My rating: 4 of 5 stars
This is a probing look into the philosophical underpinnings of the British National Health Service. It fairly treats the subject from the perspective of potential intent of the original framers to the end result; revealing the arbitrary nature of socialized medicine with its eventual intrinsic self-interest to emphasize supposed basic foundational principles such as Need, Quality, Equality, and Cost (the latter being more of a concern to the ministers of health than those ministered to), and on the other hand to obscure the methods or end-results of those philosophies in practical application through an opaque leviathan bureaucracy that is blind to the vision of its mission and stone-deaf to any criticism of the outcomes. The former occurs through the inherently arbitrary ‘eye-of-the-beholder’ nature of the foundational principles, and the latter is achieved through a system that is designed to “stop up all channels through which protest are meaningfully heard” (hence the book’s title). The unhappy consequence of such squelching of information is brazen corruption and naked exploitation that is veiled by pseudo-technical happy-talk that is targeted to frustrate Reason and meaningful reform. This is not an unpredictable result of any kind of organization that has been entrusted with a large proportion of a nation’s wealth and has a strong self-interest to retain control of that wealth.
One core economic principle guiding the NHS is the concept of a cost per Quality-Adjusted-Life-Year (QALY) that is designated by the Orwellian “NICE” (National Institute of Cost-Effectiveness) Counsel; which currently rests at around $U.S.35,000. Fortress NHS identifies the necessity of a QALY for this type of controlled health economic system to function, but reveals that outside of The Fortress such concepts as a ‘QALY’ do not exist. It is no more rational to speak of a ‘cost per QALY’ than it is rational to speak of a ‘cost per unicorn’. This concept of a QALY also has important implications in areas outside of a person’s health status since other factors (e.g., employment or social status, eating habits, etc.) can influence a QALY; thereby justifying even more intrusion into the personal choices of individuals and more arrogation of wealth and power to The Fortress.
Reading this book gave me renewed appreciation for the care with which we should reform our social systems in ways that concentrate enormous power and wealth into fewer hands because that power will inevitably be used to resist any meaningful change and always tends to primarily serve the self-interest and preservation of the mother-organization rather than the interest of those whom it was originally intended to serve.
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