So the NHS has had quite a week, between Graham Linehan's defence of it and Peripheral Vision's attempt to get rid of it (or is it Liberal Vision's attempt? I've read through both websites and I still can't see any reason for the distinction beyond Mark Littlewood trying to become Darth Vision by establishing a Stelios-like grip on the word...) For those of us who have been watching the progress of US healthcare reform for a while, it's nice to have you all on board at last.
It's been particularly strange watching those developments from Wales, the one place where socialism in the NHS still lives and breathes, where Aneurin Bevan is not so much respected as worshipped. Indeed, the Welsh perspective makes the argument that we shouldn't run headlong into unconditional defence of the NHS even easier to understand. But equally, we should reflect on what #welovetheNHS is doing and why.
Healthcare, however, is an issue they can unite behind and one where they can unleash their favourite weapon; fear. They've got plenty of practice using it too; Republicans have been having Democrats kill your grandmother since 1993, when Harry and Louise famously destroyed Bill and Hillary's reform package, albeit at the cost of one of the great comic moments in political history;
Today's Republicans, on the other hand, aren't nearly clever enough to deliver another Harry and Louise. All they have is rage, not at the relative merits of particular policies, but at the very idea of actually doing anything at all. The Obama plan isn't not as good as what they've come up with, because they haven't come up with anything at all. Instead, the Obama plan has to be tantamount to treason, fundamentally anti-American and the first step on the road to the United Soviet Socialist Republic of America. And so, while the Obama plan has almost nothing to do with the NHS, because the NHS is supposedly the anti-thesis of the American (read: anarcho-capitalist) way it becomes the exemplar, the font of all horror stories, the inexorable consequence of the thin end of the Obama wedge.
If the debate remains locked in that cycle of paranoia, reform is doomed to fail. What America needs is a debate about the reality of its healthcare system. I wish I could remember exactly who it was who described American healthcare as a Rolls-Royce system; able to do anything so long as you can afford it. For all the miracle pharmaceuticals developed and all the multiple-transplant surgeries it develops, American healthcare continues to deliver measurably worse outcomes on almost all chronic conditions at almost all income levels; the headline figure of the uninsured is scary enough, but the relationship between income and healthcare outcome at all levels is positively terrifying. What's more, you don't need me to tell you that it does so at the highest cost (both relative and absolute) on the planet.
But even more importantly, while the debate is about the morality of a supposedly un-American system it won't manage to be about a fundamentally un-Christian one. To me this is the most confusing element of the lot; Republicans have absolutely no proposals for healthcare reform, save virtually indemnifying doctors from malpractice suits to reduce insurance premiums (although at the expense of accountability for medical competence.) And yet the Christian base of the Republican party continues to support a party platform that condemns millions of Americans to death and suffering. If that base can be made to think of that for a moment, it might notice that actually, the Republican position is according to their morality positively evil and will lead to them rotting in hell.
So by all means let's have a real debate about the future direction of the NHS and let's be honest about what it can and must do better. Equally, however, let's remember that the way the NHS is being portrayed by Republicans right now is positively fraudulent and that if we allow such criminal distortion of the truth to continue, we will all be just as culpable for the millions of Americans living in real fear, not of socialised medicine, but of no medicine at all.