17,356 arguments against the NHS

That’s how many lives would have been saved in the UK had the NHS performed at the level of the top 10 countries.

Such was the conclusion of the study of 38 developed countries conducted by Imperial College London. The study ranked the countries on four key patient-safety indicators: maternal mortality, treatable mortality, adverse effects of medical treatment and neonatal disorders. 

Norway came in first, followed by Sweden and South Korea. Britain placed 21^st, behind such global powerhouses as Austria and Estonia. The only consolation is that the US finished 12 places below the UK, though I doubt those 17,356 families of NHS victims feel properly consoled.

Add to that number those who managed to survive the NHS’s tender mercies but came out with appalling and preventable disabilities, and the picture is painted in predominantly dark hues. I can’t say I am surprised.

One of the first things I heard when settling in the UK 36 years ago was: “We are proud of our NHS.” At that time, I had no personal experience of that service, but my antennae began to twitch.

The only other country I knew that broadcast such pride to the world was the Soviet Union, where medical care was on the par with the poorer African countries. A good friend of mine, a doctor himself, once said to me he’d rather have a serious operation in Zaire than in Russia, and he knew both countries well.

Yet the Soviets insisted their healthcare was wonderful because it was free. I can only repeat what William F. Buckley said on the subject when visiting the Soviet Union. The tour guide attached to him kept reciting that boastful mantra. Buckley, well-trained in sound economics, smiled his supercilious smile and said: “Nothing is free, child”.

What the guide should have said was that Soviet medical care was free at the point of delivery, which would have been more precise. Yet it’s unclear how that particular method of financing medical care could claim moral or any other ascendancy.

Because that was all it was: a method of financing. An appendectomy costs the same whether it’s the state paying for it or the patient. A sensible argument can be made that it’s likely to cost more if the funding comes from the state, if only because of the multiple layers of bureaucracy separating patient from scalpel.

Hence Soviet braggadocio had no basis to it, other than an ideological one. It enabled paid propagandists, like that tour guide, to claim that socialism was superior to capitalism because it was the state paying for medicine. Soviet hospitals, mainly acting as anterooms to the morgues, somewhat weakened the argument, but foreign visitors weren’t told that.

Having left the Soviet Union, I spent 15 years in the US where medical care was excellent at the time, although it wasn’t free at the point of delivery. Mostly it was financed by private insurance companies, with the state stepping in only when a patient had neither insurance cover nor any means of paying for treatment.

I was never in that position myself, but some of my friends were. I noticed that the care they received at municipal hospitals was incomparably better than anything the Soviet Union could offer, and every bit as good as what I received at private hospitals. They had the benefit of exactly the same doctors, the same equipment and the same drugs as did private patients, although they didn’t have private rooms and gourmet food.

What the US medical care conspicuously lacked was an ideological aspect. No one said he was proud of it, no one held it up as proof of capitalism’s superiority over socialism. When people got ill, they were treated, usually extremely well, and no one made a fuss about it.

Then I moved to Britain, and suddenly it was back to the USSR, mercifully in that aspect only. Educated people were telling me they were proud of their NHS. I had no data at my fingertips to argue in specifics but, relying on first principles, I couldn’t believe that a publicly funded Leviathan employing tons of deadwood (as all socialist enterprises do) could deliver anything to be proud about.

“What exactly are you proud of?” I’d ask, always receiving the same reply: our medical care is free. I’d come back with the Buckley retort, to the effect that nothing is free, only to be told that ‘free’ was a figure of speech. It stood for free at the point of delivery, which was almost as moral.

The musky odour of Soviet hospitals wafted in. So, when it came to medicine, the British were as ideological as the communists, and equally irrational. They were proud of having a healthcare financed in about the least efficient way known to man just because that method of financing was socialist.

Since then, I’ve seen, heard of and experienced many horror stories about infections acquired in our unhygienic hospitals killing patients (my beloved mother-in-law went that way), people waiting months or years even for operations classified as urgent, cancer death rates similar to those in the Third World.

What I haven’t seen is any lessening of the pride that indoctrinated Britons are mandated to feel about the NHS. Since that feeling is strictly ideological in nature, it’s impervious to facts, such as the current study showing exactly where British medicine ranks in the world.

I’ve been writing about the NHS for decades, and I’ve learned enough about it to continue paying exorbitant amounts I can ill-afford for private insurance. (Incidentally, those people most proud of the NHS campaign for the abolition of private medical care.) So the survey didn’t surprise me at all.

What did surprise me was the low ranking of the US and also of France, eight places below the UK. I haven’t encountered American medicine for 36 years, and it has clearly slipped precipitously during this time. My American friends have been telling me that for years, but I never quite believed them.

My experience of French medical care, both primary and secondary, is much more current, and I’ve always found it better than our NHS, if not quite as good as our private medicine. Just goes to show how inadequate personal experience is.

Yet the French and Americans have one thing in common: neither claims a high moral ground on the basis of their medicine. They may do so for other reasons, but not this one. This absence of ideological afflatus goes a long way towards putting their medical care in my good books.

These tomes are firmly shut to the NHS – as they were shut to Soviet medicine. Never mind the ideology, chaps, feel patient safety.