Newspaper article The Evening Standard (London, England)

We've Got to Pay to Save the NHS; Iain Duncan Smith's Suggestion at the Weekend That All but the Poor Should Pay to See a Doctor Has Been Rubbished, but Theodore Dalrymple, a Practising Doctor, Says It Is the Only Realistic Solution

Newspaper article The Evening Standard (London, England)

We've Got to Pay to Save the NHS; Iain Duncan Smith's Suggestion at the Weekend That All but the Poor Should Pay to See a Doctor Has Been Rubbished, but Theodore Dalrymple, a Practising Doctor, Says It Is the Only Realistic Solution

Article excerpt

Byline: THEODORE DALRYMPLE

IT is a lamentable fact of human nature that free gifts are not much valued: and the connection between the taxes we pay and the health care we receive is so tenuous and abstract that many people still regard a visit to the doctor or to the hospital as free of charge.

The attraction of the free is irresistible: anyone who has seen doctors, none of them on the bread line, flock to free lunches offered by drug companies could possibly doubt it.

Moreover, some of those who do remember that the taxes they pay are what fund the NHS react rather like people who patronise the type of restaurant that offers you all you can eat for [pound]4.95: they may not be hungry any more, but they have paid their money and by God they're going to eat their pound of flesh, even if it kills them.

In the circumstances, it is not altogether surprising that quite a number of patients attend the doctor's surgery for the same reason that the climber climbed Mount Everest: because it is there. Neither is it paradoxical that, while many people attend the doctor for no good reason, or for a very trifling one, about a quarter of all NHS outpatient hospital appointments are not kept by the people for whom they are made.

Similarly, it is not surprising that some people use an ambulance as a glorified taxi. The London Ambulance Service estimates that a third of its calls are not for real emergencies, and I know of one man who lives very near my hospital who has called an ambulance as an emergency more than 100 times this year alone, when he desires to return home from an afternoon or evening out.

Mr Duncan Smith's proposal-that we should henceforth-pay to visit the doctor seems eminently sensible, and by no means the hardhearted, Gradgrindian proposal that it will no doubt be depicted as being in some quarters. Indeed, only a deeply infantilised nation, that looks to an omnipotent parent (the state) to take care of it, could find anything remarkable in this mild suggestion.

Of course, a terrible picture will at once be painted, of the prospect of hordes of desperately ill people staggering about the streets or expiring quietly at home for lack of medical attention.

This doesn't seem to happen in other countries, including France, where people pay to see the doctor and actually live longer: but perhaps we British are peculiarly susceptible to diseases brought on by the fear of parting with a fiver.

Cases will no doubt be found of old folks who have died because of lack of medical attention through absence of cash. But before we dissolve into the kind of tears that used to be brought on by the description of the death of Little Nell, let us remember that genuinely ill people often have to wait a long time to see their doctor precisely because their doctor is seeing so many cases that do not need his attention. …

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