Saturday 4 April 2009

NHS is failed socialist experiment, says Dan Hannan

Tory MEP Dan Hannan continues to enjoy the plaudits of the US right. It is a touching mutual appreciation society. Sean Hannity expresses his desire that Hannan will one day be Prime Minister of Britain. Hannan is glad that Fox is bringing "some sanity" to the debate about the global economic crisis.

Nobody seems to have told Fox News that Hannan backed Obama to win the Presidency. (Hannan watchers will not be surprised that he believed that whether Tory MEPs sit with the European People's Party was not just the most important issue in the Tory leadership contest but also the central consideration in assessing potential leaders of the free world. Though Hannan's first preference was the maverick libertarian Ron Paul.

In any event, Hannan is back on message in opposing the Obama-Brown approach to the recession. Though it is worth noting that Hannan does recognise the democratic legitimacy of Obama as President, unlike many of his new friends and admirers on the US right, and so resisted invitations to take cheap shots at the US President.

However, Sean Hannity also believes that Hannan can provide important testimony to persuade Americans not to introduce universal healthcare and here Hannan was very happy to oblige with his analysis of the terrible mistake which Britain has made in deciding to have a National Health Service.

"If you see a friend about to make a terrible mistake you try and warn him ... We have lived through this mistake for 60 years now. It began with the best of intentions. It began because people thought it was wrong for those who weren't well off and who couldn't afford the best healthcare to be treated differently. Everyone felt it is a nice togetherness solidarity thing if we all took part in this experiment. But the reality is that it hasn't worked. It has made people iller ... As long as you have a socialist system, no amount of extra spending is going to save it".

(Many thanks to northernmonkey on labour home for the tip and the link to the video, also picked up at RecessMonkey if you want to watch it for yourself).

Very interesting. This might make a particularly good theme for Hannan's keynote slot at the Tory Spring conference.

But, just to be boring, let's just dig a little bit into the facts about comparative healthcare so we can see if Mr Hannan's warning to the Americans stacks up.

US health spending is by far the highest in the world. It has this year hit $2.5 trillion or 17.6% of GDP. Spending is projected to double between 2008 and 2018, to $4.4 trillion or 20.3% of GDP, with public spending rising to half of the total over that period.

In terms of bang for their buck, the Americans are not doing well. As Reuters reports, "The United States spends more on healthcare than any other country, but its system is widely considered inefficient and it lags many other nations in key quality measures".

Michael Marmot is acknowledged as the leading academic expert on comparative health outcomes, and has written that:

It is well known that among rich countries, there is little correlation between gross national product (GNP) per person and
life expectancy. Greece for example, with a GNP at purchasing power parities of just more than US$17000, has a life expectancy of 78·1 years; the USA, with a GNP of more than $34000, has a life expectancy of 76·9 years. Costa Rica and Cuba stand out as countries with GNPs less than $10000 and yet life expectancies of 77·9 years and 76·5 years.

Japan - less rich but more equal - has life expectancy at birth of 81.9. Note just how terribly the most affluent society on earth is performing on infant mortality.

The evidence from the authoritative University College London study for the World Health Organisation provides conclusive evidence that the most important cause of health outcomes are broader social inequalities, noting that this 'gradient' effect exists within all developed countries as well as between them. As the Equality Trust notes, on the basis of the evidence compiled by Richard Wilkinson and Kate Pickett:

Americans living in more equal states live around 4 years longer than those living in more unequal states.

That is not because the more equal states are richer; it is because inequality matters more than absolute levels of income. That may be counter-intuitive, but a large part of this is to do with status anxiety and stress levels in relatively unequal societies. Look at the comparative evidence on mental health.

The NHS has done a great deal by taking healthcare away from the ability to pay. But it does not compensate in terms of broader well-being and health for the greater social inequalities in the UK than in other European countries, most strikingly in Scandinavia. The NHS does provide better health outcomes for the level of expenditure on health than the United States does overal. The issue about how to improve outcomes is of course a legitimate and important one. Reforms within the NHS have been informed by aspects of both European and US experience: but that is a million miles from scrapping the established - yes, socialist and popular British - principle of treatment based on need rather than ability to pay.

Doesn't that sound awfully Fabian? Well, only up to a point these days, because thinking Tory David Willetts said last month that the Tory party now "gets it" on inequality, having failed before to understand why relative social position matters so much:

The evidence has become stronger and stronger that inequality matters. That gradual accretion of the data shows that it is where you are relative to other people which matters enormously. I think that is an issue that my party had not registered, and that has now come home.

It would be very nice if this was true. I hope it is - but I have my doubts. Willetts also said the days of arguing about the core principles underpinning the NHS were over.

Hannan's honesty in saying he opposes that is is rare. Most Conservatives are against the socialist principle of the NHS in private yet champion it in public. (Boris Johnson's chief of staff Anthony Browne has also written in the past that his personal view is that "that we should ditch the ideology and ditch the NHS. This is what a great many Tory thinkers think: many Tory think-tanks have put up schemes for various insurance based models.

David Cameron has made that debate verboten in public. So many Conservatives engage in doublethink about the NHS. believe it is bloated with extra spending yet they campaign against "Brown's NHS cuts" and single out the NHS as the area where they will still match Labour spending plans. They campaign for more spending on local hospitals and maternity services.

So perhaps it is Hannan who deserves credit for honesty and consistency, though the pragmatic pro-NHS approach of the Tory leadership is tribute to how entrenched the core principles of the NHS are with the British people.

On the question of how much inequality matters, I suspect most Conservatives agree more with Hannan than with Willetts: that will continue to be the case unless the Tory leadership really wants to have that argument and flesh out its claim to progressive credentials.


DavidBrede said...

Hooray for Hannan for exposing the real thoughts of the Tories sheltering behind the smile of the nice Mr Cameron.

James James said...

I'm getting tired of these Labour smears.

Most of your post is irrelevant, since Hannan does not advocate that we change to the American system. He advocates "universal health accounts", like in Singapore.

I happen to disagree with him on this, but please stop trying to drown out anyone who voices a smidgen of critism for the NHS, especially when they're proposing alternatives. The NHS is a failed socialist experiment. Can't we at least listen to people with new ideas?

Anthony Z said...

If quoting something that Dan Hannan's own words is a smear, what is a glib unsupported statement that the NHS is a failed socialist experiment? Incisive comparative analysis?

Charlie Marks said...

"Hannan does not advocate that we change to the American system"

Not in public, he's not stupid. The tactic is baby steps - first universal health accounts, then they'll work on the "universal" bit.

Anonymous said...

So if people are unable to afford healthcare, they should do without or have to rely on the charity of others?

We don't fully realise how lucky we are to have the NHS.