I can't help but think that since the 80s these systems have been deliberately rigged to fail, to give an excuse to privatize or introduce parallel for-profit options.

That seems a bit surreal. I sometimes read free-marketers who speculate that certain people are intentionally making the US Private healthcare system worse in an attempt to get socialized medicine. That's the first time I've read a suggestion that socialized healthcare was intentionally being made worse to push a private option.

I dunno, maybe healthcare is just hard to get right, whether run publicly or privately. Maybe we still know very little about how to treat and fix the human body, but rapid progress in other areas of technology and the numerous developments we have made in healthcare lead us to think otherwise.

If you read about the NHS it's honestly hard to think otherwise. But also forcing cuts by underfunding programs is something conservatives talk openly about wanting to do: https://en.wikipedia.org/wiki/Starve_the_beast

Well i base my claims on the observation that recent years have seen more and more administrative processes that have been introduced in an effort to emulate free market pressures on public health services.

This based on the idea that free markets are better at operating efficiently.

Thing is that the ultimate goal of any enterprise is wealth extraction.

The most direct such extraction is via racketeering.

But baring that the next best option is to offer a tangible product or service others are willing to pay for.

But note that the goal is not to offer good product or service, it is wealth extraction. Thus one will aim to offer the most minimal product or service one can get away with at the highest price.

So no, i don't think there is any reason why they should fear that the US system is being gamed to introduce public health services. It is being gamed to maximize wealth extraction by everyone involved.

On the other hand, ruining existing public health services to make private equivalent look good would directly lead to increased wealth extraction by those involved with the private health services.

> That's the first time I've read a suggestion that socialized healthcare was intentionally being made worse to push a private option.

It's actually not an uncommon opinion in the UK, at least among the people I know. In fact, Thatcher herself introduced much of the bureaucracy into the NHS in the form of the "internal market".

>That seems a bit surreal. I sometimes read free-marketers who speculate that certain people are intentionally making the US Private healthcare system worse in an attempt to get socialized medicine. That's the first time I've read a suggestion that socialized healthcare was intentionally being made worse to push a private option.

In the US they are literally doing this right now with the post office. In the UK they did it with the rail network.

It's a standard part of the privatization playbook.

I think another part of the problem is that we still don't know how to run large centralised organisations in a way that doesn't lead to continuous bureaucratic expansion.

flip flopping for profit

Both Labour and the Tories have gutted the NHS at various times. Bureaucracy comes from both sides too.

Labour did not gut the NHS. Their policy on bringing the private sector into the NHS was probably a bad one - PPI was more expensive than direct public investment for hospital rebuilding but kept the costs off the national balance sheet, maintaining a helpful fiction.

But Labour significantly increased spending on the NHS, from 5% to 7% of GDP before the banking crisis (which with GDP falling saw spending rise in GDP terms by about another 1%.)

Since the Tories regained power they've been cutting back on NHS spending (and more dramatically on social care, which increases the demands on the NHS.) That's why we're seeing the horror stories once again of waiting lists and winter crises, which had last been common under the previous Tory administration in the early 1990's.

http://www.publicfinance.co.uk/opinion/2015/10/nhs-spending-...

decreasing spending is not the only way to gut the NHS. Increased bureacratic oversight, unionisation of the labour force, realigning the focus and core competencies, increasing demand for consultants over doctors, you name it. The NHS was in a terrible place when David Cameron came into power, and granted it's gotten worse since, but making out that the conservatives are the only ones who have pushed the NHS to breaking is ridiculous and fallacious.

Labour could have done things better (far too many public sector reorganizations to which all governments seem prone) but things were really pretty awful in the NHS in 1997 with long waiting lists and crises every winter.

The public sector employment figures on page 13 of this report are pretty telling: https://www.ifs.org.uk/bns/bn145.pdf

1991-1997: NHS headcount static at 1.2M under Tories

1997-2010: NHS headcount grows to 1.6M under Labour

2010-2013: NHS headcount begins falling under Tories

One of the things Labour has done pretty well in the past is to bloat out the government with bureaucracy and paper-pushers so they can point to the total number and say "employment increased" or "the NHS is expanding" while throttling the capability of the organisation to perform its function effectively. Part of the reason the NHS is in the situation it's in now is that the ratio of front-line medical workers to administrators and managers has shifted over time (https://www.kingsfund.org.uk/projects/general-election-2010/...). There's also the case of a number of IT projects that have been extremely expensive and/or have failed disastrously, and increases in regulatory burden under Labour.

Headcount is generally not a good metric to measure productivity or effectiveness as it's a number that politicians love to manipulate to for their respective ideologies (social welfare expansion for the left and budget restriction for the right).

The figures you link to show very little to no change in staffing proportions between 1999 and 2009. Professionally qualified clinical staff sum to 52% in both years, increasing exactly in line with total NHS employment.

Figures I found for 1997 and 2007 are similar, showing proportions of clinical staff at 49% and 51% respectively. http://content.digital.nhs.uk/catalogue/PUB00829/nhs-staf-19...

And medical school intake has risen from 3,749 in 1997/98 to 6,262 in 2012/13 - a rise of 67.0 per cent. http://www.nhsconfed.org/resources/key-statistics-on-the-nhs

It's still not enough - Britain spends maybe 2% GDP less on healthcare than other rich European countries. But at the end of Labour's time in power, there were 1/3rd more doctors and nurses employed by the NHS. The funding increase helped enormously.

Edit. But yes, the massive IT projects in the NHS were a hugely wasteful like all massive government IT projects. The approach of the Government Digital Service seems to be a huge improvement.

New Labour put in all the ground work, and the Conservatives ran with it.

Building lots of infrastructure under Public-Private-Partnerships - built up massive bills - brought in under the Conservatives, massively expanded under New Labour.

The internal market, a new Labour innovation, brought in massive inefficiencies, and private profits along the way.

The current government is battering a massively weakened system.

Yeah, Blair "Labour". The french term "champagne left" is very apt in that regard.

You can't say someone isn't Labour just because you personally disagree with their work. New Labour was still left-of-centre, even if it was closer than previous Labour institutions.

Left and right transcend economic class. The idea that the left is rooted in the working class is a complete fabrication.

Gordon Brown also harmed the NHS by the way. Considerably.

The whole thing of the "new" Democrats and "new" Labour is making a show of staking positions that are essentially a middle finger to their core constituencies.