Ca n'est pas mieux ailleurs, mais ça ne console pas

Theodore Dalrymple

The Fix Is In

Why Britain’s National Health Service spends so much and does so little
22 March 2010

Americans would do well to ponder a recent admission by a former British minister in the Blair government. On March 2, the Guardian reported that the ex-minister, now Lord Warner, said that while spending on Britain’s National Health Service had increased by 60 percent under the Labour government, its output had decreased by 4 percent. No doubt the spending of a Soviet-style organization like the NHS is more easily measurable than its output, but the former minister’s remark certainly accords with the experiences of many citizens, who see no dramatic improvement in the service as a result of such vastly increased outlays. On the contrary, while the service has taken on 400,000 new staff members—that is to say, one-fifth of all new jobs created in Britain during the period—continuity of medical care has been all but extinguished. Nobody now expects to see the same doctor on successive occasions, in the hospital or anywhere else.

The ex-minister admitted that most of the extra money—which by now must equal a decent proportion of the total national debt—had been simply wasted. (The same might be said, of course, of the increased outlays put toward state education.) But his explanation for this state of affairs was superficial and self-exculpating, to say the least: he said that the NHS received more money than it knew what to do with because of managerial inexperience. “It was like giving a starving man foie gras and caviar,” he said.

As it happens, the NHS knew exactly what to do with the money: give it to its staff, new and old. British doctors, for example, are now the second-highest-paid in the world, though not necessarily the happiest. They have accepted the money on condition that they also accept—as quietly as mice—increasing government interference in their work. When you go to a family doctor in Britain, he is more likely to do what the government thinks he ought to do and will pay him a bonus for doing than what he thinks is right. This is sinister, even when what the government thinks is right happens to be right.

There is a possible explanation other than managerial inexperience for the waste, namely that the waste was intended and desired: indeed, that it was the principal object of the spending. Experience has long shown that further spending by state-monopoly suppliers of services (if services is quite the word I seek) benefits not the consumers but the providers. And they—ever more numerous—naturally vote for their own providers, the politicians. Thus the NHS has become an enormously expensive method of ballot-stuffing. Personally, I would rather have outright electoral fraud. It would be less expensive and slightly more honest.

Just before the last election, the chief executive of one of the hospitals in which I once worked was overheard saying, “My job is to make sure that the government is reelected.” (The government’s job, in turn, was to make sure that she remained chief executive.) She also explained that the hospital could expect no increase in its government funding, unlike other hospitals—because it was located in an area in which most people voted for the government anyway.

****************
Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His most recent book is The New Vichy Syndrome.