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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

Can the NHS be reformed? Or is major surgery required if it is to make a full recovery? We need to come up with much more radical reform than is currently being proposed. And if that doesn’t work, instead of accepting the somewhat back-to-front NHS version of TINA – in which we are told that there is no alternative to a welfare-state-era model of provision frankly unfit for the 21st century – we need to replace the NHS with something better.

According to Benedict Spence, writing in the Independent, ‘pretty much all of our European counterparts have a universal and in many cases much better healthcare system than the UK – and, horror of horrors, most European healthcare is what we would call “privatised”’. The UK is unusual among developing nations, he says, whose often social-insurance-based systems often perform better than ours (for example, in cancer survival rates). And yet, the defenders of the NHS remain ‘aggressively insular’.

Dave Clements

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22 comments to Samizdata quote of the day

  • Paul Marks

    Actually France and Germany and so on are moving further AWAY from freedom in healthcare, so is Switzerland (and just about everywhere else).

    Once health care is accepted as a “right” (turning the traditional meaning of the word “right”, a LIMITATION on government power, on its head) then the bills to government go up and up and, eventually, government direct control of health care follows.

    Does it work? No it does not – but that does not matter, as it is political suicide to propose ending it.

    Any problems with the NHS (for example piles of dead people who died from easily curable medical problems) will be blamed on “the cuts” (which are as real as dragons and unicorns) and evil Conservatives.

    Is there any way of saving the lives of people who die because of the present system? No there is not – it is politically impossible to save their lives. A government that tried to do this would be voted out – indeed there would be revolt in Parliament (by M.P.s scared for their seats) and the government would fall long before an election.

    When I was born little Andorra (up in the mountains) had no Welfare State – none, no pensions, no government health care (none of it).

    It was adopted in 1966 for the same reason that Iceland adopted state education in the early 1900s (even though everyone in Iceland could already read and write without state schools), ideological fashion. Ideological fashion (and not much else) dominates the world.

    There was no need for Andorra to do what it did in 1966 – any more than there was a need for Iceland to introduce state education in the 1900s, or Switzerland to introduce unemployment benefit in the 1970s. Or Britain in the early 1900s undercutting the Friendly Societies by introducing government schemes to do what the Friendly Societies were already doing.

    After all when America started to introduce the “Great Society” schemes in the 1960s poverty was at all time LOW – just as poverty was at all time LOW when government took over in Britain in the early 1900s.

    There is never a real reason for these polices – but there is no chance (none) of reversing them.

    At least not this side of “The Collapse” (TM).

  • Eric Tavenner

    Can the NHS be reformed? Or is major surgery required if it is to make a full recovery?

    No, just shoot it in the head and put it out of everyones misery.
    It’s replacement? A free market.

  • Bruce

    Simple test:

    Compare, (if the data is actually available), the relative rates of “death by medical misadventure” between the various systems.

    See also; acute and chronic “injury / infection” rates. And “secondary infections” during hospitalization. For example; going in for a relatively routine appendectomy and spending the next six weeks with drips and drains hanging out of your body, because you contracted a Staphylococcus infection IN THE HOSPITAL.

    Probably “state secrets”.

  • It can’t be reformed for the same reason the BBC won’t lose its charter: Brits go all soft in the head when it comes to these two institutions, it’s something of a religion to them. Any talk of change is howled down, and whilst it would be comforting to say it is only the demented Left doing the howling, my experience tells me this isn’t true.

  • Mr Ed

    The astounding culture of excellence in the NHS never ceases to amaze, 500,000 patient documents mislaid.

    NHS England is investigating whether any patients have been harmed by an administrative mix-up.
    Some 500,000 documents containing medical information, including cancer test results, were mistakenly put in storage rather than being sent to the GP or filed in the patients’ records.
    An investigation is under way, focusing on the estimated 2,500 patients who may have been adversely affected and need further medical checks.
    So far, no harm has been reported.
    The error occurred when a mail redirection company hired by the NHS failed to pass on documents that had either been incorrectly addressed or needed re-routing because the patient had moved to a new GP surgery.
    The company, NHS Shared Business Services, has expressed regret for the failings, which occurred between 2011 and 2016 in the East Midlands, the South West and north-east London.

    Since the company is only referred to in passing, methinks it is an inside job, set up by NHS connected types, so as to milk the taxpayer, but isn’t all of it like that?

    Edit here is the company website, a ‘joint venture’ http://www.sbs.nhs.uk

  • Stonyground

    Ah but you see, it was a private company that screwed up. If the health service was private it would be even worse.

    Our situation reminds me of the joke where some guy asks for directions and is told that if he wants to get to said place he wouldn’t want to be starting from here. If I am unhappy with the NHS I can take out private health insurance but that means that I would be paying twice. I suppose a start would be to offer some kind of tax rebate to people who are prepared to pay their own way. I now have type two diabetes which would be taken into account if I took out health insurance now. If not for the existence of the NHS it would presumably have been normal to take out health insurance as soon as I started work so that this wouldn’t have been a problem. Over my lifetime I have paid colossal amount of money into the NHS and used it very little. I would have to acknowledge a certain amount of good fortune but I have also taken reasonable care of myself over the years. Strange to consider that type two diabetes only affects really overweight people who live on chips and sugar. Or so I have been told by the Governments propaganda machine.

  • Jim

    @Tim Newman: I don’t think the UK public are as keen on the NHS as you think. I think the public are increasingly experiencing the ‘delights’ of the NHS first hand and this is colouring their opinions of it. I think the opposition to reform of the NHS does not come from the public but the vested interests – the unions and the Left. They are the one’s screeching like mad about ‘Saving the NHS’ out of pure self interest the moment anyone merely suggests its not the wonder of the world they keep telling us it is. Its a Potemkin Village of NHS support. Look what happened in the Copeland bye election – the Left made a specific ‘Save the NHS’ plea, and lost to the baby eating b*stards of the right (in image terms, if not reality). The public are seeing through the rhetoric, and instead judging the NHS on their own experience of it.

    I would guess that as this process continues there will be an untapped oil well of votes building up for the first political party to have the balls to formally propose reforming the NHS into a more continental insurance based public/private system. I predict this to happen somewhere between 2020 and 2030, based purely on the concept that it took just over 70 years for socialism to destroy the Russian state, so the same timespan will apply to the pure socialism of the NHS, founded in 1948.

  • TomJ

    Bruce: I doubt reliable data is available because the medical profession has yet to undergo the revolution that aviation underwent a few decades ago and seriously start looking for errors that can subsequently be avoided: http://www.newstatesman.com/2014/05/how-mistakes-can-save-lives

  • Seth Roentgen

    Japan operates a public/private health system, with public insurance contributions going to the provider.

    Last year I was diagnosed as having a benign tumour on my thyroid. I had two CAT scans, two biopsies and an NMR scan. These were all public hospital tests. I had an operation at a private hospital. Day one: seven hours under the knife (general anaesthetic). Day two: catheter removed and I was walking. Day three: drips and drains out. Day four: stiches out and I was released.

    So, four days after a seven-hour operation I was fit (and very happy) to go home. My personal top-up (tests, private hospital) to the national insurance scheme cost me about UKP800.

    The hospitals (public and private) were immaculate. The equipment and staff first rate. The costs proportionate. I am fortunate to be in Japan for treatment.

  • (I’ve mentioned this before but it will bear repeating): A Scottish Labour activist recently happened to “ask Gordon Brown what his greatest achievement in government was. Although he did not take personal responsibility, he did list a doubling of NHS spending …” (my emphasis).

    Labour did not make the NHS’s output any better. On the contrary, it was after 5 years of this “doubling of NHS expenditure” that headlines like “If the NHS were a patient, she would be on the critical list.” started to appear. (Natalie mentions one of the many reasons in this post – one-word summary: over-regulation.)

    That is why Jim (February 28, 2017 at 10:00 am) has a point when he says that the UK public are not as keen on the NHS as Tim Newman (February 28, 2017 at 4:35 am) suggests. Maggie, recognising exactly Tim’s point (that in the 80s, any battle against the NHS was un-winnable) concentrated on running it within its budget, so she would not be politically vulnerable. But since Labour’s orgy, the public know something is wrong. As detailed in Natalie’s post, many professionals – and some of the public – know ‘not enough money’ isn’t the issue.

    That said, Dominic Cummings interesting post on how the Brexit referendum was won mentions the NHS several times. Read the whole thing, but for this thread also search each occurrence of ‘NHS’ and read that bit. I think it has lessons to teach.

  • Phil B

    @Jim – Pournelle’s IRON LAW OF BUREAUCRACY applies to the NHS. In fact, it might be said that it is the finest example of the species, being the third biggest employer in the world (The Chinese Army and the Indian State railways being no’s 1 and 2).

  • John B

    “Can the NHS be reformed?”

    Can an elephant fly?

    No and No – both for the same reason… inherent design flaw.

    NHS is a State monopoly.

    It is agreed that State monopolies do not/cannot work for well documented reasons – see USSR or UK’s foolish Marxist post-war experiment.

    It is also agreed that incontestable monopolies are bad news for consumers.

    The Government has its own department to investigate and stop monopolies from forming or break them up if they do.

    The same Government operates monopolies in Healthcare and Education and elsewhere but does not investigate itself over this.

    Funny old World.

  • John B

    @Paul Marks

    “Actually France and Germany and so on are moving further AWAY from freedom in healthcare…”

    What does this mean exactly? Upon what do you base this?

    I have lived in France for 15 years and I see no changes.

  • Stuck-record

    As Paul says at the top of this thread, some things cannot be changed. Ever. But some things don’t have to be changed. There is an alternative.

    Look up the concept of ‘Exit Not Voice’.

    Healthcare is one of those. It’s about to undergo a vast technological transformation that will – to a large extent – bypass huge chunks of it. The first generation of health tracker products are here. They are very basic, but they are a paradigm shift. And over the coming decade or so will shift a great many people’s health care needs from expensive, time-consuming, and potentially dangerous, symptomatic treatment (i.e. when the illness has manifested itself), to relatively cheap, quick, and safe predictive treatment (i.e. when the AI monitoring your health app tells you there is a problem).

    We will still need a lot of the other stuff but a very large proportion of the population will actively choose to prevent themselves becoming ill – especially since they won’t have to do anything other than carry a small device, and stick their finger in a small box once a week.

    Preventative care could well end up being much less specialised (and therefore less regulated) than the current medical cartel. Even if there is an attempt by the medical industry via government to prevent this, it’s unlikely that the millennial generation – who are used to having instant access to every technological advance – would stand for it.

    In the same way that the mobile has destroyed the landline, Internet is in the process of destroying TV and the mainstream media, email killed the letter, et cetera, the giant health monopoly is about to be bypassed.

    Wait for the squeals.

  • Runcie Balspune

    The problem with centralised healthcare is it becomes centralised, and subject to the massive soviet-style thinking of big government.

    Mobile technology must have reached the point that anything up to and including an x-ray can be conducted in one’s own home. Make hospitals smaller, and only for the really urgent cases, this not only solves the superbug problems but you can almost guarantee that most people will be far happier at home watching Holly get goosed by a Noo Noo than hours in A&E or waiting for a blood test.

    What idiot actually thinks that clumping as many unwell and disease ridden plebs together in one place is actually a good thing? Hospitals don’t need to be some f*cking shopping mall with a few rooms for beds stuck on top as most that I’ve visited seem to become. The entire concept needs to be turned on it’s head so we have “distributed” healthcare, not giant MRSA breeding laboratories.

    The paradigm shift needs to start with stuff that should not be provided, but the nanny drug dealer state would be loath to let it’s best customers get off their NHS addiction.

  • Nicholas (Unlicenced Joker) Gray

    John B, re- monopolies. Someone once pointed out, at a Parliamentary inquiry into competition in the economy, “How come there’s only one monopolies committee?”.

  • Paul Marks

    John B.

    I base it on rising government spending on health care and (of course) increasing regulation of health care in these countries.

    And all other countries.

  • Stonyground

    @Stuck Record
    That is interesting. Just yesterday a leaflet fell out of my triathlon magazine inviting me to invest in a health check kit that involved a blood test based on a finger prick.

  • Richard Thomas

    I’ve been calling myself a libertarian for a long time now and though I won’t defend it, there’s something about the NHS that I kind-of like. I think the major issue is that the positive aspects of the NHS and other socialized systems (though let us not forget that insurance itself is a voluntary social system) are not currently available from (most) existing private insurance systems. Is there any possibility we could move towards this? The most trying issues of private insurance seems to me to be

    1)Support for pre-existing conditions. This is a tricky one and may be somewhat intractable
    2)Continuance of insurance through changes of employment. This would be an easy fix, I would think. I know many people who feel trapped in their job because of the insurance it provides (this may be a particularly American problem). The ability to maintain the same insurance policy through job changes and short periods of unemployment seems like a no-brainer
    3)Support for the genuinely temporarily down-on-their-luck. I would pay a little extra for this (though I’m not suggesting that anyone should be forced to), particularly if it would be available to me should something happen.

    Additionally, perhaps insurance policies could also be adapted to allow partial coverage through guaranteed low-interest loans.

    There are so many creative solutions out there that I can only think they’re being disallowed by government regulation.

  • Richard Thomas

    Stuck-record, I am sure you are aware that 23andme has come under attack from the medical community. I really have not paid that much attention to them but it’s clear they are charting a path forward in the analysis and treatment of disease and are, as such, a threat to the establishment.

  • Jim

    Note that todays pro-NHS march is made up virtually entirely of NHS workers, unionists and Leftist politicians, ie the vested interests. There is no broad non party political public support for it.

    http://www.bbc.co.uk/news/uk-39167350

  • DP

    Dear Samizdata Illuminatus

    Imagine what a state provided ‘free at point of use’ feeding programme would look like for the average punter.

    I suspect there would have been riots in the streets within weeks of a National Food Service being implemented.

    Roll on the day when Google, Amazon or some garage startup come up with home diagnosis machines, along the lines suggested by Stuck-record @ February 28, 2017 at 3:48 pm.

    Just as the e-cigarette has evoked howls of outrage from the public health and anti-smoker industries, such devices would not be welcomed because of their terminal threat to the established industries.

    Makes one wonder how we ever managed to make progress in the past, or indeed, now.

    DP