“Evil,” ”Stalinist,” “Nazi.” Full of incompetence and bureaucratic bloat; a socialist system that rations care; a system where patients wait months to have their tonsils out or are left to die in squalid, ill-equipped hospitals by order of sinister death panels.
That’s how the Republican Right and anti-healthcare reform crazies characterized socialized British medicine over the summer as they railed against President Obama’s already-compromised ideas about fixing our broken U.S. system.
How did such an alleged abomination as the British National Health System (NHS) begin, and why does even the probable next Prime Minister, elitist old Etonian Conservative leader David Cameron, insist that he’ll strengthen rather than scrap it? The details and the “Who’s Who” of the story may surprise you.
The NHS is really the creation of one man, Aneurin “Nye” Bevan. It was he who was appointed Minister of Health in the incoming Labour Government that came to power after the British people had thrown Churchill out in an electoral landslide in 1945.
Bevan, then forty-seven years old and the government’s youngest member, was widely held to be the greatest orator of his generation, and Churchill’s only rival. Representing a South Wales coal constituency, he had been sent down the mines by his father at fourteen. A self-educated intellectual and long the editor of the leading socialist weekly, Tribune, Bevan was the undisputed leader of the Left. Wasp-tongued, lightning-fast on his feet, and brilliant with the wounding barbs that win debates, he was the only man in Parliament whom Churchill was said to fear. It was Bevan who in 1943 had led a parliamentary revolt on behalf of the so-called Beveridge Report, a wartime study commissioned by Churchill from the eminent social scientist Sir William Beveridge, to look into ways of bringing about fundamental social change--including universal heath care--in Britain when peace finally came. It was published, became an instant best-seller, and proved immensely popular. Bevan’s amendment—which, though defeated, garnered considerable parliamentary support--demanded Beveridge’s ambitious plan be implemented immediately. “The report describes the conditions in which the tears might be taken out of capitalism,” he said in the debate. For that, two years later the incoming prime minister, Clement Attlee gave him the job as Minister of Health.
To pinpoint his allegedly hypocritical love of lavish living, his enemies, who were legion, dubbed him “Nye the Bollinger Bolshevik.” So it was appropriate that, three months after the election, a delegation of senior British doctors arranged a preliminary meeting with the minister over dinner at one of his favorite haunts, the Café Royal, a luxurious London brasserie favored by the rich. One of them said later, “We screwed our nerves up. We might have been going to meet Adolf Hitler.” But after noticing Bevan’s well-tailored suit and legendary charm, he was forced to revise his opinion: “We were quite surprised to discover he talked English.”
Six of the seven doctors in attendance represented Britain’s general practitioners (primary care physicians) and were passionately opposed to Bevan. The seventh, Lord Moran, was the only one who liked what he heard from the minister that night. Moran—a recently ennobled Dr. Charles Wilson—was president of the august Royal College of Physicians, and was there in the plush surroundings of the Café Royal representing Britain’s specialists and hospital consultants. “Corkscrew Charlie,” as Moran was known behind his back, was one of Britain’s medical grandees, and as it happened, Churchill’s doctor. Indeed, Lord Moran had no other patients. During the war, his mission was to keep his often physically frail patient alive and alert as a matter of strategic national importance. He now proceeded to become Bevan’s friend and tutor in all matters medical. The NHS was very largely shaped by the two of them over a series of very expensive meals.
They met regularly at Madame Prunier’s, the best French restaurant in London in those austere post-war days when food rationing still ruled, and an average family had to make do with a weekly allocation of three eggs and a single of rasher of bacon. Over lashings of cold lobster and Dover sole (Madame Prunier was famous for her seafood), they shared ideas. Both agreed that the war had created a unique opportunity, an environment in which the public was receptive to government planning and central control. Moran confessed to Bevan he’d always wanted to see a free, universal, single-payer national health care system created, and that he had shared these thoughts with Churchill. Bevan had three questions. “How do we get good care for all when standards vary from one hospital to another?”
“Nationalize the lot,” Moran replied. “Get rid of local government control”
“How do we deal with the doctors?” Bevan asked next.
“Bribe the primary care physicians, and woo them with good arguments. Then force hospital doctors and specialists, the most important group in ensuring first class care, to accept salaries,” Moran retorted. “Reward them well. Pay them more then they get on average now. Give the good ones merit pay, and allow them to treat their private patients on the side.”
“What about the teaching hospitals and university medical schools?” was Bevan’s final question.
“Leave them alone, basically. They represent the future.”
It was Bevan, not Moran, who proposed that, instead of Sir William Beveridge’s planned flat insurance payment scheme in which each citizen was obligated to make the same contribution, he would insist that the government fund the NHS centrally out of the exchequer, so that the rich would pay a larger percentage than the poor under the progressive British progressive tax regime.
The tripartite structure for doctors that was incorporated into the Bill, however, was Moran’s idea. And so was the notion of nationalizing the hospitals. Specialist doctors were prepared to accept these radical notions because they more than doubled their average remuneration. However, Bevan’s proposed legislation, published in 1946, was vehemently rejected by the British Medical Association (BMA), which represented Britain’s 30,000 primary care physicians.
One former chairman of the BMA said, “I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to National Socialism as practiced in Germany.”
The BMA was initially up in arms because it feared that by nationalizing the hospitals run by local authorities, Bevan would strike down doctors’ cherished professional independence and their right to buy or sell general practices (both of which Bevan proceeded to do). “Primary care physicians,” Moran said with contempt, “are doctors who have fallen off ladders.” Churchill concurred, telling Moran that, “The doctors are not going to dictate to this country.” Always blunt, Bevan called them “poisonous dwarves.” The Minister saw medicine as a profession in which the profit motive ran counter to social values, and he despised most doctors who, he believed, were willing to put their own interests ahead of the public’s.
To win the BMA around (which he skillfully managed to do in the end, enrolling over 90 percent of BMA members into the NHS by 1948 when his Bill became law), required bribery. “I stuffed their mouths with gold,” he famously said. Churchill, now leader of the minority Conservatives, put up a halfhearted fight against Bevan. In Parliament, he delegated opposition to the NHS Bill to underlings, never uttering a word himself. Whether this was out of fear of Bevan’s killer tongue as some have alleged, or whether Churchill was influenced by Moran into clandestine acceptance, is unknown. He told an audience of doctors a few years later that, “In my view, Lord Moran did his duty in recognizing that he should lead a policy of co-operation with the government.” Though publicly professing publicly to despise Bevan--“a squalid nuisance” he once called him--Churchill was clearly privately sympathetic to Bevan’s initiative. He certainly admired his prodigious political gifts. “I wish we had someone who could speak like that on our side,” he once remarked.
In later years, Churchill even tried to claim authorship of the NHS for himself. “The measure,” he was fond of saying, “is of course the product of the wartime national coalition government of which I was the head.” There is a smidgen of truth to this assertion, since Churchill had promised to implement Sir William Beveridge’s proposals for healthcare, as well as unemployment benefits and national pensions, once the war was over. The trouble was the British people had not believed him, and it was that fact, more than anything, that had caused his defeat.
After winning his battle with the BMA, and after steering the Bill with consummate skill through a fractious and sometimes hostile cabinet (where the main battle had been over the issue of nationalizing all hospitals rather than letting a majority remain under local government control) and through complex debates, Bevan’s National Health Act became law on July 5, 1948. The parliamentary achievement was his, and his alone.
The triumphant minister decided to launch his NHS at Park Hospital in the gritty, northern industrial city of Manchester, choosing to do so at the bedside of a thirteen-year-old girl named Sylvia Diggory. She was suffering from acute nephritis, a potentially fatal liver condition, and had been in the hospital a few weeks when she noticed that it was being gussied up for an important guest. But the first moment Sylvia knew she would be meeting Bevan was when he walked up to her bed and shook her hand. He asked if she knew that it was an historical occasion. “Yes,” Sylvia said.
Sylvia Diggory, the first person in Britain to be treated by a brand new NHS, absolutely free, is still alive today, and Bevan’s biggest fan. “He was charismatic and larger than life, very charming and articulate, with the most attractive voice with a Welsh lilt. In no time at all he had everyone in the hospital like a gigantic fan club,” she recently told the BBC. “The higher echelons of the medical world and the establishment were on the whole agin’ the poor man, but it didn’t stop him, so he must have been a giant.”
Nye Bevan died in 1960 and is remembered as the most brilliant minister of health the country ever had. In the wake of the Tony Blair era and Labour’s rightward drift, he is also mourned by many as “the lost leader of the left." Due to his vision, courage, and drive, Britain became the first country in the Western world to offer all of its people comprehensive health care, free at the point of delivery. It remains the most successful initiative ever taken by the democratic Left in the twentieth century and the most enlightened social reform in British history. Over the intervening sixty years, no government of whatever stripe has dared uproot it, replace it, or abandon its principles--not even that of Margaret Thatcher. It is the nearest thing Britain has these days to a religion.
It was Sarah Palin who called the NHS “evil.” She also called it “Orwellian.” If she’d only bothered to research Orwell, let alone read him, she may have discovered that he was in fact Nye Bevan’s friend, admired him greatly, and worked for him as literary editor of Tribune while trying to find a publisher for Animal Farm. Orwell was thoroughly in favor of the NHS, though eccentric as always, he believed the Attlee government had made a mistake giving it so high a priority. He thought the abolition of the undemocratic House of Lords and the closing down of the famously elite English public schools, bastions of privilege and snobbery such as Eton, where he’d been so unhappy as a boy, should have been tackled first. Ah, well....
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