Sunday, 30 August 2009


Have you ever experienced one of those moments when you feel like utterly railing against something or someone? They’ve let you down, they’ve treated you badly, and you’re determined to do what you can to draw the flaws of the whole system to as many people as you can?

I have, and there’s a fine line to tread between, on the one hand, acting on a natural – and often legitimate – sense of injustice, and on the other, being aware that mishaps happen in life and one’s own indignation isn’t always the best guide to social injustice.

There’s a debate raging in the USA about reforming the system of medical care. The only headlines it has made over here came when Daniel Hannan, the Conservative MEP and supposedly a rising star of the party, described the NHS in an American TV debate as ‘a terrible mistake’ which we have lived through for 60 years.

I don’t know what Dan Hannan’s experiences of the NHS are. I can only assume he’s had some bad ones, and in this he’s not alone. But can anyone really justify calling the NHS a 60-year mistake?

He also said the NHS ‘makes people iller’. What, everyone? A majority even?

I sometimes get frustrated with the NHS, and in my more cynical moments feel it should be called the National Sickness Service, because by and large it only wants to know you if you’re sick. I wish it concentrated more on ‘health’ and did more preventative work like its excellent babies/toddlers health visitor service, and its many screening programmes, but is that sufficient ground for calling it a 60-year mistake?

There are two indisputable facts about the British system compared with the American. Firstly, the average person is better off under the NHS than in America. The NHS is geared up for catching everyone, regardless of circumstances – you don’t find poor people here having to hold fund-raising events to pay for operations, as frequently happens in the USA.

Secondly, we pay only 8.4% of GDP on healthcare, compared to the 16% of GDP spent by Americans, and all like-for-like comparisons show the NHS as better than the sum total of American medical care. Because we pay for the NHS through our taxes, the cost is spread across the entire country and so isn’t nearly the burden that insurance is for Americans.

What Hannan has done is to compare the medical care the rich of America get with the medical care the rich of Britain get. On that comparison, I wouldn’t be surprised if the US system comes out better. But that’s not the basis on which I want to build a national medical insurance system, thank you.

And this lies at the heart of why the Conservatives still haven’t won people round to the idea that they would be a more benign government than they were in the 1990s. Personally I think David Cameron is a fundamentally decent guy, but he has some nasty people in his cabinet, and Dan Hannan’s outburst merely shows how difficult it is for a Conservative leopard genuinely to change its spots.