The NHS Crisis: Austerity, Not Single Payer, Kills

Britain’s National Health Service is in the middle of a deadly and completely predictable crisis. As an unusually cold winter bites and Australian flu hits the nation, the NHS is facing immense pressure.

Official statistics show 16,900 people were forced to wait in an ambulance for more than 30 minutes before being seen at the emergency room (called A&E in Britain) over Christmas week. On December 21, the overwhelmed health service cancelled tens of thousands of “non-urgent” operations like cataract removals, and that cancellation was extended on January 2 through the end of the month. On New Year’s Eve, 93.5 percent of NHS beds were occupied. By January 4, 23 out of 145 of the NHS’s acute hospital trusts were on “black alert,” meaning that 100 percent of their beds were in use.

The pressure on hospitals is always higher over winter, when illnesses like flu are worse. NHS England cited “higher levels of respiratory illness and some indications of increasing patient illness severity and flu.” But flu happens every year, and these bed crises are becoming a yearly problem. Though this winter is seeing record strain on the NHS, last winter was a disaster, too; this time last year, exactly 23 NHS trusts also declared black alert. Black alerts happened over the 2015/2016 winter, and the year before. Why isn’t the NHS prepared?

For that, we have to look to the Conservative (also known as Tory) government, led by Prime Minister Theresa May, a textbook omnishambles. The NHS has been consistently under-funded by the Conservative government. It’s not just cuts, though May cut spending on public health—things like sexual health services—in 2017. It’s that its increases in funding cannot compete with rises in demand, particularly with an aging population and a lack of social care.

In 2013, the NHS said it had a £30 billion funding gap, and the Tory response to this was to provide £8 billion in extra funding and require the NHS to find the other £22 billion in cuts. To this day, the government claims it has fully funded the NHS, by requiring it to find its own cuts. It gave the NHS a hacksaw, told it to choose a limb to amputate, and tells everyone else it saved its life by not shooting it in the head. But everyone else is not fooled. Nigel Edwards, chief executive at the health think tank the Nuffield Trust, said in 2016 that “the NHS has never experienced this level of austerity for this long a period.”

The Conservative government response to this latest crisis has been predictably shite. The NHS minister Philip Dunne caused outrage when he said “There are seats available in most hospitals where beds are not available,” in response to a question from a Labour MP about patients sleeping on the floor. May planned to demote Health Secretary Jeremy Hunt in a cabinet reshuffle this week. Instead, after he “argued strongly with the prime minister that he should be allowed to stay in his role,” she not only relented but expanded his brief to include social care, too.

Presumably, the logic behind this is that the NHS crisis is really a social care crisis, too. “Bed-blocking,” where elderly patients who have been treated can’t leave hospitals because they have no arrangements for care when they leave, is a rising problem. In January 2017, the Telegraph reported that bed-blocking had risen 42 percent in one year, with 193,680 “bed days” lost in November 2016.

Just like the frozen Baltimore schools we covered last week, this is an example of how underfunding public services is not only morally repugnant, it always ends up more expensive, too: A 2016 independent review found bed-blocking was costing the NHS £900 million per year. Cuts in one area only cause more expense in another.

But it’s hard to imagine adding social care to Hunt’s remit is going to improve it. As health secretary, Hunt tackled the problem by introducing bed-blocking monitoring targets for NHS Trusts, which threaten their funding if they don’t free up enough beds. That does nothing to fix social care, which isn’t provided by the NHS. If frail old ladies can’t go home because they have no one to help them keep themselves alive, telling the NHS to get on and turf them out anyway doesn’t fix the problem—especially if those patients are just going to return with another illness anyway.

Which brings us to the inevitable US conservative response to this crisis: pouncing on the news like a particularly shitheaded cat to prove that single payer is bad, and therefore shouldn’t be tried in the US.

It shouldn’t even need pointing out to very important New York Times columnists like Stephens that the NHS isn’t a single payer system, it’s single-provider. Medicare for all, for example, wouldn’t look like the NHS, where the doctors, nurses, and other staff are employed directly by the government.

But this isn’t the point, satisfying as it is to point out that Stephens is a huge idiot who can’t get the simplest things right and doesn’t deserve a high-profile Thought Thinking Man job any more than I deserve to be head cheerleader for Oregon State. The point is that this crisis is not a result of having a government-run healthcare system. It’s the result of under-funding that system, and the social care system supporting it. (This is to say nothing of the fact that, of course, the American system has similar problems for a different reason: People in America go without care all the time because they can’t afford it.)

The lesson from the NHS crisis for single-payer advocates is not that they’re wrong: It’s that the fight for adequate healthcare is going to be bigger, longer, and more arduous than ending the private insurance-based system we currently have in the US, as massive as that task seems. It will, over time, require a wholesale change in how we think of what of as healthcare. As the young and brilliant healthcare expert Tim Faust wrote in Jacobin last year:

If people are getting sick and dying because they don’t have a place to live, or if the places they live are unsafe, then housing is health care, and you build housing to bring health care costs down. If people don’t have access to healthy food to eat, then food is health care, and you provide them with affordable or free food options to bring health care costs down. If people live in fear of their personal safety — if they are assaulted or beaten at home, at work, by the police, or by their domestic partners — then safety is a form of health care, and you provide safe havens for them to bring health care costs down.

In other words, a single-payer program is not the goal. Single-payer on its own cannot be the goal. Single-payer does not solve the biggest sin of commodified health care: that taking care of sick people isn’t profitable, and any profit-driven insurance system thus disregards the most vulnerable.

“Single payer” isn’t a plan by itself, nor does it tell us exactly what the system would look like. It could be done well, or badly. The fight for health justice wouldn’t end if the Sanders Medicare for All bill passed tomorrow. But the idea that single payer necessarily means people sleeping in hospital corridors, or that the cause of overburdened care is government involvement and not the exact kind of austerity and under-funding that conservatives worship in American government, is absurd. It belongs in the bin. Get in the bin, Bret Stephens.