Eight years ago, I wrote about the opening ceremonies of the London Olympics, which presented in song, dance, and spectacle a history of Britain so ideologically tendentious as to rival the Communist propaganda of Howard Zinn’s A People’s History of the United States.
The basic narrative, in case you missed it, was this: a green and pleasant land is mutated by capitalism into a place of dark satanic mills and then, thanks to leftist agitation, metamorphoses into a glorious welfare state whose crown jewel is the National Health Service. Featuring a veritable army of children in sickbeds and women in nurse’s outfits, and leading to a climax in which the letters “NHS” were spelled out in lights, the whole thing had the feel of an unusually fervent worship service.
As Andrew Gilligan observed in the Telegraph, the NHS had finally undergone its “final transformation from a healthcare system into a religion”; a Tory MP who dared to call the show “leftie multicultural crap” quickly caved under pressure, assuring the BBC that “we all love the NHS.”
Two years ago, spurred by a word in a Theresa May speech, I was moved to revisit the topic of the NHS. The word was “precious.” May used it to modify “NHS,” as in “our precious NHS.” As I wrote at the time, “one might easily forgive her for describing, say, Britain’s finest doctors and nurses as—oh, I don’t know—how about ‘treasured’? Or for using such language to celebrate modern medicine—robot surgery, wonder drugs, cutting-edge diagnostic technology.” But the woman was referring to a government bureaucracy!
As I soon discovered, May was far from the first to call the NHS “precious.” In fact, “our precious NHS” turned out to be something of a cliché. I found this depressing.
“Even at its most successful,” I wrote, “a welfare state doesn’t exist to give life meaning—it’s no more than a means to an end.” In other words, it’s human lives that are “precious”—not the system, however excellent, by means of which their health care is organized and paid. And let it be noted, moreover, that the NHS is far from excellent—about which more presently.
“The National Health Service,” wisecracked Nigel Lawson in his 1992 memoirs, “is the closest thing the English have to a religion.” (Lawson, the father of food writer Nigella Lawson, served as editor of the Spectator and, later, as chancellor of the exchequer under Margaret Thatcher.) That sentence may well be the most frequently quoted remark ever made about the NHS—quoted by NHS critics because they oppose its sanctification and by NHS supporters because they’re true believers.
A Powerful National Myth
Tracking UK developments during the current lockdown, I’ve seen that the NHS faith is at least as potent as ever. Indeed, the pandemic has spawned a new mantra, served up endlessly at press conferences and during commercial breaks: “Stay at home. Protect the NHS. Save lives.”
Protect the NHS?
Encountering this slogan repeatedly, I wondered: when did this nonsense start, anyway? Plenty of Western countries have socialized medical systems. Nowhere are they talked about in the reverential way that the Brits talk about the NHS. How, I wondered, did this come to pass? Obviously it had to be a matter of lifelong brainwashing. Could it be that NHS worship goes all the way back to its founding by the post-World War II Labour government that replaced Churchill? But no: it takes time to build a community of believers, doesn’t it?
Poking around online, I ran across a 2017 piece in which British writer Benedict Spence noted that “the concept of ‘free’ healthcare at the point of use has been drummed into us from infancy.”
In a 2016 article by Lee Jenkins, I read this passage: “The myth that’s been created and force-fed to a starry eyed national congregation is that before the 5th July 1948 Britain was a nation without medicine or doctors, where 40 ft. piles of dead were to be found on every street corner while plague stalked the land. Then lo, from on high there did appear and descend hospitals, with nurses and surgeons who also appeared from the aether.”
Then there’s the writer and psychiatrist Theodore Dalrymple, who, on July 5, 2018, the NHS’s 70th birthday (which, he reported, had “provoked an orgy of national self-congratulation worthy of the former Soviet Union”), posited that one reason Brits are “so attached to the NHS” is that they “accept its mythology,” notably the belief “that, before it started, there was no decent healthcare to speak of.”
All these writers underscored that the NHS myth is just that—a myth. Spence pointed out that, contrary to the public relations, cancer survival rates in the UK “lag significantly behind the likes of Slovenia and Ireland, not to mention Japan, Belgium, the Netherlands, Germany and New Zealand,” while the stats for avoidable deaths “are even worse.” In 2017, Tim Black charged that the NHS’s many chronic problems include “carelessness” (as demonstrated by “myriad tales of care-home abuse and patient maltreatment”) and nanny-stating intrusiveness into people’s lives “in the name of public health.”
As for Dalrymple, he called the NHS’s performance “mediocre at best,” noting that its hospitals are “run-down,” that they have fewer beds and CT scans than their counterparts in other Western counties, that health in countries like France and Spain “has improved much more in the past 70 years than in Britain,” that survival rates for “various cancers, heart attacks and strokes” are “lower in Britain than in most western European countries,” and that the NHS “often inflicts humiliation and suffering on people, which happens much less frequently or is even unknown in other countries.” In fact, declared Dalrymple, health in Britain “improved at the same rate before the NHS as after it,” so there’s “no more reason to worship the NHS than the Inland Revenue or the Department of Fisheries and Agriculture.”
Each of these writers argued for radical healthcare reform.
“It’s heresy to many,” insisted Spence, “but it’s time to privatize the NHS.” Brits, asserted Dalrymple, need “to stop pretending that we can run a service that is both universal—covering everything medical that can possibly be done—and is also free at the point of use,” and to exchange the NHS for “something better.”
Reform as Blasphemy
The main obstacle to any reform, of course, is the myth itself. The NHS being a religion, wrote Jenkins, any criticism of it “is tantamount to blasphemy,” while those who use non-NHS doctors and hospitals “are the new apostates, shunning all that’s good and right in favour of the immorality of the private sector.” The first step in healthcare overhaul, affirmed Dalrymple, “is to stop worshipping the NHS as if it were a god or a holy cow.” Black made the same case: “the NHS doesn’t need saving; it needs demystifying. And perhaps then, stripped of its ideological role as the long therapeutic arm of the state, it might be possible to have an honest and open debate about what exactly we want from a national health provider.”
Easier said than done. Why? Because, stated Tim Black, although the NHS “is always seemingly in crisis,” reverence for the NHS makes it virtually impossible for politicians or government officials to respond in a remotely constructive fashion:
no matter how severe the problems, no matter how poor the service provision, no matter how intolerable the current set-up, the much-publicised crisis never provokes an interrogation of the nature of the NHS. The NHS is always there to be saved, never criticised . . . The NHS’s problems are always someone else’s fault. There is never anything wrong with the NHS itself.
So it is that the NHS’s very aura of holiness, ironically, ensures that it’ll remain shoddy and second-rate.
Black went on to make an observation that, for me, helped illuminate the unique and seemingly impregnable role of the NHS in British life:
the NHS, this most sacred of secular cows, has become just about the only way for the state to establish a meaningful relationship between itself and its citizens. It provides the state with its moral purpose, and citizens with an idea not of the Good Life, but of the Healthy Life. It allows the state to relate itself to us not as citizens so much as patients . . . .Through the idea of the NHS, the state can connect to us as our carer, our protector, our alcohol-averse, anxiety-assuaging healthy-lifestyle guru, “from cradle to grave.”
Put it this way. Free people in a free country recognize their government as a necessary evil that should remain as limited and unobtrusive as possible as they go about their own lives and make their own decisions. As a free country metamorphoses into a welfare state, the government seeks increasingly to extend its tentacles into every corner of the people’s existence—taxing this, subsidizing that, regulating this, supplying that—thereby exercising more and more control over the people’s lives and decisions.
It can be hard to persuade free people to allow their government to intrude into their lives; in the UK, the chief means by which the government convinces the people of their need for that intrusion is the nonstop propaganda telling them that their well-being—no, their very lives!—depends upon on the government. Hence the ramshackle but relentlessly romanticized NHS becomes the instrument by means of which the British state retains and exercises its power over British subjects.
Protect the System, Not Human Life
But at the same time, something even more insidious—indeed, terrifying—happens. When a socialized healthcare system itself becomes “precious,” the lives of the people themselves take on a subsidiary importance. Medicine’s ancient and noble objective of doing everything possible to save a human life becomes subordinate to the goal of preserving the healthcare system itself, even if at the cost of human life.
In a 2015 article, Douglas Murray touched on this dark issue. He suggested that the NHS was becoming “the dominant and only untouchable force” in the British state, which meant that its enemies were the “enemies of the state.” And who might the enemies in question be? Why, those British subjects—“the eaters, the drinkers, the old, the infirm”—the cost of whose present and future medical needs exceeds their present and future value to the state as workers and taxpayers.
This is what happens in every country with a socialized medical system. I’ve seen it up close in Norway, where I’ve lived for two decades. For the relatively young and relatively healthy, the system can seem like nothing short of a godsend. Doctor visits are cheap. Medications are cheap. Even if you need major treatment to get back on your feet, the cost, if any, won’t bankrupt you.
But once you reach a certain age, or your health declines to a certain point, you’re a burden—a threat to the system’s continued existence. And suddenly you realize that it’s the system’s continued existence, not yours, that matters.
Murray put it this way: “Increasingly we are all expected to put our shoulders to the task of assisting the great effort of permanent NHS rescue.” Recently, wrote Murray, an NHS gynecologist had formally informed the UK’s Education Secretary that students should be encouraged to have children before 30. Why? Because of “the spiralling costs to the NHS of IVF treatment for women who have left ‘trying for a baby’ to their thirties and forties.”
Similarly, the head of NHS England, appearing on the BBC, had chided the public about obesity, which also, of course, ends up depleting the NHS budget. As for drinking, Murray noted that the NHS defined “binge drinking” as the consumption of “as little as two glasses of wine.”
But the greatest of all offenses against the NHS is aging. If you’re “not still a fully productive member of the economy” in your nineties, observed Murray, you may well end up being told that any medical care accorded to you is a waste of NHS resources. “Already you hear it mentioned in government that an 80-year-old costs the NHS seven times as much as a 30-year-old,” Murray wrote, adding that “it’s not hard to see how the idea will grow that older people—by staying around—become burdens and eventually enemies of the state.”
In fact it’s already widely accepted in the UK that people in certain circumstances can reasonably be considered “burdens” on the NHS—for example, a baby who, in 2018, had to be taken to the United States for life-saving heart surgery when the NHS denied him care (the NHS was ultimately shamed by international publicity into covering the operation’s costs) and a pregnant woman with “developmental disabilities” who was forced last year to have an abortion.
Defenders of the Faith
NHS reform is a no-brainer. Yet would-be reformers are up against a phalanx of fierce and powerful NHS champions.
Among them is Polly Toynbee, the longtime Guardian columnist who, in a piece that appeared only a couple of days before Dalrymple’s anniversary blast, acknowledged that the NHS “is our religion”—and pronounced this a good thing. Toynbee mentioned one of the latest installments in the British government’s never-ending pro-NHS propaganda campaign, a BBC “film poem” by Owen Sheers entitled The NHS: To Provide All People. Toynbee gushed over it—praising it as “heart-stopping…a psalm to humanity”—and approvingly quoted Sheers’ description of the NHS as “the most radical and beautiful idea we’ve ever realized.”
Yes, Toynbee acknowledged, the NHS was not in great shape. But she nonetheless rejected Tory calls “for NHS ‘reform’ that would end its founding principles.” Her case against NHS reform read as follows: “The BBC and the NHS are the best of social democratic symbols, whose very existence, let alone their success and popularity, are an affront to all that Tories believe.”
In short, Toynbee’s support for the NHS has nothing whatsoever to do with the quality of medical care it affords and everything to do with socialist ideology, political symbology, and partisan struggle. If Toynbee and her innumerable allies in Britain’s left-wing establishment keep boosting the NHS myth instead of working with their political opponents to improve actual healthcare, it’s precisely because the NHS is a great deal more to them than a mere healthcare system.
It’s the ultimate emblem of an all-powerful, all-intrusive government—a government whose hold on the very keys to life and death they’re hardly about to sacrifice.