Some conversations over the last couple of weeks have had me thinking
People seem to view entitlement differently – we all pay our taxes to pay for the core services but some of us use them more than others. I have worked for 15 years and paid my tax but been fortunate enough to not need a great deal from these services – as I see it, part of the equality the tax system creates is that those who earn more pay more and statistically are less likely to use the services and so hopefully pay disproportionally more for services used so that those who have a need can get the care and support that they require. And yes, it is wrong that often that need for increased medical care or social support is because they are earning less or unable to work. It is wrong that it is often a vicious circle.
My main issue is that there is a limited pot of money.
Even taxing the top 10% of wage earners more is not going to increase that pot of money dramatically (sorry but evidence seems to suggest that the top 10% whilst earning more are also more likely to up sticks and take themselves and the tax they pay if a tax regime gets too punitive)
The trouble is that with minimal resources and over demand, for example, the NHS is never going to be able to deliver the services we are all entitled to. Somewhere it has to give. And some people it appears are more likely to step back and not insist on the system giving them their entitlement.
I was shocked to read a survey on one parenting site asking if people would lie to get an early scan for ‘reassurance’. Early pregnancy is awfully worrying, early pregnancy loss is horrid but if the NHS could afford to give early scans they would. If someone lies about a threatened miscarriage they take resources away from someone who may have a real and greater need. When I had a threatened miscarriage with Littler at 18 weeks I was told that whilst guidelines suggested they should scan me to confirm if the baby was dead or not but there was insufficient funding and I would have to wait three weeks for an anomaly scan because they just couldn’t afford to scan miscarrying women after 12 weeks. They gave me a shot of anti-D, a pat on the arm, advised a bit of bed rest and to come back if the bleeding got unmanageable or the pain unbearable. Never mind the pain of not knowing what was happening. Fortunately I had a brilliant midwife who spent a long time listening to my tummy and eventually found a heartbeat.
Scarce resources also come into the argument about what sort of birth a woman is entitled to. No woman should suffer unnecessarily, should have pain or fear during her births but where do you draw the line between allowing women to make the decision about whether to submit to a c-section and medical professionals doing so. A c-section costs several multiples of a ‘normal’ delivery plus has the attendant additional costs of post operative care.
Could the scarce resources be better spent on educating women ante-natally to reduce the likelihood of problem births with associate post birth trauma and interventions?
Should counselling be offered to empower women about their birth choices?
Or should women be able to choose to not go through labour, especially if they have had a difficult experience previously?
Where do we draw the line?
Does entitlement mean we should automatically get what we are entitled to or should any consumption of scarce resource be balanced with an understanding that if you use this resource (and perhaps you didn’t need to) someone’s Grandparent may not get rehabilitation after a stroke, someone’s baby may not get sufficient neonatal care, someone’s husband may not have a heart problem detected early enough to save them?
Should use of the NHS come with warnings like cigarette boxes saying if you use this service then x cannot happen elsewhere?
How do we deal with not having enough money to give everyone everything they would have in an ideal world?
Where do we draw the line between entitlement and desire in a world of scarce resources?