Eight proposals for a less irrational healthcare debate


Housing and Planning
Critics of the NHS often find it frustrating how emotional many otherwise completely reasonable people become when it comes to the health service. True, healthcare is always and everywhere an emotive topic. There is probably no country in the world where you can see the participants of a political discussion programme expressing widely divergent views on healthcare in a perfectly calm and reasoned manner. But there are a number of particularities, over and above the topic-specific difficulties, which make the British healthcare debate especially immune to reason. These find their expression in a few recurring catchphrases which appeal to strong sentiments, but which contribute nothing to our understanding of how healthcare works.

If I had my own discussion programme and was hosting a debate on healthcare reform, there are a number of phrases and non-statements which I would altogether ban from my show, and a speaker reverting to any of them would be expelled from the studio. More specifically, I would make every participant sign the following code of conduct beforehand:

1. Avoid phrases like ‘The NHS once saved my life’ (aka ‘The NHS once saved my [insert a close relative]’s life’). Presumably, what you mean by that is ‘Modern medicine saved my life’, or ‘A skilled doctor saved my life’, or at best ‘The fact that a medical treatment I needed was both available in this country, and accessible to me, saved my life’. Before you blurt out a commonplace phrase like the above, ask yourself: would you have died if you had contracted the same condition whilst living in the Netherlands, France or Belgium? You only have permission to claim that the NHS ‘saved your life’ if you have a good reason to answer this question in the affirmative.

2. Don’t talk about how you once fell ill while travelling through a third world country, and how your experience of their healthcare system made you realise how wonderful the NHS was. Ask yourself whether you would invoke a comparison like that if the programme was about the state of the infrastructure, the quality of the social housing stock, or educational performance. What would you make of someone who argued: ‘I have been to Zimbabwe, and it’s a lot worse there, ergo, everything is great here’?

3. For the same reasons as outlined under Point 2, don’t benchmark the contemporary state of the NHS against healthcare in the Victorian era.

4. If you make international comparisons, don’t pretend the world consists only of the UK and the USA. Nobody in the UK wants to introduce the American healthcare system. But you may come across people in this programme who want to introduce something resembling the model of healthcare in the Netherlands, or Switzerland, or France, or some such country. If so, tell them why you think the British model is superior to the Dutch, the Swiss and/or the French model.

5. Don’t pontificate about the fact that the UK has achieved universal healthcare coverage. Every developed country apart from the US has achieved that much (a fact which the Obamacare campaigners have, quite understandably, milked rhetorically). The UK is far from unique in this regard; it is only unique insofar as this fact is still being pointed out all the time.

6. Don’t say ‘But healthcare is not a commodity!’ or any variation thereof. Medicine is not charitable volunteering; it is a highly formalised profession, and in this sense, of course healthcare is a commodity. The commodification argument would make some sense if you were talking about, say, childcare: childcare was once provided informally within extended families and personal networks, and has since become a service that is contractually exchanged. It has thereby become ‘commodified’. But we do not have a choice between commodified and non-commodified healthcare. We can only choose whether healthcare goods/services are bought and sold under conditions of market exchange, or under conditions of government direction. If you see this as a matter of principle, explain why you think the latter is morally superior to the former.

7. Don’t assert there is no self-interested behaviour in or around the NHS. If a citizens’ initiative fights against the closure of a local hospital, or if healthcare professionals demonstrate against a reform that would expose them to a bit of competition, they are clearly pursuing their own interests. If you think this form of political rent-seeking is morally superior to the profit-seeking of a healthcare provider or an insurer, explain why.

8. Don’t escape into abstract rhetoric about ‘the spirit of 1948’, or ‘the founding principles’, unless it is relevant to people who are stuck on a waiting list or who receive substandard care today.

Admittedly, the studio would probably remain empty under those conditions. But maybe that’s why I’m writing blog posts rather than presenting a TV show.

Dr Kristian Niemietz is the IEA's Editorial Director, and Head of Political Economy. Kristian studied Economics at the Humboldt Universität zu Berlin and the Universidad de Salamanca, graduating in 2007 as Diplom-Volkswirt (≈MSc in Economics). During his studies, he interned at the Central Bank of Bolivia (2004), the National Statistics Office of Paraguay (2005), and at the IEA (2006). He also studied Political Economy at King's College London, graduating in 2013 with a PhD. Kristian previously worked as a Research Fellow at the Berlin-based Institute for Free Enterprise (IUF), and taught Economics at King's College London. He is the author of the books "Socialism: The Failed Idea That Never Dies" (2019), "Universal Healthcare Without The NHS" (2016), "Redefining The Poverty Debate" (2012) and "A New Understanding of Poverty" (2011).

1 thought on “Eight proposals for a less irrational healthcare debate”

  1. Posted 06/04/2013 at 13:53 | Permalink


    I always find your posts interesting, thoughtful and well argued. It is a great pity that you aren’t on the TV or radio more rather than juvenile loudmouth commentators like Owen Jones and Laurie Penny. Why is this?

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