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topping-up-the-nhs

This story about Debbie Hirst and her cancer treatment has even hit the NY Times. To recap, the NHS does not pay (upon the grounds of cost effectiveness) for the use of Avastin, a breast cancer treatment. Ms. Hirst decided to pay for it herself and then was told that if she did so she would also have to pay for all of the other treatment from the NHS, something that of course she had already paid for once through the taxation system. Alan Johnson said:

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.

Quite so, the founding principle seeming to be that it’s is better that some die so that we can all be more equal. Greg Mankiw asks an interesting question:

Should a parent who hires an after-school tutor for his child be barred from sending the child to the public [i.e. State] schools?

Or the parent who teaches a child to read at home? Or the patient who pays for gym membership, or better food, or vitamin supplements, perhaps those who buy their own paracetamol should be denied the care they have already paid for? As the Professor points out:

Some people like to think of health care and education of basic human rights. Maybe they are. But they are also normal goods. That is, the income elasticity of demand is positive. It is hard to escape the conclusion that the right cost-benefit calculation for providing the good depends on the income of the consumer. Achieving both efficiency and equality in the provision of these goods is impossible.

As both are impossible we must make a choice. Should people be allowed to spend their own money as they wish, over and above the care that the NHS provides? Or must we have the equality of the grave? You won’t be surprised to find out that I am for the former: it’s your money, do as you wish with it.