Give an inch...

We took our 8 week old son to our local GP this week after a real struggle to book an appointment. The media coverage of swine flu has clearly played its part in filling doctor's surgeries across the country and around the world, so access to the diaries of medical professionals is tough. Having said that, on arriving at the surgery there was a large white board in front of the receptionist's desk with two numbers on it - 216 and 178. These were the numbers of hours of missed appointments in that surgery over the previous two months. Based on the number of GPs working there, and based on a 5 day working week this equates to around 3 hours per day, per doctor of missed appointments. What an unbelievable waste, and what a representation of how selfish some people can be.

As I sat there waiting to introduce our little fellow to Dr. Greaves I was pondering why such a situation should exist, and what should be done to correct it (I like to think there is always a solution, economic or otherwise). Fundamentally, as I have grown to believe, if you give something to somebody for nothing, they will not treat it with anywhere near as much respect as something that they have to contribute towards. While all taxpayers do indirectly contribute to the provision of the health service in the UK, their contribution at the point of consumption is nil - and to me that is where the problem lies.

The NHS in the UK has its faults, but at its core it is full of good people trying to do good things for people. It is an unwieldy and difficult organisation to run, and sadly for the employees of the NHS their position in society is undervalued. I believe that this is at least partly because what they give to people has been turned into a right for all, and this sense of entitlement and the fact that it is undervalued go hand in hand.

On a visit to Hong Kong last year, I visited a GP and paid the equivalent of £15 for the privilege - and received prescription medicine worth comfortably more than that figure. In France, there is a flat charge of around 3 euros per GP visit - a small sum, but one that I am sure guarantees that more appointments are fulfilled. The absolute level of contribution does not need to be a large figure, in fact it could be that a charge is only applied for missed appointments, but the principal that I believe needs to be applied is that in order to have a relationship that is fully valued there needs to be give and take. This rule doesn't just apply to running a health service, but is probably a pretty sound approach to running any organisation.

As Barack Obama pushes for healthcare reform in the US, he has been met by scathing criticism from the Republican right and progressing the reform bill through Congress is likely to be very tricky. At its core the aim is to provide health insurance for the 47 million Americans who do not have any, and drive down the spiralling costs of healthcare. The issue of whether a particular standard of healthcare is a right or a privilege goes to the core of what it is to be American, and is separating opinion accordingly.

In the UK the "Welfare State" concept as coined by William Beveridge in 1942 aimed to address the five "Giant Evils" in society: "squalor, ignorance, want, idleness and disease". Clement Attlee's 1945 Labour government pledged to eradicate these Evils, and the government undertook measures in policy to provide for the people of the United Kingdom "from the cradle to the grave." On the surface, a very noble and moral ambition.

The policy itself resulted in massive expenditure and a great widening of what was considered to be the state's responsibility. It would appear that the reform bill that Barack Obama is trying to push is polarizing US opinion for this reason - firstly it will be very expensive to provide, and secondly, in the context of all of the financial bailouts of the past year, it may represent a structural shift in the level of state involvement in peoples lives for the foreseeable future.

In a country that prides itself on the people in its society that demonstrate the ability to help themselves, this looks like an unacceptable form of charity. The American dream upon which the last 50 years of economic growth is based has at its core the principal that regardless of who you are, hard work will allow you to progress. There aren't many situations in the US where you get something for nothing. From my point of view, past governments haven't done enough to truly help the real underclass that is growing in their society, but I can completely understand the segments of US society who don't want to create some of the helpless aspects of British society engendered by the freeloaders using the NHS. As always there is probably a middle ground to be found, one that retains the charitable aspects of the NHS, but that also means that healthcare is properly appreciated by those who have access to it.

Something for nothing is an unsustainable situation not only for the cost associated, but further because of the way it affects the motivations of those who have access to it. As Mae West once said, "Give a man a free hand, and he'll run it all over you."