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.

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Samizdata quote of the day

In the NHS, unforeseen demand simply results in more queuing and rationing. Given that budgets are largely fixed by the political process, and resources are allocated to different parts of the service based on highly speculative demand estimates, deviations in demand can lead to acute shortages.

Of course, on the margin, having more resources can help. An NHS awash with cash would no doubt be under less pressure than it is today. But no reasonable amount of funding would solve these structural economic realities entirely.

There is a reason the NHS has these winter crises regularly, and other countries do not

Ryan Bourne

24 comments to Samizdata quote of the day

  • Ken Mitchell

    I thought that the “winter crises” were caused by all the doctors taking “continuing education classes” at Swiss ski resorts at the same times.

  • There is a reason the NHS has these winter crises regularly, and other countries do not

    It may also explain why the NHS model has never been copied in any other country. We have swapped Christianity for the NHS, a secular article of faith.

    As with all forms of socialism, this is doomed to failure.

  • Paul Marks

    Sadly I believe that no rational discussion of healthcare is not possible in the public square in the United Kingdom – people have to believe in something, Americans (at least the traditional ones – not the modern university types with their mixture of Frankfurt School of Marxism and French Post Modernism) believe in the Bill of Rights – limiting government, and the British believe in the NHS – a promise from government. The logic of this, applied to everything else, would produce the situation of Cuba or North Korea – which is indeed the aim of the recently elected Labour Party National Executive Committee, and this will (most likely) come to pass in the United Kingdom after the next general election.

    Turning to more positive matters – for all the talk of Obamacare not being repealed in the United States, the Obamacare “mandate” (really a tax on the poor – as most ordinary people “paid the penalty” rather than try buy the wildly expensive “insurance”) was quietly repealed in the tax reform – people who go to “pay the penalty” (pay the Obamacare tax) this year will find it no longer exists. Also the, illegal, subsidies to the insurance companies (Corporate Welfare in an extreme form) were abolished last year.

    Alas there has been no free market deregulation in the United States (although Senator, doctor, Rand Paul still works for it) – but there have been the above positive developments.

  • Paul Marks

    An extra “not” – normally I forget them rather than add one. Let us hope that the double negative is a good omen and rational discussion of healthcare is possible in the United Kingdom.

  • It’s a sad state of affairs when even the French Healthcare model is better than the UK NHS one.

  • Eric

    Isn’t this the basic complaint against planned economies anywhere?

  • bobby b

    I can understand rationing basic wellness care, or even the “I don’t feel so good” doc visits. I cannot conceive of rationing Accident and Emergency Care.

    Got caught between two frisky 1500 lb cows last week. Ran over to the local (small, very rural) e-clinic. Was with the doc in about 20 minutes, in x-ray 20 minutes later, got some stitches and a wrap, and was done three hours after arriving. Total bill was $420 cash.

    I just called my local doc for follow-up and stitch removal. Made an appointment for tomorrow morning. They don’t even take insurance – just cash, card, or check. That’ll probably run me $150 or so.

    I’ll be out of pocket around $600.00. No waits, no insurance premiums, no tax dollars. If a doc fails to satisfy, I can shop elsewhere next time. I understand that the NHS would have been “free”, but there are many ways to measure cost, and I still think we’re cheaper.

  • Thailover

    Liberty means the right to act, I.e. the right to create, produce, and/or earn something. To create, produce or earn something is to own it. Spoilers: your life is your property. you also own the consequences of your choices. You have the right to act, not the right to have. Not you nor anyone else has the right to Health Care. Tough titties.

  • While the quote has valid economic content, it is important to note the points in Natalie’s post. There’s a reason why the NHS did not have such regular crises two decades ago (which, not coincidentally, was the year of Labour’s election). And as regards “An NHS awash with cash would no doubt be under less pressure than it is today”, Labour tried that – and so ensured that the NHS would never be awash with cash again, whatever the government.

  • Umbriel

    @Paul Marks — the Obamacare mandate isn’t exactly a tax on “the poor”, inasmuch as the very poorest are on Medicaid rather than buying insurance at all, and a large tier of the somewhat wealthier get a government subsidy for some or all of their Obamacare insurance premiums. So the people paying the “penalty” were always a specific slice of middle-income folks not insured through an employer.

    It’s also worth nothing that the meaning of the term “poor” can vary widely by context. Here it refers to low income, and thus includes some younger retirees who may have substantial assets squirreled away but aren’t old enough to be covered by the separate Medicare system.

  • Stonyground

    Just an anecdote about the day to day workings of the UK healthcare system. I am a type two diabetic. When first diagnosed I was issued with a little gadget for checking my blood glucose levels. After a couple of years of ordering repeat prescriptions for the lancets and test strips, I was issued with some that didn’t fit the tester. I emailed the pharmacy at the surgery and was informed that I needed to come in to get a new tester. The new tester wasn’t as good as the old one and had a tendency to give false readings. Because I have a pretty good idea of what reading to expect, these were fairly easy to spot and I would simply test again. This isn’t too much of an issue for a type two but for type ones is potentially dangerous. I now buy my consumables from Amazon so that I can continue to use the old tester.

  • John B

    @bobby b

    ‘I cannot conceive of rationing Accident and Emergency Care.’

    But that is precisely what people waiting hours for treatment in corridors and lying on the floor is, rationing.

    Scarce resources must be rationed one way or another. Competitive free markets do it best.

  • I’ll be out of pocket around $600.00. No waits, no insurance premiums, no tax dollars. If a doc fails to satisfy, I can shop elsewhere next time. I understand that the NHS would have been “free”, but there are many ways to measure cost, and I still think we’re cheaper.

    My clutch failed on the motorway last month, costing me just over £600. I have two forms of breakdown cover, one with my bank account and one through my car insurance.
    The reason apart from the similar figure I mention it is that getting squashed by a cow is a random, yet bound to occur sometimes (and therefore happens all the time over a large enough population) event like a clutch failure, and yet here in the UK we leave one to the market and the other must be provided by the government.

    Had Mr. Clutch been the National Clutch Service I would likely still be waiting for a new one to be installed and have lost a massive amount (unrecoverable from in actual fact) of wages. Instead I only missed one day of work.

  • Paul Marks

    John Galt – actually many countries copied the NHS (which was itself NOT original – but a copy of the Soviet health service created in the 1920s), I think the difference is that other countries do not have a religious faith in it. For example Italy has had an NHS since (I think) 1978 – but no one in Italy expects it to work.

    Even France and Germany are moving to a more and more statist model – once the government starts paying the bills the natural tendency is to move step-by-step to state control. The Fascist alternative, supposedly private ownership but with government paying the bills, is not stable – as the bankruptcy on Monday reminded us.

    The United States will not be immune – people really do not like Corporate Welfare (government paying big insurance companies and drug companies – “Big Pharma”) it is not a sustainable model. Either the government funding will stop or government control will emerge.

    The house will “become all one thing, or all the other” – government finance for private companies will not last.

    The United States already has many government hospitals – the state hospital system in Louisiana (excellent – if one wants leprosy), the county hospitals in many States, and the Federal “Veterans” hospitals. This sort of thing (only much worse) will become the norm if government funding of healthcare (Medicare, Medicaid and so on) continues.

  • Paul Marks

    The 1986 “Emergency Room” Act is a classic example of why Fascism does not work. The government (stimulated by LIES about women being flung out of hospitals in the middle of giving birth) passed a “law” that insisted private hospitals treat anyone who turned up (including illegal immigrants) and demands “emergency” (i.e. any) treatment.

    “Surprise” this (along with all the other interventions over decades) helped push COSTS into outer space. The efforts to make insurance compulsory has now FAILED (the United States is not Switzerland – America has a large Third World population, especially since the Immigration Act of 1965, they are not going to pay for health insurance), so where is the funding going to come from?

    “From the taxpayers” – well then the nominal private ownership of hospitals will end, under the present Fascist system (of nominal private ownership – but the government tells you what you must do with “your property”) the private ownership of hospitals is an illusion anyway.

    The system will go one way or the other – the compromise position (Fascism) is not sustainable. If the state tells you want to do with “your property” it will end up taking over officially.

    Finally note to idiots – Fascism does not mean National Socialism, I am not saying that people such as President Johnson wanted to gas the Jews on anything like that.

  • Paul Marks

    There was an effort to make the entire American economy (not just healthcare) Fascist – the National Industrial Recovery Act and National Recovery Administration (General Johnson’s jackbooted “Blue Eagle” thugs), it was struck down 9 to 0 by the Supreme Court in 1935.

    Interestingly American college students, and High School students are taught that the National Recovery Administration was a good thing – and the “reactionary” Supreme Court was wrong to strike it down.

    Interesting that “anti Fascist” young are such fans of FASCISM (for the NIRA and National Recovery Administration were directly based on Mussolini’s Fascist Italy), perhaps they do not even know what Fascism is.

    I would try and explain that Fascism is based on the “German form of socialism” or “War Socialism” of World War One – but I doubt that the young know what that is either. Most likely they think both Imperial Germany and National Socialist Germany were “controlled by the capitalists” or whatever the Marxist teachers and college professors have taught them. Confirmed by television and Hollywood movies of course – capitalist companies pushing Marxist messages.

  • Runcie Balspune

    The failure of the NHS is summed up for me whenever I have to do a blood test, you arrive tired, hungry (often intentionally under instruction), frustrated by the public transport (I personally can’t drive afterwards) or the parking space/charge, and then, after seeing a “what the f*ck do you want” receptionist, you wait for hours among a group of noisy people exchanging their germs and viruses, not to mention bringing your own germs and viruses into a place frequented by people who might not survive them, yeah, thanks Runcie.

    Now, if someone said to me “hey just wait at home all day and we’ll send someone round to take a sample at some point”, I would be happy, the hospital rids itself of hundreds of potential MRSA carriers visiting and frees up some prime ward space, parking spaces and traffic issues, and can schedule as and when they like, as most people wont actually mind lounging around the house for the whole day either binge watching or pottering around.

    They might even consider contracting out, Uber Phlebo anyone?

    But as with the other posts around, the concept of the all-encompassing NHS fails to see how this can be improved.

  • Fraser Orr

    Runcie you are exactly on the money here. The problem is that when government pays then you, the customer doesn’t matter. When you pay, and you have options, all of a sudden the red carpet gets rolled out. The “What the f**k do you want” receptionist suddenly becomes they “can I bring you a cappuccino” receptionist.

    (Yeah, seriously, that happened to me at a car repair shop I frequent.)

  • Stonyground

    I’ve mentioned here before the fact that we get excellent service when we take either of our cats to the vet. We have pet insurance that means that we have to lay the money out and then claim it back. The vet provides good service because they know that I could take my money elsewhere if they didn’t. Regarding blood tests, I have to have one every six months. I have it at my local surgery and the process is handled very efficiently. I’ve found that if you book an early appointment they are generally on time, appointments in the evening tend to run a little late but still only by about half an hour.

  • bobby b

    “When you pay, and you have options, all of a sudden the red carpet gets rolled out.”

    Had stitches removed and sore ribs prodded this morning. They were busy – I saw the doc 15 minutes later than my appointment time. I received apologies from three people, and a fresh chocolate-iced doughnut. Total bill was $112.00.

    Ten years ago, when insurance was paying my (much higher) bills, I would have waited an hour or two, and been made to feel like a cost. Now, I’m treated like an asset.

  • llamas

    YHS has been quiet lately because I have been wrestling with an orthopedic issue for a couple of months. Entirely due to my own clumsiness. It’s painful and restricts my activity.

    Thanks to the absolutely-awesome tracking app that my healthcare provider has, I have the entire timeline up on another screen on my phone.

    X-rays on the same day as my first appointment with my PCP. Ultrasounds two days later, MRI scheduled for next day. Saw orthopedic surgeon that day, she cancelled MRI but sent me for more X-rays during her consult to confirm her diagnosis. No surgery at this time. So a complete workup and surgical consult in less than a week. She had open slots for surgery within days.

    Physical therapy twice a week, they have appointments from 6.00 am to 8.00 pm because people are working. Awesome facility, looks like a $1000-a-month health club. And they are resolving my problem.

    Every appointment was on-time or early, there’s no receptionist, the app tells you where to go and who you will see, how long it will take, anything else you need to know. Everyone treats the patients like royalty.

    To date, my out-of-pocket costs $272.83 (the app keeps track for me). I have 4 more weeks of PT and then I see the surgeon again.

    I have decent health insurance through my work, it’s OK but not stellar. Sure, I’m going to have to pay some more before I’m done, but I’m happy to do so because of the amazing speed and awesome service I am getting.

    How long would I have to wait for this sort of thing on the NHS, I wonder? How many days of my life would I fritter away in waiting rooms ? How many weeks or months of discomfort and restricted activity would I have to give up before I got well?

    I’m just askin’.

    llater,

    llamas

  • Nicholas (Unlicenced Joker) Gray

    Just ban winter! It’s not rocket science!

  • Paul Marks

    Quite so Umbriel – and I apologise for not seeing your comment before.

    Some States have indeed been mad enough to expand Medicaid – which was unsustainable even before it was expanded. This means that the Federal Government is throwing money at a handful of States – including one of the richest States (Massacgysetts) that needs to be ended and ended now.

    As for Britaiun – the 200 BILLION Pound “PFI” scandal means that “public private partnership” is dicredited, and rightly so.

    The idea that “the taxpayer will pay, but private companies will make it efficient” never struck me as understanding that “the taxpayer will pay” destroys all hope of things working well.

  • Thailover

    “Interesting that “anti Fascist” young are such fans of FASCISM (for the NIRA and National Recovery Administration were directly based on Mussolini’s Fascist Italy), perhaps they do not even know what Fascism is.”

    The only thing these morons “know” is that fascists and communists hate each other, and since they’re marxists, then those that offer pushback to their jack-booted nonsense much be “fascist”.

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