Advantages–Disadvantages — Private, profit-making companies running medical services

Health care is an awkward commodity: the buyer is frightened, poorly informed and rarely in a position to shop around. That is why, although privately run medicine brings real benefits, I believe they are outweighed by the damage that the profit motive does once companies are trusted with a nation's health.

The case for private provision rests on competition. A clinic that loses patients loses income, so it has every reason to cut waiting times, buy modern scanners and treat people courteously. This is not mere comfort, since faster diagnosis of a tumour can decide whether treatment succeeds. Private hospitals also relieve pressure on public wards: each patient who pays for a hip replacement elsewhere frees a bed for someone who cannot. Where the public system is underfunded, this extra capacity may be the only way some operations happen in reasonable time.

These gains, however, come with costs that fall on the people least able to bear them. A company paid for each procedure profits from doing more, not from keeping people well, so unnecessary tests and treatments are a predictable result. Private firms also tend to cherry-pick profitable cases, such as routine surgery on healthy adults, and leave emergencies, chronic illness and the elderly to the state. Meanwhile, they recruit doctors and nurses who were trained at public expense, so the public service is left with the hardest work and fewer hands. The United States, where commercial insurers and hospitals dominate, spends more per person than any other rich country, yet medical debt remains a common cause of personal bankruptcy.

On balance, private health care works well as a supplement, but its advantages shrink and its harms grow as it replaces public provision. Because speed for those who can pay is bought with poorer access for everyone else, which is hard to square with the idea that health is a basic need, I consider the disadvantages the heavier side.