Get It Together: The NHS
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We took something universal, and damaging, and unjust - illness – and forged from it something unique, and generous, and fair. The NHS, as it was conceived in 1942 and built from 1948, became the template for the provision of universal healthcare across the world.
The arguments from the Conservatives, in 1946, were exactly as you’d hear them today; one, we can’t afford this magnificent thing. Two, greedy people will misuse it.
Almost nobody visits the doctor unless they have to. It is only in economic modelling that people are persistently unreasonable.
In short: Conservatives started off hating the NHS. They have never not hated the NHS.
The NHS is one of the greatest humanitarian projects ever undertaken in peace time, anywhere in the world.
The Mirror Mirror study compares us to ten other developed nations – Australia, Canada, France,Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the US. It puts the NHS at the top, for everything.
The bullish exterior of the Americans can give you the impression that they know what they’re doing. But underneath it is a shambles. They have the highest costs per capita in the world; life expectancy is, believe it or not, worse than it was in the 1970s.
In the US, they spend 34% of their healthcare budgets on management. This isn’t fraud or mismanagement or error; it’s just what it costs.
The annual health spend in America is $2.7 trillion, or 17% of GDP. No one even knows how much of that is embezzled, but in 2012 the former head of the Centres for Medicare and Medicaid estimated that fraud, plus the fighting of fraud, added up to $272 billion across the entire health system. *
In 2000, ‘nearly half of American bankruptcies were due to medical bills. By 2007, it was 62%, of whom – this is the chilling bit – 78% were insured.
It is wrong to make money from another’s misfortune, and because it is wrong, it unleashes that spurt of sadism that makes it more expensive. The profligacy and straight swindles of the private sector are not the reason privatisation is wrong; they are a symptom of the fact that the nation’s health is not a private enterprise.
The health service is not some unviable pipe dream, a sweet thing we managed in yesteryear. It is better than it has ever been. It is more viable than ever; the alternatives are so laughably poor. If it has financial problems, that it because it’s been either underfunded, skinned alive by the private sector, or both.
Only politicians would come up with an adversarial system, because adversity is all they understand. If you want your GP appointment to sound like PMQs, put Jeremy Hunt in charge of it.
Market strategies, whether they’re ersatz ones like non-price based competition, or semi-private ones like PFI, or full-on corporate outsourcing, are mainly good at delivering public funds into private hands. They cost the NHS a lot of money; the benefits, so desperately sought by the people who believe they must be there, are pretty contested and vanishing small when set against the disadvantages.
There’s no reason why we shouldn’t look at health the way we do at primary schools – what’s to stop you getting involved? We can make our healthcare a co-production.
Knowing it to be the best doesn’t mean preserving it in aspic. If we trust one another to protect its foundations, we can build something grander still. Can we still afford it? It’s the best money we’ve ever spent, and will remain so.