This week, U.S. conservatives seized on the case of Alfie Evans, a 2-year-old British child who died Saturday from a progressive neurodegenerative disease that had destroyed most of his brain. The boy’s parents were embroiled in a legal dispute over his care, and petitioned for Alfie to be flown from his National Health Service (NHS) hospital in Liverpool to receive specialized care at a hospital in Rome. A Manchester judge denied their appeal, ruling that all medical opinion had shown that the child’s life could not be saved and that to move him would be against his best interests.
By Wednesday, #AlfieEvans had become a rallying point for American opponents of a universal health-care system in the United States. Sen. Ted Cruz (R-Tex.) tweeted Wednesday that the case was “a grim reminder that systems of socialized medicine like the NHS vest the state with power over human lives, transforming citizens into subjects.”
It’s not the first time in recent months that conservatives have made such an argument. President Trump tweeted in February: “The Democrats are pushing for universal health care while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!”
Many observers — including Prime Minister Theresa May — were quick to point out that the thousands of protesters in central London were demanding more public funding for the NHS, which is so popular that it’s been dubbed the U.K.’s “national religion.”
Attacks on the NHS, however, are as old as the NHS itself. In fact, by invoking the specter of a bloated, ineffectual and inefficient NHS, conservatives have helped to sink legislative proposals for universal health care in the United States at key turning points in U.S. history.
When the NHS was introduced in 1948, the U.S. was closer than it had ever come to implementing a universal system of health care. President Harry S. Truman, backed by a U.S. labor movement at the peak of its power, incorporated a plan for universal health insurance to be financed through the Social Security payroll tax into his “Fair Deal” agenda. Conservative and corporate interests were fiercely opposed to the proposal, especially the powerful physicians’ trade association, the American Medical Association (AMA). Fearing loss of autonomy over the profession, the AMA invested millions of dollars over the course of the late 1940s and early 1950s in a massive lobbying and public relations campaign to defeat a universal system, using the slogan “the voluntary way is the American way.”
From the beginning of the AMA’s lobbying effort against universal health care, it adopted a comparative approach that highlighted the purported failures of emerging government-managed medical systems abroad. “The long-term objective is to put a permanent stop to the agitation for socialized medicine in this country,” AMA representatives declared in a 1949 speech, “by convincing the people, through a nationwide campaign of education, of the superior advantages of private medicine, as practiced in America, over the state-dominated systems of other countries.”
The AMA’s principle target was the new British NHS. In speeches, radio spots and pamphlets that it distributed to every doctor’s office in the country, the AMA invoked “the medical frustrations, the general confusion, and the tragic shortcomings of the British experiment,” suggesting that “the British predicament stands as a glaring, timely example for all Americans to study and ponder.”
But the AMA misleadingly conflated the tax-funded NHS with U.S. proposals for a payroll-funded system. “The fact of the matter is that the plan for National Compulsory Health Insurance in the United States is dangerously similar to the British system — in its basic outlines, essential features, and administrative complexities,” ran one national AMA radio spot, warning of “all the evils and dangers which are now visible in the British medical extravaganza.”
Central to this argument was the fact that British government expenditure on the NHS — which did in the first years of its operation exceed original estimates — proved that government-managed health care led to spiraling costs. The AMA president said in 1950 that the cost of the NHS was “unpredictable and uncontrollable … only its direction can be predicted, for that is always upward — far beyond the blissful, hazy estimates of the planners and socializers.”
Finally, the AMA argued that the quality of care under the NHS was inferior to that provided by private insurance, and that “the American people will never stand for the kind of medical care that is being dispensed in Britain today.” AMA spokesmen claimed that under the NHS, there were widespread shortages of both medical equipment and nursing staff. They also argued that there was rampant abuse of the system, with patients seeking treatment for such trivial complaints as “wasp stings and insect bites” at the expense of those who needed urgent treatment for serious medical concerns. Such an “Old World scourge” threatened to bring a “sick, harassed Europe to a strong, healthy America,” the AMA warned.
The AMA’s campaign, with the British NHS very much at its center, proved devastatingly effective. By the early 1950s, public opinion had largely turned against universal health care, and several versions of the Truman proposal died in committee. There wouldn’t be another major legislative push for universal health care in the United States for decades — the next Democratic presidents, John F. Kennedy and Lyndon B. Johnson, focused instead on care for the elderly and poor, which became Medicare and Medicaid.
As the question of universal health care again comes to the fore of U.S. politics in the run-up to the midterm elections and the next presidential election cycle, Trump, Cruz and other conservatives are again employing distorted caricatures of the NHS, and there is sure to be more to come.
But the problem with this strategy is that today, it is much harder to portray systems like the NHS as a failure. On the contrary, after 70 years of operation, the NHS is proof that universal, single-payer systems work. About 60 percent of U.K. residents report being either “satisfied” or “quite satisfied” with the NHS overall. Studies rank the U.K. first in the world in patient care and equity.
Equally important, this quality of care is provided at far less cost than U.S. care. Organization for Economic Cooperation and Development statistics show that in 2016, the U.K. spent 9.7 percent of gross domestic product on health care, compared with 17.2 percent in the United States. Despite spending far more on health care, the United States ranks significantly lower than countries with universal health care on many metrics, including life expectancy, infant mortality and health outcomes in proportion to spending. The evidence is there: Universal systems like the NHS have proved themselves to be not only just, but effective. But history shows how politically potent it can be to misrepresent them.