Reply #132: Sure

[Prophet 451]

"on the residual effects after Maggie and Major intentionally underfunded the NHS for 17 straight years in a Tory effort to undermine the system and get the British to support US-style privatization?

The campaigns of Major and Thatcher had a couple of effects. They completely failed to make the people support US-style healthcare but one thing that did happen was that we ended up with a generational shortage of doctors and nurses. Essentially, the Tory compaign had three elements: Deliberately underfund the system, discontinue incentives to train and choke the system with layers of beurocracy. The first, you know about. The second involved removing training incentives and retiring placement schemes. The result is that we have a sort-of "lost generation" of medical staff which we've had to make up by creative use of the Highly Qualified Immigration Scheme (a system where would-be immigrants with skills we are short of get preferential treatment). The beurocracy is, gradually, being removed but it's a slow process due to institutional inertia.

"What actually happened to the NHS -- and the health care providers who work under that system -- during that period of temporary national madness? "

Well, the NHS carried on, as it always has. Amid public uproar, admittedly. A few doctors took a look at what they needed to earn to provide for themselves and their families and jumped to private practice but the majority stayed in public practice and suffered along with everyone else. Little effort was made to replace doctors who died or retired, with the result that you saw locums constantly and a lot of people had little idea who their listed doctor actually was. That's not an inherent fault of nationalised medicine, it was the direct result of Thatcher and Major's attempt to cripple the system.

It hasn't fully recovered yet but it's getting there. Replacing the training incentives got would-be medics back in training again; improving the pay and benefits got a lot of nurses to come back and the HQIS and Commonwealth agreements brought in a lot of medics from the Commonwealth nations, mainly India and the Carribean. The main problem is what's referred to as "institutional inertia". That is, the additional layers of beurocracy became part of the system and the system grew around them in teh same way as coral reef will grow to encompass anything placed upon it. The result is that removing those middle management is a slow and thankless job. So, it's a work in progress.

"Did Blair and the neocons actually restore some or all the necessary funding required to run a first-class national health care system, or is the NHS still suffering from "death by budget axe?" "

Some. Let me state, for the record, that I can't stand Blair and never could. That said, he inherited a situation where the Tory government had cut taxes to the bone and underfunded public services. Although Labour took a hard swing to the right under Blair, restoring the NHS was a priority but he suffered in that he had to deal with a whole generation (my generation) who had grown up under the Thatcher tax regime and who wanted the services without being willing to pay the taxes for them. So, while some of the funding was restored, he didn't dare raise tax rates to the necessary level to pay for all of it.

Brown... Alas, Mr Brown. It's worth noting, BTW, that even the Conservative party here says they want to fully fund the NHS. Brown is suffering from what my old PoliSci teacher called "a carnival of catastrophes", being so buffeted by one crisis after another that there is little time left to address existing priorities. Since Brown came to power, he's had to deal with the financial implosion, a very nasty (and still ongoing) expenses scandal, numerous backbench revolts, the after effects of both wars and an extremely hostile public (inherited from Blair). The result is that while he's continued the funding increases that started under Blair, he's had no time to properly address the institutional problems which have been around for twenty-odd years now and his time is running out.

If the NHS was abolished and a US-style triage by wallet system was put in place here, I honestly think there'd be open revolt. It wasn't that long ago when Thatcher's attempt to impose a poll tax caused nation-wide rioting and forced her government to back down (although Thatcher, as ever, was immune to self-examination).

I think your main problem is going to be the American (well, American right and media) ingrained belief that voodoo economics can and will work. What that leads to is an outright refusal to tax the rich at anything above bare bones rates. What you need to avoid like the plague is what seems to be happening: Legislation which locks in the power of insurance companies.