Saturday, 31 January 2015

The Letters NHS Stand For National Health Service. This Is Why We Need It

I was horrified to see 's attack on the NHS in the Telegraph (h/t Glyn Moody) today. Play this in the background while you're reading his faux-patriotic polemic against the one thing that stands between my arthritis-ridden knees and utter penury.

Apparently, this is where he's coming from. Watch me take it apart.

We do not need the NHS because of Churchill, who was for it

Like a Resurrection Man from back in the day, he creeps out to the churchyard at St. Martin's Church, Bladon, to dig up the mouldering corpse of Sir Winston Churchill, who was indeed instrumental in leading the nation to victory during the Second World War, and no, we should never forget that. And like all liars, he leavens the mix with a nugget of truth:

The Tories resoundingly lost the 1945 election, and so Labour introduced the NHS, but the idea was common ground.

Why yes, old chap, they did. How utterly ungrateful of them. But why? Servicemen returning from war were not willing to sublimate themselves to the system for its own good in the hope that the net benefits would trickle down to them.

As a ventriloquist would, he sticks his hand in Churchill's wizened mouth and mimics his raspy voice:

“Disease must be attacked, whether it occurs in the poorest or the richest man or woman, simply on the ground that it is the enemy.” 

Wait, that was Churchill's view, not the Labour party's. In practice, they tended towards pragmatism and the need to make their policies work in practice. Indeed, even in a speech attacking the doctrinaire nightmare of socialism, the Conservative British Prime Minister, Harold Macmillan, said in 1959,

"Go around the country, go to the industrial towns, go to the farms and you will see a state of prosperity such as we have never had in my lifetime - nor indeed in the history of this country." 

Yeah... Tory policies would never have delivered that because they're all about leaving it to the market — or to altruistic individuals — to deliver services, essential or otherwise. But the market is not about delivering services, it's about making money. Even altruists expect to receive some kind of recognition or impose some restrictions on who can access their services. In this statement here, your slip is showing, Charles.

Lie #1: There is no private healthcare in Britain

Lovers of the NHS say health is “too important to be left to the market”; but food is just as vital as health, and no one argues that a National Food Service should be the sole supplier of nourishment to 90 per cent of the population. If customers had to wait in Tesco for even a tenth as long as they often have to wait in A&E, they would be rioting in the aisles. And why, anyway, should what is important in human life be decided by others? What morality lets you choose who cuts your hair but not who removes your cancer? 

That is disingenuous in the extreme. We have always had private healthcare here in the UK. A brief search reveals a wide variety of pick 'n' choose private options, there's more than just BUPA. This is not the result of Tory policy, it's the result of market forces. People want private healthcare and there has never been a serious effort made to end private healthcare provision. And apparently, the industry is thriving. This reminds me of a Twitter exchange I had with Tory councillor Alan Ward on 30th January. They try to funnel your thinking by framing the argument between the lesser of two evils, but as I pointed out there are other options. They're just not willing to put them on the table. We already have the option to use private healthcare providers and the existence of the NHS has caused them to compete on service. That can only be a good thing.

Lie #2: the NHS is responsible for its own failings

Read through this list of complaints Charles makes:

Of all the main services provided in Britain today, I would argue that the NHS has the worst moral effects. These include:
  1. Queuing. You can’t choose, so you must wait, often for something that matters a lot.
  2. Producer power. The people who provide the services construct them to achieve their targets. They are not allowed to respond to what people actually want. This power is concealed from us by …
  3. Guilt. Every day, thousands of patients are made to feel bad if they ask for something. This is wrong: patients should be the only point of the whole thing.
  4. Unnecessary death. The Mid-Staffs case was only the most shocking of many. This could not happen on any large scale if patients could choose.
  5. Contempt for the weak. In a system where each extra patient is a burden to the system rather than a customer adding to the viability of the enterprise, the authorities decree who doesn’t matter. In our culture, this usually means that the old and the mentally ill are ill-treated.
  6. Sentimentality. We tend to still our own fears about hospitals by cooing about how noble doctors and nurses are. Some are; some aren’t. They are no better and no worse than staff in hotels, solicitors’ offices, undertakers’ firms or veterinary practices. Mostly they are much more inefficiently directed.
  7. Self-righteousness. The NHS effectively invites everyone to blame somebody else for what is wrong – fat people, drunks, smokers, foreigners, private doctors, “penny-pinching” politicians, independent contractors, women with “too many” babies, people who dare to be over 80. It is easier than changing the dreadful system.
  8. Pessimism. Centralised medicine creates artificial shortage so it makes everything new seem dangerous. “People living longer”, for example, is presented as a terrible problem, when it is broadly a good thing. A free society with a growing population can cope with it.
  9. Self-delusion. We like telling ourselves that the NHS is “the envy of the world”. Most other civilised countries have medicine for which the state ultimately pays. None, except for Canada, has such a top-down centralised system of state medicine as ours. 

Like all authoritarians, Charles makes this a moral issue. To disagree with him is to disagree with morality itself. But hasn't the Coalition Government cut spending on the NHS during its tenure? That explains the queues, doesn't it? Fewer staff and indeed, hospitals, mean more pressure is put on that which remains. Only those who can afford private healthcare will avail themselves of it. Most of us can't.

Lie #3: Conservatives care for the weak

Right, so that explains gutting the welfare state, closing down hospitals, defunding the NHS, and trying to get people to cash in their pension pots to stimulate consumer spending. If they really cared about the most vulnerable, wouldn't they be putting plans together to manage them and their problems? Oh, hell no. Apparently, that's a socialist thing, dear.

Lie #4: The NHS's supporters are self-righteous

Says the man who wants to demolish it and force us onto unaffordable private healthcare schemes. The only reason it's a dreadful system is because its funding has been gutted and its services parceled off and sold to the private sector. Here's a hint: stop spending our money on unaccountable quangos and use it to pay for more frontline staff. In any case, look who we see blaming others for the problem: not the person responsible. While I'm on the subject, look up "NHS scroungers" on the search engine of your choice. Tell me again about how NHS supporters are self-righteous when the right-wingers are using the scrounger argument to justify getting rid of it.

Lie #5: Centralisation creates artificial shortages

Look up the term "buying power," Charles. IPR creates artificial shortages because the monopoly over production and distribution, which gets extended by evergreening, prevents anyone else from innovating on the drug or appliance. That's anti-competitive. Since these items are the "intellectual property" of the manufacturers, they can charge whatever they like for their products. You were saying? Don't get me started on "anything new" being seen as dangerous. Drug-wise, it's usually some evergreened product presented as the Second Coming when it's not all that effective. Restricting production and distribution to those who comply with a licensing regime creates artificial shortages, Charles.

Lie #6: We need a growing population

Oh, no we don't. Our crumbling infrastructure is struggling to cope with the people we have and we've got a significant number of unemployed. Meanwhile, since you're also gutting state education, we're having to import qualified professionals because we're not producing them in enough numbers ourselves. So, since you also gutted funding for geriatric care, how are we going to cope when those additional people grow old? Shouldn't we be putting our unemployed to work caring for the old folks we have now? When we can care for the people we've got, I'll entertain the possibility of getting more in.

Lie #7: Other countries have better state-funded medicine than we do

Really? Well you haven't named them. Shall I? What about the USA? Oh, wait, no it doesn't. Middle-income people who can't afford insurance, are stuck in part-time jobs so don't get insurance from their work, and don't qualify for a publicly-funded option fall between the cracks. Their only option, at this point, is to beg for money from an assortment of charities or online crowdfunding sites. Is that what you want to reduce the British middle class to, Charles?

Lie #8: Mismanagement means we have to get rid of it

Oh no we don't. We do, however, need to manage it properly. We also need to recognise our interdependence. The tragedy of the commons means we can't let the few hog the resources of the whole using "personal freedom" as an excuse for their selfishness. This means we must call people out when they expect the rest of us to fix the messes their personal choices create, and make them take responsibility for being part of the solution themselves. That is how good management works. In my job, I do my best to avoid using the printer because printer ink and paper costs money. By setting an example to my colleagues, I help to reduce the overall use of ink and paper, creating a net saving for our department. Now let's transpose that to our attitudes towards the NHS and the usage thereof.


We need the NHS. As an arthritis sufferer who has a job I help to pay for it and probably put in more than I take out. I don't mind that; I'm part of a society in which we all depend on each other in a variety of ways and helping others ultimately helps me. Since the only alternative is to return to the charitable or private enterprises that failed to deliver the level of care we needed before the Second World War I will fight for this tooth and nail. That said, we do have private healthcare and it's doing very well, thank you very much. And that's no lie, Charles. Argue with me if you dare.

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