Wednesday, 2 January 2008

A Sad Anniversary

The NHS is 60 years old.

Any criticism of this national institution is usually spun as criticism of the sainted nurses and doctors who work therein. Let's get this straight. It isn't. It's bureaucrats I hate, not the medical profession. It's socialism, the root cause of Bureaucrats I blame for rubbish hospitals, not the poor bloody infantry dealing with the skewed incentives built into the system of healthcare delivery that a vindictive, spiteful and short-sighted government put in place after the second world war.

Now, the NHS enjoys the misplaced affection of the people of this country who forget (or have been brainwashed into forgetting) we used to have a world class health service before it was nationalised, and now we have a distinctly second rate one: on all measures: research, cancer survival, operations, waiting times, cleanliness we perform less well than France, Germany, the Scandinavian countries, Australia, when we had one of the best at year zero. Our Peers have not flattered the NHS by copying it, with good reason.

Now your average lefty will use the word "underinvestment" probably with the words "decades of" beforehand. He will then cite the USA as the counter example. The most intelligent thing to do at this point is punch him in the face. It is not about the money: The UK spends approximately the OECD's average per head on health per capita. What is interesting is that the public spending is more than the rest of Europe, but there is almost no private sector provision in the UK. That is where the difference lies. Nor is the USA's pure insurance with limited state-help the only other option: No other country has an NHS; most have a mixed, decentralised system. No other country's health service is Free to its users.

Health spending in the UK is, and always has been adequate. Despite this we have far fewer doctors per head of population and fewer Nurses than the OECD average. Life expectancy is in the bottom Third, and survival rates for serious conditions are rarely anywhere near average. If you're British, don't get cancer.


The answer is in one of the NHS's founding principles: "free at the point of delivery", and in its name: "National". Because there's no cost to patients, they are more likely to seek unnecessary medical help. This creates costs and removes resources from the deserving. It means an army of bureaucrats is required to direct resources as there is no information on demand coming from a market. Bureaucracy is rarely efficient or responsive and there are inevitable delays in deploying innovative treatments which are made available rapidly to those in insurance-based systems. This explains our poor cancer survival rates. Secondly, if you aren't rationing by price, and no cost is put on time, waiting lists are the inevitable result. They are noticeable for their absence in all other systems. Again delays in seeing specialists are a cause of poor survival rates in the UK for most serious conditions. National means the world's second largest employer has been created. Efficient? Responsive? unlikely!

As a result of this bureaucratic control, politicians see fit to meddle: We're left with ridiculous ideas like Cameron's of fining tax-financed organisations, the PCTs for each hospital acquired infection; or the Prime Minister pontificating on cleaning regimes, as if 1.3 million employees can be micro-managed from the centre. Resources are scarce, and it is important to direct what you have most efficiently and markets do that most efficiently. It is the "Free at the point of delivery" which ensures that private medicine is a marginal part of total expenditure, and ensures shortages of doctors, equipment and time.

The NHS: the third worst thing to happen to Britain since the war, behind the Welfare state and the European Union. We need to dismantle the NHS, return to local management by doctors who should start charging patients for doctors time. Insurance needs to be built into the system and private cover needs to be tax-deductible.

Unfortunately you need to undo 60 years of Socialist propaganda before the public will accept what needs to be done. Either that or have a Government with balls the size of watermelons, with a mandate to change the system and there's no chance of that happening any time soon.

So Britons will continue to die younger than necessary. Well done NHS.


Gary Monro said...

Amongst your various salient points the one with which I most concur is your observation that, being free, 'users' (I think that's what we're called now) seek out unecessary treatment. Yes, they would - and, worse, they become more ill as a result of never having to factor health spending into their normal day-to-day spending.

Not that anybody wants to be ill but, unfortunately, people will more likely take their health seriously if they know there's a financial penalty for being sick. The NHS takes away that penalty so people allow themselves to get ill, safe in the knowledge they'll be put right for free.

Thus the NHS - which has done fantastic work for members of my family, incidentally - inadvertently makes us sicker than we might have been without it.

Anonymous said...

God you do talk drivel!

Rarely have I read a piece of such ill-informed dogmatic rubbish.

Power to the People and a Happy New Year


Anonymous said...

So many truths and all at once. You really cannot say such things to the British people who were long ago pithed by modern democracy. The people are reduced to zombies. They do not even realise that they have been down graded to delta status by the political ruling class, who can elicit voting reflexes by uttering such words as "Democracy", "Equality", "For all the people, not just the few", "End of Boom and Bust", "I take no lessons from the Tories". Politicians can lie openly and without shame and though we realise it, we accept it. They learned, from the left, to condition themselves by autosuggestion at least six decades ago. Remember average intelligence is only average, but it carries a vote, Lennin and Stalin, Mao and Pol Pot knew this so well.
So the people now vote for benefits, average health, and average education, which is average, and they know well that someone else will have to pay. The poor and the shiftless will be the majority voters for the majority party. That Sir, is why we have three political parties all of the left.

Jackart said...

Joel... You're a socialist, who actually believes that the NHS is something this country can be proud of. You react like a born-again christian being having an atheist point out the absurdities of the Bible. You haven't thought about this. You've just accepted the shibboleth.

Just calling something "ill informed drivel" doesn't make it so. That's Alastair Campbell politics, that is, and I expect better from you.

Anonymous said...

Come up with a valid argument and we can discuss it properly. What you have just written is plain nonsense.

No one suggests the NHS is perfect, but it is not 'free'. We pay for it in taxes. It is 'free at the point of delivery' to guarantee everyone can get healthcare - something not available in the US.

Sure, suggest some improvements but by blindly opposing the NHS, imagining it is some Soviet-style behemoth, feverishly linking yourself to libertarian, neo-Darwinist 'survival of the fittest' arguments, you are doing yourself a disservice.


Jackart said...

I clearly state "free at the point of delivery" and subsequently use "free" as shorthand for that. In suggesting that "Nor is the USA's pure insurance with limited state-help the only other option" I'm implicitly rejecting that in favour of the kind of mixed approach common in the rest of the world.

The problem with British Health system is first that it is Free at the point of delivery with the second being that it is national.

I argue for a significant degree of state provision. There should be widespread insurance, with some of the poorest being supported by the state. People should pay up front for some services to prevent abuse.

This is not some libertarian fantasy. I'm being realistic and looking at what every other country does. The NHS is a socialist fantasy and it costs lives.

Twig said...

Agree 100%. Anything of value given for free will be abused. In France you get healthcare free at the point of delivery and you receive a bill afterwards. The govt. will then contribute about 75% towards the bill. That's why their healthcare is better than ours because the users pay, they value it more they know what it costs and they do not abuse it.
Why should IVF be paid for by the NHS? – if there were a charge for IVF the demand would fall and if somebody cannot afford IVF they cannot afford to raise children.
There was a case a few years ago where a young girl had her legs broken and reset on the NHS to make her 2 inches taller so that she could work as an airline cabin attendant – that is abuse; if her family had been asked to pay she would probably have settled for a job on the check-in desk.

CresceNet said...

Gostei muito desse post e seu blog é muito interessante, vou passar por aqui sempre =) Depois dá uma passada lá no meu site, que é sobre o CresceNet, espero que goste. O endereço dele é . Um abraço.

Twig said...

Here's the link

Henry Crun said...


The NHS is a Soviet style behemoth and that is because it is bound by government bureacracy and the target driven managerial mantality that is stifling public services. It employs more managers and administators than doctors and nurses. Doctors do not have the final say on the best treatment for patients.

I'm not a healthcare "user", I'm a patient, and which to be treated as such. This manangement consultancy drivel that people are either "users" or "customers" is just plain wrong. I have built a relationship of trust over many years with my own GP and I trust hime to tell me what's wrong with me when I visit him in his professional capacity. All too often, GPs paarticularly take the least line of resistance when treating their "users" because starting with worse case scenario first and working backwards costs too much.

I for one, would welcome a national medical care scheme sucha as I had when working abroad. My employer operated a contributory medical aid scheme where they matched my monthly contributions. Visits to GPs were covered to 75% of the cost, all prescribed meds were covered 100% and hospital stays were covered 100%.

Well, the socialists will cry what about the poor and disabled? The poor and disabled are treated by the state (as they are now) the indolent will have to prise themselves away from their plasma screens and just have to go and work for a living just like the rest of us.

recyclist said...

If you had looked a bit more closely at the graphs available on the OECD website, you would have seen that your argument is utter nonsense.

Yes, we are bottom of league table for survival rates from colorectal cancer, and a whole lot of other stats make the NHS appear relatively poor.

Your disdain for your fellow British must have blinded you to one particularly telling statistic available with this graph:
We are 20th out of 28 in terms of doctor consultations per capita. Hardly evidence for the British being freeloading hypochondriacs.

Jackart said...

It's not central to my hypothesis, that the NHS is the wrong structure. Seeing a GP is easy, but you try seeing a specialist...

How many GP consultations will you need to persuade him to refer you?

Trixy said...

I wrote something similar in an essay during my economics degree (although with more equations. And words.) and they didn't like it very much. They loved the one I wrote about big business ripping off farmers, though....funny, that.

Anonymous said...

Well and soundly stated Jackart. Competition breeds excellence and a nationalized system allows neither. Here in the U.S. the costs for elective procedures not covered by insurance have plummeted.
A good example of this is "Lasic" or laser surgery done to improve ones eyesight. Because this is
elective it is not covered by most health insurance plans. This means that physicians who specialize in this procedure have had to compete with each other to attract business. The result has been that the quality of care has gone up significantly and the cost has dropped nearly 50% over a ten year period. There has been a similar but inverse phenomena here in higher education. The cost has risen steadily as the "Federal Guaranteed Student Loan Program" has blossomed.
When American universities gained access to the giant Federal tit, they raised the cost of everything
and continue to do so.


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