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.
