Choice as an alternative to responsibility

[andrewducker]

A recent study in the UK indicated that one of the reasons that teenagers were having more mental problems than they used to was choice - they weren't being presented with a way forward, there was no life path awaiting them, instead there was a huge number of choices, none of which offered any kind og guarantees.

In the old days you could choose apprenticeship, or a degree, or just get a job at the age of 16 and feel that you were fairly secure that you had just become something that you would be for the rest of your life. This wasn't always the case, but it was so often enough that you weren
t left stressing yourself into nervos collapse that the choices you made at age 16 were going to leave you in a complete mess 10 years later because your chosen path didn't lead anywhere.

Survey after study has shown that most people have no idea about and no interest in the things that are going to affect them in the longest term. It may even be beyond them to understand them. If you asked most people about pensions and investing in their future, they wouldn't have any idea how the different options worked, the underlying factors in the market, etc. Nor do they want to know about them - they just don't want to starve to death on hitting 65. Which is (one of the reasons) why the attempts to get people to invest in pensions have by and large been complete failures.

It also doesn't explain why the government is so incredibly big on choice in the NHS. Unlike some countries, we're lucky enough to have a system that guarantees treatment for all. We all contribute towards it, we all live safely in the knowledge that we wont be bankrupted by medical payments or die because we couldn't afford them. It's not perfect by a long way, but it's a vast stress reducer (just talk to an American without health insurance...)

The last thing people want to do is _choose_ where to have their medical procedures take place - they want a qualified professional to book them in with another qualified professional so that the correct care can occur. So why force choice on them? How many people would have the first idea how to even start choosing a hospital to be treated in? It's just a bizarre route to take the NHS in and nobody seems to understand why they want to do it.

I had a sudden realisation this morning that it's because they have no idea how to run the NHS any better. In market-driven sectors, choice allows the public to promote services they like and destroy ones they don't. We choose Pizza company A over Pizza company B because they make better/cheaper pizza and so A flourishes while B goes bankrupt. We don't have to personally analyse the management structure and weed out waste, or look at the supply chain to see what their ingredient sources are like - we judge the end product and the market magically causes better pizza to appear (over long periods of time, with any luck).

So the feeble hope of the Labour leadership is that providing a similar choice to the public over hospitals will cause good hospitals to flourish and bad ones to vanish and they won't have to be responsible any more. This despite the fact that hospitals can _never_ be a commodity product - they're a luxury product; and luxuries operate under very different market conditions.

NHS Choice isn't their way of making your life easier, it's their way of abdicating responsibility for making the hospitals run well.

Suddenly I've gone from not being sure what to think of it to being dead set against it.

Comments

[nickys.livejournal.com]

I think you're right. A lot of this 'choice' stuff is designed to make individuals feel that they are personally responsible when institutions fail them.

[heron61.livejournal.com]

Also, we are presented with a host of near meaningless choices to give the illusion that we in some way control our lives. These sorts of false or meaningless choices are more prevalent in the more capitalist sectors of life, where people are confronted with seemingly useful choices between different brands of many commodities that are essentially identical. However, these same pseudo-choices clearly make an equally excellent dodge for state-run institutions.

[cx650.livejournal.com]

My questions start with the institutions. Why do we need them to decide for us? Why are so many things nowadays regarded as the government's responsibility? We are supposedly intelligent and better educated than our forebears so what is wrong with taking responsibility for our own actions?

[andrewducker]

Because the vast majority of people aren't anywhere near enough educated to make decisions about kinds of medical care. If they were they'd be doctors...

[cx650.livejournal.com]

I was asking in the general sense rather than specifically medical. Your post started that way before particularising the NHS.

[andrewducker]

Aaah - the answer is 'because most people are not actually capable of telling the difference between the 13 different kinds of bran-flakes and will therefore plump for the one with the nicest packaging'.

Which is why you'll discover that in many cases half of the competing brands are owned by the same company...

[green-amber.livejournal.com]

You haven't admitted you got this all from Jeremy hardy :->

[andrewducker]

??? I didn't. He had a minor rant about care, which wasn't that different from what dozens of other people have been saying (albeit he was more amusing). He didn't say why they wanted choice...

[green-amber.livejournal.com]

Joke. R u home? can you ring me? I am bored senseless. Indicate if poss!

[andrewducker]

Just tried and someone with a Slavic accent denied all knowledge of you...

Want to give me a thirty second call?

[green-amber.livejournal.com]

Okey doke. They're throwing me off the net anmyway. wasn't gonna try you when i wasn't sure if you were home yet or whsat.

[catamorphism.livejournal.com]

The last thing people want to do is _choose_ where to have their medical procedures take place

What the hell are you talking about? I have hypothyroidism. Many doctors refuse to treat this condition with adequate medication (a combination of the fact that they go on lab tests and assume the tests have the same meaning for every patient, when they don't -- i.e., they assume that if you're between 0.5 and 5, you're fine, when in reality one person might only feel fine when they're between .1 and .2, and the next might feel fine at 10, and the fact that many people with this disease are female and are therefore just malingering and not really sick). Currently, I'm being undermedicated because my health insurance plan won't allow me to see a specialist other than the two on their list, which means finding one of the 1-in-10 doctors who know their shit is out of the question unless I want to pay for it myself. I sure as hell would like a choice about whether I'm going to see a doctor who will take me seriously versus patting me on the head.

[andrewducker]

We don't have medical insurance. And the standard of care here is very much designed not to vary from area to area. We still have problems with it, but the whole point is a standard quality of care for all.

If you want to see a specialist privately, you still can, of course.

[catamorphism.livejournal.com]

Sorry, I don't believe the "standard quality of care" thing -- in any field, there are differences in the levels of knowledge of various practitioners. Not all software engineers have an equal level of expertise on Java -- some of them might know more about C instead, some might just be stupid. Similar statements can be made about doctors and specific health problems. "Being able to go outside the system and see a specialist", which is a property that seems to be shared by your national health care system and by HMOs here, is nice, but doesn't help those who don't have the money to do so. Whenever you build a health care system that doesn't include choice, you're basically guaranteeing that richer people will get better care.

[cx650.livejournal.com]

The NHS may be intended to have a national standard of care but it is quite obvious that it is not currently achievable purely because of different area health authorities criteria for funding allocation.

[octopoid-horror.livejournal.com]

But the standards of care/attention/type of medication likely to be given vary from region to region. If you talk to people who have had mental health problems in different parts of Scotland, let alone the UK as a whole, local authorities (and filtering through to local medical facilities/practices/brain-talky-doctors etc have wildly different ways of funding/treating etc.

It's a standard quality in that there -is-, theoretically, care for all. What that care is depends on where you are.

And many, many other factors.

I can't remember who, someone knowledgable, was mentioning how there was a mental condition that it's very hard to get accepted as having if you live/work in edinburgh.

Elsewhere in Scotland, the same condition is accepted as being a Real Thing That Is Serious, but other conditions are not.

[paddie-gal.livejournal.com]

I have to agree with catamorphism - my sister is coeliac (gluten-intolerant) and has SO many problems trying to find someone within her NHS area that (a) understands what it is and how to treat it and (b) doesn't just think she's a picky eater. I mean, her most recent GP told her that she should try a gluten free diet for 6 months, and then come off it, because "there's no reason not to eat gluten, but if you want to cut it out for a bit, to make yourself think you feel better, then go ahead" - this is when current research is showing that Coeliac sufferers are up to 50 times more likely to contract bowel/colon cancer, as a direct result of not being on a gluten-free diet.

Equally - regardless of what Labour are pretending to think is a good idea - if you weed out all the bad pizzerias, and all you're left with are fairly decent, then they can gradually lower their standards, to reduce costs etc, and then you end up with every one being a lower, crappier level, which is worse than where we are now!! I think, certainly in my mind, if I had to go to hospital for something, I would rather that I had a choice as to where to go and who to see - I know of several fairly ancient hospitals in the area, that I wouldn't particularly like to go to, and a couple of modern, more patient-friendly ones, that I would choose, if Ihad to make the choice. I think most people, faced with serious surgery, or long-term medical care needs, would research (to a certain extent) what was available, who had the latest equipment, the best track record etc, and considering the postcode lottery that affects the NHS, this can only be a good thing.