TCS Daily


The Fix Is In

By Theodore Dalrymple - March 22, 2010 12:00 AM

Americans would do well to ponder a recent admission by a former British minister in the Blair government. On March 2, the Guardian reported that the ex-minister, now Lord Warner, said that while spending on Britain's National Health Service had increased by 60 percent under the Labour government, its output had decreased by 4 percent. No doubt the spending of a Soviet-style organization like the NHS is more easily measurable than its output, but the former minister's remark certainly accords with the experiences of many citizens, who see no dramatic improvement in the service as a result of such vastly increased outlays. On the contrary, while the service has taken on 400,000 new staff members—that is to say, one-fifth of all new jobs created in Britain during the period—continuity of medical care has been all but extinguished. Nobody now expects to see the same doctor on successive occasions, in the hospital or anywhere else.

The ex-minister admitted that most of the extra money—which by now must equal a decent proportion of the total national debt—had been simply wasted. (The same might be said, of course, of the increased outlays put toward state education.) But his explanation for this state of affairs was superficial and self-exculpating, to say the least: he said that the NHS received more money than it knew what to do with because of managerial inexperience. "It was like giving a starving man foie gras and caviar," he said.

As it happens, the NHS knew exactly what to do with the money: give it to its staff, new and old. British doctors, for example, are now the second-highest-paid in the world, though not necessarily the happiest. They have accepted the money on condition that they also accept—as quietly as mice—increasing government interference in their work. When you go to a family doctor in Britain, he is more likely to do what the government thinks he ought to do and will pay him a bonus for doing than what he thinks is right. This is sinister, even when what the government thinks is right happens to be right.

There is a possible explanation other than managerial inexperience for the waste, namely that the waste was intended and desired: indeed, that it was the principal object of the spending. Experience has long shown that further spending by state-monopoly suppliers of services (if services is quite the word I seek) benefits not the consumers but the providers. And they—ever more numerous—naturally vote for their own providers, the politicians. Thus the NHS has become an enormously expensive method of ballot-stuffing. Personally, I would rather have outright electoral fraud. It would be less expensive and slightly more honest.

Just before the last election, the chief executive of one of the hospitals in which I once worked was overheard saying, "My job is to make sure that the government is reelected." (The government's job, in turn, was to make sure that she remained chief executive.) She also explained that the hospital could expect no increase in its government funding, unlike other hospitals—because it was located in an area in which most people voted for the government anyway.


This article first appeared on City-Journal.com.

Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His most recent book is The New Vichy Syndrome.
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8 Comments

Welcome to a Future coming to an America near you...
...particularly deep blue and deep red states. The 'purplish' ones (swing states) will get most of the money, just like they did during the Depression in the FDR era.

And old people (who vote 2:1 Republican and vote reliably and often) will be targeted for elimination. The Death Panels will be very real, folks.

The death panels again
"And old people (who vote 2:1 Republican and vote reliably and often) will be targeted for elimination. The Death Panels will be very real, folks."

You admit that fiscal constraints will determine how much the nation will be able to spend on health care in toto. That's very good.

But what will be limited, whether we're talking about public or private HC (also with its very clearly defined spending limits) is certain procedures. Not classes of citizens. And it's certain that as a public program expands we'll be seeing much more in the way of preventive treatment for the previously 'uninsured'-- as opposed to the emergency treatment we see so often for them now. So we'll be expending pennies to save dollars, and will have better outcomes than under the present system.

We're paying for those people anyway. But their treatment gets added to hospital overhead and so goes back to us and our insurance carriers to be paid.

You haven't noted that every private carrier at present has its own 'death panel'. This is the board that examines every large claim to see whether there might not be some way the carrier can welsh on having to pay it.

No.
I admit that fiscal restraints will determine how much of at total failure socialized medicine will be evident to the public.

"And it's certain that as a public program expands we'll be seeing much more in the way of preventive treatment for the previously 'uninsured'-- as opposed to the emergency treatment we see so often for them now."

No, it isn't. Obama and his cronies said people would get coverage the moment he signed the legislation and he specifically said preventative care would be immediately available. That has not happened to the chagrin of people now showing up at the doctor asking for free treatment. It is amazing how the media doesn't care to report these kinds of 'sob stories'. Furthermore, the plan as outlined in the legislation just passed is to move some 16 million people to Medicaid, which is rationed to the point now that doctors and pharmacies are starting to not accept business with those patients.

"You haven't noted that every private carrier at present has its own 'death panel'."

What is the number one 'denier of care' providers in this nation both on a total as well as per capita basis? Medicare and Medicaid, not the insurance companies...who come dead last.

The 'board' is to kill off the old folks, Roy. Just like a House Dem said that that abortion funding had to be in there because having more kids will raise costs.

Of course, this will get repealed. Especially when Medicare physician reimbursements get slashed 21% THIS August thanks to the bill just passed. Why, I believe that will be a national "doctor's strike" on old patients right before the November elections.

Watch for the lying Dems in a state of total panic scramble to pass a special bill to change that while the media looks the other way.


I see
So the sins of the past hundred years are being excused, as health care legislation has been blocked in Congress-- while Obama, having signed the bill into law a scant 14 hours ago, is to be castigated for not having mechanisms in place yet that hospitals can take as a guarantee of payment.

This kind of argument, your specialty, is fraudulent.

As are the following:

That the media might have had time to publish a paper wherein such "sob stories" might appear. There are no sob stories, as you well know. Liar.

That Medicare-Medicaid is the "number one denier of care". Also as you know, every policy out there, whether public or private, places some limits on coverage. Liar.

That there is some "board" whose duty it is to kill off old folks. Not just a lie, but a stupid one.

Doctors, pharmaceutical companies and even insurors are all on board with the new bill-- because they finally know they will be benefitting from the new business coming their way. And I think you know this too.

We know because their stocks are showing the uptick. It's a good bill for the industry and a fair to okay one for the public.

What sins?
What sins?

Last time I checked, signing up for health care insurance was a private matter and completely voluntary.
ObamaCare is not.

"...of the past hundred years are being excused..."

Past hundred years? The average joe didn't even start getting health insurance until the 1940s, really. And the government didn't start to really warp the health care market into the irrational mess until the 1960s, when Medicare was passed. Some 'hundred years'.

"while Obama, having signed the bill into law a scant 14 hours ago, is to be castigated for not having mechanisms in place yet that hospitals can take as a guarantee of payment."

Uh...YES...because Obama PROMISED just last week that would not be the case. People who bought that hook,line & sinker have been starting to show up at doctor's offices with the expectations that their 'free lunch' would be waiting for them, as a result.

Nothing fraudulent there. Just facts.

"That the media might have had time to publish a paper wherein such "sob stories" might appear. There are no sob stories, as you well know. Liar."

Really? Just because your favorite Obama propaganda outlet isn't covering it magically means they aren't out there? I'm going to give you one chance to back out of that position before you completely embarrass yourself Roy. One chance. This is it.

"That Medicare-Medicaid is the "number one denier of care".

"Also as you know, every policy out there, whether public or private, places some limits on coverage."

I didn't say otherwise. I just said that Medicare-Medicaid (and the VA) are the worst. Of course, you either can't tell the difference or you are deliberately obfuscating the issue.

"That there is some "board" whose duty it is to kill off old folks. Not just a lie, but a stupid one."

No it isn't. It's there. It isn't just a 'board', either. The entire bill is designed to achieve that sort of demographic euthanasia.

"Doctors, pharmaceutical companies and even insurors are all on board with the new bill"

A complete lie. Poll after poll proves that at least a third of doctors will quit/retire early. Meanwhile, Walgreens has stopped filling Medicaid prescriptions already.

"..because they finally know they will be benefitting from the new business coming their way. And I think you know this too."

What new business? You mean the kind where they have to give up their afternoon golf game because they have to make up for the losses with more volume of patients while exponentially having to waste even more time dealing with bureaucrats?

"We know because their stocks are showing the uptick."

That has nothing to do with the health care reform.

"It's a good bill for the industry and a fair to okay one for the public"

Really? If it is soo damn good, then why does Congress, the executive branch, congressional STAFFERs (unelected mandarins) and unions get -- after DEMANDING -- an exemption to it then?

I know you are a total Commie and all, Roy. But you have to learn the fine art of promoting your statist utopia dream while not destroying your credibility in the process.



These sins
This statement is utter BS:

"Obama and his cronies said people would get coverage the moment he signed the legislation and he specifically said preventative care would be immediately available. That has not happened to the chagrin of people now showing up at the doctor asking for free treatment."

None of that is true. Nor is this: "Obama PROMISED just last week that would not be the case." You'll have to show me something to the effect that he promised us coverage would begin before the bill was even signed.

Just so you know, various parts of the new plan will take effect between late this year and 2014. You may have read any number of supposed 'sob stories'-- but there's no way people have been suffering from the effects of a bill that hasn't yet even passed into law.

I know you're anxious to believe all this stuff. But really! Use your head.

Next, I mention that when the bill was signed stock prices for publicly held medical HC insurors and pharmaceutical companies went up. It may be that you're not bright enough to make the connection-- but this is a sure sign the investors understand those companies will be making more money than they were before.

The new bill will be very good for business. And for the most obvious of reasons. It forces poor people to buy insurance and then gives them the money to do it with. This is actually a terrible approach. BUT it was the only one they could use to get a bill to pass.

"Past hundred years? The average joe didn't even start getting health insurance until the 1940s, really. And the government didn't start to really warp the health care market into the irrational mess until the 1960s, when Medicare was passed. Some 'hundred years'."

Teddy Roosevelt was the first US president to try to get us national health care. It was defeated.

"If it is soo damn good, then why does Congress, the executive branch, congressional STAFFERs (unelected mandarins) and unions get -- after DEMANDING -- an exemption to it then?"

The Public Option, that was defeated, was an attempt to give every American the same kind of care that members of Congress have been enjoying. They're not exempt.

And in fact, in a sense, everyone is exempt. Obama has said all along, if you like the coverage you have now you can keep it. That goes for everyone.

If you want to challenge anything I'm saying here, ask me to provide evidence. And if you want to continue telling me the crazier parts of your comments are true you can provide me with evidence. Don't just sit there and babble.

Rigghtt
"None of that is true. Nor is this: "Obama PROMISED just last week that would not be the case."

Sorry you weren't watching TV. He was on the stump just days before the bill was voted on...totally lying through his teeth. He said people would no longer get denied access to care because of pre-existing conditions even though that was right in the Senate Bill with regards to the 'children' that insurers had to cover up to age 26, for example.

He was spouting so much nonsense just to drum up votes the real question was 'what did he say that was actually truthful?'

"Next, I mention that when the bill was signed stock prices for publicly held medical HC insurors and pharmaceutical companies went up"

Yeah, because investors who were worried they would be nationalized or worse breathed a sigh of relief.

"Teddy Roosevelt was the first US president to try to get us national health care. It was defeated."

So? The 'sins' you described was the current system vs Roy's Ideal Fantasy World. The current system was not in place until the 1940s or even later, actually.

"he Public Option, that was defeated, was an attempt to give every American the same kind of care that members of Congress have been enjoying. They're not exempt."

Once again, you only prove that you don't know what the hell you are talking about. Did I mention 'public option'? No. I said that the congresscritters and their staff were EXEMPT from the requirments of the bill that just passed. Apparently, they don't want crap anymore than you or I do.

"Obama has said all along, if you like the coverage you have now you can keep it"

Really? And when I lose my job I get to keep it? Nooooo...I have to buy a plan approved by government bureaucrats. You are so full of it, Roy.

"you can provide me with evidence"

Sorry, but I won't waste my time doing the equivalent of proving to you that the sky is blue -- especially since you insist on wearing filtered eyeglass lenses that make it look red.

"Don't just sit there and babble"

You're one to talk.

Spirited but unconvincing
I don't think there's any doubt but that the intent of the bill was to make it impossible for insurors to deny coverage due to pre-existing conditions. And so to make such a claim would NOT constitute "lying through his teeth". You and I have different definitions of such.

The insurance industry, ever astute in finding ways to subvert legislative intent, has already found a dandy loophole. This is something that obviously will have to be addressed in subsequent legislation.

Legislation you will heartily oppose. So why shouldn't I be calling you a baby killer?

Two. The fact that health insurance and pharma stocks all went UP after the legislation was passed certainly seems to be the strongest possible indicator that the investors think they will be making MORE money in the future than they have been making up until now. And as you apparently don't understand this, let me take you through it in detail.

Before, they thought the income-producing shares they possessed held a value of X. And after, they felt they had a value of Y. And they thought that Y should be greater than X, because they thought the basis of profitability had been strengthened by the legislation. Which is a postulate to which I agree. As should you.

So... your point is?

Three. It is certainly to the point that this country has been trying for one entire century to get comprehensive health care for every American. And has largely been failing at the task, due to concerted opposition in the corridors of actual power.

It would also be inaccurate to say that "The current system was not in place until the 1940s or even later". You weren't aware that Medicare-Medicaid was only signed into law in 1965? That's within your own lifetime. You should have remembered it.

Four. You say "Did I mention 'public option'? No. I said that the congresscritters and their staff were EXEMPT from the requirments of the bill that just passed. Apparently, they don't want crap anymore than you or I do."

They don't want it? But they already HAVE it. Congress, as you should have known, has an excellent health plan, funded by the public purse. This new bill is a first step toward making just such a plan available to the public.

But if you have some point I haven't addressed here, you could actually describe what it is you think Congress has exempted itself from. You and I don't read the same things, and it may be that you could actually enlighten me.

Five. I find this exchange to lie right at the heart of the debate:

Me: "Obama has said all along, if you like the coverage you have now you can keep it"

You: "Really? And when I lose my job I get to keep it? Nooooo...I have to buy a plan approved by government bureaucrats. You are so full of it, Roy."

Then you would say we both agree to the following: that our historical tradition of sticking businesses large and small with the burden of funding employee health care is fundamentally flawed? And that it should be replaced by a better system?

That's precisely the rationale behind calling for what a majority of the public originally said they wanted: a public option, so they could regain job mobility and not be beholden to sinking ships just to pay for their family's health.

So you should be in favor of that approach. And even, to some lesser degree, be in favor of the compromise we ended up getting. Because if there were no public participation, such as Medicare or supplemental funding, the health of our citizens would be a burden exclusively falling on the backs of business. This new bill is a first step away from making business the fall guy.

Okay. There's five points I've made. Rebut them. Or, if it's any easier, just give us more empty, unreferenced chatter.

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