The pioneers of Britain’s welfare state may have had good intentions. By founding the National Health Service (NHS) in 1948, they hoped to improve access to treatment for the poor. But, more than sixty years on, it has become a bureaucratic monster that ranks among the worst-performing health care systems in the developed world.
Socialist central planning failed in the Soviet Union, and it has failed again in the NHS. In the absence of market prices, resources must be rationed by state officials. And as Russian housewives once queued for bread, British patients now queue for health care. Winston Churchill once defined socialism as “Queuetopia”.
Today the NHS has many hundreds of thousands of people on waiting lists. Despite years of reform and tens of billions of pounds of extra funding, it is still common for patients to wait several months for routine procedures such as hip replacements.
Even those with potentially fatal conditions may face long delays, while life saving treatments are often denied by bureaucrats on grounds of cost.
One deadly result is that cancer patients in Britain are far more likely to die than those in the United States. Cancer survival rates compare very badly with those of other rich nations.
But the NHS can’t even get the basics right – such as providing patients with adequate food. In 2007, there were almost 30,000 incidents of malnutrition, and a large proportion of patients are undernourished in NHS hospitals.
It is important to emphasise that these problems are not due to a lack of money. Expenditure on health in Britain is not low by international standards. In the absence of market prices and profits, health expenditure is allocated inefficiently by government officials. The system is further hampered by powerful unions that have thrived since nationalisation. It has been estimated that the NHS employs more than four times as many managers and support staff per nurse than a typical British private hospital.
Perhaps the most damning indictment of the NHS, however, is that it has failed in its original objective of eliminating health inequality. In practice, as with all socialist systems, those with the best connections and the loudest voices get better treatment and greater choice.
Yet despite such abject failure, the NHS has proved highly resilient to change. A key lesson from the British experience is that once people perceive health care as “free”, they will fiercely resist reform. Once socialist entitlements are introduced, it becomes almost impossible to roll them back.
America’s existing health care system is far from perfect – it is over-regulated and producer interests are too powerful. But as the Democrats prepare to push reforms through Congress, US policymakers should examine closely the disastrous experiment in collectivised medicine across the Atlantic. Britain’s NHS nightmare suggests that President Obama’s faith in government is misplaced.