Saturday, 28 March 2009

The problem with "public" services

Something that has perplexed me for a long time is why we put up with government providing so-called public services. Ask the little people two questions and I think I know what the answers will be. "Would you send your children to an independent school if you could afford to?" "Would you use private healthcare if you could afford to do so?" There will be some who will answer in the negative on grounds of political ideology, but my guess is that the vast majority would give affirmative answers. Then ask them why they would use private-sector services and my guess is that they would say they are better than the services offered by the State. It would, of course, be fair to point out that many of the answers would not be based on direct knowledge of the superior quality of private-sector schools and hospitals (although increasing numbers are now receiving treatment in private hospitals where they have had to wait too long for a new NHS hip or the removal of a gall bladder). However, one factor cannot, in my view, be denied namely that those providing services in the private sector have to keep their standards high or they will lose customers.

Current provision of education and healthcare by the State is sought to be justified by three main arguments. First that the little people cannot afford to buy these services privately, secondly that there are some services (such as emergency medicine) which are not routinely provided by the private sector and thirdly that universal provision can only be guaranteed by the State delivering the service. Each of them has something going for it, but not much.

It is undoubtedly true that Mr Average on £27,000-ish a year would probably find it very difficult if not impossible to fund his childrens' education and his family's healthcare if it had to come out of his wages. But that is an argument for the cost of these services being borne by all through, in effect, insurance. After all, that is what taxes spent on healthcare and education really amount to, they are insurance premiums collected from the many and spent when they are needed. There is absolutely no need to go one step further and say that because Mr Ordinary can only receive these services because everyone else pays premiums as well, so the collector of the premiums must provide the services. I am not aware of calls for the Prudential and Norwich Union to have in-house teams of builders and mechanics to provide the service required by a customer who makes a claim on his household or motor policy.

It is also undoubtedly true that the provision of emergency medical cover is not routinely undertaken by private healthcare companies. That simply gives rise to the most important question in the English language: "so what?". The reasons they don't offer this service are that their customer base is not wide enough to justify the enormous infrastructure costs of a 24-hour emergency department and the costs of premiums would be too high to attract sufficient customers to cover those costs. These limitations do not mean the private sector cannot provide emergency medicine and the limitations themselves will not apply if the government is simply the funder of health care.

What is not true, in my opinion, is that universal provision can only be guaranteed if the State is the direct provider. There is a need for universal provision but this can be assured by contractual and/or statutory duties to provide services to Scumsville as a condition of having the contract to provide services to Nicetown. The State can retain a responsibility to provide services if no one else is prepared to do so for the money offered. I can be fairly sure that power would rarely if ever have to be used.

It seems to me that the problem with State education and healthcare is that they are provided by the State rather than just funded by the State. It leaves them open to political interference which, as we have seen in spades, creates huge difficulties for those actually delivering the services at the bottom of the pyramid. Constant chopping and changing of performance criteria does nobody any favours. One manifestation of that problem is that a top-down nationwide system of anything requires so many layers of bureaucracy that vast sums of money are consumed passing information back and forth.

My most serious concern is that government run services are affected by the need to satisfy the government first and the consumer second. What actually happens in schools and hospitals is what the government requires to happen, and even that fails to be achieved in too many instances. Some of these requirements are intended to improve the service for the consumer, but not all. Now, the government will say they are all aimed at benefitting the consumer because the government thinks it is best placed to define what the consumer wants. I don't think that is so, nor do I think it can ever be so because there is no such thing as a single set of desires or values of the users of all schools and all medical services. Furthermore, when government wishes to use these public services for the purpose of social engineering there is a necessary conflict between what it wants and what the little people want. If there were no such conflict there would be no case for social engineering. By its very nature social engineering is about trying to coerce the little people into changing their ways and that automatically creates conflict.

If the top-down model of providing these important services were sound we should be able to expect uniform excellence after sixty and more years of honing the model. Instead we find governments of both parties launching more top-down re-structurings and constantly fiddling with their day-to-day operation. The concept of State provision is, in my view, fundamentally flawed. It does not work, it has never worked and it can never work. Government should be striving to find ways in which it can fund these services at acceptable cost to the taxpayer while keeping its interfering nose out of things it has no capacity or ability to manage.


3 comments:

Gus said...

Yes, that'll work. Just like America.

Could do the Armed Forces as well.

dmc said...

education could definately do with being nonpolitical.In my day we learnt about countries in geography,now they learn about global warming(unproved and intensly political)but have no clue to where the countries are that would be affected by it.Most do not even know our own country.
The rot is also in the teacher training too,most are so leftwing based that acadenic brilliance is ignored or discouragede.
The rot is very deeply embedded but there is no hero to rally behind.

google said...

Spot on, Bigot.

Another concern is the enormous waste created by the imposition of targets and the inspection regime that ensures compliance with those targets. And, of course, it's very demoralising for anyone working to satisfy targets, rather than taking pride in doing a good job.