The NHS Religion

As St Theo's Day approaches, now is a good time to reflect on the twelve months that have just passed and ask some fundamental questions about the way we can save our proud profession and the healthcare system it is a part of. My answers might be controversial and objectionable to some readers. During my career in the UK National Health Service I went through many changes. I began as a very naive and quite antagonistic teenager who quickly got sucked into leftist politics through the powerful trade union presence in the Oxford hospital community. The ethos of that mindset was very polarized and inflexible: public-good-private-bad. I became disillusioned with trade unionism very quickly. I was probably only really hardcore for about a year. As my twenties dawned I developed a more nuanced view of the NHS. However I stuck to the principles of public-good-private-bad long after I had become much more centrist on other issues. This was because I experienced NHS privatization directly, from the inside. The NHS trust introduced policies that I regarded as insane, although they were actually very cold and calculated; see the background links below. This preserved in me a dim view of private enterprise, at least when it comes to public utilities and essential services. As I matured through the years I came to understand that the public sector in its present form is actually far from perfect. I also came to understand that the private sector can take many forms and not all of them are bad. Socialists have a go-to answer whenever their critics bring up the excesses and brutality of the Soviet Union: "Yes, but that wasn't real socialism!" Well, could it be that what we see in the world today which the socialists lambaste so much is not real capitalism? This video by Niall Murphy is very interesting:  https://www.youtube.com/watch?v=bwZ32nUIEFo. 

Niall brings up some of the same points that I have been contemplating, including an awareness of the difference between the different socio-economic models that are given the label capitalism. He uses the terms "monopolist" and "gangster capitalism", which is attributed to Terence McKenna. Stefan Molyneux calls it "crap-italism", to distinguish it from something that might turn out to be more positive and vigorous, if it's given a chance. The essence of capitalism is said to be the free market. Its supporters claim this encourages perfection through producers competing to provide the best product. Economic growth is indefinite and therefore good capitalism grows it quicker. Its critics say it leads to greed and, in an economy in which capital is limited to a fixed amount, it results in wealth being hoarded by a very few people at the expense of the majority. However, in the NHS there is no competition. The reason contractors are so awful is not because they are private companies, but because they can do whatever the hell they like because they constitute a synthetic monopoly. They're only keeping their place through corruption. They therefore enjoy a parasitic relationship with the NHS, pocketing as much of their fees as possible by doing the cheapest and nastiest job they can get away with. This maximizes short-term profit at the detriment to their employees and the patients they serve. There is no free market involved. The patient cannot choose not to use one company and choose to use another instead. Where's the competition? Also a healthy system would not only have different firms competing to maximize results. To maximize results they would have to sacrifice short-term profit to deliver a better service. To do this they would have to invest more, raise their overheads, pay their staff more and take better care of them. They would also have to value proficient staff over those who were less so, because proficient staff generate profit; whereas in the present state-corporate bureaucracy all staff are worth exactly the same, see: https://hpanwo-hpwa.blogspot.com/2016/12/nurse-sacked-for-praying.html. By sacrificing short-term profit they would be building a secure future of long-term profit. Niall also describes state bureaucracies as "grim and soulless", and that's very true. I only really appreciated that point quite a while after I had moved on. I have no final answers to this matter and I am still thinking it over, but I have moved away from the more conventional suggestions that involves nothing more than better funding and reform by the state alone.

See here for background: https://hpanwo-hpwa.blogspot.com/2018/01/carillion-collapse-update.html.

And: http://hpanwo-hpwa.blogspot.com/2013/02/the-nhs-to-be-privatized.html.

And: https://hpanwo-hpwa.blogspot.com/2018/01/bransons-nhs-billion.html.

And: https://hpanwo-hpwa.blogspot.com/2014/07/allyson-pollock-at-tedx.html.