Nigel Lawson said the NHS was the closest thing the English had to a religion but for progressives it now forms the basis of a viral conspiracy theory. Namely, that a shadowy nexus of Tory ministers, private insurance giants, Big Pharma and the United States government is working to abolish the NHS before our eyes. As with all conspiracy theories, this one pieces together facts and semi-facts (private health firms would, of course, like a bigger slice of the market; yes, some Tory politicians want more privatisation) into a collage of inferences, connections forced and motives assigned, at the top of which sits the Emmanuel Goldstein du jour.
The latest iteration of the conspiracy theory is that Donald Trump is conniving to snatch Britain’s health service and hand it to US corporations to divvy up for spoils. But those wishing to protest the Brexiteer plot to sell off the NHS in trade talks should be asked to consider the environment and recycle the placards from their earlier protests against the EU plot to sell off the NHS in trade talks. Just like when they were opposed to TTIP, critics of an as yet non-existent (and may-not-even-happen) US-UK trade deal are convinced they have stumbled across a dastardly plan.
The problem is that it’s the same plan they’ve been stumbling across for decades. There are only three certainties in life: death, taxes and Labour claiming the Tories are about to privatise the NHS. For 62 per cent of the NHS’s lifespan — 15,978 of 25,902 days — it has been in the hands of Tory governments, and yet Britain’s socialised healthcare system remains stubbornly socialised. Tory voters report higher levels of satisfaction with the NHS than Labour or Lib Dem voters (though this tends to be the case with supporters of the incumbent party) and a key Conservative demographic, the over 65s, are the most satisfied of all. Even if the Tories didn’t care about alienating the 53 per cent of Britons who are ‘very or quite satisfied’ with the NHS, bumping off a service beloved of their base would certainly be a brave electoral strategy.
And yet progressives have convinced themselves, variously, that the NHS is being privatised, has already been privatised or is about to be privatised. Guardian columnist Rhiannon Lucy Cosslett hallucinates an NHS ‘in the process of being deliberately run down by the Conservatives so it can finally be privatised’. Keep Our NHS Public co-chair Tony O’Sullivan says we can’t trust the Tories ‘not to use the NHS, this jewel in our crown, as a cheap bargaining chip in order to curry favour with Donald Trump’ while adding that ‘we clearly cannot trust them to be straight with us about the true extent of privatisation happening right now in our own back yard’. The completely sane lads over at the People’s Vote campaign warn that the efforts of pharmaceutical corporations against Obamacare display ‘the political culture that feeds their desire to break our NHS’ and add that ‘America First means putting the NHS last’, a courageous line to include in a document whipping up a fresh spasm of market nationalism.
The conquering ambitions of boardroom bullshitters are one thing but the realities of British politics are another. What progressives who buy into the Great Privatisation Panic don’t appreciate is that the Tories aren’t actually run by Hayek’s hipsters over at the Adam Smith Institute. Conservatives don’t like new ideas, which is why they’ve spent much of the past two centuries not having any. New ideas mean change and Tories neither like nor know how to manage change. The Tories don’t support the NHS because they’re socialists; they support it because they wouldn’t have the first clue how to go about replacing it. Sometimes inertia has its upsides.
Why is this conspiracy theory so effective? Ignorance, sentiment and fear. ‘Privatisation’ is a scary word in a country where, even post-Thatcherism, hang-ups about who delivers a service are as prevalent as concerns about its quality. For some reason, the fact that almost all GPs are private contractors is largely avoided by peddlers of the privatisation myth. The nice lady who doles out Fred Flintstone vitamins to your kids isn’t the face of private medicine they want. Nor are the numbers terribly favourable to the conspiracists. The NHS spent 7.3 per cent of its commissioning budget on private services in 2017/18 (compared to 7.7 per cent in 2016/17) and a total of £1.1bn on outside providers out of a planned spend of £124.7bn. This isn’t galloping privatisation; it’s barely even ambling.
Britons have a Pavlovian response to any mention of the NHS. Listening to a Brit talk about a middling healthcare service that oversees 9,000 avoidable deaths annually is like watching those videos of North Koreans weeping for Kim Jong-un because he made the sun rise again. In the Guardian, Cosslett writes:
‘Our relationship to the NHS is intimate. The maxim from “cradle to grave” is apt: it has brought most of us into the world and it will be there when many of us leave it. Its many hands have touched our skin, sewn it up and in many cases delved inside it, to our organs. They have mopped our brows and washed us and reassured us in moments of sadness and loss. And in return it has asked us no payment.’
It reads like an episode of Holby City written by an inspirational quote generator. Those who have felt the brunt of the NHS’s inadequacies recognise this as more than harmless purple prose. It is the ideological reinforcement of a lie — that our only choice is between well-intentioned mediocrity and barbarism; that it’s an A&E waiting room or death in a US hospital car park. If the NHS is so world-beating, why must gratitude be enforced by an emotional protection racket?