R4isms: NHS and Homo Fabian Neanderthalensis

Listening to Radio 4, as I do on my wind-up Baygen radio, there was an interesting programme on Neanderthals last night. No, not Westminster Hour, but the ancient hairy kind. No, not The World Cup, actual Neanderthals, Homo Neanderthalensis.

Some interesting factoids came up to tuck away in my Trivial Pursuit cheek-pouches, such as the evidence suggesting that they were top tier predators, eating a diet similar to that of lions and tigers and likely had to use their organisational skills as much for defending the kill from other predators as much as making the kill in the first place.

What jumped out was a statement, and forgive me if this is not verbatim, discussing the life-span and robustness of these early people in that there is evidence that injured people were rested and laid up, supported by others, so that their injuries could heal rapidly. It was:

"Well, there was no NHS back then"

This is spoken by what we might describe as intelligent, learned people.

I could understand it if they said there was no penicillin or antibiotics, though I would question that even. No wheels for sure, but "No NHS"? There was no NHS in WWII, for goodness sake!

The mindset that pre-NHS was some barbaric dark age where we hunted mammoth, where we existed with flint knives and bearskins, so far away as to be forgotten, as if the NHS was some absolute fixture.

Of course, to many it is. To many, not having the NHS in all its forms is like being thrown back to an antediluvian nightmare, with, I suppose, those cruel Libertarians cast as the Cro Magnons threatening their existence with a steely eye and modern weaponry, as in William Golding's The Inheritors*, or the ruthless Fins in Pathfinder.

The NHS in its entirety is a sacred cow, or should I say some kind of cave-painting, fixed on stone, to be observed and worshipped. Extended, but never altered or replaced. To criticise is to blaspheme.

It has always been.

It must always be.

Wrong.

The NHS is more than it was originally supposed to be. It was only meant to be a universal State run health insurance programme**. It is now a de-facto monopoly and one that is being portrayed as eternal - "from everlasting to everlasting"! So it is written, so it has become.

To consider something that is systemically dysfunctional by nature of its monopoly and the third party payer problem, as eternal and unassailable is reckless folly.

The NHS needs to evolve. It needs to end the monopoly. It needs to look at what it was aimed to do, not what it as become. Healthcare provision does not demand a state monopoly. Healthcare provision does not demand NICE. It does not demand micromanagement, Soviet style, of our healthcare needs, with individuals manacled to some geographic fiefdom in the shape of your PCT and SHA that you can only escape by moving house. The PCTs and SHAs are not held to account in the true sense. They do not face extinction.

For the likes of Frank Field to think the unthinkable, he needs to encompass our attitudes to Healthcare, Housing and Schools, as well as what is known as Welfare, for all these things are part of what is currently provided as entitlement and makes up for a massive redistribution of wealth through coercion with all the unintended consequences, the negative incentives and distortions.

To ring fence or worship any of these is to condemn the UK to be Homo Neanderthalensis, cowering in a cave while modern man outside, coming from India and China, flexibly adopt, adapt and thrive. We will be sitting there, huddled around the embers of a fire we have forgotten how to make, looking out on a landscape full of animals we know not how to hunt.

* a course book in my school days.

**Even that has unintended consequences of forcing out independent Friendly Societies, because a State insurance provider has subsidies and by nature of the State being a monopoly, would steadily be given monopoly power and advantage. This was seen in the need to extend the monopoly power to provision even before the scheme was launched.