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Britain’s NHS idolaters cling to the Commonwealth Fund’s rosy but skewed assessment of the National Health Service like shipwreck survivors cling to floating wreckage

Brexit is not the only issue which reveals the intellectual limitations and paucity of vision of our politicians. Simply whisper the letters “NHS” and the vast majority of parliamentarians instantly turn into zombies, mindlessly repeating the same worn-out old paeans of praise to centralised government healthcare as though they were under the control of a hypnotist.

There are few better demonstrations of this pathology than yesterday’s segment on BBC This Week, in which Andrew Neil questioned uncritical acceptance of the Commonwealth Fund study (the only survey which routinely rates the NHS favourably) and Kate Andrews of the IEA gamely tried to advance the heretical notion that Britain might do well to learn from other advanced countries when it comes to organising healthcare delivery.

This went down like a lead balloon with bipartisan couch-warmers Anna Soubry and Alan Johnson, whose minds are both welded shut against any information that might suggest that the NHS is not, in fact, the “envy of the world”. Neither host Andrew Neil nor Kate Andrews are able to break through this veil of self-imposed ignorance:

From the segment:

Andrew Neil: Let’s just take the Commonwealth Fund now, because you politicians on both sides, you’re always using it —

Alan Johnson: Well, it’s the only one —

Andrew Neil: No, it’s not. It’s the only one in which the NHS does well, and actually in the Commonwealth Fund it measures inputs, not outputs, not patient care. Indeed, on the patient care – on actual health outcomes – even in the Commonwealth Fund the NHS comes tenth out of eleventh. The Guardian remarked on the Commonwealth Fund: “the only serious black mark against the NHS in Commonwealth Fund research was its poor record of keeping people alive”.

Alan Johnson: Yeah, America came eleventh, by the way, but…

Kate Andrews: Why America? Why not Germany or Belgium or Switzerland or France?

Alan Johnson: Because you came on here and said Trump has a point, are we supposed to talk about Sweden when you said Trump has a point?

Kate Andrews: You’re right, I did say Trump had a point, this whole point is that the NHS is failing, that doesn’t make America any better. Look, I’m from America, I’m not coming over here saying look, adopt the American system”, as I said in the video I wish both countries would look at Switzerland. But let’s stop painting this black and white decision because it’s not about USA versus NHS.

Alan Johnson: The Commonwealth Fund is the only one who measures things like health inequalities and fairness and how it affects the poorest —

Kate Andrews: What is fair about thousands more people in European countries surviving? What is fair about that? What is fair about the fact that 13,000 more people in Germany every year will survive the five most common types of cancer? What is fair about that?

Alan Johnson: [Becoming more incoherent and hysterical with every passing moment] You quote that without saying — as if the NHS was very keen for people to die of cancer —

Kate Andrews: No, of course they’re not, but we can do something about this —

Alan Johnson: One of the biggest problems is early reporting, is people going to their GP, particularly men —

Anna Soubry: Absolutely, it’s the biggest factor.

Kate Andrews: Great. Well, you need access to the GP, don’t you? You need shorter waiting times.

Anna Soubry: We have – please, please, don’t tell me that you don’t have – depends on where you live —

Kate Andrews: The waiting times for this country are appalling compared to their European counterparts.

Anna Soubry: [Disingenuously talking about same-day emergency appointments rather than scheduled GP appointments] Excuse me. Your GP, it depends exactly where you live, because certain GP surgeries like mine, I can see my GP if I want to on the morning that I have – I can ring up and can get in straight away. It depends where you live —

Kate Andrews: That doesn’t sound like a very fair system. It doesn’t sound like a postcode lottery is a very fair system.

Anna Soubry: No, it’s not a postcode lottery.

Kate Andrew: Well he [Alan Johnson] is talking about fairness, and that’s what the NHS is good at, but you were talking about a postcode lottery system. There’s nothing fair about that system, and there’s not a lot that’s very good about it either.

So the NHS is perfect, equality of dismal outcome is preferable to aspiring toward excellence, and if you are one of those people whose deaths would have been prevented by another, superior healthcare system it’s your own stupid fault for not seeing your GP (the unnecessary gatekeeper to practically all NHS care) on time. So say Tory wets and Labour centrists alike.

This is mental subservience to the Cult of the NHS, pure and simple. Every day, the high priests of the NHS surpass themselves in new feats of bias confirmation. One might think that the NHS coming second from last in the rather key metric of keeping people alive might give pause for introspection, but throw up any fact or scenario which suggests that the NHS is inferior and immediately two things happen.

Firstly, up goes the wall of ignorance and denial. Why are you fussing about health outcomes anyway, they splutter. Don’t you know that fairness, ease of access and cost-effectiveness are the only metrics worth considering? And if that doesn’t work, then out comes the good old US/UK false dichotomy, where NHS defenders pretend, quite slanderously really, that anybody who questions the NHS model or expresses an interest in learning from other countries secretly wants to emulate the US system.

Kristian Niemietz has also been fighting this lonely fight against uncritical acceptance of the Commonwealth Fund survey for a long time:

The Commonwealth Fund study is the outlier among health system rankings, because it pays little attention to outcomes – it is mainly based on survey responses and general system characteristics. But it has one category which does relate to outcomes, and in that category, the UK comes out 10^th out of 11 countries. So even the preferred study of NHS cheerleaders confirms that in terms of outcomes, the NHS is one of the worst systems in the developed world.

Niemietz concludes:

The jingoism of Little Englanders is sometimes unedifying, but it is not nearly as cringeworthy as the NHS patriotism of the left. The NHS is the country’s most overrated institution. It is the Carling of healthcare systems. It achieves nothing that dozens of other healthcare systems do not also achieve, and usually better – and it’s time we admitted that to ourselves.

I made the same point in a television interview several years ago, pointing out that if you want to make a staunchly internationalist, post-patriotic left-winger sound like the stereotypical swivel-eyed Ukipper all one has to do is whisper the letters “NHS”, at which point they will immediately start ranting about British superiority and exceptionalism, waxing lyrical about how we alone have unlocked the secret of compassionate, universal healthcare delivery, while the other, benighted nations of the world look on at us in envy.

If the NHS is ever to be meaningfully reformed, if healthcare outcomes are ever to improve in Britain relative to the countries which are overtaking us, this wall of ignorance and denial must be torn down. But just from the facial expressions and physical demeanour of Anna Soubry and Alan Johnson in this BBC This Week segment, you can see that they will not be reasoned with. And if politicians who style themselves as pragmatic centrists cannot take the emotion out of an argument and drop the NHS hagiography for an honest discussion of healthcare reform, what chance is there?

This is a cult, plain and simple. When people cannot look dispassionately at a government service but instead debase themselves by sanctifying it (as though universal healthcare were in any way unique to Britain), observing its holy days, quoting its founders and worshipping its historical figures, what you have is a cult.

 

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