Perfect markets need choice. If providers collude in pricing, say because they aren’t that many of them, the consumer doesn’t get a choice, and often has to pay through the teeth to obtain the product.
For products which are the same, for example a biological detergent, the choice comes from variation in ‘adding value’ such as perfume.
A similar argument holds for paying to have your hernia done. The actual service of the actual operation is effectively the same due to constraints posed by the functional anatomy of the human body. But would you like fries with that?
In the paperwork which surrounded the Health and Social Care Act (2012), there was the proposal that choice would lead to lead to improved quality in the healthcare market.
Healthcare is not a market for a number of reasons.
Prof Michael Sandel from Harvard has framed the complicated issues in a number of ways.
In the Guardian, Decca Aitkenhead writes:
“According to the logic of the market, the matter of whether these transactions are right or wrong is literally meaningless. They simply represent efficient arrangements, incentivising desirable behaviour and “improving social utility by making underpriced goods available to those most willing to pay for them”. To Sandel, however, the two important questions we should be asking in every instance are: Is it fair to buy and sell this activity or product? And does doing so degrade it? Almost invariably, his answers are no, and yes.”
The evidence that competition in markets to do with the provision of healthcare drives up competition is weak. This was finally conceded by the previous CEO of NHS England – but there’s a change of hands at the helm in Simon Stevens, appointed by a Conservative-led government.
That choice is so pervasive in neoliberal health policy is exemplified at the lengths to which people dismiss lack of choice.
To advocate for choice at this precise moment would be utterly surreal, given for choice to operate the system needs reserve capacity. This is clearly not the case if the NHS England masterminds seek £20 billion austerity cuts.
For example, if recent allegations – that the NHS received a shortfall of £8bn in funding for the NHS thus mandating it to make three times the volume of ‘efficiency savings’ it otherwise would have had to have made – are true, can it sensibly argued that austerity brings improved choice?
It is hard to argue against the notion that poverty brings about decreased choice. Likewise, if you run out of money in your personal budget, in effect rationing at the n = 1 level, you will find it difficult to argue that your choice has improved.
Similarly, if against the wishes of many CEOs of NHS Foundation Trusts, a cheerleader for the Government imposes a contract on junior doctors, against which 98% of junior doctors have been balloted to reject, can that really be choice?
The imposition of the junior doctors’ contract is as desperate of course as the imposition of Academy status on schools. There is no evidence that this forced conversion drives up quality.
Try another one – try being locked into repayment of a PFI loan for 30 years, a type of ‘corporate wonga’, where your repayments are at eyewatering unconscionable interest rates. Who benefits from this ‘choice’ apart from the PFI money lenders?
Rather, there is quite a lot of evidence that previous UK governments have encouraged the conversion of a well funded national system over decades into a fragmented cesspit of autonomous units, increasingly being sold a pup by the private sector, with worsening performance despite staff working their butt off.
Parents can’t get their children into schools nearby; and the class sizes are ginormous. And your local A&E is shut down as the current Government says it’s ‘unsustainable’ – i.e. does not wish to afford it.
This is not choice, but an ultimate problem in the exercise of choice is that the ‘choice’ of government we have currently was done by a small proportion of the electorate. As ever then, the resultant choice is illusory, as different newsreaders take it in turns to read the script from their corporate masters.