Expert Claims NHS ‘Cult’ Status Hinders Progress in Exploring Alternative Health Systems

Kristian Niemietz says 'NHS patriotism' is the only kind of patriotism that's socially acceptable

Kristian Niemietz, an expert on reformation of Britain’s National Health Service being interviewed by NTD in London on July 25, 2023. NTD

Britain’s health service could be significantly improved by adopting successful alternative systems that have proven effective in other countries, however, the NHS’s cult-like grip prevents any meaningful debate on the matter, according to an economist.

Kristian Niemietz is an expert on the reformation of the NHS, a topic that has seen him subject to backlash and attack.

Speaking to NTD’s Lee Hall for the “British Thought Leaders” programme, Mr. Niemietz, head of political economy at the Institute of Economic Affairs think tank said that any criticism of the NHS is considered beyond the pale, guaranteed to trigger angry responses and accusations of bad faith, due to the special status the NHS has in the hearts and minds of the British public.

Dominic Lipinski/PA

‘The Envy of the World’

Mr. Niemietz pointed out that there’s a very “peculiar set of myths” associated with the NHS. A kind of myth that, once spelled out, reveals its“ absurdity, becoming obvious and apparent.”

One of these is the idea that “the NHS is the only universal health care system in the world.” The other is that it is “the envy of the world.”

“There are, of course, other examples of state-run health services of publicly funded health services, it’s not uniquely British,” he said, adding that there are plenty of other models, even where state funding exists.

These are usually in the form of systems of overlapping regional health services.

“So Spain and Italy have systems like that. And even they are quite comfortable buying a large chunk of healthcare from the private sector,” he said.

But he said it was it is “quite unusual” to find a system such as the NHS where state financing accounts for such a big proportion of it and where the state also insists on being almost the “sole provider of healthcare.”

“It’s an unusually state-centric healthcare system,” he added.

Viable Alternatives

Often when faced with alternatives, the public hears stories and imagines an American style-healthcare system, where if they can’t afford to pay, they may end up becoming medically bankrupt.

However, Mr. Niemietz insists there are viable alternatives such as the social insurance system or social health insurance system.

“That’s basically the system of the Netherlands, Switzerland, Germany, Belgium, and Israel in a different way,” he said.

These work like a private conventional insurance system where if people do get sick, they don’t pay the doctor or hospital pharmacists directly, but they will send a bill to their insurer.

“The big difference is that in those systems, the insurance premiums that you pay, would not depend on your individual health risk,” he said.

“So if you are in bad health, if you have chronic conditions, if you have a family history of cancer, [...] or some genetic factor that makes you predisposed to some illness, that doesn’t mean that you would have to pay a higher premium or that you would be discriminated against in some other way,” he said.

“It’s a system where the what economists called the ‘good risks.’ The people in good health in this case, the good risks subsidise the bad risks, because they paid the same premium,” he added.

He said that when looking at international rankings of health outcomes, such as survival rates for cancer, heart attacks and strokes, such systems are “almost always well ahead of the NHS, sometimes among the best in the world.”

NHS

However, the discussion for change in the UK is difficult.

He said that he has faced also a lot of smear campaigns from NHS campaigners who have tried to incorrectly insinuate that he must be in the pay of some “American healthcare corporation.”

According to polls, when it comes to asking people what makes them “most proud to be British,” it’s always the NHS that is the number one response by a “massive, massive distance.”

This scores higher than, for example, Britain’s role in the Second World War in standing up to fascism.

“That is way behind the NHS by a massive distance. We’re talking about something like 40 percentage points or so. So that’s a repeated result,” he said.

“NHS patriotism is the only kind of patriotism that’s socially acceptable, that even woke progressives would accept or even embrace,” he said.

Such a demographic would normally consider patriotism “very low status, low brow,” but if it’s about the NHS, “then it becomes socially acceptable and permissible.”

“Emotional Blackmail”

Furthermore, he is often faced with defenders who tap into what he calls “NHS sentimentalism” when they say someone’s life has been saved, an argument which is used as a form of “emotional blackmail.”

“And it’s not as if everyone in the medical profession was fully signed up to this cult around the NHS. It’s just there’s an enormous amount of group pressure,” he said.

Ultimately, Mr. Niemietz said that change will not come from the NHS being seen as “bad,” ie. record numbers of patients struggling to get appointments and waits in A&E, etc.

“If that alone were enough to push to lead to a push for reform, then it would have happened already,” he said.

Though he said that in the past few years, it has become more acceptable to criticize the NHS, though the debate culture needs to change.

He added that more voices are pointing “towards better alternatives” explaining how they work and “that there’s nothing scary about them.”

“That would have to happen on a bigger scale,” he said.