Opinion | The Year in Opinion Video

Decades ago, the leaders of Britain launched a, frankly, incredible plan, to provide every kind of medical treatment to everyone free of charge. It had never been done on this scale under capitalism before, and Britain was broke. But with courage and vision, these politicians pulled it off. [INSTRUMENTAL MUSIC PLAYING] The National Health Service was born, and overnight, every medical treatment, from blood tests to brain surgery, became available to millions who could previously never afford it — no deductibles, no co-pays. Here in Britain, we are fiercely proud of the N.H.S. It’s this towering monument to social generosity, rooted in the belief that health care is a human right, not a luxury. We love it more than the royal family and football. I mean, even ISIS thought it was worth copying. [INSTRUMENTAL MUSIC PLAYING] We Brits haven’t had much to brag about of late, but the N.H.S. was one of them. Not anymore. “The worst crisis ever to face the NHS —” “— departments are described as war zones.” “N.H.S. trusts have canceled half of their elective surgeries.” “We don’t have enough beds.” “Staff are striking.” “Up to 500 people are dying each week because of delays.” It’s an absolute mess. Millions are waiting months to get treatment. People are pulling out their own teeth — all of it compounded by wave after wave of strikes. It all feels like we’re at the end of a badly played game of Jenga, and we’re all anxiously wondering: Is the best thing we’ve ever created about to collapse? [INSTRUMENTAL MUSIC PLAYING] I was brought into the world by N.H.S. doctors, in this hospital right here, and I’ve grown up, like many Brits, kind of taking the service for granted, so this whole situation is really confusing. How has such an incredible institution been brought so close to the edge of ruin? Now, talk to some politicians and pundits around here, and they’ll give you two explanations, firstly, that universal health care just no longer works and, secondly, that it’s too expensive. After all, the N.H.S. was built for a 1950s world, and a lot’s changed since then. Britain’s population has ballooned. We all live a lot longer. But this doesn’t really hold water. Throughout most of its history, the N.H.S. has largely grown to meet the nation’s needs. Until recently, it frequently ranked as one of the best health care systems in the developed world. And as for the cost, well, Britain spends just one, two, three, four, five and a half thousand dollars a year per person on health care. That’s less than almost all other European countries and way less than the U.S. Its efficiency makes it one of the best-value health care systems in the developed world. It’s not perfect, but universal health care works just fine, thank you very much. So what’s really going on? There’s clearly more to this. So my colleagues and I spoke with doctors and health experts around the U.K., and they told us a different story, one that should worry all of us, really, of a long, slow undermining of a public institution by the governments who are supposed to be protecting it. All right, let’s start with something really basic. If you want to run a health service, you need doctors, nurses, paramedics — Well, not only that. You need enough of the right kinds of doctors and nurses, right? You need to plan ahead, forecast your medical needs and replenish the pipeline accordingly. Well, for decades, the U.K. government’s failed to do any of that. And so holes appeared in our work force. We used to fill them by hiring medics from other countries, but Brexit put a squeeze on all that. The N.H.S. is now short of more than 150,000 staff. The British government finally put together a long-term plan to train new staff, but it takes 15 years to train a doctor, by which point our needs will have changed again. This kind of short-term thinking and incompetence, frankly, isn’t isolated. It’s part of a pattern that’s done a lot of damage to the N.H.S. To show you what I mean, I need to tell you a different story, one that begins more than 30 years ago. [INSTRUMENTAL MUSIC PLAYING] 1990: Margaret Thatcher passes legislation requiring hospitals to compete against each other for patients. 1997: Tony Blair forces the N.H.S. to take expensive loans to build new hospitals. 2012: David Cameron gives private contractors access to even more of the N.H.S. And then 2022: Yet another bill gives corporations more control of N.H.S. spending. Brick by brick, parts of this public institution are being handed over to the private sector. And look, privatization isn’t necessarily bad. It encourages innovation and efficiency, perhaps. But here, it’s had a destabilizing effect, draining the N.H.S. of its own doctors and nurses and burdening it with debt, all the while skimming what should be public money into the pockets of American health care corporations. Now, we’re not anywhere near the two-tier U.S. health system yet. But today, some N.H.S. hospitals, including this one right here, have whole floors reserved for private patients. Those GoFundMe campaigns for medical costs you see all over the U.S., well, they happen here, too, now as well. How rich we are is beginning to determine how quickly and how well we get treated, and that’s a violation of those core ideals at the foundation of the N.H.S. Now, there are a whole bunch of other things I could tell you about, from the, frankly, embarrassing failure to digitize patient records to the woeful underfunding of home health care. But I really want to tell you about this last one, because it’s a doozy. It’s the thing few in government will mention, but it’s critical in explaining this whole mess. [INSTRUMENTAL MUSIC PLAYING] Britain’s leaders always understood that the N.H.S. budget had to grow a little each year if it’s to work. And for its whole history, even the most conservative governments obliged. That is, until this guy. After the 2008 financial crisis, David Cameron effectively froze the N.H.S. budget. The systems lost $50 billion of investments each year for most of the last 13 years. It’s one of the main reasons these doctors keep striking. Their salaries have effectively fallen more than 10 percent in that time. And don’t forget, this is in one of the most cost-effective health systems in the world. Weakened by privatization, gutted of staff and money, the N.H.S. was in a bad way in 2019. And then, right on cue, Covid. “I don’t think the model of the N.H.S., as it was set up some 70 years ago, is sustainable for the future.” “And I think we should privatize the N.H.S. I don’t think it’s fit for purpose as it stands.” “The N.H.S. should be stripped down to providing emergency care, and all the hospitals should be privatized.” We don’t need a different health care service. We need to rebuild the one we already have, brick by brick, from the foundation up. But the political will, the courage and the vision required to do that, is evaporating. We’re at risk of abandoning the idea of universal health care itself, and if we do, we’ll all lose the world’s most famous example of an ideal: that health care is a human right and a public responsibility. [INSTRUMENTAL MUSIC PLAYING]