Re: The National Health Service
Part of the problem, of course, is that medical care has increased in all manner of costs since the 1950s. Back when the NHS was formed, most people were overjoyed that they could afford to get their broken leg set properly after an industrial accident so that they could get back to work as soon as possible, that they could afford for a qualified dentist to deal with their rotten teeth, that there was a medical professional on hand when they were giving birth and that at the ends of their lives - probably between 55 and 75 years old - there was palliative care available.
Then things like antibiotics became widely available, novel forms of medicine were introduced which required huge investments in training and equipment (radiotherapy, chemotherapy, interventions such as dialysis, organ transplants and the like), people started living longer (partly because of better healthcare) and it becomes obvious why the budget of the NHS simply has to rise above inflation across all of that period, and it also explains why premiums for health insurance have also risen.
I know someone who works in the NHS in a team which does something that even science fiction writers weren't predicting back in the 1950s - they fit people with cochlear implants. If you've never heard of such a thing, from the outside it looks like a bulky hearing aid, but the clever stuff happens inside. For suitable people, electrodes can stimulate the auditory nerve directly, giving some sensation of hearing to some people for whom hearing aids do not work. The younger the patient, the more chance the brain has to adapt, and some people who were first implanted as babies can "hear" almost as well as "normal" people. But the kit isn't cheap. Tens of thousands of pounds for the surgery, for the equipment, and tens of thousands more over the years because of follow-up and because the NHS pays an insurance premium to replace lost or damaged devices. Child has a paddy and throws his processor down the loo? Free replacement as quickly as the courier can deliver direct from the manufacturer, all loaded up with the correct settings. Package through the door, hearing restored within a few minutes.
This procedure is costing the NHS hundreds of thousands of pounds per patient these days - but back in the 1950s a deaf child would have been lucky to have been able to attend a special "deaf" school. Cost to the NHS, nil.
BBC Horizon, Curtain of Silence (1973)
BBC Horizon, Now the Chips are Down (1978) - the whole programme will be interesting to a reader of El. Reg, but the relevant part for this discussion starts at about 18m30s.
Now, the NHS is in a fantastic bargaining position with regard to many of these advances and there have been numerous stories over the years about how the NHS often pays less than a private health insurer would, but that doesn't change the fact that there are more "things" which need paying for, and the newest things are usually the most expensive. Life-saving treatments costing millions of pounds are available now, where in the 1950s the person would have been cared-for until the inevitable.
Even staff are more expensive - newly-registered nurses are going to need sufficient salaries to be able to pay off loans and make up for the four years of training because they don't enter the profession at 15 or 16 with a CSE or two any more; they have to be educated (mostly on-the-job) to degree standard, which means a couple of good A-levels as a minimum.
So it's hardly surprising the NHS costs as much as it does and while there is definitely a layer of middle-management which seems to add costs without adding any benefits (just ask any "shop floor" NHS staff), if we want to keep the concept of universal, world-leading, free-at-the-point-of-use healthcare, with no means-testing or preconditions to qualify for treatment, we simply have to accept that its budget (judging by past performance) will always have to increase ahead of inflation - but hopefully not by too much.
M.