The NHS – Let’s have a rational debate

As Camilla Cavendish remarked in yesterday’s Times, the NHS is secular Britain’s national religion. It is considered sacred and is almost immune to criticism in a way that Jesus and God haven’t been for a while.

On whether the government’s reforms should go ahead, most of the arguments against it aren’t really arguments at all, just chants of “Save the NHS!”, “NHS not for sale!”, and claims that the government is trying to “privatize” the NHS. Apparently, the NHS is so good, so sacred, so unique (last time I looked, there were many other countries with universal healthcare systems that outperform ours) that we can’t reform it in any way because, well…they’re trying to privatize the NHS! And destroy it! And Nick Clegg’s an evil traitor!

Courteousy of the Daily Telegraph (UK)

Now I’m no expert on the NHS, and I’m not going to belittle anyone who has a problem with these specific reforms. But let’s please have a rational, not emotional, debate about it. Only time will tell whether the government’s plans will work, but generally competition is a better way of running things than the state. As far as I know, some European countries do fine with an element of competition in their system, having just as much accessibility for the poor and far better results.

I don’t know whether GPs taking control of 80% of the health budget will work or reduce beauracracy. However, there was a letter written by several doctors to the Telegraph saying that GP commissioning already exists; the reforms will just increase what’s already there (remember, these reforms are partly a continuation of what was started by the previous government) and give them more of a say in the commissioning. (By the way, yes, I know there are plenty of other medical doctors who are emphatically against the reforms, but then back in the 1940s there was plenty of professional opposition to the very creation of the NHS. It doesn’t guarantee that it’s all going to be a complete disaster.)

As for the plan for an independent board allocating health resources, you can see it as Andrew Lansley trying to “weasel his way out of responsibility” if you want, but I see it as health professionals who know their job, rather than politicians who aren’t experts, doing the work that suits them. And if it’s run efficiently, it may be a far better and less wasteful use of taxpayers’ money than the primary care trusts they’re scrapping.

What really would be nice would be if we could widen the debate to the NHS itself. Is the NHS, as it is currently constituted, a good thing? Why is health and not, say, food so basic a right that the state should have a monopoly over it? Should there not be competition and people making a profit out of food (anyway, countless doctors and I might say too many public sector workers make profits out of the NHS, so why not businessmen?)? Should there be a National Food Service?

Is it fair that poor people have to pay taxes for the healthcare of rich people who could easily pay for it themselves? What if our health system was more like Singapore’s, where most people pay out of personal healthcare accounts, but if they can’t afford it, the government helps them out? Would that make healthcare fairer, less costly and better-quality?

There may be some good counter-answers to these questions. But let’s at least think about them. Being against the NHS is a thought-crime and anyone who voices this opinion stands no chance of being taken seriously by the majority of people. I really, really hope we can change this because it’s obstructive to proper debate and it’s obstructive to progress.


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