Who says there’s nothing we can teach Americans? Here’s a valuable lesson our trans-Atlantic pupils would ignore at their peril:
Push Obamacare to its logical extreme, nationalise medical care, then start counting casualties, those killed by negligence and incompetence. They’ll multiply quickly.
Today’s exhibit, class, is Malcolm Green, millionaire Pembrokeshire businessman recently awarded an MBE for his charity work.
Mr Green underwent an abdominal operation and was recovering well. Suddenly his blood pressure headed south at an alarming speed, which often is a sign of internal bleeding.
An urgent operation was needed, yet the hospital staff took 12 hours to take Mr Green to an emergency ward. There he had to wait for a further five hours before the surgeon got to him.
By then it was too late: Mr Green had bled to death. This is a tragedy of course. But it’s more than just that.
It’s yet another object lesson, one of thousands the NHS obligingly provides every year. Free medical care is dear at the price.
In common with all socialist Leviathans it starts with a lie. For nothing in life is free, and medical care least of all.
‘Free’, to a semantic rigorist, used to mean something one didn’t have to pay for. To a modern Englishman it means something different.
If pressed, he’d admit that of course somebody has to pay for all those CAT scans and ECGs. Such things are expensive; and the more inefficiently provided, the dearer they get.
If patients don’t pay for them directly, the payment comes from the government, which can only make money the old-fashioned way: either from taxes or from borrowing, which ultimately is a hidden tax as well.
‘Free’ thus means that the transfer of money from patient to hospital is mediated by the state acting as a general contractor with megalomania.
But governments are less efficient than private enterprise. So we must assume that operations are more expensive when one pays for them through the government, whether one needs them or not, than they would be if one paid for them direct, and only when one needed them.
Yet when today’s Brits pay for state medicine, they don’t just pay for operations and scans. An ever-growing proportion of our money pays for the ever-growing state bureaucracy required to administer ‘free’ medical care, something for which we would pay less if medical care weren’t ‘free’.
Since steady growth of nationalised medicine is tantamount to the state extorting increasingly larger sums from the people, ‘free’ medical care places an ever-growing proportion of the nation’s finances and labour force under state control, thus increasing the power of the state over the individual.
Another ever-present feature of any socialist Leviathan is that it eventually shifts away from its declared raison d’être and towards its true inner imperative: making the people dependent on the state and therefore subservient to it.
In the old days, a hospital was managed by two people: head doctor and head nurse (called ‘matron’ in England, class – and you’re not paying attention, Barack), in other words by those directly involved in treating patients.
However, since we’ve already established that this is no longer the primary function of medical care, its management can no longer be entrusted to medical professionals.
Control has to pass over to those whose life’s work is devoted to advancing state power, which is to say bureaucrats. The shift may be slow initially, but it’s always accelerating and inexorable. Just like a snowball getting bigger as it rolls downhill, so do the administrative staffs of medical establishments grow at a faster and faster rate.
They bear titles like Director of Diversity, Director of Community Relations, Facilitator of Optimisation and Optimiser of Facilitation. Typically, none of them has any frontline medical experience, which is fine. The NHS isn’t mainly about medicine.
Incidentally, the same trend is observable in many other walks of life as well. That’s not surprising for, if it’s the state that sets the tone, sooner or later even ostensibly private concerns will start singing the same tune.
Hence the propagation of management courses, which evoke the fond memory of the Soviet nomenklatura. There it was The Marxism-Leninism Institute, here it’s assorted MBA programmes. In both instances the graduates are judged to be qualified to manage anything, from a symphony orchestra to a hospital.
There is, however, a subtle difference between a symphony orchestra and a hospital. The former may offend your aesthetic sensibilities; the latter can kill.
The drastic shift in managerial emphasis isn’t just unfortunate but inevitable. Sooner or later all institutions, whatever their declared purpose, revert to type. In the case of the NHS, patients are increasingly seen as annoying irritants getting in the way of the Leviathan’s real business.
Hardly a day goes by without a horrible tragedy like the one that befell Mr Green making the papers. This on top of hundreds (thousands?) that pass unnoticed and unpublicised.
Then again, even the explicit promise of the NHS isn’t excellence. It’s equality, equal medical care for all, the bloke who lives under the bridge and the wealthy Mr Green.
Just as people used to be regarded as equal before God, now they’re supposed to be equal before the state, which thereby assumes divine powers. Unlike God, however, the modern state isn’t loving and merciful. It’s self-serving and spivocratic.
Effectively it’s waging an undeclared war against all traditional certitudes, and any war claims casualties. Malcolm Green is the latest one of many, and many more to come.