The relative success of the U.S. medical system underscores the dangers of putting it under government control.
No good crisis, including the present COVID-19 epidemic, should go to waste. In this respect, the high priests of Britain’s secular religion, its highly centralised National Health Service, have certainly not been sitting on their hands. There has been so much propaganda in favour of the Service during the epidemic that one might have believed that it was under central direction.
One morning, for example, I received an e-mail advertisement from a chain of bookstores (a near-monopoly in the British bookstore trade) of which I am an occasional customer, for an anthology of stories specially written in praise of the NHS titled Dear NHS: 100 Stories to Say Thank You. An anthology of poetry, These Are the Hands: Poems from the Heart of the NHS has also just been published. I will pass over in silence the emotional kitschiness of all this.
These books, of course, deliberately confound the NHS itself with the devotion and skill of the people working within it. They are not the same thing—very far from it—and it might well be that good results are often achieved despite the system rather than because of it.
The propaganda in favour of the NHS has been more or less continuous since its foundation in 1948, though it has become ever shriller, as propaganda tends to do, as it departs further and further from reality. Indeed, one might surmise that the purpose of propaganda in general is to forestall any proper examination of reality in favour of simplistic slogans convenient to political power.
I grew up, for example, in the inculcated belief that the National Health Service was, according to the slogan of the time, “the envy of the world.” Millions of people believed this, and indeed it was an assertion heard for many years whenever the subject of health care came up. The slogan was last wheeled out in any force in 2008 for the 60th anniversary of its founding.
Oddly enough, it never occurred to the people who repeated the slogan to examine the basis of the claim. Who, exactly, were the people doing the envying—not just one or two of them, but en masse? It is no doubt true that immigrants from very poor countries were pleased enough to receive care under the NHS, comparing it with what they would have received at home. But is it really much of an achievement for a developed country to have health care better than that offered in Somalia or Bangladesh?
It never occurred to those who repeated the “envy” slogan to look to comparable countries across the Channel or North Sea to see whether, in fact, those countries had anything to envy. In fact, between 1948 and 1975, even Spain under Franco performed better in the matter of improving the health of the population than did Britain. In most respects, in fact, Britain lagged or limped behind other countries, always in the rear and struggling to catch up.
What eventually struck me, then, was the willingness of so many people to repeat and believe a slogan without any compulsion whatever to do so, and without the slightest inclination to examine its truth—indeed without any awareness of the need for such an examination. There was no oppressive force to prevent or deter them from intellectual inquiry, but they preferred the comfort the slogan offered to the effort and possible discomfort of finding the truth. The NHS, or rather the idea of the NHS, played the role of teddy bear to a population with many anxieties.
True enough, many individuals may have experienced deficiencies in the service—long waiting times, offhand or disagreeable interactions with the bureaucracy, etc. But like Russian peasants of old who believed that the Tsar knew nothing of the oppression which they suffered, and would have put an end to it if he had known, the British continued to believe that the National Health Service had been born with original virtue and that the defects they experienced were exceptions. Repeated scandals of gross neglect or sub-standard treatment were shrugged off in the same way. And in a certain dog-in-the-manger way, the British were inclined to believe that if the NHS was unpleasant to negotiate, at least (being more or less a monopoly) it was equally unpleasant for everyone. Fairness and justice were equated with equal misery. Anyway, being ill is always unpleasant, so what did anyone expect?
The uncritical national admiration, approaching worship, of the NHS has required the subliminal acceptance of a certain historiography: before the NHS, nothing; after it, everything. Before 1948, the poor received no treatment but were left to fend for themselves when they were sick, and more or less, to die. After 1948, the ever-solicitous state system looked tenderly after the health of the population from cradle to grave.
It wasn’t difficult to promote such historiography by using horror stories from the past, stories which were perfectly plausible because almost any conceivable system will give rise to such stories. If, per impossibile, a new system were to replace the NHS, it would not be difficult to justify it by reference to horror stories, whether or not the new system was better. A war of anecdotes, while always gratifying to the human mind, is not the way to decide important questions such as the superiority or inferiority of a system of health care. Only anecdotes that also illustrate statistical trends or truths are valuable in such a context.
The statistics are not favourable to the NHS, at least if one chooses reasonable standards of comparison, namely other European countries. The results are not disastrous, but they are not good either. The NHS has failed even in its egalitarian goal: the gap between the health of the richest and poorest in society has only grown under its dispensation. And yet the belief in its levelling effect persists.
The propaganda in favour of the NHS has been so successful that it now accords with the sentiments of the population, a triumph that no communist regime achieved despite herculean efforts at indoctrination. The triumph has been achieved without compulsion or violence and ought to be an interesting case for political scientists who study the successful inculcation of political mythology. Of course, the danger of such a study would be that it might induce doubt or cynicism about other political mythologies, and we all need such mythologies to live by.