With Mr Cable suggesting we “Tax the rich” more, and without means tested co-payments for health, as a reasonable additional method of rationing, NHSreality wonders if this is a policy that will win the votes of non members?
Bagehot in the Economist 28th June 2018 opines:
The three myths of the NHS- The National Health Service is a great institution. It is also the subject of fairy tales
There is little mention of the underlying ideology, and the fact that morale is so low because the staff cannot buy in to the prevalent philosophy. However, the correspondence (see below) challenges Bagehot. The first is another expression of denial. The second is the reality of other systems which discourage dependency and encourage autonomy through co-payments. Do we need to “test” our politicians? Do they know that there are better outcomes elsewhere? Of course they do: that’s why they all go privately.
THE National Health Service’s 70th birthday is turning into an extravaganza. The government has given the service a £25bn ($33bn) present to mark the anniversary, which falls on July 5th. The BBC broadcasts daily encomiums to the wonders of free health care. Jeremy Corbyn, Labour’s leader, wore a large badge celebrating the NHS’s birthday at prime minister’s question time.
The NHS is the most popular institution in the country. In a survey by Ipsos MORI last year, 77% of respondents believed that it should be maintained in its current form and 91% supported its founding principles, that health care should be free at the point of delivery and funded by general taxation.
It is so popular because it is more than just a public service. It is also an embodiment of British values at their best: compassion and decency; waiting in line rather than barging ahead; being part of a national community rather than a collection of self-seeking atoms. These values were central to Britain’s conception of itself in 1948 when the Labour Party founded the NHS as part of its New Jerusalem. Many people cling fiercely to the health service today precisely because it is a reminder of a more egalitarian society and an antidote to our self-seeking times.
Walter Bagehot, the great 19th-century editor of The Economist, argued that the British constitution was divided into two branches: the dignified, which represents the nation in its symbolic form, and the efficient, which gets the work of the world done. The NHS is the most-loved British institution because it straddles this divide. It is dignified because it represents Britons’ collective view of themselves as a decent bunch of people, and efficient because it treats more than 1m patients every 36 hours.
The fact that the NHS spans the dignified and efficient divide not only explains why its birthday is being celebrated with such enthusiasm. It also explains why so much of this enthusiasm is coupled with nonsense and exaggeration. It is hard to remember a time other than a royal wedding when so many commentators have uttered so many half-truths—or indeed non-truths—with such grave conviction. Three myths are particularly cloying.
The first is that Labour summoned up the NHS from thin air; that before 1948 the poor died in the streets but after 1948 they were suddenly equipped with new hips and false teeth. In fact, the government inherited a rich patchwork of charitable hospitals, school medical services and employer- and government-subsidised health care. The 1945-51 Labour government didn’t build a single new hospital or add significantly to the number of doctors. Its achievement was to nationalise a patchwork system and make it free at the point of delivery.
The second is that the NHS is a unique embodiment of compassion. Aneurin Bevan, the health secretary who created it, sold the NHS as proof that, even as Britain was ceding global leadership to America and the Soviet Union, it was still a superpower in one vital area. “We now have the moral leadership of the world, and before many years we shall have people coming here as to a modern Mecca, learning from us in the 20th century as they learned from us in the 17th century,” he declared. But there was far more than morality at play. The service’s roots are in the “national efficiency movement” of the Edwardian era. The 1905-15 Liberal government introduced medical inspections for schoolchildren in 1907 and national health insurance in 1911, among other reforms, because, in Lloyd George’s words, “The white man’s burden had to be carried on strong backs.” After 1948 the NHS was part of a warfare-welfare state that spent 10% of GDP on defence and maintained a large conscript army because it worried that war with the Soviet Union was imminent.
The NHS does a middling job of turning compassion into care—certainly better than America, but worse than several continental countries that rely on compulsory insurance backstopped by the government. The Nuffield Trust, a health think-tank, points out that Britain has markedly fewer doctors and nurses per person than similar countries, and fewer CT scanners and MRI machines. It also has higher rates of mortality for problems such as cancer, heart attacks and strokes. On the positive side, it is excellent at providing long-term care and value for money.
The final myth is that the Conservative Party is perpetually bent on selling off the NHS to the highest bidder. There may be a few ideologues on the right who dream of replacing the health service with an insurance-based system or an American-style public-private mix. But they are outliers. Conservative right-wingers have shied away from acting on their principles. One of the first big boosts in NHS spending came in 1962 when Enoch Powell, an early champion of the free market, splashed out on 90 new and 134 refurbished hospitals. Mainstream Conservatives like the NHS because it gives the government a way of controlling health spending and ensuring value for money. Easy on the champagne
It may seem a bit churlish to turn up to a birthday party and spit on the cake. Myths can serve a useful function in boosting morale, particularly when morale has been eroded by a decade of austerity. But the myths that surround the NHS have also done harm. They have given the Labour Party an excuse to demonise Conservative reforms as “backdoor privatisation” rather than subjecting them to serious criticism. They have discouraged the NHS from learning from other countries. They have made it impossible even to think about boosting NHS revenue by charging patients a nominal sum for visiting the doctor. They may even have allowed scandals to go uncovered because nobody can bring themselves to blow the whistle on saintly NHS workers. Britain is right to celebrate a service that provides all Britons with free health care at a reasonable cost. But they are wrong to treat the NHS as an object of awe rather than a human institution with all the imperfections that being human entails.
Bagehot suggested that any discussion of boosting its revenue by “charging patients a nominal sum for visiting the doctor” is off the cards because of the Labour party’s desire to “demonise conservative reforms”. An alternative view is that bitter experience has taught the public that nominal fees soon begin to grow at an exponential rate to painful levels. Charges for prescription drugs being a good example. “Free at the point of delivery” is a red line that all voters of all persuasions know must be held at any taxation cost. P Corser Selborne Hants.
Bagehot created some of his own myths about the NHS. Edwardian health reforms did not provide the roots for legislation that created the NHS in 1948. Medical inspections of children were precisely that: to tell their parents that their child needed a doctor. Treatment still had to be paid for. Free (or subsidised) health care appeared much later. And Nation Health Insurance, “employer and government subsidised health care”, offered only minimal GP careto a minority of the working population, namely low-waged blue-collar workers. Maternity care aside, the scheme offered nothing to their wives.
The Edwardian reforms were aimed at promoting the physical well-being of the male workforce and armed services. The principles of the NHS were different, based on equality. Why else would you dedicate equivalent medical resources to post-menopausal women? Moreover, thanks to the Trreasury’s parsimony, NHI never developed in the way it did in Germany. There, a Bismarkian Health=Insurance scheme expanded to provide universal cover, the foundations of German Health Care today. Prof Noel Whiteside, Institute for Employment Research, University of Warwick.