Some 30 years ago I saw a copy of a North Korean propaganda magazine in English. My eye was immediately drawn to the glossy photograph accompanying one of the features. It showed a white-gowned Kim Il-sung talking to similarly clad scientists in a lab. The caption said, ‘The Great Leader teaching biochemists how to set up experiments.’
In a refreshing current development Dave ‘David’ Cameron chose to emulate this role model by offering nurses rather imperative advice on how to do their job. What with the so-called cuts in public services, he must have felt that his image needed some compassioning up. The downbeat in the rhythm of politics called for the upbeat of Dave showing us that he cares.
Call me morbidly sensitive, but I felt queasy at the sight of Dave ‘David’ doing a Kim impression by offering guidance in an area outside his area of competence. Actually, it’s hard to see what that might be (he couldn’t even score an outright victory against the worst government in British history). Fine, let’s call it his remit.
But I’m not here to criticise Dave. I’d like to offer a solution to the conundrum that’s but a PR opportunity to him and a matter of life or death to us. For the problem with NHS nurses isn’t that they don’t take patients to the lavatory often enough. The problem is that they are NHS. They are a symptom of a systemic disease.
Even as most believers refuse to discuss the existence of God, NHS worshippers treat any such suggestions as a heresy. They are ready to light the pyre, for the time being only figuratively. And yet the NHS is only a system of financing medical care. It shouldn’t be an unquestionable cult claiming a moral high ground. In fact it has no moral implications whatsoever, though it does have quite a few immoral ones, those based on universally discredited socialist premises.
If we look at it dispassionately, as we would with any other system of financing anything else, then we’d have to see its gross inadequacy straight away. Compared to medicine in any other developed country, the NHS, which is in essence people paying for medicine through their taxes, rather than direct, is simply not good enough. It’s only in our virtual world that it’s taken seriously.
In a real world, if medical care could indeed be financed by the state, it would be by expedients other than robbing Peter to pay Paul. The state could do a much better job by introducing what I call negative taxation for positive purposes. The underlying principle is that, rather than taking money away from the people and then supposedly using it for their benefit, the state would leave the money in people’s wallets and let the citizens fend for themselves. Rather than taxing people into submission, the state would exempt from tax the full cost of premiums paid for medical insurance. This would make private medicine tax-free, and consequently affordable to just about everybody.
Every taxpayer would have the choice of either handing his money over to the government or using the same amount to provide for his own health. The choice isn’t difficult: most patients even now would rather keep themselves out of the state’s clutches if they could afford it. The North Korean standards of medical care in the NHS are hardly news any longer, and people would welcome the alternative system. Not only would it be more efficient, but it would also be more moral — if merely by eliminating all those tax collectors and optimisation-facilitating, facilitation-optimising directors of diversity cum equality.
However, those who don’t pay tax anyway, for whatever reason, would derive no immediate benefit from negative taxation (they’d derive a vicarious benefit though, as the quality of medical care would improve). If they don’t pay tax for reasons of incapacity or poverty, they must be helped in other ways. For example, help could come from private charities that would be awash with money if the same negative-taxation principle could be applied to them. The state would only step in to help those who slip through the net altogether. As the number of such individuals would be small, this arrangement would place no unduly heavy load on the treasury.
Moreover, before long the state would begin to shrink to manageable proportions, and much of the power currently vested in it would be transferred to the people. They themselves would decide where they want to be treated and by whom. And, with the negative-taxation system in place, they’d be able to back up their decisions with cash. Reducing the state’s capacity to extort tax is thus tantamount to reducing its capacity to impose tyranny.
As someone cursed with rich first-hand experience of hospitals, both private and state-owned, in four countries, I can assure you that private works better. If you could afford it, and I’ve suggested one possible way, you’d have comfortable private rooms, the best doctors, equipment and drugs, good food, and nurses who really look after you. You’d be spared waiting lists — and the nauseating spectacle of our politicians doing a Kim impersonation.