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

One of the great tragedies of the NHS is that it has unnecessarily turned health into a Zero Sum Game. Because it has a limited budget, money spent on one treatment means that it cannot be spent on others. It therefore has to make life and death decisions based on what those running it perceive to be its priorities.

Madsen Pirie

19 comments to Samizdata quote of the day

  • Nicholas (Unlicenced Joker) Gray

    Isn’t that just like life? Never enough time or money to do all that we want, so we have to ration. This is probably one of the lessons we need to learn whilst incarnated- getting it right!

  • Julie near Chicago

    Nicholas, I don’t accuse you of reading my mind (it would be difficult in any case, as there are so many inkblots and blank spots), but it’s not very gentlemanly of you to beat me to the punch. *severe frown*

  • Nicholas (Unlicenced Joker) Gray

    See, my time was wisely spent- getting in the punchline before other people!

  • Fraser Orr

    I’m sorry guys but I think you are missing the point. Certainly time and money are limited, but the point here is that the NHS takes your money and then decides priorities with almost complete disregard to you and your circumstances.

    Were you in control of your own money again then you could prioritize appropriately. As a matter of fact I just heard of a particular example of a friend of mine who might be needing an operation. He is torn between spending six and a half thousand pounds getting it done privately this week or waiting eighteen months (yes, that isn’t a typo) to get it done in the NHS. The NHS has taken his money and allocated it elsewhere by not providing enough of this type of operation, so he has to dig in to the money that they deigned to leave him with to fix their mess.

    Time and money are indeed limited. The purpose of the free market is to provide people with options so that they, individually, can choose how they want to divide up their money and their time. The big state thinks they should take your money and decide for you, like you are child. The point is not that the NHS has taken your money, it has, more importantly, taken your power to decide. That is what we do with children, and that is kind of like how the state likes to treat us.

  • Bruce

    And their “priorities” probably have absolutely ZERO to do with the well-being of the peasantry.

  • Nicholas (Unlicenced Joker) Gray

    Fraser, I live in Australia, with a different system, called Medicare. Whilst Labor uses it for scares during elections (Don’t let the nasty Libs ruin Medicare!!!), it doesn’t make the news much. How are you going with Obamacare?

  • Phil B

    It therefore has to make life and death decisions based on what those running it perceive to be the most politically correct option.

    There. Fixed it for you.

  • There are two important aspects of the NHS. Firstly is that it is funded by taxation; secondly that it is a monopoly supplier (unless you want to pay twice).

    Many other countries provide the alternative of taking out private health insurance; this is compulsory and otherwise residents are forced to enrol in and pay through the government scheme (which is itself insurance based).

    The UK NHS scheme is dominant in the UK supply of healthcare, so it is a monopoly. Monopoly suppliers generally, by their intrinsic nature, treat their customers less well than would a multiplicity of suppliers in a free market (or rather a market that is partially free as insurers would need to comply with some government-set terms).

    The UK could introduce a private-insurance based scheme of supply (so many different insurance suppliers) with taxpayer funding through vouchers. Also with the possibility of customers choosing top-up funding above the voucher value. This would provide both more money (than just the taxpayers’ pot), and a better service by the introduction of competition of supply (insurance companies, hospitals etc).

    This insurance based approach could/would still be free at the point of use. Additional benefits could optionally be provided through additional customer cash payments (eg private rather than shared hospital room, more expensive chemotherapy options, extra painkillers).

    The problem with these sorts of schemes (vouchers with top-ups and top-up cash payments) is that allegedly there would no longer be equal treatment of everyone – the rich would get better service. This is true, but things have now reached the depths where adequate service is often only available (through customer cash payments or private medical insurance). And the failure to provide ‘adequate’ service is now affecting those well below the status of rich.

    Eventually all major political parties will have to accept the only solution to the funding (and quality of supply) problem is through (i) free-market and not government ownership of the means of health production and (ii) the use of vouchers with top-up (for both insurance and treatment).

    That this ‘offends’ the political sensibilities of many is already changing, as a larger and larger proportion of the UK population see less and less (quality of) supply.

    Best regards

  • Fraser Orr

    @Nicholas (Unlicenced Joker) Gray
    > How are you going with Obamacare?

    Obamacare is exactly what anyone with a modicum of economics sense would guess it to be — an absolute financial disaster. Much worse care for much more money. Trump is dismantling the underpinnings of it which will probably make it collapse, which is unfortunate since a more careful dismantling would be less traumatic, but our disfunctional congress has left that as the only option.

    America has the potential for a really great medical system. It is just burdened down with so much crap that it can’t breathe. You can see it in the parts of the American medical system that have escaped the much of the regulatory and Medicare/Medicaid burden. I had to get one of those “measure the calcium in your arteries” tests on an MRI machine a while ago (thankfully clean as a whistle), I walked in, wrote a check for $100, sat down, whir, whir, all done thank you very much we emailed your doc the results. I asked why it is so fast and efficient. He told me straight up because they don’t accept Medicare or Medicaid.

    This is actually a growing trend over here. Doctors that don’t accept Medicare/Medicaid and in some cases Obamacare. And not surprisingly. I have friends who are doctors and they will tell you straight up that Medicaid/Medicare always pays their bills six months late, never pays the full bill and imposes unbelievably large clerical costs on the doctors. Here it used to be the case that doctors got together with their doctor pals and set up a little business of their own. Now, the regulatory and clerical burdens are so high it is simply impractical to do so, and they get sucked up as employees into massive medical groups. I have not talked to a doctor in the past four years who is utterly depressed by the devastation Obamacare (and medical regulation more generally) have brought. In fact I haven’t talked to a doctor in the past four years who doesn’t want to quit.

    Having said that, the medical care, though massively overpriced and burdened down, is undoubtedly the best in the world. It is luxury care taken to extreme. When my ex had our kids the birthing suites were like the Savoy hotel, compared to the NHS ward my father spent his last days it was more like something from a bleak, dystopian Soviet era film. BTW, everyone says “but the NHS doctors and nurses do their best”, that wasn’t my experience with them at all. They had the demeanor of public servants — why are you bothering me with your petty needs, don’t you know I am “very busy”.

    I will try to keep my emotions to myself, but I’ll say the way the treated my father, a salt of the earth, hard working man who had never been less than kind to everyone he met, worked every moment of his life, and had taxes milked out of him from the day he left high school, and would never take a penny from the state, since that was “charity”, a man full of love, wisdom, kindness and experiences, and whom I even today measure myself against. The way they treated him like a child, an inconvenience, a complainer (something he NEVER did aside from “I’m in agony can I have a pain killer”), the way they treated him makes me so angry I can hardly express it without wanting to punch something. FWIW, he spent his last days in a private hospice. The staff in this place were an absolute delight. The place was lovely, if not extravagant, and, although I was not there on the day he died, I will always be deeply grateful to the nurse who sat with him and held his hand, and spoke kindly to him as he had his last moments of life.

  • Alisa

    It makes me angry and sad just reading that, Fraser. My belated condolences to you.

  • Paul Marks

    Agreed Fraser Orr – and I also express my belated condolences to you.

  • bobby b

    “How are you going with Obamacare?”

    So far this year, my biggest healthcare expense has been paying the fine that one must pay for the privilege of not purchasing the incredibly expensive Obamacare insurance policy.

    If one lacks employer-sponsored insurance – which is how most of America has traditionally been insured – one must go into the Obamacare market for coverage. Last time I checked, the monthly premium for a healthy 60-year-old single guy was close to $1600. But if I ever needed an abortion or homeopathic treatment, or desired to have my penis removed, I would have coverage! Of course, I might have to drive 200 miles to find a participating doc . . .

  • Laird

    Fraser’s description is spot on. (And allow me to add my belated condolences, too.) The doctors here hate the system but there is little alternative but to be absorbed into it. My doctor advised his own son not to enter the profession! Pretty sad, and it doesn’t speak well for the likely quality of the next generation of physicians (who will probably be products of social promotion, affirmative action admissions and race-normed professional examinations).

    OK, that’s enough cynicism for now.

  • Julie near Chicago

    Fraser, I too am angry and sad about your father’s treatment and his passing, just as Alisa said. Please accept my sympathy as well.

    . . .

    In Rockford, there are two doctors who operate “on retainer,” so to speak, and do not accept Medicare. (I’m a big supporter of this sort of practice, generally speaking.) The monthly subscription fee for one of them is I believe around $250/month. The other charges a sliding fee: the older you are the more you pay. The current charge for my Blue Cross Medicare Supplemental insurance is $ 236/mo; it will increase in April. (Both this insurance and Medicare have co-pay requirements, of course. Just to be fair.)

    These doctors do not accept Medicare, but they are GPs, not specialists, and do not provide any sort of lab or testing services. Therefore they warn the Medicare-eligible that we should have Medicare, in case we need a specialist of some sort (pulmonologist in my case) or any sort of blood testing, MRI or Cat-scan, or other testing. Or, I suppose, any of the various therapies such as physical therapy or pulmonary rehabilitation.

    There are very long wait times to see the doctors within the local medical conglomerates, of which there are three. Nine months or more to see the pulmonologist. I’ve learned to schedule my appointments with him a year in advance.


    At the time when it became necessary to get Medicare Supplemental (my husband’s employer closed down its long-time group insurance plan, which was excellent from the employee’s POV), Blue Cross/Medicare required one to purchase Medicare Part D (prescription drug) insurance as well. Fortunately the old group insurance had also covered the drugs, so there was not the dreadfully hefty payment due to Medicare for not having had Part D since its inception in 2009. I had been warned by various people (friends) not to sign up for Part D under any circumstances, because of the penalties and duties and fines and whatnot associated with it unless you settle for marriage-for-life to it.

    So now, The Gov has me by the short & curlies vis-á-vis prescription drugs. Many drugs are not on the Approved List, such as the potassium supplement I’m told I must take (and my experience inclines me to believe it); every year the prescribing doctor has the privilege of pleading with Medicare to include coverage for it in my particular case. Don’t know where we will stand on that this year.


    If you require oxygen and live more than 30 miles from an oxygen supplier, none of the suppliers are allowed to provide it. So I am told. Don’t know for sure if this is a requirement of the State of Illinois or of the FedGov, but the former I think. Don’t know if you would be allowed to drive yourself to a supplier to get oxygen tanks or a concentrator, nor, if so, what happens if the latter goes on the fritz. One can, of course, buy a concentrator on the open market. I have one that I bought from an outfit in Arizona, when I was living part-time in Rockford and part-time in Naperville. [Medicare will pick up most of the cost of one concentrator; but never of two.]

    . . .

    My doctors here have mentioned to me how few doctors there really are in the area, whether specialists or GPs.


    My GP is retiring in the Fall. One reason (there are others) is that he’s tired of the amount of time he has to spend stuck in front of the computer doing “paperwork,” instead of seeing patients, being a “doctor.”

  • Julie near Chicago

    I should add that as in all things, I am against the whole government involvement in the medical and related fields (such as health insurance). I don’t for a second think that all would be roses if it butted out, but I don’t think things would be as bad economically and practically.

    And I do think that Medicare itself, as well as the associated Mission Creep that has led to the present mess, is completely immoral.

    (And in regard to health care, adding to the comments pursuant to charities: A lot of people engage, as individuals, in private charity on a one-off basis that will never see itself enshrined in a tax-return form.)

  • staghounds

    Making health care decisions with politics is like making food choices with your hearing.

  • Alisa

    What a mess to deal with, Julie… Especially when it is the making of People Who Know Better.

  • Fraser Orr

    Sounds horrible Julie.

    Who would have imagined that if you cap prices and restrict supply that that would lead to shortages and long wait times?

    I mean, shouldn’t some economist add that to the body of knowledge of economics?

    (BTW, thanks all for your condolences.)

  • Nicholas (Unlicenced Joker) Gray

    Fraser, are you thinking that Economists should learn things? Why? I bet those economists who claimed that Thatcher’s reforms were bad never suffered for it! And even if some economists do know what you are talking about (a la the Austrian school of Economics), who listens to them!? If an economist wants a well-paid job, then pandering to vote-hungry politicians is the way to get it- and politicians are mainly interested in popularity, not reality!