Britain’s National Healthscare System

Don Surber has been running a smack down on the British National Healthcare System (NHS) the last few days.  I’ve been writing more in his comments section on his site than here.  So I thought I would try to expand on my thoughts.

The NHS has been getting some well deserved bad press of late for some particularly egregious cases of patient abuse that are symptomatic of what a system of socialized medicine inevitably devolves into.  And I say inevitably because it is not just a health issue or a bureaucracy issue or a government issue or anything else so narrowly focused.   It is simply the result of natural laws, like water flowing down hills, that all the utopian wishful thinking of the socialists cannot make go away.

One of the recurring responses by independent commentors to the cases that have been brought up is, “How could they allow this to happen?”

You get what you incentivize and saving lives is not what socialized medicine is incentivized to do.  It is incentivized to stay in budget.  The decrepit and inadequate facilities, foreign staffs working for peanuts and general disregard for patients they are theoretically supposed to serve is all a function of maintaining budgets.  Any administrator who takes eyes off that ball ceases to be an administrator and is replaced with one with better focus.  It is a competitive process in a socialistic system which has no feedback loop to moderate its behavior.  The competition is not for organizational or personal profit within a legally stabilized free market environment, but for personal power unfettered by outside influences; the essential driving force in a bureaucracy.

Free market medicine has multiple feedback loops.  Crappy hospitals don’t get patients, bad doctors get sued, insurance providers have to compete with each other for customers and providers, governments try to stabilize the system with (ideally) sensible regulation.  It is a system of checks and balances.

Yeah, yeah, yeah; in theory the electorate of England tells their representatives to improve the system.  But the reality is that there are good feedback loops and bad feedback loops.  A good feedback is efficient, driving the system to a desired state without overshooting or resulting in wild gyrations.  Clearly, the free market system feedbacks lack efficiency.  But in socialist systems feedback loops are almost nonexistent.  The British electorate could tell the government to fix or change the system.  But the government’s reply is to threaten the electorate’s access to medical care.  Socialism shifts all power to the government.  When the BBC wants to get more money, they don’t go out and try to produce better programing to get more viewers.  They cancell the most popular shows, effectively blackmailing the viewers to pressure the government to give them more money (or no one ever gets to see Dr. Who again).  It’s the joy of having a captive audience and control of the sources of production.

Socialism in general, like the communist governmets of Europe in particular, only do one thing well.  They accumulate and maintain power…right up to the point where the population finally decides that chaos is better than their imposed order and the revolution casts them aside.  The government/entrenched bureaucracy can and will ensure that any transition away from NHS will be as agonizingly painful to the electorate as possible.  That’s their hold on power.  If they can ensure that, they can continue to get away providing the basest medical care achievable while convincing the electorate that crap is better than nothing.

And lacking that political feedback loop, the NHS will continue to be driven solely based on bureaucrat’s abilities to stay in budget at any cost.  Health care afterall, is not what they are incentivized to provide.

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