Columns Everyday Lies

Public spending and public health

Theodore Dalrymple says the connection between expenditure and result is extremely tenuous

This article is taken from the November issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering three issue for just £5.


Whenever you see the word austerity used in connection with public finances, you may be sure that lies, simplifications, omissions and false dichotomies are sure to follow. Recently I read the following headline to an article in The Doctor, a magazine for members of the British Medical Association: Austerity — Covid’s little helper.

The word austerity is already disingenuous, to put it no stronger. The word in this context means the attempt to align government expenditure a little more closely with government income. It certainly does not mean hair shirts and monastic silence in unheated stone-walled rooms.

The headline implies what is certainly not true: that more public expenditure is either a necessary or a sufficient condition for the attainment of better outcomes. Scotland spends more on healthcare per capita than England, but its results are worse; France spends the same as Germany on healthcare, but in the matter of the epidemic at least, it did far worse.

Singapore spends proportionately less than half as much as Britain on health care, but with results that are far better (and not only in the matter of Covid). Finland, Portugal and New Zealand also spend less than we, with better results. Belgium spends more than the UK, proportionately, but had the worst results of Covid anywhere in the world, or at least of anywhere that publishes minimally trustworthy statistics, worse even than ours. The connection between expenditure and result is thus extremely tenuous.

Constantly demanding more expenditure on the NHS for the good of the population, the doctors strangely never volunteer a reduction in their own remuneration and generous pensions to pay for extra services. Their concern for the heath and welfare of the population never goes quite as far as that. The increased public expenditure that they demand — by happy coincidence on their own sphere of activity — is always to be paid for by others.

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