Against the NHS & its Twitter Cult

Order, order! The Chair reins in some excited conservatives at Port & Policy last Thursday.

A university society debate. That is all it was. University students coming together to discuss policy, and drink port too. And yet, given the horrific online reaction, one may suspect the event to have been on a motion to violently kill the country’s puppies.

The sheer volume of racist and misogynistic comments that I woke up to last Saturday, including some hideously violent death threats, tells you everything you need to know about the current state of public debate. The fact that sitting Members of Parliament and high-profile political activists alike also joined in on the Twitter ‘pile-on’ tells me, a 19-year-old student, that the toxicity within the online public sphere is only getting worse. These ad hominem attacks needlessly stop people with valuable contributions to make from speaking out, simply because not everyone can take the hate.

“I always cheer up immensely if an attack is particularly wounding because I think, well, if they attack one personally, it means they have not a single political argument left.”
―**Margaret Thatcher**

Thankfully, I am able to brush-off personal vilification. My real concern though is the attack on the mere debate of some issues, with insults replacing reasoned discourse. This hinders our ability to engage with one another so severely it prevents any meaningful change. Without J.S. Mill’s ‘marketplace of ideas’, which requires a vigorous free competition of thought, the path to discovering the best answers is seriously blocked. Essentially, a strong tolerance of debate is needed to make any kind of meaningful progress, especially within political debate. Without this wrong answers simply cannot be exposed and weeded out.

Last Thursday, in this Millian spirit, our societies decided to put on an NHS debate. In doing so, a platform was provided to weed out bad arguments and display the robustness of those which remained. I argued for the privatisation of the NHS, and thereby ensured it competed among other ideas in a fairly rigorous environment, essential to progress in any area of life. Allow me to explain the reasoning and evidence I set out that evening.

Against the NHS

The NHS is not the ‘envy of the world’, as some may put it. Yet many argue it is still preferable to a privatised healthcare system, and will often point to the US as an example against market-provision. Despite the vast majority of US citizens being covered by health insurance, approximately 91.4% in 2020, the US is certainly not the nation we should be looking to in order to solve our healthcare problems. As I argued at the Port and Policy event, it is terribly simplistic to view the world as a ‘US vs UK’ choice. After all, there are other countries in the world. Indeed, many of them have excellent healthcare systems that we should look to emulate. Look at the following three examples.

Consider Singapore, where they experience excellent health outcomes, and where an emphasis is placed on individual responsibility for healthcare. The Economist’s Intelligence Unit places Singapore 2nd out of 166 countries for health-care outcomes, and this without it having a state-provided healthcare system. Heavens above! Their Medisave and Medshield system is founded on the idea that consumers should be able to shop around for routine medical care. Medisave allows working people to divert between 7 and 9.5% of their wages into a health savings account. Medshield covers larger unexpected costs, and premiums are set by age. For those in financial need, Medifund pays medical bills, and is state funded. More than 99% of applicants to Medifund are approved, so while the Singaporean healthcare system delivers greater individual responsibility and autonomy, it still ensures vulnerable residents have their healthcare covered. Universal healthcare coverage isn’t unique to the NHS.

Or compare the outcomes of the UK’s bureaucratic NHS to the relatively free market Australian healthcare system. In 2019 Australian healthcare spending as a percentage of GDP was 9.3%, compared to 10.3% in the UK. Yet on a variety of measures Australia seriously outperforms the UK. For example, breast, prostate, lung, colon and rectal cancer survival rates are all higher in Australia than in the UK, and by as much as 10% in some cases. And in terms of avoidable deaths due to healthcare Australia scores about 50 per 100,000, while the UK scores a pitiful 70 per 100,000. The NHS is clearly not a well-functioning healthcare system.

Alternatively, there is the Swedish healthcare model. In what was previously a socialised medical system, firms have been allowed to enter the Swedish healthcare market, introducing the wonders of free competition. Healthcare is still taxpayer-funded, and free at the point of need, but the introduction of private health companies,and thereby competition, has improved services dramatically. These companies are subject to market forces, and can therefore respond to changes in demand, expanding when the state cannot. Since 2010 private companies have been allowed to set up GP-style services throughout Sweden, paid for by the taxpayer.

Healthcare services are much better as a result, with stroke survival and cancer survival rates being much better than in the UK. Indeed, according to the 2021 Commonwealth Fund study Sweden has significantly better healthcare outcomes than the UK, ranking 5th out of eleven advanced economies compared to the UK’s 9th place. This shows, as Thomas Berglund, ex-President of healthcare company Capio, has said, the “profit motive works in healthcare”. The free market has, yet again, proven to ameliorate the efficiency and quality of services where it is allowed to do so.

It is a categorical fact that the British healthcare system needs serious reform, continuing to waste billions of pounds of taxpayer money is just not an option. The Singaporean, Australian and Swedish healthcare models are just three in the world of many, many systems that are objectively better than the UK’s. We should look to them as examples. Furthermore, those on the Left need to get their head round the idea that you can have public financing of healthcare, without needlessly inefficient public provision. That way you can acquire the efficiency of the free market, while maintaining the universal access to healthcare which all Britons currently enjoy.

Instead of personally attacking those who dare to question the viability of our so-called ‘sacred’ NHS, we must all engage in discussions and debates on healthcare reform. It is only then that we can enact meaningful change

The views of the author do not necessarily represent those of the Editor of The Strand Review or any London University Conservative Association