Hideously NICE

C. S. Lewis Warned Us About This Deadly Bureaucratic Beast

The heartbreaking story of baby Charlie Gard played out during the early summer of 2017. Less than a year later, the tragedy repeated itself when little Alfie Evans endured a similar fate. Most of us have heard their stories. Both were born in England with eerily similar and rare genetic disorders. Both died before they reached age two. These kinds of heartbreaking medical events happen all too often. But it is not because of their doleful medical afflictions that you've heard of Charlie Gard and Alfie Evans. You've heard of them because they became icons for the inherent dangers of a state-controlled health care system. C. S. Lewis warned us about this kind of thing more than 70 years ago. The parallels between his fiction and modern reality are too pronounced to ignore.

A Tale of Two Boys

Charlie Gard was born in London on August 4, 2016, with an exceptionally rare genetic disorder. His prognosis was not good, but his parents found a hospital in the U.S. that agreed to offer an experimental treatment for his disease. They even raised the £1.3 million (about $1.74 million) required to pay for the treatment.¹ But the hospital where Charlie was born would not allow him to leave. Charlie's parents appealed their case to the grossly misnamed European High Court of Human Rights (ECHR), but the court sided with the hospital. It didn't want to set a precedent by sanctioning what it considered to be futile medical treatments. So rather than allowing Charlie to be transferred to the American hospital, the court determined that his life support should be removed and that he be allowed to "die with dignity." Charlie Gard passed away on July 26, 2017.

In a more recent but similar story, Alfie Evans was born in Liverpool on May 9, 2016. Shortly thereafter, he was diagnosed with a rare degenerative genetic disease. His affliction was different from Charlie Gard's, but his prognosis was similarly dire, and his hospital was similarly unwilling to try to treat him or even to keep him on life support. So his parents wanted to take Alfie to a hospital in Italy that was willing to treat him,² but again, the British hospital refused to allow him to go. The case was appealed to the same ECHR (Family Division) and received the same response. Alfie died on April 28, 2018.

The families of both of these children were not allowed to seek treatment outside Britain's state-controlled National Health Service. The power of the state bureaucracy trumped their wishes, even when the families had raised the money needed for the treatments on their own. Keep that in mind as you are reminded of the premise of one of C. S. Lewis's lesser-known novels.

The Prescience of C. S. Lewis

Mark Studdock is the main character in That Hideous Strength, the third installment of C. S. Lewis's science fiction space trilogy. Mark is an ambitious young Englishman who gets seduced by the promise of power into seeking admittance into the inner ring of a powerful organization. Mark's ambition is to be one of an elite group of men who use questionable tactics to establish an "efficient" state bureaucracy. These men see themselves as being a cut above the rest of society and therefore fit to control the world. The name of their organization, which Mark yearned to join, is the National Institute of Co-ordinated Experiments—which reduces to the ironic acronymNICE. Lewis's narrator describes NICE as

the first fruits of that constructive fusion between state and laboratory on which so many thoughtful people base their hopes for a better world. It was to be free from almost all the tiresome restraints—'red tape' was the word its supporters used—which have hitherto hampered research in this country. It was also largely free from the restraints of economy. . . .³

NICE, and the novel in which Lewis created it, foreshadowed a future Lewis feared would become a socio-political reality if the ideas he addressed in another book, The Abolition of Man, were played out. Yet, when That Hideous Strength was published, some reviewers mocked it. The New York Times described the novel as "superlatively nonsensical excitement."⁴ Time magazine called it a "well-written, fast-paced satirical fantasy."

That was in 1946.

Fiction Becomes Fact

Fast-forward to 2009. On September 21st of that year, John C. Goodman reported in an article in National Review that the British National Health Commission "recommends against any treatment that costs more than $45,000 to save a year of life. Because of [the commission's decision], British cancer patients are denied access to drugs that are routinely available in the U.S. and on the European continent, and thousands die prematurely."⁵ The official name of the commission Goodman wrote about is the National Institute for Health and Care Excellence.⁶ But the British people commonly refer to it by its acronym: NICE.

At first glance, the connection between Lewis's fiction and modern British reality seems satirical. It isn't. But the creepy stuff doesn't stop with the names. John Goodman wrote his commentary to expose the fact that some American politicians thought NICE would be a great model for the reform of the American healthcare system. In his book Critical: What We Can Do About the Health-Care Crisis, then-Senator Tom Daschle praised NICE and envisioned a national health board of presidentially appointed "experts" modeled on it. The board, he said, "would have teeth." It would recommend and control the drugs, "cost effective" procedures, treatments, and technologies to be used in all government health programs.⁷

Ten years later, the relentless pursuit of a state-controlled, so-called single-payer healthcare system continues. And make no mistake: the issue may be put on the back burner of American politics from time to time, but it will never stay there for long. Politicians of both parties will revivify it. They will tout a system supposedly better than the current one (which admittedly has problems). They will make promises that there will be no "death panels," no delays or deficiencies in treatment, no loss of access to one's preferred doctors or facilities, no increases in cost. They will not keep those promises.

The Problem with Central Control

This is not to question the motives of well-intentioned public officials. It is to acknowledge the nature of the bureaucratic beast. I am reminded of the late U.S. Senator Phil Gramm's comments during hearings about education reform in the 1990s. Gramm was bantering with a would-be administrator who favored granting control of the education system to the central government. Gramm stated that his own approach to education policy was based on the fact that "I care more about my children than you do."

The bureaucrat responded, "No, you don't."

To which Senator Gramm replied, "Okay, what are their names?"⁸

Phil Gramm's pithy response illuminates the problem with central control. No government bureaucrat cares more about your family than you do. And the implications of that simple truth are inexorable. Behind all the NICE talk you hear about the benefits of a government-controlled healthcare system, there will be budget constraints and bureaucrats tasked with holding to them. There will be medical review boards and "human rights" courts happy to enforce their decisions. The state will decide which persons are worth treating. And the state will replace you and your family doctor as the ones with the authority to make medical decisions for your children.

But the state has no moral accountability or conscience. It seeks only to disperse scarce resources as efficiently and cost-effectively as possible. And it can only do so impersonally and autocratically. So when the time comes, you will have no say in the matter. Some bureaucrat will be responsible for deciding who gets what treatment.

Someone like Mark Studdock.

That is a hideous strength for anyone to wield. Just ask the parents of Charlie Gard and Alfie Evans. 

Notes
1. "Charlie Gard: The story of his parents' legal fight," BBC News (July 27, 2017): bbc.com/news/health-40554462.
2. "Who was Alfie Evans and what was the row over his treatment?", BBC News (April 28, 2018): bbc.com/news/uk-england-merseyside-43754949.
3. C. S. Lewis, That Hideous Strength (Macmillan, 1965), 23.
4. Theodore Spencer, "Symbols of a Good and Bad England," New York Times Book Review, (July 7, 1946), 10.
5. John C. Goodman, "There Will Be Rationing," National Review (Sept. 3, 2009): nationalreview.com/magazine/2009/09/21/there-will-be-rationing.
6. National Institute for Health and Care Excellence: nice.org.uk.
7. Robert Moffitt and Gurjeet Guram, "The Concept of a Federal Health Board: Learning From Britain's Experience," The Heritage Foundation (Dec. 4, 2008): https://herit.ag/2BK4pDA.
8. Rich Lowry, "Your Kids Aren't Your Own," National Review (April 9, 2013): nationalreview.com/2013/04/your-kids-arent-your-own-rich-lowry.