Junior doctors are going on strike again. The three planned walkouts are even more futile than the previous two now that the government has decided to impose the contract.
The Health Secretary has made his decision and that is how the NHS works: the big decisions are made by elected politicians. Like it or not, the current government was elected with a clear mandate to implement its manifesto.
Opponents of NHS reform often claim that because it is publicly owned, it is somehow more accountable than if the providers were private. In fact, the NHS model is the least accountable of all - we only have a general election every five years and health is just one consideration for voters.
The NHS’s monopolistic status almost totally eliminates choice for patients. If you don’t like the food at Tesco, you can shop at Sainsbury’s. But unless you're fortunate enough to have private insurance, if you're unhappy with the standard of care you receive in an NHS hospital, your only choice is another NHS hospital. Even this extremely limited choice is a relatively recent development.
It’s more than likely that the UK will continue to suffer from medical “brain-drain” as doctors leave to work in countries where they can earn more money, but this is not a new phenomenon and certainly won’t be because of changes to the employment terms of a few thousand doctors.
It is an inevitable consequence of a “free at the point of use” service in which there will always be too much demand and not enough supply. That means rationing through waiting lists and government bureaucrats deciding which treatments patients can and can’t have.
Unfortunately for junior doctors, it also means that costs have to be suppressed, in this case their pay. The vast sums of extra funding being called for from some quarters simply cannot be provided without very significant cuts to other departments such as defence and education or very significant tax increases. Such tax increases are almost certainly politically impossible.
Until the system changes, it will continue to fail.
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