Today marks the UK’s National Health Service’s (NHS) 63rd birthday, formed under Clement Attlee’s post-war reforming Labour Government of 1945-51.
When you think of what the NHS stands for and what it has meant to the people who have relied upon it (including myself) since that day, it has been a pretty remarkable achievement. We shouldn’t forget that its formation was a result of the conditions that people lived under during the Great Depression, where levels of exploitation, degradation and malnutrition began to rival mid-19th century experiences as the clock was turned back.
For example, one fact that I learned studying history as an undergraduate, was that one-in-three volunteers for the army in 1939-40 were rejected because they were or had been so malnourished that they were considered ‘unfit’ (at a time when men were needed in the army!). That was the legacy of an economic system that allowed so many ordinary people to suffer because the markets had free reign.
The present Con-Dem coalition wants to ‘reform’ the NHS. I don’t think anyone doesn’t think any organisation – and especially those that are as massive in size as the NHS – cannot be reformed and/or made to work better, more efficiently and with a better direction of resources. That is probably always an issue.
However, we have to ask what is the purpose or reason for the ‘reform’? Is to enable various financial donors and/or political supporters to benefit personally, professionally, financially? Is it to turn back the clock to a time when people ‘knew their place’?
In Canada, there are considerable (and realistic) fears about a new ‘health accord’ to be renegotiated in 2014 under a Conservative majority government, which is led by someone, Stephen Harper, who has already started cutting public sector jobs (40,000) and is an ideologue of the free market (aka ‘free market fundamentalist’). It was a long fight to establish the equivalent of the NHS, what Canadians call ‘Medicare’ (which is different to what Americans call ‘Medicare’), led by Tommy Douglas and the CCF/NDP (Cooperative Commonwealth Federation/New Democratic Party), first establishing a Medicare system in the province of Saskatchewan and later, nationally by compelling a national Liberal minority government to bring it in in return for NDP support. (It should be noted that Canada doesn’t quite have the same type of system as the UK, but the Medicare system has provided care for the population for some 40 years or so.)
In Saskatchewan, the doctors resisted the Medicare system and so Tommy Douglas’s CCF government brought in doctors from the UK to work in the provincial system when the Canadian doctors wouldn’t! However, various provinces have allowed forms of privatisation to creep into the system, a process which has been enhanced by political parties, such as the Conservative and Liberal ones, which make public statements about supporting Medicare but engage in practices aimed at undermining it. This process is what we need to be aware of to prevent a full return to the 1930s (or worse).
When you compare Canada and the USA in terms of healthcare costs, for example, the latter tend towards almost double former’s (various sources look at this, but something like 9% of GDP for Canada and 16% for USA). The cost of administration and bureaucracy are what cost for-profit medical systems with a hodge-podge of county hospitals to support those too poor to afford health insurance. (The statistics on personal bankruptcy in the USA show medical bills are responsible for the majority of those – I read some figures that it was around 60% and of that 60%, three-quarters [ie 75%] had health insurance!)
In addition, it has meant that Canadian unions do not have to bargain over basic health insurance coverage as unions do in the USA. In part, this has made it cheaper for the economy when everyone is covered by a ‘single-payer’ system (US definition of Canadian-type approach to medical care). Canadian unions usually bargain for an extension of benefits and such things as dental coverage (not provided in Canada as it was under the NHS in the UK).
Anyways, I think it is important that we remember our history so that we are not doomed to repeat it. This is partly why I think it is very important to mark the NHS’s 63rd birthday by remembering what an achievement it was for the people and how important such an organisation is to the health of a society and an economy.