I feel quiet positive about Keir Starmer’s intervention on the NHS yesterday.
It provides a chink of hope that the political left can think beyond the NHS as holy writ – and that there might even be a chance of testing out reorganising it along the lines of one of the successful continental insurance schemes.
I feel pretty exasperated by the way we are all expected to laud the NHS and everything about it.
I am far less sure about Starmer’s proposal for taking over privately-run GP surgeries – which seems to me to be a big waste of resources. Though it may well be necessary in some cases.
I don’t want to put words into his mouth that weren’t already there, but it seems to me that any service with an open door – as A&E is still – is bound to cost too much to run. It is bound to be over-run, because of how constrained and tickboxed the rest of the public sector has become.
No organisation dedicated to eradicating self-help – as the NHS is, and all public services became under Blair and Brown – can survive in our current climate.
It isn’t that I am ungrateful for what has been done for me by the health service. Quite the reverse, in fact.
Or that I think we should somehow close the doors to anyone who wants to come to A&E.
Nor do I think it is healthy for us to make every medical pronouncement a matter of purity of belief. If we have given ourselves over to total belief in medical ‘experts’, many of us would hardly have made it to adulthood.
Nor am I claiming that somehow the strikes don’t matter. Of course they do. It’s just that people don’t always need doctors in the way they think they do.
In fact, this might be a good moment to learn the lessons of the social critic Ivan Illich, who used to extrapolate from findings that doctors were more scared of dying than the rest of us, to accuse them of being carriers of infectious fright. You can feel the truth of this whenever you tune into Radio 4, which seems to spend a great deal of time urging us to see our doctors.
Illich was writing just after the Israeli doctors’ strike in 1973 saw mortality unexpectedly go down. This happened in all three Israeli doctors’ strikes and, in two out of the three times, it went down by half.
This should not be a surprise, given that the mortality also dropped when Los Angeles physicians went on strike in 1976, and in South America the same thing happened – as it did in Canada in the 1960s.
Oddly enough, deaths do rise when nurses go on strike, though we pay them far less. I’m not aware of nay information about what happens when paramedics go on strike…
Why? We don’t know. I am not agreeing with Illich that medicine damages health. I am suggesting that there are too many interactive elements to our complex medical systems which we don’t yet understand.