Why the NHS is rubbish The modern-day assault on The fresh prince of

William Atkinson free speech Saudi Arabia

Dylan Bhundia Isaac Bettridge

A politics and economics publication Issue 6 Spring 2018

WHY
EVERYONE
IS
WRONG
Contents
Letter from the Editor WHY EVERYONE IS WRONG
The Emperor Has No Clothes ABOUT:
Hello, and welcome to this term’s edition of The Backbench,
the school’s premier—and indeed only—Politics and Eco-
THE NHS
nomics publication. With this issue, we’ve endeavoured to
take on some of the great political shibboleths of our time William Atkinson,
and seek to, in our own unique ways, debunk them. I very
much hope you enjoy them, and any errors contained with- P3
in are entirely my responsibility. I also apologise in advance
for the length of my article—more a dissertation than a EUROPE
short precise!

Events Dear Boy, Events/ A Week is a Long Time in Politics Max Kendix, P16
These two aphorisms, so ably authored by Macmillan and
Wilson respectively, are as apt and insightful now as when HATE SPEECH
they were first uttered. Last issue was a massive downer
from my perspective—mopey, bitter and depressive, as one Dylan Bhundia,P18
is as a young and foolish 17 year old. But now, literally
weeks older, as a grown up, entirely sensible 18 year old, I
have rediscovered that most excellent of virtues—optimism.
SAUDI ARABIA
We live in a time of unprecedented human prosperity, with
217,000 people lifted out of extreme poverty every day. Isaac Bettridge, P20
More than 10% more of the world’s surface is covered in
green space than when I was born at the turn of the
Millennium. And, much more importantly, the Tories are
THE CONSERVATIVE PARTY
ahead in the polls once again. Thank you for that, President
Putin. But here’s my next wager for you—we’ve passed Sameer Aggarwal, P22
Peak Corbyn. And whoever Labour’s leader is come 2022,
they’ll be beaten by Prime Minister Penny Mordaunt. You
heard it here first! Let’s hope Labour’s moderate quislings LETTERS TO THE EDITOR:
can have the nads to split in the mean time, and the To-
ries can get some houses built. Anyhow, as this may be my We welcome any articles from any
last editorial, thank you for reading, and enjoy the issue!
perspective to be emailed to our
The Backbench On the cover email address.
Issue 6 – Spring 2018
We also now encourage letters to
Editor:
the editor from any of our readers
William Atkinson
as a response to any of the articles
Deputy Editor/Design: Max
Kendix in this edition, to be printed in the
Writers: next edition - feel free to send
William Atkinson, Max these in to our address at:
Kendix, Isaac Bettridge,
Front cover TheBackbench@mtsn.org.uk
Dylan Bhundia, Sameer Ag-
cartoon:
garwal
Tanya Kendix
Special thanks: Mr James

2
NHS
Why the NHS is Rubbish
William Atkinson
It is a truth universally acknowledged that the
NHS is the envy of the world. Whereas in
America the poor go without coverage and
the middle classes are crippled by extortion-
ate costs, we Brits take pride in our health
service, which delivers universal coverage
free at the point of use and to an internation-
ally lauded standard. Nobody else has a sys-
tem so egalitarian, so successful or indeed so
popular. As Nigel Lawson (former Chancellor
of the Exchequer and, more importantly, fa-
ther of Nigella) put it, “The NHS is the closest
thing the English have to a religion”. If that’s
true, then I must declare myself an apostate.
The NHS is a national joke. This year, NHS
hospitals had to cancel all non-emergency
surgeries until February in order to divert re-
sources to this year’s flu epidemic, which trig-
gered mass overcrowding. Outpatient clinics
were shut down for weeks, and 50,000 ap-
pointments had to be cut from the schedule.
50,000! 50,000 people, suffering in pain,
waiting for surgery on everything from knees
to cataracts. All starved of treatment because
the NHS isn’t equipped to deal with flu. I
thought rationing ended after the war – ac-
cording to the NHS, apparently not. This
monumental systems failure is unprecedented
internationally. Rather than being “the envy
of the world”, as our bleating politicians so of-
ten intone, the NHS is a international disaster
story. Nowhere else in the developed world is
there a yearly tradition of a “Winter Crisis”, or
such national outcry over any aspect of
private involvement. not been copied any-
The Backbench
IIndeed, nowhere else has an “NHS” full
stop; our model of healthcare provision has
not been copied anywhere else in the world,
not even in the supposed social-democratic
paradises of Scandinavia. Don’t take this to
mean that other nations do not have univer-
sal access to healthcare, however – every
other developed nation, apart from America,
ensures everyone, from Dukes to the home-
less, have access to healthcare - often much
better quality healthcare than ours’ at that.
When politicians tell you other nations
“envy” it, especially Remain supporting La-
bour ones, they are displaying a far more
arrogant and blinkered “Little Englander”
mentality than anything ever espoused by
Nigel Farage. Indeed, to paraphrase Ronald
Reagan, it’s not that our left-wing friends
are ignorant, but that they know so much
that isn’t so.
This article is designed to tackle four key
shibboleths to do with the NHS – that it is
world-leading, that it has only recently en-
tered crisis (and that that’s the Tories’
fault), that more funding is the only solution
and that we only have a binary choice be-
tween the NHS and an American style sys-
tem, which is not what I will be at all advo-
cating. Before we begin, I must declare an
interest in the NHS. In 2013, I entered hos-
pital with a severe case of appendicitis. Had
my appendix not been removed when it
was, it would have burst, potentially killing
me. As such, I owe Watford General Hospital
my life – and, in a compete coincidence, my
birth. My qualms therefore are not with the
Winter 2017 3
birth. My qualms therefore are not with
the doctors, nurses and other profession-
als who keep our NHS running day to day;
such people, and such emergency care,
exist under any system, in any developed
nation. No, my problem is with our back-
wards, ideological, outdated, inefficient
and murderous healthcare system. Our
country has suffered enough under our
rubbish NHS. Thousands of lives have
been unnecessarily lost, and billions of
taxpayers’ money has been wasted. This
is a human tragedy and a national joke,
and should not go on any longer.
1. The NHS is not “the envy of the world”;
by international standards, it is appalling
The key difference between nationalism
and patriotism is that patriotism is self-
critical. Nationalism is founded on a single
-minded belief that one’s country is funda-
mentally superior to all the others. Patri-
otism, on the other hand, is rendered dis-
tinct by its ability to both embody a love
of one’s country for its strengths and suc-
cesses, and to note where it is going
wrong. Like a parent scolding a child to
improve their behaviour, it is a critical, re-
forming love, not an ideological one. I
think on most things the average Brit is a
self-conscious patriot, able both to love
their country, its landscape, institutions,
people and beer, but at the same time
knowledgeable of its problems; everything
from potholes to inadequate politicians.
On the NHS, however, our debate is
The Backbench
marked out by the most pig-headed na-
tionalism possible. So often do we hear
our elected representatives, the “luvvies”
in the media and the representatives of
our health service intone that the NHS is
an international leader and source of
worldwide jealousy. According to the
2012 Olympic Opening, it is something
seminal in British history that we can be
proud of as a nation. I would personally
say standing alone against totalitarian-
ism and leading the campaign against
the slave trade are more important, but
there you go. Alas, as someone unfortu-
nate enough to have skipped a teenage
leftie phase and headed straight to the
grim and depressing world of being right
-wing before you’re even 20, it shames
me to say that the leaders of the Right in
this country have also very much drunk
the Kool Aid. According to David Camer-
on, the National Health Service was “one
of the greatest achievements of the 20th
century”, comparable to the aforemen-
tioned defeat of genocidal tyranny, an
unprecedented reduction in human pov-
erty and the ending of totalitarian mis-
ery. Aneira Thomas, the first person born
under NHS care, also insists it is the
“envy of the world”, a sentiment appar-
ently supported by 565 of the population
in opinion polls. This is, quite frankly, ut-
ter madness.
To back up my (frankly controversial) as-
sertions, let us consult a few internation-
al metrics. Firstly, the Euro Health
Winter 2017 4
Consumer Index, which researches the apples with apples leaves the NHS the
quality of healthcare across Europe. Ac- worse off. However, you won’t see any of
cording to our politicians, we would expect these rankings quoted by our politicians,
the NHS to be at the top, or at least near and for good reason. They prefer a rank-
it. Alas not. In 2015, the UK came 14th in ing by an American organisation called
Europe, and has never made the top 10. the Commonwealth Fund, which ranks
This is due to “poor accessibility” – the the NHS first. Disclaimer – the Common-
worst, alongside Poland and Sweden, in wealth Fund is a left-wing organisation
Europe – and an “autocratic top-down that wants to introduce the NHS to
management culture”. The WHO also pro- America. So perhaps not 100% objec-
duced a World Health Report in 2000, tive. Even allowing for that, the Com-
which ranked the UK 18th in the world. monwealth Fund ranks the NHS 10th out
Now, we can rightly say that that is 18 of 11 on “patient outcomes”. In layman’s
years ago. So, since then, the NHS might terms, that means keeping people alive.
have improved. Except, in the mean time, Let that sink in for a second.
we have seen a Labour government that
spent over £13 billion (more than on the
Iraq War) on a computer system that did-
n’t work, and a series of Conservative
governments whose only major attempt at
NHS reform under Andrew Lansley was
both widely ridiculed and hobbled of any
radicalism by public protest. Surprise su-
prise therefore that according to the an-
nual Bloomberg ranking of healthcare sys-
tems, we are 21st, behind such economic
powerhouses as Greece and Mexico. An
OECD survey, comparing the NHS not
against every system in the world but only
those with relative similarities to it – de-
fined as “Mostly public insurance... mainly
provided by a heavily regulated public
system, with strict gate-keeping, little de-
centralisation and a tight spending limit
imposed via the budget process” – ranked
it “below average”. So even comparing

The Backbench Winter 2017 5

Even an organisation that wants to copy
the NHS admits that, on international
comparison, it is rubbish at saving lives.
One would hope that that is one of a
health service’s primary objectives, and
that the NHS, if failing on it, is seriously
structurally unsound. Asides from life-
saving, how does the NHS fare on other
metrics, such as cancer survival rates?
The government has been touting this as
a success recently, with apparent unprec-
edented rises in the numbers surviving.
No bad thing on its own of course, but
when compared to other countries, we re-
main appalling. If we matched the Nether-
lands’ standard of cancer survival, 10,000
fewer British people would die every year;
the German rate, 13,000 fewer. The Bel-
gian rate would be even better – 14,000 a
year. This would mean saving the lives of
more than the population of Watford eve-
ry decade. No wonder no European nation
has copied the NHS – we should be copy-
ing them. Compared to our continental
cousins for healthcare quality, we rank in
the bottom third, about the same level as
Slovenia. We don’t even have decades liv-
ing under Soviet oppression as an excuse
for being in the bottom third. Our suffer-
ing under state socialism wasn’t even im-
posed from above – we consent to it
through the ballot box at election after
election. Like Winston Smith in Orwell’s
1984, we have learnt to love Big Brother.
As much as I want to mock and laugh at
the NHS’ failings compared to the false
The Backbench
praise of its supporters, I can’t, or at
least shouldn’t. This isn’t funny, national
joke though it may be. These are peo-
ples’ lives being lost unnecessarily. It is
a human tragedy that every tax-payer,
politician, doctor, nurse and citizen of
this country partakes in. And it breaks
my heart.
NHS crises are not a recent, Conserva-
tive-authored development, but an inevi-
table consequence of the NHS’s design
When the NHS was established, it was a
remarkable and unique experiment in
delivering healthcare. A state-run mo-
nopoly funded out of general taxation; a
world away from the previous arrange-
ment, in the UK and elsewhere, of chari-
ty hospitals, free services for the poor
and support from friendly societies), all
without any centralized control. When
the NHS was established, it most bene-
fited two groups – working class house-
wives, who previously hadn’t been cov-
ered by the support their husbands got
from work, and the middle classes, who
had previously had to pay for their ser-
vices whereas the poor had, in the vast
majority of cases, been given service
free. Ah, the days when working in
healthcare was a charitable vocation, not
an opportunity for high salaries, strikes
and bureaucratic middle-managing –
aren’t we so glad we moved away from
that? Indeed, Labour’s 1945 manifesto
Winter 2017 5
explicitly addressed that their issue was
not that the poor lacked cover – the cover
they received was some of the best in the
world – but that it was not controlled,
overseen or regulated by the state. As ev-
er, freedom, independence, choice and
self-organization were anathema to so-
cislidt mindset.
But still, what does it matter if the service
was run by the government or not, as
long as it was providing equal quality, or
perhaps even better, healthcare? And it
did, didn’t it? Problems in the NHS, its de-
fenders argue, are a recent thing, the vile
consequence of “Tory cuts” designed to
wound an organisation destined for
“privatisation”. Leaving aside the madness
of both of these statements – NHS spend-
ing has risen every year since 2010, the
NHS was first proposed under a Conserva-
tive government and nobody in their right
mind would want to float the NHS as a
private company on the stock market
(because nobody would buy it) – let’s ad-
dress this claim. The NHS was a product
of the utopian vision for a New Jerusalem
under Clement Attlee’s post-war Labour
government, and its introduction was
spearheaded by Nye Bevan. His distinctive
Welsh jowly appearance can be seen grac-
ing the grateful walls of Mr James’ class-
room. Filled with Messianic vigour and
purpose, Bevan didn’t bother having his
officials collect any levels of information
on expected demand for the service; a
mirror, perhaps, of the lack of preparation
The Backbench
for huge levels of mass immigration to-
day. Neither did Bevan think very deeply
about the cost, touting figures like £130
million per year, something I’m sure
Philip Hammond would be very chuffed
with. His own memorandum on the ser-
vice devoted a whopping two paragraphs
out of 54 to costs. This wasn’t for lack of
information, as many studies at the time
had addressed issues like cost and de-
mand, as well as laying out the pros,
cons and expenses of various models.
But no matter- things like rationality, ex-
pense and facts were simply irrelevant
obstacles to the committed Socialist; la
plus ca change, etc.
Am I wrong to scoff though? Plenty of
things can go much better than expected
even without much prep or foresight, as
I’m sure many of us discover when exam
season comes round. Was the NHS suc-
cessful in keeping costs down, delivering
an efficient service and benefiting the
British people at large?
What do you think?
It was a disaster.
It immediately vastly overspent any es-
timate of its costs. This wasn’t particu-
larly helpful to a country recently bank-
rupted by saving the free world from tyr-
anny. Within two years the NHS was
costing twice as much as was predicted.
Whereas Germany spent its Marshall Aid
money from America on industrial mod-
ernization and national rebuilding, Britain
Winter 2017 5
spent hers’ on bailing out her new welfare which, owing to limitations on capital in-
services. A direct link can be drawn be- vestment and general expenditure, can-
tween Bevan’s folly and the next 30 years not expand sufficiently to bear the load.
of Britain as the “sick man of Europe”. By The results are gross over-crowding . . .
1950 costs were pegged at £392 million early discharge . . . long waiting lists
annually, and new cost-cutting measures which tend to grow rather than fall . . .
were introduced. Think of the uproar today and congested out-patient departments.
facing any measure proposing reducing It must be recognised that, so long as
those services freely available at the point the present wide gap exists between the
of use, such as charges for the obese or justifiable demand for hospital facilities
GP visits, and then think on this – services and their availability, no improvement in
were being rationed on the NHS, due to the efficient use of beds can be counted
cost, within three years of its establish- on to produce overall economy.’
ment. NHS rationing due to inabilities to Over-crowding. Waiting lists. Congested
meet demand are not a new, Tory au- A and Es. Familiar, anyone? NHS crises
thored problem – they’ve been structural are not a new problem, inflicted by
flaws since the very beginning. heartless, austerity-worshipping Con-
But don’t take my word for it, unrepentant servatives on a poor, unsuspecting public
contrarian that I am. Instead, here is what – they are the offspring of persistent,
Bevan had to say, in a message to Cabi- structural problems that the Labour par-
net: ty seeks to cover up or ignore whilst in
The overall picture is therefore one of imn- government, but excoriate the Conserva-
increased pressure on services ser- tives for whilst in opposition. But why
are they so persistent? We know they
are not common elsewhere in the world;
health-care rationing is a uniquely British
disease, and one I’m sure we all have
personal experience of. I once had to
wait months for an operation on an in-
growing toenail, and when I finally re-
ceived treatment it was so poor, and
made the toes so much worse, that my
parents had to shell out to have it done
privately. Such luxuries are for the few
who can afford them; the many, who still
suffer under the blight of Labour’s tem.

The Backbench Winter 2017 8

system. Socialists may loathe those who
get private healthcare, or private educa-
tion for that matter, but it only testifies
towards their own failings; an abysmal
government monopoly incentivises an ex-
cellent private sector.
Indeed, it is socialism that is directly to
blame for the NHS’ mediocrity. By making
the NHS a state-run, central government
monopoly, Labour created a structure that
was irresponsive to supply and demand.
As any keen economics student will tell
you, in a free market prices and availabil-
ity are dictated by the inter-relation be-
tween supply and demand – if supply in-
creases whilst demand stays the same,
prices fall, and if demand increases but
supply stays the same then prices in-
crease. The effectiveness of this lies in the
incentives it creates – as prices increase,
more people want to offer the service,
meaning the supply increases, and prices
fall. Furthermore, constant competition for
price and quality keeps prices down and
incentivises better quality healthcare so as
to keep one more attractive than one’s
competitors.
With the NHS, however, there is none of
this. It has no way of reacting to in-
creased demand, as it is not a market. It
is not incentivised to offer better quality
service, as, except for a rich few, it has no
competitors accessible by the general
public. It doesn’t have to compete for
your business or your money, as most
people cannot afford to go elsewhere. It
The Backbench
can afford to be rubbish year in and year
out, and our taxes will simply bail it out.
Patients are at the mercy of the Health
Secretary’s edict. Bound by the extent of
the supply he can provide, Jeremy Hunt
has no choice but to ration services, pro-
longing suffering for patients unable to
go elsewhere. Mr Hunt is the unfortunate
fall guy for a system that is structurally
inefficient and unable to direct resources
where they need to be. This is why other
nations do not have yearly “Winter Cri-
ses”, months of waiting for operations
and tens of thousands of cancelled oper-
ations a year: because no other nation
has consented to the madness of making
healthcare a central government monop-
oly. The idea that a top-down bureaucra-
cy could better guess the medical needs
of 65 million people than the self-
coordination of the market through the
demand of the public and the competi-
tion been different suppliers to provide
services, is an outdated fantasy, as ret-
rograde and unthinkable in the modern
world as “No coloureds” signs or the So-
viet Union. Why, 70 years on, should we
still have to suffer under this backward
and failed model of provision?
Winter 2017 9
3. More funding, whilst it may plug the
gap in the short-term, is not a long-term
solution
You might agree with what I’ve written so
far, and you might not. Hey, it’s a free
country, and if anyone wants to write an
article refuting all this for the next issue of
The Backbench, then please do (no really,
please do – I’ve got to fill the pages
somehow, with the length of this article
being a case in point). But I’m sure both
those who are convinced and unconvinced
will have nagging at the back of their
mind a problem and a query that seems to
refute everything I’ve been saying – un-
derfunding. The NHS might be failing,
sure. But can’t we just spend more money
on it?
I agree, more money to the NHS might
help. I’m not an ideologue – of course giv-
ing something more money to spend can
make it more generous. And when we
leave the EU, we will have back full con-
trol over the £350 million plus we send to
Brussels, of which a bit more spent on the
NHS would be a fine thing. But I do not
for a second believe that just a little bit
more money will solve the fundamental
problems of the NHS. Firstly, because I
don’t think it will spend that money well –
in efficiency rankings, the NHS comes in
the bottom third, and as £56 billion of
NHS spending is already on compensation
payments, let alone all that wasted on
The Backbench
everything from unnecessary manage-
ment to health tourism, the chance of
that money reaching those most in need
is slim at best. But, more importantly,
international comparison suggests the
old Labour solution of just chucking
money at the problem and hoping it will
go away is not an intelligent decision.
Yes, France and Germany spend more on
the NHS than we do – but Australia and
Iceland spend less, and still achieve bet-
ter results. Singapore is world leading in
its healthcare – but it spends 4.7% of
GDP, not our 11%. In fact, the UK is
above average internationally when
looked at in terms of spending, and the
reason why we lag behind our continen-
tal cousins is because, as a consequence
of its top-down structure, the NHS does
not invest in the latest technology at a
comparable rate, and because their GDP
spends also includes that money which in
the UK is spent on private healthcare.
What that means is, for example, the
German spending on healthcare includes
both my going privately for my in-
growing toenail operation and my having
Winter 2017 10
it done on the state, whereas the UK
share only includes the latter. The overall
message of this that I’m trying to make is
that it doesn’t matter as much how much
is spent, as it matters how it is spent.
Some of the richest countries in the world
have some of highest quality healthcare
systems, including the United States, Ger-
many and Japan. But the UK is also one of
the world’s largest economies, so by
rights it should be there alongside them,
rather than slumming it at the bottom of
international tables. A myopic debate be-
tween the two parties that simply centres
on who can pledge more money neglects
the underlying problems with the health
service, and at best can only act as a con-
tinual sticking plaster. In an age where
people are living longer than ever before,
with a congruent rise in ailments and
needs, such an approach is destined for
failure. We already spend more on debt
interest than we do on education or de-
fence, so for the sake of our generation –
whose earnings, after all, will be the taxes
that have to subsidise this entire endeav-
our –simply allowing spending to continu-
ally increase with no thought for economic
growth, the deficit or borrowing cannot
continue. Our aim should be to spend as
little as possible, as well as possible; a
good mantra for any organisation paid for
by the tax-payer.
It’s very easy for me to find problems with
the NHS, and to sit here and say just how
woeful I think it is. But in the long-run,

The Backbench Winter 2017 11

that won’t help anybody. What we need
are solutions not problems, and it is my
duty to provide, them. And here we must
tackle one of the greatest myths of all
about healthcare in this country.
This is not a simple debate between the
American system and ours – there are far
better alternatives out there.
I love America. Along with penicillin, the
rule of law and Doctor Who, it is one
of this country’s finest inventions. The
people may all be mad, but they have
their hearts in the right place. Our shared
language (and Netflix) means we have far
more exposure to the American way of life
then we do with our continental cousins;
how many more of you stay up watching
Friends, Stranger Things or Game of
Thrones than Babylon Berlin? As such, we
are overly exposed to the political debates
and way of life of our nation’s rowdy
younger sibling. Guns, Mexicans and
transgender bathrooms aside, there is one
American political issue that, as Brits, we
are all thought to have a uniform opinion
on – the crapness of their healthcare sys-
tem. Oh how we scoff at those silly fat
Yankees and their cripplingly expensive
healthcare. We goggle at bills running into
the thousands, and gorge ourselves on
scare stories of families bankrupted simply
to receive treatment. How barbaric, how
backwards. We’ve got it sorted – free at
the point of use, egalitarian to a tee, and
the “envy of the world” at that. Surely the
NHS should be considered one of our
The Backbench
finest inventions, not the United States
of Total Idiocy?
Reader, we’re the idiots.
Not because we don’t have the American
system, and not simply because we cling
so passionately to the NHS. We are idiots
because we believe those are the only
two models on offer. Indeed, discuss
healthcare with most people and you
would believe there was a straight choice
between the government monopoly of
the NHS and the US’s (reasonably) open
market, with the potential for people to
go without coverage, to receive high bills
and other associated problems. Such a
view – especially from those Remainers
who tell us of the need to look to Europe
– is myopic and bizarre. There are many
more potential healthcare models on of-
fer than simply those used here and in
the US, and I will seek to address the
best of them below. But before I do, I
have to hammer home the most im-
portant point that underlines them all:
they all ensure universal coverage. No-
body goes without, no matter how poor
they are, no matter their pre-existing
conditions. Only in the US is there not
universal coverage, underlining why it is
such a prime example for leftie scare-
mongering. So when people laud the
NHS for its universality, you should
shrug your shoulders – so what? There is
nothing at all special about it; indeed,
what really makes the NHS unique is its
government monopoly status, and just
Winter 2017 12
how poor quality a service it provides, But I would not agree. In a modern de-
with so little choice and competition, com- mocracy, unconstrained by the same
pared to the nation that houses it. The Constitutional devotion to freedom and
NHS distinguishes itself not by the unique- liberty that so admirably persists in
ness of its ideals, but by the awfulness of America, it is difficult to argue for a sys-
its services. tem that leaves large numbers unin-
Compared to the NHS, American sured, and confronts families, through no
healthcare is of a very good standard. By fault of their own, with punishingly costly
a set of international measures, the US bills. So I won’t try to. Partly because I
comes amongst the top results in 7 out of feel I’d be defending the near indefensi-
9 of them. For both “How many people ble, but much more because there are
are alive five years after being diagnosed better systems than the American one
with breast cancer?” and “Fewest patients out there for us to compare to which do
waiting two months or longer to see a ensure universal coverage.
specialist”, it was top of the world, and in-
deed led several other metrics as well.
The NHS, for comparison, came last in the
former, and second to last in the latter.
Indeed, America’s position at the top of 7
out of the 9 measures contrasts horrifical-
ly to the NHS, which was ranked at the
bottom of the table for a staggering 6 out
of the 9 measures used. Remember, fur-
thermore, that in the US the poor and el-
derly are aided by Medicaid and Medicare,
so that those who face the highest costs
are those either too rich to be considered
poor by the government, or too young to
be considered old. So, though it may be
directly costly to the consumer without so-
cial insurance, some would argue that
such costs, and a few people bankrupt by
high bills, is more than made up for by the
high quality care delivered to most pa-
tients, especially in comparison to the bla-
tant failures of the NHS.

The Backbench Winter 2017 13

Now, there is no healthcare system that is
universally perfect, and I have only so
much space. Visit Switzerland and Swiss
doctors will tell you the Dutch do it better.
Visit the Netherlands and the Dutch doc-
tors will tell you Germany do it better. Vis-
it Germany and the German doctors will
tell you New Zealand does it better, etc.
We could spend hours trawling through all
the metrics, pulling out elements from a
variety of systems that would all work to-
wards a better healthcare system – com-
petitive insurance markets in Switzerland,
for instance, or privately-run hospitals in
Spain. Indeed, I believe that this would
tend towards a more perfect outcome, as
the NHS’s unwillingness to tinker or en-
gage in a constant process of fundamental
reform is one of its central handicaps. But
as I say, time is short, and I’ve so far
managed to use up several rainforests in
just getting to this point. My grand finale,
you might say. An answer to the funda-
mental question I have posed – if not the
NHS, then what else?
A couple of basic recommendations to
start with. Rather than funding through
general taxation, I would introduce com-
pulsory individual savings accounts, which
are currently used in Singapore. These
discourage wasteful spending on unneces-
sary treatments, as people are spending
their own money on their care. When you
are spending other peoples’ money on
yourself, you are clearly interested in get-
ting good quality care, but you aren’t
The Backbench
fussed about the cost, as it’s not your
cash. So by forcing people to judge
whether their spending is really worth it,
introducing these accounts will greatly
reduce the amount we spend on
healthcare. They are designed for ordi-
nary, not extraordinary costs, so GP and
hospital visits, not car accidents or can-
cer. This partly explains why Singapore
spends only 4.7% of its GDP on
healthcare, whilst we spend around
11%. But, I hypothetically hear you cry,
what about the poor? Well don’t worry:
in Singapore they are covered too,
through a complex variety of methods
designed to keep costs down and guar-
antee access to everyone. This includes
a means-tested system of government
payments that ensure about the poorest
25% of Singaporeans receive aid from
the government. But what about high
costs, I again hear you hypothetically
(and for the point of my article) cry. On
this front, again, don’t worry: Singapore,
Switzerland and other nations all also
have compulsory insurance, which co-
vers people in case the money in their
health savings accounts runs out or if
they are faced with costly unusual condi-
tions. Again, saving for this should be
compulsory – an infringement of our lib-
erty, yes, but no more so than paying for
the NHS at the moment through our tax-
es.
These points are just a couple for start-
ers, but there are many other elements
Winter 2017 14
of systems across the globe we could take which those misguided ideologues of the
a look at. As I’ve sought to hammer home Attlee government would have been
here, understanding global comparisons is proud. I’m sure we can all agree I share
essential to understanding how our many qualities with Mariah Carey, but
healthcare system can be improved. Run- her and I do fundamentally disagree on
ning through all the different models one core issue – the all I want for
would take another 5,000 words, and I’m Christmas is to replace the NHS.
aware that I’ve already gone far beyond
an acceptable length for one of these arti-
cles. The joys of editorship, on public
view. But I hope that with this I’ve chal-
lenged some of the fundamental assump-
tions you may have about the NHS, and, if
nothing else, raised in your minds some
nagging doubts about some contemporary
shibboleths. As Winter stutteringly merges
into Spring, we inch somewhat close to
Christmas. Bizarre to be thinking about it
this early, I know, but I’m sure for all of
us it ranks as a highlight of the Festive
season. It is something we can look for-
ward to every year, an annual relief in a
sea of troubles. It’s not the only tradition
we’re used to at that time of year, howev-
er. We have our annual NHS “Winter Cri-
sis” to look forward to. But whereas
Christmas must (at least until Comrade
Corbyn and his fellow Marxist Puritans
take over and decide to ban fun) come
around once a year, a healthcare crisis
doesn’t have to. We are deluding our-
selves if we think the NHS is viable. It’s
crap. Let’s stop losing unnecessary lives,
and plumbing the depths of international
tables. Let’s have a healthcare system
that really is the envy of the world; one of

The Backbench Winter 2017 15

Europe
Britain was never part of the European project
Max Kendix
A common complaint amongst those on the
losing side of the referendum is that their
campaign focused far too much on the
economic impact of leaving, rather than
providing a cultural, moral or political retort
to the 'take back control' mantra. The truth
is, however, that the economic argument was
the only viable defence of us remaining. We
were never really part of Europe, the project
of ever closer unity, or the pan-European
dream.
The birth of the movement for European
integration came in the wake of the most
devastating war of the 20th century, which
saw mainland Europe flattened by all sides,
most of Europe occupied by fascist forces,
and the murders of millions of innocent
civilians across the continent. Britain, of
course, fought in the Second World War and
her people also sacrificed aplenty - but
mainland Britain never experienced the fascist
invasion and all the effects that came with
that for Europe.
The Backbench
So, when the war ended and plans were
drawn up for a new peace, Britain didn't
want or need to be inside the 'United States
of Europe'; the empire and the debts we
paid to the USA more than sufficed for an
international outlook. As Europe united in a
liberal, intergovernmental alliance, Britain
stood as a strong international player.
Then Britain's empire disintegrated and the
postwar consensus ailed in the 1970s as we
became the 'sick man of Europe'. Our
economic situation required a reboot from a
single European market.
Twice we were denied entry by the French
under Charles de Gualle, who rightly
understood that Britain had alterior motives
than moral unity after despair, and who did-
n't want France's dominating status in
Europe to be undermined. But once the Fifth
Republic formed, Britain convinced Europe
that they should be part of what was then
the European Economic Community.
For years our domestic squabbles over
Europe loomed large, hence the 1975
referendum called by Harold Wilson, fol-
lowed by emerging divisions on the other
side of the aisle. Throughout our time
‘inside’ Europe, we developed our ‘special
relationship’ with America more than Europe
in everything but trade, and our internal
politics mimicked the US far more than Eu-
rope. Our Thatcherism took after American
libertarian and free market ideas employed
by the likes of Friedman and Hayek. After a
7-year political cooling period with Major,
we ripped off the Americans once again with
‘New Labour’ under Blair taking Clinton’s
‘New Democrats’ and ‘Third Way’ message
into the British political sphere. We have
been aligned more with those across the
pond than the channel.
Winter 2017 16
Meanwhile, Europe’s domestic politics were increasingly socialist, with France, Germany and
others to this day never experiencing a Thatcher-style revolution. Mainland Europe moved
towards ever closer unity, as well as incorporating in quick succession new Eastern
members, with Britain always acting as a mitigating factor in the ambitious plans of its
partners, even if our politicians did sound increasingly Europhilic.
So when the intra-party divisions and general UK Eurosceptic movement grew too strong
and a referendum was called by David Cameron, the only argument that Remainers could
muster with conviction is an admittedly strong economic argument; the customs union, free
trade and all the arrangements associated with it have been incredibly useful for Britain. All
the baggage that came with what became the European Union, the bureaucracy and the
supposed cultural and moral union, sat awkwardly with the British people who had never
felt part of Europe. On decision day in 2016, then, the establishment may have been
shocked, but really, it was always in the running; we arrived late, and now we’re leaving
early.

Whether or not you believe in a federal, united and strong Europe, I'd urge you to think
again over whether Britain can really claim to be European; history shows us otherwise.
Perhaps Europe is a great idea, but a free trade deal with Europe is all we should have
actually signed up to.

The Backbench Winter 2017 17

Hate speech
The modern-day assault on free speech
Dylan Bhundia
Free Speech is seen as one of the guiding
principles in any modern day liberal democra-
cy, but is it under threat? And should we
allow the government to pass laws supressing
certain viewpoints and speech?
As defined by the English Oxford dictionary,
free speech is “the right to express any opin-
ion without censorship or restraint”. And as
written in the 1st Amendment of the US con-
stitution, it is the principle that “Congress
shall make no law respecting an establish-
ment of religion, or prohibiting the free exer-
cise thereof; or abridging the freedom of
speech, or of the press; or the right of the
people peaceably to assemble, and to petition
the government for a redress of grievances.”
The fact that the Founding Fathers decided to
make free speech the first amendment in the
constitution demonstrates what a key
principle it is to maintaining a free society,
and this is demonstrated by the fact that the
only speech that is not free in the USA is
speech that directly incites violence. Despite
this, the United Kingdom does not have any
entrenched free speech laws, and in addition
has “hate speech laws”.
Hate speech is speech that “attacks a person
or group on the basis of attributes such as
race, religion, ethnic origin, sexual orienta-
tion, disability or gender”. Whilst initially you
may think that having these laws is a step in
the right direction for creating a more
inclusive society, it is actually a step towards
the dark depths of government thought
The Backbench
regulation and achieves nothing in defeating
subjectively hateful ideologies. Firstly, the
issue with hate speech laws is that they are
entirely subjective – you may find some-
thing “hateful” or “offensive”, whilst some-
body else may not. This means that the de-
cision making process for whether this law is
applied in order to press criminal charges is
entirely down to the subjective opinions of
the alleged victim.
Therefore, these laws cannot be consistently
applied to every area of society since every-
body has their own individual opinions and
subjective views. This is the issue with
subjective laws – they cause confusion and
uncertainty, as what is it that exactly
equates to “attacking a person or race”? Is
it criticising Black Lives Matter? Is it criticis-
ing the Prophet Mohammed? The issue of
subjective laws is currently being demon-
strated by the social uncertainty surround-
ing sexual harassment – nobody seems to
know exactly what specifically equates to
sexual harassment, and as a society we are
confused about this.
Currently it seems to have a very broad
meaning. Laws are not supposed to be
subjective, they are supposed to objective,
like murder or robbery, since there is a very
clear definition of them, and as a result they
are consistently applied in the judicial
system.
Winter 2017 18
Secondly, suppressing viewpoints, such as
Nazism, that most normal people would find
disgusting and disgraceful does not achieve
anything. If you take a group of National So-
cialists, then make their viewpoint illegal,
they are not going to suddenly change their
views. The only way to change their views is
by taking part in an open public discourse
with them, and to prove to them, and to the
world, that their viewpoint is misguided and
the rest of society’s viewpoint is better. By
making their viewpoint illegal, the only people
that they will engage in political discussion
with is people that they agree with, and as a
consequence the law of group polarisation will
occur.
Cass Sunstein, expert in constitutional law,
professor at the Harvard University and au-
thor of 40 books including “Republic 2.0” and
“Hashtag Republic”, is the main driver behind
this theory. In 1999, he wrote a paper titled
“The Law of Group Polarisation”, in which he
describes how “deliberation tends to move
groups, and the individuals who compose
them, towards a more extreme point in the
direction indicated by their own predelibera-
tion judgements. For example, people who
are opposed to the minimum wage are likely,
after talking to each other, to be still more
opposed”.
The Backbench
What Cass Sunstein is saying is that when a
group of like-minded people with similar
viewpoints talk with each other, their views
move further towards the extreme. There-
fore, suppressing people with extreme view-
points will only push them further towards
the extreme, since they cannot express their
viewpoints in public.
Laws limiting speech specifically in the UK
could set a very dangerous precedent. Un-
like the US, the UK does not have an en-
trenched codified document, such as the Bill
of Rights, that outlines in extensive detail
the rights of each citizen.
Therefore, in the US, it is extremely difficult
to remove a citizens right to free speech or
their right to bear arms.
In the UK, all that is required to do this is a
simple act of Parliament passed by a majori-
ty. Parliament could repeal “The Human
Rights Act” 1998 tomorrow if it wanted to.
As a result of this, laws limiting free speech
can be easily passed, and there is absolutely
nothing that the electorate can do about it
until the next general election.
Free speech is not just a value, it’s an im-
portant mechanism for us to formulate and
enhance our own opinions, thereby allowing
us to discover the best solutions to the
problems that we face in society.
The use of legislation and therefore force to
prevent people from saying certain things
disrupts this process, and gives the govern-
ment and certain political groups greater
power to control the narrative in society.
Winter 2017 19
Saudi Arabia
Profiles in tremendousness: Mohammed bin
Salman, the fresh prince of Saudi Arabia
Isaac Bettridge
Saudi Arabia is not a country well known for
its capacity to change. An autocratic, religious
fundamentalist absolute monarchy with one
of the most socially conservative legal
systems in the world, Saudi Arabia is often
unfavourably compared to the sort of
might-makes-right monarchies that ruled
Europe back in the Middle Ages, a comparison
that unfortunately rings somewhat true.
However, in recent years the country has
begun to embark on reforms, allowing women
to drive and attend football matches and
moving away from strict adherence to funda-
mentalist Islam, and the credit for these
changes lies with one man- Mohammed bin
Salman, the 32-year old Saudi defence minis-
ter and Crown Prince who is next in line to
the throne of one of the world’s richest and
most powerful nations. Mohammed’s rise to
power has been swift and, for some,
shocking, and with the prince’s visit to
London this February generating much media
coverage, I thought it would be worthwhile
taking a closer look at him.
The Backbench
Who exactly is this man? What does he
want? Most importantly, with the power and
resources of one of the wealthiest nations in
the world at his beck and call, what is he
going to do next?
Mohammed bin Salman was born in 1985 to
the now-King Salman bin Abdulaziz Al Saud.
He was educated at King Saud University in
Riyadh, receiving a degree in law, and in
2009 entered politics as a special adviser to
his father, who was then governor of Riyadh
Province. Once the then-king Abdullah died
and his father ascended to the throne,
Mohammed was appointed Minister of
Defence, and swiftly set about tackling the
escalating crisis in Yemen. Rebels had
seized the Yemeni capital of Sana’a and
forced the government into exile, triggering
a civil war that was engulfing the nation and
still rages today.
The prince quickly mobilized a pan-Arab
coalition to intervene against the rebels,
thus kick-starting a war the conduct of
which has led to much criticism of the Sau-
dis. Despite this, his star has since contin-
ued to rise, and in early 2016, in his capaci-
ty as chair of the Council for Economic and
Development Affairs, he announced his
plan for Saudi Arabia’s future, appropriately
entitled ‘Vision 2030’.
Winter 2017 20
The ambitious announcement detailed plans
for increased privatization of public services,
a transition from oil dependency toward a
more mixed economy and the creation of
Neom, a vast city on Saudi Arabia’s Red Sea
coast that would take $500 billion to con-
struct, intended to attract investment in
sectors such as renewable energy, biotechnol-
ogy, robotics and more.
However, Mohammed’s rise to international
prominence is better explained through his
lobbying for domestic reforms, which have
often run up against Saudi orthodoxy. He has
successfully lobbied for restrictions on the
powers of the religious police, the removal of
the ban on female drivers, the reopening of
public cinemas and allowing female singers to
perform in concerts.
Whilst these reforms seem incredibly modest
to Westerners, in Saudi Arabia they marked a
radical move away from Wahhabist
dogmatism, in line with the prince’s publicly
stated desire to move towards ‘moderate Is-
lam’ and have his country be ‘open to all reli-
gions and to the world’. Many saw these
moves as less motivated by any patriotic or
altruistic desires of Mohammed’s and more as
a concerted effort to raise his on power and
prominence. These beliefs were seemingly
validated last November, when Prince Al-
Waleed bin Talal, along with the head of the
National Guard Mutaib bin Abdullah, the econ-
omy minister Adel Fakeih and many others,
was arrested as part of a major clampdown
on corruption. The purge was widely seen as
a calculated move to consolidate Moham-
med’s power and to strengthen his appeal
with ordinary Saudis, particularly the young,
who disapprove of the greediness of the
nation’s elite in a time of economic hardship.
The Backbench
But is Mohammed bin Salman really the for-
ward-thinking moderniser he would have us
believe he is? Despite his rhetoric about the
crackdown, many have interpreted it as a
strategic silencing of political dissent, ena-
bling him to shore up political power and
look good doing it.
The bulk of the criticism of MbS though
stems from his conduct of the war in Yemen
- Saudi air strikes in the region have been
declared as a violation of international law,
and a humanitarian crisis has emerged in
the region the bulk of the blame for which
has gone to the Saudis.
Along similar lines, one of Mohammed’s key
responsibilities as Defence Minister is man-
aging Saudi Arabia’s lucrative arms trade,
which has been involved in supplying arms
to Wahhabist insurgent groups across the
Middle East.
Many believe his ‘reforms’ have been largely
ineffectual, simple PR measures to cover up
the brutal realities of the Saudi state. De-
spite an ostensible commitment to
‘modernisation’, Saudi Arabia looks set to
continue being an absolute monarchy with
little tolerance for outside religions or cul-
tures for at least the near future, and its hu-
man rights record remains one of the worst
in the world.
For now, it’s best to regard Mohammed bin
Salman with scepticism - but only time will
tell what his impact will be on both his na-
tion and the world.
Winter 2017 21
The Conservative Party
The Conservatives don’t have a youth problem
Sameer Aggarwal
To put it mildly, the 2017 General Election did
not go well for the Conservative Party. They
went from enjoying a 20 point poll lead to
losing their overall majority, all within 7
weeks. The agreed narrative is that Labour
made gains due to a surge in the youth vote,
with a record turnout of 18-24 year olds. The
problem is that doesn’t seem to be the case.
The British Election Study recently released a
paper suggesting that actually there was
hardly any change in the youth turnout at all
and that the real problem was with thirty and
fortysomethings.
OK, so the picture is slightly more
complicated than that, but every article needs
a lead. While there wasn’t much change in
youth turnout, there was a swing towards La-
bour in the 18-24 age bracket. However, in
the much larger 25-44 demographic, there
was both a roughly 10% rise in turnout and a
hefty swing towards Labour. It was here the
Conservative majority was lost, not in the
university towns.
This is a much scarier proposition for the
Conservatives. Young voters have always
been more sympathetic to left-wing views,
with 1983 being the last election where the
group swung right.
The Backbench
However, the assumption has classically
been that as people get older and more
“mature”, they will lean more to the
Conservatives. This no longer seems to be
true to the same extent, and if this situation
continues the problem could grow in future
elections.
It is possible for these voters to be won
back. But since the 8th June, all the signs
have been that the Conservatives have
misdiagnosed their ailment, and in any are
case are providing an ineffective remedy.
See Theresa May’s hint that tuition fees may
be lowered; there is no real evidence this
subject motivated many young people’s
voting choice last year, and even if it did,
why would you vote for lower tuition fees
when Jeremy Corbyn is promising to abolish
them entirely?
While the Conservatives continue to
hopelessly try and win over young voters,
they are offering nothing to those voters in
the 25-44 demographic that could be tempt-
ed back. Whilst the election may have
changed many preconceptions (that
campaigns don’t matter and newspaper
endorsements do, for instance), it still
remains that voters essentially decide based
on self-interest. And, to put it bluntly, for
many in the 25-44 group, they are being
given no reason to vote Conservative.
On a values level, the post-Brexit Conserva-
tive Party is anathema to many of them. For
all that David Cameron was a terrible
occupant of No. 10, he did at least have a
strategy of getting there.
Winter 2017 22
He understood that this swing 25-44 group And for many, the prospect of owning their
are socially liberal, and he sought to appeal to own home became further out of reach, and
those instincts. However, since becoming rents were starting to become unaffordable
Prime Minister, May has chased the 52% who too. Oppositions always do the hopey-
voted leave, and looked to squeeze UKIP’s changey message, but in 2017, the
2015 vote and Labour Brexiteers. By taking Conservatives had nothing to counteract it.
this path, she has alienated many of those
who voted for Cameron’s incarnation of the
party.
The problem is that with not much left to
squeeze, she has no majority and nowhere to
go. However, that doesn’t necessarily pre-
clude 25-44 year olds from voting Conserva-
tive. A convincing retail offer could still have
won them back (for many years, socially con-
servative voters in the North have broadly
stuck by Labour, mainly due to the promise of
improving their material circumstances).

“May will not be the leader to win

these votes back”

In 2010, Cameron’s message was “it’s going

to be tough, but it’ll be worth it”, and after
the crash voters bought it. By 2015, real
wages hadn’t risen for 7 years, but the
Conservatives largely got away with it, with
inflation at rock bottom and austerity having
been restricted to those who vote Labour.
Yet by 2017, real wages had continued to
stagnate, the cuts had spread and the
Conservatives’ offer was essentially “things
are bad, don’t let the other side ruin it”.
Many of this age group are parents, and could
see that schools were struggling, with many
having to ask for contributions to help buy
simple things such as stationery. Police num-
bers were down and crime was rising. The
NHS was even closer to the brink.
The issue is that May will not be the leader
to win these votes back. She is the leader
who put the house on Brexit, and electorally
she has lost. Had she initially taken a more
conciliatory tone, aiming to unite remainers
and leavers, she may have kept 25-44 year
old voters on side.
Had she recognised earlier that austerity
was failing, she may have kept voters on
side. But things have gone too far now, and
if the Conservative Party’s backbone doesn’t
soon emerge and May is not replaced,
Corbyn’s ascent to power will become inevi-
table.

The Backbench Winter 2017 23

If you’re interested in writing for The Backbench, please email
TheBackbench@mtsn.org.uk with your idea for an article.
We are completely open in terms of topics and perspectives.