Daniel Hannan still wrong about the NHS/Pope still Catholic

Image: Mises Youth Club, via Wikipedia

I was planning to avoid writing about the US healthcare row. A lot of very good stuff has already been written on it, not least on this blog, and I wasn’t sure I had anything to add. But then this article on the Telegraph website caught my eye, and I couldn’t help myself. In case you haven’t been following the story, the condensed version is roughly as follows: a number of American opponents of Obama’s healthcare plans have been making a variety of outlandish claims about the terrors of nationalised healthcare, using the NHS as an example. They were helped along in this by Conservative MEP and sometime youtube celebrity Daniel Hannan, who made an appearance on hard-right dipshit Glenn Beck’s Fox News programme to explain precisely how terrible the NHS was, saying that he “wouldn’t wish it on anybody”. Labour have now seized on this as evidence that the Tories secretly have it in for the NHS, while David Cameron has done all he can to distance himself from Hannan without pissing off the Tory party’s lunatic fringe too much.

The Telegraph article I’ve linked to above is a response to Hannan’s critics from the man himself, and frankly, it’s pretty lame. He might have been somewhat misrepresented, as he claims, but his idea that Britain would be better off with a system modelled on Singapore’s is misguided at best. You’d expect Hannan to be relatively internet-literate, but apparently he’s unaware of the existence of this report, which is linked from Wikipedia’s article on healthcare in Singapore and as such took me a whole 20 seconds’ diligent research to locate. It explains that healthcare in Singapore is largely paid for by companies and individuals, with only a third of the costs met by the government. However, thanks to extensive means testing, those on low incomes have their healthcare subsidised by the government and it seems people don’t avoid getting treatment because of the cost in the way that they do in the US. It seems to work OK; overall spending on health as a proportion of GDP is much lower than in most other industrialised countries, and the healthcare Singaporeans receive apparently compares pretty favourably too. So on the face of it, Hannan’s argument looks reasonable. But then there’s the report’s all-important last section:

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

• • Singapore has developed its system concurrently with the development of the country over a number of years under the backdrop of political stability enabling successive governments to introduce consistent measures relating to individual responsibility, compulsory savings and regulatory control of healthcare services and costs
  • with a relatively small population of four million people within a concentrated land mass of 660 square kilometres, the planning of a healthcare infrastructure has been somewhat easier than would be the case for larger countries.”

It’s far from clear, in short, how far the lower expenditure is due to the system of payment and how far to the ease of setting up health infrastructure somewhere as compact as Singapore. Lacking much knowledge of economics I find it hard to see how who pays for the healthcare could make much of a difference, though if anyone who knows more than me wants to explain then that would be great. Singapore’s being a small, densely populated city-state, on the other hand, does seem a pretty obvious determinant of lower healthcare costs – it hardly seems controversial that it’s proportionately more complex and expensive to sort out healthcare for the UK’s 60 million people in an area of 244,820 square kilometres than for Singapore’s 4 million in an area 370 times smaller. Needless to say, this doesn’t do much for Hannan’s argument. If Singapore’s health system is better and cheaper mainly thanks to an accident of geography, that’s hardly a reason to adopt their method of paying for it.

There’s also another, more important point to bear in mind. Hannan may believe, as he claims to, that the US system needs improving and that he doesn’t think the UK should adopt it. But does he believe that the US has better healthcare than the UK? He went on American national TV, labelled the NHS “a 60-year mistake” and reeled off a clutch of vague anecdotes and cherry-picked statistics. This strongly suggests that he does believe the USA’s healthcare system at present is better than ours. If this is the case, then he should say so. Then he should explain why the World Health Organisation disagrees with him, putting the USA 19 places below the UK in its world rankings (not to mention 8 below Morocco, a country with a per capita GDP somewhere in the region of 4% of that of America’s). If, on the other hand, he believes that the UK has a better system than the one across the pond, then it would be nice if he could explain what’s so terrible about the US trying to provide government-sponsored healthcare for the 46 million uninsured Americans, since I’m assuming “making sure people can get healthcare” is one of the criteria the WHO uses to judge how good a country’s healthcare is. Because right now the only explanation I can think of is that Hannan has a blind ideological hatred of the State having anything to do with healthcare, and if that’s all it is, he could at least have the decency to be honest about it.