Notional Health.

Imagine the relief with which so many doctors welcomed the creation of the National Health Service in the middle of the last century; no longer would they have to worry about the comparisons being made, the judgment suspended above them like the Sword Of Damocles by their patients.
The National Health service was the worst possible implementation of a bad idea, no-one would be able to trade off good repute, the patients would have no choice about their doctors, they would no longer be able to trade their custom and make the doctors work for their living.

So today, instead of a National Health Service where patients choose who treats them, based on publicly traded reputations, ie, too many people die at this or that surgery, don't go - they have to take their chances with the 'bog-standard' GP, the doctor upon whose judgment their lives depend being just a unit, a cog in the bastard machine.(And no, the SF Chronicle did not coin that phrase, I did, on the old Society Matters - but hey, that's MSM for ya!).

Where they could have had a system in which free care followed the patients and they could still vote with their (surrogate) government custom, a system was expressly designed which prevents all competition and thus eliminated the thrust to improve or even maintain standards; and where there is no motivation or sanction other than rarely used express punishments, then the standards established(in an obsolete age) will surely disintegrate.

Thus we will have medical students going to college for the drinking contests, hospitals which kill their patients with preventable disease, and Doctor Harold Shipman, the authority figure who was a law unto himself(according to the state model) and murdered dozens of people who innocently believed in the State Medical Care Scam.
And all sorts of crummy deals being made behind the scene by alleged doctors who are in with the in-crowd.