Moving the second reading in the House, the Minister of Health, Mr. Bevan, said that the National Health Service Bill provided a universal health service without qualification, and would make universal the best advice and treatment (though owing to shortage of staffs and hospital accommodation it would be a short time before it could bear full fruit), and he had made up his mind not to permit any sectional or vested interests to stand in the way. The main instruments of the health service would be the hospitals, the general practitioners, and the health centres, the hospitals being in many ways the vertebrae.
Speaking for the opposition. Mr. Law asserted that no valid reason had been given for taking over the hospitals.…He adhered firmly to two principles: viz., that the doctor's only responsibility should be to his patient, and that, as far as his judgment was concerned, he should be responsible to no one but himself and certainly not to the State. The bad effects of the bill would only begin to show themselves in ten, fifteen or twenty years' time, when the mistake would be irrevocable.
—Excerpts from Keesing's Contemporary Archives, 1946. reprinted in the program for Washington's Arena Stage Production of The National Health, by Peter Nichols.
As everyone now knows, those bad effects are showing in spades these days, and twenty years after Britain's National Health Service was voted in, Peter Nichols wrote The National Health, a satire that savages the NHS and the welfare state for which it is a central symbol.
The mood among England's writers and intellectuals has shifted dramatically over the past two decades. In the fifties, the literary phenomenon was the angry young men, a group of writers like John Osborne and Kingsley Amis who let fly at the institutions of the British establishment for what they viewed as their hypocrisy and lack of concern for the well-being of the country's citizens.
A decade later, however, that establishment was no longer the primary shaper and controller of English life. There was a new establishment, which exercised more minute control over individual lives than the old establishment had ever dreamed of. The new establishment was the State, and in the sixties and seventies the State became the single most important target of literary satire.
That the welfare state has become such a target is extremely significant, for the very existence of satire indicates that something has gone awry within the social system being treated by the artist. There are as many definitions of satire as there are dead leaves to be raked in autumn. John Dryden wrote that the aim of satire is "the amendment of vices." Daniel Defoe believed the objective to be "reformation." Dr. Johnson saw it as an approach to literature "in which wickedness or folly is censured."
But whatever the definition, the end of satire is to attempt to cut away or cure social illness and aberration. The medical analogy is an apt one, and some satirists have compared their role to that of the physician. The physician treats physical sickness; the satirist operates on social sickness. In fact, Tobias Smollett, the 18th-century naval surgeon turned novelist and one of English literature's greatest satirists, referred to himself as "a doctor of men and manners." It is within this satirical tradition that Peter Nichols practices his craft.
In The National Health, Nichols'subject is sickness—the sickness of a group of patients, the sickness of the National Health Service that treats them, and the sickness of the larger society, for which the hospital serves as a microcosm. The entire play is set in the Sir Stafford Cripps ward for terminally ill men. (Sir Stafford Cripps, whom Churchill referred to as Sir Stifford Crapps, was the socialist minister for economic affairs whose policies in the late forties helped bring on England's economic malaise.)
The characters, as we wait for them to die, chatter about everything conceivable connected with physical, mental, and social health and in the process lampoon all aspects of English society, politics, love, racism, racial chauvinism, and even religion. The talk is fast and funny, although some of the lines smack a bit too heavily of terminal vaudeville routines. Sample: "If my old friends were alive to see me now, they'd drop dead."
The talk is broken into periodically by a play within a play, an ongoing soap opera, watched by the patients on their ward television set, which romanticizes the loves and lives of an idealized group of doctors and nurses. Also frequently breaking in are the real doctors, nurses, and a matron, whose interest in the patients as individuals, in marked contrast to the soap opera medics, is relentlessly cheerful and totally perfunctory. The doctors and nurses are martinets, and the care they provide is heavy-handed and intrusive, with everything done by the book. Moans one of the patients: "They even wake you up to give you a sleeping pill." The system leaves the patients with nothing to cling to. They are deprived of their individuality and therefore their dignity, and they are not even allowed a dignified death. "The Eskimos let their old people die in peace," says one patient. "The Eskimos haven't got a health service," answers another.
There are things I didn't like about the play. I prefer plays with well-developed plots to the fluid, essentially plotless structure favored by Nichols. Some of the humor also seemed unnecessarily offensive, marked by that curious fascination with bodily functions that characterizes so much of contemporary literature. Nevertheless, bed-pan humor and matters of individual taste aside. The National Health is a remarkable play. It is remarkable in that, despite the subject, it makes us laugh. It is remarkable for what it makes us laugh at. And it is remarkable that so many theatre-goers in a city like Washington feel like laughing at it.
Nichols is no ideologue. He lampoons conservative as well as socialist politics, and he is merciless with Christianity. But the central target is socialism, and this gives many Washingtonians trouble. A Washington Post drama critic put it this way: "If, then, this is meant as a criticism of how loused up Britain's medical system is, Nichols might have done more honestly by his argument by contrasting how the poor and middle class, which most of his patients are, would have been treated in the old days."
Now there is just a touch of validity in this criticism. The great satirists always showed us a norm against which the aberrations they skewered could be measured. But Nichols suggests no cure, and one has no idea of what his standard might be. Is it the system of "the old days" against which he is measuring today's system? We don't know, for he doesn't hint at an answer.
But this isn't really what troubles the Post critic, who would probably be shocked to be told that his comments represent cultural commissarism at its worst—namely, an attempt to dictate the contents of a literary work according to ideological predilections. But the reaction is understandable. The assumption is that wherever there is socialism, things have to be better than they were before. This is one of the unexamined assumptions held in common by many—perhaps most—of our intellectuals and writing people, and they have come to believe it just as absolutely as they believe absolutely that everything is relative.
Lately, however, in England and in much of Europe, the attitude toward socialism has been changing. It is no longer something that you must discuss and debate in solemn terms. It is no longer a sacred cow. It is, in fact, an eminently lampoonable system, something that can actually be laughed at. And this is precisely what the standing-room-only audiences at Washington's Arena Stage were doing—they were laughing at Peter Nichols' depiction of the welfare state.
A decade ago, a play like The National Health would not have elicited that laughter from a Washington audience. There were certain things one just didn't laugh at. Satires on such easy targets of opportunity as the military, businessmen, or Vietnam were one thing. But satirizing such things as state-controlled medicine simply wasn't done. If you went that far, you might as well satirize New Deal or Great Society programs. And who could laugh at that sort of subject matter?
Over the past decade, however, there seems to have been a distinct shift of national mood, as yet unchartable, but very much in the air. Perhaps it was Vietnam, perhaps Watergate, perhaps the economy, perhaps taxes, perhaps the increasingly uncomfortable intrusiveness of federal programs. But whatever the reasons, there seems much less willingness among a growing number of citizens to entrust their well-being totally to a benign centralized government. Government seems intent on proving to us that whatever it undertakes it does so inefficiently, with a minimum of concern for individual human lives and a maximum for blundering. And the more it blunders, the funnier it looks.
In the end, this is the message that Nichols seems to want us to take away from The National Health. And judging from the laughter of its audiences in Washington, that message is coming through.
John Coyne is a Washington-based freelance writer. His article is reprinted, with permission, from Private Practice.
This article originally appeared in print under the headline "Washington Laughs at the Welfare State".