In Christian Niemietz's 'Diagnosis: Overrated' is this observation:
The idea that the NHS is run by ‘the people’, as a joint endeavour, is a romantic fantasy. The NHS is an elite project, and this could not be otherwise. Collective choice is not a substitute for individual choice and ‘voice’ is not a substitute for ‘exit’. The illusory ‘accountability’ mediated through the political process cannot come anywhere near the accountability of a marketplace, or of a properly designed quasi-market setting, in which providers stand and fall with the choices consumers make, and depend on them for their very economic survival.
Anyone with experience of the NHS's sclerotic organisation will know this to be absolutely true.