catastrophic health insurance takes you to A&E. They stabilise you. You are transferred to a hospital. The hospital sends your bill to you, your private coverage provider, your HSA manager, your friendly society or a charity after.

I wouldn’t rule out the use of government health vouchers for people who genuinely lose the health lottery, like kids who get cancer, for example. They distort the market less than other forms of government funding.

So there you have it! Health care in a free-market system. This is unfortunately one of those posts where I simply don’t have the time or energy to have the comments turned on because of the crazy it attracts. So much crazy… This post is essentially thought crime… but f*ck it, that’s my specialty.


Life imitating art

By Editor
June 9th, 2013 at 2:28 pm | 1 Comment | Posted in Uncategorized

H/T Here are three ideas for you….

  • Put all alcohol in plain packaging
  • Ban betting logos on sweatshirts
  • Print health warnings on the actual cigarettes

You might think these have been lifted from the latest indie spoof movie. Think again. These crackpot ideas are actually being put forward, for real, by those who “know best”. You see that is what happens when governments spend millions supporting so-called “charities” and institutions whose raison-d’etre is to come up with ideas that justify their existence (and their next round of funding). As for evidence? Forget it. All you need is to get some of your mates to fall in behind the idea, run a few more “studies”, get public health to back it and Bob’s your uncle, your almost there.

Click here to read more: (PS. We like the solution)

“Future generations will look back in wonder at how so many fruitcakes and monomaniacs came to wield influence in the foul years of the early twenty-first century. Sack the lot of them, abolish their grants, bulldoze their workplaces and pour salt on the land so that nothing ever grows there again.”

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Another scandal – another scapegoat

By Angela Harbutt
June 4th, 2013 at 1:22 pm | 2 Comments | Posted in Sleaze, UK Politics

A lot has been discussed in the past few days about The Sunday Times expose “Cash For Access”  and Panorama’s yet to be aired (but seemingly similar) expose.

The Sunday Times alleges that “PEERS have been caught offering to ask parliamentary questions, lobby ministers and host events on the House of Lords terrace for cash”. The Panorama expose is yet to air but has resulted in Patrick Mercer MP resigning the Conservative Whip. The allegations seem similar.

This has prompted a surge of cries for Government to clean up parliament and for Ministers scrambling to “do something”.  In this instance “something” appears to be revisiting the right for constituents to recall an MP and to introduce a “register of lobbyists”.

Nick Clegg has been at the forefront of this, saying that the present scandal showed how “the political system has long been crying out for head-to-toe reform” and vowing to force a statutory register of lobbyists into law.

Reform of the political system may be necessary – but are the reforms proposed by Government the right ones? I would argue no.

I have no problem with giving voters the right to force a by-election. Always assuming that careful rules can be put in place to prevent MPs opponents from forcing spurious recalls in marginal seats.  But that rule that won’t help one iota with the subject of the Sunday Times sting – The House of Lords.

The House of Lords is in a mess. It failed to sort out the expenses fiddling fiasco – with many Lords getting off scot free despite blatant breaches of the oh-so-loose rules. OK, some had to pay back some of the money they had swindled, but there seems to be no mechanism for expelling people found to have done wrong. Surely what we need is more explicit rules for Lords and much tougher sanctions for wrong-doers?

Having not seen the Panorama programme, it is difficult to judge the extent of the problem amongst MPs.  So far all we have seen is one MP allegedly breaking current parliamentary rules. If some MPs are willing to break the current rules why would anyone assume that installing more rules (and not even rules for the MP themselves) will improve the situation?

Frankly it leaves a very bad taste in my mouth. Responding to political sleaze with a promise of a statutory register of lobbyists is akin to politicians saying

 “not our fault guv – it’s those bastards over there – blame them – we politicians can’t help ourselves”….. “When sharp suited men arrive waving £50 notes we have no free will. No choice in the matter.  What we need to do is remove temptation and opportunity from us weak-willed politicians and all will be well in the world.”

Same old politicians turning the spotlight away from themselves and onto someone else.

And then we must consider what that “statutory register of lobbyists” would look like. Because this gives me great cause for concern. How do you define lobbying and/or lobbyists for the purposes of the register?

If you define lobbyists as those who undertake lobbying activities on behalf of a third party client you are, by definition, excluding those large organisations that have in-house lobbying. A small consultancy operating for, say, Stop the Badger Cull would be required to register but a large company employing in-house lobbyists would not. That’s hardly fair – and should rightly be rejected. Even if you did force such an unfair system into place, I suggest that many organisations would simply shut down their external lobbying contracts and move the activity in-house. Back to square one – except the big boys are fine and the small guys get whacked.

Then again if you choose instead to define lobbyists as those who lobby MPs (i.e. focus on the act of lobbying) then surely you encompass thousands of people from every walk of life? Whilst it may be easy to identify those individuals who, say, spend 50% or more of their time on “lobbying”,  it isn’t, after-all, just the in-house lobbying team that can and will be deployed. Any employee, director, patron, or charity ambassador must surely be counted as a lobbyist if, in the course of their interaction with a politician, they put the case of their charity, cause, campaign or company? Are we really suggesting that Cancer Research UK (which seems to lobby the government daily on one topic or another) must register every member of staff, volunteer and cancer ambassador that ever has any interaction with a politician?

A step too far surely? Some have suggested that charities should be excluded. Well that’s where most of the lobbying comes from as far as I can see?  There are 27,000 charities out there that survive on taxpayers’ cash for more than 75 per cent of their income. I dare say a large number of those, big and small, lobby politicians all too regularly, arguing for everything from more regulation to more funding. Their vested interest – in perpetuating their income streams – runs every bit as deep as those from business. (There is a strong and growing case that those charities receiving money from government should not be allowed to lobby their paymasters at all – but that is another topic for another day).

In any event, you can’t exclude a charity lobbying for more foreign aid spend from the register but force a campaign group representing taxpayers to be included in the register, surely? Unless this whole statutory register of lobbyists business is not about reform of parliament at all, but a thinly disguised anti-business campaign.

Of course, it should be mentioned at this point that 38 Degrees raised 66,000 signatories during the consultation on “Introducing a Statutory Register of Lobbyists” supporting its statement that Government should “Stop Secret Lobbying”. And actually I am in favour of that. They also call on rules to force “politicians to reveal who they’re meeting and what they talked about”. I am in favour of that too.

It’s just as far as I am aware Ministers are already required to publish a list of all meetings they have with third parties (who and about what) together with any gifts etc received. (eg “Ministerial gifts hospitality travel and external meetings”).

Except you see they don’t always follow the rules either. I won’t bore you with the whole sorry tale (you can read it here), but one Minister had a secret (sorry “informal”) meeting with an APPG and a state-subsidised “charity” that the Minister did not include in their published list of meetings. When an FOI exposed the existence of that meeting, and later what they discussed, (including lobbying for the exclusion of certain groups from an on-going consultation) – the meeting was suddenly and secretively added to the public list of meetings on the (inappropriately named) “transparency” web site.

Of course no money changed hands, unless you consider the APPG group which secured the Ministerial meeting, receives support from the aforementioned state-subsidised charity  – in the form of administrative support, provision of materials, funding for group receptions and for design, printing, photography, and dissemination costs relating to group publications and stationery. Oh quite a bit then.

And there we come full circle. You see the problem isn’t the lobbying at all. I don’t mind that a lobbying group met with a Minister. I mind that it was kept secret. And I mind that, although against the rules, when the meeting was exposed, they just amended the public records and went their merry way. The minister received no sanction or public cross-examination.

A statutory register of lobbyists would not have prevented that from happening. Nor will it prevent future cash for questions or cash for influence scandals.

The problem here is not the lobbyists it’s the politicians – who believe they can act with impunity – and that is where the focus of attention should firmly remain rather than seeking out more scapegoats. Throwing the public a bone (in this case a register of lobbyists) and trusting it will keep then distracted until the storm blows over is an age-old politicians trick. One we we should have grown wise to by now.

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Giving the EU the red card

By Angela Harbutt
June 2nd, 2013 at 10:00 am | 2 Comments | Posted in EU, Europe

The EU seems to be a  topic of some interest here at the moment (see “Liberalising the European Union” from Barry Stocker and “EU- It really is getting sillier by the day” by Editor). Here is one more little item that may be of interest.

On Friday, Foreign Secretary William Hague was over in Germany calling for a “red card” scheme so individual nations can block laws unwanted and unnecessary EU legislation. This is, in effect, an extension of the current “yellow card” system under which parliaments in member states can force the European Commission to reconsider a law. The red card would go further by blocking legislation altogether, though, as with the current system, the proposal would need a minimum number of national parliaments to agree to have effect.

Mr Hague said it was time “to make the EU more democratically responsive” and that:

“We should explore whether the yellow card provision could be strengthened or extended to give our parliaments the right to ask the commission to start again where legislation is too intrusive, and fails the proportionality test” (read the full speech here)

Hague, it seems, is confident of securing backing for his proposals from other northern European countries, including Germany. And it looks like this proposal is set to attract cross-party support in the UK. Labour’s shadow foreign secretary Douglas Alexander is reported to have said that the Labour party would also push for a mechanism ensuring national parliaments have a bigger say in EU laws. One assumes that the Lib Dems will likewise get behind such a policy – (I believe I heard Chris Davies MEP indicating his support for the red card system on the radio yesterday, but please correct me if I am wrong).

All in all this looks like a highly practical suggestion that seeks to call a halt to the regulatory bloat coming from unelected Brussels bureaucrats. As Hague says (and I agree), the EU is not “democratically sustainable” without a “decentralisation” of powers. The challenge is to see this policy implemented as soon as possible.

That in itself, of course, in not enough. The UK action (or, more accurately, lack of action) on the olive oil jug ban was lamentable and if we are to see true reform of the EU it will require the member states to ACT when presented with unnecessary legislation, not just stand by and watch.



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Liberalism: Is the tide turning?

By Editor
June 1st, 2013 at 1:28 pm | 3 Comments | Posted in Liberal Democrats, Libertarians

An exciting couple days for all us liberals out there. Not one, but two hat tips:

First, the good news that “we are not alone”. Liberalism is not just alive in the UK, it is positively thriving. A major feature in the Economist, of all places, states “Britain’s youth are not just more liberal than their elders. They are also more liberal than any previous generation“.

Young Britons, it turns out, are classical liberals. The Economist reports:

“…as well as prizing social freedom, they believe in low taxes, limited welfare and personal responsibility. In America they would be called libertarians.”

This totally uplifting piece goes on to say

““Every successive generation is less collectivist than the last,” says Ben Page of Ipsos MORI, a pollster. All age groups

Graph courtesy of YouGov/Economist

Graph courtesy of YouGov / Economist

are becoming more socially and economically liberal. But the young are ahead of the general trend. They have a more sceptical view of state transfers, even allowing for the general shift in attitudes”

And it isn’t just IPSOS MORI saying this. The same article reports

“Polling by YouGov shows that those aged 18 to 24 are also more likely than older people to consider social problems the responsibility of individuals rather than government. They are deficit hawks.  They care about the environment, but are also keen on commerce: more supportive of the privatisation of utilities, more likely to reject government attempts to ban branding on cigarette packets and more likely to agree that Tesco, Britain’s supermarket giant, “has only become so large by offering customers what they want”.”

Do go read the article in full to get a warm fuzzy feeling all over.

But what to do about this?

Second: Mark Littlewood (who get’s a mention in the above Economist item as will be noted by conspiracy theorists everywhere) seems to have the answer. Writing in the Times [paywall] on Friday he suggests “The Lib Dems should try being real liberals“. In his hard hitting comment piece Littlewood (former spin doctor of the party and LV founder and blogger) points out the all-too-obvious malaise within the party:

“There is no acute leadership crisis, just a general sense that they are sinking. It is near impossible to discern what their recovery strategy is. Mr Clegg and his close advisers encourage the party faithful to “hold your nerve”…. But that sounds more like psychotherapy than a plan.”

Front Cover of the Economist : June 1st 2013

Front Cover of The Economist : June 1st 2013

Well said. But, this isn’t just a piece pointing out the parlous state of the party right now, he has a sensible, practical solution. Here are the key bits:

“First, they (Lib Dems) need to stop doing and saying things that have little resonance outside their declining base of party activists.”

“Second, the Lib Dems need to take a leaf out the books of many of their sister parties on the Continent. Many European politicians rightly view them as rather an odd, mixed bag with a left-leaning social democratic agenda. Not very liberal at all, in other words.”

“…the Lib Dems often come across as no more coherent than a confederation of residents’ associations. Few voters understand any driving philosophy behind their policy, merely that it is “middle of the road”.

“The party does have a strong commitment to civil liberties hardwired into its DNA, but on lifestyle issues, such as smoking, drinking or reading magazines with airbrushed photos of female models, it can’t resist the urge to agitate for greater state intrusion and control.” [see a previous post on LV “Norman Lamb: Doh!” for more on that one].

“…this actually makes a strategy of being a small state, pro-business party even more attractive — mainly because most Lib Dem MPs find themselves in close fights with the Tories”.

“A consistent, clear, genuinely liberal narrative, in which the State plays less of a role in our lives, and individuals have greater freedom to keep their own money, run their own affairs and make their own choices does not guarantee electoral success. But it surely offers a much better prospect for the Lib Dems than anchoring their ship somewhere in the centre of the ocean, as they slowly slip beneath the waves.”

Whether the appearance of his comment piece in the Times on Friday is coincidence, or deliberately timed to coincide with the Economist report, only Littlewood will know. But taking those two articles together we see not only that there is a real, and growing appetite, for classical liberalism in the UK, but there is a compelling case that Lib Dems should not just be spectators to this upswing, but capitalise on it. Britain looks ready to embrace a real liberal party – but is the party ready to be it?  Here’s hoping so.

(PS Young liberals out there might like to find out more about Liberty League and Freedom Week by clicking on the links.)


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