Skip to comments.As alternatives to the NHS are considered...Dalrymple thinks Zairean Model -
Posted on 11/19/2006 12:43:42 PM PST by UnklGene
As alternatives to the NHS are considered, which model of healthcare will Britain adopt? The French, the Swiss, the German or the American? Theodore Dalrymple thinks it might well be the Zairean -
Theodore Dalrymple May 3, 2006
The Zairean model of healthcare as pioneered by Marshal Mobutu Sese Seko is gradually being adopted in Britain - or so argues Theodore Dalrymple. This model is a simple one - the rulers receive the best healthcare money can buy, the mass of the populace get an aspirin if they are lucky. In Britain, the mass of the populace will do rather better than that - after all Britain is a much richer country. Nevertheless, Theodore Dalrymple argues that the underlying principle will be the same - excellent healthcare for our rulers, a second tier system for the rest of us.
What model of health care provision should Britain adopt - assuming, of course, what now seems very likely, namely that it cannot think of one for itself? The Swiss, German, Dutch, French or American?
I think the model that the government would prefer is the Zairean, under the late and much-lamented (at least lamented by comparison with what came afterwards) Marshal Mobutu Sese Seko. That model was roughly as follows: when the Marshal had a toothache, he got in a Boeing 747 and flew to Paris; when an ordinary Zairean fell ill with a life-threatening disease, he went (if he still could) to a nurse in a clinic and got an aspirin, if there was one.
The Zairean model is very economical. Its costliness at its summit is more than compensated for by its cheapness at its base. The cost per person of a few flights of a Boeing 747 spread over 30,000,000 people is very little. And it is very egalitarian (and therefore, by definition, just), since the vast majority of the population gets more or less the same attention, i.e. very little.
What makes me think that this is the preferred model of the government? First, I should point out that it is only the principle of the model that attracts the government, not its details as put into practice in Zaire. Britain is still at a higher level of development than Zaire; and therefore when the British population goes to see the nurse, it will get rather more than an aspirin, and the building in which she works will be considerably grander and cleaner than the mud hut of her Zairean colleague.
The government has contrived the introduction of the Zairean model with considerable cunning. One of first steps in this introduction is the dramatic increase in pay of British doctors (or should I say of doctors in Britain, which is a rather different thing) that the government has granted.
Surely, you might reply, a huge increase in pay for doctors is a recognition of their importance? It is a token of the deep respect in which the government holds the medical profession.
On the contrary: the quid pro quo for the increase in pay is ever more detailed control over what doctors do. Doctors now routinely bully their patients into attending their surgeries, to have their blood pressure checked or for some such reason, not because they think it vitally necessary for their patients, but merely so that doctors reach a target laid down by the government in return for extra payments.
Even when what the government wants doctors to do is perfectly sensible and potentially advantageous to patients, this still represents a perversion of medical practice. It makes doctors the agents of the state rather than of the patients. It is inherently corrupting, because it means that if, or rather when, the government demanded something that is not sensible or potentially harmful to patients, the doctors will be in a poor position to object to it, for they will long have sold their independence for their mess of pottage.
In fact, doctors are spending more and more of their time not on what they think they ought to be doing, but on what they are told by the government to do, in return of course for money. This is Aneurin Bevan all over again, stuffing the mouths of doctors with gold to make them acquiesce in whatever is demanded of them.
But the pay of doctors is clearly leading to budgetary problems. It is one of the causes of the deficits of NHS trusts, despite the vast additional sums that have been spent on the NHS as a whole. But pay increases are rarely reversible: and doctors no more than others will not accept to work for less than they have once been paid.
In other words, it is part of the government's strategy to price doctors out of the market that the government itself controls, to justify the employment of less qualified people. More and more work will have to be done, for economic reasons, by health workers who are cheaper to train and to pay than doctors. This is already happening: nurses, help-lines (such as NHS Direct) and pharmacists are doing an increasing proportion of the work. A government scheme supposedly trains nurses to prescribe in a mere thirty-seven days. Another scheme exists to train second-class doctors in a shorter time than it takes to train first-class ones.
Perhaps no harm will come of all of this. Much of the work that general practitioners have done in the past could equally have been done by nurses or pharmacists, precisely because so little of it needed to be done at all. A service that was free at the point of contact encouraged people to take no thought as to whether or not they needed that contact in the first place; doctors began to see fewer and fewer people who actually had much discernible wrong with them.
Having thus created and fostered an insatiable demand, it has become necessary for the government to control the escalating cost of meeting it. The educational level and rates of pay of the people employed to meet it will have to be lowered. Nurses and the British equivalent of Russian feldshers (staff whose training is intermediate between nurses and doctors) will step into the breach.
But not, one suspects, for our leaders. Epidemiology may prove that nurses and feldshers are just as good as doctors, but when one of our leaders falls ill, he will not phone NHS Direct, or consult a nurse: he will go straight to the most eminent doctor he can find, even when his illness is trivial.
This, in essence, is the Zairean model, adapted to British circumstances. Marshal Mobutu Sese Seko comes to the rescue of the NHS. There will soon be a propaganda effort to persuade us to accept the glories of the new model; but as is so often the case with our leaders, le patron ne mange pas ici.
Theodore Dalrymple is a writer and recently retired as an inner city and prison doctor.
Marshal Mobutu Sese Seko Health Care for all my friends! A lot of good it did him:-)
What worries me is that this may be the model for "Hillary Care II".
Now that insurance is taken care of, now comes their healthcare provider. Since they've chosen their insurance provider, in essence they've chosen their healthcare provider. If their insurance provider, who THEY have chosen, dictates their heathcare provider, and they don't like who they have chosen for them, they have one of 3 options. 1- Go to a healthcare provider of their choosing, and pay for it themself. 2-see A above. Or 3-See B above.
In the event that none of the aforementioned is affordable, go back to school and get a better education so they can get A-a job where the employer WILL provide them the insurance program they are deserving of. Or B-a job that will pay them more money so that they can pay for their own insurance.
If the idea of going back to school doesn't suit them. They can start their own business, and have that employer provide them with exactly the insurance plan that they want, choosing the exact heathcare provider they want.
Actually, as I think about it, this sounds pretty much like the way healthcare has been done in this country for the last...oh...500 or so years. Why is it NOW that we suddenly have a healthcare CRISIS?
Trial lawyers and "civil" "rights" "advocates".
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