No, there is no conspiracy to replace the NHS with a marketised system – and more’s the pity

It is clear that Britain’s National Health Service is failing. 7.6 million people are on a waiting list, and 41% of them say their health has got worse while waiting for treatment. The UK has significantly fewer hospital beds, doctors, nurses, CT scanners, and MRI units than the OECD average. Furthermore, the UK has the second-highest rate of treatable deaths in Western Europe.

Yet despite all the evidence, British people still believe the NHS is the single best thing about Britain. From the country clapping outside their houses to “thank our NHS” during the Covid-19 pandemic, to the Prime Minister and the Leader of the Opposition attending a mass ceremony to celebrate the NHS’s 75th anniversary, praise for this institution is everywhere.

Even though it’s self-evident the emperor has no clothes, the NHS is treated like a sacred cow. This begs the question: why are people so loyal to a system that is clearly failing them?

There is a prevalent conspiracy theory that the NHS is being intentionally underfunded by the Conservative government so that the resulting poor outcomes will provide justification for them to privatise it and transform it into the American model of healthcare. This theory is pushed by establishment figures: from senior members of the British Medical Association, journalists, and Members of Parliament.

This theory achieves two things. One, it shifts blame for poor outcomes away from the NHS as a system itself and toward the politicians currently in power. Two, it frames the debate with the assumption that privatisation is a bad thing, causing any meaningful reform to be met with fear mongering.

This narrative has caused a massive issue for opponents of the NHS as there are multiple levels of misleading rhetoric. The fact of the matter is that the Conservatives are not privatising or underfunding the NHS. Furthermore, whether it be a fully privatised system or even mixed system as seen in other European countries, free-market reform would significantly help patients and doctors.


According to OECD measures, the NHS has the 6th highest healthcare spending out of the 32 included countries at 11.3% of GDP. Yet at least within this group, there is only a weak relationship between spending levels and healthcare outcomes.

The overall share of spending on healthcare rose by 14% since 2010, making the UK’s the third highest jump in healthcare spending. The NHS is continuously getting funding boosts, yet it still underperforms.

Of course, there could always be more funding for healthcare. But why is that the only solution that is ever put forward? What if there was a way to get better health outcomes without spending more taxpayer money? What if changing the system is a better solution than throwing more money at a system that clearly isn’t working?


Scaremongering about NHS privatisation is nothing new. In fact, it can be dated back to the 1980s, where The Times predicted the NHS would be turned into an American-style healthcare system. This begs the question, if the Conservatives have been plotting to privatise the NHS for four decades, why haven’t they done it already?

One obvious answer is that they are not in fact trying to privatise the NHS.

As the IEA’s Kristian Niemietz writes:

“The NHS is also one of the least privatised and marketised health systems in the developed world. For example, the private sector only accounts for one tenth of the UK hospital sector, compared to 30% in Austria, 38% in the neoliberal laissez-faire hellhole of France, 60% in Germany, 72% in Belgium, and 100% in Norway and the Netherlands. If it really were ‘the price of privatisation that people will die’, most of the population of Europe would be dead.”

Yet despite this, the NHS conspiracy theorists consistently bang on that the government is conspiring to privatise the NHS. Time and time again, they accuse any piece of healthcare reform as an attempt to privatise the NHS through the back door. When they realise their prophecies of NHS privatisation don’t come true, they swiftly move on to accusing another piece of policy.

In his paper, Repeat Prescription? The NHS and four decades of privatisation paranoiaNiemietz points out:

“It is not unusual for privatisation prophets to spend years peddling one particular version (e.g., ‘The Health and Social Care Act 2012 is a Trojan Horse for the privatisation of the NHS’), drop it in a heartbeat and then adopt a completely different one (e.g., ‘The UK–US trade deal is a Trojan Horse for the privatisation of the NHS’).”

Moving Towards an American Model?

Even if the NHS were being privatised, it wouldn’t mean the UK would copy the American model of healthcare. Even prominent opponents of the NHS in the UK are not advocating for us to copy America. There are many other countries which have a greater emphasis on the private sector which perform better than the UK and which look nothing like America. The Netherlands, Singapore, and Australia are all examples of relatively successful mixed systems of healthcare.

Despite Bernie Sanders looking to the Nordic countries for socialist inspiration, the truth is these countries also significantly rely on the private sector for healthcare. As Ulyana Kubini wrote for FEE on Scandinavian healthcare:

“While the Nordic nations do provide publicly-funded healthcare, they also allow private health insurance options to their citizens. This private insurance allows individuals to bypass long wait times and access higher-quality care. In Sweden, over 643,000 individuals are solely covered by private insurance groups.

Similarly, in Denmark, the private supplementary insurance program, Sygeforsikring Danmark, covers over 14% of the Danish population, with 42% having at least some coverage provided by the private sector.”

While these countries don’t have free-market systems, they are a good indicator that freeing up the market somewhat results in better healthcare outcomes.

American Healthcare? Hardly a Free Market!

Furthermore, it must be pointed out that the US system of healthcare is not a reflection of healthcare under a free market system. The United States’ healthcare system is crushed by government intervention with regulations and state-supplied healthcare.

As Ron Paul wrote in The Revolution, A Manifesto:

“Just about everyone is unhappy with the healthcare system we have now, a system some people wrongly blame on the free market. To the contrary, our system is shot through with government intervention, regulation, mandates and other distortions that have put us in this unenviable situation.”

To give just one example, the American Medical Association has been lobbying the government since the late nineteenth century for stricter licensing requirements and tougher accreditation standards. While they dress it up as being in the “public interest,” the impact of this lobbying has been to restrict the supply of doctors, leading to higher prices and fewer choices.

Advocating for a True Free-Market System

Opponents of free-market healthcare too often appeal to emotion to advance their position. However, if they really looked at the facts and data, they would see that the single-payer system they advocate for continuously fails and healthcare systems with a greater amount of choice and freedom provide better outcomes. This is consistent with economic reasoning, which teaches us that choice and competition are the key to seeing higher quality and lower costs.

Advocates of free-market healthcare shouldn’t shy away from the battle due to fear of emotive arguments. Instead, they should embrace the challenge and show how capitalism is the antidote to the pain caused by state healthcare.


This article was first published by the Foundation for Economic Education (FEE).

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