One explanation is ignorance. I do not mean this in a disparaging way; the differences between countries’ survival rates are not immediately visible to casual inspection. The average Briton or Swede is unlikely to know that the five-year survival rate for colorectal cancer is 51.6 percent in Britain but 59.8 percent in Sweden, or that the 30-day fatality rates for myocardial infarction in those two countries are 6.3 percent and 2.9 percent, respectively. (The figures for the United States are 65.5 percent and 5.1 percent.) Personal experience or acquaintance is not enough to reveal these facts. By contrast, the average Briton knows that if he suffers a heart attack, he will be taken to the hospital and connected to a lot of machines, from which he concludes that he is having the best possible treatment.
Another explanation is ideology. The British population has largely been persuaded that the NHS embodies social justice. The system has become a golden calf before which even Margaret Thatcher found it necessary to bow down: “The NHS is safe in our hands,” she said. And the egalitarian nature of the NHS makes it almost the only institution in a fractured and antagonistic society that can claim allegiance across many divides. We are not proud of our armed forces any longer or, indeed, of anything else; only the NHS survives to unite us. We increasingly are a nation defined by our health-care system.
In my youth, I often heard the refrain that the NHS was “the envy of the world,” and people in Britain are still inclined to believe it, even though they probably have never met anyone who envied the NHS and, indeed, know only of Continental Europeans residing in Britain who hurry home as soon as they require medical treatment, horrified by the prospect of subjecting themselves to the rigors of a British hospital. A marked cognitive dissonance reveals itself here.
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