Here in the USA, we hear talk of imperial collapse. In the UK, everyone pretty much agrees that the empire collapsed 70 years ago, and yet the nation/republic seems to march on. They seem to be in a foul mood though. Consider this blog post, “(Why) The Death of the NHS Is a Parable of Civilizational Collapse“:

You can’t get a doctor’s appointment, unless you’re really lucky, or incredibly persistent — you’ll get an automatic message telling you no appointments are available. Ambulance? Good luck with that — they can take hours to arrive, if at all. Think about that, though, in larger terms. What does it mean to…be this painfully, jaw-droppingly, infuriatingly stupid? To give up an NHS? 90% of humanity, maybe more, would kill to enjoy such a thing. The Roman and the Gaul and the ancient Egyptian could scarcely have dreamt of such a, to them, miraculous institution. But Brits…LOL. What the…

Umair Haque, Eudaimonia and Co

So that’s a blogger’s opinion. Let’s look at two British papers, the Independent and the Guardian.

Dr Phil Banfield, chairman of council at the British Medical Association, described the “frighteningly common” situation where dying patients are forced to sleep in a corridor or on a chair while “hospitals (are) failing and falling apart and ambulances (are) stacked outside emergency departments”.

Independent

Okay, so it sounds like a series of political administrations has been underfunding it, and outcomes are not living up to the high standards and expectations of the past. But the article goes on to say they have a plan to fix it.

The NHS has lost its prestigious ranking as the best health system in a study of 11 rich countries by an influential US thinktank. The UK has fallen from first to fourth in the Commonwealth Fund’s latest analysis of the performance of the healthcare systems in the nations it studied. Norway, the Netherlands and Australia now provide better care than the UK, it found. The findings are a blow to the NHS, which had been the top-rated system in the thinktank’s two previous reports in 2017 and 2014. The US had by far the worst-rated system, despite spending the most on care.

Guardian

So it’s still in the middle of the pack of the most functional modern countries, but slipping. If your benchmark is the laughably cost-ineffective and inequitable U.S. system, it is still pretty good.

If the UK can’t do it, should the U.S. even consider the model? We do have the Veterans Administration which gets pretty high marks, and we have a system for active duty military, I guess, although I don’t know much about that. (It would be interesting for someone to compare just the VA to other countries’ systems if nobody has done that. Somebody probably has.) And then we have Medicare, which is a massive direct subsidy to the private health care system (which does nothing but complain about it), which gets reasonable marks, and Medicaid, which is a massive indirect subsidy that gets terrible marks. Still, the U.S. government does better when it is just handing out money than when it is trying to build enduring public institutions. My proposal would be to scale up Medicare to everyone (but we voted against the politician who would really have fought for this). The government could also just create a standardized medical records and billing system and force private industry to use it, or just force everyone to use whatever is used for Medicare. This would take a lot of inefficiency out of the system and maybe reduce the bureaucratic overhead of the private system down closer to the public system (yes, I meant what I said there!) while keeping whatever benefits we think the profit motive provides (those ambulances sure do arrive fast in the U.S.!), and eliminating the insane inequities in the system. This would also get preventive medicine, addiction and mental health treatment out to the people who really sorely need it, which might go a long way toward improving our intolerable drug overdoses, suicide, and even violence problems. So it would really be a win-win for almost everyone EXCEPT the finance industry, which of course owns our corrupt politicians and makes sure we can’t have nice things.