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A heretic speaks

Madeline Grant of the Institute of Economic Affairs has a guest spot in the Times. Presumably when they invited her they had an inkling of what sort of guest she would be. You really ought to buy a copy of the Times or electronic equivalent to read the whole article, but I hope that the following excerpts will give the general picture. She is metaphorically sitting with her boots on the coffee table, fag in one hand, her host’s vintage port in the other, keeping the party both appalled and entertained:

Let’s stop kidding ourselves about the NHS

… our public services are on track to become a Leviathan health provider, with only a few other minor functions attached. You might argue that this cycle of increased spending simply reflects Britain’s ageing population, but it hides some growing dangers.

Voltaire quipped in the 18th century that “where some states possess an army, the Prussian Army possesses a state”. Like Prussian military might, the NHS has embedded itself in our national psyche, consistently topping opinion polls of Britain’s best-loved institutions. Its cult status is spread on social media by people sharing personal tales and using hashtags such as #TheNHSsavedmylife, as if a publicly-funded service doing its job was somehow remarkable. Then there was the bizarre worship of the NHS at the 2012 London Olympics opening ceremony. Foreign visitors here, often with far superior health systems at home, regard our NHS mania with bemusement.

We could learn a lot from other countries. Australia offers free health cover for everyone but encourages citizens to top up these costs wherever possible. Most Australians are covered for all in-patient care and about three-quarters of GP care. The majority buy “top-up” insurance to meet the shortfall, while the state subsidises insurance premiums. Though public spending on health accounts for 9.3 per cent of Australian GDP compared to Britain’s 9.8 per cent, it outperforms us on almost every measure, including, most importantly, patient outcomes.

Sadly, given our worship of the NHS, it will be politically difficult to incorporate cost-sharing elements. But let’s at least admit that our centralised model is an international outlier and not, as is often claimed, the “envy of the world”. Even in Sweden, which the left regards as a socialist Valhalla, personal spending accounts for 16 per cent of total health expenditure, compared with 9 per cent in Britain.

Increased funding for the NHS must go hand in hand with reform of a system which favours bureaucrats over frontline staff. Despite a growing shortage of nurses, the number of managers on the payroll had risen by almost a quarter in four years. Our health service lags behind others in the uptake of new technologies — a report last year revealed it was “the world’s largest purchaser of fax machines”.

There are facts and figures a-plenty in the article, but long after they are forgotten I will remember that line about the fax machines. Sometimes a single dramatic example that encapsulates an issue can do more to change opinion than a page of statistics.

52 comments to A heretic speaks

  • HD

    All my Brit friends worship the NHS. Some think it perfect. The others think it can be reformed. I know it cannot.

  • Jim

    “Increased funding for the NHS must go hand in hand with reform of a system which favours bureaucrats over frontline staff. ”

    In light of my recent experience of the NHS via my father’s ill health over the last 3 years I would say the frontline staff are just as self serving as the bureaucrats. The whole edifice is rotten to the core.

  • Norma

    More money for fax machines. More paperwork needs pushed through to keep the red tape flowing, which in turn creates jobs, and in order to push it, NHS definitely needs more fax and photocopying machines in service. That is a very funny but sad quote, if that last part is true.

  • Stonyground

    I found the bit about fax machines jaw dropping. Although, when you think about it, since no one else uses them any more you wouldn’t have to buy that many to be the world’s largest purchaser of them. We do still have one at my workplace but I can’t remember the last time that I used it. I’m left wondering what the NHS uses them for.

  • Simon Williams

    As someone who works for a private contractor to the NHS, the main purpose of fax machines seems to be for pharmacists or GPs to electronically fill in a prescription form, print it out, then fax a copy to a pharmacy for a patient.. Or to print off case notes and fax them to a GP out of hours service, when the electronic link to that service fails. (I hope that in the next few years, they do cotton on to this whole ” let’s email a pdf to somewhere instead” malarkey, but I don’t hold out much hope…

  • I would say the frontline staff are just as self-serving as the bureaucrats. (Jim, November 1, 2018 at 12:31 am)

    I personally know both some bad and some very good examples of NHS doctors and nurses. I also know an NHS administrator – a very decent guy, who believes as firmly as Madeline Grant does that a co-pay system is the only sane way forward for the NHS.

    The tragedy of a huge government bureaucracy like the NHS is not only – perhaps not even mainly – that it attracts chair-warming paper pushers. It also attracts people who want to help the sick – and who then spend much time filling in forms and obeying administrative absurdities, and are sometimes worn down by the culture and the pressures.

  • Julie near Chicago


    My GP (works for one of the big medical conglomerates) has just retired. He says he spends most of his time in front of the computer, instead of seeing patients, which is what he enjoyed about being a doctor.

  • Clovis Sangrail

    With great respect, I think it’s a tactical mistake to compare the worst two health “systems” in the developed world!
    This is the main way that devotees of the NHS fight back against reasoned criticism: “oh, so you want American health care, do you?”

  • Jim

    “I personally know both some bad and some very good examples of NHS doctors and nurses.”

    Oh for sure, there’s good and bad. But the attempts of the good to help are usually stymied by the bad ones f*cking it up somewhere down the line. A body of the size and complexity of the NHS cannot provide a decent service if a chunky % of the staff are lazy, slovenly and downright antagonistic to the patient. It only takes one in a chain of treatment to mess that entire chain up.

    You only get good service in the NHS if you happen upon a bit of it that is staffed by the good ones throughout – this can happen in the smaller sections, GP surgery level, or small specialist teams maybe, but at the wider level you’re screwed, there will always be someone who can’t be arsed to do their job properly, and management who are either unwilling or unable to make their staff do their jobs.

  • pete

    I suspect that many people know that the NHS is not as superb as the state and its employees claim it is but they fear change because of what change in public services has brought in other areas.

    Privatisation of the trains has been a fiasco. Deregulation of the buses outside London has not worked. Outsourcing care homes to the private sector has resulted in some horrible stories. Many of our schools are now run by private firms and many of them are terrible. Our benefits system is now a shambles.

    Poor people and people of modest means are always the ones to suffer most when the state tinkers with the running of any public service in an attempt to make it more efficient, so it is extremely unlikely that they will ever vote for a party which wants to fundamentally alter the NHS.

  • Jaded Libertarian

    Ah yes, the NHS. Without it, we’d have poor people struggling to meet the cost of medical bills.

    Like, for example, when my wife went to the doctor complaining of a back injury that hadn’t healed in a year and the pain was getting so bad she couldn’t sleep. The doctor said there was a 6 month waiting list for physio, so there was “no point” in referring her. My GP almost never refers, I think they must get brownie points for essentially refusing to treat patients.

    We’re now paying £150-£200 a month for private physio and chiropractic appointments. The pain is starting to lessen and her back is starting to recover. We are however struggling to make ends meet, and this isn’t helping.

    To be honest, I’m of the view the NHS actually collapsed at some point over the last few years and no one noticed. Eventually people will though. Time and again I’m hearing of people whose doctor is refusing to treat them for genuine illnesses. Serious infections are left to fester without antibiotics. People are left in pain.

  • bobby b

    “With great respect, I think it’s a tactical mistake to compare the worst two health “systems” in the developed world!”

    With all due respect, as a 60+-year-old American, I’ve never known anyone, rich or poor or middling, insured or not, who needed medical attention and failed to receive it in a timely and appropriate manner. By all accounts, our version of “timely and appropriate” is far better than what is offered by the NHS. No one goes without medical treatment when they need it.

    Back when I bought insurance, I would routinely call for appointments – minor or significant – and then see my doctor within two days, and specialists if needed within a week. Now that I choose to self-insure, I pay drastically reduced rates to doctors who have tired of dealing with the insurance system, and I still see my doctor within a day or two. Should I suffer some medical catastrophe, I am able (and this is nuts) to quickly buy into the system for coverage.

    If you’re 65, or disabled, you’re on Medicare. If you’re even close to poor, you’re on Medicaid. If you’re not on these programs or insured, you’re going to get treatment that you need, and if the bill is more than you can pay, well, the industry ends up writing off an awful lot of debt as uncollectable.

    Perfect? Nope. But it’s a heck of a lot better than the biased reports you’ve apparently been reading.

  • staghounds

    Second what bobby B said. I live in the United States and I don’t see all the sick people we are supposed to have dying in the streets. And no one waits six months for anything, that is crazy.


    “I don’t get faxes where I live.”

    “Where do you live?”


  • To be honest, I’m of the view the NHS actually collapsed at some point over the last few years and no one noticed. (Jaded Libertarian, November 1, 2018 at 11:31 am)

    From people who lived there I’ve heard descriptions of Greece after their euro-induced meltdown which implies such a statement could plausibly be made about (at least a sizeable part of) their NHS-equivalent. It is not true of the NHS at the moment. Greece does show one scenario for the NHS’s death: no-one ever admits it and such money as there is continues to sustain elements of the bureaucracy, but eventually the patient’s part of co-pay is paying for all the actual work.

    I agree with bobby b (November 1, 2018 at 11:46 am) that the US system is very very far from being the worst in the world and indeed generates many of the medical advances that later find their way into NHS practice. In this respect, the US system is very valuable to the entire world. The NHS is also a long way from being the worst medical service in the world. Try any communist country.

    Privatisation of the trains has been a fiasco. (pete, November 1, 2018 at 11:17 am)

    My experience has been broadly positive. I do not have the impression the trains run less often or the fares are (allowing for inflation) costlier – if anything, the reverse. Of course, someone getting their service from a different company in a different region may have a different experience. I have certainly heard complaints about trains in the south-east – but I’ve a vague notion I heard them in the old days too. London is not the only place where deregulation of the busses worked: try Edinburgh before the local government inflicted trams on us. (To be fair, busses in Edinburgh were not bad in the old days too.) In our increasingly be-car-ed society, many bus routes were bound to be pressured regardless.

    Your general point about the “fear of the unknown country” where there is something other than the NHS is valid. As the saying goes, “Always keep tight hold of nurse for fear of finding something worse.” .

  • Sam

    As an American I’m curious what the, let’s say, mainstream opinion of American health care is in Britain. Obviously it’s not positive because (1) anything American must be denigrated in public and (2) according to Clovis Sangrail it’s used as a threat when the NHS is called into question. I mean here specifically, what do the talking heads criticize about American healthcare? What is your average normie’s problem with it?

    I certainly have many gripes about our system – mostly related to people trying to make it a “system” in the first place, but I honestly don’t know the talking points outside the US.

  • Andy in Japan

    Regarding fax machines, they are ubiquitous here in Japan (I get my work schedules faxed to me each day). I think here is due to the use of stamps (Hanko’s) for signitures, which the Japanese either are unnwilling to or don’t trust digital versions.

    regarding the NHS, I had long been on the view a return to the pre-1945 system of voluntary and municiple hospital provision would be a good start, but people are too blinkered to consider any chnage (I suggested this one on Facebook and got howled down!)

  • Every now and then there’s an article like this is the papers. Which never makes a blind bit of difference.

  • Rob Fisher

    Simon Williams: “let’s email a pdf to somewhere instead”.

    …where it will be left forever on a badly maintained NHS email server, whose storage will no doubt be mined in its entirety by a teenager in Russia. At least faxes are only likely to be intercepted by determined spies targeting individuals…

    And what happens when the NHS server goes down? No meds for you! Phone lines tend to be more reliable.

  • Natalie Solent (Essex)

    Rob Fisher, A fair point about the fax machines being preferable in some circumstances. I read somewhere that that the GRU or whatever they call the KGB now had gone back to typewriters for similar reasons.

    However, from recent experience of having taken my neighbour to hospital appointments several times, I can inform you that the NHS is even more hardened against espionage and/or natural disaster than the faxes would suggest. In her case at least it seemed that the NHS only gets things done by the patients collecting – not posting, collecting – letters from one part of the NHS to another and delivering them by hand to the recipient in a different hospital.

  • Rob Fisher

    Bobby b said, “I’ve never known anyone, rich or poor or middling, insured or not, who needed medical attention and failed to receive it in a timely and appropriate manner.”

    And yet I am told by British friends who claim to have spent time in the USA that its poor people are very poor, and they are unable to get healthcare until it is a real emergency. They don’t get help with the toothache or the rash.

    When I tried to reconcile these opinions, I came across this Quora answer: https://www.quora.com/How-do-poor-people-pay-for-healthcare-in-the-United-States — apparently there is something called “managed care medical”:

    You can only go to overbooked, lousy, and dirty community doctors’ offices where you have to spend the whole day in an overcrowded and unpleasant office waiting for your turn, hoping to be seen the same day. You often have to start the process all over again the next day and the day after etc.

    If you ever need to be hospitalized, you’re in trouble because you don’t have any choice but to go to the worst hospitals. You might as well die because chances are, YOU WILL DIE THERE.

    And then I thought: *that* sounds familiar…

  • terence patrick hewett

    G K Chesterton’s books “Heresy” and Orthodoxy” are ever, well worth reading: I of course as a Catholic am a Heretic.

  • Ian

    I wouldn’t get too excited over the fax machine statistic. I don’t really doubt the statistic, but I suspect it’s not nearly as bad as it sounds.

    If this statistic is true (the report doesn’t give any evidence for it) then it will be at least partly by virtue of the fact that the NHS is so effing huge. They apparently own 8,209 fax machines, which equates to roughly one per 200 staff. This doesn’t seem like a huge number to me. I strongly suspect that any company of that size still owns at least one fax-capable device or even a dedicated fax, and smaller companies probably have higher per capita numbers.

    The second possible reason not to be alarmed is because the majority of multi-function printers still have fax capability (mine has this, though I’ve never used it), so there is a question of whether these are dedicated fax machines or not, and whether the fax capability is actually being used, or whether these are just sitting there doing nothing. But let’s be generous to the authors of the report and assume these are dedicated fax machines and that they are used regularly. Anecdotal evidence seems to support this view.

    But if so, is this really so bad? We’ve already had one multi-billion-pound spaff to improve NHS tech which involved an effort to create an independent NHS internet with its own cables & pipes, etc., and which went down in flames. Sometimes just upgrading to the latest tech is not sensible, and after all faxes are reliable and probably more secure than the current alternatives. For practical purposes I’d guess it’s much, much harder for a hacker to intercept a fax than it is to break into an NHS network. They don’t work over the internet, so you’d actually require physical man-in-the-middle access to the telephone line, unless I’m much mistaken. I presume this could be done at the cabinet or by tapping the phone line on NHS premises, but this would be costly and dangerous.

    I don’t trust the NHS with tech generally. After a number of NHS trusts got totally pwned following their decision to carry on using network-connected Windows 2000/XP machines after Microsoft ceased providing security updates, what person in their right mind would think they should be sending confidential documents over email? Unless they have some clever system that only routes mail through secure NHS-controlled mailservers using end-to-end encryption (hah!), or unless they’re willing to adopt PGP or something like it on the application level, that stuff would be flying around the internet through unknown mailservers in plaintext. That would not be very wise.

    Also, if you send a fax you know it has been received, unlike with email, and the recipient has it on their desk right away. As Rob Fisher points out, that’s a big advantage for the humble fax.

    So whilst it’s a fun statistic, and whilst naturally I’m not pro-NHS, from where I’m sitting this might be the least-worst option for them. Bear in mind that faxes require very little training to operate, too…

  • Rob Fisher

    Natalie, now *that* is a secure communications channel! 😀

  • NickM

    A couple of years back I saw a GP (not my but over the county line because it was out of hours) and that was a hassle to even get seen despite it being two miles away. So that is the “N” in “NHS” kyboshed. She reffed me to a hospital and had her note typed on her computer. So she tried to email them. Nyet! So she tried to print them on the printer in her office. Nyet! So she wrote them out from the screen longhand and handed them to me in an envelope. So that’s the “S” kyboshed. As to the “H”. Well, I never exactly found out what was wrong with me and it kinda of sorted itself.

  • Paul Marks

    I do not know enough about the Australian health system to comment.

    As for the British government National Health Service – they keep sending me letters and telephoning me about my diabetes, the problem is that I do not have diabetes I have asthma.

    How can anyone have any confidence in this organisation?

    The answer is constant brainwashing – both from the education system (the schools and universities) and from the “mainstream media”. No conservative radio or television stations are even legal in the United Kingdom.

    In the United States the leftist control of the education system is just as bad as it is in the United Kingdom – and the control of television is almost as total (the exception being some shows on Fox News and Fox Business).

    That is why Americans are going to de facto elect Nancy Pelosi (a collectivist lunatic) Speaker of the House of Representatives. Constant propaganda from the education system and the “mainstream” media – of the most extreme and disgusting kind (such as implying that President Trump is a Nazi who supports murdering Jewish people).

    Constant lies and disinformation can convince most people of almost anything – that is why the “Envy of the World” stuff is believed.

  • Rob Fisher

    Sam, British complaints about USA healthcare that I hear: people in America are terrified of losing their jobs because then they lose their healthcare. And it is so easy to be fired in the USA! And poor people without healthcare get left behind, don’t get long-running health problems fixed, and don’t get treatment until the last minute when it is likely too late. Or they scrape money together and then have financial worries to add to their health worries.

  • Paul Marks


    Network Rail is 100% GOVERNMENT owned. Railways are private in Japan – they are most certainly NOT private in the United Kingdom.

    “Our schools are often run by private firms” – what on Earth is “our schools” supposed to mean? Do you mean the government schools? How many taxpayer funded schools are run by private, for profit, companies? I doubt it is a very high percentage. Do you mean charitable trusts? It is just hard to know what you are talking about.

    “The benefits system is a mess” – yes it is (I agree with you) and it has MORE taxpayer money thrown at it than ever before.

    As for the roads (busses and so on run on roads) they are also government owned – and the government runs the road system very badly indeed. A restoration of a private road system (for example the old Turnpike trusts) can hardly have happened on a large scale without me noticing. Yes they have been a few private roads – but the government owns the vast majority of the road network, the road network that is FALLING APART.

  • Natalie Solent (Essex)

    Sam writes, “I’m curious what the, let’s say, mainstream opinion of American health care is in Britain.”

    As ever in politics, we forget how large a chunk of the population have no opinion at all because they have no reason to have one. They know from TV that the Yanks have hospitals and doctors and stuff. They’ve never thought about how it is financed, but probably think the government does it somehow because that is what they are used to.

    Moving on there are plenty who seem convinced that the first thing American paramedics do upon reaching an unconscious person is check to see if they have medical insurance, and if they don’t, leave ’em lying on the street. For this segment of the population “a little knowledge is a dangerous thing”: they are probably better educated and more politically aware than the previous group, but actually worse informed. They’ve blanked out the extent to which the US government does fund healthcare, not to mention charities etc.

    Then there’s a lot of middle class, middling-informed people who are aware that, for instance, some advanced treatments are only available in America and that there is government support for healthcare for the poor. They have probably heard a lot about the worries of poorer Americans regarding health insurance. They cannot understand why anyone should oppose Obamacare, but have heard that there are such people. The fact that Obama’s words “if you like your doctor you can keep your doctor” turned out not to be true has been fairly widely reported. It’s all very confusing, they think. Perhaps Obamacare was badly implemented.

    Then there are obsessed political weirdos like our good selves.

    It is worth pointing out to this audience that there are times when the NHS can work out very well. There are plenty of dedicated and skilled staff in it. When someone gets bad news about their own or a relative’s health it can be a great blessing not to have to worry about cost.

  • Runcie Balspune

    It was mentioned on a CapX podcast that the whole public sector is starting to become the NHS with a few other services tagged on to it.

    The key feature of the NHS is that people become dependent on it, the ctrl-left like this and that is why they champion it and work for it to become greater, the more liberal among us see this as a defect and wonder why so much is done under the NHS umbrella when it could conceivably be done much more efficiently by private concerns and give people more control over their own health.

  • Clovis Sangrail

    Well that moved fast while I was working!
    @bobby b and @staghounds-I really am very glad you are pleased with your healthcare (I wish I was pleased with mine). However many health outcomes in the US are sub par for the developed world and cost per capita is 25% more than its nearest comparator (PPP dollars). Conversely, “the U.S. has the highest rate of deaths amenable to health care among comparable countries“.
    This is not too positive either.
    At least that’s what people say. I strongly suspect that the worst-served group in the US would be the “excluded middle”-too rich for Medicaid (have I got the right one?) but too poor to pay.
    I am VERY happy to be corrected and enlightened. But having seen statistics on how much money gets spent on protective medicine (i.e. protecting the doctor) in the US, I suspect it’s not sooooo good. Also end of life care costs a lot everywhere but protective medicine makes this particularly extreme in the US. Anecdata/some stats here

    And BTW, regular readers will know that I (almost) never criticise America in my comments. As an academic I’m sick of listening to colleagues doing it and I happen to be an admirer, but that doesn’t mean I believe everything’s perfect over there. You did elect Obama, for example.

    Whatever is the truth, I would be very happy if we in the UK could adopt the French healthcare system. It’s not perfect but it does pretty well.

  • Sam

    Natalie – thanks, and that about confirms what I expected.

    When someone gets bad news about their own or a relative’s health it can be a great blessing not to have to worry about cost.

    Well, quite. I’m fairly sure nobody in the history of ever enjoyed worrying about the cost of something, no? From what I’ve read about the NHS the “worry about cost” is borne by British taxpayers, and that concern extends to the very sustainability of the British welfare state.

  • Mr Ed

    Then there are obsessed political weirdos like our good selves.

    Well you speak for yourself Natalie, I would class myself in the obsessed anti-political weirdos, being opposed to politics like Pasteur was opposed to pathogens. 😀

    What I find bizarre is how people can write off politics as not important, when it is a cancer on civilisation. The more that is removed from politics, the less reverence that is given to politicians, and the greater the recognition that politics is the rewarding of failure and the punishment of success, the better.

    Then the dismantling of statism may gain traction.

    However, with the NHS, I believe that the current situation is that the political class believe the propaganda about it works, and that it is untouchable, and to be bowed and sacrified to.

    But people who have dealt with it are either disillusioned or dead.

    In passing I note that under the last Labour government, the NHS started branding itself,with its lorries advertising what they were doing, and now pharmacies carry the logo, a bit like finding portraits of Lenin, Engels and Marx littering the place like in the Soviet Union.

  • Tedd

    Sadly, given our worship of the NHS, it will be politically difficult to incorporate cost-sharing elements. But let’s at least admit that our centralised model is an international outlier and not, as is often claimed, the “envy of the world”.

    We have the exact same problem here in Canada, compounded by the ever-present, debate-stifling “argument” that, “We don’t want U.S. style health care.” (As if the Canadian system, exactly as it is currently manifested, and the U.S. system, exactly as it is currently manifested, are the only two possible choices.) We are very, very slowly getting more private money into health care. But it’s a tedious process–a hill that many, many Canadians have had to die on (literally, in some cases) over decades for any advances to be made.

  • morsjon

    the Nhs cant be reformed. The government needs to fund an insurance based scheme in parallel for a few years and gradually switch people over. Expensive in the short term but the only way in my view.

  • bobby b

    “Conversely, “the U.S. has the highest rate of deaths amenable to health care among comparable countries“.”

    There’s a good deal of evidence that these numbers are not due to differences in health care systems, but rather differences in lifestyles.

    There was a report published by the U of Pennsylvania back in 2009 that concluded just that. The report fails to uphold the beliefs of the rather large crowd who favor more public (??) money being channeled to health care, and so the report never got a large public play, but it’s worth reading if you’re interested in the subject.

  • bobby b

    Clovis Sangrail
    November 1, 2018 at 7:05 pm

    “I really am very glad you are pleased with your healthcare (I wish I was pleased with mine).”

    I’m curious.

    Are you displeased because you have (had) an illness that took longer to diagnose/fix than you expected? Or because you received substandard care?

    Or did you have difficulty getting access to care for financial reasons?

    I ask because these are completely different problems. I’ve had the joy (in the distant past) of misdiagnoses, ineffective treatments, and the like, but I have never had to wait for care, even when I was uninsured and cashless. And, even when the care was less than competent, it was delivered quickly.

    If I show up at an emergency room injured, with no ID and no insurance papers and unconscious, I still receive care, and the payment issues are sorted out later. Some private hospitals will transfer me to a public hospital after I am stabilized in that situation, but I can’t begrudge them that.

  • Jay Thomas

    The NHS is deeply baked into British people’s self concept. Not being proud of ‘Our NHS’ marks you out as some kind of anti-social weirdo and a vaguely alien one to boot. Disliking the NHS is to the modern Briton what disliking Baseball and Thanksgiving Day would have been to a 1950’s American. A sign you aren’t really a part of the Nationalgemeinschaft.

  • Julie near Chicago

    bobby, wrt to your comment here and also in the previous discussion about medical murderers —

    I know Eden Prairie is pretty upscale, but so is Naperville, Ill. (western suburb of Chicago). In June, 2008 I went to the E.R. there. After 24 hours of poking, prodding, and general fussing they told me I might have lung issues and to see a pulmonologist stat!. The earliest appointment I could get was three months later. When he finally saw me, he said 3-6 months, write your will.

    Thankfully, the meds he prescribed worked like a charm, and here I am, still able to regale you all with interesting little personal anecdotes.

    As you may or may not remember, “here” is Rockford, Ill., about 30 miles S. of the Wisconsin border and though roughly the same size as Naperville, just a very large tad less upscale.

    We are cared for by three medical conglomerates. When I finally moved up here for good, I had to wait something like 9 months to see the pulmonologist. I have to schedule appts. 6 months in advance. The situation up in Madison (Wisc.) is the same. I think Naperville hasn’t improved either.

    I need to have surgery to remove wholesale a deep sore in the area of the tush. It requires a plastic surgeon, and the one here refuses to do it. The Mercy conglomerate has a guy who actually works for the U. of Wisc. conglomerate and drives down here one day a week to see patients. He’s actually available only half of the one day/week. There are two rheumatologists, both in smaller (but still large) partnership practices. One wouldn’t even give me an appointment. My pulmonologist ordered the tests required by the other rheumatologist. I took ’em, his office sent them on.

    Three times.

    Finally the rheum. office said their docs refused to see me. The nurse at the pulm. office got on the horn with them and said wotthehell !!! Now I have a rheumatologist, goodie. Turns out the service has him (the senior man by far) and two younger turks. It was the latter two who decided from my pulm. referral that I didn’t meet their criteria.

    The guy I’m seeing said, Oh, it’s because the referral ran to 23 pages. They read halfway through and didn’t see the test results. I only found them because I read backwards through the referrals, and the test results are on the last page of the report.


    I sincerely hope that when you hit whatever the age is now for Medicare that you have a huge fund available if you decide to stay self-insured. I had excellent ins. through Argonne’s group plan (my Honey’s employers). What with the insurance companies going belly-up and rules changes and whatnot, Argonne closed the group plan. Bye, Blue X. So I had no more Major Medical (~ $1200/year, IIRC). The only alternative available in Illinois at the time was Blue X Medicare Supplemental, which is what used to be Major Medical I guess. This year the price tag is $ 251/mo, or $ 3012/year; up from $ 221/mo last year. It will go up again next year.

    In order to be eligible for Medicare Supplemental, I had to take Medicare Part D. Thank God the group plan had included Rx prescriptions, or I’d have had to pay Medicare for the 12 years I didn’t have Part D. Now I’m locked into it.

    I knew I didn’t want Part D from the very first. This whole sad story I tell you because if you ever do run low on funds and have to get Medicare, you will have to have Part D, and if you get there with no prior Rx insurance, you’ll have to pay through the nose.


    Now as everybody Stateside knows, the situation with medical care and health insurance here is very fluid. Perhaps something will be done to fix this mess by the time you all need seriously good care. And hopefully there will still be all these well-trained hotshot specialists in the biz who can help you.

    So the foregoing is as much a warning as anything else.


    By the way. There are two GP docs in town who go the “conciérge” route. The one guy I didn’t even consider. The other charges — guess what — $ 250/mo! True, he promises to see you within 48 hours (I think it is). But both of them remind you that you will also need Medicare or some other insurance, because they can’t do the lab work or surgery or fix whatever else ails you.

    Cheers! 😀

  • bobby b



    Again, for emphasis, yuck.

    Quick question: Was your issue (of getting some MD to sign on to handle your problems) one of a lack of ability to pay, or of docs being full up on patients, or medical incompetence, or . . . ? I’ve encountered enough issues of misdiagnosis, mistreatment, apathy, and the like throughout my life – some for myself, but mostly for others around me – but I’ve never had anyone straight out refuse to treat me or others because we couldn’t pay. Perhaps I’ve been lucky.

    I appreciate the warning re Medicare and all of its subgroups and parts. I’ve always figured that, between smoking, driving fast cars and motorcycles (summer) and fast snowmobiles (winter), getting routinely squished between huge animals, backwoods hunting and other firearms-related hobbies, a past as a divorce lawyer generating the considered hatred of quite a few ex-husbands, and several other odds-affecting lifestyle choices, I’d never really get a chance to face age-related vagaries, and so it’s an area in which I’ve chosen to remain ignorant, but then, here I am starting my sixties anyway, so maybe I’d better learn.

    I don’t go the concierge route. When I need med work (which, over the past twenty years, has been primarily accident-related, not illnesses), I go to local cash med clinics and get stitched and bandaged up, for a couple of hundred bucks. I used to have the same gold standard of insurance that you had – BCBS – and while my worst-case exposure was more limited by coverage, I was finding myself paying more than that as deductibles and co-pays. Now, because of the insanity we currently operate under concerning pre-existing conditions, if I contract something serious, I can be on insurance within a month. Wish I could wait until my house was on fire before I bought fire insurance, but property insurance remains a rational system.

    My primary approach to insurance as I age has always been, I’m never getting old. As my eighty-seven-year-old dad says, good luck with that.

  • Rob

    “Increased funding for the NHS must go hand in hand with reform of a system which favours bureaucrats over frontline staff. ”

    I assume that sentence is describing the system as favouring bureaucrats over frontline staff, rather than my first (mis?)reading which thought it was arguing for a reform which favours bureaucrats over frontline staff. 😀

  • staghounds

    Our poor people get sick from the diseases that actual poor people do not eat enough, afford to smoke enough, or live long enough to get. Diabetes, stroke, cancer. (And in some demographics, shooting each other.)

    And yes, when you aren’t paying at all for something, you are likely not to get the very best. If you’re going to the soup kitchen and the homeless shelter, don’t expect the Crillon.

  • Runcie Balspune

    strongly suspect that any company of that size still owns at least one fax-capable device or even a dedicated fax, and smaller companies probably have higher per capita numbers.

    As an IT technician I can probably tell you that most companies still send faxes, in the financial industry it is still an accepted method of trade confirmation (along with Handwritten Letter and Telex).

    However, very few probably have fax _machines_, more likely they use PCs with “virtual fax machine” software that automatically coverts to PDF or uses OCR to convert to text.

    From a nursing friend I know of General Practices that still use fax machines, even though the document always starts as electronic and could be easily (and cheaply) sent via email, it gets printed and sent, for some unknown reason (probably related to someone else paying for it).

  • llamas

    I wouldn’t get overly-exercised about the number of fax machines in use in the NHS, and here’s why – I’ll take a small wager that admin in the NHS is exactly-like admin in (one or two other UK public agencies of which I have knowledge) – the SOP consists of printing out hard copies of electronically-transmitted documents and filing them. Electronic transmission is seen as a more-convenient route for moving documents, but the final work product remains paper. Bureaucrats gonna bureaucrat.

    At least the fax machine saves the time and effort of the printing-out stage. I wouldn’t worry about how many fax machines or printers they have, but I’d love to see the amount of printer and/or fax paper that they use.

    To the larger question. Politics is downstream of culture. The NHS has successfully ingrained itself as a part of UK culture, like the monarchy and driving on the left – and so goes the politics. Impossible is a big word, but changing the NHS in any meaningful way is as close to impossible as you can get in UK politics. Just look at the things they do – like kill hundreds of people at a time by neglect and incompetence, or deliberately sentence a helpless infant to die, while the police and the courts are engaged to make sure he does die as ordered – and there’s barely a peep of protest.

    A few years ago, I posted a comment here about how the UK social services were so immune from consequences that they could get away with just-about any imaginable atrocity. The exact form of my words escapes me now, but I think I’ll dig them out and restate them for the NHS. It’s come to the same point.



  • Clovis Sangrail

    @bobby b

    I’m curious.
    Are you displeased because you have (had) an illness that took longer to diagnose/fix than you expected? Or because you received substandard care?
    Or did you have difficulty getting access to care for financial reasons?

    Well, I didn’t want to bore you with my own experiences-they merely confirmed my prejudices which started when I observed the treatment of my mother-in-law. The worst example of her care was her being sent home from A&E (ER, screaming with pain from an undiagnosed broken pelvis.

    My own experiences include being discharged from an observation ward with pneumonia and a very high temperature and fainting in the hospital on the walk back to my car (it’s OK, there was no fuss-everyone ignored me) and being told not to visit my GP when I got chicken pox aged 37 and was hallucinating with a temperature of 107F, because she had never had it and really didn’t want to catch it.

    So I guess the answer is substandard care and inability to obtain care.

    I pay for health insurance and private dental care (and pay for the NHS via taxation). There is no dentist in my area who will take new NHS patients.

  • Jim

    “The NHS is deeply baked into British people’s self concept. Not being proud of ‘Our NHS’ marks you out as some kind of anti-social weirdo and a vaguely alien one to boot. Disliking the NHS is to the modern Briton what disliking Baseball and Thanksgiving Day would have been to a 1950’s American. A sign you aren’t really a part of the Nationalgemeinschaft.”

    I disagree. Thats the official line taken by the vested interests – the unions, the leftist politicians and the rightist ones who can’t think for themselves, plus the likes of the BBC etc.

    Out in the real world people are increasingly noticing how crap the NHS is, as their elderly parents are mauled by its tender mercies, or they experience its failures with their own medical care. I can honestly say I don’t know anyone who is a fully paid up NHS worshipper. Some acknowledge its crapness but are afraid of what might come instead, but none are unconditional flag wavers for it.

    Public support for the NHS is taken for granted, its actually far less than the usual suspects make it out to be.

  • Julie near Chicago

    Thanks, bobby.

    Problems are a paucity of docs in some specialties, and up here, of GPs too — don’t know about Naperville these days. Until the lung diseases reared their ugly heads, I saw a doc once in a blue moon. But to take myself off the group plan would have been silly, as far as I was concerned. I mean, you never know when you are going to be mowed down by a mad bull or something.

    In Naperville, at the time there were two pulmonologists (pop. >145,000). The one was a newly-minted Muslim feller with no reputation; and for reasons of playing it safe, I wanted to avoid Muslim doctors. (It’s really not my fault that a proper subset of Muslims have committed a lot of carnage in the U.S., and a larger subset cheered when one of the former bunch did something truly heinous. And both groups contain people who had had sterling reputations. It does cause a sensible person to be a little bit wary — at least for as long as the officially recognized aim of those who speak loudly and globally in the name of Islam is insistent that Islam is going to Rule the World, by hook and by crook.)

    Anyhow, that was merely an aside. In Rockford, as I say, there are three conglomerates. I was with Mercy until the episode where I kept falling and ended up in the hospital. (The only other time I ever was hospitalized was when the Stork was too busy to keep up with its delivery sked, so I had to do the job myself.) Now I am with a different outfit, the best of the three by reputation.

    At least there is some degree of cooperation amongst the docs of these three, in my experience anyhow.

    There was never an inability-to-pay issue.


    You write,

    ” … [I]f I contract something serious, I can be on insurance within a month.”

    According to what I was told at the time my Blue X group plan was closed, in Illinois your choice was Medicare or Medicare, and that only during the Open Enrollment period of October. Unless you wanted to go through Exchanges. At the time in Illinois, BX had little or perhaps no competition…the alternatives would have been Humana, Aetna, or [I forget]. Since then, I think BX is the only one left. There might be more alternatives if you don’t have Medicare–not sure about that.


    What the sitch is with the seriously poor or improvident, I really don’t know from first-hand observation. But I surely don’t hear much news about people dying in the streets from lack of medical care, or of food either. And as I say, Rockford is not the ne plus ultra of upper-crust communities. We do have a healthy and vibrant drug-and-gangs community, which does not entirely restrict itself to its home turf. I could easily believe that there’s a high rate of medical misfortune in that “sector.”

    (I am told that Rockford is smack in the middle of the two favored drug routes between Chicago and Madison, Wisc. — capital city of Wisconsin, and native home of the U. of Wisc., Go Badgers. And a hotbed of Leftism and Progressivism since at least the turn of the 20th Century….)

  • Julie near Chicago

    To be perfectly clear, had I wanted strictly private insurance I might have been able to get it — I’m not sure. But since I wanted to keep my Medicare insurance the situation was as I described above.


    There is always, of course, the deductible.

  • Julie near Chicago

    And by the way, bobby, I completely agree with you about the insanity of requiring insurance to pay for pre-existing conditions.

    What this really is, is partially-prepaid medical care. Nothing to do with insurance (which is a system based on the pooling of risk, a probability operation).

    Confucius say, Calling things by their right name very important.

  • James Watson

    A quick comment.
    My wife suffers from MS. She has done so for some 40 years. The deterioration has been very slow, so that we were able to go to Mallorca three times a year, even though she needed assistance to board the aircraft. Only in the last couple of years have our trips ceased because her condition became too bad for her to travel. She can neither urinate nor defecate normally and she cannot use her legs at all. Some three years ago, when in Mallorca, she became very tired and we barely got home before she went into a coma. She had a serious urinary infection. She was very lucky that she survived. In the last twelve months, we have had two occasions when she had a lot of blood in her urine. She has been in hospital for a couple of days on those occasions.
    The NHS saved her life – there is no doubt. Or rather, the skill of the doctors saved her life. By the way, she is 77 years old.
    I agree that the NHS is plagued by problems, not least of which are the massively punitive ‘settlements’ of accusations of negligence. But in my wife’s case, I have nothing but praise for the care and attention she received.
    It bothers me that lawyers milk the NHS for millions of pounds because the NHS does not immediately admit that mistakes were made in specific circumstances. There are circumstances where a perfect diagnosis is not possible. Very old people die because they are very old and their hearts, lungs, kidneys, brains, etc, can no longer cope with demands made upon them. I have long held that the reason that we die, eventually, is that a major organ breaks down and ceases to function.
    It is bound to be the case that the more such ‘major organ’ problems can be held in abeyance by drugs, the longer that people who would have died will be kept alive. That ‘unintended consequence’is the biggest problem that the NHS has.
    I am, of course, not advocating that old people should be allowed to die. What I am saying is that the costs associated with keeping old people alive should be separately assessed and not lumped in with the proper concerns of the NHS. Such costs should be properly associated with ‘palliative care’.
    Perhaps the ‘charities’, such as CRUK, could use their massive income from TV adverts to provide such care.
    Again, we see the uselessness of politicians.

  • Julie near Chicago

    James, I am sorry about your wife. I know it must be terribly hard for both of you. My best wishes.

  • Natalie Solent (Essex)

    James Watson,

    Thank you for your comment. Like Julie, I send my best wishes to your wife and to you.

    I quite agree that some of the problems of the NHS are the problems of success, and are shared by all healthcare systems in developed countries. The need to raise the retirement age is another example of where a wonderful development, that people are living longer, does nonetheless cause difficulties that must be dealt with honestly and transparently.

  • James Watson (November 5, 2018 at 2:53 am), one of the very few ways in which the NHS benefits from being a government-run, no-co-pay system is that it gives UK legislators a motive to restrain the payments the NHS makes to ambulance-chasers. I recall a US lawyer (some two decades ago now, but I think the difference still applies) complaining that UK compensation law was barbaric, by which he meant that a guy like John Edwards could not have acquired so many tens of millions if the alleged medical errors he made a profession out of suing had happened in NHS hospitals in the UK. In the US, hospitals sometimes insist on procedures that have no statistical benefit simply because they know from experience that lawyers can make a court disbelieve they were not (statistically) likely to avert some bad outcome, where in the UK (sometimes because the US legal system has compelled the creation of a dataset of counter-examples) the NHS can follow statistically-verified practice instead of legally-intimidated practice.

    There is a downside even to this. NHS administrators know this UK situation. They also know that the NHS will never be bankrupted and replaced by an alternative for its errors, and that media coverage will never conclude “so we must replace the NHS”, and that patients mostly cannot say, “we will take our custom elsewhere”, nor need they care about those who can. That is why, for example, many an NHS hospital was far slower to deep-clean against superbugs than UK private hospitals – leading to many avoidable deaths – because the doctors and nurses knew it was needed but the NHS administrators took their own sweet time finding budget for it, unlike the private operators whose admin were alarmed far quicker. The moral of this is that, sad to say, even ambulance chasers sometimes motivate better behaviour than a bureaucracy.

    You are right that in the modern world, the culture of “How dare you, O skilled doctor, ever make a mistake!” – especially when contrasted with such things as “How understandable that you, O prejudice-encountering immigrant, should swiftly become radicalised” – can be ugly, but this is not an area where the costs for the NHS stand out in world medical systems, but rather the reverse.