The NHS: Safety net or straitjacket?
Robert Colville need not fear. The NHS will not come ‘tumbling down’ so long as its beneficiaries possess freedoms that may yet be sacrificed to sustain it
Writing at Telegraph Blogs, Robert Colville fears he may have seen the end of the NHS: class disparities in lifestyle and health.
He observes that that the wealthy and well-educated – what might once have been termed the upper and middle classes of our day – are living in an increasingly health-conscious manner. Despite this, the NHS is challenged by the costs of treating poor lifestyles. Colville writes:
“So why all this talk of soaring levels of obesity and binge drinking? Well, that's the issue. Those things aren't a problem for the rich, or even the middle, but the poor. And this class divide is not just huge, but widening.”
He moots that this growing class divide in lifestyles – and the subsequent burdens placed upon the health service – will undermine common support for the NHS’s founding principles. Will the middle-to-high earners, whose taxes sustain it, remain willing to contribute when the majority is spent treating other peoples’ vices?
Or has he puts it, “will we look (on our new itemised tax bills) at the vast chunk of our money that goes towards the NHS, and start to wonder why, when we've been such good boys and girls, we should have to subsidise the sinners?”
I think that this reading of events fundamentally misreads the relationship between the NHS and that section of the population whose taxes sustain it. The upper and middle classes in this country would, I feel, never consciously abandon the NHS model unless forced into it by dire circumstances or eased out of it so gently they don’t even realise.
The NHS is too important to their self-image. It is one of the few pillars of post-war Britain still standing, the idea that we have come up with a healthcare system so totally fair that it is “The Best in the World”. It allows us to look down, if not on continentals (whose healthcare systems we know little about), then at least on Americans. The social democratic virtues that underpin the NHS are an article of faith for most of the population.
We aren’t going to let anybody fall through the mesh of our social safety net. Yet the problems Colville highlights remain: why should the increasingly health-conscious upper classes continue to subsidise the unhealthy lifestyles of others?
If the past is any guide, they won’t. But they won’t change a thing about the NHS. They will simply take away the freedom of the general population to indulge their expensive bad habits.
I’ve written previously for ConHome USA on the impact of British universal healthcare on personal liberty. In short, I explained that British healthcare means that your health is everybody’s business. Instead of being faced with personal consequences for bad decisions – such as higher insurance premiums – the consequences of your bad decisions fall on the public treasury. Thus all taxpayers have an incentive to constrict your liberties to spare the public purse.
To demonstrate the corrupting influence this could have on attitudes to liberty, I provided the example of doctors lining up to cheerlead extensions to the smoking ban. They had mutated into authoritarian lobbyists who reasoned that it would be much easier to outlaw behaviour that made people sick than to treat them.
You can see that sort of attitude writ large in the current debate on the future of the health service, whose current model has a relatively short shelf life remaining. Reformers argue that the NHS must become ‘preventative’ in its focus – but how can it prevent, save by restricting freedom?
In this article, for example, Daniel Poulter MP claims that the time has come to “consider introducing a minimum unit price for alcohol to help save the NHS millions of pounds.” This measure is explicitly aimed at “the very people whose lives are being ruined by cut-price supermarket cider, wine and lager” – in other words, the awkwardly expensive poor.
Where alcohol leads, cigarettes, fast food and who knows what else will follow. That’s the flip side of our commitment to the NHS: we thrust our charitable spirit on the nation with irresistible force with one hand, whilst clawing back as much of the costs as we can with the other by passing authoritarian legislation and punitive taxation. We lay on the social safety net, but only after we’ve bound the irresponsible in a social straitjacket to save on the wear and tear.
So Robert Colville need not fear. The NHS will not come ‘tumbling down’ so long as its beneficiaries possess freedoms that may yet be sacrificed to sustain it.
Read more on: NHS, henry hill, Robert Colville, Telegraph blogs, US health care, nhs reforms, NHS cost-benefit analyses, ConHome USA, public healthcare, Daniel Poulter MP, dilettante, and Open Unionism
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