All attempts to reduce bureaucracy increase it, and the same goes for cost. Such, at any rate, has been my experience of the British health care system—its famed, or infamous, National Health Service.

Thus, I could not but smile a little wanly when President Barack Obama said this week that he hoped an increase in the use of generic drugs, together with an expert commission to examine the cost-effectiveness of medical treatments, would make a significant impact on the vast budget deficit of the United States. We in Britain have been there and we have done that, and our health-care costs doubled, perhaps not as a result, but certainly at the same time

….

It is an occupational hazard for politicians to think that they and their ilk know best, and by all indications Mr. Obama rather likes centralization. In my professional lifetime in the centralized British health-care system, however, I have seen a hundred schemes of cost reduction, but I have never seen any reduction in costs, or at least any that lasted more than a few months. I can’t remember a single health minister who did not promise more efficiency at less cost, or a single one who actually managed to achieve it.