How to argue with a moron about the NHS

Best not to bother, to be honest

It requires a pathological level of self-delusion to believe that the NHS is an adequate healthcare system, let alone the envy of the world. We have worse health outcomes, longer waiting lists, more excess deaths, fewer beds, fewer doctors, fewer nurses and less equipment than the average rich country. The average rich country does not have anything resembling the NHS.

Even morons no longer deny that the NHS is awful. Instead they claim that its many deficiencies are due to ‘under-funding’ and ‘Tory cuts’.

On the face of it, this is an easy claim to disprove. Graphs like the one below clearly show that DHSC spending has risen from £130 billion to £180 billion since 2010, an increase of 42% in cash terms and 25% in real terms.

In my experience, providing indisputable evidence that there have not been any cuts to the NHS will not be enough to convince the wilfully ignorant that there have not been cuts to the NHS. If you are tempted to engage with such a person, expect the conversation to go something like this…

“Nice graph, lol. Now adjust for inflation.”

It does adjust for inflation. That’s what ‘real terms’ means.

“Now adjust for population growth.”

The population has grown by 6% since 2010. The NHS budget has risen by 25%.

“In real terms?”

Yes.

“Now adjust for the ageing population.”

There’s no such thing as adjusting for an ageing population, but all European countries have an ageing population and the UK spends more on healthcare than all but two of them.

“You’ve cherry-picked a pandemic year. That was when teh Tory’s were syphoning off £37 billion to their cronies for an app that didn’t even work.”

That money was actually spent on testing, which every country did, but OK, here’s 2019 instead. Fifth highest in Europe.

(Update) And here’s 2022…

“Why are you showing it as a percentage of GDP?”

Because that’s the standard way of comparing public spending internationally.

“How does it look in cash terms?”

Lower, but still above average and sandwiched between Iceland and Finland, both of which have excellent healthcare systems. Since the data for this graph was produced, healthcare spending in the UK has risen to £4,188 per person.

“Why don’t we spend as much as Germany?”

We’re not as rich as Germany. In any case, it’s not a race to see who can spend the most. Spending one in every eight pounds on healthcare is more than enough for me. Let’s settle for the kind of healthcare they have in places like Finland, Iceland, Spain and Italy, all of which spend less than us by any measure.

“But it got more money under Labour.”

It is quite clearly getting more money now than under any previous government.

“I mean it got bigger annual increases under the last Labour government.”

Yes it did, because Tony Blair went on television in 2000 and promised to increase NHS spending from 6.7% of GDP to 8% of GDP to match the EU average. Gordon Brown wasn’t too happy about this unexpected pledge but he went along with it. Between 1997 and 2009, the NHS budget tripled in cash terms and doubled in real terms.

This was the biggest increase in spending in the NHS’s history. It was not sustainable and was never intended to be sustained. It was a one-off splurge to achieve a specific spending target. If every government doubled the amount of money the NHS got, it wouldn’t be long before everything you earned went to the NHS.

Via Tom Harwood

“Yeah but all the money is being creamed off by private companies. The NHS is being privatised by stealth.”

The UK has less private sector involvment in healthcare than almost any country you can name. We have more state-owned hospitals than Spain, Italy and Germany combined. In 2020/21, spending by NHS commissioners on services delivered by the private sector amounted to just 7% of the Department of Health and Social Care’s budget. There are plenty of people making a lot of money out of the NHS, but very few of them work in the private sector.

“The NHS was the best health service in the world in 2010 before the Tories ruined it.”

I assume you’re referring to the Commonwealth Fund league table. The Commonwealth Fund is an American lobby group that foolishly wants an NHS-style system and designs its index in a way that favours the NHS. Consequently, ‘administrative efficiency’ and ‘equity’ carry twice as much weight as ‘health care outcomes’. On health care outcomes, the UK has always been second to last. In any case, it does not compare the UK to the rest of the world. It compares it to ten other countries.

“The Tories are running the system down so they can flog it off to their billionaire chums.”

Why would you run something down if you were going to sell it? The government spent £233 billion on the health system in 2021. Spending nearly a quarter of a trillion pounds on something is a funny way of running it down.

“Who funds you? Why do you want an American-style health care system? People before profit! Waah, waah, waah!”

By this point you will have realised that it is pointless arguing with morons about the NHS.

UPDATE

UK healthcare spending was £317 billion in 2024 (11.1% of GDP). Government-financed healthcare was £258 billion.