We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

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

Thousands are dying every year thanks to Britain’s health service not delivering the standards people expect and receive in other European countries. Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.

– Matthew Sinclair, TaxPayers’ Alliance (via Helen Evans)

11 comments to Samizdata quote of the day

  • We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.

    Such as?

  • ian

    According to this source(Link) death rates per ‘000 in England and Wales in 1976 were 12.5 for men and 11.8 for women. By 2006 they were 9.1 for men and 9.6 for women.

    I’m assuming that when Mr Sinclair talks about falling morality he means the opposite (otherwise his alleged point is even more bizarre) but that is not borne out by these figures. If he has an alternative source of data I would be pleased to see it, but I think he is simply plain wrong. I won’t speculate on his motives…

  • Ian B

    Is he saying that mortality was falling anyway and the NHS spending didn’t alter the slope of the graph, so’s to speak? Even so, that’s a rather weak point.

  • RRS

    I suggest that the writer was referring to the actuarial mortality scale. That is, the average life span.

    There is also the mortality rate for specific issues: Cardiac; Cancers; Infections, etc. This is a measure used to “rate” various hospitals and treatment facilities in the U.S.

    Most are aware of the serious decline in life expectancy (not to mention what one may expect out of life) in Russia today.

    That said, would anyone seriously expect the political class to surrender the monopoly over matters so vital to maintaining signifcance to their constituencies?

    Once matters of individual obligations (which include personal responsibilities) have been transferred to system of political allocations to meet needs, nothing short of collapse and restart is likely to alter the deficiencies.

    Consider how (and what would be involved in) a transition that might be achieved from NHS to even a “mixed” system such as that of the U.S. today.

    Once the political class gets into an activity that gives them vital significanace to a constituency, they are not going to release it.

  • ian

    Having done some more digging, the report proper talks about ‘amenable mortality rate’ which is allegedly a measure of deaths that could reasonably have been averted by the healthcare system. It suggests that this is a measure that does not rely on subjective opinion. I don’t see how it can avoid it.

    I’m open to persuasion, but I’m still not convinced that that this is the dispassionate analysis it claims to be.

  • RRS

    After taking the time to research the actual study at:


    It is quite clear that there are two points made.

    The most important is that of Ameliorable Mortatlity, the kinds of things healthcare is supposed to improve (Cardiac Care, e.g.)

    Secondly the effectiveness of expenditures on the trends of falling mortality rates vis a vis comparable European communities (Netherlands, e.g.)

    How that will begin to play out in life expectancy trends vis a vis others in the community may become an issue.

  • guy herbert

    That’s how I read it, too.

    You can’t just look at people being steadily more healthy and credit the NHS with it, which is what tends to happen, because people are more healthy in almost all countries than they used to be, whatever the structure of healthcare. Much of the improvement in health is due to better living standards rather than medical improvements, which is one reason it isn’t consistent between social classes.

    I’m not sure I like the TA’s approach to get their headline numbers, though, because they still aren’t comparing like with like. You could just about blame direct deaths from hospital infections, where we’ve got more of them than elsewhere, but it is very very hard to do anything with the survival statistics, and not really feasible to compare mortality between populations and do factor analysis for healthcare systems.

  • RRS


    If one is in the U.S and needs a heart by-pass, one might first ascertain the statistical mortality rates for that service at various facilities (ask a Canadian).

    There has been a consistent improvement in most of the Ameliorable Mortality (things that can be affected by treatments and care) in the U.S., which, despite all griping about rising costs (much for pharmaceuticals) has had a measurable economic return; spend more but get increasingly extended and “better” lives as a result. That is not happening in the U K.

    Monopoly conditions can make that unattainable (as do some preferred provider, HMO and insurance programs do in the U.S.). But, if there is to be no escape from the (politically dominated) monopoly, those paying for it should not be “dispassionate” about changing its operation.

  • Europe has effective socialized medical care. We have crap socialized medical care. As the first sailor at Trafalgar said to the second sailor about the rations, “It’s the lesser of two weevils”.

  • ian


    If you are look for a place to go for a medical procedure, then no you cannot be dispassionate. However, if you are writing a comparative study that aims to meet proper academic standards and demonstrate statistical rigour, then you do. This is essentially the same point as Lomborg is making.

    I haven’t finished looking at the paper, but so far I am unconvinced and tend to go with Guy’s comment at 3.24pm above. There are too many factors involved in survival in many of the conditions covered by these Amenable Mortality Rates, to be able to say with any degree of certainty that a comparison of rates between systems is actually comparing the same thing. As Guy points out living standards are a huge influence and unless you can control for that you are in trouble – and since no one can agree how much living standards affect health, you have no way of controlling for that variable to see the effect of the healthcare system.

  • Paul Marks

    Bottom line – the N.H.S. is not good, in spite of all the extra money tossed at it by Mr Brown.

    In fact the N.H.S. is about as good as the county (i.e. government funded) hospitals that exist in many American places.

    Would you like to trust your health to such places?