Many years ago, when I was a student in the United States, my roommate asked if it was true that ‘bums in the UK knocked down in the street’ got free treatment. I was proud to reply yes. My room mate marvelled at our ‘communist’ system.
Twenty-five years later, I am no less proud; there is no doubt that a mark of a civilised society – and of civilised politics – is the provision we make for the most vulnerable. Alas, the fact is that the price of civilisation is getting steeper and steeper. According to economist Anatol Kerensky:
‘The fiscal costs of ageing to the British government—even assuming some moderation in the relentless rise of healthcare prices and no further expansions of health or pension entitlements—are calculated by the IMF as 335 per cent of GDP. That is equivalent to roughly £5 trillion, or almost £200,000 for every British household. In comparison with such figures, concerns about bank bailout costs and fiscal stimulus plans should pale into insignificance. The situation is broadly similar in the US and Japan.’
If this projection is correct, then any government, Labour or Tory, if it is to keep the NHS free at point of provision, and paid for from taxes, will have to do one of two things (or both): it will either have to cut back entitlements or raise taxes to meet them.
The spectre of ever-rising NHS costs also raises the prospect of the NHS becoming the cuckoo in the nest, with other public services sacrificed to keep it fed.
This does not mean we should want to see the NHS privatised or uninsured ‘bums in the street’ left to die.
It means that we need to think about the correct balance between state and private provision within the NHS. Perhaps the NHS continues to provide acute and emergency services, but a mixture of state-private provision applies elsewhere and the state carries on paying medics’ salaries, to ensure that doctors will work in remote or poorer corners of the country.
It means we have to accept that any public service needs not only money but a civic culture that tempers the demand for unlimited entitlement.
It means questioning just how far we want to go in financing the NHS at the expense of other public services. In the UK, we are a long way away from even beginning to consider these matters seriously.
Politicians treat the NHS like a political football but also like a political hot potato. That tells us one reason why politicians lie when it comes to the NHS: perhaps the public don’t want to hear the truth.