It is often said that the British treat their National Health Service like a religion, but it dawned on me this week that the “like” is redundant. During the lockdown, signs appeared in people’s windows, saying “THANK YOU NHS” under rainbow symbols. The faithful were enjoined to stand on their doorsteps every Thursday evening to applaud the system in a rite called “Clap for Carers.”
After a while, I noticed that the rainbow signs were cropping up in churches, sigils of the syncretic religion that Britain is adopting as Christianity loosens its grip. Last Wednesday, to mark the 75th anniversary of the nationalization of healthcare by the post-war Labour government, there was a service of thanksgiving at Westminster Abbey, attended by senior clergy, both party leaders, and members of the royal family. To see how downright weird that is, try to imagine a service of thanksgiving for any other state bureaucracy — the Health and Safety Executive, say, or the Financial Conduct Authority.
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What makes it even odder is that, by any normal measure, the NHS is a mediocre, underperforming system. Every international comparator shows that Britain does badly on waiting times, survival rates, and overall health outcomes.
Yet, for all this, no one wants to touch it. The attitude of politicians, media, and, yes, the general public can be summarized as “Fix the NHS but don’t change anything.” One BBC program marking the 75th anniversary featured a litany of complaints about poor care, long waiting times, and the danger of being ill at weekends and then, without irony, finished with a children’s choir singing “Happy Birthday NHS.”
People used to maintain this doublethink by blaming underfunding. Indeed, in a conspiracy theory that is every bit as wild as QAnon but is, for some reason,. fashionable among educated people, the Tories are accused of underfunding the NHS as a prelude to selling it.
Never mind that the Conservatives have been in office for more than two-thirds of the NHS’s existence and have never made any move toward market reforms, let alone privatization. Look, rather, at what has happened to the budget. Britain now spends proportionately more on healthcare than 28 out of 32 OECD states. The only real argument for the NHS — that it was a second-class system for a third-class price — has gone.
In 2000, the U.K. health budget accounted for 27% of day-to-day public spending; next year, it will hit 44%. Britain is becoming a healthcare system with a government attached.
As the former health secretary, Sajid Javid, pointed out last week, the NHS will account for more than half of all state spending by the end of the decade. Javid wants a royal commission to look at alternative healthcare models, but it is telling that he had to wait until announcing his retirement as an MP before daring to suggest it.
Why do Brits resist change? Part of it is simple inertia. Ours is a wealthy country, and it would be surprising if, despite the NHS’s failures, most medical interventions were not satisfactory. Patients come away with their ailments addressed, know that they won’t be sent a bill, and don’t want to be ungrateful. They muddle the clinicians working in the system with the system itself. How many times do I hear the bizarre assertion that “the NHS saved my life”?
At the same time, defenders of the NHS have somehow convinced the country that the only alternative model is America’s. In much the same way, defenders of the U.S. system give the impression that the only alternative is Britain’s.
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In fact, the U.S. and the U.K. have dire healthcare systems compared to almost any other developed nation. I am all for the special relationship, but it might be worth asking why, say, the Swiss or the Dutch do so much better than we do. Or, if you want to stick with the Anglosphere, look at Singapore’s ingenious system of personal healthcare accounts, which produces some of the best life outcomes anywhere for a fraction of what our two countries pay.
In 2009, I told a U.S. TV audience not to copy our system and briefly became the most hated man in Britain. Since then, public satisfaction with the NHS has fallen from 70% to 29%, and, despite record spending, an almost unbelievable 7.4 million people are waiting in line for treatment. Yet we maintain, against all the evidence, that Britain’s system is the best available. If that isn’t religious dogma, I don’t know what is.
Daniel Hannan is a British writer, journalist, and former politician. He is the founding president of the Initiative for Free Trade and a former member of the European Parliament for South East England from 1999 to 2020. He is a member of the Conservative Party.
Supporters of British and American healthcare have convinced themselves that the other is the only alternative
