If the NHS is ‘fair’, give me unfairness any day
Did I ever tell you about the time the National Health Service relieved me of my piles? It’s a painful story — and for many of you, no doubt, already far, far more information than you want. But I do think it goes a long way towards explaining our ongoing Eloi-like subservience to the great, slobbering, brutish NHS Morlock which we so rose-tintedly delude ourselves is still the ‘Envy of the World’.
Look, if you don’t want to read about piles (‘’roids’ if you’re American), I should skip on a few pars. The key thing to recognise is that from tiny beginnings, they mutate into an all-consuming misery. Enjoying a night in front of the TV? Yeah, but the piles! Having a relaxing bath? Yeah, but the piles! Fancy going riding? Eek! You can see why Napoleon — a fellow sufferer — felt compelled to conquer half the world. Anything to distract yourself from what’s going on down below.
So naturally when a surgeon relieves you of the buggers, you feel exceedingly grateful. I remember coming round after my op in my overstretched local hospital — King’s in south London — two or three years back, and thinking the thought that occurs to all British citizens at some time or another: ‘Gawd bless you NHS! You have saved my sorry arse!’
One reason for my gratitude was that the treatment was free. Gosh, I love being given expensive things for free, don’t you? I like it so much I think I’d almost rather be poor and get lots of free stuff than I would be rich and be able to afford anything I wanted. Free stuff — thanks, lovely Dan from Mongoose cricket bats — feels like a gift from God; proof that life isn’t quite as sucky and thankless and horribly unfair as you imagine.
Another reason for my gratitude was that I wasn’t dead. You do half expect it when you go into an NHS ward. You think, ‘Well if they don’t get my records mixed up with that of a patient marked “Incurable. Please put this man out of his misery now” (or, worse: “Penidectomy”), then I’m almost certain to contract MRSA, as virtually everyone does in NHS hospitals these days, and spend the whole of the rest of my life in a living death.’ (Not that I knew at the time I hadn’t got MRSA. I just took a lucky guess.)
And I suppose the final reason for my gratitude — as with my near drowning experience a fortnight ago — was the pure experience value. Lying in the beds either side of me were people you never get to share such intimate experiences with in the normal course of sheltered, middle-class life: people from the kind of families who mug you or knife you in a pub fight, only wearing their kindly, sympathetic human face because they’re ill in hospital and you’re ill in hospital and it’s all very bonding.
I think I might just have given you the three main reasons why so many British people are so infatuated with their beloved NHS: it’s free; it quite often cures you; it treats everyone equally. But does any of these put the NHS beyond criticism? I should say not, and let’s deal with them one by one.
First: ‘free’. Well, it’s just not, is it? The NHS sucks more of our hard-earned cash than any other government department — £100 billion a year and counting (which is three times more than we spend on defence and about £30 billion more than we spend on education), much of which it wastes on bureaucracy. I don’t know about you, but — despite what I said earlier — when free things get so expensive I think I’d rather have the cash.
Second: the NHS (generally) doesn’t kill you and generally makes you feel better. Well, bully for it. I don’t want to sound ungrateful here, I appreciate what doctors and nurses do. But aren’t we slightly missing a key point when we go into raptures that our newborn has been safely delivered, or we’ve got a new heart valve, or the Rayburn has exploded on our hand causing the skin to shrivel all whitey-grey and leading to enormous pain which (eventually, after a three- or four-hour wait) the duty doctor in casualty has helped soothe with morphine and a plastic bag full of anti-burn gunk?
It is their job. Curing people is what they like to do. If they were of a different persuasion, they would have become, maybe, torturers in Evin prison, or Interahamwe, or Harriet Harman. But no, they chose a life in the caring professions because they care. Plus they’re paid for it. Plus, if the NHS didn’t exist, they’d still be there. Contrary to what most British people seem to imagine, health is not a zero-sum game where either you get your medical treatment grudgingly served up in rationed form by an efficient state or none at all. There are other ways, you know. Look at Singapore.
Third, it even treats poor people. Yeah? And? So does every other healthcare system outside the Third World, up to and including the Great Satan of Medical Heartlessness the USA. Just because you think the NHS is sclerotic, unwieldy, top-heavy, squalid and wasteful is not the same as thinking that everyone below the poverty line should be left to die. Not that you would have guessed it from the wave of public outrage that greeted Dan Hannan’s measured and constructive criticisms.
Sure the NHS has its good points. But it is, au fond, a creaking relic from the age of austerity, more-than-my-job’s-worth Soviet fellow-travelling and ‘soak the rich’, which treats its users less like valued customers than like unwelcome, greedy supplicants in the manner of Oliver Twist begging for a second bowl of gruel.
This is a very odd state of affairs and I’m frankly amazed that more people can’t see it. Here we are, free citizens of a more-or-less free-market democracy, well used to making regular, grown-up budgetary decisions based on how much we’ve earned through the sweat of our brows: McDonald’s or the Ivy; Portofino or Whitby; Prada or Mister Byrite. Yet when it comes to perhaps the most important issue of our whole existence, viz: how, when and where we die, and in how much pain — we seem to think it only fair that the decision is handed over to some sinister government bureaucrat.
If this is ‘fair’, give me unfairness, please. I’ve always thought that the quest for equality — at any rate in its socialist form ‘equality of outcome’ — was the most toxic mainstream political doctrine of the last 100 years. The NHS is a grim vestige of a discredited philosophy whose only virtue, as Churchill nailed it, is ‘the equal sharing of misery’.
Death is the great leveller. Till then, there’s the NHS hospital — probably the one chance a tax-paying, law-abiding citizen gets to experience how it feels being admitted to prison or going to a dole office to claim welfare. Is this a snobbish point to make? Quite possibly, which is why hardly anyone dares make it (though everyone secretly thinks it, especially as they grow older). But you’ve got to admit there’s something ever so slightly wrong about a society where all your life you can struggle hard to improve your circumstances and that of your family, bettering yourself through study, honing your tastes, scrimping and saving and working your butt off so you can live in greater comfort, but where you only have to get ill and — BAF! — you’re a nobody, just one more scrounger to be fed inedible food and ignored (or called by your Christian name) by overstretched nurses in an airless mixed ward rank with decay and swarming with antibiotic-resistant bacteria.
It’s not how I want to spend my last days. Mind you, if I say similar things on Any Questions this Friday, I doubt the studio audience will allow me the luxury.