Thread by @DrMQureshi

1/14 Insurance models of healthcare (European-style of course, we'd never let USA get near NHS!) have been proposed in UK for decades. Difference is that NHS is now on its knees, so arguments for insurance are getting louder. But let's look at @KateAndrs position in more detail.

https://twitter.com/bbcquestiontime/status/1677037492388651009

2/14 Firstly, insurance adds layer of bureaucracy which is intrinsically more costly than tax-funded healthcare. Insurance costs include actuarial analysis, cost of billing, cost of collecting, legal costs, admin, etc.

3/14 Secondly, insurance schemes deliver profit by excluding high-cost customers. But Nobel prizewinners eg Arrow & Sen explained insurance companies can't predict healthcare costs for patients accurately, vitiating the efficiency of market competition. They have to over-charge.

4/14 Given this, Nobel economist Kenneth Arrow admitted at end of this video that UK's taxpayer-funded system was the LOWEST cost in the world. Later in this thread for why that changed.

5/14 Thirdly, German model compels citizens to pay % of salary into public health insurance scheme, and compels insurance companies to provide care. There's nothing intrinsically more competitive or efficient in this model, so why is it producing better outcomes?

6/14 Could it be that Germany (and the EU average) spends MUCH more on healthcare per capita than the UK? Could THAT be a reason that their healthcare systems are performing better than NHS?

7/14 Given hype about AI in the NHS, you might be surprised to learn our capital spending (includes investment in IT, as well as equipment, buildings etc) has been far below EU average for many years. Could THAT be reason their healthcare systems are performing better than NHS?

8/14 Or could it be that Germany has many more physicians per capita than we do in the NHS? Could THAT be why Germany's outcomes are better than ours?

9/14 Worth adding here that Germany's health insurance system isn't innovative. It started with Bismarck in 1883 and has grown piecemeal. The genius innovation was the NHS, which cut out unnecessary & wasteful bureaucracy. Going to insurance would take UK backwards, not forwards.

10/14 Having established taxpayer-funded is intrinsically more efficient than insurance, and better performance in European comparators can be linked to higher funding/resources, there IS waste in the NHS. Caused by politicians who are now saying NHS isn't working. Who'd guess?

11/14 Politicians divided NHS into "purchaser" & "provider". UK parliamentary health committee said DH commissioned reports into this artificial "internal market" and refused to publish data. But we know even in 2010, admin costs of the NHS internal market were 14% of NHS budget!

12/14 Another major wastage in the NHS is that politicians have turned to PFI deals, borrowing money from private financiers at high interest rates linked to RPI inflation - massively increasing NHS debt simply as an accounting trick to mask public spending.

13/14 Last but not least, NHS beds have decreased to level where taxpayers are funding private beds for NHS patients. Perversity of this reached new levels when public paid for private hospitals to stay open and empty during Covid19. So much for the market!

14/14 Oh, and whatever they tell you about the European model, the UK Chancellor cited Kaiser model in the USA, Trump said NHS was for sale, Tim Ferris (pals with Epic Corp) is directing NHS digitisation, and an American insurance giant has infiltrated every layer of the NHS.