Recently, I came across a comedy sketch entitled ‘Privatising the NHS‘ from a show called Revolting, which is currently airing on the BBC. The writers thought they were illustrating the brutal reality of a heartless idea, but all they succeeded in doing was encapsulating a nation’s irrational fear of privatised health care.
In the skit, a few accountant-like men in suits intervene when a man goes into cardiac arrest. As he lies there dying, they pull out his credit card and plug it into a chip and pin machine to take his payment for the emergency medical care he is about to receive. The payment doesn’t clear and so they declare “he’s gone”. The doctor points out that the patient is still alive and that he can save him, but they solemnly reiterate that he’s dead.
You can’t successfully satirise anything unless you understand it and all good jokes have a kernel of truth. The sketch proves this because it’s premised on a miscomprehension of for-profit management of hospitals and requires us to believe things about human nature that history and our daily experience of life tells us isn’t true.
The sketch writers ask “What would a privatised NHS look like? “Would it be bureaucrats not doctors deciding whose life is saved?”
Fundamentally, it’s not who decides but what decides. What decides whether someone’s life should be saved is human empathy and not whether a hospital is funded coercively through taxation or funded peacefully through economic exchange or donations.
The U.S. doesn’t have a tax-funded healthcare system, but over half of America’s hospitals are charitable ones. Day and night, doctors and nurses there are unconditionally providing medical care and saving people’s lives – i.e. without first receiving payment or checking the bank balances of their patients. And this has been happening since public hospitals emerged from almshouses over a century ago.
This reality is why the sketch doesn’t work. The hospital imagined in the sketch, which is one with administrators who have no regard for human life and routinely leave people to die who could be saved, doesn’t exist in real life. It never has and it never will. Such an institution is a figment of the confused mind and fearful imagination of the average liberal/progressive, who believes there is a fundamental antagonism between human welfare and profitability.
Even if such a hospital did exist – let’s say it was owned and run by sociopaths – it wouldn’t stay in operation very long. After all, who on earth would fund a hospital that had a policy of letting people die who could be saved? If the sociopaths wanted to keep their hospital running, then they would have to adopt a policy of attempting to save every life, thus showing society that the resources tied up in it and consumed in its operation aren’t being wasted.
Today’s liberals and progressives believe human welfare and profits aren’t harmonious ends despite the fact that the pursuit of profits on a global scale, i.e. capitalism, has been rapidly decreasing poverty and raising the standard of living in the least developed parts of the world for the last several decades. The selfish and uncoordinated pursuit of profits across the developing world has done far more to reduce human suffering and increase human welfare than all government programs of International Aid have ever done.
It is perfectly reasonable to assume that there are no charitable or private hospitals in the world today which have a policy of refraining from saving the lives of people whom don’t have enough cash or credit to pay for the treatment they are about to receive. If the writers of this sketch believe there is or ever could be, then they must have an awfully low opinion of their fellow-man. And the bogey man of ‘privatised healthcare’ must give them sleepless nights.
On the flip side of having little faith in the innate goodness of man and of being afraid of human freedom is a reactive and blind faith in government action and in state power. Which, oddly enough, means having total faith in the people to whom we hand state power. It requires believing that they are not imperfect creatures like the rest of us, but rather all-knowing saints. This might be comforting, but it’s foolish.
In asking “Would it be bureaucrats not doctors deciding whose life is saved?” the sketch writers reveal they believe that under the current system it is always doctors and not bureaucrats determining the fate of patients. But this is totally wrong. The opposite is too often true.
The current system makes one man, the Minister of State for Health, ‘responsible’ for all aspects of hospital care, NHS performance and operations, the workforce, patient safety and maternity care. Responsibility always means control. This means the Minister of State Health controls, to some degree or other, how every hospital in the UK uses its resources and thus, ultimately, how they treat their patients.
His and his many colleagues’ decisions, which are set in stone in the form of regulations, trickle all the way down and determine, to an ever-increasing extent, the type and quality of treatment any given patient receives – or even whether they receive any treatment at all. Multiply that millions of times and imagine it happening every day and that is the essence of the NHS.
This is the very definition of bureaucrats deciding whose life is saved and who receives hospital treatment or medical care. The nightmarish scenario the sketch writers imagine would occur in a future privatised NHS is effectively happening now. It’s happening every day.
The only difference is that the make-believe bureaucrats in the sketch produce this result intentionally (but regretfully), whereas real-life bureaucrats produce it unintentionally (but not regretfully). But this difference is of no consequence or comfort to someone who doesn’t receive cancer treatment because of where they live or who dies after being left in a hospital corridor.
Of course, the Minister of State for Health and his merry band of bureaucrats never intend to deprive anyone of hospital treatment or good quality care. Indeed, they only ever have the very best of intentions. But the grand plans they impose upon hospitals to make the NHS work better never produce the desired effect. The inevitable unintended consequences of coercive government control over the decision-making of hospital managers and thus over the behaviour of everyone under their control and the use of the resources under their control is always human suffering and death.
The root of the problem is that bureaucrats have replaced hospital managers and medical professionals as the ultimate decision makers regarding how hospitals are managed and their daily operations. Essentially, decisions are made by referring to general rules codified as laws, which are unthinking and blind, instead of being made by the reasoning minds of experienced professionals.
The basic theory behind having an entire government bureaucracy peering down on hospitals like Greek Gods sitting on clouds is that bureaucrats can ‘oversee’ the big picture and thus can make wiser decisions than the people on the ground. Ergo, patients get better care than would otherwise be the case if hospital managers and medical professionals were left to act and use resources according to their own knowledge and judgement.
However, the Greek Gods were wiser than men only because, according to legend, they were omnipresent. But bureaucrats don’t have the power to be present everywhere and thus don’t have the power to know more than hospital management and staff can know. In fact, bureaucrats can only ever know less.
There are two insurmountable problems that the government Department of Health faces. Firstly, unlike the hospital management and staff, bureaucrats, however well-educated, cannot access and acquire all the knowledge necessary for making the most informed and thus most rational decisions about all aspects of any given hospital’s operations.
Secondly, bureaucrats have much less incentive to show due diligence in their decision-making process than hospital managers, surgeons, doctors and nurses. Why? Because the former pay no price for being wrong. And why is that? Because it’s the latter who (are forced to) act upon the decisions and plans of the former, and thus it is hospital managers and staff who pay the price. Even if the price isn’t always the financial cost of losing their jobs, it will always at least be the psychological cost of guilt or shame.
There’s a tragedy behind all this, which is that whenever we encounter doctors, nurses or any hospital staff acting unintelligently or in ways that are detrimental to the well-being of patients we blame them for it. Because it seems to us as if they are acting freely and entirely according to their own intelligence and judgement.
But that’s mostly an illusion. In truth, most of the time, stupidity or poor care isn’t the result of a lack of competence or compassion on the part of the NHS workers we encounter. It’s because they’re usually acting according to a set of decrees laid down by the Department for Health or else doing only what is possible with the resources they have as a result of the budget it decided their hospital should have. The spirits of bureaucrats haunt every member of staff in every hospital across the land.
The next time you have an encounter with a doctor or a nurse, try to picture a bureaucrat holding a gun to their head and whispering in their ear to remind one’s self of the power they invisibly exert over the person who is trying to help you. We should always keep in mind what is ultimately preventing dedicated medical professionals from providing the best possible medical care to their patients.
It is the state power wielded by the members of the Department of Health, whose hubris means they labour under the pretence that their coercive control of hospital managers and medical professionals is guided by knowledge – knowledge which, in reality, they can’t have because the structure of the healthcare system they oversee renders it inaccessible to them.
Fundamentally, the NHS is failing to achieve its aim of providing the best quality health care to everyone because that goal has been superseded by the goal of satisfying the countless demands of bureaucrats. This is inevitable when health care funding is distributed among hospitals according to the plans of bureaucrats and not according to the needs and wants of all people as expressed through profit and loss signals. And when bureaucrats, who believe they can possibly know what’s best for every hospital, every ward, every department and every patient in the country, are the ultimate decision-makers for all hospitals and clinics.
It’s not surprising that the BBC is broadcasting such nonsensical satire or that some mainstream comedy writers are producing it. Most people remain ignorant of the reality of the NHS and confused about the idea of privatisation of healthcare. But it’s a good sign that the idea of privatising health care is being discussed at all – even if it’s just to ridicule a confused conception of it.
As the German philosopher, Arthur Schopenhauer, once observed, “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
I suspect it will be a long time until the British public accepts as self-evident that privatised health care costs society less and provides a better quality service to it than a government-run and tax-funded system. The problem is that few people have experienced privatised health care because it’s relatively very expensive. (But it’s only expensive because private providers are operating in the shadow of a government monopoly which provides the same services for free, and therefore the customer base for private providers is diminished considerably).
If only there was a parallel universe where a free market in health care operated, which people could slip into and see the difference with their own eyes. They would quickly realise all their fears and assumptions were unfounded. But what would surprise them more would be seeing the founding ideal of the NHS, which was for everyone to have access to and receive quality medical care – actually being realised in this reality.
They would see that here it didn’t matter which postcode people lived in, everyone had access to all treatments and drugs, which came on the market as soon as possible. People weren’t left to die in corridors because, unlike the NHS, hospital managers and staff didn’t have to choose between doing what is best for the patient and doing what is best for the hospital. These ends were one and the same. They would see a society with a far greater supply of doctors, which meant people could see a doctor that day, and cheaper prescriptions being delivered by drones.
What would absolutely astonish them, however, would be the absence of a centralised agency overseeing and controlling this coordinated, organised, cheaper and more efficient health care system. To people who have only ever known government-run healthcare, this would be like seeing the stabilisers taken off of a bike and then seeing the bike remain upright.
It would look like magic, but it would just be the real and wonderful product of human freedom and free markets. The same forces that created the world of abundance and technological wonders we live in and which continue to enrich our lives. We need to shift government out of the way and unleash those forces on medical and health care to prevent even more people suffering and dying unnecessarily.