I’ve recently started watching “The Man in the High Castle,” a TV adaptation of a Philip K. Dick novel. It tells the story of what the world would have been like if Germany and Japan had won WWII. It really does make you consider how life would have been different, and how things that we take for granted now might have been totally different had the victors been the Axis instead of the Allied countries.
As a corollary, it made me think about what healthcare provision in the UK might have looked like if the NHS had not been created in 1948.
Prior to 1948, the provision of health services was largely private and mainly based on three sources:
- Charity and the voluntary sector
- Private health care: Hospitals were fee-paying or voluntary; primary care was mainly fee-paying or insurance-based
- The Poor Law and local government: Poor Law hospitals were transferred to local government by the 1930 Poor Law Act
Bear in mind that average life expectancy in 1948 was far lower than it is today:
There were a number of ways to assess whether someone was entitled to free healthcare provision, which mainly centred around means testing. Private healthcare could be bought directly from the hospitals or through private insurers (as is still done), and most payments were made upfront.
If the 1942 Beveridge Report proposing widespread reform to social welfare had not been written, and the NHS and welfare state had not been pushed into being, what might the state of healthcare be like today?
It could be very similar to the situation in a number of other European countries, such as France and Germany where there are a number of of statutory health insurers. People can join these through their employers, there is cost-sharing, some key exemptions, and around 10% of the population take private healthcare insurance (compared to 11% in the UK). Alternatively, could it have ended up more like the United States, where around 14% of people are uninsured for healthcare service provision?
Nations tend to be very protective of their approach to healthcare. So, as a Brit, I like to think that with the balance between left and right that the UK seems to strike in its governments (although the two have been more blurred over the last 20 years), we would not have reached the same situation that the United States has found itself in, spending over 17% of its GDP without achieving effective healthcare coverage for all those who need it. (As a comparator, the UK currently spends around 9% of its GDP on healthcare). Of course, my U.S. collegaues may be less enthusiastic than me about the provision of “socialized healthcare.”
It is possible that without the NHS, there could have been a more striking difference in the healthcare services available to the “haves” and the “have-nots.” Three-tiered healthcare services with only limited services available to those who are too poor or ill to pay, and a “squeezed middle” segment who are too rich to qualify for free treatment, and too poor to pay for everything they need.
For all of its faults, I’d argue that a healthcare system that is free at the point of care for all those who need to use it is a social ideal that many countries have strived for over the years. The NHS is not perfect, many people have to pay for their prescriptions, and the same doctor can be accessed far more rapidly for an elective treatment using private healthcare insurance than via the NHS. However, for the British people, it is the closest thing we have to a national religion, and woe betide the Man in the High Castle who tries to take it away from us.