David Thompson


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March 05, 2012



Your step-dad's experience is a case study in how government intervention in a simple economic dynamic has loused up the incentives to provide the desired service. To wit, he needed medical services. Transport to where that service is rendered was paid for regardless of the patient's actual arrival. Once at the location of medical service rendering, again the consumer of that service was tertiary to the remuneration of those providing said service. It is my fervent hope that at some point, people will embrace the unalterable fact that it matters naught the service or good provided; unless the provider's gain is based upon the satisfaction of the consumer, such provision will be substandard.

Oh, wait. People already know this, as evidenced in their day-to-day choices in the marketplace. But for some odd reason they think government can short-circuit this process when the subject is "health care." What rot.



Well, my lingering impression is of a demoralised atmosphere and a sense of powerlessness, in that there didn’t seem to be a mechanism for correcting the series of failures. At no point did the failures engender any hint of concern among the staff or any discernible urge to ensure they didn’t happen again, or any urge to compensate or reassure the people on the receiving end. At no point did we feel like valued customers with any kind of leverage. Incompetence and mishap seemed to be par for the course and nothing to get indignant about. I don’t mean to suggest that the staff involved were necessarily bad people; merely that they were demoralised by the institution and accustomed to delivering third-rate service. And of course getting away with it.


My too familiar knowledge of the NHS is of a mix of some extremely dedicated professionalism, and occasional extremely irritating behaviour towards patients, who can be variously patronised, ignored, fobbed off by receptionists, nurses, and consultants who don't want to answer questions. It's made clear the patient needs them, not the other way around.

When you're an inpatient at a supposedly GOOD hospital you can ask for a doctor and wait all day if they assess (from a verbal explanation from a nurse) that you are less serious than the others on their list.

The nurses and doctors alike give the impression of being completely overworked and constantly at breaking point. I often wondered (and still do) how truthful this impression was. After all, if you're about to break with the strain, surely more and more patients lives are at risk? Perhaps they are, at that.

Later, watching a silly BBC "watch junior doctors at work, training and play" documentary, I saw young doctors looking after emergencies and patient-requests from several wards per-doctor, which certainly backs up their story of being stretched to the limits.

The depressing (semi-informed) suspicion I get, overall, is that we have come to expect a level of health-care that can't be economically sustained. But the Americans apparently don't like their (insurance based) model much either, and look to europe for inspiration.



“It’s made clear the patient needs them, not the other way around.”

I think that’s the nub of it. The patient has little, if any, practical leverage. In the example above, the general air was one of “you’ll get what you’re given and like it.” Of course, shit will happen, as the philosophers say; but shit will happen a lot more often in a socialised system with no user-driven means of correction.


"Why, then, do people still love saying that the NHS is “the envy of the world” "

Because criticism of the NHS is a Taboo. Probably the very last taboo in British culture. The Left has been fantastically successful in building this, to the point where a hospital can kill literally hundreds of people with easily preventable infections yet it is still unthinkable to challenge the system that hospital exists in.

Ted S., Catskill Mtns., NY, USA


The problem with the system here in the USA goes back to World War II and (unsurprisingly) government intervention. (No, Europeans, we don't have a free market in health care or health insurance here in the USA!) During the war, Franklin Roosevelt instituted wage and price controls. The only way employers could get around the wage controls to get better workers was to offer benefits, such as health insurance, which was eventually declared an untaxed benefit.

The upshot is that if your employer pays for the health insurance, it's untaxed; it he gives you the money to buy your own health insurance, it's taxed as regular income. So people are locked into employer-provided health insurance, which makes the labor market less flexible.

This is combined with grandstanding politicians trying to add more and more goodies that health insurance companies have to provide as part of the "insurance" policies (which are, of course, not insurance in the same way that automobile insurance is), which naturally drives up the price of the insurance.

Every time somebody here in the US starts talking about single-payer health care, I suggest we should have single-payer legal care, with all the same regulations on doctors put on lawyers. And, of course, there's no lawyer anywhere who does anything worth more than minimum wage.


Of course, shit will happen, as the philosophers say; but shit will happen a lot more often in a socialised system with no user-driven means of correction.

That's the nub of it.


Okay, someone explain to me (an American) the NHS scenes in Moore's Sicko.


> Left-wing academics and journalists continue to dismiss that desire with their specious claim that broken-windows policing is an unjust assault on the poor

Does rather sound like left wing academics think poor people are criminals.


Overwhelmingly peaceful Occupiers assault and rob woman while screaming homophobic epithets, overwhelmingly peacefully.

She asked them not to riot in her neighbourhood.

Horace Dunn

David and co...

Have you seen this?


What on earth can it all mean?

Hey Skipper
Bureaucracies, inevitably, are selfish. They are constructed according to the convenience of the producer, not the consumer (although, oddly, they are often unpleasant places for the producers to work in). Not for nothing does the word “patient” mean “one who suffers.” Suffering is guaranteed by the system.

Hmmm. That must mean "patient" and "student" are synonyms.



“What on earth can it all mean?”

Oh my. They’ve managed to be both crass and bewildering. When someone misjudges their own advertising so badly, we should obviously give them our money and put them in charge.

sackcloth and ashes

'What on earth can it all mean?'

It looks like an advert showing how the EU can deal with other states and cultures (China, Brazil, the Arab world), and can use its 'soft power' to influence.

This is of course demonstrated in practice by the EU's success in ending the war in Bosnia and preventing genocide, its achievements in persuading the Chinese to improve their human rights record, its ability to persuade Russia to improve its relations with its neighbours, its ability to persuade Iran to give up its nuclear weapons programme, and its crowning success in securing an Israeli-Palestinian peace deal.

Oh, and talking of batshit insane adverts ...


Ted S., Catskill Mtns., NY, USA


I got a message saying that the video was removed by the user.

Horace Dunn

David, Sackcloth
Thanks. I'm somewhat relieved that I'm not the only person to respond with a degree of bafflement.

Ted S
Removed? Very odd. Someone alerted me to an article in the Daily Mail on this topic. The report contains a number of stills from the video and, if you scroll down, the embedded video is working (at the time of writing!)...


Horace Dunn

Sorry, forgot to add...


"Oh, and talking of batshit insane adverts ..."

These lefties just can't help giving themselves away, can they?


Sackcloth & Horace,

Given the Guardian’s perilous financial situation, you wouldn’t think they’d have much cash to blow on ponderous, convoluted mini-movie adverts.

Still, if you look at it literally, it pushes the main Guardianista buttons. First, it’s hugely self-flattering - they see the news as others don’t (which is often true but not in a way they probably mean). The home-owning pigs (geddit) are the villains (defending their own property by boiling the intruder). The big bad wolf isn’t actually that bad and is asthmatic (because criminals are the real victims, as everyone knows). The home-owning pigs, however, aren’t the biggest villain, which is – of course – “the banks.” And because the banks are so evil, people riot in the streets, thereby “sparking debate.”

You can see how it might appeal to the Guardianistas’ root programming.

sackcloth and ashes

I'm just stunned that the video shows 'mortgage riots' at the end. I mean, the idea that a civil insurrection could arise because people are unable to make payments for loans that they voluntarily agreed to, in order to become property owners ... You'd have to have inherited your town-house in Hampstead to even think that that's realistic.

sackcloth and ashes

Daniel Hannan highlighted this on his 'Telegraph' blog - the video has been removed, and has obviously been sent down the same memory hole as Richard Curtis' 'let's blow up all the oiks who don't believe in global warming' classic:


The EU's Directorate on Enlargement has sent out the following statement. Translations inserted in square brackets:


We have received a lot of feedback on our latest video clip, including from people concerned about the message it was sending.

[We have just been bollocked and ridiculed for a fatuous and self-serving piece of propaganda which wasn't worth the money burned, and which was borderline racist]

It was a viral clip targeting, through social networks and new media, a young audience (16-24) who understand the plots and themes of martial arts films and video games.

[It was a failed attempt to be 'down with the kids' which patronised its audience, and which could not have been more embarrassing had we got Carl Douglas to do the soundtrack]

The reactions of these target audiences to the clip have in fact been positive, as had those of the focus groups on whom the concept had been tested.

[We showed it to one of our Polish interns, and she seemed to like it. Does anyone know what the word 'kurde' means?]

The clip featured typical characters for the martial arts genre: kung fu, capoeira and kalaripayattu masters; it started with demonstration of their skills and ended with all characters showing their mutual respect, concluding in a position of peace and harmony.

[The clip showed three nasty threatening foreign types beings subdued by the diplomatic skills of Europa, as represented repeatedly from Jacques Poos to Catherine Ashton. We can't understand why people thought it was crass, offensive, and utterly delusional]

The genre was chosen to attract young people and to raise their curiosity on an important EU policy.

[Because that is of course a productive use of taxpayers money, and none of the hoi polloi enduring austerity programmes because of the Eurozone fuck-up could possibly mind]

The clip was absolutely not intended to be racist and we obviously regret that it has been perceived in this way. We apologise to anyone who may have felt offended. Given these controversies, we have decided to stop the campaign immediately and to withdraw the video.

[It's just as well we didn't go with our original idea for a black-and-white minstrel show].



“You’d have to have inherited your town-house in Hampstead to even think that that’s realistic.”

And realism is the very first thing you think of when someone says ‘Guardianista.’

sackcloth and ashes

Talking of 'realism' I wonder what the NUJ will make of the Graun's efforts to subcontract out their journalism to unpaid volunteers?

carbon based lifeform

"Whitehall departments spent £1.4 billion in an attempt to save £159 million by sharing back-office functions such as personnel and procurement."



Well, hallelujah! He sees the light!

"They seemed to believe that their own feelings were more important and trumped anyone else's..."

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