Of all the main services provided in Britain today, I would argue that the NHS has the worst moral effects. These include:
1. Queuing. You can’t choose, so you must wait, often for something that matters a lot.
2. Producer power. The people who provide the services construct them to achieve their targets. They are not allowed to respond to what people actually want. This power is concealed from us by …
3. Guilt. Every day, thousands of patients are made to feel bad if they ask for something. This is wrong: patients should be the only point of the whole thing.
4. Unnecessary death. The Mid-Staffs case was only the most shocking of many. This could not happen on any large scale if patients could choose.
5. Contempt for the weak. In a system where each extra patient is a burden to the system rather than a customer adding to the viability of the enterprise, the authorities decree who doesn’t matter. In our culture, this usually means that the old and the mentally ill are ill-treated.
6. Sentimentality. We tend to still our own fears about hospitals by cooing about how noble doctors and nurses are. Some are; some aren’t. They are no better and no worse than staff in hotels, solicitors’ offices, undertakers’ firms or veterinary practices. Mostly they are much more inefficiently directed.