There are two subjects which get to the very heart of what a modern, prosperous country is all about – education and healthcare.  Few citizens of Europe or of North America (for example) would argue with the premise that it is a sine qua non of a civilised country that our children are properly educated and that we all have access to good and affordable healthcare. Starting from that premise we then have to look at the reality that whilst our nations are prosperous that prosperity is far from evenly spread – the poor will always be with us. It is not socialism to say that we have a moral duty to ensure that the entitlement of good education and good healthcare does not depend on the individual’s ability to pay. But it is also highly morally questionable to deny those with the money to buy for themselves and their families access to what they believe to be better schooling or better medical treatment.  So to ban fee-paying private schools or to prohibit private sector and profit driven medical insurance schemes would involve the “politics of envy” and cannot be supported. The challenge for society is not to penalise the privileged few but to try and ensure that so far as possible the population at large is both well-educated and that its health is protected.

In the United Kingdom we have public ownership and politically controlled education and healthcare systems. Neither works perfectly and a minority of the population choose to opt out of some parts of both the State education system and of the National Health Service  (NHS) – that is their right.  But whereas there are quite a few adults who have been entirely privately educated there is virtually nobody in Britain who has not been a customer of the NHS – and most of us take for granted that NHS doctors (General Practitioners) provide us with basic healthcare services and that we do not have to pay for them. The leader of the Conservative Party David Cameron, who is from an extremely prosperous and privileged background and who has a level of wealth that would probably put him in the top 1% of the population, is a case in point. When his handicapped son Ivan died earlier this year Cameron played fulsome tribute to the NHS saying how important this service and the decided people who work in it had been to him and his family.  No wonder Cameron reacted angrily when one of his Members of the European Parliament, Daniel Hannan, rubbished the NHS on American television. Hannan was not only being offensive – he was just plain wrong.

The NHS is one of the largest employers in Europe and it is a very large and immensely complex institution. Debates about how to make the service more efficient, patient focused, cost effective and so on have been in the public arena since its inception way back in 1946 – the year of my birth incidentally! That is hardly surprising and it is right – if substantial proportions of taxpayers money go on the NHS it is right that the public questions all the time how it is run and what it provides.   But what is rarely in question is the very principle of the NHS itself – the commitment of successive British government of whatever political colour has been a constant – even Margaret Thatcher said that the “NHS is safe in Conservative hands” – and in the main it was. True there will be debates on the fringes of what the NHS provides and some key elements of healthcare, like Dental treatment, have moved significantly towards the private sector. But NHS dentistry still provides for most of the population and in my experience it continues to offer a good service. I go to an NHS dentist – and very good he is too!  

I do not suggest that the United States models its healthcare system on the NHS – not because the NHS doesn’t work but because it is quintessentially of us, created by us and for us. It is not a model for anyone else nor was it ever meant to be. The healthcare systems in most of Europe are different from the NHS – it may be that some work better and that some are not as good as what we have in Britain. But the absolutely key point is all of the European systems are based on the principle that I outlined at the beginning of this piece – that in a prosperous country all should have access to a healthcare system that provides for their needs irrespective of their ability to pay. In America that is self-evidently not the case – factor in the increasingly costs of healthcare insurance for those who can afford it (or who have employers who provide it) and you have a situation in which major reform is essential. The reform is needed because there is a moral imperative to do something – something that President Obama has articulated with passion and resolve. And reform is necessary not because there is an ideological battle which needs to be won by the liberals against the conservatives – that is far too trite and facile a viewpoint. It is necessary because America has a duty to its citizens no less than the duty that European governments have to their citizens. And on the issue of healthcare America is failing its people.

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