The NHS is a Zero Sum Game

In my book, “How to Win Every Argument”, I document many types of logical fallacy. One of these is the Zero Sum Game, in which resources are believed to be limited where they are not. In popular parlance some call this the “pizza pie” fallacy, stating that if a group were to receive a bigger slice, others must receive smaller ones. This only applies to cases involving a fixed size.

Many falsely suppose that at both national and international levels, if poorer people are to receive more, it must come from richer people. This has never been true. Poorer people become richer when wealth is created, not when it is redistributed. I cannot think of a single undeveloped country that has ever become rich on money transferred from richer ones; they have done it by trade and exchange, by selling goods.

One of the great tragedies of the NHS is that it has unnecessarily turned health into a Zero Sum Game. Because it has a limited budget, money spent on one treatment means that it cannot be spent on others. It therefore has to make life and death decisions based on what those running it perceive to be its priorities.

The money spent on intensive care for a severely premature baby cannot also be spent on giving several elderly people the hip operations they have been waiting for. The money spent on an exotic new drug that might give a cancer sufferer a few more months of life cannot also be used to provide kidney transplants to those who need them to survive.

The NHS as presently constituted must decide how its fixed budget is to be allocated between competing claims for treatment. This is why there will always be a demand from different parts of it for more funds for their specialist area, and why the BBC will always be able to highlight “underfunded” areas to expose as a “scandal.”

There are several solutions to this  problem, including that of turning the NHS into an insurance-based system in which people know what their level of cover is, and what treatments it will buy. The alternative is to continue with a system in which demand is infinite but funds are limited, and to have its rulers make decisions about people’s lives that gods might make, but humans should not.