In my previous post, I called the NHS illiberal. This has received at least one criticism so I thought I’d explain.
Firstly, I’m not calling the concept of seeking to ensure every person in the country has access to health care illiberal. There are very good arguments for why this is liberal, and I tend to agree with them. What I am calling illiberal is the means we use to attempt to ensure this.
Unfortunately, there is a tendancy in this country to believe the propaganda which has been fed to us over the years about the NHS, that it is the envy of the world, that it is a marvelous system and there could be no better.
Frankly, that is utter rubbish. What we have is a system which is creaking at the seams, which cannot provide the coverage it claims to for everyone and which the rest of the world look at as an example of how not to do things.
This tendancy to idealise the NHS means that any attack on it is an attack on any system of universal health care. This is not the case. True, some in the liberal tradition do reject the idea of universal health care, they make good arguments, but I don’t believe their arguments are conclusive.
So, why is the NHS illiberal?
Firstly, it is state owned. As a rule of thumb, there is a liberal justification for national ownership of natural monopolies, but health care is not even close to a natural monopoly. To have a state owned health service flies in the face of liberal tradition and thought about restricting state power, of dispersal of power. Instead, the NHS is a socialist construct, constructed using the myth of state control being effective.
The NHS is centrally managed, a fact which makes it even more illiberal. It cannot respond to local circumstance. The national pay structure treats all nurses as the same, all areas of the country as the same, it distorts the labour market and makes it more difficult to work in more expensive parts of the country. Liberals try not to distort the labour market, they know that such acts are dangerous and distort market signals. The last Liberal government knew this when confronted with massive unemployment they sought solutions which would enable the market to operate more effectively rather than distort it.
If you wish to talk about equality, not of outcome but of the liberal concept of opportunity, the NHS fails on that front. It prevents any opportunity for choice in treatments or care for the vast majority of the population.
The monopoly the NHS has on care prevents some from getting the treatment they need. If you are mentally ill and violent towards staff, rather than getting care you are liable to be banned from getting care. The decrease in the number of hospitals makes it more difficult to get alternative care if you’re not satisfied with the care you’re getting.
Targets are a nonsense, and whilst not a central part in the construction of the NHS, they are part of today’s system. They are a symptom of the central control by politicians. Nobody can know the circumstance of every patient, nobody can hope to manage the NHS to provide the best possible care for all. Liberalism explains why.
The NHS is fundamentally an illiberal system. At its heart, the failures of the NHS are due to illiberal nature. A liberal government would seek to correct this. There are various possible systems, none without problems, but most more liberal. We need serious debate about them in the Liberal Democrats. It is possible to ensure health cover for all with a far far more liberal system and that should be our aim.
