Britain and America Embrace ‘One Nation Conservatism’
With the ascension of Boris Johnson and shifting approaches to the health care crisis, a new kind of politics is forming on the right.
The easy cliché of transatlantic politics—no less true for being easy—is that Britain’s political trends often anticipate America’s.
For instance, back in 1979, Margaret Thatcher’s victory signaled a shift toward free-market policies. The following year, the victory of the like-minded Ronald Reagan spelled the same for the U.S.
More recently, the June 2016 Brexit vote heralded a turn away from neoliberalism; soon thereafter, Donald Trump, tapping into the same anti-cosmopolitan vein, dubbed himself “Mr. Brexit” and went on to win the presidency.
Now, Boris Johnson’s big win suggests that the same nationalist themes still resonate, and that’s a positive augury for Trump’s re-election prospects. (As an aside, the day after the UK election, the satirical Babylon Bee cackled, “British Progressives Horrified As Boris Johnson Removes Mask Revealing Self To Be Donald Trump.”)
To be sure, there’s still an ocean of political differences between the two countries—yet in some areas, the two Anglospheric nations might be converging.
A case in point is health care. In 1948, the United Kingdom, led by the Labour Party’s Clement Attlee, established its National Health Service (NHS). The following year, 1949, Democrat Harry Truman hoped to make national health insurance for Americans the centerpiece of his second term. But it was not to be. Truman’s proposal, dubbed “socialized medicine,” was slain by the American Medical Association, at the time a conservative, if not reactionary, group.
Back in Britain, the NHS had its share of hiccups—snafus of implementation helped cost Attlee his premiership in 1951—yet it has proven to be enduringly popular. Indeed, at the opening ceremony of the 2012 Olympics in London, the NHS was the theatrical and emotional centerpiece.
Meanwhile, in the U.S., the march towards national health insurance has been far more circuitous, albeit still headed in the same direction. Medicare and Medicaid, enacted in 1965, now cover more than 108 million Americans.
Another mostly unheralded victory for health coverage came in 1986, when President Ronald Reagan signed into law the Emergency Treatment and Labor Act, which guaranteed emergency room access to anyone, regardless of ability to pay. We can observe that EMTALA is not uniformly enforced—plenty of indigent patients are quietly turned away or sneakily shipped elsewhere. Still, the law has proven to be another plank in the nation’s health care floor, however inefficient and costly it might be. In fact, the overall program that helps compensate hospitals for EMTALA-related coverage spends more than $18 billion a year—not chump change.
Yes, the ambitious “Clintoncare” plan was defeated in spectacular fashion in 1994. Yet just a few years later, Democrats and Republicans worked together to enact the more modest Children’s Health Insurance Program, which today covers another 9.6 million Americans.
Then in 2010 came the Affordable Care Act. In the decade since, Obamacare has mostly survived the many legislative and legal challenges aimed at it. And so today, less than 10 percent of the U.S. population is uninsured. In addition to EMTALA, the deeply dispossessed have access, hopefully, to the more than 1,200 free health clinics across the country.
So we can see: while America has never had an epiphanic “NHS moment,” the goal of universal coverage has been gaining, in dribs and drabs, over the last six decades. To be sure, the results have not been pleasing to purists on either the libertarian right or the socialist left—but then realistic pluralists have a phrase that fits: muddling through.
Now attention should be paid to the latest political development from across the pond: the overt revival of “One Nation Conservatism.” On December 13, standing in front of Number 10 Downing Street, Johnson introduced “our new one nation government, a people’s government.”
One Nation Conservatism dates back to Benjamin Disraeli in the 19th century. His was a vision of a prosperously united society, respectful of private property and tradition, yet at the same time mindful of the needy and unlucky. As Johnson, then the mayor of London, said in 2010, “I’m a one-nation Tory. There is a duty on the part of the rich to the poor and to the needy, but you are not going to help people express that duty and satisfy it if you punish them fiscally so viciously that they leave this city and this country. I want London to be a competitive, dynamic place to come to work.”
We might underscore that at the time, the Tory Johnson was, yes, the mayor of London. In other words, with a suitable message, a conservative can win in big cities—and today’s American Republicans might pay heed.
And speaking of American Republicans, this author took note of Johnson’s words in 2012, lamenting that national GOP candidates Mitt Romney and Paul Ryan conspicuously lacked a one-nation ethos. They lost the general election.
Of course, in the three years since Trump’s election, the politics of health care have shifted, away from libertarianism and towards the Obamacare status quo. Thus it’s no wonder that Republicans were battered in the 2018 midterms, where health care was the number one issue. Moreover, the GOP was battered again in 2019, as pro-health care Democrats won gubernatorial elections in two red states, Kentucky and Louisiana.
American voters are sending a clear message. So perhaps the Republican Party is ready to receive a helpful hint from the mother country.
In fact, the 2019 Conservative Party manifesto was not only helpful, but copiously detailed. Under the heading “Strengthen the NHS and social care,” the document declared: “The NHS represents the best of this country. It is there for us when our children are born, when our friends and families fall sick, when our loved ones succumb to old age and ill health. It is precious to all of us—especially because it is free at the point of use and there for you on the basis of need, not your ability to pay. We as Conservatives believe passionately in the NHS.”
In addition to this general encomium, the manifesto included additional specific pledges about the NHS, such as a promise to bring on an additional 50,000 nurses. Did we mention that Johnson won in a landslide?
Johnson managed to use his support for the NHS in two ways. First, in his vocal support for health care for all, he rebutted the standard left-wing accusation that the right is heartless. And second, he was able to argue that the Tories could actually be more trusted to take care of the NHS, because unlike Jeremy Corbyn and his loony lefties, the Conservatives wouldn’t wreck the economy that supports it, as well as other social programs.
Such good-shepherding is the standard wisdom of a mixed economy, and it’s hard to argue with success, both political and economic. Indeed, prosperous countries, seeking to heal the divides of class, ethnicity, geography, and luck, should always be looking to meliorative programs as part of a plan for sturdy one-nationhood.
So now, even in Republican-ruled Alabama, leaders are moving to improve rural health care. And as the 2019 election results are fully absorbed, we can expect more Republicans to move toward the one-nation ideal. For a Republican Party that depends on the working and middle classes, that’s a necessary shift, because that’s where the votes are.
A few observers have, in fact, seen this shift coming. For instance, here at TAC, Chase Madar wrote in 2017, “Within five years, the American Right will happily embrace socialized medicine.” That prediction, to be sure, might prove to be a bit bold in its timing, as well as bald in its word-choosing. That is, Republicans might never embrace “socialized medicine.”
After all, we Yanks, having won our independence, are free to come up with our own political nomenclature, even if policy ideas tend to mix together somewhere in the mid-Atlantic. Yet in terms of policy essentialism, Madar will be vindicated soon enough.
Of course, as a certain Brit playwright, well known, too, on these shores, might have put it (were he writing on contemporary matters), a socially conservative national health plan, by any other name, would smell as sweet.