The NHS truths the Left don't want you to hear
Until very recently, Health Secretary Wes Streeting tried to market himself as a radical health reformer, who is not afraid to poke sacred cows. While his reform-minded rhetoric always remained at a highly-abstract and general level, Streeting deserved some credit for it, because he did not have to do this. He had the courage to say things which he knew would rub some people up the wrong way, not least the Corbynite wing of his own party.
Sadly, that brief period of NHS candour is now officially over. Streeting, the self-styled reformer, is no more. He and his colleagues have fully retreated into their comfort zone.
During the recent local election campaign, Labour distributed a leaflet that showed a mock medical bill, and a doctor holding up a credit card reader. The message was clear: vote for us, because this is what the other lot want to do to you. On Twitter/X, Labour are now frequently posting dire warnings about the alleged evils of insurance-based healthcare systems. This is exactly that old-school NHS cultism which Streeting used to disavow until five minutes ago.
It may work for him. The NHS may be falling apart, but the cult around is still going strong. In the eyes of its keenest defenders, the NHS can do no wrong. They have quietly dropped the old cliché about the NHS being 'the envy of the word', and replaced it with a slightly more subtle version, which goes something like this:
Once upon a time, the NHS used to be the best healthcare system in the world. But then, from 2010 on, it was systematically defunded. It was deliberately run into the ground, so that it can be privatised more easily. A privatised system would mean luxury healthcare for the rich, and Wild West medicine for the poor.
None of these claims are true. Let's have a look at each of them in turn.
The NHS was never the best healthcare system in the world.
The idea that it ever was can be traced back to a ranking compiled by the Commonwealth Fund, an American healthcare think tank, which relies on a very unusual methodology, in which medical outcomes only account for a fifth of the total score. This matters, because on medical outcomes, the NHS has always been one of the worst-performing healthcare systems in the developed world – as even the Commonwealth Fund study shows. There is no turning point after which the NHS's performance suddenly deteriorated. It was just never good in the first place.
At the end of the 2010s, age-adjusted real NHS spending per capita was only marginally higher than it had been in the beginning of the decade. Put differently, the NHS budget only just about kept pace with population growth, population ageing, and inflation. This clearly constituted a slowdown in spending increases compared to the previous decade. But it does not constitute a 'defunding'.
In any case: that period of relative spending restraint is already over again. The NHS budget was given a massive boost during the pandemic, which has only been partially reversed. Public healthcare spending in the UK stands at just under 9% of GDP: one of the highest levels in the world.
Conspiracy theories about secret plans to privatise the NHS have been around for decades. I wrote a report on this three years ago, for which I went through the news archives, and I found warnings about the NHS's imminent demise from every year since 1980.
But somehow, it never happens. The NHS remains an unusually state-centred system. Most healthcare systems, including tax-funded ones, use a mix of public, private for-profit and private non-profit providers.
There are no plans – secret or otherwise – to privatise the NHS. More's the pity. Because there is nothing wrong with private healthcare systems.
There are good examples of private, insurance-based healthcare systems, most notably in the Netherlands and Switzerland, which are nothing like the dreaded system of the US. These systems cover everybody: poor people are exempt from health insurance premiums and co-payments. Under these systems, rich and poor alike get faster access to medical treatment, and better medical outcomes, than they would on the NHS.
The only thing these people don't get is a naff feel-good mythology around their health systems.
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