Ep. 193 How Dare Trump Criticize Britain’s National Health Service

15 June 2019     |     Tom Woods     |     14

Krugman is horrified that Donald Trump has been critical of the National Health Service (NHS) in Britain. Why, the NHS is doing a great job! We put Krugman’s arguments under a microscope.

Krugman Column

“Mar-a-Lago Comes for British Health” (June 6, 2019)

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  • Lysander Spooner

    I am British. The NHS is indeed in crisis.

    The problems are exactly as Austrian economists would predict: long wait times, poor outcomes, massive inefficiencies, and so on. The lack of consumer power means that the users of the NHS frequently get frustrated & most waiting rooms have a prominent ‘violence will not be tolerated’ sign. I have never seen such a sign in a commercial business. As you would expect, the actual health outcomes (do you die or not) are really poor compared to other systems.

    Everyone has a story of terrible care (misdiagnosis, poor treatment etc). Yet almost all British people support the NHS and are horrified at the idea of opening it up to profit seeking companies.

    It is a fascinating situation. People don’t seem to grasp that profit is already the basis for the NHS: each individual employee gets paid & so is acting at an individual level as a ‘profit seeking actor’. And for every story about poor outcomes is a story about a caring employee who does his or her best: I think that the average person, having gone through the government run school system, has no concept of the superiority of the free market and simply imagines that good intentions are sufficient to create good outcomes. Plus people have an inherent ‘my country, right or wrong’ attitude that is impervious to rational analysis. None of the political parties have any sensible policies for the NHS.

    I wish I could see a path to a better health care system in the UK.

  • Tuppenceworth

    Wonderful as ever. Thought I might venture a couple of notes from a small island for clarity:

    1) Be careful when it is said the NHS is a “universal” (or “socialist”) system. It is a tax-funded health service, “free at the point of use”, but it is not a monopoly. A health insurance market and private hospitals exist alongside. There are no weird rules imposed on this private market as far as I know — insurers are free to set premiums and choose policyholders however they like. Lots of companies provide health insurance packages to their staff. If people can’t get fast or available treatment “on the NHS” they “go private”.

    2) The real-life NHS is widely acknowledged to be awful! Everyone complains about their local surgery or the state of the hospitals but at the same time have a romantic, almost religious, ideal of the (“our”) NHS if you ask them about it in principle. No idea why as it is not so much the case with state-funded schools.

    3) Yes, the NHS does quite well on most healthcare indicators. Oh, except for health outcomes. But I’m sure we are ironing out that minor wrinkle.

    4) Contrary to reporting, Trump made no demands about American firms privatising the NHS on his state visit. He was asked by a journo if the NHS would be “on the table” in any future trade negotiations post-Brexit. He turned to May and asked “what’s that?”. She said “It’s the, uh, National Health Service” and he answered, “I think everything should be on the table”. He clearly had no idea what was really being asked so why would he say “no”?

    PS. For waht it’s worth, the state visit seemed to go quite well as far as I could tell.

    • MDBurk2754

      Re. 1): It IS very much a monopoly in that, re. the UK, it is the only health related entity that exists via resources siphoned/extracted from its citizenry via force, aka taxes. I doubt the “… health insurance market and private hospitals…” that “…exist alongside” can do the same(?) and unless they can, then to what extent do they “…exist alongside” especially re. their ability to compete w/a business rival (the NHS) that is- compared to the “… health insurance market and private hospitals…”- giving its services away for free? What need is there to impose ANY “…weird rules…” in such an advantageous (for the NHS) circumstance when that one rule (the ability to tax citizens) exists in the first place? Re. your last sentence, why should anyone have to “go private” (especially when, by doing so they pay twice, once in taxes to the NHS and again in whatever monies they pay to the “…health insurance market and private hospitals…”) if resources are already being taken- by force- from a country’s citizenry and, as previously noted, being done so in the first place?

      General question here: When it comes to ANY good/service demanded by anyone be it healthcare, education, food, clothing, shelter, transportation, communication systems, etc., etc. etc., do governments exist for their citizenry or does the citizenry exist for the government?

      • Tuppenceworth

        Well, a monopoly would mean it was the sole provider, at least as I understand the definition. The NHS is not a monopoly in that sense, although from discussions people might easily believe it was. This was what I wanted to clarify.

        Yes, it’s true you pay twice to use private services (same as for a private school). People choose to use private medical services because the private hospitals are better, the waiting times are shorter and the range of treatment can be wider. In the episode it was said that universal systems have the safety valve that patients can travel to the US — I just wanted to point out that people can already turn to private care in the UK without having to do that. Obviously the more well off you are, the more likely you are to use the private provisions — for many it’s prohibitively expensive, I wasn’t trying to play that down.

        Hope that clears things up a bit.

  • http://ludwigvanel.wordpress.com Ludwig van El

    Does anyone remember seeing Benny Hill? Not too, flattering about the NHS

  • https://www.facebook.com/app_scoped_user_id/YXNpZADpBWEZAlM2N4dWItZAmRBd1ZA4VXg2OHhOSUxmUTdlczRrT0thRXhXbDM4ekFCX1dTX0gyMFBFQkNYclg0RFVfWjBTd3VuMExTR1pQMXJkODdxYmJQVHFmdkdDRldTamNReVFSTFhF/ Jon Hanemann

    if you’re 50 or over in the UK and seriously ill and don’t have private insurance, but a shovel.

  • Tom

    It’s no mystery why these healthcare systems all seem to work about equally well: beyond a certain minimum of healthcare, health outcomes are dominated by demographics, lifestyles, and culture, not healthcare spending. That is probably because the big causes of death, cancer, heart disease, obesity, and accidents/murder, cannot be substantially reduced through treatment, only through prevention.

    If you plot the often-cited statistic of life expectancy vs per capita spending using linear regression, the US looks like an outlier. If you plot it using quadratic regression, you’ll see that there is a maximum life expectancy at around $2500/year, and beyond that, life expectancy declines again with increased spending.

  • Tom

    I would also point out that Medicare+Medicaid+VA together spend about as much per American as many European healthcare systems spend per capita; that is, the US government could provide European-level public healthcare out of existing budgets and leave the US private system entirely untouched and unregulated.

  • https://2vnews.com 2VNews

    Phase Out Plan:
    Abolish the income tax, tax code and IRS.
    Enact the Fair Tax (sales tax).
    States, counties, cities and local municipalities should abolish property taxes, all fees including license fees and all other taxes, including income taxes. Replace with sales tax.
    Phase out all federal safety net programs. Make it illegal, by amendment, for government at any level to run or pay for any entitlement program of any kind.
    Update the safety net. Have a means tested financial safety net (cash/voucher) at the state level (they have financial restraints), not a safety net based on government run programs for everyone.
    No benefits for those who do not qualify for assistance. A true safety net. And people would be reminded of the cost of government every time they spent a dollar.

    • martinbrock

      Running for emperor?

      • https://2vnews.com 2VNews

        You have poor comprehension skills.
        This plan leads to less power for the emperor.

        • martinbrock

          You’re telling everyone everywhere in central North America how they may associate (states, counties, cities, local municipalities), raise revenue and expend it. Neither the POTUS nor the Federal government as an organization exercises so much power today. What you describe is the furthest thing imaginable from decentralized, libertarian governance.

          • https://2vnews.com 2VNews

            The tax code is violence.
            Forced education is violence.
            Fiat money is violence.
            Forced government programs (e.g., Social Security) are violence.
            Incarceration for the consumption of products is violence.
            Forced labor wages are violence.

            Read the Bill of Rights, it puts limits on government force – so does my plan.

  • martinbrock

    Every state agency always desperately needs more money, so they’re all “broke and not working”. This rhetorical slogan has no more bearing on the effectiveness of the NHS than on the effectiveness of the post office, DOD, NASA, FBI, INS, …. Then there’s our perpetually crumbling infrastructure, even while the interstate highway system is the envy of the world (according to Bush I).



    Rather than picking nits about the semantics of “infant mortality”, why not acknowledge what every American already knows? The U.S. healthcare system sucks. It doesn’t suck ’cause “free market”, but it sucks nonetheless. Even a fully socialized healthcare system like the NHS is no worse than the corporatism we endure in the U.S., and the NHS costs much less.