A Meaningful Debate on the NHS Must Examine the Premise on Which It Was Founded
By Staff News & Analysis - August 21, 2009

SIR – Professor Stephen Hawking (pictured left with Barack Obama) and some of your correspondents (Letters, August 15) claim they would not be alive today without the NHS. They assume that unless the state provides it, universal health care would not exist. However, there was good universal health care in Britain before the NHS, provided partly by charitable hospitals and trusts dating, in some cases, from the Middle Ages, partly by friendly societies to which millions paid subscriptions, and all underpinned by a strong ethic among doctors that treatment should not be withheld on purely financial grounds. These trusts were ambushed by Bevan in the biggest forced expropriation since the Dissolution of the Monasteries. The friendly societies withered and died, leaving us in the hands of a vast state monopoly. And the doctors had their mouths "stuffed with gold" to silence their doubts. That stuffing continues to this day. When Attlee's administration set up the NHS, it made no claim that health care was inadequate. It simply argued that provision would be more efficient if centralized. Sixty years on, we know what value to place on that proposition. Nicholas Guitard Poundstock, Cornwall – Telegraph Letters

Dominant Social Theme: A debate should take place?

Free-Market Analysis: This was a letter received by the Telegraph in response to an article on the failings of the British health care system. The system, which is constituted actually of several separate branches, is fully nationalized. The government both employs medical workers and pays for medical procedures. The system was put in place after the Second World War when Britain was even more formally socialist than it is today.

The reason the above letter is important is because it illustrates how private industry works to take care of the needy and indigent when government programs are not available. Many seem to assume, in this "modern" era, that government programs are all that stand between society and the endless implacable cruelty of poverty and want. But in fact before activist government of present era, there were in the West and especially in America plenty of examples of private safety nets that took care of the less fortunate.

The above letter references how a combination of a professional medical ethic, combining with a religious and social commitment provided a strong safety net without government assistance. Of course, there are the defenders of government programs who will point out that the nature of private charitable programs is indeterminate and that they contain holes through which many fall. But in fact public programs are no more efficient, and likely less so.

Government programs indeed tend to be rigid, slow and inefficient. They are administered by a bureaucracy that in general is worried about errors that will jeopardize its quasi-sinecure. Private safety nets, in the original sense (as opposed to today's tax-advantaged charities) are often run via religious institutions and through volunteer community efforts. These latter individuals are motivated by spiritual and philosophical approaches that may have little to do with a salary. They truly work at a grass roots level.

A good example of this sort of approach can be seen with the American "Shaker" religious movement. This was a variant of Quakerism and preached a fairly direct and personal relationship between the individual and his or her God. The Shakers did not believe in conjugal unions. In order to become a Shaker, one had to live apart from the other sex. Indeed, the Shaker towns in America, abandoned now, still offer two separate doors to each dormitory, one for the men and one for the women.

One of the most interesting things about Shakerism is that its 19 villages (at the peak of the movement) took in many orphaned children and gave them good upbringing, which included schooling and a healthy lifestyle. There have been many reasons offered for the Shakers' decline and eventual die-off, but the one that seems the most pertinent to us is the rise of state-run orphanages, which greatly cut the supply of babies to the Shakers.

Thus it was that the creation of a state-run safety net deprived a private religious institution of potential converts. While not all children chose to stay with the Shakers once they reached maturity, apparently enough did to ensure the vitality of the religion throughout much of the 18th and 19th centuries.

When it comes to government, the idea that only official watchdogs are feasible and appropriate is also questionable. There is a long history of private watchdogs (US Consumer Reports comes to mind) and these private industry groups that inform the public about various industrial dangers are likely to be driven out once the government takes over with its own services. Of course the argument can be made that government is necessary to make private industry behave. Sweat shops, forced labor, etc. are areas where it is said that Western democracies have provided considerable relief.

But while the initial contributions of government oversight may be positive, the eventual configuration may be a net negative. One only needs to look at the environmental movement to see this principle at work. Initially, government-enforced environmental rules led to a clean up of water and wilderness in America and Europe.

But these initial developments have given rise to cap-and-trade schemes, an overwhelming campaign to indoctrinate the public with information about a probably non-existent global-warming threat and generally Draconian rules that are driving businesses of all sizes into penury and bankruptcy. Initially government solutions may seem modest and workable, but almost inevitably this seems just the proverbial camel's nose under the tent. Government begins well but, unrestrained by competitive counter-forces ends in apparent madness. The UN-supported idea that ones' breathing (carbon) jeopardizes the planet is a good example of where government programs can end up.

After Thoughts

From our point of view, the biggest example of the sort of mechanism described above is the Western central bank. Introduced supposedly to manage money so as to ameliorate booms and busts, central banking with its incessant money printing and price fixing increasingly creates terrible difficulties for economies worldwide. These are just now being recognized in a big way thanks to the Internet. And just as we anticipate, in this Internet era, an eventual falling away of many of the worst government programs, so do we anticipate the reinvigoration of a gold and silver market-based money system – a system that would wipe away more poverty than a thousand central banks.

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