The media were a-buzz this week with stories of overspending NHS Trusts in England. We’re told that 65% of Trusts and 90% of hospitals ended the financial year in the red with a total combined deficit of £2.45 billion. If you dig into just about any of our governments’ health strategy documents in the UK and read between the lines of management speak you will find consensus that the NHS in its current form is essentially “unaffordable”. Responses to this are varied.
The UK government seems to think that allowing private companies to deliver NHS services will make the organisation more efficient, which will make it cheaper to run and therefore more “affordable”. How this can be achieved when the primary purpose of said private companies is to cream off as much profit as possible is not clear. Skeptics doubt the efficiency savings will ever materialise and, if they do, will soon disappear into the pockets of directors and shareholders.
Meanwhile the Scottish government is pretending to invest in healthcare by getting the private sector to build new hospitals on the never-never while at the same time “redesigning” services in order to cut annual budgets in the hope of making healthcare “affordable” come the day when an independence referendum returns the “correct” result.
All of this is a fine example of the fallacy of affordability, which contends that the limiting factor in any enterprise is the availability of money. It is hard to overstate the idiotic small-brained numbskull incompetence that allows such a stupid idea to hold sway.
The purpose of the NHS is to provide care for those in need. Our capacity to provide such care is limited only by the skills, energy and compassion of the people who work in the NHS and the stuff that they have at their disposal. There is an abundance of these things in the world, therefore the NHS is a long way from hitting the limits of its capacity to help those in need.
Money is merely the tool that we use to mobilise people and stuff to do useful things. We create money out of thin air at almost zero cost, and we’re awash with it. To suggest that our health services are “unaffordable” because of a lack of money is ludicrous. The only thing that we lack is the wit to recognise that we’re currently using money in just about the stupidest way possible, and that we can do it so much better. Money is nothing more than an abstract idea to which we all agree to subscribe for our common convenience. There is no natural law that prevents us from changing the way that money is put to use.
For instance, we could decide to give everyone a chunk of money every month as a right of citizenship. The idea is an old one that’s been gaining popularity of late, sometimes described as a universal basic income (UBI). Let’s have a look and see what effect UBI might have on the NHS “affordability” crisis?
There are something like 1.35 million full time equivalent employees in the NHS across the UK. If the first £1,000/month of every one of these salaries was covered by UBI the wage bill of the NHS could fall by as much as £16.2 billion/year, which makes a combined annual deficit of £2.45 billion look very “affordable”. A similar effect would be seen across all public and private sector wage bills, opening up opportunities for increasing the real (i.e. human) value of goods and services across the whole economy.
“But”, I hear the skeptics cry, “we can’t afford to pay everyone in the land £1000/month!” Well, you’re right, skeptics, but only if you insist on floundering about in the quagmire that is our current financial and fiscal systems. Elsewhere on this site I discuss the merits of sovereign money and ubiquitous negative interest, the combination of which makes UBI, and many other good things, eminently “affordable”.
The combination of UBI and negative interest is not the only solution to the problem – there are other ways to skin the cat that may turn out to be more effective – but the absence of any attempt by those who peddle the affordability fallacy to tackle the root of the problem is inexcusable. Behind every “affordability” story lies unnecessary human suffering. All that is required to alleviate that suffering is for us to recognise the magic of money and learn how to make it work properly. Why we are still dithering about pretending that there isn’t enough money to do the things that we all know need to be done is completely baffling.