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[afro-nets] Privatisation will wreck UK's NHS (4)
- From: Peter Burgess <Profitinafrica@aol.com>
- Date: Fri, 7 Oct 2005 12:48:06 EDT
Privatisation will wreck UK's NHS (4)
I would like to take up the point that "The web is great for
transparency and accountability. However, please remember that
those who are most vulnerable to pricing, are usually the ones
who cannot access internet."
In my view, the vulnerable should not have to worry about being
"ripped off"... the system should be "safe" for the vulnerable.
This is what a civilised society should be doing... and the web
is a wonderful way to start a process of transparency and ac-
In my view public or private is not an important issue at
base... the question is performance. Public tends to be awfully
inefficient and costs high with low performance, and private
tends to be high performance and high profit and high prices.
Neither, at the limit, is what a civilised society should be
faced with. The idea of equity, as in fairness, and the idea of
a reasonable relationship between costs and prices and results
seems to be at the heart of the issue. But what constitutes a
reasonable relationship between these things.
I will argue that this is not something the vulnerable are in
any position to determine. But it is something that the account-
ing professional should have addressed. Sadly, the accountants
have dropped the ball on this, as in many other areas of profes-
sional conduct... and we are left with a simplistic choice be-
tween high cost low performance public sector and low cost, high
profit, high price services delivered by the private sector.
Neither of these are good choices for a modern civilised soci-
I always try to remember that everything has a cost, and every-
thing has a value. If value is bigger than cost, then society is
ahead as a whole. But who covers the cost is then a secondary
question... is it the government and the taxpayer... or is it
the user that gets the value... or it is something in between. I
will argue that it is something in between, and the issue of
"affordability" needs to get into the equation as well, and the
question of social equity.
One of the successful new forms of organization that has emerged
in the USA during the past two decades is the idea of private
public partnership... it has made a huge difference to the qual-
ity of life in New York City. The reason for success... a number
of things that are all converging for the benefit of society and
all the many stakeholders.
But many new ideas and innovations do not have good outcomes...
many initiatives have a hidden agenda that benefits the wrong
people. And many initiatives happen because there is just no
other way to address a catastrophic failure... and I would argue
that health in developing countries has to face the crisis of
totally failed public finance and therefore absolutely no abil-
ity on the part of the government to fund what needs to be done,
and a hopelessly complex donor oligopoly that does almost no
performance analysis at the grassroots level, and what it does
in the way of monitoring and evaluation is generally too little
and too late.
I am not against privatization... but I am against the profi-
teering that usually results when a private monopoly is estab-
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The Transparency and Accountability Network
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and others in South Asia, Africa and Latin America