…by Rudolf Klein.

Sometimes I feel my contribution at work is entirely too technical, so I have decided to broaden my knowledge of the political context of my work by reading this excellent introduction. This seems particularly apt since although I lived in England as a child, and have a British Citizenship, I am essentially Australian and my knowledge of the National Health Service (NHS) must necessarily be at something of a remove. So I hauled it out of the King’s Fund Information Centre on Friday and have read quite a bit already during the long and complex railway meanderings of my weekend.

This book traces the philosophical and political debates surrounding the formation, management and renewal of the NHS since its inception in 1948. Given that the NHS was the first single payer national health system in the world, and radical at the time, this makes the topic marginally interesting even from the perspective of someone whose job does not directly involve this well-respected institution. The book gives both a context for the “radicalism” that the NHS represented, and a cogent analysis of the competing interests of its progenitors and its management. It’s interesting that things which can seem so radical and new from the outside can actually, upon closer inspection, be seen to have been at least in part just the natural consequence of the muddled ideas of a bunch of pragmatists, and the NHS is no exception, as one sees in the first chapter. And really, I think in the end this is a more interesting discovery than if one were to learn that the NHS sprang fully-formed and novel from the madcap ideas of a pure Socialist dictator. It makes it seem simultaneously both grander and more humble than such a project, and makes clear that while from the outside the NHS may have seemed a radical idea worth copying (as indeed it has been), from within it was a natural continuation of more than ten years of tinkering.

So far this book has been interesting and insightful, and already I’m able to draw parallels and contrasts between the policy debates of then and now. It will help at the very least in establishing a context for what I do. But for a non-professional reader, who can stand a little dry historical writing – and particularly for my American reader, for whom the topic of health care reform remains rather more topical than perhaps it is in England – I recommend it (or at least the first few chapters) as an insight into the nature of a single payer health system, and the political realities which drive its creation. I think it will be fascinating to read, 50 years from now, the equivalent account of the health care reform which America has to have…

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