Readers who have been following the intense, almost hysterical, debate in the United States over Barack Obama’s plans to reform the American healthcare system will know how strongly the Republicans have reacted to the proposed changes. The nation has the worst public health system among the developed nations, despite spending almost twice what the British spend on their NHS in terms of per centage of GDP. Millions of Americans are of the view that somehow a public health system that extends coverage to the huge number of uncovered citizens is an evil socialist innovation that would deprive them of choice and the quality of care they currently get.
While Obama has been battling right-wing prejudices and health industry vested interests to push through his reforms, the debate has crossed the Atlantic to Great Britain. The private health insurance lobby has been pumping millions into an effort to kill the Obama health reform bill. In the process, it has launched a number of TV films that seek to rubbish public health institutions like the NHS, and have featured prominent Brits critical of the system. One of them, Daniel Hannan, a prominent member of the Conservative Party, and an elected member of the European Parliament, said in an interview with Fox TV: ‘Because you’re our friends, and if you see a friend about to make a terrible mistake, you try and warn him. We have lived through this mistake for 60 years now.’
In Britain, this attack on the NHS was immediately made the focus of a Labour counter-attack on the Tories. For months now, the Tories have maintained a large lead over the governing Labour Party, and it was generally assumed that David Cameron and his party would easily win the general elections due by next June. Over the economy and Afghanistan, Gordon Brown has been on the defensive. His plodding, lacklustre leadership style has been constantly criticised by friend and foe alike. Suddenly he has been thrown a lifeline, and the Tories, generally buoyant due to their poll numbers, have scored an own-goal.
Despite all its many faults and weaknesses, the NHS is an institution most Brits are very proud of. Established by the post-war Labour government in 1948, the public health care provider has grown into a behemoth. Launched with a budget of 437 million pounds (today’s equivalent of nine billion pounds), it now spends 90 billion pounds annually, and employs 1.5 million people, making it one of the world’s biggest employers. Around half this number has clinical qualifications of one kind or another. Ninety-thousand of NHS employees are doctors in hospitals, while a further 35,000 general practitioners man clinics across the country.
The size and scale of the system have allowed it to provide excellent medical coverage to the entire population, and this government has pumped in more money than ever before. I have been using the NHS ever since I began spending a large chunk of time in Britain every year over the last six years, and have no complaints. Indeed, when my English friends criticise some aspect of it, I point out that to somebody who has spent much of his life in the Third World, the NHS is a marvellous example of what can be achieved to provide universal health care.
Even Sarah Palin, the loopy, lightweight vice-presidential candidate, weighed into the debate by declaring that Obama’s proposed reforms would introduce ‘death panels’ that would decide who would get life-saving treatment and who would not. One feature of the reactionary American campaign is that in the NHS, old people with terminal illnesses are denied expensive treatment, thus effectively condemning them to death. Even though this allegation is utterly nonsensical, it is still believed by millions of simple Americans.
The other day, I watched a live televised town hall discussion in which Obama tried to convince his hostile audience that Americans deserved better health care than they are currently getting. As he recounted facts and figures, I could see the eyes of his audience glazing over. The truth is that most middle Americans, when faced with complex issues, prefer easily digestible sound-bites rather than complicated arguments. For them, the healthcare lobby has shaped the debate by denouncing state intervention as a socialist evil compared with the private-insurance dominated schemes that currently are the principal source of medical care.
Despite greater spending on health care, American life expectancy is lower than in Britain, and infant mortality is higher. And yet, the debate is not about better care for more Americans, but is seen as a clash between private and public care. In American minds, the former is the preferred option, as Barack Obama is discovering. If his reforms are passed by Congress, they will be a watered down version that will not resemble the NHS in any way.
Given the pride most Brits feel about their medical system, the Tories are bound to suffer from a backlash in public opinion due to the attacks launched by leading Conservative lights on the NHS. Even before the criticism launched by Daniel Hannan, Labour had been warning of Tory cuts in public expenditure if they came to power. David Cameron, on the other hand, has been trying to re-brand the Tories as the caring party in a bid to bury the image of the Conservatives as ‘the nasty party.’
The truth, as usual, lies somewhere in between. Many Tory politicians are well-off and can afford private health insurance. Their experience with the NHS is limited, and they resent having to pay taxes to keep the public system going. For them, the American model with individuals and employers picking up the tab is more attractive. They forget – or ignore – the fact that in this system, millions are too poor to get medical care. Thousands are pushed into bankruptcy every year as they have been stricken with serious illnesses or accidents, and cannot afford decent treatment without going into serious debt.
But as Britons enjoy ever-increasing life-spans, medical costs are bound to grow, and the young will have to carry the burden. How this will translate into electoral politics in the future remains to be seen. However, political parties will have to remember that older people tend to vote in larger numbers than the young. And in the elections scheduled for 2010, the Tories will need to remember that the NHS has a powerful constituency.
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