May 05, 2006


A good peice about the unfairness of centralised rationing like the NHS and schools.
What makes the NHS so fair? You already know the official answer. The NHS is fair because it conforms to the Marxist principle: from each according to his ability, to each according to his need. NHS services are free, and funded from general taxation.

Of course, this is precisely what makes the NHS such a shambles.
So everybody gets the same, poor, service despite putting in very different amounts. Fair would be you get out in proportion to what you put in, if you don't want something why should you be forced to buy it for somebody else?


Blogger tomdg said...

What is fair, eh? At one level, fair means that everyone gets exactly the same treatment regardless of their personal circumstances - rich or poor, old or young. Only a centrally-controlled, state-funded service can provide that level of fairness. To each according to their need, and their need alone.

At the other end, it is a fact of economics which the right-wing tend to conventiently ignore, that the utility of money is not constant but varies with income / wealth. £5 is a lot more money to me than it is to Bill Gates, and a lot less than it is to my friend who's unemployed. Whenever you measure a "cost" in money, you're introducing a bias in favour of the wealthy. The true human cost would be equal, not if everyone paid the same amount, but if the different amounts everyone paid made everyone feel equally unhappy. Clearly that's impossible to achieve, but it's achieved better by e.g. the combination of income tax and reduced benefits (reduced because we could pay more if we didn't fund the NHS) than it is by a flat rate. Besides - and this is another thing the right prefer not to see - with wealth comes power, and with power comes responsibility. From each according to his ability - what could be more fair than that?

The third dimension is the dimension of use. Some people use the health service more than others. In many cases this is just due to misfortune; it would be unfair for them to pay more because of that. On the other hand in some cases (active smokers, sporting injuries, some obesity cases, illnesses where the person has refused vaccination - not being medical I can only draw up a poor and indicative list) the person involved has some responsibility for their condition. But even here there's a balance to be drawn with justice against compassion. But then compassion isn't really a right-wing concept either, is it?

You know, in Adam Smith's day, the mechanism by which wages were kept above subsistence level was that, if they went any lower, people starved to death and hence the supply of labour went down. Is that the kind of system you'd like?

10:48 am  
Blogger chris said...

You forget the most important definition, and the one that was the core of the article that I linked to. It is fair to get out in proportion to what you put in.

If one person works hard in order to save up and pay for a service then it is not fair to them that some savage can come along and demand it without any effort on their part to cover the cost of it's creation. Nothing is created without effort, and that effort needs some compensation. Simply giving according to need might be nice in a world with unlimited resources where everything could be gained without effort, but that isn't the real world. But reality isn't a left wing concept is it?

9:55 am  
Blogger tomdg said...

Reality? Well, it's certainly not a concept right-libertarians trouble themselves with.

So, would you like to see a system where people were paid solely in proportion to the effort they put in? Perhaps a flat hourly rate for time spent working (as opposed to sleeping, fag breaks, etc?) I doubt it somehow. So if that kind of fairness doesn't apply to income, why should it apply to healthcare?

In terms of getting out what you put in: it's certainly not fair to measure what you put in by money or willingness to pay it. All that tells you is how wealthy someone is.

Surely given limited supply, rationing by need is fairer than rationing by wealth?

10:05 am  
Blogger chris said...

If you hadn't noticed in reality people are paid by how much they work (and how much their work is valued). Piece work, or being paid by the hour is common. Even on a salaried contract there will be set hours that you should work with set amounts of time for breaks. There are also flexitime contracts that again require that you work a certain number of hours for a set amount of money. Do more work than is contracted and you get more money through overtime. That kind of fairness does apply to income, why shouldn't it apply to healthcare?

9:08 pm  
Blogger tomdg said...

Being paid by the hour wasn't my key point, it was being paid by the hour at the same rate. That's blatently not the way it works now (you mention in parentheses the key difference: "how that work is valued"). I don't have a problem with people earning different wages, but you have to accept that it's not a simple question of what you get out is what you put in. That was my point.

7:30 am  
Blogger chris said...

Of course they get different amounts out doing for different things. Different things cost different amounts to do in time, physical or mental effort, or required training. They get out in proportion to what they put in.

8:52 am  

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