IN SUMMER 2012, about 27 million Britons tuned in to the London Olympics’ opening ceremony, dreamed up by the Oscar-winning director Danny Boyle. Central to the show was an homage to the National Health Service (NHS), the United Kingdom’s singlepayer health care system, that featured hundreds of volunteer nurses dancing around bedridden children. Transcending political affiliation, support for the NHS may be the strongest uniting force in the United Kingdom. As the Conservative Party politician Nigel Lawson put it in a thinly veiled shot at the Church of England, the NHS is “the closest thing the British have to a religion.”
Less than a decade after the London Olympics, the COVID-19 pandemic deeply strained the system’s human and financial resources. The number of British doctors considering early retirement doubled over the first year of the pandemic. More than half of the NHS’ doctors worked extra shifts, over a quarter of which were unpaid. Total health care spending was 24 percent higher in 2021 than in 2019. And in November 2022, NHS Resolution—the organization that handles NHS patients’ claims—allocated £1.3 billion ($1.6 billion) in anticipation of an increased volume of claims related to the pandemic. In December 2022, the U.K.’s top health care leaders warned that the country faced a “prolonged period” of excess deaths due to people not having timely access to care.
Simply put, the NHS is collapsing. Physicians and nurses are leaving the profession at an unprecedented rate, and students are entering other fields. Seven million Britons—more than one in 10—are waiting for treatment. And while COVID certainly accelerated the NHS’ decay, it did not cause it. The system had been showing symptoms of an underlying problem for decades. Indeed, the NHS was destined to fail from its very inception.
That’s not just true of the NHS. It’s true of many of the world’s most vaunted government-run health care systems. They have deep flaws built into their very design, and now they’re showing signs of severe strain.
BISMARCK AND BEVERIDGE
MODERN MEDICINE WAS born in the wake of the Industrial Revolution. With technological progress came biological discoveries that made longer, healthier lives attainable. But medical access was expensive, so
