NHS v Insurance BS

Why do Farage and other Right-wing politicians keep attacking the NHS, suggesting that we should move to an insurance-based system? The reason is simple – the NHS provides health security for everyone, and undermining it would not only make most people extremely vulnerable in the face of corporate whims, but enable profiteers to make billions at the expense of people worried about their health.

But many people in the UK, especially among the young, have forgotten how the underfunding of the NHS that went on during Conservative-led governments from 2010 to 2024, has severely weakened our health services, and led to growing complaints about its shortcomings. The devious mantra is now “you can’t keep throwing money at it”, with the insinuation that something like the US insurance system should take its place.

In order to save the NHS, we must let as many people as possible know what a shift to an insurance system such as the one in the US would mean for us. To begin with, instead of having a free to access health service funded by taxes paid according to citizens’ wealth and income, people would have to try to buy health insurance coverage when the best coverage would be unaffordable for most, while many would not be able to even pay for the most patchy unreliable coverage. In the US, tens of millions of people cannot afford health insurance, and when sick, they cannot even see a doctor.

It is often said the US system is impressive in being the one that spends the most per person on healthcare in the entire world. But in practice, a vast portion of that money goes to treatment for the rich who have the best insurance coverage, and to the profit column of the health insurance companies. Not surprisingly, health outcomes in the US (with lower life expectancy and higher maternal mortality) are worse than comparable countries.

Between the very rich who can sit back and relax, and the poor who have no choice but to suffer in silence, the majority have to set aside money to buy some form of mediocre health insurance. The coverage and claims processing are all designed to minimise what the health insurance companies have to pay out to help people in need. Deductibles, exclusions, copayment clauses, all come into play to leave people without sufficient funds to pay for diagnosis, scan, treatment, medication, or operation.

With claims delayed or even outright denied, people have to go into terrible debt, and some end up bankrupt. According to studies published in the American Journal of Medicine and the American Journal of Public Health, almost two-thirds of all bankruptcy filings in the US were linked to medical expenses or illness-related loss of work. With health insurance often linked to employment, losing one’s job when one is sick is compounded by the loss of one’s health insurance as well.

Unlike the NHS which enables patients to contact doctors and hospitals directly for help, US style insurance system requires people who are not well (and their families) to navigate a highly complex bureaucratic maze to claim insurance coverage to pay to be helped by doctors or treatment in hospitals. It can take a long time, with claims rejected, and substantial medical bills to pay when the necessary funds are not covered by insurance after all.

Under the NHS, any nationally approved medication can be obtained through a subsidised prescription from the GP. With the US approach, pharmaceutical companies can charge whatever they want (and the medical drug costs in the US are among the highest in the world), and it is up to the private insurance companies to decide how much of the cost, if any, they would cover on any given claim.

People may want to moan about the NHS, and Right-wing politicians may do all they can to starve it of the funding it needs, but if we make it abundantly clear to everyone what a deathtrap the profiteering insurance-based alternative would be, we can keep the political focus on strengthening the NHS.

The Old Frayed Citizen Test

In order to become a British citizen, one of the many hurdles to get over is the ‘Life in the UK’ citizenship test. The rationale for requiring applicants to pass such a test is presumably to see if they have a good enough understanding of life in the UK to be a citizen here. But unfortunately the people who set this examination have failed a basic intelligence test themselves.

First of all, what is it about ‘life in the UK’ that one should know in order to live as a citizen in this country? Is it to do with knowing how to use public transport; how to greet people (or not); where to get a good takeaway; how to ignore interminable scam calls on the phone; or when to ask to speak to a councillor (and when to seek help from a counsellor)? It turns out the questioners just want to take people on a whimsical quiz (here are a few delightful examples) - What medal did Mary Peters win in the 1972 Olympics? How many Scottish ski resorts are there? Where was Florence Nightingale born? When did Britain become permanently separated from the continent by the Channel? Which poet was inspired by daffodils and nature?

Secondly, even if there is a case for demanding people share a reasonable degree of common cultural and historical knowledge to be citizens of the same country, that commonality should surely be based on reality rather than the inklings of a wannabe quiz-night question setter. Research has long established that the vast majority of Brits have not a clue what the answers are to most of the questions in the ‘Life in the UK’ test. 66% of us would not pass! So all the test does is to establish that those who pass it do NOT fit in with the British public in general.

Thirdly, instead of concocting some parlour game that tests one’s far-from-general knowledge, any examination that is meant to help ascertain if someone is ready to be a citizen of a country should relate to that person’s understanding of the rights and responsibilities associated with that country’s citizenship. Here are just a few examples: how to report on crime and suspicious behaviour; what constitutes peaceful protest; what are the different roles of MPs and councillors; how to get medical help; how to check the reliability of information sources; what to do about loud noises in the neighbourhood; how to pay taxes, request support, etc.

The compilation of questions and appropriate multiple choice answers is something experts in the field of citizenship education and citizens advice are well prepared to assist. A guide should accordingly be produced to help those applying for citizenship learn about what it would be like to be citizens of the country. Indeed, the guide should be an integral part of citizenship learning for all existing as well as new citizens. From school age on, all members of a country should be supported in developing a practical understanding of the mutual expectations between themselves and others (and statutory institutions).

It is important to remember that this should not be reduced to rote learning of mundane facts (e.g., how many MPs sit in the House of Commons, or who acts as the returning officer for elections to public office). It should focus on what is valuable for citizens to grasp to act responsibly and secure the support they are entitled to. And there should be trained teachers and advisors to help people learn to be effective citizens.

It's time to set aside trivial pursuits, and bring on a meaningful citizenship test.