N.H.Yes?

I’ve started and abandoned a dozen blogs since the last I posted and simply not had the time to ride those thought buses to the terminus. It’s happening more and more just lately as deadlines for real work appear on the distant horizon then suddenly loom large before disappearing in the rear view mirror; forgotten ticked-off events that mark my passage towards my own ultimate deadline. This might sound a tad morbid and forlorn but it’s natural to wonder about how we prepare to meet the end.

Oh, I’m sure I have a couple of active decades left in me yet, but how active and more importantly, with what level of agency? Given the parlous state of, well, everything, will there be enough left in the pot – both mine and the state’s – to facilitate a dignified descent into comfortable docility, or will there simply be no pot left to even piss in? Even the most optimistic of us, even the luckiest, must surely entertain dark thoughts, on occasion, about what might lay ahead.

All of which is why, whether we believe in it or not, whether we worship at its altar or avoid it altogether, we really should be concerned about the state of the National Health Service. Once a ground-breaking and quite possibly world-beating system of keeping the labour force healthy and productive it has become a deified monolith of gargantuan proportions. It employs a ridiculous number of people – yet there are daily calls for more – and it consumes a huge amount of ever-more-thinly stretched national resources. And as its customer base expands exponentially this is a situation which can only worsen.

Those who paid for it all – the elderly who now rely on it and who also need social care, now that society has abrogated responsibility to government for every aspect of its wellbeing – are unsurprisingly disdainful of how its largesse is extended to all comers. The free-at-the-point-of-use model is no longer viable as fewer and fewer people now actually contribute to its funding, yet more and more funding is demanded. The whole thing is on a one-way journey to collapse unless something new happens.

The decades-long row between Conservatives and Labour over this supposed national treasure isn’t good enough. Labour must not be allowed to get away with demanding ever more money yet having no realistic method by which to raise it. And the Conservatives must stop throwing £billions into its gaping maw while kicking the can of unpopular reform further down the road to ruin; nobody is listening when they insist that they have spent more than Labour ever did, because all they see is their grandmother waiting months in agony for a hip replacement.

The Tories have got to stop trying to appear reasonable; they lost the insincere battle for popularity far too long ago. That is the Labour confidence trick and it’s wearing thin. We don’t need reasonable, we need backbone and a dose of effective medicine – a political emetic to vomit up the flux. Stop gingerly picking at the scab and prolonging the pain; steel yourself for the sting and rip the damned thing off. People will complain whatever is done, but until what is done is drastic and transformative, the only thing you will hear will be those complaints.

Nurse!

When a structure is crumbling, there is only so much you can do to shore it up. There comes a time when you need to cut your losses, tear it down and start over. The NHS is not a unique and inviolable, precious thing which cannot be touched. It is just another symptom of the loss of British backbone, identity and resolve. And part of that Britishness was not relying on others to fix our problems. We may have already lost the ability to deal with all this, but if we don’t heal ourselves, who else do we think is going to do it?

National Treasure

A Labour supporter and NHS flag-waver appearing on BBC’s The Big Questions on Sunday morning spoke enthusiastically about fiscal multipliers; the notion that government spending can stimulate the economy. Yay, spend! But this ignores the simple fact that basic economics is about how we individually and collectively allocate scarce resources with alternative uses. In this respect, money is not a resource but an exchange mechanism allowing us to avoid barter and directly trade labour and materials we possess or control for other labour and materials we desire.

His argument is that if we plough more money into the NHS this would pay more people who would then spend locally, thus stimulating other businesses, all miraculously making profits from that original injection of capital. But where do those businesses source their raw materials? And how many in the local economy are saving for their own, nobly selfish needs and how many are sending money abroad? Come to that, how much of NHS funding goes to buy goods and services from overseas? All of this is a drain on that funding, making the miracle of fiscal multiplication less likely.

Providing government assistance for an area overcome by natural disaster, or local industrial collapse, buying time for the local economy to get back on its feet is one thing, but sooner or later the assistance has to stop, or risk that society becoming dependent on the charity of others. Unfortunately, once that welfare tap has been turned on you need to keep opening it ever wider. (See whole swathes of formerly industrial regions whose old fester and whose talented young leave) Yes, but, the argument goes, the NHS is different; better health in society IS a form of profit, providing healthier workers, who live longer, with fewer end-of-life costs. This is a noble and moral belief, but is it true?

When we decide how to spend our money we effectively ration our consumption to keep within our means, foregoing one good for another where necessary. Those who use the least amount of NHS services are generally the wealthiest, opting to go private, only when they actually need to, on their own timetable. Yet they pay the most into the pot. At the other end of the scale the vast majority of those who use state-supplied medicine contribute nothing to it. Dressed up as ‘need’, those who contribute little gorge themselves on the free stuff. More free stuff, less incentive to ration its consumption.

The NHS. Doing as well as expected...

The NHS is an almost perfect model of what happens when the state tries to organise anything. There is no real price mechanism to allocate resources, just an ever-expanding need, a capacious maw that always needs feeding. For as long as there is an NHS, the Labour Party (for which it is a deity) will ceaselessly declare that we have six-hours/three-weeks/two-days, etc to ‘save’ it. But no matter how much this emotive pleading appeals to the hard-of-thinking we must never forget Mr Micawber’s sage advice.

"Annual income twenty pounds, annual expenditure nineteen pounds, nineteen shillings and sixpence, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery."

Physician, heal thyself.

If you build it, they will take the piss...

The eternal conundrum of the NHS is a riddle that may never be solved; where does all the money go? Variously described as a shining example to the world, a victim of its own success and a basket case, the National Health Service costs half of our entire annual budget. Okay, it’s not that much, but at £120 billion last year this is £4000 a year for each one of the nominal 30 million taxpayers. Of course, a huge number of those taxpayers are also in receipt of tax credits and other benefits so a conservative estimate probably makes it closer to £10k per head for those who receive no such rebate.

People in those income brackets and above of course are less likely to be sick, more likely to have access to private healthcare and even if they do succumb to illness are often too busy to seek treatment, certainly for minor issues. So it turns out that the NHS is really a wealth redistribution system, used disproportionately by those who play no part in funding it. I’m not arguing for dismantling it, nor for selling it off; bizarrely, for an evil, baby-eating Tory type, I think it is a wholly good thing that we have a health service accessible to all and free at the point of use. And yet...

It’s the same old thing, isn’t it? The left denigrate the rich and want to tear down capitalism and never seem to understand that if they get their wish and the costs of the welfare state had to fall more heavily on weaker shoulders the system would simply buckle under the strain. There is only so much money to go around and the NHS has been pleading poverty every single year of my sentient life.

Of course it can’t go on delivering an expanding menu of treatments to an ever greater population. Austerity isn’t mean; it’s living within our means. However you look at it, pouring more and more money into a system whose appetite is never satisfied is an appalling business model. Build it and they will come; give it away for free and they will gorge themselves. How, as a nation with our population, can we be so poorly that the NHS boasts of being one of the biggest employers on the planet?

Obviously, rationing healthcare is a dangerous road to go down; some need so much more than others. But shouldn’t we, as a society who pays for it all, start to take responsibility for this thing we can scarcely afford? If you knew you hadn’t the funds to replace it, would you deliberately crash your car? If you’re not going to eat it, why buy food with a short shelf life and then throw it away? So why eat, drink and drug yourself sick, relying on the health service to rescue you later?

The NHS is not free. I’ll say that again: the NHS is not free. Every penny it spends comes from the same source that funds defence, police, transport, education and your pension. Every bandage, pill, operation, therapy and consultation costs you, the taxpayer, and denies that funding to something else considered vital. You expect to draw on that pension for longer and longer these days, while also having your age-related illnesses eased? Which other fund do you sacrifice?

Take one every four hours... if you can afford it.

So, while nobody is suggesting you suffer in silence, if you really want to continue having access to non-judgemental care without up-front fees, how about taking some responsibility for your own health? And why not exercise a little personal triage before that automatic trip to the surgery? You keep demanding that the government saves our NHS. Why not save it yourself?

Seasonal not fair!

Christmas is just over ten weeks away and already I'm being chastised on Twitter for not welcoming it with open arms. But why would I? Christmas is like all the bad ideas you ever had made whole, amplified and embraced unthinkingly into a parody of religion, but just for a season; the adoration of the baby cheeses, a bit of good vicarious Samaritaning and fabling via the telly and an apocalypse, all done and dusted in a few short weeks and topped off with the rueful hangover of never-again apostasy as the credit card bills arrive, mid-January.

The approach of Christmas heralds the deepening gloom of months when you never see daylight (not that I generally see much anyway, working as I do in windowless, air-conditioned spaces), when doing anything outside is a matter of chance and you grit your teeth as you wait for the sun to return. And the event itself is a prolonged disappointment, like watching shares you bought ill-advisedly slip ever further away from returning a profit. Or seeing your pension pot disappear over the side of Robert Maxwell’s yacht.

Christmas it has been said is a time of year when you are forced into the company of people who you really don’t know as well as you ought... and if you are honest, people you don’t really like all that much. Like your investment, everybody loses except the recipient of all the money - the Christmas God. How is it, you have to wonder, that with the exception of the kids everybody puts far more into Christmas than they get out? Even the time honoured method of saving up a bit at a time to even out the strain has become sullied since the Park Group Christmas club went bust in 2008.

In the run-up to the season of bad will to all men, sincerity is disposed of in a shallow grave as promises turn to dust and everybody starts blaming everybody else for the fiasco. Families use Christmas as a time to inflict on those too young to flee for the holidays the horrible truths and distorted allegiances behind why they spend their weekends at daddy’s and although they shouldn’t really say this, daddy’s girlfriend is a bit of a slut, isn’t she, darlings?

This Christmas, once again, the NHS is in need of a bit of cheering up and although they really want to help and they understand how it got this way, it really is the fault of the Tories. Oh, they don’t mean to be nasty; they just can’t help it, you see. But like Saint Nick himself this is a story which comes around as regularly as the frosts. There has always been but a few days or hours to save the NHS and this tale of old has been gleefully told around Labour conference camp fires since the NHS began. 

Ah, the old traditions die hard...

So this year, let’s ALL save the NHS. Cancel commercial Christmas and help the homeless instead. Drink less, eat less and lessen the load on A&E and stop falling for the bullshit, else your blood pressure may bring on a stroke. We claim to be sophisticated and intelligent celebrants, so let’s all wake up and realise that Christmas is sod-all to do with prophets and Christ and everything to do with profits and vice. Cheers!