No Hope Left for a Healthcare System that Saves More Lives

The British, on all sides of the political spectrum, love the NHS. It is a source of national pride. Even most of the proponents of free enterprise - ‘dry’ Tories included - look across the pond to America and conclude that the National Health Service is exceptional. They conclude that it is one of the few things that would be disastrous in the hands of private enterprise. But in doing so, they are drawing a false dichotomy between the healthcare options of the UK and the US. When I ask people “have you heard of social health insurance?”, they look at me as if I’ve just spoken another language. 

It baffles me how few people have considered Social Health Insurance (SHI) as an alternative to nationalised health care. Adopting it would save tens of thousands - and potentially hundreds of thousands - more lives each year than the NHS. It also baffles me how oblivious people are to how poor the performance of our NHS is. The NHS almost always ranks in the bottom third in international comparisons of health system performance. I hadn’t heard of SHI until I read Kristian Niemitz’ paper ‘Universal healthcare without the NHS’ - and he remains one of the only people I hear talking about this in the press. I had a small glimmer of hope before the pandemic, when flaws such as appalling Accident and Emergency (A&E) waiting times were exposed, that people might finally consider alternatives to the NHS. However, the almost-religious rhetoric we have created around the NHS over the past year has meant that my small glimmer of hope has now disappeared faster than an NHS consultant at the end of their shift. There is no hope for better healthcare. Those who really care about saving lives should abandon their affection for the NHS. 

The NHS was launched 5th July 1948, and it seems to have retained the public’s undying affection ever since. This was the beginning of the so-called ‘post-war consensus’ of the 1950s and 1960s, where both the Labour Party and the Conservative Party both agreed upon the provision of the National Health Service alongside the nationalisation of crucial industries and Keynesian demand management in the interest of maintaining full employment. But although the Tories supported Labour’s decision to found the NHS, it is often forgotten that the Conservatives, whilst in favour of universal provision of healthcare, had wanted an insurance-based system rather than a nationalised system. A historian acquaintance tells me one should never spend too long dwelling on counterfactuals, but oh, how I wish the voters had not turfed out Churchill in 1945. 

The NHS was and is morally superior, swathes of people think, because (quite rightly) it doesn’t discriminate against the impoverished. Income is not a barrier to the access of healthcare. Meanwhile, across the pond, over 10% of the population are uninsured. Fees are extortionate (as is the insurance itself) due to the inelastic nature of demand for healthcare. People are unfairly financially crippled for years by a 10-minute visit to the emergency room.

And over the past year, love for the NHS seems to have become unquestionable. Don’t get me wrong: I’ve massive respect for those NHS workers who have worked tirelessly this past year. But I think those workers would be able to save even more lives in their respectable jobs if we had a social health insurance system of healthcare. Just as a system of universal healthcare provision is morally superior to the US’ healthcare system that discriminates against the poor, a universal healthcare system that saves more lives than another universal healthcare system also ought be morally superior to anyone who values human life. The consistent failure of the NHS to save lives that other healthcare systems would, to cut A&E waiting times, and to cut appointment waiting times, has long been blamed on a lack of funding from the “Nasty Tories”. If only we spent more on healthcare, the socialists craw. Nobody dares question whether the nature of the system itself might happen to be flawed. But they should: what if we could have a healthcare system that’s both private AND universal? We can: just take a look at what many countries like Belgium, Germany, Israel, the Netherlands and Sweden are already doing. Hardly renowned as bastions of the rapacious free-market, are they? 

These countries all have a system of social health insurance (SHI). How does this work? Social health insurance involves means-tested insurance premium subsidies and a legal requirement that everyone must have insurance. Individuals can shop around between different private and competitive healthcare providers. Meanwhile, even the homeless have access to healthcare with fully subsidised premiums. Social health insurance escapes many of the ills of conventional insurance with its regulations. Firstly, ‘community rating’ means insurers cannot vary premiums according to one’s health risk. Secondly, an obligation to contract and no exclusion clauses means that insurers cannot reject applicants on the basis of personal or family medical history, pre-existing conditions or other risk factors. 

How does this fair when compared to the NHS? As detailed in Niemitz’ paper (which I do encourage all of you to go read after this) age-standardised cancer survival rates show that 9,000 more lives would be saved each year if the UK’s breast, prostate, lung and bowel cancer patients were treated in the Netherlands rather than on the NHS. The comparable figure is 12,000 more lives saved if treated in Germany, and 14,000 in Belgium. What’s more, one of the highest rates of avoidable deaths in Western Europe is found in the UK - 13,000 avoidable deaths could be prevented each year if we reduced the rate to the Dutch levels. I don’t think I need to explain why a universal healthcare system with private providers produces these stark differences compared to a nationalised system: the answer is obvious. God bless the free-market! 

This all sounds incredibly exciting, but I am afraid the situation is hopeless. I once hoped that the Thatcherite zeal latent within all of us Tories, our avowed faith in the superiority of private enterprise, would prevail. I dreamed we were on the long march towards SHI. Niemitz hopes for small steps to be taken by allowing individuals initially to choose between different Clinical Commissioning Groups (CCGs). But that hope has faded like a NHS consultant’s handicap on a golfing ‘day off’. Remember when everyone was accusing the Tories of “privatising the NHS” just because they decided to contract a few private companies to help provide the services that would remain free at the point of use? The media storm and public outrage were so outrageous that the number one sticking point in doorstep conversations I had with voters whilst canvassing was their fear that the Tories were about to make them pay for healthcare. That was before the pandemic. That was before the NHS posters and clapping. Do you really think the public would even contemplate any movement towards SHI after the pandemic’s rhetoric? Not in a million years. 

Chloe Dobbs (NEO for OCA Liaison, Ex-NEO for Legal, Ex-Publications Editor) is a second year reading Philosophy, Politics and Economics at Pembroke College.