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Capitalism won’t fix the NHS’s bureaucracy problem

14 May 2018

1:39 PM

14 May 2018

1:39 PM

James Delingpole is right, of course, to extol the virtues of capitalism (‘We don’t deserve capitalism’, 5 May) but wrong to imagine that if only we stuck to strict capitalist principles we could cure problems like the allegedly system-clogging bureaucracy in the NHS. The United States probably has the most ‘capitalistic’ health service in the world; but it has seen an even greater rise in numbers of bureaucrats than the NHS, contributing to its ranking as the world’s most expensive healthcare system.

Or take US universities: they too operate on a very capitalistic model which has seen student fees rise steeply over the past three decades and has burdened the campuses with huge bureaucracies.

Capitalism in and of itself is no bulwark against bureaucracy, because bureaucrats are necessary; they have the job of ensuring that organisations actually work. But bureaucrats need to be held in check — and neither capitalism nor socialism has ever managed to devise a perfect way to do this. At least in the case of our own dear NHS, a combination of spending limits and political pressure (however feeble) are something of a brake on wasteful pen-pushing; people complain loudly if things aren’t working and managers eventually respond.

Capitalism is unmatched for creating wealth — its merits when applied to public goods like education and healthcare are much more debatable.

Robin Aitken
Oxford

Robin Aitken’s letter first appeared on this week’s Letters page.


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