The UK’s NHS is now hit with a nurses strike, though only for a day. The nurses say they are overworked and underpaid. They are. They want an increase in pay of 5% above inflation. That works out to 15.7%. The independent pay board which sets their salary recommended a 4% increase.  The nurses’ pay fell by 5% when adjusted for inflation over the last decade. The problem, which no one wants to face as the NHS is very popular among the voters, is that the country can’t afford its medical system. Neither can the US, but we can print money to paper over the problem – at least for awhile.

The NHS provides “free” medical care at a cost the voters don’t readily see. The problem is that which always occurs when the cost of a service is separated from its delivery. Here is how the system is paid for. First, of course are taxes. They don’t come close to covering the cost. Next is the subsidy that almost no Brit thinks about. With a population of just shy of 70 million, about 10% buy their way out of the system by purchasing private health insurance. They pay into the system, but don’t use it. Analogous is the family that pay school taxes, but sends their children to private schools. If this 10% of the UK populace (that’s 7 million new patients – I used a calculator to be sure) decided to drop private insurance and use the NHS instead, it would collapse under a backbreaking load.

The NHS attempts to contain costs by rationing care. It does so mainly by delay. It takes about a year and a half to get a hip replacement. The same is true for the Canadian national healthcare system called Medicare. The pandemic hit the NHS very hard. About 400,000 patients are on a waiting list for hospital care – a number more than 300 times that of the pre-pandemic period. The number of hospital beds is well below that needed. The NHS went 60 years between its enactment and the building of a new hospital. The service has fewer doctors than the average for the EU.

Back to the nurses. The government fearful of detonating a wage explosion has declined to increase their salary more than that recommended by the board mentioned above. More nurses than previously was the norm are leaving the NHS. There currently are almost 48,000 nursing vacancies in the NHS. The public reportedly supports the nurse’s demand for increased salary. But if they were asked if they were willing to have their taxes increased to cover the NHS shortfalls, they likely would have responded differently. There’s only so much “free” stuff that people are willing to pay for.

The long term outlook for the NHS is grim. As is typical for their ilk, the politicians have promised their constituents more than they can deliver. This phenomenon is older than Christianity. Quintus Cicero advised his famous brother Marcus in his A Short Handbook on Electioneering, “That people would rather you lie to them than have you deny them your help.” 

The NHS likely will not collapse. It will stagger along with underpaid staff and inadequate service both made worse by the aging of the British population. As long ago as 2015 the Guardian reported that two-thirds of the NHS hospitals provided inadequate care. As Lincoln observed, you can fool some of the people all of the time. The rest, in the UK, have private medical insurance.