The Financial Ethics of Healthcare Privatisation: United States vs. the United Kingdom
Benjamin S. Donaldson
Abstract:The provision of healthcare is a service often caught at the crossroads of ethical and financial considerations. In this paper I outline the relative benefits of the healthcare systems in the US and the UK from both a financial and ethical perspective. The quality of care provided in the US appears to be high, but not high enough to warrant the cost suffered by citizens. Equally, the service provided in the UK is universal, but lacking in efficacy and efficiency. The NHS could benefit from greater privatisation of key non-medical services and the introduction of minor fees for common procedures and treatments. Not only would this improve efficiency, but would likely result in a higher quality of care than currently provided.
Introduction
The provision of healthcare by private companies has long been a source of controversy, especially in countries where healthcare is generally handled by the state. Since 1948, the provision of healthcare in the United Kingdom (UK) has indeed remained a nationalised service. When government provided healthcare, arguments arose when there was suggestion of private involvement. The common ground of opponents to privatisation was their rejection of the sentiment and precedent set by privatising elements of a nationally owned service. The National Health Service (NHS) was founded upon one principle – it is unethical for the sick to pay for treatment out of their own pocket. However, the financing of free healthcare for all is unsurprisingly a costly program and as such privatisation remains an effective solution to combat cost. The NHS of England and Wales absorbs 19% of all spending in the UK. Comparatively, expenditure on important areas like education, defence and transport range from £87m to £37m respectively – a range of 11% to 4.7%.
In the US, the quality of healthcare for certain socio-economic groups is superior to that of the UK. Instead, the problem here is clearly opposite – the limitation in healthcare spending is not an issue. Broadly speaking, the market decides who and who does not get treatment through the provision of insurance for those who can afford it. The ethical failure here is obvious – the duty of the government is to protect the citizen and treatment for the sick is perhaps the most obvious embodiment of this deontological principle. But, if private healthcare can deliver a better quality of treatment, then perhaps the utility of privatisation has been undervalued. That is to say, could private healthcare provide the greatest good for the greatest number when compared to nationalised healthcare? Once more, the cost of socialised healthcare has already been proven to be monstrous in both its size and ability to draw on funding that could be spent elsewhere. The purpose of this paper, therefore, is to find the optimal point between privatised and nationalised – between financially minded and ethically minded.
Definitions, Data and Fact
Measuring and understanding the relative quality of both US and UK healthcare is central to their comparison, as the quality of healthcare serves as an endorsement of the means through which it exists. For instance, if British healthcare treated a greater percentage of the population, and did so more successfully, than American healthcare, then our question would be easily answered. Alas, the comparison is not that one-sided; there is more to consider than the success of medical treatment and the reach of this treatment. The healthcare system is titled as such due to its wide-ranging and intricate infrastructure. Evaluating one system to be better than the other requires multivariate analysis. For instance, as a percentage of population, the American system lags far behind in hospital admissions. A rate of 10.7% when compared to the British rate of 25%, suggests more people are generally going untreated for illnesses. This is perhaps linked to an associated fear of the cost which comes along with treatment and is certainly not because Americans are in less need of medical treatment – on average, life expectancy, obesity and access to exercise facilities are worse in the US than in Britain (Brown, 2013). In this singular regard, the American system can be viewed as worse, but this alone is not worthy of total condemnation. This single example serves as a good indicator of the importance of multivariate analysis in the proceeding comparative study, especially as the US system starts on a somewhat poorer position due to its reputation. Common measures of healthcare quality used by organisations such as the OECD and health.org include qualities such as efficacy, accessibility and safety (Sutherland & Coyle, 2009).
The United States: Benefits of The Private System
The provision of healthcare in the US has long been a source of controversy and demonization. To most, the idea that one is punished via payment for illness is as foreign as it is unsettling. However, it is important to provide a full account of this system rather than the one experienced by individuals without health insurance – these instances are where the popular horror stories propagated by particularly partisan news sources detail over ‘$5000 in bills after an E.R. trip despite the lack of treatment’, and similar stories. The legitimacy of these stories, amongst a plethora of others, is covered next. For the meantime, serving as rare example, we will be extolling the virtues of the private healthcare system offered in the US.
