The Telegraph’s Charles Moore has just published a most interesting column. Here’s a snippet:
Given that health service reform is unpopular, and that politicians like to win elections, you would think that governments would avoid reform. So when they keep coming back to it, it must be for a reason.
That reason is as simple as the question above, but it can never be publicly stated by the reformers. They cannot even admit it in their heart of hearts (assuming they have such an organ), because it is a politically unthinkable thought. It is that the National Health Service is, always has been and always will be a rotten way of doing things.
This is hard to see because the NHS arose from a good idea – that people should be able to get good health treatment without financial worry. Unfortunately for Britain, this was acted upon at a time when centralised state socialism was at its height. So the NHS was constructed to carry out Whitehall commands. It was even imagined that these commands could be so efficiently obeyed that the cost of care would actually fall. The thing was a fantasy of the state planner. It is the reality, not the fantasy, which strikes the patient – and the patient’s friends and relations – every day.
Healthcare is the single biggest ticket item in every Provincial budget. In some cases approaching 50% of all tax dollars consumed by Government. Health and Welfare for Immigrants in Canada consume 24B tax dollars each year, year in year out. More than we lavish on Quebec, the Natives and the Operating budget of the military combined. Free Healthcare for the world is going to collapse the country and the taxpayers in Canada. No non citizen should recieve any free Healthcare or other free entitlements at all. This is insanity.
They keep trying to reform NHS because nobody will work there. Those hospitals are like Mad Max dystopian nightmares.
I think it’s a System’s Problem. By this I mean that having a state-run centralized health care – or any state-run centralized system that must include millions of people in that system – is bound to fail. How can I explain it.
A simple comparison is biological. A biological organism, made up of only a few cells, does indeed operate within a ‘state-run centralized system’. It doesn’t differentiate those few cells into specialized actions.
But as life entities become made up of many cells, centralized operations are no longer functional. They waste energy getting information around the whole, they lose energy- and information – moving around the whole system. Messages get lost, data from the envt doesn’t get processed very fast as the system is ‘overloaded’ with its own internal processes; the system can’t react with any speed or flexibility. Disastrous.
So- Nature moves into complexity or decentralized organization. This means both local and specialized processes within the organism, where local control emerges and can process energy, matter and information much better. And, we see, in nature, that specialization emerges both within and outside of the organism – so, bees pollinate flowers, which the flowers can’t do on their own.
The emergence of diversity, local solutions, local authority – in the development of complexity is a basic and robust process in nature. The more ‘cells’ there are to deal with, the more complex the organization – relying on local authorities, a variety of processes and activities.
It’s the same in a society. Think of a society as a massive biological system. With a population in the few hundreds, that society can have a central and single authority. But in the multimillions, the system must move into a complex organization.
That means a limited central control and an increased focus on local control, flexible local responses, diverse response to diverse needs.
The fertility rate in Canada has fallen from 3.81 in 1960 to 1.67 in 2009. With a shrinking base of potential tax-payers, socialized medicine will run out of other peoples money sooner or later.
Saw this question on the web: Approximately 40% of Ontario’s budget goes towards Health. Which other essential services will be crowded out when it goes from 40% to 80%?
ET, you are exactly right. If you read the comments on the article from people like nurses that work in the system their complaints focus on meeting the requirements of a centralized bureaucracy meaning endless and repetitive paper work.
Both my mother and sister were nurses so I can sympathise with their complaints. Newer RNs now have a Bsc degree and don’t want to do bedside nursing, they want to be in management.
As we saw in Ontario with the disaster of EHealth and the incompetence of Smitherman Ontario has just copied the NHS.
Compare this with the Shouldice Hospital, a smooth running private dedicated business. Went there last week for an unscheduled checkup. In and out in a hour.
Health is personal, it is up to the individual to take care of him/herself. The idea that another person should care (pay for) another’s health is preposterous unless the sick/wounded person is a soldier.
People should save for emergencies and pay for treatment – and the marketplace for care should be wide open for competition. People pay for a ‘sick’ automobile and they pay for the care of sick animals; there is no health care for cattle or horses. No one would leave their pet poodle in a filthy clinic, why do they agree to leave their sick family members in filthy hospitals? Why do they never complain? We have paid billions for something that we hesitate to complain about because we are brainwashed into believing that it is free!
Before the days of medicare people took care of themselves because a stay in the hospital cost money out of their personal pocket. Doctors vied for patients and hospitals vied for the privilage of caring for paying customers. As a consequence, quacks (incompetent doctors) were forced out of business and filth in hospitals was unknown – they waxed floors and used bleach! All hospital laundry was snow white (bleached), starched and put through a mangle (ironed). Hospital staff wore white uniforms (dirt shows on white) and closed, clean shoes. Nobody shuffled around in dirty pants and/or slippers if the hospital wanted business.
Hospitals made rules and enforced them, if patients did not like the rules they were free to leave whenever they wished – all drugs were paid for by the patient so the patient was consulted before administering any drugs.
I was wounded in a hit and run accident shortly after medicare was mandated in B.C. Things had deterorated but most of the staff had been trained and had worked in private hospitals. Nurses and Doctors were interested in my recovery and treated me with respect and compassion. I had very long hair and one nurse wanted to cut it off because I could not care for it – I refused to allow her to cut my hair and an older nurse told the young nurse off and took over the care of my hair. The older nurse said to the young gal “this girl will get out of here and she will want to look presentable because she will need to get a job” – how practical and decent. My room was kept clean and my ashtrays were washed in bleach (yes, patients could smoke in bed in those days) as were my sheets and hospital gowns. The food was good and I got a menu with several items to choose from for every meal. Visitors were evicted as soon as visiting hours were over (more rest for patients).
I agree with RFB, no immigrants or new citizens should qualify for ‘free’ health care because they have not paid into the system. The business of health is not free for taxpayers.
The BSc. nurse thing. Sometime during my lifetime RNs went from a 2 year in-hospital training program to a 4 year degree program. They now imagine themselves much higher on the social scale than previously. It takes close to 100 grand to get their ar$es out of bed in the morning. The system has even created LPNs or RNAs to do the work they used to do before they became so damned important. Are RNs better than they were 50 years ago? Anecdotes say no. I think that regulation of the professions might be placed with the government. In my profession standards keep getting constantly raised, in my mind, to create a shortage raising the professions status and income.
Governments will never do the right thing unless there is a gun their head … that means it will take a violent revolution to get any meaningful change in any country … look at history … it’s all there.
Thats why there is so much resistance to 2 tier. It would show up the huge flaws in the public system and all the non contributors would want service from the private system.
Having grown up in Canada, lived in U.K. for the first fifteen years of my adult life, and back in Canada for the last thirteen, I see the only differences between Moore’s description of the NHS and what I have seen and heard of Canada’s medicare as only matters of detail and degree. The essential nature of such systems is the same, and he is right about them.
If you think that Canada’s health care system is politically sacred, not even Thatcher would touch the NHS.
What Jema 54 said.
Having worked in and with some government departments during my career one feature stands out: A small agency or branch with a clear and limited mandate is effective, economical and generaly what taxpayers’ hope all government services should be. The clarity of the mandate is the most important as even a large organization (National Defence) has a clear mandate and operates fairly effectively.
Health care does not have a clear mandate. Is it illness prevention (itself a wide and unclear mandate)?, is it healing the sick?, researching illness? Add the huge size of the organization both directly employed and indirectly employed (physicians, hospitals (most are still privately owned albeit by charitable societies)) across ten provinces, Lord knows how many Health Authorities, the Feds, and three territories as well as municipalities etc etc and it is understandable why the effectivness falls as the cost rises.
Devolution to private or even pure provincial (ie repeal the Canada Health Act and transfer tax points from the Dominion government to provincial governments) will not solve the national issue but there will be some areas which work better than others. I believe there will be an overall improvement.