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The NHS is frequently praised as the ‘best in the world’ by many (most?) people in the UK. This despite the fact that it measurably NOT.

The NHS’s record of healthcare efficiency is even worse. It now sits in 35th out of the 56 countries measured. This suggests spending more and more taxpayers money on the NHS would be as effective setting fire to most of it.

Here’s a simple example to illustrate why socialised medicine leads to bad outcomes:

Socialised Medicine:
You have a problem with your knee. You book an appointment with your General Practitioner, who sees you after 8 days. They listen and agree that you need physiotherapy and refer you on. Six months goes past and you eventually get to see a physio at a hospital in a neighbouring town. They seem disinterested and give you some exercises to do that you’d already found on YouTube and which failed to help. You are told to come back after two months when you’ll be seen by a new disinterested physiotherapist.

The whole process was long and very frustrating. It was also expensive, costing the taxpayer several hundred pounds while still not even fixing your problem. I’m sure this story resonates with many that have had to interact with the NHS.

The main problem here is: There’s no incentive for the socialised physio to do an outstanding job. They have become little more than a public servant – they just need to turn up to work and do an acceptable job. In return they’ll receive a monthly paycheck and a generous pension when they retire. The system has stopped their interests being aligned with those of their patients.

Now lets contrast a different incentive model.

Free market Medicine:
You pay less tax, and with some of the money saved decide to go and see a physiotherapist to fix your knee. Your town has 10 self-employed physiotherapists. How to choose? Well, you search a comparison site online which gives their details, prices, opening hours, and specialisms and customer reviews. You want an evening appointment, so that immediately filters out 5 of them. You’re down to a short list of 5:

John: Very experienced physio, reasonable price. BUT looking at the reviews, it is clear that he has stopped giving a good service. Perhaps he has personal problems that have impacted his practice, in fact some reviews mention that he smelt strongly of alcohol! You can also see on the review site that he’s currently under investigation by his regulating body. HARD PASS!

Jenny: Newly qualified physio, lower price than the rest. Only a few reviews, but they have been very positive. POSSIBILITY

Geoff: Specialises in the elderly and people with disabilities. Reasonable price and good reviews, but probably not the right physio for you. PASS

Mariam: Experienced, good reviews, good price. STRONG POSSIBILITY

Pat: Specialises in sports-related injuries. Expensive, but you can see reviews from well-known athletes in his bio. STRONG POSSIBILITY

After some deliberation you pick Mariam and book an evening appointment in 2 days on her online calendar. She is able to quickly diagnose the problem and gives some manipulation, followed by a series exercises you do at home. 4 weeks later you book in again with symptoms 75% resolved. She advises you to continue the exercise. There’s no need for a third appointment and you thank her by writing a review of your experiences.

It’s clear in this example that free market medicine wins. You’ll get a far better service, much more quickly and at lower cost than the socialised alternative, and your problem will actually be solved! It’s blindingly obvious to me that the best way to receive great service at the best price is to align the physio’s interests with those of their patients. This is colloquially known as having ‘skin in the game’. A physio employed by a socialised health service has no skin in the game. They are just: ‘physio level 4, pay band B’. You MIGHT get a good service (after the 6 month wait for an appointment), but it’ll just be a matter of luck…you’re just as likely to be seen by ‘John’ as by ‘Mariam’ AND you’d have no say in the matter.

Note: I’m not suggesting that anyone can call themselves a physio and practice. There is a clear role for the government in ensuring that they are properly qualified and insured, and that people have redress under the law if the physio don’t do their jobs properly.