Perspective: Death By Bureaucracy
December 13, 2024
The assassination of the United Healthcare CEO in Manhattan sent shockwaves not only for its horror but for its sudden justification as Americans resent the problems they face with the health care system. In another shocker, the Supreme Court is currently hearing a very large issue based on a very small argument. Constitutional protection of transgender people in the workforce has been decided. Now state-paid medical and surgical intervention for minors without parental approval may be next.
Instead of stirring American political waters I would rather talk about several trends in the National Health Service in Great Britain. We Americans know very little of it except that it is apparently wonderful and works. True enough but, like our post office, there are serious issues.
One problem is wait times. Just as the U.S. veteran system was severely criticized the indifference that led to one year wait times, England is much worse. Common wait times in Great Britain approached and then exceeded the one-year mark. Then the government said it will increase the budget by a £1b in order to reduce wait times to one year. How nice.
Here’s what the Economist, a British news magazine, has written.
Britons still love the idea of the National Health Service (NHS). The service, at 75 years old, is still capable of providing outstanding care. But the NHS is also in grave difficulties. Many patients died waiting for ambulances and lying in hospital corridors. Hospital waiting lists exceed 7m. One in 11 positions in the NHS is vacant and: there are many (labor) strikes. May 25, 2023.
Britain has some of the worst five-year-survival rates for killer diseases such as lung, colon, and breast cancer. Life expectancy in Britain lags behind most other rich countries. More than 70% of Britons now agree that their beloved NHS is “broken”. May 25, 2023.
The proportion of patients who wait more than 12 hours in ‘accident-and-emergency’ departments to be admitted has risen from 2% to 7% over the past year. (These) delays are leading to 300-500 additional deaths per week. June 11, 2023.
Some 13m people in England cannot see a dentist through the National Health Service (NHS). Access is so bad that some Ukrainian refugees are returning home for dental treatment. August 13, 2024.
Assisted dying (is supported by) a bill brought before Parliament (to) give terminally ill patients in England and Wales a right to request their own death. It (was) debated on November 29, 2024.
So, death will produce substantial cost savings? How did this mess happen? I'd like to suggest that when ‘the people’ make a social contract (a constitution) with elected officials, a bureaucracy slowly emerges. Then, and here's the point, it takes over as if it had a mandate of its own. Bureaucracies have a proper place, but they can also become as indifferent and devastating as a natural disaster.
A bureaucracy strikes me as being like George Washington on his horse. The horse has amazing strength and abilities, but it is directed by the president. By strong contrast, the war elephants (oliphants in Tolkien's Ring Trilogy) are fierce rampaging warriors. Are they actually controlled by their riders? Maybe for a moment but usually the riders are hanging on at great risk to their own lives not to mention the lives of those who are in their way. Serve people? Maybe incidentally. These warriors follow an agenda of their own.
From what we just learned of the NHS, is it a tame horse or a rampaging oliphant? Franz Kafka wrote compelling stories of mindless bureaucracies one hundred years ago. When the Brits elect a new Prime Minister, or we elect a new president, can they tame the oliphant? Or even hang on? We will find out. American health care has been a wonder for me and my family. We thank God. The state was supposed to be the good and wise people who did things right. Many die as the oliphant rampages through Great Britan.
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