It never happened in the way we think it happened

Every 14 July, France commemorates the storming of the Bastille, which kick-started the French Revolution. ‘Bastille Day’ is not just a bank holiday. It is part of France’s national story, the great founding myth of French Republicanism. It is a powerful story of ordinary people rising up and overthrowing an oppressive elite.

But it is not a true story. The history that is ‘remembered’ on Bastille Day is only very loosely based on actual events. The historical storming of the Bastille was pointless (the building was almost empty at the time), and the French revolution ended in well-known failure.

And yet, if a historian pointed this out on Bastille Day, they would be rightfully dismissed as a pedant and a bore. Bastille Day is a founding myth, so judging it by how historically accurate it is would completely miss the point. The point of a founding myth is not to understand what happened in the past, but to foster a ‘team spirit’ here and now. It is irrelevant whether it is a true story, as long it is a shared story, which helps to create a group identity.

In the UK, it is the National Health Service which has acquired features of a founding myth. It is a story of ordinary people getting together, putting their differences aside, and deciding to organise healthcare collectively. A nation rose above itself, and created a healthcare system run by the people, for the people. As columnist Owen Jones puts it:

“The welfare state, the NHS, workers’ rights: these were the culmination of generations of struggle, not least by a labour movement […] set up […] to give working people a voice.”

RAF veteran Harry Leslie Smith even became a minor political celebrity by recounting his version of the NHS founding story at a party conference:

“It was an uncivilised time [before the NHS] because public healthcare didn’t exist. Back then, hospitals, doctors and medicine were for the privileged few. Because they were run by profit […] Sadly, rampant poverty, and no healthcare, were the norm for the Britain of my youth. That injustice galvanised my generation, to become, after the Second World War, the tide that raised all boats. […] Election Day 1945 was one of the proudest days of my life. […] I voted […] for the creation of the NHS”.

It is a powerful story that arouses strong feelings. But like the popular version of Bastille Day, it is also almost completely untrue. The creation of the NHS had nothing to do with pressure ‘from below’. The health service was, at least initially, a brainchild of social elites, not a product of ‘People Power’. The general public never demanded a government takeover of healthcare.

This is well documented in a paper in the English Historical Review, entitled “Did We Really Want a National Health Service? Hospitals, Patients and Public Opinions before 1948”, which reviews contemporary survey evidence. To quote from a contemporary summary of various surveys:

“[T]he evidence before us seems to indicate a fairly large amount of resistance to State interference in the field of medicine […] roughly half the population was opposed to any major change on the health front, a quarter disinterested and a quarter in favour”.

The author of the paper concludes:

“[I]t is clear that little evidence exists to support those seeking to claim an inclusive popular mandate for radical reform as a justification for implementing contentious policy”.

A paper in Studies in American Political Development, which examines the political factors behind the emergence of publicly funded healthcare systems in different countries, also finds:

“the overwhelming evidence is that these early programs were promulgated by government elites well in advance of public demands”.

It is equally a myth that the NHS opened up the benefits of modern medicine to everybody, while under the preceding system only the rich had access to healthcare. Of course there were substantial improvements in health after the creation of the NHS – but there were also substantial improvements in health before the creation of the NHS. In long-term time series of population health data, the impact of the introduction of the NHS is not discernible. Pre-NHS trends and patterns, positive and negative ones, mostly continued.

Does any of this matter? People love the NHS today, so who cares about ancient history?

Unfortunately, there is a massive difference between the French and the British founding myth. Bastille Day refers to an abstract event in the distant past; the way we interpret it today has no tangible impact on contemporary politics. There is therefore no reason why people in France should not remember this event in an idealised way.

The NHS, in contrast, is not just a founding myth. It is also an actual healthcare system that treats actual people, here and now. There is nothing wrong with sacralising a historic event, but there are big problems with sacralising a health system, especially if it means that even well-founded criticism is treated as heresy (or in the best case, misrepresented as an attack on individual doctors and nurses).

And it is about time for a bit more honesty about the NHS’s shortcomings. As I show in my new IEA Discussion Paper ‘Diagnosis: Overrated’, the NHS is falling behind comparable health systems in a lot of respects, and this is about more than just a lack of money (although that is a factor). The NHS derives much of its sacrosanct status from its founding myth story. If we want a more honest debate about the future of the health service, shedding some light on its mythical past is not such a bad way to start.

This was first published on the Institute of Economic Affairs blog.

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9 Comments

  1. mikesquires says:

    Wrong on both counts. The French revolution was a success and the popularity of a universal system of healthcare,so clearly pointed out in the article you mentioned, was introduced because of popular pressure.
    It remains so well loved because it is so cheap compared with private systems-and with so much better health outcomes.

  2. lallygag26 says:

    Socialist Association reprints an article from the ultra neo liberal Institute of Economic Affairs without a commentary…..even with the blog rider that views ‘don’t necessarily reflect the views of the Association’ this beggars belief….

    1. Martin Rathfelder says:

      You can learn from listening to your opponents. Are you suggesting that what Niemietz says is untrue?

      1. Nico says:

        “Opponents”? Seriously? Are you suggesting you in any way disagree with the neoliberal Niemietz?

        1. Martin Rathfelder says:

          His conclusion is that we need more competition. We do not think competition generally has beneficial effects in healthcare.

      2. lallygag26 says:

        What exactly are we supposed to be learning from this? What do you think is the ‘truth’ of it?
        Did political leaders of the ilk of Beveridge, Attlee and Bevan have more to do with the actual creation of the NHS than the general populace? Answer, yes. Does that change the fact that its creation arose out of a general anger in the population that they were expected to die of poverty on the one hand as a result of the whim of their industrial masters and die of war on on the other at the behest of ‘queen and country’? Answer, no.
        There was revolution in the air. That was what gave the post war Labour Party the power to act. The tide that raised all boats was a tide with teeth.
        My mother was a nurse before, during and after the war: before and after the creation of the NHS. She knew the difference it made.
        Niemietz’s ideological drivel being taken by anyone in any way as refutation of the experience of Harry Leslie Smith disgusts me, ‘sorry, your sister didn’t need to die in a workhouse, after all, there was a great health service available to the poor in the 1930’s – apparently your mum and dad didn’t pay attention’…. seriously????
        And do I need to point out that it was liberal reformers in the 19th century who brought about the abolition of child labour? I’m sure that there’s plenty of evidence that people thought at the time – for many different reasons – that it shouldn’t have been abolished. Poor people would have worried, no doubt, that they wouldn’t have the means to support their children if they didn’t work. Should they have been listened to and child labour remained the norm? By Niemietz’s reasoning you would have to say the principle’s up for debate, at least. But then, as 5 year olds in my grand-daughter’s primary school are being lectured about punctuality as ‘the best preparation for the world of work’, perhaps it already is.
        History is certainly being rewritten, but not by the left. It is the right (in the person of Nigel Lawson) who created this phrase about the NHS being ‘sacrosanct’, ‘closest thing to a religion’. It has been used constantly to mock and invalidate the support of the people for a system which is designed to look after them. But it completely ignores the fact that, much as doctors are admired and nurses loved, the NHS has always had to deal with complaints from patients, family, carers and staff about the way it functions – as has and does every healthcare system around the world. Nothing to do with ‘being like a religion’.
        The mockery, on the other hand, has everything to do with the contempt of the free marketeers for anyone who can’t pay for what they need.
        As for the substantive point of the final paragraph ‘the NHS is falling behind comparable health systems in a lot of respects’, that’s true. And unless we return to public ownership, public delivery and public accountability that will continue. It’s not the concept or ‘the founding myth’ of the NHS that’s at fault. It’s 25 years of politicians and neo liberal think tanks like the IEA, who hate the fact that it is a socialist creation, chopping its founding principles to pieces bit by bit.
        But then, as the Socialist Health Association you know that…..don’t you?

  3. Interested Person says:

    Another great myth of the founding of the NHS, usually adhered to by doctors is that doctors were involved in founding the Service. The placards seen at protests held recently all suggest doctors are now the greatest supporters of the NHS but when it was founded they were its greatest opponent.

  4. I have to declare an interest here. My aunt died aged two because my grandparents couldn’t afford the doctor under Kristian Niemietz’s “not so bad” system, and I would have been long dead under the US system (haemophilia and Schmidts syndrome are both potential killers, and hugely expensive to treat). Having said that, my doctorate was in ethics, and I am not sure I would trust someone who equates Christian ethics (not to be confused with Christian deism of course) with communism, and who is a supporter of the notorious Taxpayers Alliance. Not only that, his idea of the NHS is presumably what he has learned from studying. He has not lived it for 66 years, and nor has he stories in his family about the huge difference it has made to ordinary Briish people. Most of us can recall similar back stories. This is simply a second hand version of the truth as told from a rather right wing agenda and as such not particularly trustworthy. I am not an economist, but greater experts than this gentleman tell us his ideas belong to a century, and are old hat. Those of us who have any knowledge of our family history, or who have studied UK history, have seen this scenario before. Our parents and grandparents realised that that it was not working except for a priviliged minority, and the decades since they have been slowly reimplemented are showing us just how useless the idealogy still is in modern times. Of course Niemietz will deny this. Sad to say I have not seen any really rigerous academic rebuttal of the more modern approach. I would love to see something worthwhile I could get my teeth into, and maybe even take on board as a useful approach. However from all I have seen and read, it seems the only weapon they have in their armoury is unsubstantiated idealogy and rhetoric, delivered with a supercillious superiority and a dollop of condescension – denegrading anyone who happens to disagree as a “lefty”. I am not a “lefty”, but neither am I a fan of Friedrich Nietzsche, the darling of the German right wingers, indeed most right wingers, since they plainly see themselves as “supermen” rather than anomolies, and dangerous anomolies at that for the survival of humanity into the far future. I have a first hand knowledge of poverty, having worked with the unemployed and sick in one of the worst areas in the UK for a number of years. Has this gentleman any knowledge of the real word out there – suffering poverty disability and pain borne by the most amazing people, or is he basing his ideas on journalistic sensationalism (Benefits Street, and other sensationalist programmes on welfare and the NHS are entertainment, not reality, and the journalist at the centre of this phenomenon was caught out in the US) and dehumanised statistics? As for the NHS It is so easy to starve a system and then announce it needs replacing by one that suits a self interested minority, but I am not sure we need to know what extreme right wingers, most of whom are not even supported by ordinary conservative/right wing voters – are thinking – it is enough to know a bit about game theory,and paradigm theory to know where he, and others like him are coming from.

  5. rotzeichen says:

    You can sum up this article with this statement from David Willetts himself

    “The IEA continues to show the vitality and relevance of free market economics.” – David Willetts MP

    More Neo-Liberal rubbish and support for privatisation.

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