But, having lived for 26 years under such a system, I cannot say that I share Krugman’s enthusiasm. Explaining the nature of the new National Health Service in the late 1940s, the British socialist Aneurin Bevan told reporters that “if a bedpan dropped in a hospital corridor, the reverberations should echo in Whitehall.” (“Whitehall” is the part of London in which the national government is located.) Bevan got his way — and how. In England nowadays, when bad things happen to patients, we do not blame hospitals, doctors, and drug companies but politicians and their appointees. Those who follow Parliament are thus treated to the absurd spectacle of the prime minister being asked to comment on individual medical cases in far-flung corners of the nation. This he seems to have accepted as his role. Never does he say in response, “Why am I being asked about this?” Never does he ask whether it might be better if the state got out of the hospital business. Instead, in each and every instance, he takes responsibility and promises to look into it.

Does he do so? Rarely. Because mistakes in delivering health care are catastrophic for those seeking reelection or trying to push an agenda, politicians in Britain spend the vast majority of their time worrying about perceived rather than actual improvement. Government, by definition, has no competition, which means that those who staff it can lie and spin and cover up mistakes not just with impunity but with the full force of the state at their back. Thus do results become less important than statistics, reforms less important than spending, and patients less important than careers.