Jay seems enamoured of the latest piece by Michael Moore, namely Sicko. I have yet to see the film, and after the Riefenstahlism of Fahrenheit 9/11, I will need some persuading, but Jay has asked me to comment on the British public health care system which features in the film.The National Health Service (NHS) was one of the foundation policies of the post-war Socialist government that was elected over Churchill in 1945 and ever since has been lauded as one of the best elements of the European model over the American one. Yet the usage of the system varies enormously by class and income, and the experience differs by region and by individual.
As with any system that seeks to offer free-at-the-point-of-delivery service to 70 million people, it is going to be hit and miss. Indicative of this is the fact the employers continue to offer private health care as a perk. Private health care doesn't necessarily guarantee you better care (indeed many doctors work in the NHS and privately simultaneously) but you are able to choose the doctor you see and are more likely to be able to choose the date of treatment should it be needed. In total, it is designed to take out of the randomness that people feel afflicts the NHS. Whether seeing your general practitioner (GP) or having an operation at a hospital, like teachers at a school, the experience is often all down to the individual who is providing the care.
Yet the principal complaint made against the NHS is that the quality of care is deteriorating not because of the individuals involved but because of systemic faults. Created in 1945 when the demands of the population were different, it is now faced with a much larger population who are living longer. In facing up to these challenges, the system was widely seen as being consistently underfunded during the premiership of Margaret Thatcher and her successor, John Major. Blair was elected specifically on a promise to inject large amounts of money into the system which he duly did in the first 5 years of his rule. However, the level of care was not perceived to have changed much, in fact it was considered to have further deteriorated. Complaints were made that in being given money on condition of meeting certain performance targets, the hospitals recruited more middle managers to handle the budgets and ensure that targets were met, rather than hiring more doctors or nurses.
The solution to this is often see as introducing elements of free-market style resource allocation to the system, which then falls on the ideological barriers of the ruling Labour Party which, adhering to its socialist roots, does not want to see any privatisation of the health service. In that very British way, continued small scale changes will be made to the system rather than full scale reform, with both parties committed to ensuring it is funded and strengthened.
So, we now have a system which has had an enormous injection of extra cash, which is still free to all, but is widely seen to fail its patients due to a lack of structural change yet is still cherished.
That's the politics. But what about the day to day reality. Well, as mentioned, that's highly subjective. Whilst you can read daily newspaper reports of every increasing waiting times for critical operations or nurses deserting the system due to poor pay and conditions, my personal experience of the system has generally been good but this is perhaps because I generally only see my GP a few times a year. The one time I had an operation, to remove wisdom teeth, I had done under private care. Why? Well, because the wards in NHS hospitals are not particularly pleasant and the risk of being stuck with unpleasant staff could be mitigated by recourse to private health care. This meant I could go to a hospital, which by recommendation, was well staffed and comfortable.
Yet, the key point is that even if I didn't have private health care, I could still have the operation done for free. I may have had to wait longer and ended up in less pleasant surroundings (they key word there being may) but I could still have it done for free. In fact, since leaving my comfortable job a few months ago, I don't have private care anymore but am safe in the knowledge that should anything happen to me, I can still see my GP or be referred to a hospital. This feeling exists implicitly at the back of the mind of everyone on the UK, whether they have private care or not. But mostly importantly, it exists in the minds of the elderly or poor who rely on the system the most. This reflects an essential element of the British social compact: namely, that no matter what your income or social status, the state should be obliged to provide health care to you.
How sustainable this view is with a burgeoning population remains to be seen. There are undoubtedly severe problems affecting the system, but it has yet to be proved that the NHS is unviable as a concept. More privatisation is likely yet this need not reduce the ability of the system to continue to provide free care to all, especially if the quality of care improves as a result.
Here for the me, is the main question. It is not about whether a system is private or public, whether it is free for all, or free for some and not for others, but does it provide the best care for the most numbers? So far, from a utilitarian point of view, the European model seems to work better than the American one. More people are looked after to a better level. However, this is not to say a well structured ubiquitous, private system could not do better but that no one has managed to achieve it so far.
But for the timebeing, in the UK, whilst the doctors and nurses who continue to work in the NHS still believe in the system, despite all its flaws, nobody fears that they are too poor to be ill.
