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We love the NHS

All wars have unexpected casualties; in the US, the rhetorical war on anything that smacks of nationalized health insurance briefly took out Stephen Hawking's citizenship. It is, as Bugs Bunny said, to laugh:

People such as scientist Stephen Hawking wouldn't have a chance in the U.K. where the National Health Service would say the quality of life of this brilliant man, because of his physical handicaps, is essentially worthless.

Language Log's Geoffrey K. Pullum surmised that the problem is that Hawking's speech synthesizer doesn't sound British. (Pullum may not be aware that American film critic Roger Ebert's voice synthesizer does have a British accent, one so fluidly and emolliently English that Ebert and his wife refer to the synthesizer as "Sir Larry". Maybe Ebert and Hawking should swap.)

IBD has admitted the error, and slightly recast its original point, claiming now that Hawking's fame means the NHS treats him differently, and look, see, his own Web site says he has 24-hour care paid for by foundations. We were right all along: the NHS is bad! Three points. First: Hawking was diagnosed with ALS when he was 21, and had many years of care before he became famous. Two: rich, famous people get the best of every health system ever invented. See also the Royal Family. Third: what does IBD imagine Hawking's situation would be were he American?

Hawking was a bystander. The real ire, astoundingly, has been saved for, of all things, the British National Health Service, surely the least likely organization to be tasked with providing health care for Americans. Why is an economic model for providing health care being evaluated as if it were about issuing axes to doctors with orders to use them on anyone over 80?

The rhetoric - one hesitates to call it a debate - over Obama's health care plan - reminds me of the 1985 campaign against legalizing divorce in the Republic of Ireland ("Divorce hurts women and children. Vote NO.")

So some US opponents of national health insurance claim Obama wants to bring in death panels, and that the quality of health care will plummet. Whereas, the reality is that even if you dispute the 47 million figure, increasing millions of Americans have no health insurance, that the majority of American bankruptcies are due to medical bills, and that more than half of those had health insurance. The reality is also that the ongoing replacement of full-time jobs with benefits with part-time jobs and "permatemps" mean that increasing numbers of what used to be the middle class will not be covered at all. Improve the detail of Obama's plan, by all means. But does anyone seriously think the problem has not grown since Hilary Rodham Clinton's plan failed? Does anyone think that fighting over things that aren't in the plan will help matters?

For people to react this viscerally to insurance proposals says there's more going on than rational opposition (and even more rational lobbying by insurance and pharmaceutical companies spouting the evils of "socialism"). This reaction is, I believe, American Dream interruptus. It is the worst side of the pioneer spirit: the US is the land of opportunity; anyone can have access to superb treatment if they work hard enough. You make your own life, you "take care of yourself", government interference will only steal from you. You can see echoes of this in Esther Dyson's "Health 2.0" piece for the FT this week, in which she seems to suggest that better information will revolutionize health care. net.wars covered the self-quantifying movement in October 2008, and better monitoring may well help many people, but it will not solve the question of how to pay for MRIs, cancer drugs, or Alzheimers care..

Americans who genuinely believe the NHS is a bad thing are, I think, making the same mistake I made in the 1970s: they read the complaints about waiting lists, geographically uneven care, and rationed treatments, and think it must be bad. Whereas the reality is that British people complain about the post yet expect letters to arrive within 24 hours, the public transport yet juggle multiple routes across London in their heads, and the weather, which by any reasonable standard is mild, even friendly.

I have learned better.

Among all the thousands of people I have met in the UK, not one has ever said they would scrap the NHS. None has ever suggested the UK would be better off with a US-style health insurance market. To be sure, some have supplemental private insurance. But everyone agrees: for catastrophic health care you can't beat the NHS. Friends of sick US friends raise funds so they don't have to choose between drugs and food; sick UK friends do not spend their limited energy fighting through insurance company paperwork and begging insurance companies for treatment. People do not go bankrupt in the UK because of medical bills. Many of my American friends now envy me my access to the NHS - for which I pay in taxes.

The NHS may be the most democratic institution ever created: it is a rational way to share an expensive resource as well as a social compact. Because sooner or later, no matter how hard you work and how pure a lifestyle you lead, health problems will come for you, too.

Yes, we love the NHS. Millions of us.

Wendy M. Grossman's Web site has an extensive archive of her books, articles, and music, and an archive of all the earlier columns in this series. Readers are welcome to post here, follow on , or send email to netwars@skeptic.demon.co.uk.


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