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Who Runs the Show? To operate his plan Bevan has appointed 138 executive councils, each composed of 25 members who serve as volunteers, somewhat as do the members of U.S. draft boards. Bevan insisted, in opposition to some of his Socialist colleagues, that the boards remain nonpolitical, i.e., that Conservatives may serve on them. "We have taken money out of medicine," he said. "I will not let politics take hold." British hospitals, virtually all taken over by the Ministry, are run by special hospital boards, usually composed of the same officials who ran them before. In the whole British health service today there are about 10,000 voluntary administrative workers; Bevan's Health Ministry itself gets along with only 800 paid staffers.
The executive council's job is to review the doctors' list of patients; they have the right to reassign patients if one doctor gets too heavily loaded. If their area is short of doctors, they have the right to keep a physician who wants to move away, from doing so. On the other hand, if their area is "overdoctored," they may refuse to let new doctors move in to practice under the health plan.
Although the majority of British doctors were originally opposed to it, 86% have joined the plan. Not all have done so because they wanted to, but because they could not earn enough money from private practice any more. Few can afford to hold out. Said one fashionable specialist: "Let's not be blind. In a few years, there'll probably be no private practice at all. All you do by not joining the plan is eventually to commit hara-kiri."
The doctors get 17 shillings ($3.40) a year for each patient on their list, regardless of whether they call on him every day in the year or not at all. A doctor can have a maximum of 4,000 patients on his list, which would give him a gross income of $13,600. In a few regions, there are more doctors than necessary (e.g., one to each 1,000 patients along Britain's south coast). The result is that doctors' income there is low. Though Bevan could raise their fees, he refuses to do so in these cases because he wants the south coast physicians to move to "underdoctored" areas.
Ride on the Escalator. Actually, few British doctors now make less money than before the scheme went into effect; many make more. Almost all doctors are overworked, because of the enormous increase in patients and because of the new chit-writing and form-filling they must attend to. Contrary to dire predictions before the plan went into effect, doctors are free at least of one worry: there have been relatively few hypochondriacs. "It's been just like it was when they first put escalators in the underground stations," explains
Bevan. "People then said Londoners would waste their time riding up & down them. Well, perhaps a few did, for the first week. But they soon got tired of it."