That a centralised bureaucracy is the right way to run some tings is entirely true. There are such things as market failures, times and places when the free market unadorned just isn’t the way to run things. There are also times when a centralised bureaucracy just isn’t the way to run things, when harnessing the power of those markets, that self-regulating economy out there, to do things is a better even if not perfect way of deciding upon matters. Our trick is to know when which is which.
Health care seems to be one of those not centralised bureaucracy things.
Breast cancer survivors have complained that screening letters are forcing them to relive the trauma of their battle. Women who have had double mastectomies to remove the disease have said they are still receiving invitations for mammograms, even though they have do not need to be screened. Now, charities are calling on the NHS to better link its IT systems in order to prevent the distress. The NHS system automatically posts letters to British women between the ages of 50 and 70 who are registered to a GP to invite them for regular breast screenings, including the time and date of the appointment. According to NHS Digital, Women in England are called and recalled for screening using an application called Breast Screening Select (BSS). Using the application, doctors flag higher risk individuals as well as remove patients from the system. However this is not always the case and women who have survived the disease and are living ‘“flat” – having had two mastectomies – are still being given screening appointments.
A database concerning breasts, we might think that it would be possible for such to contain the information of who has had them lopped off. Apparently not. So, what lesson to learn from this?
We might start with Hayek and the pretence of knowledge. No central organisation is ever going to have enough information to be able to manage or do things in real time. As at the top, sometimes we put up with this as the non-central model works even worse. But harnessing that local knowledge would produce a better outcome perhaps?
The idea of running the nation’s health care through that one centralised bureaucracy would therefore seem to rather fail.
We do, of course, see a comeback to this idea. That we’ve been starving the NHS of the resources it needs (cont. pg 94). Except of course we haven’t, we spent £11 billion and change on trying to upgrade those computer systems and we ended up with not one single usable line of code from the adventure. We tried to do that upgrade in a centralised manner of course.
Perhaps, again, we should be trying to harness that local knowledge? Possibly, adopt the method of some other countries, where individuals hold their own medical records? Individuals who would, we might assume, know whether they’ve been lopped and thus make sure their medical records reflected that fact?