Wednesday, December 21, 2005

The Tax Consumption Merry-Go-Round

Oh no, the NHS mess goes on and on:

GPs offered cash to let patients book in advance

A few years ago it was usually possible to book an appointment with an NHS General Practitioner for, let's say, Tuesday week at 10am, at a mutually convenient time. It was occasionally tricky to get an appointment the same day, if say you phoned up at 11:45am, but if it was serious enough, in most places I lived in the country the Doctor would generally try to fit you in somehow. Not perfect, but as the most private part of the NHS, the GP service was perhaps the least worst of a bad bunch. But the politicians couldn't help but get their oar in even further, into the fruit pie.

"What? You can't always get a GP appointment the same day for some trivial problem you're only going to the doctor with so you can shaft your employer with a day-long sickie, so you can watch a football game? This is outrageous and a direct contravention of your footballing Human Rights!"

So something had to give. The politicians gave GPs extra payments for ensuring that if anyone phoned up and wanted a same-day appointment, they got one.

Go on, guess what happened next! Yes, to absolutely nobody's shock, except the politicians, for a short while it became astonishingly easy to get a same-day GP appointment, but virtually impossible to get a convenient one at 10am on Tuesday week. Doctors now started holding the whole day's appointment slots open just in case somebody phoned and wanted an immediate sick note. And the unforeseen consequence? The GPs got paid more for doing less. As the same-day bonus payments hit their bank accounts, they gradually started doing less work to ensure they always had free slots to get the same-day appointment cash, so the patient throughput became less; this led to further shortages of what you might call GP up-time. Perversely, it then gradually became even harder to get an appointment the same day, than it had in the bad old days of less government intervention. How so? Well, the only way of getting a GP appointment became to phone the same day. To get a morning appointment, you now had to join a herd of other people all phoning at, say, 8:30am. Getting through would be a minor miracle in itself. Often, once you did break through the engaged lines at 8:45am, you would be told that all the morning appointments had gone.

"Can I have one tomorrow morning?"

"Oh no, sir. As part of our improved NHS service we only offer same day appointments, so we're keeping all of tomorrow free, until tomorrow morning."

"Can I have an appointment late this afternoon, then?"

"Oh no, sir. As part of our improved NHS service we only offer afternoon appointments after 11am this morning, to ensure everyone can get an appointment the same day."

Absolutely mind-boggling. In my pre-Austrian days, I found that shouting down the phone line didn't really help. Sometimes this could go on for days until you gave up, and then phoned one morning at 11:01am, for an afternoon appointment, which did of course mean you had to take the whole day off work to spend ten minutes being told by some politically correct nerk that you ate too much of this, or drank too much of that, when all you wanted was something for a really sore throat. But what the heck. Employers can always carry the cost for employees taking the whole day off. That's what they're there for.

And so because of this preposterous solution, much worse than the original problem, everyone complained to their politicians. And the next Chicagoan market-like solution? GPs are now going to be paid even more to offer the service they used to offer years ago for nix, to get advanced appointments. So now they'll get two subsidies where previously they had none, for exactly the same service.

This, of course, does assume that these two subsidies aren't unbalanced. Because whichever one is greater will skew GP behaviour in that direction. So if they get more for later appointments, it's bye-bye same-day appointments. And if it's less than same-day appointments, we'll be stuck with the current mess. So by intervening with perfect plans, the central planners have wrecked something which used to work, albeit imperfectly, but adequately, and without any need for the cost of all this planning and subsidy. Government in action. Don't ya just love it.

Oh, and if you read the linked article above you'll find GPs are also going to get even more tax-paid subsidies to maintain obesity and learning disability registers. How nice of Big Brother to take notice.

I wonder if all the obesity and learning disability statistics are now going to shoot up? I wonder. It'll be worse than all those non-existent olive trees in Greece, which attract all those billions of Euros in EU subsidies. They'll be skinny economics professors on both registers, before you can say cash payment, and the GPs, whom I once used to respect before I realised they have become the biggest bureaucrat snouters in the trough, will have even more toys on their Saab convertibles. God Bless the NHS and make mine a brushed magnesium and beechwood gear stick lever.

The founder of the NHS, Nye Bevan, really did have it right when he said that to create this gorgonic monster he would have to stuff the doctors' mouths with gold. You were right then, Nye, and you're right now. I hope it makes you feel proud to have been such a profoundly great socialist cock-up artist. Thanks a trillion.

The entire NHS should be privatized, immediately.