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The three paradoxes of private medicine
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     EDITOR—The online debate of Longley's personal view starts with criticism of the author, followed by attempts to understand his rationale and psychology and a general discussion of public and private healthcare systems and their political implications, ending with examples—positive and negative—of the results of their coexistence.1

    Most correspondents take issue with Longley's three paradoxes: paying for health care can be disempowering, private medicine does not seem to cost anything, and the joy of clinical resolution is tainted by shameful feeling of compromise and guilt. Many find nothing wrong with paying for private medicine, but if someone doesn't like it, he or she doesn't have to do it, as "not everyone is cut out to travel." Payment for service is not a reason to suspect ulterior motives in staff—after all, even staff in the public sector are motivated by money, in the shape of a salary.

    Several correspondents try to analyse where Longley's feelings of guilt might originate. The fact that the UK population has become used to poor service since the second world war—and that this attitude is endemic—is one candidate. On the whole, correspondents agree that hypocrisy is worse than shame or guilt, and some point their fingers at the author for this.

    One correspondent illustrates with her own experience that the NHS is not worse than private care; another reminds us that Longley would have reached the reverse conclusion—private care is no better than the NHS—if his expensive private consultation had resulted in a year long wait till the next appointment. And a third rightly points out that it's not NHS care that is poor but access to it.

    A US practitioner asks why it is acceptable to be taxed for care and have to pay again to get decent customer service and, further, why every patient should not have the choice that paying with real money brings. A general practitioner from Southampton reminds us that certain essentials in life—housing, food, water, clothing—are not free either, so why expect something less essential to be?

    Two correspondents illustrate with examples what is intrinsically wrong with private medicine in the United Kingdom: it enables people with money to jump the queue before being put back into the public system. This may be a serious drain on resources, but it also begs the question whether anyone with money or initiative, or both, should have that advantage.

    In contrast, Switzerland and France are cited as examples of countries where a combination of private and public systems works well, and a London based fertility specialist explains how private and public medicine together have advanced medical research in the United Kingdom. Maybe another US doctor has a point when he says that Longley should celebrate the strengths of both systems instead of shedding crocodile tears?

    Birte Twisselmann, technical editor

    BMJ

    Competing interests: None declared.

    References

    Electronic responses. The three paradoxes of private medicine. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7465/579 (accessed 6 Oct 2004).