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Toot for the NHS

I was lying on a piece of blue tissue roll in one of Tony Blair’s world-class Accident and Emergency hospital departments, a few weeks ago, at around 3am on a Sunday morning. As you do, in such a situation, I was thinking about death, and Simon & Garfunkel albums. But being one who recently qualified as an NLP practitioner, under the tutelage of Californian shaman Richard Bandler, I thought to myself how can I turn this around into a positive experience? How can I come out the other side of this seemingly grim situation mentally refreshed rather than mentally battered? So I made a deal with myself. If I make it out the other side of this alive, I stipulated, I’ll turn the entire experience into a piece for Samizdata. You see, some of us mad-eyed libertarians really do care.

So I was going to bend your ears with a Theodore Dalrymple-style diatribe on the drunken street scum of Berkshire, around me, demanding to be allowed to smoke, and arguing with stoic nurses while dripping with blood from self-induced beer-night injuries. I was also going to mention, in passing, the unpleasant tone of the queue managers, the uncomfortable beds, and the reasons why I was waiting to be seen, after a MASH-style nurse triage, rather than why there wasn’t already a swarm of surgeons all over me instantly administering reassurance, sympathy, and curative scalpel blades. But then I thought, come on Andrew, stop being such a Victor Meldrew prima donna. You’re still breathing, you sad git.

You’ve got a problem, of that there was no doubt, but at least the nurse had seen me, and had determined that a glorious English sunrise would see my smiling face for at least one more happy time before Death sent Mort along to claim his latest victim. The scum of Berkshire may have been regretting picking fights with broken bottles, and the bed may have been uncomfortable, but the surgeon would be along in a minute, right after seeing that screaming baby that had just come in after me. Maybe I wasn’t in the best hospital in the world, and maybe the NHS is crawling with MRSA, and maybe I had been made to shout my medical predicament to the receptionist, behind her plexi-glass shield, so that the fifty other people waiting could hear every detail, but at least I was in the best hospital in the nearest 100 miles, and I would have refused to swap my current position, lying on this blue paper roll, with anything other than instantaneous transportation to Dr McCoy’s sick bay on the starship, Enterprise. Thankfully my condition that night didn’t prove immediately fatal, as may be obvious. Three years at the Royal Hallamshire Medical School, in Sheffield, has made me into a dreadful hypochondriac, where I know enough to be dangerous, but not enough to be useful. It turned out that what I thought was a potential surgical emergency was something treatable by Nurofen. What a big girl’s blouse, you might be thinking, and you might be right. But what happened next, or rather, what didn’t happen next, is the real root of the problem within the NHS.

For my rather painful condition, which I later learned happens to 20% of the people in Britain at some point in their lives, usually caused by some form of trauma, might have been a cancer, an aggressive one, and that this nasty potential cause had to be excluded before any further treatment could be considered. So I thanked my nice South African doctor, which New Labour had successfully removed from the world’s poorest continent to fill the gaps caused by early-retiring UK doctors sick of endless target-driven paperwork, and asked him how long it would take to organise a proper scan. A day, I asked, maybe by Wednesday?

And then I found out why the NHS has succeeded in delivering Britain the worst cancer death rates in the entire western world. “Oh,” he said, with obvious admiration for the way the NHS may manage to treat cancers better than somewhere like, say, Namibia, though even this may be debatable. “Go and see your GP tomorrow. They should be able to sort you out within a couple of weeks.”

Within a couple of weeks! You’ve got to be kidding me? I had something inside me which could have been metastasising right now across my entire body, into my brain, into my lungs, and into my kidneys, and the NHS was going to wait a couple of weeks before taking the issue any further, before even examining me properly? “Don’t worry,” he said, almost gleeful that he could get me out of his Accident and Emergency department without any further need to treat me; this must have been given him the right to tick some box on a piece of paper, I thought. “It’s only a small chance it’s cancerous. You’re the wrong age group.” And with that, he was off, stethoscope around his neck, the way all we poncey medical students used to wear them when desperately trying to impress nurses. Only a small chance of cancer then, not a big one. That was good, nothing really to worry about. I didn’t have the heart to tell him that I too had studied those same normal distribution charts he was thinking of, and that I already knew I was in the wrong age group, at least for the bulk of cases. But that these curves had very long tails on both ends, when I last saw them, and I was well within one these tails. But I didn’t want to upset the nice doctor. He was a busy man doing his best, I knew the structure of the NHS wasn’t his fault, and I was preventing him from carrying out his duty to get that four-hour waiting time target down. Sorry doc. Next time I’ll sit outside in a tent, like they have at some NHS hospitals, as the four-hour waiting time target only applies as soon as you cross the department threshold. So if you’re held in a tent outside, you can be out there all night but the hospital will still reach its four-hour waiting time goals, as you aren’t brought in until it’s only three hours and fifty-nine minutes to go before you’re seen. Why are bureaucratic targets always just so fine and dandy? And don’t laugh America. When the Democrats get in again, and they get Medicare past you, it’s your turn next.

Fortunately, before these denizens of the state turfed me off their premises, a nice young lady doctor gave me some impressive looking painkillers, the kind they give to elephants before they shoot them, and sent me into the night, another grateful, though worried, supplicant of the producer-led NHS. Trying to take my mind off things, this led me to think of another major problem the NHS has created, one caused by a subtle jobs protection scheme long hidden under the guise of political correctness. For the government needs doctors, to meet all of its stupid target promises, so it has ramped up the numbers of medical school places. Each medical student takes at least five years to train, soaking up, along the way, hundreds of hours of consultant time, and costing hundreds of thousands of pounds per doctor, to the poor sodding taxpayer.

And shortly after many of them qualify, they give up medicine, or go part-time, to concentrate on looking after their families, often started with another doctor who continues to work in this well-protected and generously salaried, and particularly well-pensioned, state-controlled profession. This is good for the BMA, and the medical establishment, who control the student entry numbers into the medical schools and NHS career grades, as it ensures there are a limited number of doctors who can therefore demand and receive excellent salaries and pensions, as they all move in a cohort up towards lucrative consultant or GP status. Or, as one nice professor said to me back at medical school, “Just keep passing your exams, Andrew, and you’ve got a well-paid job for life. We’ve designed it to work out that way. That’s why junior doctors will always be under pressure. Because we need to avoid a career pyramid, as each junior doctor must be guaranteed a senior post when they’re older, and we can’t do that, as a profession, if we expand the numbers of junior doctors.” Oh, the highways and byways of jobs-for-the-boys protectionism. And so well camouflaged. Don’t you think?

But getting back on-topic, this constant haemorrhaging of newly-qualified doctors is terrible for NHS patients, as there is a constant shortage of doctors. However, it would seem many people go to medical school, not to be doctors, but to meet doctors who they can marry and have children with, with a comfortable middle-class salary to support them all thrown in for fun. Wouldn’t a dating agency be cheaper? Well, not to the student, who is still highly subsidised.

Although even Tony Blair’s fatuous Junta may make medical students pay a few of the hundreds of thousands of pounds it costs to fund their training, over five years, this will still be a fraction of what it costs the rest of us in tax. So the end result is that the NHS are now throwing billions of pounds at the training of doctors, while knowing it will lose many of them before they become productive, because they were only in it to acquire the right “status” in the first place, or to impress their parents, or just to get a “nice” degree, without ever expecting to work full-time. So what am I suggesting? Slavery? Should we force all newly-qualified doctors to work 60 hours a week, for 20 years, after they qualify? Even better, do we need to round up all those ungrateful drop-outs who did three years, and force them back into the profession to work under the same Gulag conditions, possibly as porters if they won’t do their exams?

Well this might be a socialist solution, I suppose, but not what I had in mind. No, what we need to do is make prospective medical students pay the full cost of their medical training, to ensure they’re properly motivated to actually practice medicine later, when they qualify, so taxpayers aren’t forced to carry the financial burden of impressing Johnny and Jane’s parents. The market will remunerate them accordingly, later, via medical charges. We also need to open up the medical schools to however many people want to train in them, so that the dreaded market will work out how many doctors we need, rather than the BMA or the UK government, in their collective wisdom, for their own convenience.

The market will also cut the cost of training as much of what an NHS doctor does in five years is complete rubbish. Yes it’s nice that every British doctor knows about virtually every area in the entire medical world, in quite some detail, but is it essential that they do so? Does a psychiatrist really have to pass surgical exams? Does someone who has only ever wanted to be a surgeon really have to study community medicine? You might think so, but it seems clear to me that these long degrees covering every possible topic are mainly about jobs protection and profession entry limitation. The market will be the best place to decide the issue. And for the market to work effectively, to maintain an evolving balanced structure, we need to privatise the NHS in its entirety, so that good hospitals, with good professionals, will prosper and spread best practice, and the bad ones will go bust with inadequate staff everywhere being forced out into professions they’re better suited to.

But, I thought, wandering through Reading in the dark, at 4am, nobody is allowed to say anything regarding the numbers of early-profession leavers, in medicine, as it’s obvious I’m talking about mostly, though not entirely, female doctors, and that this topic is a sacred cow, with often over 50% of a typical medical school’s intake being women, even though the largely male consultants give them less attention than male students, with the system knowing that many of them will fail to make it much further than medical registration and occasional part-time work at their local GP practice. And this is despite medicine being one of the most over-subscribed University courses in the country, where I’m sure many who could do it, and who would stick to it given a chance, are excluded because of the first-year pressure on places. But gotta keep those junior doctor numbers down, remember, to keep a consultant post open to every man, so the admissions tutors and the BMA never complain too much. Full course payment by each student will solve this early-leaver problem immediately, of course, as only the truly dedicated will ever apply. I know I’d certainly have been a little less cavalier in chucking myself into it if I’d known I’d be handed the bill. But what are the chances of this happening to such a profession, one burrowed so deeply and comfortably within the Leviathan? Well, they’re odds-on, if I ever become life-president of the United Kingdom with my political motto, “Government is useless, I will hand you back everything”. But unlikely otherwise.

BTW, my last political act will be to sack myself to remove the last parasite.

So where was I? Oh yes, wandering off into the night wondering, rather melodramatically it must be added, with the 20-20 benefit of hindsight, if I was about to die. Now, the sensible thing would’ve been to phone BUPA up the next day and get seen immediately by a consultant, but your useless idiot here panicked. The one last real link I have to my socialist roots is my emotive belief in the NHS, a Soviet-style monopoly to which I devoted three years of my life. So I tried in vain to sleep, something I’ve had a lot of trouble with over the last few weeks, and retreated into grateful guinea pig mode. “They must know best,” I tried to fool myself. “I’m in the wrong age group.”

Fool. Next time I’ll know what to do, but please forgive my stupidity and halfwit behaviour. It’s easy to be rational, when you have a clear mind, but difficult when you’re not getting much sleep.

So, the next day at 8:30am sharp, I booked an appointment at my GP’s surgery, and I was there by 10am being prodded and poked once again; the most private part of the NHS, the GP system, is one of its few saving graces. “Oh, we should be able to get you into the hospital within two weeks. It seems unlikely it’s cancer.”

“Yes,” I replied. “I’m in the wrong age group.” Jesus, did we all read the same textbook? What a bunch of automatons they turned us all into.

And so began the wait. Little sleep. And the wait. The postal workers strike didn’t help. “Where is my appointment slip?” I used to wonder, every morning, with increasing fury. Then after the promised two weeks had been and gone, my resolve to trust the NHS finally broke. “Right, that’s it. I’ll doorstop the bastards if I have to and they’ll have to get the police in there to get me out. I’ll make sure I take two tape-recorders and a digital camera. Outpatients Department here I come.” And then, just before I was about to drive down and physically attack the Byzantine Empire that is the NHS appointments system, a letter popped through the letterbox. The appointment letter had arrived, and more importantly the NHS appointment number within it, a veritable sliver of gold.

“Great,” I thought. “It’ll be tomorrow morning, and I’ll found out one way or the other.” And then ripping the sucker open, like a Willy Wonka chocolate bar with a magic ticket, I found out what Dr John Reid, the New Labour Secretary of State for Health, had decided on my behalf. In his magnificence, via one of his numerous flunkeys, he’d decided I needed another ten days on the shelf. Yes, that potentially aggressive cancerous condition was scheduled to be seen 24 days after I had first presented it, in its glory, to the sanctimonious monster that is the NHS. I bet Tony Blair doesn’t wait 24 days to be seen in the Chelsea and Westminster, if his toenails need clipping. I bet Tony Blair doesn’t wait 24 minutes, but then, of course, the state does need him a lot more than it needs me. All I do, along with all the other miserable suckers, is pay for the damn thing.

And so there I was, finally, this morning, Nurofenned up to the gills, nervous, and perspiring, a grateful supplicant thankful to the monster that was deigning to let me enter its glorious marbled halls. Fortunately, I had the luck to meet one of the nicest and best doctors I have ever met, a total star who would make a fortune in my free health system of the future, who gave me the good (or the bad) news, that you poor unfortunate people haven’t heard the last from me yet. Ha ha! I live again, to be accused of insanity by various Guardian readers, Europhiles, other libertarians, and men in white suits.

But Jesus H. Christ. What a terrible four weeks. I suppose if you look at it from a macro point of view, it was a sensible use of resources. It probably wasn’t cancer, and consultant surgeons are a precious resource, so from the government’s economic point of view they weren’t risking losing too much tax income, by sweating me for 24 days while I put my life on hold. And even if I’d died that would’ve been one less state pension to pay, and my family were probably protected by insurance, so the welfare costs would’ve been minimal. So let’s make him wait. We’ll get to him in our own good time. And what’s he complaining about anyway? He’s alright. Isn’t he! And Andrew, baby, it wasn’t personal.

Which is of course the point. Only a free system can deliver health care where the person matters, not the system.

And so, I can only say to Mr Blair, in the best J.R.Ewing fashion: “Tony, you can stick the NHS where the sun doesn’t shine.” From my point of view that was perhaps the worst four weeks of my life, where I was unable to work, unable to sleep, and unable to communicate properly with anyone around me, which made my family’s life a total misery coping with this morbid Klutz. What a banana. And they call this a ‘service’?

In the sense, of course, that the bull services the cow.

My experience, and the similar experience I’m sure of millions every year in the United Kingdom, in a nutshell, is that this is the battle we have to win, the direct fight between the individual and the state. Here I am, a piddling UK taxpayer, being forced to hand over at least £8,000 pounds a year to a compulsory NHS health insurance policy, for my family, whether I want to or not, and all I get back is something I wouldn’t pay £800 pounds a year for, in which I may be lucky or unlucky depending on which specialists I’m designated to see, which is dependent on where I live in the country, and on which particular waiting list target the government, in its vast munificence, is concentrating on, at that particular moment in time. Yet that massive wedge of coerced tax, extracted ultimately at gunpoint from my wallet, prevents me from being able to afford proper health care, for me and my family’s benefit, which on a free unprotected market would be better and cheaper, anyway. Well sod that. From now on it’s BUPA all the way, either through insurance or direct payment, with as much private health care as I can afford to provide to my family. Professor Hoppe wants me to try to withdraw from the state, to bring about its decline, and I shall do my best to meet his stipulation.

And pity the poor sods who do find, after such waits, that they do have cancer. I shudder to think how long they’re currently waiting for the actual treatment. And here’s where another old phrase comes back to haunt me from days in Sheffield. I can’t remember who said this, perhaps some sarcastic oncologist or other, on a bad day in Sheffield’s Western Park hospital, but the refrain was like this. “The patients have to wait so long for radiotherapy, these days, most of them are dead before they get here.” Good for clearing waiting lists, I suppose. And for keeping down the payout figures on government pensions. Toot for the NHS? I should coco.

That this monolith, the NHS, has survived so long, is a testament to the virility of the free market which sustains it via taxation, with inflation-busting increases in spending every year for decades failing to realise much in the way of improvement. Someone else may have the exact figures, but a 20% increase in spending on the NHS recently got us something like a 1% improvement in productivity. Let’s just thank God that more of the British economy isn’t run on these Soviet lines, these days, as it used to be in the 1970s, or we’d all be down the tubes. Maintaining hospitals in this hideously inefficient manner surely cannot continue for much longer. I jest of course. I’m sure it will continue indefinitely until the British people wake up.

However, spitting in the wind as I may be, as an ungrateful taxpayer, who has only had to take this merest brush from the NHS’s callous disregard for human life, I demand that this system be changed, and that the people who work within it, and the patients who are forced to use it, are all freed. Immediately. Give me back my money. I am not an NHS number. I am a free man.

The sooner the NHS is privatised the better. It cannot come soon enough.

That, and I’m going to claim maximum marks for managing to sneak the word ‘ haemorrhaging’ into the piece above. And tonight I’m going to drink a very large bottle of champagne. Cheers!

21 comments to Toot for the NHS

  • llamas

    Andy Duncan – I am glad that it turned out to be nothing serious.

    More than this, affiant sayeth not.



  • Tony H

    Cheers! to you too, Andy (raises glass of Chilean Merlot to lips) and thanks for an absolutely stonking read – cogent, impassioned, sincere and a bloody ripping yarn. I shall copy this (anonymised) to a GP friend of mine for his comments. Never mind Dr Dalrymple (pretty readable himself) you ought to be in the Spectator or some other journal of record.
    When my brother was dying earlier this year in a NHS hospital, I felt almost guilty at my constant reflections upon the failure of the sluggish bureaucratic behemoth to serve my brother and assist his (skilled, caring) medical practitioners in curing him. You articulate my criticisms far better than I could.

  • James Versluys

    Having been to the great NHS before it was considered a boondogle*, and the shock to the system was more than enough to make one pray for the horribly unequal care of the American Vulgnation. In point of fact, I went to the same hospital/rec center that you did. Except I hadn’t had my full Innocents Abroad experience yet, and was thus under the impression Britain was an industrialized nation. Sorry, sorry, musn’t judge, musn’t be…

    Well yes, judging is good. The care managed to suck and blow at the same time, which I am sure is a physics anomaly. It was insane: I went for the only thing I ever go to the hospital for, which is to say a martial arts injury.

    I had been two years previous in an American emergency room, and had to wait too. The American hospital, a smallish regional hospital on the outskirts of Houston, was filled with immigrants and the various effluvia and errata of society -it was the ER room I was close to, not the one I would have initially chosen- and yet I was fed cookies and tea (real tea, a kind a good englishman would not have sneered at) by a helpful woman looking after the needs of the waiting. On a difficult friday night I waited 90 minutes and got an X-ray for a mere sprain.

    At the excellent, progressive, forward thinking NHS palace, I was forgotten. Entirely. I don’t know how it managed, but after I’d checked in, they lost everything (this being ’95). Terribly sorry old chap, let’s do this again. So they checked me in again a mere 7 hours later. Did I go to the front of the line? Dear heavans no! How silly of you to ask. Instead, I went through the machine-processing medical wait again and, during monday at one in the morning, had to wait a mere five more hours to get treatment.

    Then the treatment started. Thank Vishnu! Well, don’t thank him yet, because then I got left on one of those beds (which were, admittedly, comfortable and not the ones you described), where I waited a mere two hours to talk to the doc. I would tell you how he dealt with the injury and what further transpired, but I fear for your sanity at that point and won’t subject you to yet one more horror story.

    All in all, I found out that despite the horrifying care stuck next to vicious yobs (oh! And I got in a wee fistfight right there in the waiting room. Did I mention! It appears being an American, I’m not loved by everyone on the planet! I know, it’s too shocking to be true), that the whole business took so long I could have gone to the GP monday morning.

    The moral to all this is a tad obvious, namely that avoiding socialized medical care is paramount. As a good, straightforward, stupid American rube, I will do the good, straightforward, stupid American rube thing and start shooting when it comes round our way. But then I’m an American, and I would say that, wouldn’t I?

    *- Wait, was there such a time?

  • zack mollusc

    ……and if BUPA screw up, or complications set in, they dump you back onto the NHS.
    BUPA are cherry picking (and who can blame them, it is a business).

  • Rich

    Whilst I do support a private health system, it is worth noting that it is not all roses.

    Being somewhat of an adventurous chap in my younger years, I’ve seen the inside of the emergency room a few times in the NHS. A few years ago I moved to the States. Here’s what you have to face:

    Finding health insurance in the first place. Many places offer health insurance as part of the job, plenty don’t. Those that do, nearly all require a copayment. A lot of those that do are reducing their coverage, increasing their copayment requirements or doing away with it altogether. If you have a pre-existing condition and can’t get into a group insurance scheme, forget it. If you have to pay for your insurance yourself, it’s damn expensive and costs are rising above inflation every year.

    Lose your job, you have to keep paying those insurance premiums. So not are you worrying about finding another job and paying the mortgage, you need to keep the health coverage up too.

    I had to take a trip to the emergency room recently for a mysterious pain. The pain went away on its own over the course of a couple of hours. The Doc couldn’t find anything but I had an X-ray “just to see”. Then (over the course of several weeks) a visit with another doctor, then another doctor then another surgical procedure “just to see” end result after $4000 (after the discount the insurance co got) of medical messing around? Still don’t have any idea what the cause was. I am certain that the system as in place in the U.S. encourages unnecessary medical procedures.

    Oh, of course, the insurance doesn’t cover 100% of the bill so then comes the invoices. Just what you need when you’re unemployed and sick.

    Oh, and on your way through the hospital, don’t forget to take a moment from your pain to enjoy the palm trees, marble floors and vaulted atriums that your insurance premiums are paying for. Try not to let your thoughts be dragged away by wondering if you’re going to be able to find a job before you have to tell the mortgage company that you’re not going to be sending them any more cheques [Note: Yes, I did thankfully].

    Oh, then of course, the local hospital had a falling out with my insurer so I can’t go there anymore.

    The NHS has its faults. But it does tend to concentrate on healthcare and doesn’t so much waste money on fancy gimmicks. Medical procedures cost, not make it money so they won’t prod and poke you without good reason. And above all, when all else has gone to crap, it’s just there.

    I have no doubt that a free market system could be run better. But libertarianism aside, between having to work with the US system or the UK system, it would be UK every time for me.


  • Abby


    I represented a woman who had her trailer seized and sold at auction to pay her hospital bills. Yet US federal law requires hospitals to treat everyone who walks into the door without regard to ability to pay, so the poor use them as primary care facilities. Anyone with property to attach is liable for his own bills. That’s called social justice: the working poor subsidize the indolent poor.

  • Scott

    Andy, glad to hear that the diagnosis was less dramatic than you feared.

    I sympathize with James and Rich. While stationed in Britain with the US Army I had the distinct pleasure to be able to suffer under both the NHS and the US Military medical systems. Two bastard offspring separated at birth, apparently.

    But! While in the States insurance/PPO/HMO copays do suck, and while coverage isn’t generally 100%, consider that the NHS sucks its funds from that stupid 17.5% VAT (where in the States is sales tax even remotely close to that) and from the 85% petrol tax (where in the States does gasoline cost from $6-$8 a gallon?). In Britain, you’re paying for healthcare whether you use it or not. In the States, not so much. And don’t bitch to me about insurance premiums. I’m self-employed and I pay less than $125 a month for top-notch health/dental/vision coverage. That’s far less than I paid for lesser coverage with my former employer.

    Andy, as to the costs of training new doctors I found I quite like the program offered by the US Army. A prospective or current pre-med student (4-year program over here) can apply to the Army for a Reserve commision as a Second Lieutenant. Their tuition, fees and books are paid for by Uncle Sugar, while never having to don a uniform or make a formation *AND* while drawing a modest monthly stipend from the Army. Upon completion of the undergrad course and acceptance to a medical school, that second lieutenant is promoted to Captain (that’s a double-promotion) and again, all tuition, fees and books are covered… while again never having to don a uniform and *STILL* drawing a monthly stipend.

    Following completion of medical school and passing the boards, this new doctor is required to fulfill a six-year obligation to the military. Six years. That’s nothing. Refusal to complete the obligation results in the doctor having to pay back all tuition and fees that were paid on their behalf.

    It’s pretty simple, and I’m frankly surprised that the NHS doesn’t have a similar requirement for medical students in Britain.

  • Doug Collins

    When unfavorably comparing the US to the British system please bear in mind that the US system is hardly a free market one – at least free market in the sense that the consumer of the product is also the buyer of that same product.

    Medical services are bought by insurance companies (paid often by employers) , by the US government and by the state governments. Sick and injured people only consume them. Except for copay requirements and by insurance deductables, the patients are merely raw material for the system.

    None of the purchasers of medical services have any interest in keeping the cost down, as they all derive a benefit from the income stream passing through their hands. The bigger the stream, the bigger the benefit. That, more than anything else, is the reason medical costs have become so monstrous.

    I heard a story recently, that sheds some light on how far things have gone.

    A friend of a friend, a Mexican national, recently found that she had unfortunately contracted uterine cancer. The procedure for treatment, in a hospital in the ‘Frontera’ or rural area across the Rio Grande from Eagle Pass, Texas, was straightforward. A day or two after her diagnosis, she spent about $100 at the apothecary, where she purchased drugs, anesthetics, sutures etc for the surgical procedure. She took them with her to the hospital the next day, where for $700 the cancer was removed. She convalesed for a day or two then went home. I do not know the outcome yet, I hope it is a favorable one.

    While this may seem primitive, I see no reason why the surgeon should not have been just as skillful or the operation just as sterile and effective as one carried out across the border.

    My father is currently fighting a valiant battle with cancer here in the US. This cancer is being treated with chemotherapy. So far he has had a stroke because no one thought to tell my mother that the chemo tends to make one prone to diabetes. She was concerned with weight loss and made a lot of milk shakes for him, which apparently led to the diabetes and to the stroke. He has a knee prosthesis, which is a site for infection. Again, no one bothered to worry about the immune system suppression that the chemo causes. Result: near fatal septicemias following several chemo treatments. Recently they removed the prosthesis to try to eliminate the chronic infection. These days the hospitals have changed from denying painkillers to pushing them. My mother finally threw the nurse out of the room after she tried to push the button on the morphine pump when my father wouldn’t. We had learned – not through the medical staff – that morphine tends to lead to strokes.

    After all this, I am much less inclined to look down on the practice of medicine south of the border. At least there I don’t think I would have this sneaking fear that the medical establishment might be just as happy if some of their older patients didn’t make it.

    As far as cost – even with all the government ‘assistance’ it will be astronomical. $700 will probably not even cover the laundry bill.

  • Abby

    You seem to have some misconceptions about the US healthcare system, Doug. You should look more carefully at how insurance functions, particularly the role of HMO’s.

  • nitro nora

    In America, sorry to disappoint you, everybody receives excellent & prompt care, especially compared to what I just read in this blog. To the poster Abby, I think you are leaving out some important details in your client’s sad story. When I was penniless, i was carried into a hospital and walked out, and the state paid for everything, including the best specialist in the area requested by me and post surgical care and physical therapy. Perhaps your client had assets but skipped the insurance“>health insurance, and tried to get something for nothing. Hey, folks, if you have assets and choose to skip buying the coverage, you are on your own. Now I have assets and so pay for my insurance“>health insurance, and I choose the “HMO” that best suits my health care needs. I have Choice—get it? After reading Samizdata’s story, and countless others like it from UK and Canada, I cannot emphasize to you that the private way is superior is every way. I pay happily, because I have quite a bit of control over the health-care product I am paying for. I do not pay high taxes to fund all the medical things I do not and never will utilize. Yet still, I was carried into an Colorado USA ER just a couple months ago, and walked out 24 hours later. It cost me 100 dollars over and above my insurance“>insurance premiums. A hassle? I don’t thinks so. You people just cannot understand how fine it is to be treated like a respected human when you are helpless. Let me carry on a bit more: a little problem with my knee? How about an xray & MRI within 24 hours, a diagnosis within 36 hours. All at a clinic 10 minutes from my home. The “health care crisis” in the US is an issue that was manufactured by the American Democratic party and the media. The free system is not perfect, but it sure sounds like a better deal than what you in the UK have.
    Nitro Nora
    Grand Junction CO

    ps our median household income is 50,000 US dollars per year. Pretty average. Pretty classy care for an average joe, if you ask me.

  • Free market campaigners in the UK are often accused of wanting to overturn the NHS in favour of an American-style system but actually that is not so.

    Even we know that healthcare in the US is so heavily regulated that it greatly increases the cost to the consumer.

    What we seek is a free market in healthcare not a state-backed private monopoly or a regulated supply side.

  • Doug Collins


    While I realize that the US system is less a government creature than the British one, my point is still that the patient, in a large number of cases, is insulated from the cost of medicine. To the extent he is insulated, then some other entity is paying the costs and that other entity is making the decisions – on the ultimate basis of its own benefit.

    Government is not the only institution that insulates the patient. When HMO’s and insurance companies are paid by someone other than the patient, as they are in many cases, the patient’s welfare is at best only one consideration. If most people bought and paid for their own, non-group, insurance this would be a minor consideration, since individual choice would mostly shape the system. That is not the case. Regardless of the details of HMO’s and insurance, I have to believe that he who pays the piper calls the tune.

    If you are saying that I am wrong in my contention that the system tends to inflate costs because insurance, particularly HMO’s try to cut costs, then in a sense I have to agree with you and admit error. However they do that by rationing or otherwise limiting choices. Suppose there was an HMO type organization that provided you with groceries. They might very well feed you more cheaply than you would feed yourself, and they would serve the purpose of keeping you alive. If, however, there was little competition for your business- say because your employer grudgingly provided groceries as an employment benefit, then you might find your suppers less exciting than they are when you do your own grocery shopping.

  • Julian Morrison

    Their attempt to cut costs can inflate costs. Consider: HMOs etc only want to cut net costs. It doesn’t matter to them if a doctor has to do $100 worth of red tape, and adds this to the bill, so long as they can use that red tape to deny $1000 worth of cases as “not covered”.

  • Abby

    David and Doug,

    While you are both correct that insurance and regulation are a part of the reason healthcare is so expensive in the US, these are but symptoms of a greater malignancy.

    It is the rapacious American tort bar who are responsible for this mess (and a great many others besides). To sum it up: the plaintiff’s tort bar — with its ceaseless manufacture of malpractice suits — is a bulging paracite which feeds on the entire healthcare system.

    In medical malpractice cases it is easy for plaintiffs to force a favorable settlement as long as they can withstand a motion to dismiss. Urban juries consistently “run away”: they see damages as a chance to give untold millions of dollars to “one of them”, while simultaneously screwing the reviled insurance company.

    That in turn makes malpractice insurance catastophically expensive. My neighbor is an ob/gyn who paid $200,000 last year in premiums; after a year of working impossible hours, she netted $35,000. This year she has doubled her fees. But this is only part of the problem.

    It is the threat of lawsuits which forces doctors and hospitals to order every possible test, and adopt every possible regulation. It is a sound legal strategy: they create a voluminous record of evidence proving that if anything goes wrong, or is missed, one can still meet the legal “standard of care.” Physicians and hospitals are not as state regulated as you think, David. They suffer from an extreme form of self-regulation, driven by fear.

    The increasingly expensive and numerous tests, stringent self-regulation and Am. Med. Assn. guidelines, coupled with the stunning med mal premiums for both doctors and hospitals, are all the result of lawsuits.

    As if that weren’t enough, there are gross distortions in the international drug market which redound to the disadvantage of US consumers.

    The ruin the tort bar has brought us is what makes US healthcare the most expensive in the world. That it is also the best is at least some consolation.

  • Abby

    Nitro Nora, I share your contempt for people who try to “get something for nothing”. And as you’ve said, the quality of care is very good whether you’re paying for it or not. I think the system’s sucess is a result of the fact that the government dosn’t yet make all the decisions. It is very bad at that sort of thing.

    Unfortunately, its too late for the public education sector. Evidence of its failure abounds.

  • Brennen

    The cost of plastic surgury is falling because insurance doesn’t cover it. Welcome to the actual free market. I think falling rates for all types of treatment is what we all want. A free market is the only way to do it. The problem is everyone is a communist these days. Read any magazine or book and all you get is marxist crap. I doubt people want healthcare that is not regulated because they fear capitalism.

  • I’m hardly one to trumpet the NHS, but when I got hit by a car due to my own stupidity I had no worries at all. Seen promptly, X-rayed within a couple of hours, fracture clinic and cast the next day, and out by lunchtime (broken thumb and collarbone, no big deal).

    Only thing that struck me was the instant I was out of the bed, the next patient was getting in. It was like an assembly line. 😉

    Though, this must be tempered by…

    a) I came in on an ambulance with amnesia, so I think they were worried about me and maybe I jumped the queue to get X-rayed. Though my injuries were actually very minor.

    b) this is Addenbrookes Hospital in Cambridge I’m talking about, and apparently it’s one of the better ones.

    To temper this I figure I should also bring up the story of my wife who wanted cosmetic surgery, she went to Slovakia to get it done for one fifth of the price and just as good, and she plans on returning to Slovakia to buy private healthcare there rather than have any surgery done by the NHS. So much for health tourism.

    Mind you I think thats because Slovak doctors get paid a fifth of what British doctors do, so it’s ridiculously cheap there.

  • Rich;

    Ask yourself why you need insurance in the first place? It is an indictment of the American “health care system” — as free as it is — that creeping socialism has brought us to the point where insurance is considered nearly a matter of life and death.

    What’s next? Grocery insurance?

    Frigging ridiculous.

  • Abby

    I am stunned: Insurance is socialism? Mark, that is preposterous. Although, I would be interested to hear the reasoning which led to this conclusion.

    Insurance exists because the market desires it (this is why there will never be any of your “grocery insurance”). If people want to roll the dice and hope nothing serious happens, then that is certainly a high-risk and high-reward strategy. But most people want, and buy, insurance for very good reasons: People don’t like gambling with their family’s lives.

    Insurance is a brilliant financial innovation. It spreads the catastrophe-risk among the population, bring an absolute sense of health security to its clients. That’s why people demand it and will pay for it. That’s why it exists.

    The insurance companies are not wrong for making a profit: they provide a valuable service. A service which makes our economy more efficient and prosperous, and keeps our people healthy and happy. As for the cost, the root of that outrage isn’t government regulation, it’s the US trial bar — many of whom are now billionaires.

    So no, Mark, insurance is not socialism; in fact, it is quite the opposite. Private insurance and socialism are mutually exclusive.

  • Nitro Nora

    your last two posts are right on the money.
    Nice thread, folks!

    Nitro Nora
    Colorado USA

  • dan

    Cancers aside, most of the things that people go to the emergency room or the GP for are things that will either

    a) clear up on their own with small scale intervention (colds, muscle strains, cuts, etc.)

    b) clear up on their own but should have some skilled treatment and follow-up (syphillis, broken bones, etc.)

    Think about all the things that have taken you to the doctor’s office in your life: flu shots, flu cases, immunizations, minor burns, small breaks and sprains, etc. How many really needed the attention of someone who’s paid $120,000+/yr and who spent 7 years in school?

    Health care is expensive in part because of bad malpractice law, but also because it’s restricted to an artificially small pool of providers. I bet a sawbuck or two that someone who has paramedic training could successfully treat 70%+ of the people who come to the emergency room or the GP office. Nurses could probably handle most of a GP’s workload. But because we have this investment in “Doctors” being so necessary, we limit supply and thus increase costs.