Health wars: six myths about the NHS debate

It all started with a factual error in a publication almost unheard of in the UK. ‘People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless’, said an editorial in Investor’s Business Daily (IBD).

The author appeared not to realise that Hawking, who is almost completely paralysed by motor neurone disease, lives in the UK and must have received a considerable amount of treatment via the National Health Service (NHS). ‘I wouldn’t be here today if it were not for the NHS’, said Hawking in response to the article. In the overheated debate about President Obama’s healthcare plan, some Republicans have taken to misrepresenting the standard of care provided by the NHS. Senator Charles Grassley, for example, wrongly suggested that Senator Ted Kennedy would not have been treated for his brain tumour if he had lived in Britain because the NHS would not regard someone aged 77 as worth treating.

The rights and wrongs of the debate about American healthcare should have been of academic interest to British people. Yet when the TV comedy writer Graham Linehan posted a message on the social networking website, linking to the IBD article, with the tag ‘#welovetheNHS’, the reaction was remarkable (1). Tens of thousands of people responded with #welovetheNHS messages of their own. You can even add a Twibbon – a virtual version of the on-going craze for coloured, campaign ribbons – to your Twitter profile picture, saying ‘I ♥ NHS’.

Where there is a bandwagon, it will quickly be pursued by a crowd of politicians trying to jump aboard it. Gordon Brown twittered ‘PM; NHS often makes the difference between pain and comfort, despair and hope, life and death’. The health secretary, Andy Burnham, chipped in with a message of such cynical calculation that it’s a wonder the casualty departments of the nation weren’t filled with people sickened by it: ‘Andy Burnham: Over the moon about strong support for NHS – an institution I will defend to my dying day, 2nd only to Everton FC.’

Conservative leader David Cameron was quick to join in. ‘Just look at all the support which the NHS has received on Twitter over the last couple of days. It is a reminder – if one were needed – of how proud we in Britain are of the NHS.’ Sadly for Cameron, one of his party’s Euro MPs, Daniel Hannan, has been widely quoted as saying he ‘wouldn’t wish the NHS on anyone’, all tending to reinforce the notion that Labour is the party of the NHS while the Conservatives would try to privatise it or at least cut back spending on it. In fact, Cameron has been keen from the moment he became Conservative leader to prove his undying love for the state-run service.

In order to understand this debate properly, we need to debunk a few myths.

1. The NHS is the worst/best* healthcare system in the world
(* – delete where applicable)

The recent lovefest has been somewhat surprising, given that the newspapers are normally full of criticisms of the NHS. In recent times, we’ve seen complaints about: poor standards of hygiene in hospitals; the high rate of hospital-acquired infections like MRSA; dubious decisions to ration certain drugs or treatments; overworked staff; the impossibility of getting a non-urgent doctor’s appointment; the limited time you’ll get with the doctor when you do see one; car parking, telephone charges and meals at hospitals, and so on. Healthcare is, to some degree, rationed by waiting list. Getting an initial assessment from a general practitioner is usually easy enough, but you may have to wait a week to get test results, even longer to see a specialist, and then wait again to get treatment.

NHS care could certainly be improved and a proper public debate about the future of the service is long overdue. But the horrendous delays that became typical in the Eighties and Nineties, when it was not uncommon to wait 18 months to get some kinds of operation, are largely a thing of the past. While there has been some experimentation with using market forces and outside services, the most important change has been an increase in spending. More importantly, as compared to the US system, patients face few, if any, charges once they have seen a doctor. So while getting treatment can sometimes be inconvenient, patients are spared the worry that they won’t be covered by an insurance company, or that they will be forced to make crippling contributions to get care.

2. The US system is private

While the main avenue for most Americans in getting healthcare is through an insurance policy, mostly paid for by their employers, the public sector is surprisingly large. According to the World Health Organisation’s World Health Statistics 2009, the UK spent the equivalent of 8.2 per cent of gross domestic product (GDP) on healthcare in 2006, of which 87.3 per cent was state-funded. In the USA, the equivalent of 15.3 per cent of GDP was spent on healthcare in 2006, of which 45.8 per cent was state-funded.

In fact, according to the WHO figures for 2006, the US government spent more per capita ($3,076) on healthcare than the UK government ($2,908). The state-vs-market discussion is not a particularly useful one.

3. The NHS is free

In that ‘#welovetheNHS’ stream on Twitter, there has been constant reference to ‘free’ healthcare on the NHS. In reality, of course, the NHS spends over £100billion per year – roughly 20 per cent of UK government income. The British system is free at the point of use, by and large, but that simply means that it is paid for from taxation.

4. The NHS is socialist

This is a myth that is far from exclusive to the UK. From free marketeers to NBC’s liberal anchorman Chris Matthews, plenty of people in America seem to believe that there’s something socialist about state-run healthcare. No, there isn’t.

The NHS was introduced under a Labour government in 1948, but the need for some kind of national system of healthcare had been recognised by all the major parties. In 1935, 60 per cent of army recruits were found to be in no fit state to fight. The doctors’ organisation, the British Medical Association, called for a unified, national health service in 1938 (3). The reshaping of British society around the government-directed war effort after 1939 meant that the nationalisation of healthcare after the war – along with other essential services like the railways and coal mining – was a relatively short step. State-run it may be, but the NHS provides healthcare on the cheap to this day. That’s why even the house magazine of British business, The Economist, prefers the NHS to the US system (4).

The NHS is certainly not egalitarian. It is quite clear that people in different parts of the country can expect different standards of care, as summed up by the phrase ‘postcode lottery’. Sometimes, it is simply a case of who can be the most demanding, which means that middle-class and well-educated people frequently get better treatment than the poor, immigrants and anyone else not savvy enough to work the system.

5. It’s ‘our NHS’

Given the circumstances in which it came into being, after a depression and world war, and through the election of a Labour government, the NHS is widely seen as a unique, not-for-profit system in which we all have a stake and where patient need is paramount. The architect of the NHS, Aneurin Bevan, bombastically described it as ‘the most civilised achievement of modern government’. Compared to the feeble services available before the Second World War, the NHS was certainly a step forward, but the NHS is no more ‘ours’ than any other public service. We pay taxes to provide it, but we have little or no control over it. If the NHS is the caring, sharing institution that it is claimed to be, why has it always relied on an army of low-paid staff, disproportionately women and immigrants, to keep it going?

The myth of ‘our NHS’ has, however, had some important consequences. It has helped to keep wage costs down. How dare workers in an institution dedicated to treating the sick selfishly divert resources to their own wallets? From the point of view of patients, NHS care is treated as a blessing rather than something we should reasonably demand in a modern society.

Moreover, the NHS is one of the few elements of British identity that still has some respect today. While most people are cynical about the royal family, have long-since stopped going to church and, as the recent expenses row illustrated, have little but contempt for our political leaders, the NHS is still regarded with great esteem. To some extent, that esteem is well placed. After all, the NHS would have crumbled were it not for the vocational attitude of many of its staff.

The trouble is that this high esteem has been alighted upon by politicians of all persuasions as a means of intervening in our lives in a way that would be deemed unacceptable in other spheres. Through the conduit of the doctor, the nurse and the midwife, all sorts of social engineering goes on. In fact, there is a nasty little trend towards rationing healthcare on the basis of lifestyle. Obesity and smoking have both been used as excuses to deny care in recent times, for reasons that go well beyond the strictly medical.

Ideological attachment to the NHS stands in the way of having a proper, open discussion about its flaws and its future. While people are rightly sceptical about any discussion of reform, on the basis that it may be a flimsy cover for cutting spending, it is also quite clear that the NHS could be better than it is. It is also clear that more and more aspects of everyday life are being medicalised. While this trend is by no means unique to the UK, the stranglehold of the state over the supply of healthcare gives it a particularly authoritarian edge.

6. The healthcare debate is about healthcare

When people on one side of the Atlantic freak out at the thought of socialised healthcare, while those on the other defend it to the hilt, this suggests that this debate has got very little to do with the statistics on healthcare costs and disease survival rates. Rather, the debate about health has taken on an inflated importance due to our broader fears about the future. Facing real uncertainty about the direction that society may take, only exacerbated by the economic crisis, many people feel extremely nervous about any kind of change.

The unique position of the NHS in British society means that people are particularly sensitive about attacks upon it. Writing in The Times (London) on Saturday, Janice Turner summed up this reaction: ‘As the rage over President Obama’s healthcare reforms descends into attack ads and town-hall gunfire, don’t you dare speak ill of our NHS. It is the one thing, in our digital, atomised, privatised, multi-ethnic age, that unites us; our irreducible essence, the very best of us… It shows that decency, fairness and compassion, the national traits we fear died with nobler generations, live on.’ (5) Woe betide anyone who thinks that the NHS is merely a system of healthcare delivery.

Turner’s comments chime with a wider sense that an era may be ending, without any positive notion of what will replace it. As Sean Collins notes on spiked today, that anxiety is mirrored in a variety of ways across the political spectrum in America, too (see America’s health wars).

We should, of course, always be looking to improve the way we care for the sick. But the current debate on both sides of the Atlantic only reveals the overblown importance of health in modern life, and the unhealthy state of political life.

Rob Lyons is deputy editor of spiked.

(1) How Father Ted creator Graham Linehan sparked NHS backlash on Twitter, First Post, 12 August 2009

(2) World Health Statistics 2009, WHO

(3) Slump Socialism: the Depression, the War and the Working Class, by James Wood

(4) God save the NHS, The Economist

(5) America has no right to speak ill of the NHS, The Times (London),15 August 2009