Notes and references

There is just one important piece of evidence comparing performance of the entire NHS with just one chunk of the hugely variable market in health care in the US, the Kaiser Permanente (KP) health care programme in San Francisco (Feachem, G.A., Sekhri, N.K., White, K.L., 'Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente ', British Medical Journal 2002; 324: 135-43).According to Prof Feachem, KP provides a higher quality service than the NHS at a much lower cost.Surprisingly, he has as one co-author, Prof Kerr White, formerly a lifelong advocate for a national health service covering the whole US population.KP is not representative of the whole US care system.It is nominally not for profit.Profits are listed in its balance sheets, but they are apparently mostly shared by its medical staff and administrators.It is generally recognised as the most enlightened large unit so far developed in the US.However, even as a comparison not between two national systems, but between the NHS as a national system and KP as a single large corporate unit, like was not compared with like, and many other aspects of this study make its conclusions extremely doubtful.Its methodology falls far short of the standards normally required for research papers in peer-reviewed journals.2 Gannon, Z., Lawson, N., Co-Production: The Modernisation of Public Services by Staff and Users, www.compassonline.org.uk,accessed 1 January 2010.The idea of co-production in public services seems to have originated from Gail Wilson ('Co-production and self-care: new approaches to managing community care services for older people', Social Policy & Administration 1994; 28: 236-50).3 Webster, C., The National Health Service: A Political History, Oxford: Oxford University Press, 1998.I had already read Webster's excellent official history of the NHS, but those volumes naturally compelled him to restrain so far as possible his own opinions to what the civil service would tolerate.In this short history he combines inside knowledge of how government policies were made, or more often allowed to drift along making themselves, with refreshing expression of his own exasperation with drifters or, occasionally, admiration for rare examples of imagination and leadership.4 Adam Smith held more enlightened views than most of the people who now claim him as a founding father of classical economics.Here is what he had to say about the state: Civil government, so far as it is instituted for the security of property, is in reality instituted for the defence of the rich against the poor, or of those who have some property against those who have none at all.(Smith, A., An Enquiry into the Nature and Causes of the Wealth of Nations (1762), Oxford: Oxford University Press, 1993, p 413) And about how it should be funded:The subjects of every state ought to contribute towards the support of the government, as nearly as possible in proportion to their respective abilities; that is, in proportion to the revenue which they respectively Notes and references (Preface)

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