Prime Minister Boris Johnson of the United Kingdom is set to lift nearly all of his country’s COVID-19 restrictions on July 19. Some British media outlets are calling it “Freedom Day.”
The public response to Freedom Day is similar to what we saw in the U.S. as governors started lifting restrictions in their states earlier this year. Some people are calling Johnson reckless, others say it is high time. A major difference, however, is that U.K. discussions of COVID-19 policies begin and end with the National Health Service (NHS).
Many Americans are aware that the U.K. has a single-payer healthcare system. The overwhelming majority of British people rely on it for their care. The NHS’s budget this year is around $300 billion, including over $80 billion to handle COVID.
I lived in the U.K. between 2013 and 2015. While there, I developed some health problems and, as a result, I experienced a great deal more of the NHS than I ever expected. I never got a single bill or made a co-payment, which was strange and wonderful.
However, most Americans don’t realize the amount of propaganda needed to sustain the NHS in Britain. British people know that the care the NHS provides can be terrible sometimes, but they are taught to adore it anyway. They believe the NHS is intrinsically good, with any problems always being the result of underfunding or meddling by politicians. British people often talk about the need to “cherish” and “protect” the NHS. They call it “our NHS,” “our most precious national treasure,” and “the envy of the world.” When I lived there, I was struck by how people from different backgrounds all seemed to use the same vocabulary when talking about the NHS.
Americans who watched the opening of the 2012 London Olympic Games got a small taste of the NHS propaganda machine. The ceremony featured a “tribute to the NHS” in which dancing NHS nurses teamed up with Mary Poppins to save a child from the grim reaper. British people get spoon fed messages like this on a daily basis from birth. And I mean literally from birth since most British babies are born in NHS hospitals.
After that, children are relentlessly catechized about how lucky they are to have the NHS caring for them. I could list hundreds of examples but here just are a few: A recent children’s book called We love the NHS was published with the stated aim of teaching children “the need to cherish and fund the NHS for future generations, and to know that it will only continue to exist if we work to ensure it does so.” During the COVID-19 shutdowns, children all over Britain were roped into weekly events applauding NHS workers. They were also encouraged to draw pictures of rainbows to express their thanks to the NHS. Prince William and Kate Middleton published photos of their younger son, Prince Louis, making some of these pictures.
As British children become adults, the message that the NHS is wonderful is reinforced at every turn. This year, July 4 was inaugurated in the United Kingdom as the first annual “Thank You Day,” on which people are supposed to express their gratitude to the NHS. According to the NHS website, “members of the public are being encouraged to mark the day in numerous different ways, from picnics to barbecues, outdoor parties to drinks.”
In a recent book called Dear NHS: A Collection of Stories to Say Thank You, celebrities ranging from Emma Watson to Paul McCartney “share their stories of how the national health service has been there for them and changed their lives in the process. By turns deeply moving, hilarious, hopeful and impassioned, these stories together become a love letter to the NHS.”
The NHS also has a non-profit arm called NHS Charities that raises private donations. Prince William and Kate Middleton are its official patrons. Apparently, the $300 billion the NHS gets from British taxpayers still isn’t enough. During the pandemic, 100-year-old Captain Tom Moore became a national hero by raising millions for NHS Charities by making laps in his garden with his walker. He received a knighthood from Queen Elizabeth for his efforts.
NHS propaganda does occasionally overstep the boundaries. Last year, NHS Charities produced an ad showing Santa Claus in the ICU, presumably suffering from COVID-19, and being nursed back to health by NHS staff. Parents complained the ad scared their children, so it was withdrawn.
Support for the NHS crosses all party lines. Politicians sometimes seem to be competing with each other to see who can praise the NHS in the most superlative terms. Last year, after recovering from his own bout with COVID-19, Boris Johnson released a video in which he said “We are making progress in this national battle because the British public formed a human shield around this country’s greatest national asset: our National Health Service… We will win because our NHS is the beating heart of this country. It is the best of this country. It is unconquerable. It is powered by love.”
Keir Starmer, leader of the opposition Labour party, made a video about his mother, an NHS nurse who fell ill and became a patient. “The NHS which she’d served and loved as a nurse suddenly became, if you like, her lifeline. Many, many times she got gravely ill, and it was the NHS that she turned to,” he said.
Despite all the propaganda, the NHS’s biggest advantage is that most British people have never experienced any other type of healthcare. When I lived in Sao Paulo, Brazil, I became friends with a British expatriate, who once confessed to me in hushed tones that she probably could not move back to the U.K. because of the NHS. Sao Paulo has a world-class private health care system and she’d gotten used to seeing doctors whenever she needed them.
Most British people know on some level that the NHS care can be terrible—usually from first-hand experience. But they have been taught it doesn’t matter in the bigger picture. Every person I ever talked to about the NHS has had a horror story. One mother told me she’d received such negligent care while delivering her baby that she was plunged into deep post-partum depression. Another friend told me that after surgery she was sent home too soon from an overcrowded hospital; as a result, her wound became infected and she was ill for weeks.
However, simply sharing a few of these anecdotes does not capture the grim bureaucratic nightmare of living with the NHS. Conservatives sometimes quip that in a single-payer system, your healthcare would be like the DMV. I am not necessarily opposed to single-payer healthcare, but that is a fairly good analogy for the NHS.
While I was living in the U.K., I was diagnosed with a rare, serious condition. It was nearly impossible to get any answers about what was going on with me. I received letters in the mail from doctors I had never met in person and who were unreachable by phone. At one point, I was referred for a test to a hospital located 170 miles from my home. Since I had just given birth eight weeks before, I hoped the test could be done at my local hospital instead. I spent three months trying unsuccessfully to get that arranged. Eventually, I submitted and made the journey to get my test.
Thankfully, not long after that, we moved to South Africa, where I had access to excellent private healthcare. Several specialists I saw there expressed amazement that I wasn’t referred for surgery as soon as I was diagnosed. My condition had become much harder to treat due to the delay. But that’s the NHS. If you are not bleeding to death on the hospital floor, you get pushed to the back of the line.
Again, I am not necessarily opposed to single-payer healthcare, but it needs to be much better than the NHS.
What about the COVID-19 crisis? I hate to think how bad things have gotten in the U.K. A study found that nearly 1.6 million surgeries were delayed or cancelled in 2020 and that figure is projected to rise to 2.4 million this year. A columnist for the Daily Mail described how his appointment with a specialist had been delayed by seven months.
The British media is referring to this situation as “the NHS backlog.” That makes it sound like the pile of emails you have to answer when you get back from vacation. In fact, it’s a humanitarian disaster. Thousands of people will suffer and even die thanks to this so-called backlog.
To quell possible discontent among the masses, the NHS propaganda machine has gone into overdrive. The NHS’s 73rd birthday on July 5 was celebrated even more lavishly than usual. Prince William and Boris Johnson attended a service of thanksgiving for the NHS at St. Paul’s Cathedral. Queen Elizabeth awarded the George Cross to the NHS. The George Cross is the U.K.’s highest award for gallantry and heroism, and it is usually given to individuals.
When l lived in the U.K., I sometimes wondered if there might be a tipping point, when care would get so bad the British people would finally have had enough. It remains to be seen if the fallout from COVID-19 means that moment has finally arrived.
Where does that leave America? Healthcare in this country is hardly a panacea. But perhaps we have an advantage over the British in that we all agree our system needs to be fixed. No one would ever describe Medicaid and Medicare as “our greatest national asset.” The U.K.’s relentless pro-NHS propaganda makes real reform that much harder.
Emma Freire is a freelance writer who has been published in the Federalist, Human Events, and others. Over the past decade, she has lived with her husband and three children in Brazil, South Africa, and Europe, but she identifies as American.