I always thought the fad for wholemeal bread was a new thing. Apparently not:
More than that - it is a cure for constipation and its attendant evils and will do more to maintain health than all the medicines ever sold.
From The Times 20th March 1911.
He can say that again. And probably did. This was the first Times report (that I can find) to cover the Spanish Influenza. At the time (2 June 1918) it had killed 700 people in 10 days and there were well over 100,000 sufferers.
The disease would appear pretty much everywhere over the next few weeks, go away again over the summer and come back with a vengeance with the onset of winter. It peaked at about exactly the same time as the signing of the Armistice and ended up killing perhaps 20m people.
And people are worried about swine flu. Call that an epidemic? This is an epidemic!
Ho hum. There’s been a big media campaign7 on this this week. They seem to want some sort of restriction on the sale of alcohol - although whether this involves higher taxes or a higher age limit I really don’t know. My guess is that Tesco is simply jumping on the bandwagon before it’s too late - although it must be said this seems a tad out of character for Tesco - usually they’re pretty keen to keep out of politics.
Now as a libertarian I tend to be rather against this sort of thing. In principle6 I would like to see no restrictions on the sale of alcohol8 at all and in theory I believe that this would make the world a better place.
What’s interesting is the coalition of motivations that’s been assembled. On the one hand are concerns about public order - teenagers getting legless and causing trouble3 - and on the other worries about an “epidemic”1 of alcoholism.
The second point is easy to deal with. My health is none of the state’s business. Except, of course, that it is - by virtue of the existence of a state-funded NHS whose casualty wards groan with the results Chateau Laffite abuse. For me that’s just another reason to abolish it2.
On the point about public order, well, this is not a simple one. My guess is that a lot of the problems are caused by the welfare state combined with compulsory education4. However, I’m not immune to the idea that underneath the surface the British aren’t all that civilised and that drunkenness is simply what they do5.
1. “Epidemic” indeed! What a misuse of the English language. Now that’s something that ought to get added to the list.
2. Yes, that’s the NHS that should be abolished not Chateau Laffite. See Against the NHS.
3. Yeah, I know, if they’re truly “legless” they’re not really going to be in a position to cause trouble but you know what I mean.
4. See Brian Micklethwait’s Abolish the Welfare State and restore some Respect. See also The Trouble With Child Labor Laws by Jeffrey A Tucker which is sort of related.
5. My understanding is that England was for a long time an astonshingly violent society and that the low levels of crime recorded in the century before 1970 were something of an aberration. Think Gin Lane in the 18th Century - no welfare state, cheap booze, mass disorder.
6. See Why I am a Libertarian
7. In both senses of the term
8. I think most of the same arguments as used in the drugs debate would apply here. See Sean Gabb’s A Neither Profound Nor Original Article on Why the Sale and Use of Recreational Drugs Ought Not to Be Illegal.
A few little fact- and thought- ettes I picked up from last weekend’s conference:
- “Buying health insurance is like insuring against your tyres wearing out.” It’s going to happen. Insurance is really there for the catastrophic and unexpected. Like appendicitis, for instance…
- In Switzerland a few years ago they made health insurance compulsory. Prices doubled overnight.
- They also introduced laws against carrying guns in public. Street crime rocketed. Home invasions, where guns and their use remained legal, did not.
- In a lecture on the EU. I paraphrase: “European politicians love to be able to tell their publics that the EU has forced them to introduce such and such an unpopular measure.” Seeing as I’d never heard a British politician say this I had to ask. Turns out that the British are unique in this. They will never admit that Brussels has tied their hands.
- The Berlin government is £40bn in debt. That’s about £14,000 for each inhabitant. Makes the Shinkansens sound cheap.
They knew exactly how to get the highest standard of nursing care out of us and sloppy habits (how we loved our sloppy habits) were just driven out of existence; humiliation worked a treat and it became pointless not to do a job properly first time. Always the first thing that was pointed out to you was that you had somehow endangered a child's life in the process. Even down to touching a swing door to open it, never touch a swing door, you push it with your backside...Somehow I don't think it's like that nowadays.
Squander Two’s accounts last year of his wife’s never-ending string of illnesses and the appalling treatment she received at the hands of the NHS were, at times, heartbreaking. I was kind of getting used to the idea that things might be getting better. As it happens they are getting better. But there’s still the odd setback and the NHS hasn’t changed a bit. See here and here.
Wat Tyler looks at the NHS Supercomputer:
We’ve blogged the disastrous NHS supercomputer so often, it hurts (start here). And by now we all know the grisly numbers- £6bn originally declared, now officially £12bn (except for Health Minister Lord Warner who blurted out £20 bn), and anything up to £50bn actually predicted by industry insiders.
Sounds like yet another NHS horror story. If we’re lucky it’ll just be cancelled. If we’re very, very lucky.
Doctor Crippen describes the latest safety-inspired madness. Junior doctors have been banned from prescribing. But because learning how to prescribe has always been an on-the-job business it means that in future none of them will be able to prescribe. And so, in the name of safety, the world is about to become a more dangerous place. Again.
Possibly. It’s by no means certain. Of course, they might realise their folly, introduce a training scheme and the nurse practioners that the good Doctor so fears might well do a perfectly good job. Might. But, then again, this is the government so the likelihood is that they’ll just screw it up as usual.
Incidentally, while I have a great deal of time for Doctor Crippen when it comes to his hatred of nurse practioners I think he’s barking up the wrong tree. It all smacks rather too much of wanting to preserve a closed shop. Which I am against. That’s not to say that I support the government here. While it might be perfectly sensible to have nurses (and others) doing work normally performed by doctors this is a government scheme and it’s bound to screwed up. See above.
Jackie links to Squander Two’s Kafkaesque tale of diabetics being put in danger by the NHS’s blind adherence to procedures which I think I can add to my list of NHS horror stories, further evidence that the NHS isn’t very good which, in turn, confirms my belief that the NHS should be abolished.
It’s not conclusive, of course. It is quite possible that other countries have similar problems, indeed, I should think it is a certainty - any system is going to have its cock ups especially when it comes to something as complicated as healthcare. Just not as many.
The Health Secretary, Patricia Hewitt, is claiming that the NHS has had its best year ever. Not entirely surprisingly, her remarks have generated quite a hoo-ha with all sorts of people saying that far from being good the NHS is, in fact, rubbish.
Now, although I would tend to agree with Hewitt’s critics, the question, to my mind, is: how would you know?
In the free-ish world the answer is very simple. A successful enterprise is one that I choose to do business with and can pay its bills.
Now, while the NHS, with its £80bn budget, or whatever it is, can probably pay its bills (hmm, thinks:"maybe, even this isn’t true"), it is not true that I or any other potential NHS patient chooses to do business with it. If, by some miracle, the NHS were suddenly privatised and its entire budget handed back to the people who had paid for it, I can’t imagine that the NHS would see much of that money ever again. No, my guess is that most of that money would be going straight to BUPA.
The government is planning to save money on casualty by giving better health advice to patients with chronic diseases - the idea being that, armed with this advice, said sufferers are less likely to clog up casualty in future.
- I sighed when I first heard this. While, for all I know the aims of the scheme might be entirely laudable they will almost certainly fall victim to the law of unintended consequences.
- Then it occurred to me that this really might be quite devious
So, the unintended consequences?
Well, who knows. This is always the fun aspect of government policy - predicting where it’s going to hurt. There’s bound to be more bureaucracy. There may be inappropriate pressure put on doctors to dissuade their patients from going to casualty when they really need it. There may be cases of patients being poorly advised and ending up dead.
The story right now is that there is a cash crisis in the health service. At the same time there is a policy of trying to turn nurses into doctors. It strikes me that the former may be being used as an excuse to introduce the latter
What makes you think that?
For starters the time lag. The cash crisis is here and now. An advisory service what with all the recruitment and training involved is going to take months if not years to make an impact. Then there is the track record. Rail privatisation being used as cover to introduce vertical fragmentation. The War on Terror being used as cover to introduce ID cards.
Dr Crippen also has some thoughts
Last week, on his BBC programme, Sweeney Investigates, John Sweeney was looking into the government's Fast Track programme. This is the scheme in which NHS patients are treated by outside contractors. Sweeney, reckoned they weren't doing a very good job. Although he didn't say it in as many words the implication was that private enterprise can't deliver health care.My take:
- It wouldn't surprise me in the slightest if there were all sorts of problems with this scheme. However, it would be wrong to think that this undermines the case for the free market
So, what sorts of things were going on?
Botched operations caused by surgeons brought in from abroad who didn't know what they were doing because they were unfamiliar with the language, procedures and equipment and, in some cases, hadn't been screened properly
How can this not undermine the case for the free market?
- the thing being examined is not a free market; it's an example of contracting out (or out-sourcing as it is sometimes known). They are not the same thing even if they both get tagged with the same "private" label. In a free market the supplier is paid by the customer. Under contracting out the supplier is paid by the state which gets its money - lest we forget - by force. I am in favour of the free market but because I am against force I am also against contracting out.
- the private ie real free market sector, is still very good.
The thing that really does it for me is NHS Blog Doctor. He is an NHS GP who blogs. He tells everyone he knows to take out private medical insurance. As he says:
When I started as a doctor, I could genuinely say to patients that they really did not need private health insurance. Better bed and breakfast perhaps, but the NHS still delivered. Now I tell people to keep up their BUPA payments whatever the cost. Sell your daughters into the slave trade if necessary, but do not forgo private medical insurance.That's one hell of a recommendation
The overwhelming majority of patients are responsible about calling out a doctor. A persistent minority are not. Some people put more thought into ordering a take away Pizza than they do into calling a doctor. Of course you have to pay for the Pizza.
According to the papers and what I’ve read, David Cameron, leader of the Conservative Party wants to keep the NHS. This has led to some pretty negative comment from, amongst others, Stephen Pollard, David Green, Melanie Phillips and Samizdata. Their view (with which I agree) is that healthcare will never get any better so long as the state runs the show.
In other words, it’s poor economics. But, I believe it also makes poor politics.
Why? Because, I think the penny is beginning to drop with the British public about the NHS. For the whole period of the Thatcher/Major government they were prepared to accept that the NHS’s failings were all down to something called “underfunding” which in turn was down to something called “those bastard Tories”. However, for the last nine years we have had a government that is not only committed to the NHS but has had oodles of money to spend on it. If there was ever a time when the NHS’s problems were going to be solved it was now. But, they haven’t been solved and everyone knows it. I get the sense from the people I talk to - and, yes, it is pretty unscientific - that the public are beginning to give up on the NHS. Not its principles - people still like the idea of free-at-the-point-of-use and everyone being equal. But they are beginning to despair of those ideas ever being combined with something remotely resembing quality.
I believe by the time of the next general election, the public will be prepared to listen to a politician who is prepared to tell them the truth about the NHS: it is bad, it is bad because it is run by the state and the only way it is ever going to get any better is if the state gets out of the picture. So, by making his remarks now, Cameron has effectively boarded a political Titanic. Oh, it’ll look and feel good for a while but eventually it’s going to take him to the bottom.
Excellent article by James Bartholomew in the Spectator comparing healthcare in Britain and the US. He points out that:
- American healthcare is better than British healthcare
- America is not a free for all - state intervention is rife (eg ownership, regulation, subsidy, law suits)
- American healthcare is not perfect
- The imperfections are in large part due to the state intervention
This is part of the puff for the Channel 4 Dispatches programme on the NHS being broadcast tomorrow night:
Secret filming captures numerous incidents of shocking and unacceptable practices, from a lack of basic hygiene and failure to implement adequate measures to protect patients against the Mrsa super bug, to the tragedy of forgotten patients left to lie in their own urine and faeces. The film illustrates how the morale of dedicated nursing staff is crushed by the behaviour of their colleagues, suggesting a profession in crisis and failing to provide the basic levels of care we have come to expect.
Schools, hospitals, clean water, policing, courts without the state. Impossible? Not only is it possible but it’s happened and not that long ago either. Jay Jardine reviews the Voluntary City.
So, just how should the government convince us to stop going to McDonalds and eat tofu? Dom has a suggestion: