The Welfare State We're In, The website of the book by James Bartholomew
September 29, 2009
How do the highest ranking health systems work?

<em>The Daily Telegraph reports that Britain has been ranked 14th out of 33 national health systems in Europe. Naturally one may cast doubt on the methodology of the analysis but all the same it might be worthwhile considering exactly how the systems that are ranked highest work. They are:
1. The Netherlands
2. Denmark
3. Iceland
4. Austria
5. Switzerland
6. Germany

I have heard quite a detailed description of the Swiss system which sounds interesting and preferable to the German one. But I know little of the systems in the four countries ranked above this pair.

Posted by James Bartholomew • Indexed in Further research • NHS

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March 24, 2005
Further research

Some possible research projects which could be useful and which, as far as I know, have not previously been done:


How many commercial and charitable schools were closed down between 1870 and, say, the the 1950s because of the competition from state schools which were offered free to the consumer? How many just closed down because they made losses, how many were taken over on the cheap by the state? How many of existing schools are effectively private and charitable schools which, over a long period of time, have effectively been expropriated by the state? How much of their inheritance – in terms of land and premises – has been sold off?

WHY? To reveal the rich inheritance of schooling that was destroyed and expropriated by the state.


The full story of how lone parenting became incentivised by government. This has never been written, as far as I know. When did lone parents first get priority for council housing, for example? How did that priority change and develop over the years? What about the various benefits that have come and gone. The ideal research result would be to create some kind of measure of how much lone parenting was encouraged at different times. It would then be a measure which could be applied to modern times. This measure could even become an important part of the political debate in Britain.

WHY? To reveal, conclusively, that the state created the lone parenting boom and the human misery that has resulted from it.


1). We now have a shortage of doctors. To what extent is this due to the role of governments and the royal colleges deciding on how many people should be trained? In other words, do we have a shortage of doctors because the government is in charge of training? How was it that, in the first half of the 20th century, we did not have a shortage when becoming a doctor was an expensive, challenging business involving a great deal of hard work.

WHY? To show, if it is true, that, far from state control and “planning” leading to the right number of doctors being trained, it caused a shortage. To reveal and explain the paradox – that we had no shortage of doctors being trained when it cost the trainees far more.

2). How many people trained as doctors then give up the profession (ideally compared to the proportion in other countries or historically.) Why do they not practice? Would they practice if training to be a doctor was a more important financial and work commitment? Would they stay if conditions for doctors were not so bad?

WHY? To sort out the cause of the shortage of doctors. To what extent is it the failure to train and to what extent the failure to retain?

3). How many hospitals and beds were there in 1948. How many are there now? Document the land and buildings – the crown jewels of British hospitals – sold off by the state.

WHY? To bring home, conclusively, how the NHS has cannibalised the inheritance created by charity and commerce, as well as local authorities.

3). If the efficiency of healthcare delivery had not deteriorated, would it be more or less expensive than in, say, 1948? Some people say, “of course, healthcare is much more expensive that it used to be. You cure people, so they go away and come back again a few years later, then you cure them again and they keep on coming back. Then there are the new expensive drugs and new, expensive operations like heart surgery”. Yes, all this is true. But on the other hand – and what rarely gets mentioned – is that modern techniques have also saved a lot of healthcare costs. People used to stay in hospitals or long-term nursing homes for months on end with TB. There may be other diseases similarly. It was also the belief of the medical profession that staying in hospital for two weeks or more was a good idea when a woman gave birth to a child. Now you can be out on the street again within hours. It also seems to be the case that the most expensive thing about modern hospital care is just filling a bed. The operations are relatively cheap. Perhaps the drugs, too. It would be very useful to have study which answered the question, “Healthcare is more expensive than it was in 1948. But is that because the nature of healthcare has changed, or because it is delivered in a way that is so much more inefficient?” One of the inefficiencies, for example, is the shortage of doctors and nurses which means they have to be paid more. Doctors in private practice cost far more than in some other European countries. Another reason it is so expensive, of course, is the waste or resources and manpower.

WHY? To establish how far the much greater expense of medical care today is really because of changes in medical practice and technology, and how much it is due, instead, to inefficiency, cartels and state control.

Incivility and crime

In the book I argue that the welfare state has led to incivility and crime. I believe I credibly links between, for example, lone parenting and delinquency. But it would be good to try to establish more precisely what aspects of the welfare state are most powerfully linked to incivility to crime. This could be done in a number of ways. One would be to make a comparative analsysis of different kinds of welfare state around the world and different levels of crime and incivility. In Italy, for example, there is I understand, a low level of lone parenting (partly at least because the welfare state does not finance it so readily there). What is the relative level of crime and incivility there?

One could seek out the most extreme contrasts: countries with high lone parenting and low unemployment (care should be used to differentiate real low unemployment and official low unemployment). Such countries could be compared with those which have the opposite: low lone parenting and high unemployment.

WHY? To bring home to doubters the impact of the welfare state on behaviour. To make the analysis of the impact more precise.

Posted by James Bartholomew • Indexed in Further research

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