NHS-Worship, Non-Contributory Welfare And Britain’s Idea Of Fairness

Save Our NHS

Blind devotion to our indifferent, non-contributory welfare state plus a warped definition of “fairness” are holding Britain back

The Guardian’s ongoing “This Is The NHS” series is really pushing my buttons at the moment. The newspaper is clearly particularly proud of their feature project, which makes the series’ blatant NHS hagiography and stunning lack of intellectual curiosity especially infuriating to read.

As a journalistic exercise it has been utterly contemptible, constantly telling people what they want to hear – that the NHS saves lives (as though that were not a feature of every healthcare system), that it employs many hardworking people – rather than what they need to hear in order to make an informed, dispassionate judgement about whether the UK’s unique approach to healthcare delivery is sustainable in the future.

Any and every inconvenient fact which suggests that the NHS is not in fact the “envy of the world” is immediately shot down in the series of articles – like when the Guardian quotes a professor of European public health‘s dismissal of reports criticising the NHS as being “market oriented”, as though the accusation automatically ends the argument, and as though we could not have foreseen that opinion by simply reading his job title.

For the better part of a month now we have been treated to statements such as this, comparing the NHS to other healthcare systems and – unsurprisingly – finding it to be the best in the world:

A mission statement set in 1948 for a universal service free at the point of use is under strain like never before. People are still able to see a GP free of charge – though booking an appointment is becoming harder. It will cost nothing to call out an ambulance and go through A&E, to undergo chemotherapy or major surgery. And yet about 11% of the population prefer to pay for private health insurance.

“And yet”! And yet despite having this state-provided, socialist wonder on our doorstep, an astonishing 11% of the population elect to pay for supplementary coverage. Could it possibly be because cancer outcomes in the UK are about the worst in the developed world, or because getting to see the specialist who can actually treat your condition requires going through the gatekeeping step of booking a GP appointment, often with a month-long wait before each step? No. The people who pay to go private are clearly just ungrateful, verging on insane, to want to circumvent such a benevolent system.

Yesterday, this saccharine coverage – and the Guardian’s publication of a parsimonious little online calculator enabling readers to calculate how much they “cost” the NHS – prompted me to write:

But of course we all know exactly why the Guardian is so eager to talk about how much we cost the state (and chide us for doing so) yet desperate to avoid talking about how much we contribute. Because to look at both sides of the equation simultaneously would be to encourage the public to ask whether they getting value for money. And it would reveal – as we now know – that the majority of us are net takers, or beneficiaries, from the system.

The Guardian’s whole anti-Tory, anti-austerity schtick is built entirely on the notion that we all contributed to our public services, and that the dastardly Evil Tories are cutting services to which we have all made substantial financial contributions. They seek to perpetuate the vague notion that we have a contributory welfare system, when in reality Britain’s welfare system is defiantly, depressingly non-contributory.

And that, right there, is the real problem.

Not the NHS itself – a flawed but well-meaning organisation filled to the brim with mostly hard working and well intentioned people – but rather, the warped view we have of the concept of “fairness” in this country, and the desperate lengths the Left will go to to stop us from thinking rationally about important issues.

In Britain, the word “fair” has been taken by the Left and forcibly redefined to mean “redistributive”. You’ll see it in public discussions of any issue from tax policy to healthcare – no policy can ever be described or promoted as being “fair” unless it takes from the privileged few and given to the “disadvantaged” many. Everything now has to be redistributive – or at least, nothing can ever move in a less redistributive direction, resulting in a one-way ratchet to ever bigger government.

Thus Gordon Brown’s decision to hike the top rate of income tax from 40% to 50% was bold, progressive and generous, while George Osborne’s decision to undo just some of that punitive and unproductive tax increase (cutting the top rate from 50% to 45%) was a corrupt, almost immoral “giveaway to millionaires”.

And thus a healthcare system based on insurance – which might see people who make unhealthy lifestyle choices pay more, rather than being subsidised by their peers – is considered unthinkably bad, while the NHS model, funded through our progressive tax system, is lauded as being inherently good and virtuous. Indeed, the only way that the NHS could be improved in the eyes of its most ardent admirers would be if wealthy people could be targeted and forced to pay arbitrary additional “NHS tributes” every time they experienced success or felt any kind of joy in their unfairly privileged lives.

And this is why it is almost impossible to imagine real reform of the NHS, the welfare state or any other major modern edifice of British public life. Because “fairness” has been corrupted from its more authentic meaning, the meaning which we might apply in any other context in life – the principle of reward being commensurate with effort, or “getting out what you put in”. And while we may still be taught The Little Red Hen as children, as adults we much prefer to virtue-signal by nodding along to the mantra that fairness means the state blindly treating everyone exactly the same.

But there is nothing “fair” about the status quo. As this blog noted last year while discussing Britain’s homicidal welfare system:

Usually it’s good when government does not discriminate. Justice, for example, should certainly be blind, as the old saying goes. But when it comes to social security, we choose to regard our welfare system as a “safety net”. Yet any fisherman knows that different nets are needed for different environments, and likewise a one-size-fits-all safety net for citizens experiencing unemployment or hard times simply won’t catch everybody. Some will slip through entirely and crash to the ground, while others will become ensnared and trapped forever. In other words, when it comes to welfare we should actually want the government to actively discriminate.

[..] The problem – and the great moral rot at the heart of the British welfare system – is that the state makes absolutely no distinction between the perfectly-fit, perfectly-able eighteen year-old who can’t quite be bothered to look for a job, and people of more nuanced and complex circumstances. Worse still, the system treats people who have worked hard for many years, often contributing enormous tax payments to the Treasury throughout their lifetimes, in exactly the same perfunctory way that it treats a person spat out of compulsory education at eighteen without the curiosity or drive to find a career.

[..] People talk about the welfare system as being a “safety net” without thinking, and for some people it may function as such tolerably well, if they ever use it at all. But for many thousands and millions of others, our universal and non-contributory system – which remarkably, despite being the product of classic Big Government, takes absolutely no account of our individual lives and circumstances – is no such thing.

If a person is born into deprived circumstances, our social safety net is far more likely to resemble deadly quicksand, seeming benign at first but quickly trapping the victim without hope, dragging them ever deeper with each desperate exertion to break free. And if they are even moderately well-off but suddenly fall on hard times, Britain’s universal welfare system certainly isn’t like landing in a soft safety net – it’s more like smacking into a concrete floor from a fifty-foot drop.

Contributory vs non-contributory. Kristian Niemietz of the IEA perfectly encapsulated the difference between these two principles in an IEA article from 2013:

The difference between a contributory and a means-tested welfare system is not just an administrative one. The two reflect completely different conceptions of fairness, and different understandings of what a welfare system should be there for.

A contributory system is based on an understanding of ‘fairness’ in the sense of ‘proportionality’, or reciprocity: the more you have paid into the common pool, the more you should be entitled to take out of it. Quid pro quo, something for something. In a means-tested system, meanwhile, fairness is understood as supporting the needy, with support being proportional to need. The more you need, the more you get, and if you don’t need support, you won’t get any.

And goes on to explain that despite originating from an utterly perverse interpretation of “fairness”, re-establishing the contributory principle is politically toxic in Britain because it would mean breaking the association – forged in the many decades since the Beveridge Report was first published – between the word “fairness” and the idea of the state treating everybody exactly alike, regardless of merit:

Due to their emphasis on proportionality, contributory systems are not, in themselves, redistributive. They are only redistributive to the extent to which they deviate from the contributory principle, which no system adheres to in an entirely pure form. But a welfare state that honours contribution cannot, at the same time, be strongly redistributive, and a welfare state that is strongly redistributive cannot, at the same time, honour contribution. In this sense, those who have recently discovered their love for the contributory principle are not telling the full story. They are right to point out that the British welfare state offers those who have worked and contributed for a long time a rough deal. But they fail to mention that this is precisely what redistribution is all about. If the welfare state has little left for those who have a paid a lot into the system, it is because all the money has already been spent on non-contributory transfers.

So unless our new contribution enthusiasts are also planning to substantially expand the welfare state – and I take it that that is not their intention – then they can only restore the contributory principle by reducing the extent of redistribution. Since nobody appears to be prepared to do that either, ‘something for something’ is hollow rhetoric. There will be no return to contributory welfare.

It seems to me that there are two potential ways to go. On one hand, we could move toward a more genuinely contributory welfare system. Under such a system, the amount of (say) unemployment benefit received would vary according to prior salary and past taxes paid, making it closer to unemployment insurance – a disbursement intended to provide a time-limited “soft landing” in the event of unforeseen job loss. Means testing would cease under such a system. And while a basic payment would be available to all citizens, those who contributed most would receive more help should they fall on hard times.

And on the other hand, we could accept that this more discerning form of “fairness” is politically toxic and unachievable, cut our losses, and focus instead on making the current bloated and inefficient system of applying for a complex array of potential benefits much more streamlined. And our best hope in this case might be to follow the lead of Finland and implement a form of Basic Income (otherwise known as negative income tax).

Basic Income offers something to both the political Left and Right. For those on the Left, the principle of universality is maintained. Everyone receives a guaranteed, flat-rate disbursement from the state every month, regardless of their wealth or income level, to be spent on essentials like food and housing or frittered away on foreign holidays as the recipient needs – or prefers. And for those on the Right, the expensive bureaucracy involved in means testing is eliminated, nobody is ever disincentivised from working, and the existence of “flat benefits” may eventually help to normalise the mirror concept of flatter taxation.

Is Basic Income “fair”? Strictly speaking, not by either of the two definitions discussed here. It is neither actively redistributive, and nor does it deliver more benefit to those who contribute the most. But despite the many criticisms of Basic Income, it is eminently pragmatic. And this itself is a huge advantage. Rather than having the Left and Right continue to shout at each other and fight each other to the awkward draw which has bequeathed us our current system, Basic Income – once bedded in – could help to depoliticise welfare and guarantee a minimum living standard for all citizens at the same time.

These are debates that we could be having in this country, if only we were able to stop patting ourselves on the back for the enlightened “compassion” of our current welfare state. These are some of the radical policy ideas that we could be debating – not as fringe intellectual arguments but as serious policy discussions.

But the debate never happens. And unless something changes, it never will. Politicians – and newspapers like the Guardian – keep us nodding along to the same tired old soundtrack about how lucky we are to have institutions like Our Blessed NHS and welfare state, and we keep on agreeing, even as they kill people.

Beveridge Report - Welfare State

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National Religion Daily Penance: How Much Do YOU Cost Our NHS?

NHS - National Religion - How Much Have I Cost The NHS - Worship - Self Flagellation - Socialism

Don’t join in the Guardian’s fawning worship of the state – you don’t owe the NHS anything

If any further proof were needed that conservatives and socialists think differently and see the world in a completely different way, you need only look at the latest feature in the Guardian’s nauseating, saccharine “This Is The NHS” series, a self-flagellating little feature asking “How much have I cost the NHS?”

In this post, the Guardian takes a break from exploiting real-life stories from doctors and patients to emotionally manipulate people into blindly supporting Britain’s unique but unexceptional healthcare system, and instead invites you to plug your personal details into their online calculator so that you can find out exactly how much money Our Blessed NHS lavishes on you every year. You ungrateful wretch.

The Guardian intones:

Public spending on health services reached £2,069 per person in the UK in 2014-15, but it does not benefit everyone to the same extent. Your annual cost to the NHS depends on your gender, age, and how frequently you use the health services, according to estimates from the Nuffield Trust.

So the total cost of your healthcare increases as you consume more healthcare services. Riveting stuff. Great investigative journalism.

The calculator does throw up some interesting numbers. Interestingly, if you sit stubbornly at home and never use a single NHS service or treatment of any kind, you somehow still manage to cost the health service hundreds of pounds a year.

Meanwhile, at the other end of the spectrum, if you were really unfortunate and had every possible thing go wrong with you (once) in a given year, the NHS could be on the hook for as much as £180,410 – though I suspect that the calculator is holding back here, and that some patients may comfortably exceed this total without having to check every single box:

How Much Do You Cost The NHS - 3

How Much Do You Cost The NHS - 2

Also interesting is the fact that the only mention of mental health and associated problems from addiction to depression is buried deep in the “Other” section, and not given the prominence that a right-on publication like the Guardian might be expected to lavish. One can only speculate as to the reason for this sudden downplaying of mental health issues.

But the really interesting and revealing fact is that the Guardian published the article at all – and the conspicuous lack of a counterpoint piece asking how much we each contribute to the NHS (or indeed any of our other public services) every year through our taxes. Why the obsession with how much we are individually costing the state (or harming the environment with our carbon dioxide emissions, or doing any other Bad Thing) when there is no equal curiosity about how much we contribute? Looking at one side of the equation is meaningless until you also have visibility of the other.

This deliberate omission is especially galling at a time when some citizen-focused governments are now providing individual taxpayers with an itemised receipt every year, showing how much of their taxes have been spent on different areas of the budget like education, healthcare and defence. George Osborne even brought the practice to Britain, to the inevitable howls of protest (and accusations of disseminating propaganda) from the Left.

It may seem trivial, but this is a fundamental difference in mindset. Issuing a receipt showing how and where government is spending your money is an act of transparency and an acknowledgement that the government derives its legitimacy from – and can only function with the consent of – the citizenry.

Publishing a sanctimonious little online calculator so that your left-wing readership can calculate how much they cost society with every breath, on the other hand, elevates the state above all. It presupposes that we exist only at the pleasure of the government, that the state has a rightful claim on all of our possessions as well as the product of our labour, and that we should be grateful for any trivial sum that we are allowed to keep for ourselves after we have funded the Public Services behemoth.

Doing things the Guardian’s way – focusing on how much taxpayers “cost” their own government – inverts the proper power relationship between citizen and government, which should rightly be one of the state existing to serve and protect the people, not the other way around.

But of course we all know exactly why the Guardian is so eager to talk about how much we cost the state (and chide us for doing so) yet desperate to avoid talking about how much we contribute. Because to look at both sides of the equation simultaneously would be to encourage the public to ask whether they getting value for money. And it would reveal – as we now know – that the majority of us are net takers, or beneficiaries, from the system.

The Guardian’s whole anti-Tory, anti-austerity schtick is built entirely on the notion that we all contributed to our public services, and that the dastardly Evil Tories are cutting services to which we have all made substantial financial contributions. They seek to perpetuate the vague notion that we have a contributory welfare system, when in reality Britain’s welfare system is defiantly, depressingly non-contributory.

Some of us contribute vastly more to the exchequer than we will ever receive back in public services. Some of us struggle to break even. And others are on “take” mode for pretty much their entire lives – often for very justifiable reasons, but other times much less so. Most of us will fall into different categories at different stages of our lives.

But the Guardian doesn’t want people to know or think about any of this, or have access to this information. The prosperous middle-class couple on a joint six-figure income, blessed with good health and the lifestyle habits to maintain it, may well balk when they realise how much they are contributing to the NHS compared to what they receive back in a given year, or the equivalent projected lifetime figures. And they may balk again when they realise that their chain-smoking neighbour who trundles off to the doctor at the first sign of a cold contributes far less.

In short, real transparency about contributions made and benefits received would encourage a more consumer-like mindset among the people, forcing them to take responsibility and make the decisions which are best for them and for their families. And this goes against everything that the Guardian believes, because they want us to be a nation of state-dependent drones, flopping around helplessly, utterly reliant on services and/or alms disbursed by the government.

So, to recap: Itemised bills from the government for services provided to you by the state? Wonderful, brilliant idea, and a great way to remind us of everything that the beneficent nanny state does on our behalf.

Itemised receipts from the government showing the breakdown of how your tax payments are being spent? Evil propaganda designed to mislead the people and whip the lemmings up into a hysterical rage.

Glad we cleared that up.

A scene from the Olympic opening ceremony celebrating the NHS

NHS Worship - London Olympic Games 1

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This Is The NHS

Save Our NHS

British healthcare reform should be the subject of forensic journalistic analysis and urgent debate, but all we have are saccharine, uncritical devotionals to the NHS

If you were the CEO of a company whose costs were relentlessly increasing and competitors gaining ground with every passing quarter, what would you do?

Would you waste valuable time looking back wistfully on the glory days, when every product launch was an unparalleled success and new customers were queueing around the block? Or would you take a hard-headed, dispassionate look at what was necessary – redundancies, divestments, acquisitions, innovations – to reshape and refocus the firm to prosper in the new, harsher environment?

Any executive worth their salt would do the latter. Corporate graveyards are littered with the bones of executives and companies who chose to dwell on a romanticised, sentimental vision of the past rather than face the difficult future.

Sadly, when it comes to the NHS we adopt the former, toxic mindset. Rather than thinking dispassionately about how best to deliver healthcare to an advanced nation of 65 million ageing, fattening citizens, we prefer to think of the glory days of socialised healthcare while utterly neglecting the future. We prefer to smugly bask in what we consider the wisdom and compassion of the post-war generation who created the NHS rather than ask ourselves whether what worked in 1948 will still work seventy years later in 2018, let alone by its centenary in 2048.

There is more than enough blame to go around for this depressing state of affairs. The NHS-Industrial Complex, that vast and interconnected web of (sometimes but not always well-meaning) special interests is certainly at fault. So too are glib and cowardly politicians, who would rather fire up a crowd (and win re-election) by making empty promises to Save Our NHS rather than grapple with the difficult (and politically toxic) detail. And we ourselves are to blame, for continually rewarding this short-termist and opportunistic behaviour in others.

But today’s entry in the Healthcare Hall of Shame is the Guardian newspaper, whose natural left-wing political leanings have prompted one of the worst cases of journalistic NHS hagiography in recent years. This time the Guardian have outdone themselves with their new ongoing series, This Is The NHS.

Visit the This Is The NHS mini-site and you will be confronted with three main types of story:

  1. Personal “the NHS saved my life” accounts from grateful patients
  2. Sympathetic “behind-the-scenes” profiles of staff, hospitals and departments
  3. Hectoring nanny-state demands from the public health lobby

Some of these stories are very moving, dealing as they do with illness, loss or periods of great hardship and vulnerability in the lives of their subjects. But none of them come close to explaining why taxpayer-funded, government-provided healthcare is the best possible solution for Britain. Both of these maxims – taxpayer funded, government provided – may still be optimal. Maybe. But is it not worth doing any kind of comparative analysis to be sure?

And when the physical expression of our healthcare policy is one of the five largest human bureaucracies in the history of the world, is it really not worth checking that we are on the right track, that a government-run National Health Service still makes sense?

Apparently not. Emotion and stubborn attachment triumph over reason, and we are supposed to suspend our critical faculties and clap along to each positive story about the NHS without questioning what treatment (if any) in each scenario is unique to the NHS and would not have been given to an equivalent patient in, say, Canada or France.

I take this extremely personally. Like most people, I have had occasion to use various NHS services throughout my life, sometimes – such as when I came down with appendicitis – at times of physical pain and imminent danger to my wellbeing. Naturally I was very grateful for the excellent, professional service that I received.

But I deeply resent my natural feelings of gratitude – and those of countless other people, many of them featured in the Guardian’s This Is the NHS series – being taken and deliberately twisted into a cynical piece of emotionally manipulative propaganda by journalists and special interests with a strong (and shamefully undeclared) desire to maintain one very specific model of healthcare funding and provision. That is simply not right.

The Guardian would hate this analogy, but with their navel-gazing, introspective examination of the status quo when it comes to British healthcare, they are exhibiting the same lazy superiority complex shown by US conservatives when ObamaCare was being debated. Like American conservatives, the Guardian (and nearly the entire British Left) stubbornly believe that their respective systems are the envy of the world, and insist on saying so loudly and repeatedly while failing to provide any proof whatsoever to back up their assertions.

As the ObamaCare debate raged in America, countless Republican politicians and Tea Party activists could be found ranting about President Obama’s evil socialist plan to destroy the “greatest healthcare system in the world”. And today, as David Cameron’s Conservative government rearranges the deckchairs in an attempt to look purposeful when it comes to healthcare, foaming-at-the-mouth left-wing activists shriek to anyone who will listen about the Evil Tories and their dastardly plan to sell off the NHS to their rich friends while leaving the sick and elderly to die on the streets.

Of course, both claims are ridiculous hyperbole. The Affordable Care Act (ObamaCare) was a relatively timid, incremental and (thus far) underwhelming attempt to expand the existing system of private healthcare coverage to more Americans. And whatever privatisation schemes the Tories may have cooked up to date are a drop in the ocean in terms of the total volume of services delivered by the NHS, and do nothing to change the twin fundamentals of taxpayer-funded care, free at the point of use.

So given the fact that nothing remotely shocking or remarkable is currently happening in terms of British healthcare policy, why publish the This Is The NHS series in the first place? The Guardian portentously explains:

Our aspiration is to examine a broad range of issues, from the strains on A&E to standards of care for the elderly, the multi-layered issues surrounding mental health, chronic disease, the high cost of drugs and the impact of alcohol. And exciting treatments using new sciences and cutting-edge technology. We want to understand the dilemmas over prioritisation, over-prescribing and the cost of drugs. And the fiendishly complicated way the service is managed and run. We want to address the question: do we have the NHS we need? The aim is to do this through diaries, fly-on-the-wall reporting, interviews, films and explanation.

We have asked a large sample of our readers what they want from this project. The most engaging focus, ahead of anything else was … hope. “I’d like to see both sides of the story, as all we hear about is the failings or pay issues,” one reader said. “What about those patients who have been cared for amazingly, staff who are brilliant at their job and enjoy it?” Another urged that amid all the perceived problems: “The successes of the NHS need to be celebrated.”

In other words, the Guardian is seeking to satisfy the desire of its left-wing readership to hear stories confirming how wonderful the NHS is. Sure, there will be a few token negative experiences thrown in to give the appearance of objectivity (though anecdotally, I have noticed far more positive than negative stories thus far). But there will under no circumstances be any challenge to the fundamental assumption that the NHS model is Good and Virtuous, and not to be questioned under any circumstances.

Imagine if the Guardian set out to create a similar month-long deep-dive series examining the workings of the Ministry of Defence and Britain’s armed forces. The Guardian’s journalists and commentators would have a field day forensically examining and questioning every element of spending, every organisational aspect and every core function. They would see it as their journalistic duty to take a root-and-branch view of the whole organisation, to muse about the very meaning of defence and national security in the modern age, and question whether the existing deeply historical structures are equal to our current and future challenges. And they would actually be right to do so, even though they and this blog would come to very different conclusions.

But when it comes to the NHS, nothing and nobody is allowed to challenge the dusty 1940s dogmas upon which the British healthcare system is built. Everything is up for debate – so long as the answer involves pumping more money into the same, fundamentally unreformed system.

This is stubborn childishness in the extreme. An infantilised British public (particularly the metropolitan left-wing segment who comprise the Guardian’s readership) demand stories which make us feel better about Our Beloved NHS, and which reassure us that the NHS is doing lots of great things despite the endless succession of negative headlines. And the Guardian responds with a spectacularly uncritical, depressingly uncurious series of devotionals to the decaying status quo.

I’ve said it many times before, but it still bears repeating: our blind, unquestioning devotion to the NHS is quite literally killing us. And thus far, the Guardian’s “This Is the NHS” series – which could have been the catalyst for a serious discussion – is just another smug monument to our national sickness/religion.

NHS Worship - London Olympic Games 1

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