State Run Medicine Doesn't Work (The NHS Was A Terribly Stupid Idea)

Britain's NHS was founded on a dangerous series of myths and misconceptions.

Aneurin Bevan, the politician who founded the NHS in 1948, did so on the basis of a local insurance group which provided health care in return for weekly contributions. He was a keen fan of Karl Marx and the best we can say for him is that he probably meant well. (Winston Churchill wasn't so kind. He once described Bevan as a squalid nuisance.) Unfortunately, he clearly didn't understand that you can't turn a small, amateurish, honest little organisation into a huge, national organisation without exchanging the passion, the purpose and the goodwill for an enormous amount of harmful bureaucracy.

Bevan seems to have believed that a national health service was a `good thing' because health care, like education, should be free to the user. He wanted the State to be responsible for paying all the bills; installing the State machinery between doctors and patients. That was his first absurd, calamitous mistake. Why should the State provide a free health care service? The notion that health care or education should be `free' because they are essential is downright silly. It would make far more sense to say that water and shelter should be free. Why is it a sign of a caring society to have free health care and free education? It is argued that these are essentials for life and so must be available to all without cost. This argument can be destroyed in one word. Food. I don't see anyone offering free food to everyone - regardless of need. It is far better to give poor people the money to buy whatever food they need than to give them State-controlled food hampers. No one suggests that supermarkets should be run by the State and food made available to anyone who wants to wander in and wheel a trolley. And yet it would make more sense to have nationalised supermarkets than it did to nationalise health care.

Besides, most of the NHS is not essential to life (infertility operations, breast enlargement and sex change operations are hardly vital to survival) and most of the education system is not crucial (the bit that teaches media studies springs to mind as an example of the utterly unnecessary). Am I the only one to think it odd that we provide patients who want them with free sex change operations but charge patients for essential dental treatment, for spectacles and for drugs they need to stay alive. Too much of the NHS is organised to satisfy the doctors rather than the patients. Home deliveries have more or less gone for pregnant women. Home visiting has been reduced to a bare minimum. There are waiting lists to see a consultant, to have basic tests done and to get into hospital. People even have to wait to get an appointment to see their GP. Family doctors now hide behind duty rostas, deputising services and white-coated receptionists. Cottage hospitals have been replaced with huge, bug-ridden, expensively equipped battery hospitals. It should be no surprise that the British were never healthier than they were during the Second World War. The death rate of workmen over 50 years of age has for some years now been higher now than it was in the 1930s. More people than ever are dying of heart disease and the evidence shows that a man or woman who has a heart attack will probably be better off staying at home than going into hospital. We have more doctors than ever but their education is paid for largely by the drug industry and, as a result, more than half the adult population and over a third of the children in Britain take a drug every day of their lives. Britain leads the world in fertility treatment and yet thousands of mentally handicapped patients roam the streets because the NHS provides no facilities for them. Four out of five patients who go to see the doctor have nothing wrong with them that wouldn't get better with a good holiday, a modest win on the pools or a little friendship and understanding. People want guidance, support, kindness and caring but thanks to the NHS they get drugs and a system that doesn't give a damn.

The idea that hospitals and doctors should be part of some national system is nonsensical. Bigger simply means employing more bureaucrats. The existence of a central authority, and the employment of layer upon layer of administration, makes the NHS expensive and inefficient.

Bevan's other, incredibly stupid, idea was that the NHS would help eradicate illness. Really. It apparently never occurred to him that some people might like going to the doctor, especially if someone else was paying for it.

Nor did he realise that the NHS would end up approximately four times as expensive as private care because of all the administration.

And, most important of all in my view, he completely failed to understand that the NHS would destroy the traditional relationship between patient and doctor (employer and employee) and create a new one (supplicant and civil servant bureaucrat, a dispenser of good things and keeper of the gate). He also failed to understand that anything Governments organise is required to be inefficient, uncaring and incompetently run.

Bevan believed that the NHS would pretty well cure all illness. The opposite turned out to be true. Knowing nothing about medicine and even less about people he thought the cost of the NHS would fall as people were cured. In fact he produced an extraordinarily expensive and wasteful bureaucracy which is addicted to spending. If he had wanted to protect the poor he should have set up a scheme to give money to the poor to buy private health care. This would have been cheaper and more efficient but most importantly it would have maintained the purity of the relationship between doctors and patients. The NHS encourages a paternalism that is stifling and destructive. Doctors, not patients, take decisions. Medical decisions are designed to conform more to the wishes and needs of the doctor rather than the patient. Putting the legs of a pregnant woman into a stirrup is for the convenience of the doctor not the patient. Too often patients allow the decisions to be made for them. Few doctors are prepared to allow patients to live with mild disabilities. For example, a patient who gets mild chest pain after walking for five miles will be told that he needs surgery. A patient who develops leg pain after cycling for a few miles will be referred to a surgeon. No doctor will today think of telling a patient that he can, if he wishes, simply live with his symptoms, adapt his life to live around them, and change his lifestyle to produce a permanent improvement. Doctors make the decisions on how much pain is tolerable and on when life is worth living. These are ethical decisions, value judgements and moral pronouncements. The NHS encourages medical imperialism.

Today, the big question that no one ever dares to ask is: `Is the NHS a good thing?'

As questions go it is the herd of rampaging wildebeest in the sluice room. Politicians, journalists and earnest members of the medical establishment talk endlessly about restructuring and reorganising the NHS. But they never talk about getting rid of it. No one with the authority to do anything ever dares question the effectiveness and efficiency of the NHS. No one ever asks if it is necessary. No one ever questions whether it is providing patients with the best type of health care. No one ever questions the role of the State in providing health care. No one ever dares ask whether the NHS is good value for money. The NHS has become a political icon. It is inconceivable that any politician would dare suggest a debate to discuss shutting it down.

And, in my view, most important of all no one dares to discuss the ways in which the NHS has damaged the relationship between doctors and nurses on the one hand and patients on the other.

For me the big problem with the NHS is not simply the fact that it is enormously wasteful and bureaucratic (though it is both of those things) but the fact that it has produced a fundamental change in the all important relationship between health care professionals, on the one hand, and patients, on the other. There is no dignity. There is no respect. There is no pride.

Because they work for the State, doctors and nurses are now civil servants. GPs have attempted to retain their independence by officially remaining self-employed. But it's an accounting independence not a primary independence, designed more to minimise personal tax liabilities rather than anything else. GPs claim that they are self-employed but it is more of a tax fiddle than a serious ideological claim. For all practical purposes GPs, like hospital staff, are civil servants in the same sort of bracket as tax inspectors, planning officers and airport security staff. And, like all civil servants, they enjoy vast amounts of authority and very little responsibility.

The fundamental problem with civil servants is that their loyalty is to the State, rather than to the people who are paying their wages. Civil servants tend to acquire a superiority complex. They absorb the power they represent and become incredibly snotty when dealing with `members of the public'. (Just try dealing with a tax inspector or a traffic warden if you doubt me.) When you go into a Post Office you realise that there is a huge difference between government employees and other people. Government employees don't care; they don't have any interest or pride in what they do. They turn up for work because its marginally more interesting and much better paid than staying home and watching daytime television. That's how the NHS now operates. Doctors and nurses really don't give a toss whether you live or die as long as they get home on time.

The standard Government employee knows that what he does doesn't really matter - as long as he is loyal to the State. Incompetence and laziness are excusable and will be defended by the State and its other apparatchiks. The State's employees know that they must always defend anything done on behalf of the State because if they don't the State's authority will be diminished. And as far as the State is concerned, authority is everything. Ronald Reagan, former President of the United States of America, was spot on when he said that: `The most terrifying words in the English language are: `I'm from the government and I'm here to help.''

This doesn't matter terribly much when we're just dealing with tax inspectors. But it does matter a good deal when health care professionals are involved. It matters a great deal and when health care is involved, the standard State employee mentality is simply unacceptably dangerous.

There are a host of problems with having a State owned and run health service. Decisions made by governments are bad because they are always made for the wrong reasons. And in the world of medicine the wrong decisions are made for the wrong reasons by the wrong people because there is no one to stop them. The right people (those few doctors and nurses who care) are bullied, frightened and overwhelmed. The truth isn't just ignored, it is hidden, suppressed and those who dare to ask inconvenient questions are silenced. It is crucial to remember that anything the State organises is organised for the benefit of the State. That's the way statism works. As Ayn Rand wrote: `The difference between a welfare state and a totalitarian state is a matter of time.' Trade unionists who are united work for their own benefit (rather than for the benefit of those they serve). Professionals who are united work for their own benefit. Large corporations are organised for their own benefit and have identities, purposes and aims of their own. And any organisation set up by the State will exist to protect and preserve its own integrity and status.

Everything is made worse because the three parts of the unholy trinity (the Government, the drug industry and the medical profession) all support one another and deliberately work against the interests of the patients.

In the days before the NHS, doctors offered cut-rate or free services to patients who couldn't afford to pay. I once looked through the accounts book of a doctor who worked in the 1920s and 1930s. He charged his well-off patients a fee for every consultation or home visit. But if he knew that patients couldn't afford his fees he charged them half-price. And if he knew that patients couldn't afford even that then he waived his fee and charged them nothing. Hospitals and hospital consultants did the same. The medical profession did not include doctors who would allow their patients to die for lack of treatment. No one was turned away because they did not have the money to pay for a consultant or a bottle of medicine. Doctors considered that they had a responsibility towards the less fortunate. Free medical care was widely available for the poor.

It is perhaps difficult to accept that such a system can work. We have been brainwashed into thinking that the State must take responsibility for everything. But this has happened simply because those who work for the State want to control everything; they want to extend their power into every aspect of our lives. We have lost the ability to imagine a system wherein free people might solve problems without threatening one another with lawsuits or threats of violence.

The traditional relationship between doctor and patient was simple. The patient asked the doctor for help. The doctor offered advice and treatment. The patient paid the doctor. No one else was involved. (Things were different in China where patients paid their doctor when they were well and stopped paying when they fell ill but this doesn't really concern us and nor does it affect my argument.) If the doctor wasn't much good his patients didn't go back to him. The doctor (and nurse) had a vested interest in providing patients with the best possible care.

The introduction of third parties into this relationship (in form of the State or an insurance company) changed the dynamic of the relationship in a fundamental way and changed the responsibility and loyalty of the doctor.

The bottom line is that patients need control over doctors and the best way to arrange this is for them to have control over the money (even if the State has to give the money for them to spend). As St Matthew warned us: `No man can serve two masters.'

Today, doctors have lost all their independence and although GPs in the UK may have preserved a quasi financial independence (for purely personal tax reasons) they are civil servants just as much as tax collectors and policemen are civil servants. They are paid by the State and their primary allegiance is to the State. The doctor's loyalty is to the State because the State is now his employer. The traditional, basic link has been broken and the doctor is responsible to the State and not to the patient. This is why doctors vaccinate their patients (the State wants them to) even the evidence clearly shows that its a dangerous and ineffective business which benefits only the vaccine manufacturer (and, to a certain extent) the State. Doctors have become obedient and fearful and are bullied by the bureaucrats. Moreover, medical staff will in future be increasingly constrained and instructed by meddling, ignorant, self-interested, self-elected lobbyists represented by a myriad of patients groups, clinical networks, health and well-being boards, citizens' panels, official and unofficial busy bodies and the now usual plethora of health and safety morons.

Doctors used to be primarily concerned with protecting and serving their patients. Today, they are primarily concerned with protecting their relationship with the State and, like most civil servants, serving the State and making as much money as they can. Authority corrupts as much as power. And the medical profession now a part of an authoritative system which is utterly corrupt. The state machine is demanding and it demands blindness of its servants; blindness to anything new and potentially threatening or critical of its systems and methods. Purpose and value have been abandoned. Doctors are bribed with money and less work. The machine destroys but rewards generously. State controlled health services lead to a confused mixture of needs, wants and demands with lobbyists and politicians deciding how the money should be spent. The open ended demands on the NHS's obviously limited resources are never met and so choices have to be made. Some live and some die. The strongest lobbyists win. The weakest patients die.

The whole organisation of the NHS is devised to satisfy the State's requirements, rather than the needs or best interests of patients. Doctors are supposed to serve patients but they are constantly ordered around by State bureaucrats. They do what the State tells them to do because the State is the master. So, for example, when the NHS becomes involved in GP care it promotes larger medical centres because these fit more comfortably into the bureaucracy. The State forces GPs to adopt appointment systems (which are unpopular with doctors and patients and which have been proven not to work) because the State likes control.

Separating the interests of doctors and patients and forcing doctors to identify with and become allies of the State (their employer) means that the triumvirate, the unholy medical trinity of doctors, drug companies and State become united and create what is effectively a single organisation. The losers can only be patients. The normal counterbalance to special interests such a doctors, drug companies and government is the existence of a powerful body with other interests. Patients as a group are too weak and too ill-informed (and inevitably too frightened when they take an interest) to protect themselves. They need support, help, independent honest advice and guidance. All those things used to come from doctors but the balance was changed when the NHS was created and it has been getting worse throughout the NHS's existence. Today, policies which might benefit patients are forgotten as policies which benefit the unholy trinity are pursued zealously, selfishly and without feeling or compassion. When a cottage hospital in Budleigh Salterton wanted to save money by throwing my mother out of her bed, her then GP, who might have been expected to speak on her behalf, spoke with the hospital. The State employees must stick together to defend the interests of the State. The trinity campaigns vociferously, buys the best lobbyists and creates laws to control those who oppose it. It also controls the media because the media has no choice but to believe what doctors tell them to believe. Dissidents are silenced even within the profession. The trinity controls everything and buys all the power it needs. The trinity either convinces the public or confuses it so that clear thinking and sensible, objective conclusions are impossible to reach. Doctors as State employees are afraid to make decisions in case it is the wrong one, so they go by the book. They follow the test results and they hire committees and consultants to produce reports and recommendations which are invariably so vague that there can be no blame if things go badly.

Because NHS staff are Government employees they have high job security. Self-interest is controllable in companies and businesses because consumers and shareholders do have some power. But Government employees are immune. They use the State to promote their self-interest at the cost of the taxpayers - in their case, patients. Of course, there are moral and honourable employees. But they are overwhelmed by the system and just as a chain is as strong as its weakest link so everything depends upon the selfishness of the most selfish employee. We have to remember that the NHS is one of the world's largest employers and the good tend to be overwhelmed and exploited and dispirited by the bad who are not above using threats to get their own way. Government departments, such as the NHS, have no concept of time because they don't have to rely on customers paying their bills and coming back. Apologies are never made because the State is never wrong.

The NHS spends money in wrong areas; failing because of greed and incompetence it has, like many large Statist organisations become concerned primarily with its own survival, and more concerned with the protection and enrichment of its servants, than with looking after the people it is supposed to look after.

The NHS is a great organisation for doctors, nurses and bureaucrats. But it is disastrously expensive for the State. And it is terrible for patients. Doctors and nurses go through the motions but they are now civil servants and civil servants always look after themselves and the State before they look after anyone else. Inevitably, this means that patients come last. They are regarded as something of a nuisance because hospitals and health centres would run much more efficiently and comfortably without them. Like other state employees, doctors and nurses are overpaid and underworked. The NHS was always a naive and appalling idea. The government cannot run anything efficiently. They certainly cannot and should not run health care.

Because of the State’s intervention (and the absence of any link between money and work) doctors working for the NHS are now grotesquely overpaid and underworked and demanding (their union, the British Medical Association, was the first to protest when a government report pointed out what everyone has known for years, that public sector workers don't pay enough for the pensions they get). Within the NHS (as with all other State departments) money has been separated from effort. With the usual disastrous consequences. Genuinely caring, sensitive young people don't want to go into medicine because it has become overregulated and controlled and bureaucratic. People who like money, filling in forms and obeying authority will flock to medical schools. But those people will make terrible doctors.

There is no integrity within the modern NHS. Medicine today is all about money. Doctors may tell what they think is the truth but they don't tell the whole truth because they don't know the truth; they just tell the part that the drug industry doesn't mind being told.

The sole aim of the NHS is to satisfy bureaucratic targets and to provide secure, undemanding employment for large numbers of people. The NHS is the third largest employer in the world and the aim of the modern NHS is not to cure or to care for patients but to provide secure employment for a vast army of jobsworths many of whom earn six figure salaries and are provided with pension funds worth millions of pounds. The success of the NHS is measured not by the number of patients it helps (or at what cost) but by the number of artificial and dangerously irrelevant targets it meets. One significant result of this is that in a curious and amazing way the NHS encourages both the under-treatment of patients.

Doctors and nurses are members of the world's primary service industry but in Britain the NHS has encouraged them to serve themselves above all others; a culture of selfishness that precludes caring. Patients are regarded by bureaucrats, doctors and nurses as at best an inconvenience and at worst a nuisance. Everyone working for the NHS seems to have forgotten why they are there. Separating consumer from cheque writing just doesn't work in an era of selfishness. There is no such thing as `public service' these days.

Within the NHS, patients would be well advised to start every medical experience with the notion that everyone they meet is an idiot who cares only about their paycheque and getting home early. You may meet a few well-meaning folk, and a tiny few who really care about you, but, in order to protect yourself, and to give yourself the best chance of survival, you should no more expect to meet sensitive, undemanding, caring people working in a hospital than you would working in a tax office or car showroom. It may be an unpleasant and depressing thought but it is inescapably true that the people you meet in the NHS are there because they are paid to be there. Forget all historic notions of vocation and dedication. And remember: anyone who works for the NHS is a Government employee.

Whenever State medical systems have been created they have proved to be a mistake. Statist politicians in other countries drool over the NHS and claim that it is a success. But they only claim it is a success because they are told it is a success and because they want it to be a success. If they looked at it closely they would realise that it is a failure. The truth about the medical system the rest of the world is told is wonderful and wants to emulate is that it kills people at great expense.

The NHS has shown us only too vividly that the Government really has no place in health care. A Government controlled health service is unhealthy for everyone. The State way is to take all the authority and the responsibility away from people. And that is, in the end, disastrous. Patients have been taught to become totally dependent on the system and more aware of their rights than of their responsibilities. By deliberately and systematically taking over responsibility for our health, and by ignoring the fact that in the majority of illnesses the body can heal itself, NHS doctors have increased the demand for resources and they have produced a new type of medical problem: doctor-induced illness in patients who never needed treatment in the first place. The 21st century craze for interventionism is slowly killing us. The sad truth is that in the 19th century health care was long on charity and short on science. Today, health care is long on science but short, woefully short, on charity and understanding.

And things have been made infinitely worse by the fact that political changes have put enormous pressure on a poorly designed health service. Now that Britain is part of the European superstate, and run by the European Union's meddling bureaucrats, the nation no longer has any control over the number of people allowed into the country. This is a problem because the Government has not built up enough infrastructure to cope with all the immigrants. The NHS (like Britain's roads, our drains and our water supplies) is essentially Victorian and cannot cope. And so now the overpopulated UK is in crisis. And now that former Prime Minister Brown has wrecked the economy for generations to come the infrastructure will never be repaired or brought up to standard to cope with the people who are flooding in. (The only good thing is that the floods coming in will stop soon because, thanks to EU distributions, countries such as Poland and Romania are improving rapidly and will soon be more prosperous than the United Kingdom and offer better health service facilities.)

The real tragedy is that no one in politics (or the medical establishment) will ever dare question the usefulness or purpose of the NHS. Institutional cowardice means that politicians will refuse even to consider the possibility of closing down a dangerous administrative nightmare. And sheer professional greed and self-interest means that doctors (who know they would never make as much money if they were in private practice) will never campaign for the abolition of the golden goose. Instead of fighting against the system on behalf of their patients, doctors now are the system. Doctors and nurses have become institutionalised. They are part of the State. They have been bought, indoctrinated and incorporated into the bureaucracy. And the tragedy is compounded by the fact that patients have been isolated by that same system.

Doctors and nurses are now making big money out of the Government. They fight for their own pay and conditions of service but no longer fight for the patients they are paid (and professionally and morally obliged) to serve.

Britain has an increasingly incompetent, increasingly expensive and decreasingly trustworthy infrastructure. We can no longer trust the police to keep our streets safe. We are abused by loutish border guards if we dare to leave the country. We are treated as criminals by the Gestapo-like clerks working for HMRC. And the main purpose of the NHS is now to provide wealth, security and a leisurely existence for the vast army of lazy, self-centred ruffians who work for it. Doctors and nurses have (like long-stay patients) become institutionalised. They accept everything and question nothing. They have sold their souls to the State. There are much better ways to provide free health care than by allowing the State to run things.

Medicine is now owned and controlled by politicians and drug companies and bureaucrats. They make the rules, pull the strings and although it is taxpayers who pay the piper it is the corporate string pullers who choose the tunes. Doctors and nurses are not on our side. They are on their side. Too many are now officious and spiteful; beholden to the rules. And it is all happening everywhere in the world. Medicine is becoming increasingly institutionalised and state-controlled. The evil trinity (State, medical profession and drug industry) has gone global.

Copyright Vernon Coleman 2012 Taken from Do Doctors And Nurses Kill More People Than Cancer? by Vernon Coleman. This book is published by EMJ Books. For details of how to purchase a copy please visit the shop on this website.