The philosophy of the NHS is wrong and Jeremy Hunt should look to American Paul Ryan for a dose of reality
Our new Health Secretary, Jeremy Hunt, needs to look at ideas as well as numbers and vested interests.
He should listen to Paul Ryan, Mitt Romney's choice for his vice presidential candidate in the USA elections, who has expressed concerns over the ideas upon which the NHS is based.
My Ryan says that "Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care."
He is absolutely right.
If the state takes over ultimate health care responsibility from the individual, there are inevitable consequences:
Individuals come to think that they have rights, and hence can demand a service without at the same time having to recognize that the service is inevitably the product of the life and work and integrity of someone else.
Any thinker who allows himself or herself to be the property of someone else ceases to think. Doctors who allow themselves to become mere units in state provision of health care, rather than people who are responsible for their own philosophical and mental integrity, are not worth asking the time of day let alone their opinions on clinical or personal problems.
People often assume that the state will care for the less fortunate. When presented with evidence that it does not do so, they complain that it should – but do not feel obliged to take any positive helpful action themselves.
Thus the state is the cause of the Inverse Care Law, whereby those most in need of help are least likely to get it. The state creates a cruel, arid, uncaring society that smothers individual compassion and human charity.
The state cannot be relied upon to produce responsible clinical care at the time that it is needed.
A true sense of commitment can only be the product of an individual mind and personal philosophy. It can never be instilled by rules, regulations and committees.
If resources are distributed according to need:
People compete with each other to establish their need rather than their capacity to do well on their own account.
The individual demands his or her so called ‘rights’ without any thought that it is at another’s expense.
The corporate body, answerable for its expenditure of public funds, spends its budget up to the hilt – or even overspends regardless of the needs of others – so that it can demand the same again or even more the following year.
Little attention is paid to the capacity of the recipient to benefit from the resource. An absolute need may be totally unchanged even after all the resource has been devoured. Meanwhile someone else with a lesser objective need is left with no possibility of the benefit that could have been his or hers because the resource has in effect been squandered.
Scientific assessment of benefit takes second place to the repetitive, mindless, arrogant hollerings of political pressure groups.
If services are free at the time of need:
Perceived needs become relative rather than absolute. Meeting a need does not satisfy: it merely shifts attention to another need.
Instead of the individual patient not being able to afford treatment, the state runs out of money so that either the individual cannot get treatment at all or, alternatively, the treatment that he or she can get is not worth having.
The proponents of the system point to a few people who have been dramatically helped ‘at no cost’.
They play on the fear or pity of their listeners – and in so doing make them into supplicant pap.
Also, they disregard what is happening in general to the NHS by focusing upon a few fortunate patients in particular.
The state comes in time to be thought to be indispensable and with that goes every last individual freedom.
If the ideas and principles of the NHS are wrong then the practice will inevitably fail. True compassion can only be individual.
If I choose to help you or not, that is my affair but I shall reap the consequences. I have to earn my place in a compassionate society through my actions for others.
By contrast, the state can never be compassionate. When A gives the life of B for the benefit of C, but A expects the credit for himself or herself, this is the essential prerequisite for totalitarianism.
This is why Ayn Rand, the author of Atlas Shrugged, which Paul Ryan recommended his staff to read, is right when she says that the difference between a welfare state and a totalitarian state is only a matter of time.
I first formulated these ideas in 1980 but nobody would publish them. The NHS was a sacred cow, as it clearly still is for Danny Boyle, who produced the opening ceremony for the Olympics, and many others.
Now that the NHS brand is to be sold around the world, we may find that there will be no takers.
After all, the NHS has existed for over sixty years but no other country has copied it. Clearly it is not the envy of the world.
A system that does not work in practice is a bad system, however virtuous it may superficially appear to be in theory.
We need Paul Ryan here to give us all, including Jeremy Hunt, a stiff dose of reality.
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