One of the most curious political phenomena of the Western world, writes Dalrymple, is
the indestructible affection in which the British hold their National Health Service. No argument, no criticism, no evidence can diminish, let alone destroy, it. The only permissible criticism of it is that the government does not spend enough on it, a ‘meanness’ (with other people’s money) to which all the service’s shortcomings are attributable. In effect, the NHS is the national religion.
Very quickly after its inception, the NHS
established itself as a sacred cow in the mind of the British population. A certain historiography of healthcare became an unassailable orthodoxy: that before the service was established, proper healthcare was not available for the majority of the population which, if it was treated at all, was maltreated.
The NHS was founded, Dalrymple explains,
in the great egalitarian aftermath of the Second World War, when a brave new equal world would arise from the ashes of the old. If healthcare were provided to everyone irrespective of his ability to pay, on a foundation of a highly progressive tax system, how could the system fail to be egalitarian? It was its egalitarianism that appealed so strongly to the population. Perhaps there was also the hope that one would get more out of it than one had put into it, that it was a kind of lottery with a much higher chance of a winning ticket than in a normal lottery.
Unnoticed by the population or by the NHS’s ideological praise-singers, Dalrymple points out,
the NHS had no egalitarian effect, rather the opposite. The difference between the health of the top economic decile of the population and that of the bottom decile, which had been more or less steady for decades, began to widen immediately. The difference in the standard mortality rate of the richest and poorest is now almost double what it was when the NHS began.
But the myth that it is egalitarian
lives on, perhaps because it appears to spread its inconveniences over the entire population equally (but only appears to do so – the reality is very different).
Another myth that persists among the British, Dalrymple notes,
is that foreigners somehow envy them their health service, which might just be true in Nigeria but is certainly not true of any European anyone has ever met. On the contrary, the NHS has a dismal reputation among all Western Europeans and its hospitals are to be avoided like night-time excursions in Dracula country.
The operation was a success but the patient died
Very occasionally, support for the mythology comes from elsewhere in the world and is given wide publicity. For example, in 2014 the Commonwealth Fund published a report comparing 11 Western health care systems. According to the report, the British NHS
was best on all measures except one, in which it was the worst apart from the US system. The measure on which it was next to worst was the number of deaths preventable by healthcare. On every other measure it was simply splendid. This rather reminded me of the 19th-century surgeon’s refrain, ‘The operation was a success but the patient died.’ No doubt it is naïve of me, but the prevention of preventable deaths seems to me the whole, or at least the most important, purpose of a health care system. If it fails in that, it fails in everything.
The fact that thousands of people die every year in Britain who would have been saved in any other country in Europe
simply does not register, any more than that repeated scandals in the NHS destroy the national affection for it.