Dear Mark,
Should the US copy the UK national health service? No, no, and thrice no. The opinion polls here, which usually ask loaded questions almost as stupid as
"Are you content with your free national health service, the envy of the world?", show that most people are grateful to have a health service that is free at
the point of use. However, if people who have been in hospital are asked whether their experience was favorable, the enthusiasm begins to wane. If
people who have used both the publicly-owned hospitals and the private-sector hospitals are asked to compare them, they are generally appalled at the
state of the public hospitals. There is also mounting concern that the nationalized health service keeps costs under control by what economists call
"rationing by death": a recent careful comparison between the health systems in Germany and in the UK, comparing the number of operations per head
of population to treat life-threatening diseases in 11 categories showed that twice as many such operations are performed in Germany as in the UK, and
at half the cost. When the study was reported to the National Audit Office by the Chairman of the Public Accounts Committee of the House of Commons at
my instigation, nothing was done.
Worse, I recently investigated a case in which an old but viable patient in intensive care was deliberately killed by the anesthetist on duty in a London
teaching hospital because there were not enough beds in the serious-trauma ward and a younger admission needed the bed. He reported the case to
management, which did nothing. I reported the case to two of the 95 separate bureaucracies that run the national health service, and both of them did
nothing. One of them said nothing could be done because its chief executive was attending the Labor Party Conference. I discovered that London at that
time had just 14 serious-trauma beds, while Berlin has a specialist center with 500 beds, serving a far smaller population. Another recent comparison has
shown that a patient's chance of surviving cancer is better in Poland than in the UK.
Nearly everyone realizes that the British national health service is monstrously inefficient, but few have enough financial acumen or knowledge of the
figures to realize just how inefficient it is. Broadly speaking, it costs 2-5 times as much to do any given intervention in the UK as it costs in the
publicly-funded systems anywhere else in Europe. Union Spanish practices and inefficiencies abound: for instance, there are some 64 distinct grades of
hospital porter, with salaries between one grade and the next varying by less than $1/week. Training of surgeons has been reduced to a joke:
pre-qualification standards have been repeatedly lowered, British surgeons are now among the least well-trained in the world, and survival rates even
after quite routine operations are extremely poor by international standards. Worse, a mad European law known as the "Working Time Directive" is now
being applied with ludicrous savagery throughout the hospital system, so that young house doctors learning their trade, who might previously have
worked 60-70 hours a week for a few years to learn their trade, are now forbidden to work more than 48 hours - and, insanely, at the insistence of the
European Court of so-called "Justice", the EU dictatorship's instrument of terror, the 48 hours includes "on-call" time when the doctors are sitting at home.
A handful of dedicated surgeons pays no attention to the directive and works as many hours as are needed so that at least the emergency cases are
treated.
At the primary-care level, the Government five years ago introduced a mad new contract for general practitioners by which they were given a 30% hike in
salary while being allowed, for the first time, not to attend life-threatening emergencies at night. The result has been catastrophically expensive: whereas
previously the cost of night-time emergencies was small and manageable, in rural practices such as the one in which I live the local health board has
calculated that, not least because of the Working Time Directive, the cost of providing doctors to attend emergencies at night and at weekends (a total of
2 call-outs a month, on average) is - get this - $1 million a year. Not surprisingly, the health board has withdrawn out-of-hours cover, so if you get a heart
attack out of hours up here you die. This policy is described by the Stalinist propaganda name of "community resilience"!
Medico-scientific research is also now a joke. The present Government arbitrarily decided some years ago that research should be confined to five quite
narrow areas, so that anyone who makes a discovery in an area outside the shortlist is refused permission to conduct trials. And, if a new medication
needs to be evaluated, one must first fill in a 150-page European Union form. This applies even to the evaluation of new uses of pre-existing medications.
No clinical trial can be conducted unless there is evidence that the new medication is efficacious and safe: yet no evidence that it is efficacious and safe
can be obtained without a clinical trial. In a recent instance where a new use of a pre-existing medication was tried out on me, sparing me the need for
painful monthly injections and vastly reducing the cost of treatment, as well as greatly improving my health, the results were splendid, so the surgeon
applied for permission to try the technique out on others. He was turned down flat when he asked to conduct a clinical trial of the new technique he had
invented, on the ground that there were no previous clinical trials demonstrating the efficacy of the technique. His research assistant had had to spend 31
days, full time, just compiling the necessary information to fill out the ludicrously complex EU form. Unsurprisingly, hardly anyone now does serious
pharmaceutical research anywhere in the European dictatorship's territory.
How have things descended to this state? One reason is that the national health service is a shibboleth, sacred cow or taboo. If any politician dares to
speak out and point out any of the numerous defects in this collapsing system, which now costs twice as much to run as it did a couple of decades ago
but with negligible improvements in mortality rates, he is immediately pounced on and told to be silent. Recently Daniel Hannan, a commendably
outspoken Conservative member of the European duma, told an American audience that, at all costs, they should avoid introducing a nationalized health
system such as the UK national health service. He was, predictably enough, howled down by the governing Labour party. However, he was also ordered
to be silent by the leader of his own party, who then issued a series of hasty and head-bangingly stupid public statements about how wonderful our
national health service was.
Why are the politicians so cringingly fearful? Because the NHS now employs - get this - almost 1.5 million people. Add in their families and you have the
largest single vested-interest voting bloc in the world. The monster has become so grossly big that no political party now dares to take it on and deal with
it. When I recently arranged for an NHS specialist with first-hand knowledge of the murder of an intensive-care patient by the national health service to go
and see the opposition Conservative party's health spokesman, the spokesman praised the specialist for his "courage" but made it entirely clear that he
did not intend to lift a finger to improve matters, because his party leader would sack him if - publicly or privately - he said anything that in any way implied
any criticism of the national health service, however justified.
It was in fact Winston Churchill, in a radio "fireside chat" to the nation in the darkest part of the Second World War, in 1943, who first told the people that
there would be a national health service. The Labor administration that took office immediately after the War had to borrow very large sums of money
from the US in order to set up the NHS, and the last payment in service of that debt (at a highly favorable 2% interest rate - God bless America) was only
paid off in December 2006. It was John Maynard Keynes who negotiated that loan. The biggest mistake that the Labor government made was to act at the
bidding of its trades-union paymasters and nationalize the hospitals. The original bipartisan scheme had been to ensure that the poorest would have just
as much access to the (then-private or charitable) hospitals as everyone else. That principle was agreed among all parties, and the Labor party itself had
had no plans to nationalize the hospitals. However, when the unions raise an eyebrow, Labor descends on to one knee, touches its forelock, and obeys.
Against the protests of all other parties, the hospitals were nationalized. The result is that the national health service is, in effect, a Communist country,
ruled by fear and funded at every point by the State.
Anyone within the system who dares to step out of line and suggest that some of the more flagrant abuses (such as the deliberate killing of patients, or
deaths caused by the frequent refusal of ill-trained surgeons to do difficult operations because their personal death-statistics would be worsened if they
failed) is menaced with dismissal, or even actually dismissed. For instance, the risk manager of one hospital where a patient was murdered refused the
management's pressure to sign off on a document accepting that the patient's death had been inevitable, whereupon she was dismissed on a manifestly
trumped-up pretext. She then threatened to take the hospital to the employment tribunal and to publicize the case, whereupon she was bought off with a
promotion to another part of the health-care system, in a post well beyond her true capacity, with a lavish increase in salary.
Recently in one of London's teaching hospitals it came to light that one of the leading surgeons was profiteering by the sale of organs to foreign patients
as part of his private practice, when there were many patients on the national health service's list who needed the organs. However, the surgeon in
question was well in with the management and, when his malfeasance was discovered, he was promoted out of harm's way. Corruption of this kind is rife
throughout the system, but the few members of parliament who dare to challenge it are fobbed off by the bureaucracy, and do not have the support of
their party leaders to pursue matters.
No country anywhere in the world has copied the British national health service, and for very good reason. The most important lesson from our dismal
system is not to nationalize the hospitals. One thing that could be learned from us, though: medical negligence claims are not a license to print money
here in the UK, though we are beginning to head in the same direction as the US. Perhaps the best of all possible worlds would be a system in which tort
reform places sensible limits on what can be claimed, except in the very grossest cases of willful negligence. The hospitals should remain privately or
charitably run. And the poorest should be given rights of access to the best of treatment - the original principle of the national health service, and the one
aspect of it that has been copied elsewhere.
Perhaps the most obvious danger in the UK system is the sheer size of the vested-interest group that the 1.5 million employees of the national health
service represent. This enormous bloc is so big that even Margaret Thatcher never dared to take it on. David Cameron, the "leader" of the opposition
Conservative party, who took a very early decision that he would do and say nothing that might in any way upset the enormous and burgeoning
State-sector bureaucracy of which the national health service is the largest single part, will certainly not have the courage to address even one of the
scandals, inefficiencies and corruptions that I have merely touched upon in this note. He, his health spokesman, and his advisors have cravenly decided
that actually confronting any problems such as these, would be more than his job was worth. They have no idea how angry the few good people in the
national health service are at their abject failure to get to grips with this crumbling, putrid leviathan. As Francis Bacon put it in one of his essays, "Beware
small men in great place." A British-style national health service in the United States? Don't go there.
- Christopher
Should the US copy the UK national health service? No, no, and thrice no. The opinion polls here, which usually ask loaded questions almost as stupid as
"Are you content with your free national health service, the envy of the world?", show that most people are grateful to have a health service that is free at
the point of use. However, if people who have been in hospital are asked whether their experience was favorable, the enthusiasm begins to wane. If
people who have used both the publicly-owned hospitals and the private-sector hospitals are asked to compare them, they are generally appalled at the
state of the public hospitals. There is also mounting concern that the nationalized health service keeps costs under control by what economists call
"rationing by death": a recent careful comparison between the health systems in Germany and in the UK, comparing the number of operations per head
of population to treat life-threatening diseases in 11 categories showed that twice as many such operations are performed in Germany as in the UK, and
at half the cost. When the study was reported to the National Audit Office by the Chairman of the Public Accounts Committee of the House of Commons at
my instigation, nothing was done.
Worse, I recently investigated a case in which an old but viable patient in intensive care was deliberately killed by the anesthetist on duty in a London
teaching hospital because there were not enough beds in the serious-trauma ward and a younger admission needed the bed. He reported the case to
management, which did nothing. I reported the case to two of the 95 separate bureaucracies that run the national health service, and both of them did
nothing. One of them said nothing could be done because its chief executive was attending the Labor Party Conference. I discovered that London at that
time had just 14 serious-trauma beds, while Berlin has a specialist center with 500 beds, serving a far smaller population. Another recent comparison has
shown that a patient's chance of surviving cancer is better in Poland than in the UK.
Nearly everyone realizes that the British national health service is monstrously inefficient, but few have enough financial acumen or knowledge of the
figures to realize just how inefficient it is. Broadly speaking, it costs 2-5 times as much to do any given intervention in the UK as it costs in the
publicly-funded systems anywhere else in Europe. Union Spanish practices and inefficiencies abound: for instance, there are some 64 distinct grades of
hospital porter, with salaries between one grade and the next varying by less than $1/week. Training of surgeons has been reduced to a joke:
pre-qualification standards have been repeatedly lowered, British surgeons are now among the least well-trained in the world, and survival rates even
after quite routine operations are extremely poor by international standards. Worse, a mad European law known as the "Working Time Directive" is now
being applied with ludicrous savagery throughout the hospital system, so that young house doctors learning their trade, who might previously have
worked 60-70 hours a week for a few years to learn their trade, are now forbidden to work more than 48 hours - and, insanely, at the insistence of the
European Court of so-called "Justice", the EU dictatorship's instrument of terror, the 48 hours includes "on-call" time when the doctors are sitting at home.
A handful of dedicated surgeons pays no attention to the directive and works as many hours as are needed so that at least the emergency cases are
treated.
At the primary-care level, the Government five years ago introduced a mad new contract for general practitioners by which they were given a 30% hike in
salary while being allowed, for the first time, not to attend life-threatening emergencies at night. The result has been catastrophically expensive: whereas
previously the cost of night-time emergencies was small and manageable, in rural practices such as the one in which I live the local health board has
calculated that, not least because of the Working Time Directive, the cost of providing doctors to attend emergencies at night and at weekends (a total of
2 call-outs a month, on average) is - get this - $1 million a year. Not surprisingly, the health board has withdrawn out-of-hours cover, so if you get a heart
attack out of hours up here you die. This policy is described by the Stalinist propaganda name of "community resilience"!
Medico-scientific research is also now a joke. The present Government arbitrarily decided some years ago that research should be confined to five quite
narrow areas, so that anyone who makes a discovery in an area outside the shortlist is refused permission to conduct trials. And, if a new medication
needs to be evaluated, one must first fill in a 150-page European Union form. This applies even to the evaluation of new uses of pre-existing medications.
No clinical trial can be conducted unless there is evidence that the new medication is efficacious and safe: yet no evidence that it is efficacious and safe
can be obtained without a clinical trial. In a recent instance where a new use of a pre-existing medication was tried out on me, sparing me the need for
painful monthly injections and vastly reducing the cost of treatment, as well as greatly improving my health, the results were splendid, so the surgeon
applied for permission to try the technique out on others. He was turned down flat when he asked to conduct a clinical trial of the new technique he had
invented, on the ground that there were no previous clinical trials demonstrating the efficacy of the technique. His research assistant had had to spend 31
days, full time, just compiling the necessary information to fill out the ludicrously complex EU form. Unsurprisingly, hardly anyone now does serious
pharmaceutical research anywhere in the European dictatorship's territory.
How have things descended to this state? One reason is that the national health service is a shibboleth, sacred cow or taboo. If any politician dares to
speak out and point out any of the numerous defects in this collapsing system, which now costs twice as much to run as it did a couple of decades ago
but with negligible improvements in mortality rates, he is immediately pounced on and told to be silent. Recently Daniel Hannan, a commendably
outspoken Conservative member of the European duma, told an American audience that, at all costs, they should avoid introducing a nationalized health
system such as the UK national health service. He was, predictably enough, howled down by the governing Labour party. However, he was also ordered
to be silent by the leader of his own party, who then issued a series of hasty and head-bangingly stupid public statements about how wonderful our
national health service was.
Why are the politicians so cringingly fearful? Because the NHS now employs - get this - almost 1.5 million people. Add in their families and you have the
largest single vested-interest voting bloc in the world. The monster has become so grossly big that no political party now dares to take it on and deal with
it. When I recently arranged for an NHS specialist with first-hand knowledge of the murder of an intensive-care patient by the national health service to go
and see the opposition Conservative party's health spokesman, the spokesman praised the specialist for his "courage" but made it entirely clear that he
did not intend to lift a finger to improve matters, because his party leader would sack him if - publicly or privately - he said anything that in any way implied
any criticism of the national health service, however justified.
It was in fact Winston Churchill, in a radio "fireside chat" to the nation in the darkest part of the Second World War, in 1943, who first told the people that
there would be a national health service. The Labor administration that took office immediately after the War had to borrow very large sums of money
from the US in order to set up the NHS, and the last payment in service of that debt (at a highly favorable 2% interest rate - God bless America) was only
paid off in December 2006. It was John Maynard Keynes who negotiated that loan. The biggest mistake that the Labor government made was to act at the
bidding of its trades-union paymasters and nationalize the hospitals. The original bipartisan scheme had been to ensure that the poorest would have just
as much access to the (then-private or charitable) hospitals as everyone else. That principle was agreed among all parties, and the Labor party itself had
had no plans to nationalize the hospitals. However, when the unions raise an eyebrow, Labor descends on to one knee, touches its forelock, and obeys.
Against the protests of all other parties, the hospitals were nationalized. The result is that the national health service is, in effect, a Communist country,
ruled by fear and funded at every point by the State.
Anyone within the system who dares to step out of line and suggest that some of the more flagrant abuses (such as the deliberate killing of patients, or
deaths caused by the frequent refusal of ill-trained surgeons to do difficult operations because their personal death-statistics would be worsened if they
failed) is menaced with dismissal, or even actually dismissed. For instance, the risk manager of one hospital where a patient was murdered refused the
management's pressure to sign off on a document accepting that the patient's death had been inevitable, whereupon she was dismissed on a manifestly
trumped-up pretext. She then threatened to take the hospital to the employment tribunal and to publicize the case, whereupon she was bought off with a
promotion to another part of the health-care system, in a post well beyond her true capacity, with a lavish increase in salary.
Recently in one of London's teaching hospitals it came to light that one of the leading surgeons was profiteering by the sale of organs to foreign patients
as part of his private practice, when there were many patients on the national health service's list who needed the organs. However, the surgeon in
question was well in with the management and, when his malfeasance was discovered, he was promoted out of harm's way. Corruption of this kind is rife
throughout the system, but the few members of parliament who dare to challenge it are fobbed off by the bureaucracy, and do not have the support of
their party leaders to pursue matters.
No country anywhere in the world has copied the British national health service, and for very good reason. The most important lesson from our dismal
system is not to nationalize the hospitals. One thing that could be learned from us, though: medical negligence claims are not a license to print money
here in the UK, though we are beginning to head in the same direction as the US. Perhaps the best of all possible worlds would be a system in which tort
reform places sensible limits on what can be claimed, except in the very grossest cases of willful negligence. The hospitals should remain privately or
charitably run. And the poorest should be given rights of access to the best of treatment - the original principle of the national health service, and the one
aspect of it that has been copied elsewhere.
Perhaps the most obvious danger in the UK system is the sheer size of the vested-interest group that the 1.5 million employees of the national health
service represent. This enormous bloc is so big that even Margaret Thatcher never dared to take it on. David Cameron, the "leader" of the opposition
Conservative party, who took a very early decision that he would do and say nothing that might in any way upset the enormous and burgeoning
State-sector bureaucracy of which the national health service is the largest single part, will certainly not have the courage to address even one of the
scandals, inefficiencies and corruptions that I have merely touched upon in this note. He, his health spokesman, and his advisors have cravenly decided
that actually confronting any problems such as these, would be more than his job was worth. They have no idea how angry the few good people in the
national health service are at their abject failure to get to grips with this crumbling, putrid leviathan. As Francis Bacon put it in one of his essays, "Beware
small men in great place." A British-style national health service in the United States? Don't go there.
- Christopher
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