Wednesday :: May 11, 2005

Left Populism 101: The National Health Service

by rayman

Building on my post from yesterday, I'd like to briefly focus on how a populist message/approach works in practice. One of the things I find amusing about the populism-is-icky technocrats I alluded to yesterday is that, almost without exception, they are in favor of a universal health care system in the US. But they never stop to ponder how to sell this plan in the face of the inevitable Republican blitzkrieg. Therefore, I think it's instructive to note how the Labour Party, led by Aneurin Bevan, instituted the National Health Service in the late 1940s. Overcoming fierce opposition by both the Tories and British Medical Association, the NHS was the crowning achievement of the post-war Attlee government.

How did they do it? I'm afraid the populism-averse centrists both in the blogosphere and in the Democratic Party won't enjoy the story. This BBC summary neatly recounts Bevan's brusing battle, and the bare-knuckled economic populism that carried the day:

Bevan had fought tooth and nail to ensure all the people of Britain could receive the best medical care available whether they were a banker or a miner, free at the point of use.

Overnight, the patchwork provision of medical services, which left millions of people with little or no reliable health care, was swept away. But the establishment of the new health service was strongly opposed by the Conservative Party and by the Doctor's professional body, the British Medical Association (BMA).

They feared both the new service and the flamboyant socialist minister whose mission it was to create it. Once Bevan had published his Bill on the health service in 1946, one former chairman of the BMA described Bevan's proposals in the following terms:

"I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany. The medical service there was early put under the dictatorship of a "medical fuhrer" The Bill will establish the minister for health in that capacity."

The BMA was concerned that by nationalising both the charity hospitals and the former poor law hospitals run by local authorities, Bevan would strike down doctors' cherished professional independence, and their right to buy or sell general practices. They feared their new role, with a salaried income, would reduce them to the status of mere civil servants.


Once the Health Bill became an act in the closing months of 1946, the BMA immediately adopted a policy of non co-operation with the health service and refused to negotiate with the minister on their conditions of service.

But Bevan was determined to prevent a sectional interest derail an act of Parliament. He described the BMA as a, "small body of politically poisoned people" who had decided "to fight the Health Act itself and to stir up as much emotion as they can in the profession."


By NHS D-Day, July 5, 1948, 90% of doctors had signed up for the new service. But although Bevan had in the end comfortably won the battle, he could not resist one last attack on those who had stood in the way of his dream.

In a speech on the eve of the heath service's launch, Bevan called the Tories "lower than vermin". When the prime minister, Clement Attlee, suggested the opening of the NHS should be celebrated as a national institution supported by the whole nation, it was too much for Bevan, who replied:

"The Conservatives voted against the National Health Act, not only on the second but on the Third Reading. I do not see why we should forget this."

Did Bevan really call the Tories "lower than vermin"? Eww, how rude of him! But seriously, when the day arrives where universal health care will finally be put on the table, the opposition that Bevan and Labour overcame will be nothing compared to the fusillade of fury the Republicans and their media cronies will unleash. I'd hate to go into this monumental battle with the populism-is-icky crowd, who'll soon realize that all the statistical breakdowns and pie charts will be useless in the face of the right-wing onslaught.

Indeed, the Clinton health care debacle in 1993-94 offers some dispiriting clues as to how a policy wonk-driven health care campaign can falter. The Clinton plan, crafted by über-wonk Ira Magaziner, was extremely popular with the public when it was first rolled out. The problem is that neither Magaziner, Hilary, nor anyone else in the Clinton White House could effectively push back against the months-long smear campaign engineerred by Dole, Gingrich, and the right-wing media. Also, the Magaziner plan was almost Rube Goldberg-like in its complexity, so much so that many of the putative supporters barely understood it (this academic essay (warning: PDF) helpfully summarizes the slow, painful death of Clinton's plan). Contrast this with the inherent simplicity of Bevan's NHS plan.

The Clinton health care fiasco is a tragicomic example of what can happen when centrist technocrats are not only placed in charge of policy, but politics. On the other hand, the NHS example demonstrates how fire-and-brimstone populism is essential to the implementation of universal health care, not only to maintain the public's support, but also to surmount the formidable opposition from the vested interests. Thus, the populism-is-icky crowd, who strongly favor universal health care, should think long and hard about how the scorched-earth politics of this battle will play out on both sides, not just the policy minutiae. Tomorrow, I'll offer some concluding thoughts about what role, if any, populism can play in today's Democratic Party.

rayman :: 12:44 PM :: Comments (3) :: Digg It!