June 9, 2009
By Robin Harris, D. Phil.
In response to Leftist criticism of her policies, Margaret
Thatcher once tartly observed that, "what we need from these people
is not advice, but an apology". Unfortunately, they still prefer
advice; and back in July last year, Gordon Brown, Britain's
unreconstructed socialist Prime Minister, was offering it again to
US Presidential Candidate Barack Obama, when the latter visited
London. Mr Brown specially let it be known that Britain's centrally
controlled, tax-funded National Health Service could serve as an
"inspiration" for future US reforms. President Obama's precise
plans have yet to be announced. But, whatever the details, it is
clear that they start from the same assumptions as Mr Brown's.
Namely, the (Federal) Government must step in to rectify market
failure, greater centralised regulation is required, and, by
implication, the promotion of self-help is a lost cause.
These assumptions are, of course, recognizably socialist, even
if the mechanisms adopted are not. The critics are, therefore,
right to predict that the ultimate result could well turn out to be
what American liberals really want, but don't admit to wanting --
the crowding out of private provision, the undermining of the
insurance principle, and a government-run, single payer system on
British or Canadian lines.
When Brown met Obama, Britain's NHS was celebrating its
inglorious sixtieth birthday. It stands now, in the midst of a
modern consumer-driven society, like one of those grey, shabby,
concrete blocks of socialist housing in Eastern Europe, that no
body wants to live in and every one wants to see down, but no one
can afford to remove. In 1948, when the British were used to
queuing and rationing, and the Wartime command economy still made a
kind of sense, the NHS summed up the mood of the nation and offered
the fulfillment of its aspirations. Yet it was always a child of
ideology. In the words of its Labour creator, Aneurin Bevan, "a
free health service is pure socialism". And so, in the name of
socialism, it had to be centrally controlled, down to the last
detail. "If a bed pan drops in a hospital corridor, the noise
should reverberate round the corridors of Whitehall", said Bevan.
It had also to be a state monopoly. So Bevan ruthlessly snuffed out
other provision, nationalizing 1334 voluntary hospitals and 1771
municipal hospitals, disadvantaging existing insurance schemes, and
squeezing out private medical practice by making general
practitioners financially dependent on the NHS.
It was a political triumph but an institutional disaster -- for
one simple reason. Government cannot efficiently provide health
care any more than it can efficiently provide food, housing,
clothing, culture or a day at the races. The cost of the NHS
immediately spiraled out of control and kept on spiraling, despite
the conviction of the experts that there was a definable amount of
ill health and thus a limited cost involved in remedying it. The
system was all embracing and self-destructive. No pricing meant no
priorities and rationing by queues. No competition meant the
dominance of producer interests and lack of innovation. No consumer
choice meant a take-it or (usually) leave-it attitude. The NHS was,
in truth, a huge nationalized industry in everything but name. But
belief in the NHS, unlike belief in other state run corporations,
became for a time what a Tory Chancellor of the Exchequer, Nigel
Lawson, summed up as "the closest thing the English have to a
Despite that, the Conservatives made some reforms, creating an
"internal market" for health care. The interest groups fought back
and the public were uneasy. Tony Blair then won the 1997 election
on the more than usually mendacious slogan "24 Hours to Save the
NHS". The Tory reforms were shelved or reversed - before Blair,
himself, grew frustrated and tried to reintroduce them by stealth.
The political quid pro quo was, however, an enormously complicated
array of centrally set targets and, above all, a huge further
injection of tax payer's money. Since 2000, spending on the NHS has
risen by eighty percent, after inflation. Even now, with the
country's finances in ruins, spending on health is to keep on
growing -- and the Conservative Opposition promises neither to cut
it, nor to redirect it through an insurance based system.
All that extra money has, of course, seen improvements. Why
shouldn't it? More doctors and treatments must yield some benefits.
Waiting lists for treatment, though also subject to fiddling, are
genuinely rather shorter. Health outcomes have generally improved
-- though not at a significantly faster rate than before the
But it has been a bad bargain for the tax payer. Because the
reforms were piecemeal and tentative, because they were all
concentrated on the supply not the demand side, because there is
still no effective competition, and because the professional
cartels are unchallenged, most of the extra money has gone into
gold plating pensions, hugely increasing doctor's incomes, and the
wasteful acquisition of new equipment.
No one should be surprised. Government does not have the
knowledge to run any business. Above all, it does not have the
knowledge to run a monopoly business -- yet, whenever it gets
involved, government hankers after monopoly.
Those in America who favour a model in which government does
more and the insurance principle matters less have not only to
explain the failings of US Government funded Medicaid. They have to
explain why, despite all the administrative effort and extra
resources, the British NHS is an abject failure compared with the
insurance based systems in Europe.
The record is dreadful. Shortly after Brown offered Obama his
advice, the European Health Consumer Index reported that health
care in Britain was worse than in Estonia, although Britain spent
four times more per head. Indeed, Britain came out near the bottom
of the European league on cancer survival rates, waiting times,
MRSA infection and the speed of access to new drugs. Another study
conducted at about the same time found that British women have one
of the lowest life expectancies in Europe.
The NHS prides itself on its nationwide preventive strategies.
So why are the British becoming obese faster than any other nation?
And in view of the Government's up front, incessant campaigning,
why does Britain have among of the world's highest abortion and
teenage pregnancy rates? But what about that fine old socialist
shibboleth "fairness"? Surely, the NHS, with its one-size-fits-all
obsession, has ensured that money doesn't matter in health care?
Quite the contrary. Like every centralised, nation-wide monopoly
system, the NHS is susceptible to manipulation. Those who can do so
move to where the care is best and then use their connections and
their skills to make the most of it. Government studies confirm
that inequalities in health have widened not narrowed, whether
measured by heart disease or hip replacements. And increasingly,
those who want speedy treatment and can afford it go abroad.
But socialism was always so. It coerces others and then consumes
its own. It thus entails cumulative and ultimately catastrophic
failure across the board. Socialist systems are all but impossible
to restructure, because of entrenched vested interests and because
of abandoned habits of self-help. Yet Britain's socialists are
unmoved. They are still advising, not apologizing. Their American
admirers should, though, be persuaded to sample Britain's
socialized healthcare before -- if they survive the experience -
being permitted to recreate it back home.
Harris was a member of Prime Minister Margaret Thatcher's
Policy Unit and is now Senior Visiting Fellow at The Heritage
First Appeared in Human Events
In response to Leftist criticism of her policies, Margaret Thatcher once tartly observed that, "what we need from these people is not advice, but an apology". Unfortunately, they still prefer advice; and back in July last year, Gordon Brown, Britain's unreconstructed socialist Prime Minister, was offering it again to US Presidential Candidate Barack Obama, when the latter visited London.
Robin Harris, D. Phil.
Senior Visiting Fellow
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