by MATTHEWS
Actors in a sequence meant to represent Britain’s National Health Service (NHS). Performed during the Opening Ceremony at the 2012 Summer Olympics, Friday, July 27, 2012, in London.
Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.
Aneurin Bevan, In Place of Fear, 79
“Socialist social policies are, in my view, totally different in their purpose, philosophy and attitudes,” from those of capitalism, wrote the British social policy academic Richard Titmuss in 1967. “They are (or should be) pre-eminently about equality, freedom and social integration.”1 However, equality was not the only central ideal: “Socialism is about community as well as equality,” Titmuss argued. “It is about what we contribute without price to the community and how we act and live as socialists.”2
Integral to Titmuss’s ideal of socialism was his approach to policies for the provision of public services. He maintained that egalitarian social policies could not be achieved without “an infrastructure of universalist services.”3 This meant making the same means of existence—beyond a residual or minimal level—available to all members of society. By making services universal, users would not be subject to any humiliating loss of status, dignity, or self-respect.4 That is, universal services prevent humiliation because they do not discriminate, and this would in turn mean that they would provide better services to the poor. In addition, if services were not provided universally, they might not be made available at all, or, those who could purchase them privately would do so, leaving the rest of society to rely upon a lesser, residual service, deepening social divisions and inflicting a sense of inferiority and shame.5
Responsibility for the provision of welfare, Titmuss claimed, should primarily be assigned to the community, with all members contributing to each other’s welfare in a spirit of fellowship and solidarity.6 This community provision of welfare would be achieved largely through the state, with the government programs and directives reflecting the general desires of the community. “It is the responsibility of the state, acting sometimes through the processes we have called ‘social policy,’” Titmuss wrote, “to reduce or eliminate or control the forces of market coercion which place men in situations in which they have less freedom or little freedom to make moral choices or to behave altruistically if they so will.”7
Origins of the NHS
Titmuss frequently invoked Britain’s National Health Service (NHS) as the epitome of this kind of welfare universalism, arguing its scope and services were more comprehensive than any other aspect of the welfare state.8 Of the mature capitalist countries after the Second World War, the United Kingdom was among the first to implement a collectively provided universal health care system, establishing the NHS in 1948. And it was the pursuit of socialism, through class struggle, that led to the creation of the NHS: universalism, collectivism, and social solidarity were the pillars on which the system was built. To understand this history, we must examine the life of Aneurin Bevan, a central figure in the fight for democratic socialism in Britain. To this day a controversial figure on both right and left, as Minister for Health and Housing during the 1945–50 Labour government, Bevan institutionalized in the NHS his vision of a socialist Britain.
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