emperor: (Default)
posted by [personal profile] emperor at 04:42pm on 13/05/2011 under , ,
One of the things that has concerned me for a while with the thrust of government policy is its faith in the private sector (or, perhaps, its lack of faith in civil servants), and in the power of markets to make everything better. There's an assumption that government departments are large inefficient bureaucracies staffed by indolent jobsworth civil servants who are impossible to fire, whereas the power of the market means that companies can do the same jobs better and for less money. This lead to the privatization and marketization of utilities and the railways, and I think is underlying what looks rather like attempts to move towards markets and privatization in the NHS and university sectors.

One of the problems with markets is that they tend to value easy to measure things over things that are harder to quantify[0]. In healthcare, this seems likely to result in quality of care being sacrificed on the altar of driving down costs. The NHS Confederation agrees: "Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the USA confirms this, with falling prices and reduced quality, particularly in harder to observe measures". And, for all that some people in the US make a great deal of money out of healthcare, it's hard to see it as anything other than deeply dysfunctional on the whole. Even many UK doctors are against the proposed reforms, substantially because of their market-based nature[1].

In a similar vein, the government is trying to introduce a market element into higher education via variable tuition fees; there is also talk of encouraging more private input into the university sector, maybe even allowing companies to fund places at university for their chosen students. It seems likely that this is partly motivated by the successes of the big American private universities; but as this LRB article notes, even if you don't care a fig about public good, the US system doesn't deliver cost-effective excellence in Universities.

I appreciate that the boat has rather sailed, but I think it's time we realised that private enterprise may not be the best way to run services in the public interest, and that sometimes things that are hard to measure are more important than cold, hard cash.

[0] There is an ethical question here, too, of whether profit is the best motivation for, well, anything, but I think that's an aside for now
[1] http://www.bmj.com/content/342/bmj.d7.full [probably behind a pay-wall]

Reply

From:
Anonymous( )Anonymous This account has disabled anonymous posting.
OpenID( )OpenID You can comment on this post while signed in with an account from many other sites, once you have confirmed your email address. Sign in using OpenID.
User
Account name:
Password:
If you don't have an account you can create one now.
Subject:
HTML doesn't work in the subject.

Message:

 
Notice: This account is set to log the IP addresses of everyone who comments.
Links will be displayed as unclickable URLs to help prevent spam.

July

SunMonTueWedThuFriSat
            1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9 10
 
11
 
12
 
13
 
14
 
15
 
16
 
17
 
18
 
19
 
20 21
 
22
 
23 24
 
25
 
26
 
27
 
28
 
29
 
30
 
31