The Sick Contract: Or Why You Should Pay to Use the NHS

When the NHS was founded by Aneurin Bevin in 1947 it was a very simple time for medicine. Antibiotics had only just emerged and medics had very few tools of much use. 

In this era surgery was dangerous, medicine lacked ammunition and specialities such as intensive care were just pipe dreams. In fact, it's difficult to imagine what you could actually do as a Western doctor pre-antibiotics, such is the all-encompassing reach of this miracle.

Antibiotics changed everything. Surgery became safe and with it the ability to keep sick people in an anaesthetic coma for days and even weeks. Medicine was no longer at the mercy of invisible bacterial pathogens that would stalk and kill the sick, weak and elderly. Maternal mortality, which had already dramatically improved with the awareness of antisepsis plummeted to levels that surely have never been seen before in history.

Maternal mortality per 1000 births - UK

Maternal mortality per 1000 births - UK

It is difficult to see how Bevin could have known of the momentous changes that antibiotics would create in our health system. In just half a century medicine would go from mainly consisting of having a sympathetic bedside manner to a place where with enough money you could do almost anything. Antibiotics were the Big Bang of Western medicine and into this exploding universe was born the NHS. A system that was designed in the post war period because:

...no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.
— Aneurin Bevan

It was a noble aim.

What Bevan didn't realise was that when he stated that the 'NHS should be free at the point of delivery' he created a noose around which the NHS would slowly strangle itself. He had no idea how enormous Western medicine would become, how fantabulously expensive and bloated. 

The Sick Contract

Scary masks or £10 Fee - your choice

Scary masks or £10 Fee - your choice

In sociology the sick contract is the concept of how society and sick people inter-relate. In essence it boils down to these two aspects:

  • Society will look after you when you are sick
  • Sick people will try to get better

When anthropologists look through societies throughout the world they find this same recurring contract. Sometimes this contract takes apparently extreme and psychedelic turns: in South America this may involve drinking ayahuasca to connect to other realities and in Africa ceremonial incantations involving 'witch doctors' occur.

The patients within these societies don't really have an awful lot of choice in whether they take part in these ceremonies, even if they may be unpleasant at times. It is expected, it is part of their contract with society.

This is where the problem with the NHS exists: 

The NHS fundamentally breaks the sick contract.

There is no obligation within the NHS for the patient to try to get better. For instance: many doctors have now given up even suggesting to people to lose weight, stop smoking, eat healthily, walk more etc. Partly this is because everyone, realistically, is aware of this; partly because it predisposes the doctor to complaints where, within the NHS and GMC, you are presumed guilty until proven innocent; but mainly it is because the patient is under zero obligation to take the advice. There is no contract, the relationship between healer and patient is completely unbalanced

When a Tory MP suggested that type 2 diabetics should pay for their insulin he was met with howls of protest yet this makes sound sense. Type 2 diabetes is a disease that will, practically and often, be cured by losing weight: not always, but enough of the time that in any sensible society these patients would be expected to have an ideal weight before getting free insulin. Furthermore, insulin makes you put on weight thus making your diabetes worse in the long term!

No sane society would encourage sick people to get sicker whilst absolving them of any responsibility to get well!

Yet, the NHS does this over and over again, it is written into it's DNA; and so, in it's current form, is DOOMED TO FAILURE. 

How, then, do we fix this?

£10 or a private dance from bez - your choice

£10 or a private dance from bez - your choice

The only way I can see to keep the spirit of the NHS going, and to start fixing it, is to charge an access fee. A fee that forces the patient to evaluate their side of the contract. Are they doing enough to try and make themselves well? This fee isn't punitive, it is simply the financial equivalent of a man in a scary mask and weird looking hair dancing around you until you pass out.

I would suggest £10 for GP; £20 for A&E and £40 for A&E after 11pm at night. At each step in the system there is also a nominal charge. For instance £10 for a CT scan, £10 for an overnight hospital bed; £10 to see a specialist etc etc.

This charge has to be for EVERYONE (apart from children) and for those who are struggling society can set up a charitable fund (in much the same way that hospices have to work) to help them pay.

Bleeding heart liberals will gnash their teeth and wail at the 'unfairness' of this but this is quite frankly ridiculous. Water, food, housing, are all way more important to health than 'healthcare' (better named as 'disease-care'); yet society is quite happy that people should pay for these. 

Without changing the contract the NHS collapses.. then people will find out what 'healthcare' really costs.