The Best Public Health System

Yuan Ju pays tribute to the NHS and all those who have contributed to it.

We are celebrating the 70th anniversary of the establishment of the NHS. In my opinion, this system is the only remaining guardian angel of the ultimate human civilisation: It is probably the only large-scale social system that is equal to all, whether he or she is a billionaire or a nameless person. Everything else in the world seems to have given way to money.

This 70-year-old medical system is based on three fundamental principles that remain the core of the NHS until today:

  1. meet the needs of everyone;
  2. be free at the point of delivery;
  3. be based on clinical need, not ability to pay.

The main funding sources of the NHS are general taxation and National Insurance contributions, rather than commercial insurance or service charges. The total annual expenditure is about £140 billion, serving 65 million people (so on average, the cost per person is about £2,000). It is the world’s largest public health system with 1.6 million employees, placing it in the world’s top five employers, along with the US Department of Defense, McDonald’s, Wal-Mart and the Chinese People’s Liberation Army. The NHS covers the entire UK, with NHS England being the largest component, employing 1.2 million employees, including 150,000 hospital doctors, 40,000 family doctors, 300,000 nurses and 20,000 first-aid personnel, across 1,600 hospitals and special care centers.

The fair and efficient high-quality service provided by such a large system definitely justifies its current investment and expenses. Compared with 7% of GDP in the UK, this figure in the US is 16%. In terms of per capita health expenditure, PPP adjusted, the United States, Switzerland, Germany, the Netherlands, and Austria top the list, while the UK is almost the lowest in developed countries, lower than France and Japan. An important reason behind this is that it is not eroded by private corporate profits.

Despite all the difficulties that this system faces, I have received the most sincere and genuine smiles from NHS medical staff. There has never been any financial concern there, which has always made me feel a sort of unreality in a world dominated by commercial interests. It is almost the best system on this planet for equity and efficiency, and it is one key reason why I think Britain is perhaps the most civilised country. My personal stand, shared by many friends and colleagues, is to support its development without any reservation and I am willing to accept further increases to the income tax rate if this is specifically for the NHS.

There are two sectors in which I am firmly opposed to privatisation: education and health care. The former safeguards the initial justice of a society, while the latter protects its procedural justice. As for other experiences during one’s progress through life, it seems reasonable to leave these to endowment, talent and effort.

All the doctrines and theories that advocate a commercial insurance system and believe the market will promote competition, lower prices, and improve quality in these areas of public life are either naive mistakes or insidious deception. On the contrary, in my view markets for non-essential commodities and services can be completely privatised, and competition will have a significant positive effect towards efficiency and welfare.

Many people who have a reasonable amount of understanding of microeconomics might think that market structure can affect price and lead to improvements in quality. That is superficial. A competitive market does not solve all problems, but its performance is highly correlated with the attributes of the goods. If a certain commodity has a very low price elasticity of demand, even with more competitors and fierce competition, it will not place significant influence on its price.

The reforms and practices in the energy sector (e.g., gas and electricity), as well as in the commercial health insurance market, have eloquently proved this. Health care reforms in the Netherlands, Germany, and the Nordic countries offer further examples. Despite the large number of insurance institutions and strict governmental regulations, insurance premiums have soared year after year, while medical care and medication are interfered with by insurance institutions. This is not even to mention the situation in the US.


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