“In your country, how do you pay when you go to hospital?” my consultant asked.

It was my last day of work in Tanzania. I had been told about the cost of medical treatment. I had seen the itemised bills that were filed right alongside clinical notes, making sure that patients would be billed for absolutely everything from use of an operating theatre down to the 1000TSh per swab used. I had known that they were the tip of a very large iceberg and I had thought about the people who didn’t even seek medical attention because they knew that they couldn’t afford it. And I stood in the middle of a hospital corridor and I tried to explain Aneurin Bevan’s vision to a man who had to work within this system.

“It’s free,” I said. “In my country, we have a thing called the National Health Service. It’s paid for out of our tax. It works so that everyone contributes what they can afford, according to how much they earn. You pay nothing directly. You aren’t charged when you go to hospital and you don’t get a bill later. It doesn’t matter whether you don’t have a job or you don’t earn much and only pay a little bit of tax or you have a very well paid job and pay a lot of tax, everyone is entitled to the same healthcare. There are some people who have private insurance, too, and that might mean that they get seen faster for things that aren’t emergencies. But, generally — ”

“No charge?” he asked. “If you need to see a doctor, you can see a doctor? And you can get treated? And you don’t have to pay for it?”

I nodded.

He looked at me as if I had just told him that I could prove the existence of God. “It’s a wonderful thing,” he said. “It’s an amazing thing. You’re very fortunate to live in such a country.”

I am. I know that I am.

I don’t pretend that the NHS is perfect. It has flaws and inefficiencies and is often tied up in entirely too much bureaucracy. But the things that it stands for are things that represent the very very best of us. It’s there for us when we need it. It’s never turned us away because we’ve had the wrong social standing or the wrong bank account or the wrong kind of insurance. It tries so very hard to be, as Bevan and Atlee wanted, a universal service based on clinical need. It is a hundred times better than the alternatives. It is a wonderful thing. And it is a national treasure.

I wonder if the 316 MPs who voted in favour of the Health and Social Care Bill yesterday realise that.



  1. I really doubt it, Beth. They seem to me to be losing sight of the ideal which, like you, I feel is so very precious and important. I honestly can’t imagine living somewhere without the NHS for all its faults.

  2. Having lived under both systems, I much prefer the NHS. I’ve had access to “the best healthcare in the world,” in the US (yeah, right), and paid upwards of $20,000 per year for the two of us to have the privilege. Believe me: you have better care in the UK. True, they have more machines and better facilities, but the level of care just isn’t there, even for those who can and do pay for it.

  3. Within the confines of cabs, I have heard repeatedly the opinions of the masses (or, the drivers, who feel sure they speak for the masses). Especially in London I heard many cries of how the NHS ends up supporting the indigent and drunk (i.e., Scots, to the Londoners) and how at least in American you get what you pay for, and if you don’t pay, you don’t get.

    In all likelihood, both systems could use a little tweaking (to say the least) but I would never want the UK to lose the NHS. Indigents or not (and it’s not likely there are fewer in London) it’s exceptional that a government is taking care of the basic needs of its people. Love my country, but really hate its focus on profit instead of people. On one hand, yeah, we’re rich. On the other hand, it’s an eighth of the population that has all of the money. We are so out of balance – and historically, that way lies bloody revolution…

  4. They do feel sure of that, don’t they? I had a cab driver earlier this year who asked what I did and then told me all the ways in which I should fix the Scottish Blood Transfusion Service, as if I have anything like that much power. I was running late for that bus to Perth and had Alan on the phone while I swore up and down that I’d be there in a minute, oh Lord please don’t leave, and all I could think was what if I missed the bus and had to listen to this guy berate me about the SBTS and the NHS all the way to Perth.

  5. Pingback: Wishlist for 2014 | The Road Less Travelled

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