For the benefit of my foreign readers, I should make clear that despite the protestations of the current dork masquerading as the Archbishop of Canterbury, the Church of England is not the national religion, it is the NHS! The people of Britain (dread words!) kneel and pray to it in adoration despite it being the biggest Ponzi scheme ever invented – well, it was but those ‘damn Yankees’ have out-done us again with their ludicrous ‘Obamacare’ nonsense. But perhaps the financial tectonic plates just shifted and finally reality will bring the temple crashing down.
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Fuck me! What was that?October 11th, 2015 |
 44 comments to Fuck me! What was that? |
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The great [policy] “advance” of ObamaCare over NHS has been the establishment of cost transfers and cost spreading amongst individuals and participants, largely through non-governmental (but intensely regulated) entities – principally insurers.
The NHS “policy” runs all costs through against government revenues, which may call for “re-diversions.”
A pleasure and an honour to be entered into these hallowed columns.
Agreed mate, it truly is a secular religion, irrational to its core
RRS – as you know, the companies who foolishly supported Obamacare are already being betrayed by their “friend”.
As for the NHS – no matter how much it fails, its failure will be blamed on “the cuts”. That these cuts in government spending are mythical is beside the point.
The quotation treats the NHS as an article of faith – but that is literally true, it is a religious faith for most British people.
To be “against the NHS” is to be against helping the injured and sick, to be in favour of sickness, injury and death.
Against such a position no evidence or argument is important.
One might as well try to argue in favour of Freedom of Speech or against “Gun Control”.
“I do not think we are in Kansas anymore Toto”.
As in Kansas it is possible to think (and say) things that would (at best) bring total exclusion from society here.
If the financial tectonic plates have just shifted, it’s a shame it’s happening while Corbyn is the leader of the opposition
The Democrats tried the same thing: anyone who opposed Obamacare was said to be “against healthcare”, as if they wanted to abolish all medicine. While that’s more insidious – since it can be hastily explained away by saying that “everyone knows” what they mean, while they carry on saying it – the situation in Britain is worse. People seem actually to believe that anyone who opposes the NHS (assuming they recognise that such a strange beast can possibly exist) wants poor people to die in the streets while “the rich” look on, laughing, from their plush hospitals.
Interesting bit by David, by the way. One might almost think that the union-dominated NHS is deliberately overspending in order to provoke the government into taking action, which will then be paraded on all the TV news bulletins as evidence of its savagery. A sort of miners’ strike redux, only this time it won’t be so obvious to the casual disinterested observer what’s really going on.
“To be “against the NHS” is to be against helping the injured and sick, to be in favour of sickness, injury and death.
Against such a position no evidence or argument is important.”
True, at the moment. But it will not ever be thus.
The NHS is socialism, pure and simple. To each according to need etc. And as such WILL fail. Its not a question of if, its when. My rough guestimate of when it does collapse under the weight of its internal contradictions is based on the idea that it took 70 years for socialism to collapse in Russia, and that as the NHS has the advantage of leaching off a free(ish) market economy rather than a pure command economy, it should take a bit longer for socialism to kill it too.
I predict the NHS will not survive its 100th birthday, and at some point in the next 30 years will die, to be replaced by something that works in other parts of the world. It will be along protracted death, with periods of crisis, interspersed with brief spells of improvement, but ultimately the impracticality of providing a free universal service with employees who have zero incentive to provide a decent or efficient level of service will at some point cause catastrophic failure.
Now you could argue that we’ve had catastrophic failure already (Mid Staff etc) and that hasn’t killed it. Thats not the point – the point is that the NHS will die when enough of the population have experienced the grim reality of it such that when the next crisis occurs the reaction is not ‘Lets do something to save the NHS, its wonderful!’, its ‘For f*cks sake lets kill it and do something different!’. We are not at that point yet. I would say that at the moment its 50/50. Half of of people have had a bad experience, or know someone who has, half haven’t. And given the power of the status quo, that’s enough to keep it staggering along. But the religious power of the NHS is waning. Labour use it all the time as a tool to bash the Tories, it no longer has the effect it once did. People now know the NHS will be sh*t whoever is in power, and pretending that having a Labour govt will make all the difference is utter nonsense. We are thus moving towards the inflection point – when we hit it the end will be quick.
So despair not. The NHS will die, and I (aged 44) will hopefully live to see its successor.
Great quote. It is quite literally true – the adoration of the NHS is indeed a secular religion in the United Kingdom.
More broadly, adoration and reverence of welfare state Ponzi schemes is a core pillar of Progressivism, which is the demonic religion of the modern West.
Or maybe we should despair. Sometimes it’s darkest just before it goes pitch black.
If all Presidents want to leave a lasting legacy, so they won’t be forgotten, why not give them all the Rushmore treatment? Have a whole chain of mountains with faces of Presidents carved into them? Vice-Pees can have a smaller carving, below the reigning P! How many suitable mountains does the US have?
There is an element of residual Christianity from the Second Great Commandment – that we should all care for one another – that probably underlies English public support for an attempt at something like the NHS.
That an error has occurred in how that care is to be provided (through a political process) to supplant all other ways of caring is difficult to accept. A good intention ought to be the cause of appropriate results.
Still, all that is a bit superior to what really lay behind the U S concept that everyone should share the costs (inter alia) of birth control pills for the fecund – ObamaCare style.
@PM
They were not “supporting,” they were carving out areas for cash flow opportunities. They goofed.
You are so right the “Risk Corridors” programs (reinsurance) have not produced enough net receipts to cover the claims and payments are being pro-rated (How did Lloyds miss this marvelous perversion?). Many now have “Reinsurance Recoverable”[?]instead of cash, so they will dip into investment income. Right now it look as tho’ that “Recoverable” will require federal funds (calling Paul Ryan).
to be replaced by something that works in other parts of the world.
Thing is, most of the world with a health system that is liked by the people tends to be quite like the NHS.
On the whole healthy rich people like private health care, the rest know that they are better off clubbing together and doing it that way. You can call it “Socialist” if that floats your boat, but plenty of non-Socialist groups work by clubbing together to pool resources and even out rewards (lawyers call them “partnerships”, but also see the Green Bay Packers for a prime US example). So most rich countries have a basic system for the masses, to which rich people can pay to get better treatment, as a cost-effective alternative.
That the NHS is badly run, and has perverse incentives built in, is doubtless true. But I can’t think of a cost-effective system that is non government funded. The US right goes to town about “Obamacare” and how it is “Socialist”. Yet their health care system would collapse without the non-profit sector (only 20% of its hospitals are properly private). And even then US health care provides very poor value for money (unless you are wealthy, of course).
So sure, replace the NHS with something that is shown to work better. Emphasis on shown. Because until then all the bluster about it collapsing is just that. People aren’t going to get rid of it for a system that some dogmatic Libertarians tell them is better, just because it is sufficiently un-Socialist, and therefore ipso facto better.
My prediction is the reverse. That the NHS is one branch of the government that cannot be removed, short of a right wing coup d’etat. You’d be better spending your energies concentrating on things that are possible to change, and just as wasteful of public money. Tertiary education for a start.
Chester, I agree that “the NHS is one branch of the government that cannot be removed, short of a right wing coup d’etat”… to which I would also add “or short of general economic collapse”. But otherwise your comment is largely wrong about everything.
No, not “if it floats my boat”, the NHS is full blown socialist by any reasonable definition of the term ‘socialist’.
And if it is not owned and funded 100% by the state, then it is not socialist but rather a mutual or a cooperative or a partnership or some such, which are materially different things to the NHS, because you can simply opt not to join them and not to pay for them. Can the Green Bay Packers throw members of the public in jail for declining to help fund them? No? And can the Green Bay Packers go broke? Because if not, why are you conflating them with the state funded, state owned, state run NHS?
So are you under the impression it operates in a largely unregulated free market? Or even a kinda sorta free-ish market?
You are not from Mid Staffordshire I take it?
I don’t think all, even most, opponents of the NHS have a beef with it being 100% government-funded. It’s more a case of their having a problem with it being 100% government run. The French healthcare system is mostly government funded, but the provision of services is private and highly competitive. So although the French system is so expensive it is bankrupt, you at least get good healthcare. The NHS is supposedly pretty good for treating anything that is about to kill you or if you are smashed up in a car wreck and about to succumb to your injuries, but for everything else it is pretty poor (dentistry?!) And when there is a massive screw up or incidence of bureaucratic cruelty, there is no feedback mechanism to get things changed. The 100% government funded part is the least of the issues, IMO.
As Jim says, to be against the NHS will not be considered to be beyond the Pale forever. I think that the narrative of the political and media class is that the NHS is sacred, but eventually with enough people pointing out the piles of corpses and botched operations, and the funding arrangements, many more might question why this ‘envy of the World’ is not copied elsewhere and why no one else seems to want to copy it.
There are few left alive in the UK who can remember what was there before the NHS, and pointing out that it was built on nationalising extant hospitals might well beg the question in the more alert but uninformed ‘How come there were hospitals to nationalise?” ‘How did people get healthcare before the NHS?’.
The next step is to point out how people could get healthcare after the NHS, or after it ceases to be effective in any form of provision. From my visits to people in NHS hospital over the last few years, I might think that basic hygiene is an unfamiliar concept to the NHS. It also feels like re-visiting my 1970s primary school in terms of the decor and effects.
Some points in no order:
A significant portion of the voting population still remember either the creation of the NHS or its early days. But they are getting fewer in number at every election.
If pressed, it is hard for the zealots to keep defending their position when they are asked: “Are patients in France and Switzerland dying in the streets because their systems are state funded/private provision models? Yes or no” Cue ‘yeah but, no but, yea…’
I believe that a big part of the problem is that politicians are themselves member of the Church of the NHS, or if not then cynically pandering to it. It may be the case that employees (and families of employees etc) and contractors of the NHS are a big enough voting block to be worth fearing.
Once could argue that the problems of the NHS are not mainly its being run by the government, but some other factors including powerful vested interests, and a lack of any incentive on the part of patients to use other taxpayers money as carefully as their own. There is of course pretty good evidence that these problems and government provision go hand in glove.
The GP system appears to me a terrible waste of money. In the 9/10 times when I have gone to see the doctor either for an ailment of mine or of my children I have been either told ‘don’t know’/’leave it for a bit and come back if it doesn’t get better’ or the symptom was specific enough for me to already have identified it on the internet, so the GP visit was really just to get the referal I already knew I needed.
With the best will in the world, even a fully efficient private system will still have cross subsidy from the young, healthy and rich to the old, poor and sick. A big part of the problem is therefore not how these services are supplied, but the cross subsidy. Of course, that makes it more important rather than less that health services are provided efficiently.
Peter T wrote:
‘I believe that a big part of the problem is that politicians are themselves member of the Church of the NHS, or if not then cynically pandering to it. It may be the case that employees (and families of employees etc) and contractors of the NHS are a big enough voting block to be worth fearing.’
You think? At 1.3 million direct employees, and an annual spend of 140 billion pounds sterling, the NHS is far-and-away the largest special-interest group, voting bloc and lobbying force in the UK. It simply dwarfs all the others put together. It has turned itself into the deadliest third rail of UK politics.
40 years old, and still completely accurate:
https://www.youtube.com/watch?v=Eyf97LAjjcY
https://www.youtube.com/watch?v=x-5zEb1oS9A
You think they’re joking – but they’re not. Many politicians and union leaders see the NHS exactly like this.
llater,
llamas
Surprised PdeH did not lay it on to the bitter end about socialism (in its older textbook definition).
State control of the means (and modes) of production.
At NHS who controls the means and modes of production of services; what services are to be delivered; the physical facilities for the services – and, the cost margins?
“State Capitalism?” hardly. There are only shortages, not surpluses.
If that ain’t classic socialism, the same as “nationalization” of any other sector, many have marched in the streets for naught.
You understand that “public” and “non-profit” are not synonymous, right?
The NHS is, undoubtedly wasteful. The NHS has, more importantly, sent UK citizens to the cemetery early. How many, by how much, and would a properly incentivized private system have sent fewer to an early grave? That, it would seem, would be a better conversation to be having. To start it, you need, a podium, a press release, and large brass balls to set it up and have a presser at the gates of a cemetery. Take your best guess at the number and set up your hypothetical private system as would have created fewer tragedies but for the shortsighted state worship that has turned the collective brain power of the UK away from even considering the possibility that the NHS is costing, not saving lives on net.
Lather, rinse, and repeat at cemeteries all across the land.
Yes I do agree, the performance of the NHS is pretty patchy, but it does have areas of expertise and levels of care the equal of any. To this you must add that not all of its staff are indifferent to their responsiblities, many give it their very best. Suggesting that everything about it is bad lacks credibility, although many of the comments above truthfully expose some of its failings. However I cannot help but think that these outcomes reflect the attitudes of the nation. For example, Briton’s appear to have largely abandoned the concept of personal hygiene and the wearing of decent clean clothing, just as they have in growing numbers decided to ignore sensible rules for looking after themselves. The growing disaster of diabetes is just one consequence of this shift in interest, the costs of these foolish behaviours will further deplete the standards of future care. I have no answer for this, well that is not true, I have answers but not ones that are acceptable to the population as a whole.
“Or maybe we should despair. Sometimes it’s darkest just before it goes pitch black”
What could possibly replace the NHS that is more socialist than it is today? Any reform of the NHS, absolutely anything, would be an improvement over what we have. What we have today cannot (in economic terms) be any worse. Free goods, rationed only by queuing, and provided by people with utter self interest above that of the patient. Yes it can get practically worse than it is today, with lots more people dying and suffering needlessly etc, but thats a consequence of its very nature.
I predict one day there will be demonstrations and riots outside NHS hospitals, as the divide between those who use the system and those who run it for their own benefit widens. The service will get worse and worse, and the pay and pensions of the staff will get better and better, and no action will be taken against those responsible for the crises as they occur. There will eventually be a public reaction. In fact the tipping point may be very small. Some random person’s death because of maltreatment or neglect will crystallise public opinion, in the way the picture of the dead Syrian boy did. So many people will think ‘That could be me or my mother/father’ and demand change. Politicians will be taken totally unawares by the publics sudden demands for action, because they of course listen only to the High Priests of the NHS cult.
It is then that people with the ideas of how to reform the NHS, the ones who are currently p*ssing against the wind of the NHS religion will need to come forward with proposals for change.
Barry Sheridan wrote:
‘Yes I do agree, the performance of the NHS is pretty patchy, but it does have areas of expertise and levels of care the equal of any.’
And Mussolini made the trains run on time.
‘To this you must add that not all of its staff are indifferent to their responsiblities, many give it their very best.’
But that’s not the point. The problem is not the efforts of some of the staff, who no doubt give it their very best, just as you suggest. One of the major problems of the NHS, and so many other similar systems, is that a very great number of the staff do NOT give it their very best. And many more are putting their very best into doing things which have nothing to do with healthcare provision and everything to do with enlarging and protecting the organization and the political and social power it wields. Remarking on the skill and dedication of those people in their work is like admiring the physical dexterity of a bank robber as he picks the lock of the safe.
In a private, for-profit system, these people would be weeded out and their wasteful and counterproductive efforts eliminated from the system. In the NHS, these are very-viable career directions. Just skim the jobs pages of the Guardian. How many diversity managers and outreach coordinators does it take . . . . ?
In a private system, jobs are costs, and efforts are made to trim them.. In the NHS, jobs are a benefit, to be expanded. wherever possible.
llater,
llamas
Brits seem to thimk that Americans are dying in the streets because of lack of health care. Yet, by all measures, survival rates are similar for similar populations. So, where’s the evidence to support higher death rates? Sometimes people die because they do go to see a doctor. Sure, people worry about medical bills. But that is a stimulus to getting a good job with health insurance. That’s not a bad thing.
I thought the national religion and latest fadish eschatology was Global Warming Doomsday scenarios.
Maximo, people ‘not here’ think this because they’re aware of the propadanda, but not the facts. The facts are that for decades, anyone, and I mean anyone, could (and can) walk into a hospital’s emergency room and they MUST be treated by federal law. And if they can’t pay for treatment, a very large segment of the bill if not all of it is simply written off. Hospitals along Amerca’s southern boarder routinely go broke from treating illegal aliens, their kids, etc. Jose has the sniffles? Go to the emergency room.
“I predict one day there will be demonstrations and riots outside NHS hospitals, as the divide between those who use the system and those who run it for their own benefit widens. The service will get worse and worse, and the pay and pensions of the staff will get better and better, and no action will be taken against those responsible for the crises as they occur. There will eventually be a public reaction. In fact the tipping point may be very small. Some random person’s death because of maltreatment or neglect will crystallise public opinion, in the way the picture of the dead Syrian boy did. So many people will think ‘That could be me or my mother/father’ and demand change. Politicians will be taken totally unawares by the publics sudden demands for action, because they of course listen only to the High Priests of the NHS cult.”
I wouldn’t bet on that prediction. The slow decrement on the quantity and quality of the services will go on forever and nobody will ever protest. Each individual customer will find particular examples of neglect/malpractice in the system. That doesn’t mean he will fight for the betterment of said system. He will try to navigate it the best he can without worrying at all about the other victims of the evil invention called public health. That’s the human nature.
Llamas, my understanding of the NHS is adequate enough to recognise that what it has become is related to a combination of its sacred cow image, weak politics, historic underfunding, growing and indeed open ended demand and the use of it by those whose ends are entirely unrelated to patient or medicine. We would happily agree I think if we were to spend more time discussing it, so presenting me with clever put down analogies is entirely unnecessary. Having over my life experienced a mixture of military medical care, NHS and private hospital treatment I know which I prefer, but rectifying the issues of the current system by presenting the theoretical advantages of differently run systems is not going to help because the British people want the NHS to survive, and survive it will. What maybe possible is for standards to be grudgingly raised by public demand, but do not bank on this. Samizdata repondents are fantasising that anything else will come about.
If the Mid Staffs scandal did not bring the whole thing down, I cannot see what will.
Incidentally, I’ve recently come to the conclusion that the NHS is loved by politicians and their statist lackeys because it gives them a handy justification for sticking their beak into every nook and cranny of people’s lives. Without state healthcare doctors would have to heal the sick instead of lobbying to ban anything which might taste nice or feel good.
Tim, the politicians simply reflect public sentiment. Britons are and have been enamoured with socialism for just about the whole of the twentieth century. In this they are leading the way as most populations within the western sphere are now drawn to these ideals.
V for Vendetta was a Hollywood movie.
Yep.
Not sure about the hygiene (been to the UK several times, and observed nothing offensive on that front), but surely the main reason for the rise in diabetes everywhere in the West is this.
Immigrants aside (no idea, but sounds plausible), not exactly: in the US anyone can walk into an ER and must be treated, and their bill may well be written off – unless they have any kind of property that can be mortgaged or sold. Which – meaning the property part – is the way it should be, really.
That’s always been my biggest complaint with socialized medicine. Every time money runs short someone will grind the numbers and say “We don’t need more funding if we can stop people from doing x.” Drinking, smoking, riding motorcycles, driving sports cars, whatever. Once you start going down that road there’s no end to it. Where I live they’re trying to re-brand gun ownership as a “health issue” so they can start adding new restrictions.
Not sure what part of the UK Barry lives in but we clearly move in very different circles 😉
With government health contro-, um, care, even political science majors can live this speech-
https://www.youtube.com/watch?v=8g2dkDh4ov4
Part of the problem is that a large proportion of the people believe both that it is in the interest of private providers to screw their customers and that “our” NHS is somehow run by and for “us”..
The IEA had a good piece with a nice, memorable name for this sort of thinking:
http://www.iea.org.uk/blog/the-maggie-simpson-delusion-the-nhs-is-not-%E2%80%98ours%E2%80%99
Great article Tom, I shall harvest a SQOTD from it!
It was on this very site that I first heard it said that the customers of the NHS are not the patients, but the government. The patients are an afterthought.
From TomJ’s linked article:
” ‘It is difficult to comprehend how Circle can maintain a proper standard of healthcare while maximising profit; as a company they would have to make a profit, but that can only come if costs are cut – such as a shorter stay in bed to recover,…”
When I had my one and only stay in hospital I was kept in for several days after I had recovered because I still needed two injections of antibiotics daily and it was apparently too difficult to arrange for me to have these as an out patient at my local surgery. I had the last injection early in the morning and it took the whole day for me to be discharged. Plenty of costs could be cut by eliminating this kind of inefficiency without any reduction in care.
Stonyground wrote:
‘When I had my one and only stay in hospital I was kept in for several days after I had recovered because I still needed two injections of antibiotics daily and it was apparently too difficult to arrange for me to have these as an out patient at my local surgery. I had the last injection early in the morning and it took the whole day for me to be discharged. Plenty of costs could be cut by eliminating this kind of inefficiency without any reduction in care.’
Around here, a private for-profit service will send an RN to your house twice daily to administer your meds and check anything else medical that needs checked. On my ride to work today at 5.00 am down US23, I was en convoi with no less than 3 ‘NurseCars’, presumably headed from their office to their first appointments. Cost per day ~ $200, vs $1000-$1500 per day for basic hospitalization. Math so simple, even a llama can do it.
Your point about waiting for discharge is telling – again, what matters in the NHS is not the wellbeing of the patient or the cost to the system – what matters is the organizational process.
llater,
llamas
@ Barry Sheridan – well, I didn’t go to offend you, and if I offended you, then I apologize.
However, I doubt very much that we would agree about much to do with the future of the NHS. I’m afraid I read things like this
‘What maybe possible is for standards to be grudgingly raised by public demand, . . . .’
and I just laugh out loud. Standards have been falling steadily for 50 years, to the point where hundreds, maybe thousands of people die unnecessarily in debacles like MidStaffs, and the only people who were punished in any way were a few nurses who were fired for gross negligence and misbehavior. None of the management team or the vast hordes of diversity managers and outreach coordinators suffered the slightest consequences, and in fact many of them were promoted or moved to other lucrative positions within the Leviathan.
If that sort of thing doesn’t get standards raised, then nothing will. The tales of abuse and neglect just keep on coming, and nothing changes, and nothing will change – because the NHS is now an employment, purchasing, benefits and vote-buying system that does a bit of health-care as a sideline.
The only way to raise standards is to kill the NHS Leviathan and replace it with a system that properly incentivizes the desired goals. For the record, I have no quibble with the original Bevanite concept of ‘healthcare for all, free at the point of delivery’ – it’s just that the NHS long ago left that behind as an organizational goal.
You seem to think that it’s possible to ‘rectify(ing) the issues of the current system . . . ‘ but it isn’t – the issue IS the current system, and the only cure is to sweep it away entirely. As TomJ’s linked article makes clear, the idea that it can just be steered back onto it’s ‘proper’ course is a delusion, because it’s no longer about healthcare, and anyone who talks about ‘rectifying’ the system in terms of healthcare issues is no longer talking about what the system actually does.
llater,
llamas
I didn’t even need home visits, I was up and about by this time and could have made my way to the hospital or my local surgery quite easily.