MR. ANTHONY LEJEUNE

MIDDLESEX, ENGLAND

I shall present the following argament:

(1) Lobody would deny that there is something very wrong with Britain's national Health Service. As Dr. alpole Lewin, the Chairman of the Council of the British Medical Association said recently: "hat other business would badget 2149 million for the Health Service in 1943, spending more than 23000 million a generation later, and still be nowhere near getting a comprehensive service?"

Despite this huge budget, the Health Service is chronically short of money. Many of its hospitals are squalid with age. The doctors and nurses are under-paid.

Some casualty departments have been closed

for lack of staff. The number of doctors seeking to emigrate from Britain continues to increase, and now constitutes a significant proportion of the entire medical workforce. The Health Service survives at all only because there is an inflow of doctors from India and Fakistan, but these arc of varying quality.

The number of patients who take out private medical insurance, in order to pay for private - rather than Health service tre- treatment when they are sick, also continues to increase. They include more than 10,000 doctors, nearly a third of all the doctors in Britain. health service patients may have to wait up to four years for non-urgent operations. Official figures snow that 37 per cent wait more than a year, and nearly 20 per cent more than two years.

2.

(2) The question arises: are these defects in EXEK some way peculiar to Britain, or are they inherent in any scheme of socialised

medicine?

They are, I believe, certainly inherent in any scheme of this kind, which purports to offer all medical services completely free at the time of use. Demand for medical services did not, as the founders of the RS expected, diminish. On the contrary it has increased indefinitely. Demand at nil cost is unlimited: but the

available supply of medical services cannot be unlimited.

through

Jecause people believe that they have already paid texation and weekly National Insurance stamps for the Health Service, they feel entitled, if not actually obliged, to get as much as they

can from it. Their attitude towards the doctor also changes.

Since this fax demand cannot be fully met, some form of rationing has to be introduced. Delays, long waiting lists, perfunctory consultations, lack of choice, are a form of rationing. Certain very Single scarce facilities, such as to rooms, bedside telephones, and the attention of senior doctors for relatively minor ailments, inevitably (though this is usually denied) go first to politically important people: and this tendency must increase, in Britain no less than in the Soviet Union, if private facilities unavailable.

become

(3) Under this system of socialised medicine not only is the demand artificially increased but the supply is artificially

diminished. A lower proportion of the Gross national Froduct (5.4 per

3.

cent, compared with 7.8 per cent) is spent on medical care in Britain than in the United States - because people are not deciding for

themselves how much of their own resources they want to spend on their own and their families' health.

The supply of voluntary and charitable donations also to a great extent dries up; this has been a major cause of delay in the renewal of britain's hospitals. much money is unnecessarily consumed by the

administrative superstructure, and much time

including doctors'

..ost important of all, the politicians, who socialised medicine

are the ultimate paymasters, have to allocate
there

money from the public purse, on which are innumerable rival demands. ressed from all sides, they will never allocate to medicine as much money as, from an objective point of view, might be desirable. To save money they will impose restrictions on what doctors, dentists and hospital administrators are allowed to do. Doctors in Britain have, so far, largely retained their freedom to prescribe, but some items deaf-aids, spectacles, cosmetic dentistry have been kept at

a shoddy utilitarian level.

(4)

It has been suggested that, in order to minimise the political element in the allocation of resources, money should be channelled through some relatively independent body, similar to the University Grants Committee. But the analogy is only too relevant. As spending on universities increased, the University Grants Committee came under more and more political pressure, and has been more and more restrictive

58-442 O 75 - 2

4.

in what it allows.

(5) In addition to these indirect political pressures, direct political factors inevitably intrude on any State-run service. "Faybeds" in national Health Service hospitals are being phased out purely because of political agitation by certain manual-workers' unions.

If private medicine is allowed to continue beside a national Health Service, the contrast in standards is apt to become embarrassing. This in turn leads to political attacks on the private sector, which will be accused of draining resources away from the Health Service. Just such an attack is beginning in Britain now.

(6) The danger always exists, and bEDNEX is increasingly hard to resist as the Health Service exetopsxand develops, that doctors will become servants of the State, careful

Sometimes

Even if they

ee at the expense of their patients - not to offend their political masters. resist this tendency, they can do so only by becoming politicised

themselves.

(7) The British system is not, of course, the only form of socialised medicine. Some of the disadvantages have been avoided in other countries. But the major and deadly disadvantage is unavoidable

the incursion of politics into what should be personal and medical decisions.

Unmet health care needs in this society are reflections of unequal distribution of wealth. The so called health care crisis is by no means a health care crisis. More people have access today to better care than ever before in history. If we could do today with the diagnostic and treatment sophistication levels of the '60's and freeze it there, the politicians in all probability would have to look somewhere else for a crisis to intervene in with the prospects of higher voter gratitude. To make people share all their medical expenditures is by necessity setting a precedent for sharing the costs for all other expenditures. This has been the trend in Sweden for a long time. Let's take a

look at the mechanisms and the results: