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Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

Samizdata quote of the day

It’s the NHS first got me thinking how the power of the narrative distorts so much of how organisations & ideas are viewed. This one starts; “Staffed by dedicated doctors & caring nurses the British National Health Service is the envy of the world…”

It runs for a couple of paragraphs, was first written the day before its inception & has been repeated so many times it’s probably encoded somewhere down in our DNA by now. It’s not just that the public believe it. Almost everyone connected to the NHS do as well. Doctors, nurses, administrators, politicians. Even most of the media. It makes it impossible for any of them to view it with a clear eye.

The incidents quoted above… others much worse we’ve heard about in the last few years… they should be part of the narrative as well but it just rewrites itself over them. Edits them away so the next time comes as exactly the same shock as the one before & the one before that. No-one actually learns any lessons or does anything because the narrative reassures them it’s not necessary. They’re just aberrations. Momentary & inexplicable blips in an otherwise perfect system. Or just signs that even more money needs tipping into it. That the engine that’s coughing & banging & spewing out smoke & broken parts would be running as sweet as a sewing machine with just a little more fuel.

- Commenter ‘Bloke in Spain’

25 comments to Samizdata quote of the day

  • David Bouvier

    The objective evidence of poor outcomes, poor care and a callous indifference even resentment of patients is exactly what some would predict for a state industry.

    It has taken a couple of generations to erode the social capital of the healthcare system but it is going fast. It is unable to renew itself. It is like a Soviet housing estate – unrepaired, decaying.

  • AndrewWS

    The power of the narrative also distorts how the people who run the system think of themselves, which is why the NHS reacts so badly to criticism and hounds whistleblowers so viciously.

  • llamas

    David Bouvier wrote:

    ‘It has taken a couple of generations to erode the social capital of the healthcare system but it is going fast. It is unable to renew itself. It is like a Soviet housing estate – unrepaired, decaying.’

    and I nominate that for SQOTD.

    Only to add that the process was not solely one of erosion – there was/are several healthy and active movements trying specifically to ‘reform’ the social capital of the healthcare system, along the lines of feminism, ‘social justice’ and a half-a-dozen other fads and fancies. All of these movements have established cadres and 5th-columns within the NHS, none having anything whatever to do with the provision of healthcare.

    llater,

    llamas

  • Cavalier

    The NHS behaves just like all the other nationalised industries do/did – it is the National Coal Board with a smiley face-mask on. I spent some time in NHS hospitals in the early 1950′s – the golden era, remember. The nurses were nasty, ignorant, sadists and the doctors were pompous, self-important scoundrels on the make. As that idiotic old socialist Shaw once said “All professions are conspiracies against the laity.” The medical profession are no different, indeed they are the founders of the shaman tendency.

  • RRS

    I submit that it is * not * the narrative that sustains NHS in the UK and is bringing about the development of comparable institutions in the US. The depersonalization of services is the natural result of bureaucratization of any facility or institution through which the services are accessed or provided.

    The social orders in most of the developed economies have developed sufficient coalitions of interests to become Rent Seeking Societies.

    In a Rent Seeking Society, a sufficient proportion of the members have determined to find methods of using the mechanisms (and hence the coercions) of governments to achieve access to, or benefits of, services, assets and security for the particular groups of interests in which they are members. In doing so they create requirement for “departments,” “commissions,” and “bureaus” to respond with those provisions through governments for those particular goals of a Rent Seeking Society.

    The nature of Rent Seeking generates the development of bureaucracies in governments, and in turn the further development of bureaucracies that manage or operate the facilities to serve those politically generated demands.

    In order to function, bureaucracies must operate as hierarchies in accordance with fixed procedures that require extensive efforts to circumvent. Bureaucratic operations, by nature, must be impersonal and de-personalized, otherwise the fixed procedures will result in ineffective or uncertain results.

    A Rent Seeking Society will accept the deficiencies of bureaucratic depersonalization so long as there is a perception that the perceived overall benefits to a sufficient proportion of the members exceeds the
    known (and publicized) individual injustices, tragedies and farces.

  • bloke in spain

    To add to my original comment, it’s worth considering how the NHS & particularly its supporters react to exposure of its failings. How often the words “This isolated case shouldn’t detract from the dedicated….” “The effect this unwarranted claim has on morale the hardworking & caring….” are in the preamble to any response. From then on, it’s the critics of the organisation who are on the back foot as any criticism of the part becomes criticism of the whole. Transpose that argument to almost any other sector. Estate agents. Banking. How would it fare? (Listen to the laughter) But then they don’t have decades worth of narrative to protect them. In many cases the opposite. Their narratives are invoked to condemn, even when the failing isn’t theirs. (Why you’d hear the laughter?)
    How much does the power of the narrative effect the way organisations & issues are viewed? The BBC seems to have got by on its for decades. Under attack now but holding up much better than the press whose own narrative runs the other way. AGW’s a recent one, but grafted on to the already running environmental saga. Try & dispute any of the evidence or strategies for reducing & you’re drowning polar bears or just a denialist in general. Saves having to confront the details.
    The latest’s a doozy isn’t it? Corporate tax avoidance. There’s little evidence whatsoever of any actual tax law breaking so the whole thing’s turned into a morality narrative. Company C is accused of avoiding tax. Company C conclusively cleared of avoiding tax. Often in court. Doesn’t matter in the slightest, because the arguments are so complex bothered to understand them. The narrative is more persuasive. It’s getting to the point, just choosing a well known name at random’s enough for a conviction. No evidence or trial required. And with this one, we can actually watch the thing being written. Identify the handwriting. Few axe-grinders with agendas for the plot, UKUncut or the US equivalents to provide the knights in shining armour, various columnists, talking heads & slebs to take up the tale. It’s got to the point you can throw anything in the mix, the narrative incorporates it.

  • Whaddya Mean

    For something that is ‘the envy of the world’ there doesn’t seem many people rushing to replicate it.

  • Jim

    Given it took the USSR approx 70 years to go from inception to disintegration, crushed under the internal contradictions of socialism, I reckon that the NHS will hit the wall around 2030 as its a pretty much perfect mirror of a socialist society, and as such will suffer the same fate. I’m giving it a few extra years as it is funded by a sort of capitalist economy which will make more resources available than a command economy could.

  • Rich Rostrom

    Jim: I’m giving it a few extra years as it is funded by a sort of capitalist economy which will make more resources available than a command economy could.

    Partial, gradual failures are much more insidious and dangerous than obvious complete breakdowns.

    Thus bad governments which are obviously bad get overthrown or voted out quickly.

    Bad government which do a fair amount of things right persist, and can do even more damage in the long term. This is especially true when they are propped up by favorable external circumstances, such as improving technology, successful capitalist businesses, or a stream of cash from resource exports.

    Bad governments adapt, like all parasite organisms. Those that do too much obvious damage get killed off. The survivors are those that loot and damage as much as possible without provoking lethal reaction. They “learn” to operate just on the safe side of the line.

    But even well-adapted parasites can eventually kill their hosts. And the damage they do is more likely to be fatal when it is finally perceived.

  • lucklucky

    Well Communism lasted 80 years and it is still kicking in many heads.
    With brainwashing millions can be killed and still be praised.

  • John W

    “I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.”

    - Atlas Shrugged.

  • James Strong

    The quote from Atlas Shrugged shows that, although she was a philosopher of merit, Ayn Rand was a lousy writer of prose fiction.

    All of that was what Dr. Hendricks ‘said’. Awful; it’s halfway between an academic paper and an academic lecture. No normal person has ever *said* anything like that passage.

  • Stephen Willmer

    James Strong, she wrote in her fiction like a Victorian, and novels of that era are full of such stuff.

  • PeterT

    It isn’t possible to ‘write well’ as a fiction writer, if you are trying to explicitly convey a deep intellectual message at the same time. And I find Atlas Schrugged better written than Heinlein’s work for example. My only critique of Atlas Shrugged is that it is far too long, more so than is required to deliver its message.

  • I forget who it was who commented on one of the blogs (could have been at Tim Worstall’s place) who said the reason airport security is so miserable for the passengers is because the passenger isn’t the customer: the government is the customer. I’d not thought of it that way before, but it explains so much about state run “services” everywhere: the government is the customer.

    And so it is with the NHS. The government is the customer, and provided this customer is not going to have its reelection chances reduced by the NHS, then the customer is happy. This is why the NHS leaps on any criticism from patients, because it makes the customer look bad. The idea that the patients are the customers in the NHS is laughable, it is quite clear on whose behalf the organization is run.

  • Richard Thomas

    Just to state that if this was made QOTD because of my nomination, I was actually nominating Perry’s statement that was just above bloke-in-spain’s (which was presumably in Smiteland at the time). Thus this SQOTD may have actually been selected by the Smite mechanism. My god, perhaps it’s becoming sentient.

  • Paul Marks

    Sadly in most major nations government control of health care is increasing, not decreasing.

    Reform does not appear to be a real option (in this or anything else), the present collectivism will grow and grow….

    Till it collapses.

  • RRS

    P M

    Exactly! And the “present collectivism” is comprised of the Rent Seeking Societies of the Developed Economies.

  • To me the human negligence in these terrible cases is not necessarily the fault of gov’t healthcare per se, since there are similar horror stories in the U.S. as well. What damns the NHS in my eyes is that it has to ration care, sometimes to tragic effect, since scarcity perforce follows artificially low prices.

  • Laird

    TSI, yes there certainly are instances of horror stories like this in US healthcare. But they are rare, and tend to get corrected very quickly. (Also, when they do happen people get sued for large amounts of money, which threat tends to focus the mind of hospital administrators and personnel. I don’t think that happens in the UK.) Furthermore, the worst examples seem to occur in VA hospitals, which are (wait for it) government controlled facilities. So I think that pretty much it is the fault of government healthcare per se.

  • doug galecawitz

    you could easily be describing any piece of government, or the whole thing, or any scandal of corruption, or all of them, with that last paragraph. it long ago ceased to shock me that with every fresh corruption scandal or imprisoned politician people would ultimately look at said politician as an aberration. never could the curtain be pulled back to reveal that the whole bloody game is corrupt to it’s very sub-atomic core.

  • Paul Marks

    RRS is correct.

    And “rent seeking”, parasitism, can only go so far – before the host (civil society) is killed.

    As for me….

    The culture throws me.

    That was brought home to me by the “Games” – or rather by the, much cited, ceremonies around the games.

    So the basic cultural principles of Britain are……

    Pop music (I will make no comment on that stuff), “humour” (of sorts that mean nothing to me) and the NHS?

    Many counties have government hospitals.

    Some Roman Emperors established them…..

    But, in Britain, government hospitals appear to be a central cultural principle – a sacred one (a substitute religion for an atheist country).

    Very well, I note this alien culture.

  • RRS

    PM –

    More in sorrow than solace:

    “The essence of culture is interpenetration. From any part of it the searching eye will discover connections with another part seemingly remote.”

    Jacques Barzun

    The Culture We Deserve (1989) p. vii

  • Paul Marks

    RRS – yes.

    Jacques Barzun.

    The last great representative of the old conservative French culture (that left bank insects like Sartre revolted against).

    And a reminder of a once great influnce in American intellectual life – and a positive influence.

    Hard although it is for the young to understand – once French culture was (in part) a good influence.

    Bastiat (and the rest of the French School) provided a clear alternative to the interventionism of most Germanic economic thought. English economics was (contrary to what is often claime) often a confused mess – as was English philosophy.

    A.L. Perry and so on were direct followers of the French School.

    And in general culture – the New Humanism of Irving Babbit and P.E. Moore (the main alternative to the left in American culture) had a French source.

    Cool (without being cold), logical – and defending univeral standards and principles.

    Against Germanic historicism (which is really relativism) and Pragmatism (which is American relativism).

    “I know all this Paul”.

    Yes – but not many people do.

    Especially now.

  • Paul Marks

    Two ironies of history.

    That Jacques Barzun (the heart of French, indeed Western, classical culture) should outlive the leading “young rebels” against what he stood for.

    And that the heart of classical European culture should end up living in Texas.