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2014年邓肯·坦纳论文奖获得者。反对“神圣不可侵犯的事物”:国民保健制度反对派与医学自由协会,1948 - 1972年

Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

作者信息

Seaton Andrew

出版信息

20 Century Br Hist. 2015;26(3):424-49. doi: 10.1093/tcbh/hwv011.

Abstract

This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

摘要

本文通过考察医学自由联盟(FFM)来重现对国民医疗服务体系(NHS)的有组织反对,该联盟是一个由医生组成的保守组织,在20世纪50年代和60年代挑战了国有化医疗保健这头“神圣的奶牛”。尽管由于该机构史学研究的缺陷,人们对反NHS政治兴趣寥寥,但本研究提出了撰写该服务新历史的方法。该项目的核心是认真对待NHS更广泛的意识形态和情感特质,并认识到对于政治光谱的各方以及普通公众而言,该服务一直是战后英国身份认同的一个有争议的象征。本文认为,NHS的两次“危机”——对成本的恐慌以及全科医疗中的幻灭感——不仅仅是关于预算和薪酬的分歧,而是充满了保守党对英国战后轨迹焦虑的政治敏感时刻。医学自由联盟将NHS想象成一个经济上危险的官僚机器,它扼杀了医疗独立性,并有可能将国家推向独裁。保守党内部的盟友、私人医疗保险行业和自由市场“智库”与医学自由联盟合作,对该服务的运营和意义的辩护发起挑战。要理解为什么NHS仍然是“英国人最接近宗教的事物”,就必须既考虑信徒,也考虑叛教者。

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