The coronavirus crisis has spawned a host of new hashtags that tell us how to behave. There’s #StayingHomeSavesLives, #SafeHands, and #FlattenTheCurve. In the United Kingdom, they have an extra one: #ProtectTheNHS.
For British people, the battle against coronavirus is all about protecting their beloved National Health Service (NHS), a taxpayer-funded healthcare system that offers treatment to all UK residents. This is just as important as saving lives.
Prime Minister Boris Johnson articulated as much in a video message after he was released from an NHS hospital following his own near-fatal bout with the virus: “We are making progress in this national battle because the British public formed a human shield around this country’s greatest national asset: our National Health Service,” Johnson said, “We will win because our NHS is the beating heart of this country. It is the best of this country. It is unconquerable. It is powered by love.”
The Royal family has also gotten involved. In April, Prince Charles released a video to praise “our remarkable NHS.” In another video, Prince William and Kate Middleton and their three children applauded NHS workers, with every member of the family dressed in the same shade of blue as the NHS logo.
Of course, many leaders around the world have paid tribute to their countries’ healthcare workers during coronavirus—and rightfully so. But there is something different about what is going on in the UK. The rhetoric about the heroic doctors and nurses of the NHS battling a crisis is a standard part of their national discourse—even when there is no pandemic.
PUBLIC HEALTH CARE AS A WAY OF LIFE
The NHS is the largest single-payer healthcare system in the world. Its budget for 2019/2020 is GBP 140.4 billion (about $174 billion), making it the single largest item of public expenditure. Nearly everyone in the UK relies on it for their healthcare. Only around 10% of the population has private insurance, and even these people typically still use an NHS GP as their first point of contact.
“The National Health Service is the closest thing the English have to a religion.”
I lived in the UK between 2013 and 2015, while my husband was a student there. We also relied on the NHS for healthcare; I gave birth to my first child in an NHS hospital. It is difficult to describe the dominant, central role the NHS plays in British life to people who have not experienced it first-hand. British people talk about it constantly. And, since everyone has personal experience using the NHS, everyone has an opinion.
Discussions of the NHS often reference politician Nigel Lawson’s famous quotation from 1992, “The National Health Service is the closest thing the English have to a religion.”
Although that analogy has never made much sense to me, I think, if the NHS were similar to any religion, then it might be in the way the people of North Korea worship their Supreme Leader, Kim Jong-un. Kenneth Bae is an American missionary who was detained in North Korea between 2012 and 2014. In his book, Not Forgotten: The True Story of My Imprisonment in North Korea, Bae describes the endless propaganda films he was forced to watch: “This is the consistent message North Korean people hear from the moment they come into the world: The Leader is all you will ever need. He loves you. He cares for you. He will provide you with whatever you need.”
Similar to North Koreans, British people are indoctrinated into the NHS from birth. Literally. The vast majority of them are born in NHS hospitals. Their childhoods are steeped in NHS propaganda. They will regularly hear how wonderful the NHS is and how lucky they are to have it. During coronavirus, children across the UK have been drawing rainbows to show their support for the NHS.
When they grow up, they work for the NHS; in a country of 66 million, the NHS employs 1.5 million people. When I lived in the UK, I rarely met a family who didn’t have at least one member employed by the NHS in some capacity. The average British person will rarely, if ever, experience any other type of healthcare over the course of their life.
Support for the NHS also crosses all political affiliations. I had a friend who described herself as a libertarian, but she said to me, “We have something so precious in the NHS. We have to defend it.” I wanted to explain to her that you cannot call yourself a libertarian and also support a $174 billion government healthcare program, but it would’ve been a waste of time. Her belief was firm.
The sacred, founding principle of the NHS, is that care should be “free at the point of use.” In other words, you don’t pay for your treatment directly. However, as my husband and I frequently commented to one another during our time there, “It’s free, but you do pay for it.” The British pay for their healthcare system through high taxes and a high cost of living—the consequence of a 20% vat.
They also pay with their time. My prenatal ultrasounds at the local hospital often ran two hours or longer behind schedule. At my doctor’s office, I usually had to wait four weeks to schedule a routine blood test. The NHS lags behind the health care systems of other developed countries on many significant metrics. This is the inevitable result of having a one-size-fits-all, centrally planned health care system that is shielded from market dynamics.
British people are indoctrinated into the NHS from birth. Literally. The vast majority of them are born in NHS hospitals. Their childhoods are steeped in NHS propaganda.
The British are certainly less brainwashed than North Koreans in that they have access to information about the rest of the world. Plenty of people I spoke to were aware, on some level, that their healthcare is subpar, but they simply did not seem to care. I told a friend who worked for the NHS that, while I still lived in the United States, I had been diagnosed with a non-life-threatening condition on a Friday and underwent surgery the following Wednesday. She gave a nonchalant shrug and said, “Yeah, that would never happen here.”
To the British, the shortcomings of the NHS are somehow never the fault of the NHS. They always blame the government. I can’t tell you how often I heard a British person say something like, “If only the politicians would keep their hands off the NHS. It should be run by doctors.” They believe politicians are the reason the NHS exists in a perpetual state of crisis.
The truth is, however, that many of the failures of the NHS are due to its own non-elected managers.
Christopher Snowdon, the Head of Lifestyle Economics at the Institute for Economic Affairs, a think tank in the UK, recently wrote that NHS leadership made decisions in March that resulted in a lack of personal protective equipment for many frontline healthcare workers. It was the government, however, that took the blame. According to Snowdon, a recent BBC news report alleged that the government:
“[T]ook COVID-19 off the list of High Consequence Infectious Diseases (HCID) in March 2020, thereby allowing ‘the government’ to weaken the guidelines on PPE use. This, it suggested, was because ‘the government’ had failed to buy enough PPE to go round. But the decision to take COVID-19 off the HCID list was not made by politicians. It was made by Public Health England and their equivalents in the rest of the UK, [NHS leadership] with the Advisory Committee on Dangerous Pathogens in agreement.”
The issue is also politicized in the UK. In the British political narrative, the Conservative Party is regarded as “anti-NHS” while the Labour Party is “pro-NHS.” In 2014, a British friend told me, “If the Conservatives are reelected, the NHS will be privatized. That’s their goal.”
Conservatives have been reelected three times since then, but the NHS has yet to be privatized. However, the fact that my friend’s view is widely shared has given rise to a bizarre dynamic that has Conservative Prime Ministers constantly insisting how much they love the NHS—Johnson’s recent Coronavirus video message is a good example of this. Only Labour Prime Ministers, like Tony Blair, could occasionally get away with enacting meaningful reforms.
COVID-19 is unlikely to bring about significant change for the NHS. If anything, the pandemic has reinforced their devotion to the institution. That’s why figures like Captain Tom Moore have emerged as national heroes during the coronavirus crisis. The 100-year-old veteran raised £33 million ($41 million) for the NHS by completing laps around his garden using his walker. Apparently, British taxpayers don’t believe the $174 billion they already contribute each year is enough.
Even after the pandemic has passed, the British people will continue to believe the NHS exists in a state of crisis, and they must do all they can to support it. They accept, as an article of faith, that the NHS is perpetually underfunded, and that public health requires their allegiance.
Their lifelong indoctrination in the NHS ensures they cannot conceive of any alternative. In the UK, #ProtectTheNHS isn’t just a hashtag. It’s a way of life.