June 9, 2009 | Commentary on Health Care
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 religion".
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 spending splurge.
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.
Robin Harris was a member of Prime Minister Margaret Thatcher's Policy Unit and is now Senior Visiting Fellow at The Heritage Foundation.
First Appeared in Human Events