The Logic of the British National Health Service

IN AN earlier paper,' I examined the National Health Service in the light of principles and aims consistent with the basic assumptions of a free society. I found the N.H.S. to be incompatible, in important ways, with those principles and aims and, furthermore, to be apparently incapable of achieving some of the narrower objectives of the medical care system itself, notably a rising standard of care for patients and continuing freedom for the medical profession. In addition, objectives achieved by the N.H.S. could be reached by alternative ways. My conclusion was that public policy should seek to build a free medical market in place of N.H.S., with governmental control and tax finance playing a significant but discriminating and subordinate role. The purpose of this paper is to take that analysis further and to try and unravel, once for all, the twisted logic that underlies the N.H.S.