Debate on Markets and Health

This house believes that a market will deliver quality and efficiency in healthcare better than central planning ever could

For the motion:

James Gubb Director – Civitas Health Unit

Steve Smith, Chief Executive of Imperial College Healthcare NHS Trus

Against the motion

Neal Lawson, Chair of Compass

Dr Jonathon Tomlinson Jonathon’s presentation is below

In the chair Martin Rathfelder Director of the Socialist Health Association

6.30pm – 9pm Wednesday 17th March 2010  CIVITAS: Institute for the Study of Civil Society  55 Tufton Street London SW1P 3QL.

The text below is a commentary on the slides.

Life expectancy

When China removed its counterproductive system of agricultural collectives and communes and industrial units managed by bureaucracies, it thereby made the rate of growth of gross domestic product go up faster than anywhere else in the world. But at the same time, led by its new faith in the market economy, China also abolished the system of universal health care; and, after the reforms of 1979, health insurance had to be bought by individuals (except in some relatively rare cases in which the state or some big firms provide them to their employees and dependents). With this change, China’s rapid progress in longevity sharply slowed down.

[Healthcare costs]

While you’re cogitating upon the brute fact that the US government spends 20% more than the UK government on healthcare and still can’t provide healthcare for 15% of its citizens, meet Stan Brock

[RAM] Remote Area Medical (reading from website)

“The vision for Remote Area Medical® (RAM) developed in the Amazon rain forest where founder Stan Brock spent 15 years with the Wapishana Indians. He lived with the pain and suffering created by isolation from medical care. He witnessed the near devastation of whole tribes by what would have been simple or minor illnesses to more advanced cultures. When he left South America … he vowed to find a way to deliver basic medical aid to people in the world’s inaccessible regions.

Along with the amazing outpouring of interest and support that occurred after CBS’s 60 Minutes profiled one of our expeditions, RAM has received many requests to conduct RAM expeditions in other states, from as far away as Washington and California.”

 Now the majority of Remote Area Medical’s work is NOT in the remote Amazon but in underserved, uninsured America.

The evidence.

Unlike the evidence in support of markets which can be comprehensively covered in a 10 minute presentation, the evidence against them is vast and can only be covered by reading big, heavily referenced book such as the following:

-The most meticulously researched book written about the unholy trinity of business, government and the NHS

-The most meticulously resrearched book written about the unholy trinity of business, government and Independent Sector Treatment centres
-The most meticulously….

-The biggest public health problem we’re facing is inequality and markets are the main cause.

-A clinical perspective –it’s written by a doctor

If you read just one book about the way markets in healthcare exploit vulnerable people who are willing to pay absolutely anything to protect their health, then you absolutely must read……. Badscience and discover why a multi-kazillionaire businessman thinks nothing of thousands of people with HIV dying in South Africa, so long as they’re buying his vitamins. Discover that pharmaceutical companies make skwillions on the side pedaling herbs and homeopathy to simple people who worry about allergies and cancer as well as making zillions selling drugs of marginal clinical value but enormous commercial value.

Amartya Sen, Capitalism in Crisis New York Review of Books March 26 2009

But it’s not only the mind boggling aura-bending-crystal-healing-naval-fluff-dusting quacks who are exploiting the sick. It’s also, sadly doctors. [Cost conundrum]

The most expensive healthcare in the US is in a small town called McAllen where the per-capita cost exceeds the average per-capita income. The reason is explained by US surgeon  Atul Gawande, the Cost Conundrum: What a Texas town can teach us about health care

“Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.”

We should be reminded of George Bernard Shaw’s introduction to the Doctor’s Dilemma.

If you want to understand markets you can read books:

Or you can do what I did and undertake some research to investigate the distribution of baked and other essential goods according to market principles by visiting the 2 street markets adjacent to my surgery in Hackney, East London: [slides]………

What people in Hoxton hope for is not choice and markets, but money.

Your future, your health, your choice!

1 in 3 of you will spend your last years with some form of dementia

1 in 4 of you will experience mental health problems and 1 in 4 of you with 2 or more chronic diseases will also be depressed (Moussavi, S., Chatterji, S., Verdes, E. et al. (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370(9590), 851-858.)

1 in 10 of you will have cancer once you’re over the age of 60

Almost 1 in 4 men and 1 in 6 women over the age of 75 will have some form of heart disease.

About 1 in 7 men and 1 in 9 women over the age of 75 will have diabetes. If you are from a SE Asian background the chance will be up to 6 times higher.

1 in 5 men and 1 in 6 women will have some form of painful arthritis

A third of women and up to 1 in 10 men will suffer from urinary incontinence

More than 1 in 10 of you will suffer from high blood pressure

Almost one in four men and one in five women aged 45 can expect to have a stroke if they live to 85.

Roughly 1 in 50 men and 1% of women will have Chronic Obstructive Pulmonary Disease

Once you are over 68 more than ¾ of you will have chronic kidney disease

Not only will you be diseased up to the earlobes you’ll also be drugged up to the eyeballs:

On average people over 60 received more than 42 prescription items per head in 2007. In 1997 they received on average only 21.

1 in 16 hospital admissions are due to adverse drug reactions and 2% of people admitted die as a result of these reactions. (Primohamed M, James S, Meakin S, et al. Adverse drug reactions as a cause of admission to hospital: prosepective analysis of 18,820 patients. BMJ 2004;329:15-19)

At our practice 60% of our patients over the age of 75 are on more than 5 repeat prescriptions and 11% are on more than 10 repeat prescriptions (search on 15.03.2010)

The good news is that so long as you don’t shorten your life due to over indulgence (an adverse consequence of food, drug and alcohol markets) the chances are you’ll live longer than your ancestors and have more time to ponder the tragedy of a culture that values quantity over quality. (unless you’re a millionaire –the life expectancy for millionaires has barely changed in the last 150 years)

I’m sorry if that has depressed you, here’s some light relief



When you are old, confused and sick do you want to hand responsibility for your health to private equity firms while you puzzle over WHICH POLYCLINC? Or SECONDARY CARE USER? Magazines (or online forums),


do you want a long term, stable relationship with an expert general practitioner who knows you and your family, who you know and trust to can take care of you and your unique mix of illnesses and medications and worries?

It’s your future, your health and your choice!