In the United Kingdom’s July 1945 election, Clement Attlee and his Labour party achieved a landslide victory over Winston Churchill and his Tories. Promising to end the Churchill government’s wartime austerity, Attlee went on to create sweeping social, political, and economic reforms that transformed Britain into an efficient and popular welfare state. Among the crowning achievements of the new government, the NHS was created to provide free healthcare to millions of British citizens, regardless of race, gender, or economic considerations. The policies of nationalization, strong trade unions, regulations, and Keynesian economics found backing in both major political parties. That is until the economic crisis and subsequent rise of Thatcherism in the late 1970’s led to a re-emphasis on deregulation, privatization, and austerity measures. Currently, many of Attlee’s policies have been scrapped in efforts to aid privatization and the free market. Trade unions have lost significant economic and political leverage, while previously nationalized industries such as the railway are now owned by private business entities. While the NHS was left untouched for many decades due to its incredible popularity, politicians today wonder about the possibility of dismantling and privatizing it. Would a privately-run healthcare system in Britain see greater advances in medicine and a higher quality of treatment? Or would a privatized system deny healthcare to those not having the privilege of wealth?
On the right, many would characterize the modern NHS as a bloated, inefficient organization. Neoliberals would point towards reports indicating that rates of successful breast, prostate, lung, and bowel cancer treatment are lower in the UK’s government run hospitals compared to their privatized counterparts in the Netherlands or their mixed public-private counterparts in Germany. Those in favor of some form of privatization argue that by allowing elements of the NHS to be privatized, these services might better be performed by corporations seeking to maximize profits. Furthermore, they argue that the competition created through privatization would lead to faster treatment times and higher quality treatment, as patients could then choose between a variety of uniquely run hospitals and then acquire the best treatment that they could afford. The NHS promises maximum waiting times for meeting with specialists so as to ensure that those in urgent need acquire fast treatment. However, the waiting times of these UK hospitals are reaching record levels, with over 4 million patients waiting for treatment. Such statistics are almost unheard of in countries such as the United States with a privatized healthcare system. A turn towards an open healthcare market and a deregulation of the healthcare industry could therefore provide millions of UK residents the opportunity to enjoy faster specialized medical treatment and likely reduce complications due to delayed treatment. Conservatives would also argue that the NHS is an expensive organization, costing Britain’s taxpayers roughly 143 billion pounds per year (or $4,192 per person). While this ranks Britain as one of the least expensive systems in the Western world (comparatively, the U.S. spent $3.3 trillion, or $9,892 per person, in 2016), some would argue that efforts to privatize parts of the NHS could further reduce this cost. Besides, critics ask, why pump money into a system that gives less than adequate care? Another commonly made argument for privatization is that an active private healthcare market would encourage innovative medical techniques that could further save lives. While there is little quantitative evidence suggesting this outcome, neoclassical economists in the Austrian School endorse free market competition as a major driver of invention.
The fervor with which some advocate privatization is only matched by the skepticism and cynicism that greets them from both left-wing defenders of the National Healthcare Service and the British population at large. They would respond that while, yes, the successful treatment rate in the Dutch system is higher, the rate at which patients are treated is significantly lower. Meaning, a significantly lower number of Dutch citizens receive treatment for medical issues than their British counterparts. Furthermore, the Dutch system often fails to adequately treat those in rural areas far from larger hospitals, as private practitioners are unwilling to relocate to poorer, less profitable areas. Therefore, even if Dutch practitioners may succeed in treatment more often, the NHS saves more lives. The economic left would also point towards healthcare as a social and public good that is inefficiently handled by a private market. There is near infinite demand for some healthcare and health treatment, giving medical companies free reign to charge high prices that exclude a large part of the population from perhaps critical medical care. If a neighbor gets sick and cannot afford treatment, that will generate a negative externality towards his fellow residents; they, too, could catch his disease and suffer the medical costs (if they can afford it). In addition, said individual will, as long as sick, not be a productive member of society. He will deprive his company of a revenue-generating worker and other corporations of a profit-generating consumer. British advocates of the NHS point towards the faster treatment of those suffering emergency injuries such as broken bones and blood loss by nationally owned hospitals as opposed to similar treatments in the United States; almost all British emergency patients can expect to receive complete treatment within 4 hours, compared to just 77% in the United States. Thus, while specialist waiting times are significantly longer, treatment for truly life threating injuries is superior in the British system than in comparative private healthcare markets.
British citizens would also point towards the privatization of the railroads as a warning to those seeking the privatization of British healthcare. Anyone who has ever been to Britain and talked to their natives has probably had a conversation about choice topics: the weather, Donald Trump, immigration, pubs, and the railways. Indeed, the population abhors the now-privatized railway system. Sold off to a variety of corporations to reduce costs and encourage free market enterprise, the result is an inefficiently run system in which competing railway lines own fragments of track, preventing smooth travel throughout the country, as the corporations compete rather than coordinate with each other. Three-hour delays are not uncommon, and British railways fare poorly compared to oft-complained-public railways in France and Italy. Strikes have risen since the privatization of railways, as workers face lower wages and longer hours, and rates of railway accidents have only increased. Defenders of the NHS argue then that the British government cannot be trusted to de-privatize an industry without massive inefficiencies that serve only to create profit for corporations.
Regardless of popular consensus, the Tory government under Theresa May has already begun the process of privatization. Under the justification of austerity and “responsible spending,” May has slashed funding for the NHS, forcing nurses to work longer hours for significantly less pay. Many nurses have been forced to leave their profession or migrate to private companies that offer better pay, creating further inefficiencies in treatment time and public healthcare quality. Noting this decline in quality, May has declared the NHS “in crisis” and begun to literally sell off parts of NHS hospitals to private corporations. The company Virgin has entirely taken over the physiology department in many hospitals, limiting the services available to those suffering from mental illness who are unable to or unwilling to pay. Many of these companies, such as Virgin, quickly became known for providing lower quality care and often being unable even to treat patients willing to pay. U.S. corporations are also eager to encroach on a new market, keenly awaiting news of further privatization efforts. Similar to the railroads, a once united system is being given off piecemeal to business entities that will likely not coordinate and perhaps even actively sabotage each other with the goal of profit. We can feel comfort, however, in knowing that while millions of citizens may lose access to healthcare and see their lives slowly spiral out of control, the free market might allow the rich to see specialists faster than ever.