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The NHS: A Sacred Cow in Need of Slaughtering

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As a frequent visitor to Hindustan, the cows in the market place wandering, grazing on cut flowers and fruit on the market stalls are an amusing and rather endearing sight. No great damage is done to the sub continent’s economy by this religious indulgence, and long may it continue.

Would that the British National Health Service was so benevolent and inexpensive. This sacred cow is now almost exactly the same age as me. I have watched its gradual deterioration year by year, and more fascinatingly I have observed the completely ineffectual handwringing that politicians adopt at election time. Everyone knows it is failing, but it is perceived as electoral suicide to say so. Even to hint the problems are not money-related leads to personal vilification. Exactly the same response one might anticipate should anyone reprimand that browsing Indian bovine.

Nurses and doctors are wonderful, even though in any other profession we would accept there is good and bad (save perhaps the armed services where everyone is a hero, much to the amusement of servicemen themselves). Budgets are ring fenced with money and resources poured into the NHS yearly but to no great avail.

At election time all party leaders can do is shrug their shoulders and whine they have put more money in than ever before. Political journalists, as always, have no clue and just wheel out poor Mrs Sproggins who has been waiting 10 years for her varicose veins to be ‘done’. As the population grows year on year, the difficulties can only get worse. So let me offer a short analysis to assist our politicians and journalists who clearly have no clue.

The really big ideological hurdle is for everyone to understand is that the state is guaranteed to fail at everything it attempts. To suggest this is not so is totally irrational because we are not struggling with theory but fact, from the town hall to any ministry you care to name.

The mental block for 95 percent of the population is to accept health care is a commodity like any other. To suppose a product can be delivered ‘free’ at the point of delivery transcends common sense. Imagine, if you will, pubs where beer is not charged for at the pump but through taxation and you can only go to the pub in your immediate location. Imagine the quality of the beer, the standard of the service, the cleanliness of the lavatories – it would of course be ghastly!

Look, if you will, at state automobile manufacture. When there were two Germanys, the East gave the world the Trabant and the Wartburg, while the West produced Audi, Mercedes, Wolkswagen, BMW and Porsche. Consider the old soviet shops where customers queued outside empty shops, while the West enjoyed Sainsbury, Waitrose, Aldi, Lidl Marks & Spencer and too many others to list. Note if you will, how modern private techniques turned Skoda – a basket case – into a major international automobile player. Contemplate again the great advances of technology together with suppression of costs: flat screen TV, mobile telephones, computers, all manufactured designed and developed by the private sector.

What main theme runs throughout this litany of success? Even the most obtuse politician or journalist must see that it is competition.

Standards in cars, products, commodities & services improve if a customer can go elsewhere. It is the competition of the market which advances mankind, yet it has been suppressed in the UK in the field of health and education. Where there is choice the service in both these vital areas, they are world class and people come from all over the world to take advantage of them.

Russians do not fight to get their offspring into UK state schools but Eton or Abbots Bromley. Needless to say, those from poor countries find ‘free to them’ health in the UK very attractive.

Much mythology surrounds the NHS. The very latest myth is that privatisation has been tried and failed, and that private funding initiatives are the same as a private health care system. This is a travesty of what has actually happened.

Under the Labour administration it was decided that some services could better delivered by outsourcing. Park that for a moment in your memory. What actually happened? A nationalised health industry run by a cartel of politicians, quangos, civil servants and trade union representatives outsourced some services under appallingly badly negotiated contracts making billions for companies to whom civil service and political negotiators were a standing joke begging to be fleeced as indeed they were.

Then the civil servants decided they were entitled to private sector salaries without the discipline of the market. This happened across the board: hospital chiefs on £200,000 pa, while the average wage for administrators is £70,000, and a fully qualified nurse or physiotherapist is just £30,000. It is not conceivable that an organisation disciplined by market forces could squander money in this fashion. Indeed up until the late 1960s there was no such thing as a professional hospital administrator. We now have a health service where fewer than 50 percent of the 1.2 million NHS employees have any sort of medical qualifications.

How is it possible for highly qualified theatre nurses to be paid only the average national wage? The market simply would not allow this to happen. Fellow libertarians know that we are dealing with the phenomenon of ‘the tragedy of the commons’. The NHS belongs to everyone so it belongs to no one. It is therefore raped at every opportunity by anyone with the wherewithal, from bureaucrats to big pharma. The British and American system is an amalgam of state and vested interest doomed to long term failure. Some continental systems work better than others, usually in a direct ratio to the local governance of the hospital and the competition allowed.

Do not be swayed, as so many are, by anecdotal experience that the NHS looked after Aunt Betty so well, or that your GP is a god among men. All of this is probably true, certainly true of my GP (Downing College rugger blue to boot!). But none of this is the point. At nearly £100bn per annum it should be better, much better – imagine putting that kind of money back in people’s pockets. Yet the modest reform of a small appointment fee has been abandoned on the altar of ‘free’ at the point of delivery.

The new dumbed down UKIP shed this last vestige of reform, although it was overwhelmingly popular whenever I mooted it on TV or Radio. Many senior businessmen have been asked to review the system and concluded it was unreformable. The whole phenomenon is political: Gordon Brown instigated a fake analysis during his brief and disastrous term of office, commissioning Mr Derek Wanless (remember the chap who steered the Nat West on to the rocks?). No change needed came the unsurprising conclusion, and arise Sir Derek. Pure Yes Minister stuff.

Before the inevitable kneejerk reaction, I’d like to say that certain aspects and expertise within the NHS are beyond question the best in the world, but the current system is like the BBC – an anachronism, anything but free, and in point of fact extremely expensive. The NHS came into being in the late 1940s. Ironically, some of the original ethos that was worth retaining has been abandoned. Reform is inevitable, and surely better undertaken now than in the storm of total collapse. Perhaps we could start by shooting everyone who refers to the current system as free.

Godfrey Bloom is an Austrian School economist, married for 30 years to a Chartered Physiotherapist


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