Should Libertarian doctors strike?

Intimidation, damage to property, civil disobedience and scared children – I am pleased to say none of these things were present when I attended the junior doctors’ march in London on 17th October, in support of my junior doctor wife and colleagues. This was the first public political protest I have attended and I left with mixed feelings.

As I approached Waterloo place, just west of Trafalgar Square, on a mild dry Saturday, the first signs of the protest were the ubiquitous Socialist Worker supporters handing out various red and black top pamphlets. They were far older than the bulk of the crowd, which consisted of Junior Doctors (those who are not consultants or GPs) mostly aged between their early 20s and early 40s, and their families. My instinctive scowl at the Socialist Workers was changed to a wry smile when I saw a stall manned by those notorious market making capitalists – Locum Agencies!

We were directed to the other side of the square where we loitered with the children, occasionally bumping into friends or colleagues, and tried to hear what was being said on the stages. I’m told it was all quite rousing, although all I could hear over the PA system was ‘hmm mm brr ggg mm sqqqll bzzz NHS! NHS!’ and a few cheers. After an hour or so we slowly walked back towards Trafalgar Square, brandishing our placards and occasionally chanting ‘Hunt must go’. The placards varied: ‘We’re quite annoyed’; ‘I’m not a gynaecologist but I know a Hunt when I see one’; ‘Not Safe Not Fair’; ‘Save our NHS’.

Saving the NHS. That is where I found things difficult. You see the doctors are correct in opposing the contract changes, which will result in significantly worse terms, conditions and pay, especially for those doctors already working lots of nights and weekends. The only reason the government would push for these changes, if I discount them wanting to precipitate a fight with the world’s weakest union, the BMA, is to save money. They wish to save this money as there is not enough money out of tax alone to run a safe, effective NHS. The problem is that doctors are already taking individual action, even with the current contract, and are leaving the UK, changing careers, locuming or cutting down their hours. This is expressed as unfilled rotas and rising locum rates.

Should doctors threaten strike action? I am aware that some on the political right believe doctors should not strike as they knew they were entering a state industry. This is ridiculous. The reasons for entering medicine are complex, and at the time of entry the quality of life in a hard, demanding yet fulfilling job was still attractive for many people. Those skilled doctors who work in the NHS would be the same doctors working in any other system. As a monopsony employer the use of collective bargaining is a legitimate market response for the self-interested worker. Forcing others to strike or operating a closed shop would be illegitimate, but freely bargaining as a collective does not, in my view, make one a socialist.

The real danger, however, is that workers trying to come an agreement on pay, with an employer that wishes to have a single contract for all similar staff, will seek out those who agree and support them. Thus industrial militancy in this usually quiet cohort of professionals can end up with a movement to the political left if their concerns are dismissed.

Regarding the NHS, the most dishonest thing for doctors to do would be to accept a new contract without fighting, as this would leave to falling staff numbers and worsening quality of care. By maintaining a strong contract that may be unaffordable under the current taxpayer funded model, they will precipitate the discussion that politicians keep avoiding. 90% of the public trust doctors to tell the truth; 16% trust politicians to tell the truth (IPSOS MORI 2014). That is because doctors will tell you bad news. Here is some bad news. There is not enough money in the NHS to maintain safe services today. This applies to private services as well as NHS ones – NHS trusts are in deficit; Circle handed back their Hinchingbrooke Hospital contract; GPs I know are closing their practices.

Accepting the truth of the lack of money in UK healthcare would enable the next conversation to take place: where should the extra money come from? When asked honestly the Great British Public may surprise politicians, who look to the past more than the future. Extra taxation seems impossible in the current economic state we are in so that solutions such as co-payments or top up payments, the first step on the road to reducing government interference in healthcare, must be permitted.

One quote for those who would condemn potential strikers. It comes from Atlas Shrugged and remains prescient today as we witness professionals taking their own industrial action by leaving the country or their chosen profession. In my view a day or two of industrial action, if it is a real signal from those who might actually leave for good, is not inconsistent with its message:

“I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.” Dr Thomas Hendricks, Atlas Shrugged




  1. Well first of all – my admiration for all medical professionals, you do incredible work.

    However, (you know that word was going to come) the principle remains the same.

    People must have the right to “withdraw their labour” – to refuse to work.

    But employers must (equally) have the right to take the refusal to come to work as a resignation and to seek someone else to fill the position.

    In short – walk out if you wish to (that is your right), but you have no right to walk back in, if your employer does not want you any more.

    By the way – I AGREE with you that the sort of people who are prepared to work regardless of pay and conditions are likely to offer low quality service.



    1. I agree with your thoughts Paul. I do feel there is a difference between strikes that use government backed ‘rights’ to push staff pay and conditions above the underlying supply and demand equilibrium (ie tube drivers who are potentially replaceable after a few months) and industrial action where central planning has kept pay and conditions below the ‘true’ market level (ie doctors where there are unfilled rotas, dangerous staff shortages and a long time time to train replacements). In a system where employers could sack a striking staff member the latter group would not be affected as employers would not be able to pursue this tactic this in any meaningful way.
      Do you feel collective bargaining is legitimate with a monopsony employer? Perhaps this is a natural market response by self-interested individuals in these circumstances, in which case the prime role of any government is to protect all those involved from associated violence or intimidation towards those who chose to work or not work during the dispute.



      1. Train services are far harder to pluralize than medical provision.

        Collective bargaining is freedom of association, as is rejecting it.


      2. I am not a fan of collective bargaining – especially in government employment. Politicians and administrators are not spending their own money (they are spending the money they TAKE from the taxpayers), and “collective bargaining” in government employment can become a conspiracy against the taxpayers – this is certainly true in parts of the United States, for example California. As for the NHS – well, unlike in Canada, the government does not have a monopoly on healthcare in the U.K. (although it does dominate healthcare).


    2. Paul beat me to it on all points.

      The monopolistic, coercive nature of healthcare provision has equal and opposite coercive reactions.

      Cure the disease, not treat the symptom, if I may be so corny to use a medical reference.



      1. Hard Tim – even in the United States when Ben Carson proposes making private medical care an attractive option for the young over their whole lives (via medical savings accounts and so on), people just assume he means throwing elderly people out of hospitals because they can not pay (that was the burden of an television interview I watched – and it was on Fox News, even they did not understand the simple point that Dr Carson was making). In Britain the whole discussion is a theological one (the NHS really is a religious belief). so I think discussing the matter is hopeless – whatever one says will be twisted hopelessly by the Witchfinder General types.


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