Health Care Omerta in the U.K.

It's fine for Brits to talk trash about the National Health Service, but not to Americans.


A few weeks ago, I sat down with Daniel Hannan, the Milton Friedman-loving member of European Parliament representing South East England, to discuss his infamous showdown with Prime Minister Gordon Brown, his opinion of the British National Health Service (NHS), and what the Republicans could learn from the recent successes of Britain's Conservative Party. When I asked Hannan his opinion of Tory party leader David Cameron—who, I argued, "lurched towards the center" in search of popularity—he demonstrated unswerving party loyalty. Cameron, he admonished, was hardly a Tory wet and is more committed to free-market ideas than his old guard Thatcherite critics were willing to admit.

The following day, Hannan repeated his criticisms of the NHS on the Fox News Channel, warning Americans that his country's health system was a "60-year failure" that he "wouldn't wish on anybody." He delivered a stark verdict:

I find it incredible that a free people living in a country dedicated and founded in the cause of independence and freedom can seriously be thinking about adopting such a system in peacetime and massively expanding the role of the state when there's no need.

Had Hannan muttered dark warnings about the British health service's sustainability on the floor of the European Parliament, the Labour Party would surely have made political hay out of it, arguing as they often do that the Tories, if given power, would speedily dismantle the NHS and replace it with a more American-style system. But this was something else entirely. To go to America, to appear on Fox News, and denounce Nye Bevan's "post-war achievement" was too much for both Labourites and squishy Conservatives.

Click above to watch MEP Daniel Hannan discuss his libertarian influences, the NHS, and his YouTube attack on Gordon Brown

The loyal lieutenant, who a day earlier had batted away my criticism of David Cameron's "New Tories," was about to be hurled under the bus by his party leader. "Cameron slaps down NHS 'traitor' MEP who branded health service a failure," read The Daily Mail headline. The BBC reported that Timothy Kirkhope, leader of the Conservatives in the European Parliament, believed Hannan "should be disciplined for his comments about the NHS and said he would be given a 'stern talking to' by the party's chief whip Brussels."

Hannan's opponents in the increasingly unpopular Labour Party seized the opportunity to defend the popular NHS by launching a full-scale attack on the Tory libertarian. Health Secretary Andy Burnham sputtered that criticism of the NHS "is unpatriotic because he is talking in foreign media and not representing, in my view, the views of the vast majority of British people and actually, I think giving an unfair impression of the National Health Service himself, a British representative on foreign media." Those British journalists who gasped when the Dixie Chicks, after excoriating George W. Bush in London, were accused of being patriotism-deficient, have been conspicuously silent when the government of Gordon Brown takes a similar line to Tory "dissent." 

On Channel 4 (which receives some funding from taxpayers), writer and television personality Charlie Brooker barked that Hannan is a "boggle-eyed, slap-headed, unpleasant, revolting, heartless, shit-brained, attention-grabbing, foetid excuse for a prick." British users of Twitter were encouraged to replace their profile photos with a "We Love the NHS" icon, publicly declaring their loyalty to Britain's largest employer. (Indeed, as Hannan explained to Fox News, "most of [the NHS's] 1.4 million [employees] are administrators…the managers outnumber the doctors and nurses. And that is the electoral bloc that makes it almost impossible to get rid of.")

The only reasonable criticism of the rogue MEP came from conservative Mail on Sunday columnist Peter Hitchens, who observed, with appropriate bafflement, that "Hannan is quite principled and really ought to know better than to belong to the Tories at all."

So why the kerfuffle? Where is that stiff upper lip in the face of criticism? The New York Times' indispensable London correspondent Sarah Lyall noted that Britons "complain endlessly" about the NHS, "deplore the system's waiting lists, its regional disparities in treatment, its infection-breeding hospitals and its top-heavy bureaucracy," but can get "a bit touchy when outsiders are the critics." Professor Karol Sikora, a British critic of the NHS, was denounced by a fellow doctor as "spearheading a right-wing American campaign to denigrate the British National Health Service." 

Ah ha! So it isn't the criticism, it's when Americans—especially American "right-wingers"—are the critics. 
Some of the criticism has been erroneous. When Investors Business Daily absurdly claimed that the physicist Stephen Hawking, who suffers from neuromuscular dystrophy, would have been allowed to die if he were a subject of the Queen (he is, in fact, British), Fleet Street's green inkers, from Torquay to Dundee, scoffed at the "increasingly ugly row" over health care that was currently consuming America. Just back from receiving the Presidential Medial of Freedom in Washington, Hawking told journalists the he "wouldn't be here today if it were not for the NHS." Without the state-funded treatment from the NHS, Hawking said, he "would not have survived."

The point, though, is not whether those living in the United Kingdom receive competent—or even occasionally outstanding—care in a socialized scheme like the NHS. It is doubtless true that the British health services "saved the life" of Stephen Hawking, just as the drug company that developed synthetic insulin surely saved—or greatly lengthened—mine. The question is not whether a wealthy, Western country with well-trained doctors and nurses is capable of provided decent treatment, but whether government-run systems, which require the rationing of care to limit always-expanding costs, are the most effective way to provide broad health coverage to American citizens.

Hawking's personal anecdote is touching, but not entirely useful for Americans (nor is the Investors Business Daily editorial). Upon watching Michael Moore's clumsy agitprop film Sicko, liberal commentator Matthew Yglesias wrote that "the focus of the film is on what he's best at—and what health wonks are worst at—human stories and experiences." If the film was successful, Yglesias wrote, the tales of insurance companies not offering drugs considered experimental, of people waiting to be treated as their condition worsened, would "be utterly devastating politically." Yglesias, who has strenuously defended the NHS, thinks such "human stories" are politically useful. So why not, in this spirit, offer a few anecdotes about the British health care system from the previous month:

  • After a story detailing a mix-up that caused an NHS doctor to remove the lung from the wrong patient, The Telegraph reports the massive amount of malpractice claims filed against the NHS: "This week it was revealed compensation to patients surged to an all-time high of £769m which means more than £2m every day is paid on average to the 16 people who lodge claims against the NHS every 24 hours."
  • A new study finds that "Only 60 per cent [of NHS health care trusts] say they routinely pay for drugs for leukaemia and other types of blood cancer that have been passed by the National Institute for Health and Clinical Excellence. Campaigners claim that patients are being let down by the system."
  • The BBC reports that a study by John Appleby, chief economist at The King's Fund, found that "The NHS is facing the most significant financial challenge in its history." If the NHS were to remain solvent, the study says, the government must scale backs services or raise taxes.
  • BBC News details the story of "A mother who spent £31,000 on life-saving treatment for her daughter while NHS bodies argued over funding is to get her money back."
  • BBC's Radio 4 reports that couples can now enter a "postcode lottery" for IVF treatment from the NHS.
  • According to The Daily Mail, three families recently sued the NHS to recover the costs of care for relatives. "In two cases the family home had to be sold to meet the huge costs for long-term Alzheimer's and Parkinson's care that should have been funded by the NHS."

Spend a week thumbing through a British newspaper and you will find plenty of similar stories detailing the NHS's famously dense bureaucracy, ever-expanding queues for treatment, and almost non-existent dental care. It is surely not outrageous to suggest that the British model is not one which most Americans would  choose to emulate. But it is outrageous for Daniel Hannan to be called a traitor to Albion for pointing such things out.

Michael C. Moynihan is a senior editor of Reason