The basic
problem lay in conventional historical British iconography and legend. Ask
almost any Britain about the
first sixty years of the last century and two themes will automatically come to
mind; the Empire and, above all, the war – the Battle of Britain, Dunkirk, the Blitz, brave Britain
standing alone against the Nazi juggernaut which had blitzkrieged its way
through most of Europe. Yes… Well… Not exactly
the most suitable themes for a global Olympic celebration.
Boyle came
up with a marvellous concept. Taking the idea of illustrating various themes
from Britain’s wonderful
panoply of children’s literature (with Mike Oldfield providing the background
music), he set this before the background of Britain’s National Health Service. This portion of the show took its title from
the legendary directions in J.M. Barry’s Peter
Pan, “second to the right, and straight on till morning.”
The choice
of the National Health Service, as the official programme put it, “the
institution which more than any other unites our nation,” was inspired. And it
sent a clear message to the world about what Britons regard to be the real
enduring legacy for them of the epic struggle of the Second World War; the
welfare state as embodied, above all, by the comprehensive right of every
British resident (and visitor) to free health care. And it is an institution
which, despite all the problems, all the complaints, all the shortcomings,
bureaucracy, inefficiency and everything else, still enjoys overwhelming
support in the British population at large. Even Margaret Thatcher, at the
height of her crusade to privatise every aspect of British life except the
military, never dared to try to seriously attack the National Health, much
though I suspect she would have liked to.
The Olympic
opening ceremony was, of course, designed as a spectacle; a playful and
artistic presentation, designed to touch us on as many levels as possible,
primarily the emotional ones. Were I in a mood to cavil, I would point out that
most European countries have a more or less comprehensive public health system,
the origins of quite a few of them older than those of Britain’s NHS. But such
a criticism would indeed be small-minded, because Danny Boyle’s choice of the
NHS as a fundamental icon in the British consciousness of the history of the 20th
Century, particularly as a replacement image for the war, makes a much more
profound point.
Beyond the
concrete territorial aggression of Nazi Germany, the war fought throughout the
world in the middle of the last century was a conflict between two ideological
systems; to use the title of Karl Popper’s seminal work, the struggle between
the Open Society and its enemies. In that respect – and Churchill was the only
allied leader who really recognised this while WWII was still going on – the
war itself was only half ended in 1945; it took 45 years more for the second
form of totalitarianism, Stalinist centrally controlled statism, to follow its
dark fascist twin.
The point I
am making here is that it seemed perfectly clear to Europeans that a major part
of the values which were at stake in the life-and-death struggle with
totalitarian ideologies was the right of every man, woman and child to a decent
life. And a prerequisite for a decent life is basic health and the treatment of
illness. Society cannot guarantee happiness, but one of its most fundamental
functions is to make possible for every last member – in the words of the US
Declaration of Independence – “the pursuit of happiness.” Illness and disease
are a major cause for suffering and, as such, make the pursuit of happiness for
those afflicted much more difficult, if not, in many cases, impossible.
Seen in
this way, basic health is a fundamental human right, a necessary condition for
securing human dignity. This was a widespread consensus among Europeans, faced
with the challenge of building up their societies after the trauma of the war,
and the defeat of an ideology which despised and rejected the fundamental
liberal Enlightenment consensus of what it meant to be human. And so the
concept of a right of all citizens to comprehensive health care became a
corner-stone of social policy in most post-war western European societies.
Even the USA,
reluctantly and in a very limited form, followed this development, this
maturing of realisation of the wider consequences of the recognition of the
rights ensuing in a society based on the recognition of the inalienable dignity
of every human person. In 1965, in the middle of what can well be called the
civil rights decade, Medicare and Medicaid were introduced. But in the wake of
this, an ideological change started to gain force.
The story
of the roots and development of what can be called neo-liberalism or
neo-conservatism is beyond the scope of this essay. The very fact that it is
vicariously named after two traditionally opposed ideological positions is an
indication of the complexity of the subject. Suffice it to say that a
combination of economic ideas (Hayek, Friedman, monetarism, etc.), deeper
philosophical concepts (Randian Objectivism for example), the growth in size and
power of corporations, moving beyond single nations to become transnational
molochs, the determination of certain powerful individuals to roll back
developments in societies word-wide which increasingly threatened their power
and economical bases, and a dollop of fundamentalist evangelical Christianity
tossed in to complicate the mix, led to an increasingly popularised basic idea
that state/societal/communal acceptance of responsibility for any aspects of
life was generally bad, always a curtailment of freedom and only to be accepted
as a measure of last resort, to regulate areas of life which could not be
regulated any other way. The eighties saw the first concrete political fruits
of this new societal paradigm under Reagan in America
and Thatcher (who famously stated that there was no such thing as society) in Britain.
A
development of the basic concept of general health care as a basic human right
became, within this context, almost impossible in the USA, as the Clintons were forced to accept in the early
nineties. In Europe too, the public health
systems came increasingly under attack from proponents of the political opinion
that the state was the root of all evil and that, left to themselves,
deregulated “markets” would provide a better world for all. As someone who has
been working as a professional within the German social health system for more
than twenty years now, I have experienced continually the stress induced by the
ongoing war of thousands of attempted cuts and programmes to increase
“efficiency.” They have nearly all been carried out at the expense of the
weakest of those treated within the system and those who work in the front-line
of actually delivering health care. What they have actually managed to save is
debatable – the only certainty is that the profits of the most powerful
involved in the system (the big pharmaceutical and insurance companies, for
example) have been secured and grown.
Fortunately,
in most of Europe – despite all the debates,
half-truths, propaganda, and downright lies – the fundamental popular support
for social health care has been too strong for the neo-libs to succeed in their
goal of dismantling it. That is what Danny Boyle was celebrating in the Olympic
opening ceremony; even in Britain,
the European country most strongly seduced by neo-liberal chimeras, the NHS
remains untouchable.
This is why
Obamacare is so important. Despite all its considerable flaws, probably
inevitable as something resulting from a complex process of political compromise
and horse-trading, it represents an enormous step for the USA in a direction of
communal moral development, one in which it had so long been behind most of the
rest of the western world. And this is why its winding-up in the wake of a
Republican victory at the end of this year can be seen as nothing less than a
step backwards towards barbarism.
Yes, public
health care is expensive. But so is any good health care, and the question
remains as to how any society can look at itself in the mirror, knowing that
thousands of its members are suffering and dying because they cannot pay for
what they need to save their lives.
Then there
is the oft cited problem of efficiency. It remains an unquestioned aphorism
that the profit-driven private sector is always more capable than bureaucratic,
over-regulated public enterprises. There is some truth in this. However, two
points should be remembered. Quite a proportion of this bureaucratic regulation
is occasioned by the need in a complex, publicly-run service to guarantee fairness and accountability. Secondly,
it can be asked whether increased efficiency in a predominantly privately
organised system actually profits the patients in the end, or whether the end
result is not frequently the delivery of the most minimal service possible, for
the highest price attainable – frequently at the cost of the weakest people
working in the system, not to mention the many patients who are deprived of
treatments because there is no money to be made on them, or because they weren’t
able to afford an insurance package which would have covered a necessary
complex treatment.
I have
worked for over twenty years now within a health system which is predominantly
publicly organised. There are many aspects of it which are ridiculous,
frustrating, badly-organised and just stupid, something about which I tend to
frequently rant, as friends and relatives will readily testify. But even in
doing this, I realise that I am complaining from a position of relative luxury.
In a structure as complex as modern health care, dealing with situations in
which many of the people who actually need to avail of the service are in truly
extreme situations, defined by pain, uncertainty and fear, there will always difficult
issues, with no easy – and sometimes no good – answers.
And, given
the fact that research and human ingenuity is always pushing the capability of
what medicine can do, there will continually be the question of costs. But for
any society which sincerely subscribes to basic values like respect and human
dignity, the question must always be; “how much can we afford?” rather than, “how
little can we get away with?”
When it
comes to the basic question of human health, I am very glad to be living in
Western Europe rather than in the USA.
Pictures retrieved from
