Trump would be doing Britain a favour by destroying the NHS
Prime Minister Keir Starmer is reportedly on the cusp of selling out our precious NHS to president Donald Trump in exchange for a trade deal.
This is, of course, nothing more than hysteria. For better, but likely for worse, the NHS is not going anywhere. All that's actually on the table is a long-running American gripe about how much the UK pays for drugs.
The NHS uses its monopsony power (being a single buyer) to negotiate lower pharmaceutical prices. This means Americans are left footing the hefty bill for research and development into revolutionary lifesaving medicines. Trump would like the UK to pay a 'fairer' share.
The trade deal could also make it easier for US drug companies to sell cutting-edge treatments to the NHS. This comes after the National Institute of Health and Care Excellence (Nice) has prevented the NHS from purchasing several high-profile therapies, such as Alzheimer's and cancer treatments, over value-for-money concerns.
The founding myth of modern Britain is that the NHS represents something particularly unique: an institution worthy of banging saucepans outside our front doors during a pandemic. In fact, universal healthcare is the norm across developed countries. What is special about the NHS is its poor outcomes despite massive public expenditures.
There are now over six million people on waiting lists that may never substantially shrink. In 2023, over 117,000 of all deaths in England were deemed avoidable, either through effective public health measures or timely medical intervention. Compared to peer nations, the UK exhibits higher rates of deaths. This is driven by subpar outcomes in cancers, heart attacks and strokes.
It would be nice to believe that the NHS is a national asset, one that someone like Trump would want to come in and buy. But in fact, it is an ongoing and growing series of liabilities that no investor would touch with a barge pole. We are now spending a whopping £205 billion annually, larger than the total national income of New Zealand.
The public is becoming increasingly aware of this situation. In April, the British Social Attitudes poll found the highest level of dissatisfaction with the NHS since the survey began in 1983. An astonishing 59 per cent of Brits said they were 'very' or 'quite' dissatisfied with the health service.
There remains a stubborn hope within the system that yet another injection of taxpayer cash, especially in the form of capital investment, will miraculously reverse the NHS's decline. But this remedy has been applied repeatedly over the years, without measurable improvement.
The core dysfunction lies not in funding levels but in the model itself. Healthcare demand is virtually limitless, yet the NHS operates within a rigid, centrally planned structure that lacks the necessary tools to allocate resources efficiently.
In the absence of prices, bureaucrats must make arbitrary decisions about who gets treated and when. And without the profit motive, there is scant incentive to innovate, cut waste, or improve service quality. The result is a system defined by delays, inefficiency, and declining outcomes, regardless of the amount of money invested in it.
The only way to fix this problem would be to destroy the NHS as we know it. To incorporate greater elements of private sector involvement, competitive pressures and social insurance, which are known to deliver much better outcomes from Germany and Singapore through to Australia.
For now, we remain mired in a phoney war, where campaigners rally to defend the NHS against an imagined Trump plot rather than confront the system's deep-rooted failings.
Matthew Lesh is Country Manager at Freshwater Strategy and Public Policy Fellow at the Institute of Economic Affairs
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