The Psychology of Britain’s National Health Service

Computer generated image of a hospital with many windows and glass doors

The British  National Health service is sometimes called — by healthy people who like socialism — the “envy of the world.”

But how enviable is it?

Charles Moore, writing in the London Daily Telegraph [ 1-30-15], has a somewhat different perspective. He writes:

Of all the main services provided in Britain today, I would argue that the NHS has the worst moral effects.

Let’s go through them, one by one:

1. Queuing. You can’t choose, so you must wait, often for something that matters a lot.

Socialism removes thought from the human process. Thought is the process of shopping, comparing, and deciding for any product or service in a marketplace. Once thought is removed, people have nothing to do but line up and wait. The service is an entitlement, granted by birthright. People flock to free services or goods, even people who don’t necessarily need it, because they’re free. This creates long lines.

2. Producer power. The people who provide the services construct them to achieve their targets. They are not allowed to respond to what people actually want.

Precisely. Most of us think, “Free health care, that’s a good thing.” We take it for granted that doctors, nurses and hospitals will treat us exactly the same way under socialism as they did when they had to make a profit. But people who don’t have to make a profit to survive don’t treat customers (or patients) the same way they would if they could go out of business.

3. Guilt. Every day, thousands of patients are made to feel bad if they ask for something. This is wrong: patients should be the only point of the whole thing.

Patients are the whole point of health care. But doctors, hospitals and nurses have an unlimited supply of patients under socialism. Their offices are constantly flooded and there’s no chance they will go out of business. They’ll be paid regardless, and they’ll be working regardless. Where’s the motivation — or the sheer energy — for doctors and nurses to treat patients with the finesse required by a profit motive if there is no profit motive? Profit may be evil, at least in the realm of medical care (many of us assume), but we sure don’t like the absence of profit’s effects when it’s gone, do we?

4. Unnecessary death. The Mid-Staffs case [one of the many scandals in the NHS] was only the most shocking of many. This could not happen on any large scale if patients could choose.

In a marketplace, people vote with their dollars. If Burger King or McDonald’s started poisoning people, customers would flock to other fast food chains to eat. In a for-profit, dynamic marketplace, this would be easy. But if there were only one food chain — McState — and it started to poison people, but people still needed to eat, what choice would they have but to keep going, and hope for the best? Politicians running McState would point the fingers of blame at each other, but nothing would change because, in the end, nobody is accountable in a government monopoly.

5. Contempt for the weak. In a system where each extra patient is a burden to the system rather than a customer adding to the viability of the enterprise, the authorities decree who doesn’t matter. In our culture, this usually means that the old and the mentally ill are ill-treated.

Anyone who lived under Communism — an absolute approach to socialism — will tell you that such a system has nothing whatsoever to do with compassion and caring. The only people who seem to believe this are people who live under free or semi-free economic systems (as in America), who happen to have a fair amount of wealth or income, and like the idea that everyone has access to free health care. They stop the analysis on paper, feel like they bubble with compassion merely for advocating such a thing, and that’s the end of it. The reality is completely different. A socialized system — of medical care, most of all — is based on command-and-control, piles of red tape and lack of accountability. Patients feel contempt for their doctors and doctors feel contempt for their patients. Neither works for the other. Everyone is a ward or slave for the State.

6. Sentimentality. We tend to still our own fears about hospitals by cooing about how noble doctors and nurses are. Some are; some aren’t. They are no better and no worse than staff in hotels, solicitors’ offices, undertakers’ firms or veterinary practices. Mostly they are much more inefficiently directed.

True. Doctors and nurses are human, just like anyone else. That will be the case under socialism or the private sector. The difference is that in the private sector, customers and patients can express dissatisfaction with poorly delivered service and move to other providers. Faced with the threat of losing profits or business, even the less kind or thoughtful doctors and nurses will be forced to deliver better care, or economically perish. In a single-payer, one-size-foisted-on-all system like Britain’s NHS, nobody is really going anywhere. Everyone is stuck with each other. There’s no built-in incentive for self-preservation on the part of those providing the care. In theory, this seems to many like compassion. “No profit; so medicine can concentrate on caring.” In practice, it’s precisely the opposite, because when you remove self-interest from the equation, you also remove the need for self-preservation. The result? Mediocre or bad care.

7. Self-righteousness. The NHS effectively invites everyone to blame somebody else for what is wrong – fat people, drunks, smokers, foreigners, private doctors, “penny-pinching” politicians, independent contractors, women with “too many” babies, people who dare to be over 80. It is easier than changing the dreadful system.

And socialized medicine gives government justification for curbing or controlling other liberties. If government pays for everyone’s health care, then government should be able to control people’s personal habits that affect their health care, correct? Depending on the ruling party’s perspective, these policies could vary. A religious conservative will want to control the sexual practices of people, since those can have a health impact (sexually transmitted disease, pregnancy, abortion) that affects the national budget. A smoking “nazi” will wish to control cigarettes. A food “nazi” will wish to control everything people eat. Like a cancer consuming individual liberty, once the government takes full responsibility for everyone’s bodies, the way is cleared to control virtually everything else. Watch and learn (in the U.S.) as Medicare’s bankruptcy worsens, as more get covered by government Medicaid and federal policy focuses more on health care as its share of the budget keeps increasing.

8. Pessimism. Centralised medicine creates artificial shortage so it makes everything new seem dangerous. “People living longer”, for example, is presented as a terrible problem, when it is broadly a good thing. A free society with a growing population can cope with it.

One of the biggest criticisms of a free market for medicine is, “Profiting at the expense of people’s illness is immoral.” However, that’s not what happens. What happens is that doctors and hospitals profit at making people well — or at least doing everything possible to make people well. If government got out of the way, people would also be free to make choices about how long to go on living when treatment for incurable illness becomes no benefit at all. We’d have to be careful, of course, to make sure that people would not be murdered against their will. But by removing government and politics from the equation, the way would be cleared to consider more rational, innovative and individualized approaches to death and dying in the context of terminal illness. Instead, we leave it to government board A or government board B to decide this for everyone. If government is funding everything, then quite naturally it will always have the incentive to be responsible for as few patients as possible. How this will play out in the context of Obamacare and Medicare’s bankruptcy is anybody’s guess; but it’s not going to be pretty.

9. Self-delusion. We like telling ourselves that the NHS is “the envy of the world”. Most other civilised countries have medicine for which the state ultimately pays. None, except for Canada, has such a top-down centralised system of state medicine as ours.

Years ago I worked part-time in what was called a Health Maintenance Organization (HMO). An HMO is like a privatized version of socialized medicine. My colleagues there used to constantly observe, “An HMO is great if you’re healthy, or if you have minor problems like colds and sniffles. A more serious condition or problem could be a whole different story.” HMOs were very unpopular with most people, for this very reason, because the fact remains that people sometimes become seriously ill, which is the whole point of health insurance and/or medical care in the first place.

In America, HMOs were rejected wholesale on moral and economic grounds. Yet Britain’s NHS — the monolithic system towards which we’ve been moving, both under Medicare and now more completely under Obamacare — is based on a coercive model where government faces little or no competition. If it’s a mess in Great Britain, it stands to be an even bigger mess in a gigantic, more complex society such as America. In an extreme case, it could even break the nation apart as fights over federal budget and health priorities tear people apart into spiteful political factions.

In Britain right now, politicians are fighting over how to make the NHS work “right.” Of course, that will never happen. You can’t make such an unjust and irrational approach to medical care ever work. In the end, it must be self-responsible and self-interested parties — patient-consumers along with doctors and hospitals capable of going out of business. Without those necessary ingredients, you’re left with nothing other than political factors, uncaring and demoralized professionals and patients who get the brunt of it.

Interestingly, it’s always the healthy and the wealthy (the pious, self-righteous kind) who make the case for socialized medicine in any form. It’s too bad that the victims of such a system are never able to tell us the real story. That’s because they’re too sick to care any more, or are simply dead.

Socialized medicine is always pushed in the name of “morality,” and such a claim tends to silence its opponents. But Moore gets to the core of that issue when he says,

Lovers of the NHS say health is “too important to be left to the market”; but food is just as vital as health, and no one argues that a National Food Service should be the sole supplier of nourishment to 90 per cent of the population. If customers had to wait in Tesco for even a tenth as long as they often have to wait in A&E, they would be rioting in the aisles. And why, anyway, should what is important in human life be decided by others? What morality lets you choose who cuts your hair but not who removes your cancer?

If it’s morality you’re after, how in the world could you ever support socialized medicine?

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