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Samizdata quote of the day – the annals of state efficiency: only 75 years late The government, in that form of the NHS, is only 75 years late in having a plan for that thing that they’ve been in charge of all these decades.
And there are people who disagree with us when we mutter that perhaps government planning isn’t the way to do things, eh?
– Tim Worstall
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The goal of governments and politicians is to get the politicians re-elected and grow the power and budgets of government departments. I know it is hard to recognize that these paragons of virtue, politicians and civil servants, act in their own self interest… but they do. They have planned for this outcome exceptionally well, and executed it with breathtaking effectiveness. Government spending grows, year on year out, for hundreds of years at about 5%, and politician re-election rates are well over 90%. They do a great job. They just do what they want not what you or I want.
AS to the NHS? Massive government growth, lots of politicians having great talking points, opposition threats that the other guy will throw granny in the street. And most of all, the utter subjugation of the populace to dependency on the state, and making them think there is no alternative. Brilliant, move. Evil and Machiavellian for sure, but genius nonetheless.
Consequently, the expression “government planning isn’t the way it should be” is correct, the expression “government planning isn’t very good” is not. You’ve got to measure with the right ruler.
I note that there’s not a lot of planning there for the administrative staff, just medical care professionals.
Perhaps, they ought to think carefully about the administrative load, and what that money is getting?
Here in the US, the ratio of caregiver-to-admin is getting close to being flipped in favor of administrative staff. Most of your Obamacare health care dollars are going to admin overhead, instead of actual healthcare.
My take on it is this: The majority of it all is grift, pure and simple. They tell you they need to spend money, look at what they build, and examine exactly who is getting the nicest spaces with the most money spent on them. The office staff has nice, spacious offices to work out of, while the medical staff in the ER and elsewhere is stuck working out of antiquated tiny afterthoughts of work areas.
This ain’t accidental, either. It’s exactly the same everywhere else in the economy, with the administrative bloat growing ever larger and more influential.
You want to solve problems? Simple solution… Take fire and sword to the admin block. If they’re shuffling paper, they’re almost certainly useless.
And, the whole thing is notably circular: You enquire as to why there’s a need for more admin, and they’ll tell you that they have to answer questions from higher authority… Which is generated by the administrators at that level, and who’re also entirely useless. The amount of paperwork twaddle generated these days is biblical in nature, and I don’t doubt but that we’re going to drown in it. Already are, TBH…
If taxpayers want to fund universal healthcare, that’s fine, but the government has no business owning and operating hospitals, the private sector can do it better. All government need do is sign the cheques. Same with schools. Of course, it doesn’t escape notice that schools and hospitals are mass employers who will doubtless support their paymasters come election time.
Kirk: As soon as the state gets involved in any industry it becomes a job creation scheme for their favoured clients, because the favoured clients keep voting for the people who give them jobs. And the only way to increase the number of jobs is to create jobs that are not the actual function of the industry. So, steelworks create lots of jobs for non-steelworks, railways create lots of jobs for non-train-drivers, hospitals create lots of jobs for non-healthworkers. We want to give out all the goodies of loverly public sector jobs, but all our clients aren’t anywhere near able to do anything useful in the public sector, so we create loads of admin jobs for them.
Welcome to state-run healthcare!
@jgh,
And, this is why I think the coming population crash is going to be a good thing… All the administridiot types are going to have to go out and do actual work, if they’re capable of it.
There was the joke in Office Space about the TPS report, and how useless it was. Under conditions of seriously tight labor markets, those demanding such reports are going to have a very hard time justifying them.
Once again we have rediscovered Parkinson’s Law.
Those who do not understand history are doomed to repeat it, or something.
https://m.youtube.com/watch?v=x-5zEb1oS9A
Seems like somebody has to post this here every year or so. Almost 50 years on and absolutely-nothing has changed. And, after all – why would it?
llater,
llamas
@llamas
Yes, in my opinion “Yes Minister” should be required viewing in all British high schools… 😀
The time to dismember the NHS before it collapses under it’s own weight, is past.
It will now collapse, so give up much hope of reasonable health care unless you are extremely rich and don’t mind being bankrupted by the medical oligarchy.
I knew medics back in the 1990’s when the management in the NHS started to increase. Apparently the managers didn’t like being shown up as incompetent by the medics, so what do insecure managers do? Hire baby managers they can feel superior to, who then hire smaller managers . . .
Example, a tonsillectomy was a routine procedure. If someone’s sick enough that you have to remove their tonsils, the same illness will probably require the removal of their adenoids which are right next to the tonsils. Simpler to do both at the same time (one dose of general anaesthetic, one recovery time). So you do ‘tonsils and adenoids.’ The managers complained that the tonsillectomy budget was overspent and the adenoidectomy budget was underspent. So for 6 months they did ‘adenoids and tonsils’ and everyone was happy . . .
“Extensive modelling” was used apparently. One would hope these models are better than the Covid ones, but probably not. So this planning is likely to have about the same, highly negative, value as the Covid response.
No Fraser Orr – the goal of government (whether national or local) is nothing to do with getting politicians re elected – the officials mostly do not care whether politicians are re elected – or actively want to get rid of politicians. Nor do politicians, these days, have a very large influence on policy – certainly they CAN make a difference at the margins, but most policies are handed down to politicians by officials and “experts”.
Does the state itself have a tendency to grow (both in spending and regulatory power) most certainly YES – see Anthony De Jasay’s work “The State”. But that is a very different thing from politicians wanting it to grow – they often (more often than you would think) do NOT want it to grow – but it does anyway.
This goes back a long way – for example the great objective of Prime Minister Gladstone was to abolish Income Tax, and his biographer John Morley noted, by the end of Gladstone’s time in office Income Tax was more firmly established than ever before.
It is true that Prime Minister Liverpool got rid of Income Tax and reestablished Gold Money – and that President Grant did the same things half a century later.
But that was long ago – and there was not really an administrative machine (a Mandarin Class of officials and “experts”) in those days.
Even in my own lifetime there have been profound changes – for example the professional administrators and “experts” were powerful (very powerful) in the 1980s – but much LESS powerful than they are now.
Covid lockdowns, and so on, were an international policy – not a decision of the NHS. Although it is worthy of note that a handful of State Governors in the United States said NO and stuck to NO – thus showing that democracy (at least at the State level) is not quite dead in the United States (as it is in so many Western countries).
As for the NHS – it was a copy of the Soviet system set up in the 1920s. But is far less political. If Mr Putin said “do X – do not do Y” to people in the Russian health system, they would at least pretend to obey. People in the NHS do not even pretend to obey British politicians (for example the endless Conservative Party ministers who keep saying “stop doing these Woke things”) – indeed they would be outraged by the very idea that they should obey politicians.
@Paul Marks
No Fraser Orr – the goal of government (whether national or local) is nothing to do with getting politicians re elected – the officials mostly do not care whether politicians are re elected – or actively want to get rid of politicians.
I agree that civil servants don’t care about politicians’ re-election any more that politicians care all that much about the size of a department’s budget. But it is a faustian bargain. We help the politician get re-elected, they help us grow our budget and power.
Government departments give politicians at least the patina of power and “democratically elected” politicians give government the patina of legitimacy. It is all clearly documented in Yes Minister. 😀
No Fraser – there is no bargain, Faustian or otherwise.
Please do not mistake me – I am not saying things are better than you say, I am saying things are worse.
Politicians who really do want to reduce the size and scope of the state “climb the greasy pole” and then find they can not.
The 1980s were bad enough – Margaret Thatcher and others complained about their limited control of the government machine, but politicians in the 1980s had vastly more control of the government machine than politicians do now.
Less than 1 in 4 people think the NHS is working well – but most people think that “more money” is the answer, ignoring (or denying) its vastly increased budget.
It is difficult not to despair.