If at any point anyone had ever asked for my opinions about the NHS I would have said it was the greatest achievement of UK democracy. However, in the last 12 months I have had more contact with it than I wanted and have had more personal reasons to be grateful for its formation. The passion I have now for the NHS is tinged with the awareness that there are close members of my family who might not be here without it and that when an emergency occurred, without any thought or concerns on my part, a tender, caring and efficient service was immediately at hand. There will be times when I am critical of the NHS, particularly when it strays into and then fails in the provision of social care, failing to see disability and old age as social problems rather than medical. However, that criticism is to seek to improve the institution and should never be used to support its demise. As Butler (2006: vii) writes when discussing her criticism of feminism – a movement she lives in and adores:
There was and remains warrant for such a mode of criticism and to distinguish between self-criticism that promises a more democratic and inclusive life for the movement and criticism that seeks to undermine it altogether.
I hope never to live in a world without a National Health Service.
Life before the NHS – a lesson from the past
Harry Leslie Smith, a survivor of the Great Depression and RAF veteran, recently hit headlines with a clear account of life before the NHS and the importance of its establishment in terms of health, equality and social justice. The times before the NHS were clearly evoked as harsh, brutal and deeply unfair, forcing unnecessary losses on families without means (the full speech can be found here: http://www.politics.co.uk/video/2014/09/25/watch-the-speech-which-reduced-the-labour-conference-to-tear) This is a story which also forms part of my personal history, aware that my father was born prematurely into a pre-NHS world, but through good fortune survived, whilst his brother did not, dying aged only 1 month old from TB. His family are only now able to buy a headstone for that brother, who was buried unmarked.
The “New National Health Service” information leaflet of 1948 states:
It will provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a charity. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness. (Cited in Webster, 1998: 24)
The use of the word charity was designed to show a change in the state’s attitude to need. Receipt of charity could be seen as stigmatising and/or demeaning. In contrast, the service being offered here was the result of collective taxpayers’ achievements.
Life after the NHS – a dystopian future
However, the cycles of history do not produce carbon copies of previous episodes. Life after the NHS whilst maintaining some features, will not be the same as life before it. This is why I am writing about Lionel Shriver’s So Much For That. Lionel Shriver has written a great novel – unfortunately, this isn’t it. (We Need to talk about Kevin is a much more accomplished and memorable piece.) So Much For That is written about the US health system and its release received a great deal of attention as it coincided with the public debate surrounding Obama Care in the US. It is an angry book spurred by the grief, injustice and guilt around the death of a good friend. It is raw and splenetic, which means that sometimes it is a tub-thumper of a novel, clunky in dialogue and firing in all directions. But it gives a different account of health care – a future dystopia, no less bleak than Harry’s past.
Based around the lives of Shep and Glynis, it uncovers the role of ill-health in relationships, when health has become a commodity, to be marketed, bought and sold. Each chapter is headed by the figures from Shep’s savings account as it dwindles to pay for his terminally-ill wife’s treatment. Glynis becomes a life with a monetary value and this skews all aspects of her care.
The doctor shot him a worried look. “I have to assume that money is a secondary issue at best, if it’s an issue at all.”
“So, if I say it is an issue, I’m an animal, right? But even if I fall in line and say, by all means, doctor, do anything you can, throw the kitchen sink at that cancer – a gold-plated kitchen sink – because I love my wife and money is no object. Why do you assume I’ve got a hundred grand?”
This makes a villain of a doctor, who presumably trained to save lives.
Because Shriver really wants to make her point this is not the only dilemma in the book. Shep needs to consider how best to care for his eighty year old father. His best friends struggle to cope with the caring responsibilities of a disabled child with a rare, genetic condition. A vibrant, healthy man is left feeling inadequate with access to cosmetic surgery, but not counselling. And one of the healthiest characters in the book is being fed sugar-pill placebos, so she does not feel left out. What it means to ‘be healthy’ can no longer be felt and understood. It warps our relationship with our body and with others:
“…At least it’s sure made you thin,” Deb said wistfully.
“Yeah, right. The Mesothelioma Diet. The book’s not out yet, but you could still get a head start by chewing on some old insulation.”
So, not only is ill-health to be feared, good health cannot be enjoyed, except by marketing professionals and insurers. Within the context of late modernity, it is consumption rather than production that drives modern capitalism implanting ‘false need’ so that need can be seen as “an artefact of the consumer society” (Dean, 2010: 37). Health and welfare are reduced to consumption goods. The novel reminds us that the market and profit margins should not have a place in meeting our health needs and determining our caring relationships.
There’s a petition here I think you should see: https://secure.38degrees.org.uk/page/s/vince-cable-fix-ttip#petition
Butler, J. (2006) Gender Trouble [2nd Edition] New York and London: Routledge
Dean, H. (2010) Understanding Human Need Bristol: Policy Press
Shriver, L. (2010) So Much For That London: Harper Collins
Webster, C. (1998) The National Health Service: A Political History Oxford: Oxford University Press