Simon T. Kaye

I’ve been enjoying the big online argument over Britain’s NHS. Fox News have thrown around the idea that it lets terrorists into the country. CNN has a pretty good overview of how everyone’s been responding to the US Republicans’ claim that the system is “Orwellian”. And the #welovethenhs tag trundles away on Twitter.

Complaining about the NHS is pretty habitual in practically every British person that I know. “I can’t believe I had to wait thirteen weeks to have my _ looked at!”, “You won’t believe how long I was waiting in Accident and Emergency and then they didn’t even do anything!”, “It’s ridiculous how our hospitals have become home to ‘superbugs’ – why can’t they just keep the places clean?”, and so on.

What most people don’t do is make the outright principled stand – they don’t object philosophically or ideologically to the cost of the NHS, the idea of living in each other’s pockets, or the loss of personal responsibility for health.

(Erm, we also don’t think the NHS lets terrorists in.)

So I’ve always concluded that most Brits want socialised health care, but they want it to be better than it is right now. What’s fascinating about the ongoing debate is that so many people seem to be leaping to the NHS’s defence completely unequivocally.

Well, let’s be measured about all of this. As a Brit by birth, I’ve used the NHS many times. So here is a FAQ:

Does the NHS provide an overall good standard of medical care? Absolutely. It works. People get treated, and it’s absolutely free at the point of use. I usually come away satisfied. Just not always.

Is that standard as high as in a privatised health system? Not at the top, but it’s far better for folks at the bottom of the chain. By the way, in the UK, people who want to can take out private health insurance and seek private aid, so there isn’t a total monopoly.

Is the NHS a massive, creaking bureaucratic behemoth? Oh lord, yes. The NHS is plagued by wastefulness, red tape and is swarming with money- and time-wasting bureaucracy. Hopefully this can be reformed.

Do most people put more money into the system through tax than they’re ever likely to get back through treatment? Of course. If you don’t like that, you don’t want socialised…. well, anything. Apart from maybe education.

Is it OK to be philosophically opposed to nationalised health care? Yes. It does work, it’s about a million miles from being perfect, but if you’re fundamentally opposed to the idea of distributing the personal responsibility for one’s own wellbeing, then you should feel free to hate the NHS.

As the chief legacy of Clement Attlee’s post-war reforming government, the NHS was originally intended to form the cornerstone of a projected ‘Socialist Republic of Great Britain’. Clearly, this never happened. But the idea was so popular and so effective that the NHS is absolutely at the heart of the UK’s version of the ‘post-war settlement.’

It’s an assumed fact of life here: people don’t think to oppose the NHS on any fundamental level any more. The single biggest compromise to universally socialised medicine in the NHS took place months after the service was inaugurated, with the introduction of prescription charges. Since then, not even Maggie Thatcher has found the time to repeal the key parts of our health care system.

Speaking for myself, I find it hard to escape the usefulness and ‘fairness’ of this system (especially when it has treated me well, as it has for the last little while).

But would I institute such an establishment again, today, if I had the choice? Probably not.

The fact of socialised health care legitimises the worst instances of government nannying. We are now nagged and scolded on a daily basis over the latest health fads, based on one or two studies somewhere in some department of medicine, and often quickly withdrawn when competing evidence is produced. We eat too much salt, we don’t eat enough vitamin C, we need certain foods, a certain lifestyle. I don’t think government should get involved with the way people live their lives. But when everyone else pays for your own health problems the responsibility for them becomes impersonal. Your weight, your habits and your choices become everybody’s business.

The NHS is unweildy, but willing; it works in earnest, but doesn’t always deliver perfect healthcare. No system can. So if you’re going to oppose the NHS, do it properly, from the ground up: do it because you think it’s a signpost on the road to decreased freedom. Everything else is just noise.