British politicians used to boast that the National Health Service was — and some left-wing holdouts maintain it still is — “the envy of the world.”
These days, beset by scandal after scandal and facing spiraling costs, the NHS would be lucky to attract a covetous glance from an accident-prone Somali, and any U.S. conservative who doubts the urgency of stopping Obamacare before it can be fully implemented would do well to pay attention to the disaster unfolding across the pond.
A report released last week revealed that as many as 13,000 patients may have died unnecessarily in NHS hospitals between 2005 and 2012.
The investigation discovered appalling standards of care, with patients being left without food and water, forced to lie in soiled beds, and left in ambulances because there were no beds available. The report further accused hospital staff of being more focused on meeting government-imposed targets than on patient care.
To make matters worse, standards were allowed to slip so dramatically because the watchdog tasked with monitoring the performance of NHS hospitals — the Care Quality Commission — covered up incidents of its employees failing to spot problems or to investigate complaints; they even used gagging orders to silence potential whistleblowers.
Ministers of the last Labour government, which set up the CQC, have also been accused of ignoring warnings about high death rates and other problems.
In a separate development, a controversial “end of life” care program for elderly and terminally ill patients known as the Liverpool Care Pathway is to be phased out, after it emerged that hospitals were abusing the system to hasten the death of patients by withdrawing food and drink.
This is arguably the greatest scandal: patients were starved and neglected not because of staff shortages or bad management, but as a result of deliberate policies aimed at freeing up hospital beds and saving money. Staff even received financial incentives for placing patients on the program.
Against this backdrop of widespread failure, malpractice, and cover-ups, another report revealed that the NHS nevertheless faces a funding shortfall of £30B ($45B) by 2020 unless radical changes are made to the way the service is organized and run.
Not only is Britain’s socialized healthcare system broken, it’s well on the way to going broke, and neither the present Conservative-led government nor Labour seems capable of carrying out the reforms necessary to prevent standards from further deteriorating.
Some of the financial pressures on the NHS can be attributed to factors beyond the control of managers or politicians, such as a growing and aging population (although mass immigration policies under Labour didn’t help matters) and the high costs of new technology and treatments. But many of the most serious failings can be laid squarely at the door of Labour’s health policies, which fostered a culture of box-ticking, obsession with targets, and secrecy at the expense of patient care.
Successive governments have tinkered with reforming the NHS, both by promoting competition within the organization and by allowing hospitals to buy services from private health care firms, but the best opportunity for change came with the election of Tony Blair’s “New Labour” government in 1997. The NHS was set up by Labour in 1948 and the party has always portrayed itself as its “guardian.” Opinion polls have consistently shown Labour as more trusted to safeguard the NHS than the Conservatives, thanks largely to a decades-long strategy by Labour of denouncing every attempt at reform by Tory governments as being designed to “wreck” the service or to privatize it by stealth.
So, in the sense of Nixon going to China, Labour was in a strong position to force through the changes needed to bring the NHS into the 21st century, but the opportunity was squandered. While Labour doubled spending on the NHS during its 13 years in office, productivity actually fell, and the seeds of the recent scandals were sown. While Blair was initially serious about reforming the NHS while preserving its free-at-the-point-of-use character, he was frustrated both by ever-increasing costs and by bureaucrats, unions, and other vested interests within what is Britain’s last real nationalized industry.
When Gordon Brown replaced Blair as Labour leader and prime minister, he abandoned genuine reform in favor of more top-down control and a target-driven culture, with each new (often fiddled) reduction in waiting times heralded like monthly output figures from a Soviet tractor factory. Staff were bought off with huge pay rises, and family doctors were allowed to refuse to provide out-of-hours cover, causing patients with minor symptoms to clog up hospital emergency rooms. Blair’s first health secretary, Frank Dobson, said of his successors:
They preferred to take the advice of management consultants to medical consultants. Huge sums were diverted away from nurses, doctors, and patients to lawyers, accountants and PR men.
Ultimately, Labour was unwilling to carry out the necessary reforms because it didn’t want to change the fundamentally socialist nature of the NHS, which with its 1.4 million-strong, heavily unionized workforce had become the cornerstone of its “client state” of government employees and welfare dependents.
The NHS serves another useful purpose for Labour — it’s a “moral” cudgel with which to beat the Conservative party. Right now, Labour and its hapless leader Ed Miliband are losing the battle for public opinion on welfare reform, cuts to public services, and reducing immigration; the NHS is one of the few policy areas in which Labour still enjoys the upper-hand in terms of public support. Scaremongering about the NHS’ future has become the party’s equivalent of Democrats playing the race card.
Britons have become instinctively protective of a public service that they’ve been brainwashed into believing is the best of its kind in the world, not just by Labour politicians but by the BBC — another national “institution” that enjoys popular support despite its own parade of scandals and its legendary political bias — and the broader liberal establishment. Also, by popular culture: who can forget Danny Boyle’s North Korean-esque “homage” to the NHS at the opening ceremony of last year’s London Olympics? (Strangely absent from Boyle’s show — dehydrated patients drinking from flower vases; babies with pacifiers taped to their mouths to stop them from crying.)
Prime Minister David Cameron hasn’t helped himself by declining to confront Britons with the brutal fact that the NHS is unsustainable in its present form. During the 2010 election campaign, he repeatedly pledged to protect and invest in the service in a bid to allay voters’ traditional fears. While some of his government’s proposals — such as giving doctors and nurses more power over budgets for purchasing care — are promising, others fall into the “you mean they weren’t doing that already?” category. For example: have trainee nurses spend a year in wards actually learning to care for patients.
The near impossibility of even reforming, let alone replacing, the NHS goes a long way towards explaining why Democrats are so keen to set America on the path to socialized healthcare. President Obama himself is on record as saying he would ultimately like to see a single-payer system, and he and other Democrats will have noted with admiration the success with which Labour has for years demagogued its opponents over the NHS. As Philip Klein writes at the Washington Examiner:
Just as Social Security, Medicare and Medicaid are not going anywhere, Obama assumes, once in place, a new health care entitlement will not only survive, but grow over time. This will be true, he’s concluded, no matter how disastrous its initial rollout is, no matter how deleterious to the nation’s finances, no matter how rife with fraud.
America’s present healthcare system does need overhauling. While the U.S. excels in some areas it enjoys only modest outcomes in others, and spends much more than other developed nations in the process. But those reforms need to be along free-market lines: Republican proposals include replacing employer-provided healthcare with a system of portable tax credits; allowing insurance to be purchased across state lines; and reforming medical malpractice laws to reduce costs. But the sorry state of Britain’s NHS is exhibit A in the case against a state-run system: rather than heading down the road to socialized medicine, America should be running in the opposite direction as fast as it can.