It’s another day, another failure, for Britain’s National Health Service. America has some prominent congressional advocates of a “single payer” system of national health insurance run by the government. They always promise high quality care at low cost. But, in fact, it always comes at a high price. Britons who get sick, and have to try to live through it, pay for it at a steep personal cost to themselves and their families.

The report of conditions in the Mid Staffordshire NHS Foundation Trust in yesterday’s Times makes for grim reading. Receptionists with no clinical training assessed new arrivals. Patients waited hours for emergency treatment, and when thirsty had to drink water from flower vases. The pressure to meet arbitrary targets encouraged doctors and nurses to ignore seriously ill patients in order to attend minor, quicker to treat, cases. One senior doctor admitted to leaving a patient with an arm broken so badly that the bone stuck through the skin with no pain relief for four hours. The hospital’s board ignored a threatening rise in cross-patient infections. When surveyed, only 27% of the hospital’s own staff was happy with the care they provided. All in all, investigators estimate that the hospital killed between 400 and 1,200 patients in a three year period.

And this was not a minor, backwater organization. The designation ‘Foundation Trust’ means that it was recognized as one of the best in Britain, supposedly meeting the highest standards of governance and financial stability. The designation was awarded on the basis of a supposedly independent investigation provided by the Trust, an investigation that has now been shown to be inaccurate in every respect. Alan Johnson, the Health Secretary, has accepted that “There was a complete failure of management to address serious problems and monitor performance.”

The relevant question now is why the system failed so badly at every turn. The problem was not that Britain spends too little on healthcare: under Tony Blair and Gordon Brown, spending on health grew by 68% in real terms from 2001/02 to 2006/07 alone, and it has continued to rise faster than inflation since then. The answer is that, as an investigation by Britain’s Healthcare Commission has revealed, the institution’s managers were so obsessed by meeting centralized targets and winning Trust status in order to escape that control that they ignored their responsibility to care for their patients.

This reveals, yet again, the fundamental flaws with top-down national health care systems, and, indeed, with excessive top-down control in all areas of life. First, the more responsibilities the bureaucrats at the center assume, the more targets, mandates, goals, and requirements they push down the system. But by trying to control everything, a top-down order ends up controlling nothing, except the flow of paperwork: the more it tightens it grip, the more humanity slips through its fingers. Second, a centralized system incentivizes people to be more concerned with managing the system than with managing their jobs. And when their job is making life and death decisions, that’s a recipe not just for failure, or even for expensive failure. It’s a recipe for inhumanity.