Birthcare lottery

Upto 20% of Britain's "home-style" birth centres may be closed due to the NHS's "funding crisis" (read, "spending crisis"), the Sunday Telegraph reports. Your options during childbirth will now, even more than before, depend on where you live and the vagaries of government allocation of funds, and NHS managers' priorities.

The point is not that medical provision should not be constrained by financial reality. It should be constrained far more than is currently the case. The point is that the people deciding which facilities to close have no idea what the preferences of their patients would be. Of course, when healthcare is free, there is demand for more of it than the country can possibly afford. In a world of limited resources, the only way to discover which services patients would prioritise (or indeed, what part of their budget they would like spent on provision of healthcare services) is to charge a rational price for the provision of those services and see whether the levels of demand at realistic prices justify its provision. Some of the birth centres would probably still close under those conditions, but others might well be kept open through popular demand.

It would be easier to accept that a facility could not be kept open because there was insufficient demand to cover its costs, than because the healthcare trust could not afford to keep it open regardless of (unconstrained) demand. But that would require acknowledgement of the lie that is the notion of unlimited free healthcare at point of use. All healthcare has to be rationed, it is just a question of whether we ration it on the basis of people's willingness to pay (in other words, their revealed preferences) or on the basis of bureaucrats' judgements about what is right for other people. That in turn would require acknowledgement of the greater lies that (a) the average of people's preferences (whatever that might be) is the answer that is right for everyone, and (b) that provision of certain goods at less than market price is the way to tackle poverty. Until we acknowledge the intellectual bankruptcy at the heart of those myths, people will continue to receive the healthcare that politicians and managers decide is right for them, not the healthcare they want.