A woman is cycling along the road; a car swerves and the woman is knocked off. Traffic halts, someone rushes for a telephone, others argue whether to lift the victim. Within minutes an ambulance arrives, treatment is given and the woman taken away to an emergency hospital. Everyone knows that whatever can be done will be done.
A man is suddenly violently sick and confused at home. His wife rings their doctor who is round very quickly. He examines the patient, calls the ambulance and explains what has happened to the wife. Three hours later the patient is comfortable in bed, having been given oxygen, X-rays, two doctors’ examinations, specialist treatment, and, if he wishes it, a detailed diagnosis of his condition.
Everybody has been very helpful. No one has paid or will pay a penny personally for this.
That is one everyday aspect of our health service. In times of emergency the service functions excellently, according to its original principles. That is not the whole story – if it were, we would be living in a medical paradise – but it is an important part of our experience.
Of all the social institutions in our country, the National Health Service is the most popular. It was founded in 1948 under a Labour Government determined to make good medical care available to everyone, and it remains a monument to successful socialism, much beloved by the population who, as voters, will turn against any government which tries to interfere with its basic principles. The National Health Service provides medical care for everyone, and payment at the point of treatment is forbidden by law. (Or course, we pay for it through taxes, as we pay for the army, roads, schools, etc., but as far as treatment is concerned, it makes to difference whether you are rich or poor.)
You, too, have a National Health Service, which sometimes functions well, sometimes badly. I have heard Ukrainians complain that the failures must be the result of ‘socialist
principles’ and suggest that an American system where patients have to pay is better.
On this issue, I and my fellow-citizens and almost everyone of the hundreds of Americans with whom I have discussed their system would agree: the American health system is a catastrophe: immensely expensive, inefficient, and a source of great dread that hangs over the lives of even rich Americans. ‘What if I fall ill and have to pay hospital fees?’ In Britain we may fear illness, but not the terror of being unable to pay for it. Sometimes doubtful Americans ask, ‘But why should doctors treat you properly if they are being paid by the state rather than the patient?’ This is a question that rightly enrages British doctors. They are decently paid, and, being human, some are better than others. But there is something disgusting in the assumption that care for patients can only be equated with money. The ‘market’ is an efficient mechanism for trading, but not for basic human services.
The structure of our service is not quite like yours. If we consider essential health provision to be (1) a personal doctor; (2) specialist services which do not require a period in hospital; (3) hospital treatment – then, whereas you combine (1) and (2) in Polyclinics, we combine (2) and (3) in Hospitals with Outpatients Departments. There are arguments for both arrangements. Nowadays we are moving towards your system with the creation of ‘Health Centres’ – small polyclinics. Our personal doctors, called ‘General Practitioners’ or ‘G. P.’s’ and our Health Clinics are based round home areas, not work-places.
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