Winner of the New Statesman SPERI Prize in Political Economy 2016

Tuesday 31 July 2012

Why the National Health Service played a central part in the Olympic Ceremony

Although the British are a patriotic nation like any other, we are also quite happy to criticise our institutions and national efforts. So before the Olympics our press was full of stories about actual or potential problems. Of course, it is another matter if someone overseas repeats these things, as a certain US politician found out. So everyone thought that being in charge of the opening ceremony was a poisoned chalice for Danny Boyle. Get anything wrong, and mistakes would be analysed in fine detail. Get the tone wrong and he would be torn apart.

Given that, the reaction to the opening ceremony in the UK has been extraordinary. Universal praise for once would not be a cliché. Not just praise of the ‘good effort’ kind – genuine emotion at having captured something quintessentially British. Examples here, and here, and here.  The appreciation seems to have come equally from left and right: when one Conservative MP tweeted that it represented ‘leftie multicultural crap’, his comment was described as ‘idiotic’ by the Prime Minister.

I think those watching from overseas will be able to understand a lot of this. There is the British sense of humour, the evocative depiction of the first transformation from a rural to industrial society, the central role of immigration, and consequent cultural diversity. But why so much time devoted to the National Health Service (NHS)? – that seemed to puzzle some in the US at least.

What is perhaps not understood outside the UK is that the British regard the NHS as an institution on an equal par to our monarchy. Not beyond criticism, but seen as absolutely essential to national life. While many aspects of the 1945 post-war social transformation have been swept aside (nationalisation of utilities) or greatly modified, the idea that the health service should be free to all and paid for through taxation is sacrosanct. In a MORI survey, when people were asked to agree that either ‘The NHS is critical to British society and we must do everything we can to maintain it’ or ‘The NHS was a great project but we probably can’t maintain it in its current form’, nearly 80% chose the former and only 20% the latter. A report for the Healthcare Commission prepared by MORI concluded

“The NHS as a whole, and in particular the principles it embodies, remains a huge source of latent pride. It is still perceived by the British general public to be one of the best of its kind in the world. People also see the NHS as critical to society, and despite concerns about its management, they feel it needs to be protected and maintained rather than re-invented.”

To suggest that the NHS should be replaced by a system based on insurance would be political suicide. That is why David Cameron promised that there would be no top down reform of the NHS if he was elected, and why many – even in his own party – suggest that his failure to honour that commitment may be his undoing.

Of course principles and practice do not exactly converge. There are some minor charges within the NHS, and there is plenty of private, insurance based provision available alongside the NHS. Nor do I want to argue that this attachment to the principle of equality of health provision is necessarily logical or consistent with British attitudes in other areas, but just to note that it exists.

Is this attachment to the NHS national self delusion? After all, many countries seem to have replaced their monarchies with alternative heads of state, and are doing just fine. I think there is a difference. The monarchy in the UK symbolises our history – its actual function is relatively trivial beyond that. The NHS embodies a principle that in critical matters involving health, all members of a society should be equal. Overall the UK is not a particularly equal society, and income and wealth inequalities have been growing, but this is one area where there is a strong national consensus that while additional income should mean that you contribute more to a health service, this does not entitle you to receive better treatment.

Do the British pay dearly for this attachment to equality in health provision? If you look at measures of quality or efficiency, the UK does reasonably well (for example here or here), but what does appear consistent is how badly the US performs in terms of efficiency. (For some clues as to why, see Timothy Taylor here.) So what seems more likely is that it is the US aversion to government involvement in health provision that is a little delusional. Which of course brings us back to that certain US politician, who not only came up with a plan to try and improve the US health care system, but when the President took it up, he has been kind enough to let the President take all the credit.

Postscript (4/08/12)

On US attitudes, see this more recent article by Uwe Reinhardt (HT MT)


  1. That certain US politician has I understand been praising socialised healthcare in Israel (sorry, learning to do hyperlinks is on my to do list). When can we start a debate on the NHS that involves systems that work (France, Canada?) and uses others (egUS) as cautionary tales? I'm not as much of a fan of the NHS as you, but agree that we should be looking at results and costs, and that won't lead us to copy US.

  2. It shows the tremendous power of try-and-see to decimate ignorance and disinformation.

    The world today is incredibly complicated; it's not 1810 anymore. So ignorance is a tremendous problem. The billionaire financed propaganda machine of the right can do profound, grievous harm. The disinformation can be, tragically, extremely effective.

    This is why the modern filibuster has been so profoundly harmful in the US; it makes try-and-see far harder. Without it we would have had things like universal healthcare and cap-and-trade long ago, and the disinformation would have been very quickly dissipated.

    Relatively easy try-and-see is just absolutely crucial in a very complicated modern world, especially with rapacious plutocrats funding a vast disinformation machine.

  3. It is nice to see that such a large proportion of your people are glad to have the NHS. It gives me hope for my country. I think that the US is far, far away from anything like the NHS though. Unfortunately, in my opinion.

    Now to my economics question. Here in the US it is often argued (and widely believed) that the uninsured push up the cost of healthcare for everyone else. The argument goes that hospitals provide treatment for those who can't pay and then transfer the cost of that to those who can pay (those with insurance). If this argument is true, I wonder how economists would explain it. I would also like to learn how to use this technique in my own (non-healthcare) business.

    In case anybody would like to respond, there are four hospitals within ten miles of me and twelve or more within thirty so I don't think it could be caused by a monopolistic hospital. And I have read a couple of econ textbooks (in case Nick Rowe is reading comments again).

  4. If we apologize for the American War of Independence (as I believe you call the American Revolution), will you take us back? I'm still not crazy about the whole monarchy thing, but I'd be willing to tolerate it if it meant we could get the NHS.

    1. Yes, gladly:) And I can assure you mate whatever the shortcomings are with the NHS, you will never die because you lack health insurance.

  5. We have free treatment for all - but this is hardly exceptional. Most (all?) other European countries have managed the same, as well as many middle income countries. Perhaps it is fear of ending up with a US style health system drives affinity towards the NHS - but there are other countries who have managed to combine free treatment for all with greater efficiency (see the second of your two links), also ezra here:

    why we British are so attached to a particular means of delivery (one centralised organisation) rather than a set of principles (free health care at point of use, delivered as efficiently as possible) remains a mystery to me.

  6. As the osteopath at the professional football club, Hamburger Sport Verein, I'm working with professional athletes on a daily basis. Over the last two months we have integrated the NES mihealth device to support our players - and we have experienced remarkable results. Our players recover faster and feel much more relaxed before games. They even want to use the NES mihealth device themselves at home.

  7. Health service is one of the broad term that deliver beneficial health care services to the people within a affordable price; therefore government and health care organizations are always worried to increase the popularity of health service through various plans and reform programs.


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