Intrusive nanny-statism of the sort now on display in the U.K. may reach our shores if we don’t summon the political and the personal will to resist it.
Intrusive nanny-statism of the sort now on display in the U.K. may reach our shores if we don’t summon the political and the personal will to resist it.
W inston Smith hated working out. Not that you can blame the protagonist of George Orwell’s dystopian novel 1984. If you lived in a totalitarian London, had to get by on rations and Victory Gin, and were forced awake by your television and then led in calisthenics by a shrill instructor who could call you out by name even while leading thousands of others in the same exercises . . . you’d probably hate it, too.
The U.K. today is not a full-on dystopia, the bobbies who arrest people for mean tweets notwithstanding. But a recent scheme initiated by Keir Starmer’s newly elected left-wing Labour government brings it just a little bit closer to a kind of despotism, albeit likely not one Orwell would have envisioned. And it’s one that could easily come to our own shores, if we don’t summon the political and the personal will to resist it.
The Starmer government announced late last month that it would begin a rollout of voluntary health screenings at employees’ workplaces. These “life-saving health checks” will, at first, be available to more than 100,000 people, and focus on cardiovascular indicators. They’ll also be geared toward men, a demographic the government claims is both less likely to get health checkups outside of work and also more susceptible to such cardiovascular diseases.
Not long ago, Americans put up with our own excessive intrusions of the state into our professional and personal lives, courtesy of the Covid-19 pandemic and governmental reactions to it. Our system resisted further incursions, such as President Biden’s failed attempt to implement a backdoor coronavirus-vaccine mandate via OSHA, and eventually snapped back to its less intrusive self.
But what was extraordinary in this country is routine in the U.K. The National Health Service, the U.K.’s universal, single-payer health-care system, has turned virtually all health-care decisions into political ones, rendering the individual’s health wholly subservient to the state. Just look to the government’s justification of this effort as “part of the Health and Social Care Secretary’s commitment to supporting the government’s mission to boost economic growth by improving the health of the nation” and “an important step towards community-focused healthcare and supporting economic and productivity through improving health, shifting the focus from treatment to prevention, easing the strain on the NHS and helping people to live well for longer.” Not for nothing did Spiked staff writer Lauren Smith — who rightly wondered how long the program will remain voluntary — describe it as “Nineteen Eighty-Four meets Weight Watchers.”
And what an odious combination. It’s hard to identify which aspect of the justification is creepier: the state’s interest in maximizing the health of each person as a potential generator of more GDP, or the nakedly bureaucratic motivation of improving the (considerable) burden on the NHS, which is notorious for its long wait times for basic procedures. The former rationale at least has a small dose of contrived concern, though it’s mixed in with a larger portion of creepy collectivism. Whereas the latter betrays a managerial callousness: One wonders if the lines for the machine that goes “ping” might decrease if this scheme is successful. And each justifies C. S. Lewis’s proclamation that “of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.”
Yet this particular tyranny was, in certain respects, inevitable in a health-care system dominated by the government. When the state is implicated in the vast majority of medical decisions, only the state’s own sufferance precludes its further intervention; the principle of personal independence is already lost. Lauren Smith’s “novel idea” that “the state leave us alone” is truly novel in the U.K. of today — so novel that it is essentially impotent. What Britons eerily call “our NHS” isn’t going anywhere, whatever its flaws. Something popular enough to be celebrated at the London Olympics and immune even to former prime minister Margaret Thatcher’s government-shrinking efforts is likely an enduring part of the political landscape there.
But Americans should not assume we are immune to political culture shifts on health such as this. The government’s role in health care continues to grow here. Democrats seem to view Obamacare, which its namesake once sold as the end of the health-care debate in this country, as merely a starting point (something many conservatives said at the time, and were called alarmist for saying). Some of them, such as Georgia senator Raphael Warnock, view the Covid-19 top-down authoritarianism as a potential template for our health-care future, as Noah Rothman recently noted. And the Republican Party, which benefited so much politically from opposing Obamacare at the time of its passage, has now not only given up on doing so (“concepts of a plan” don’t count), but has effectively committed to expanding it. It is hardly alarmist to imagine a future in which the hodgepodge of state and federal health-care programs transforms our health-care system into one that is de facto government dominated.
A health-care environment like that would combine poorly with an ailment this country suffers from even more grievously than the U.K. does: We are an increasingly unhealthy bunch. Obesity, diabetes, heart disease, and more — America’s rates of these and other conditions have been heading in the wrong direction for a long time. Our unhealthiness already costs a great deal in our current health-care system, which remains private to a considerable (if shrinking) extent. But to the extent they are preventable, these conditions provide endless grief — not all of it unjustified — for public-health tyrants and micromanagers. A more statist health-care system would likely succumb to the same nannying neurosis now on display in the U.K.
Thankfully, America is not there yet. Avoiding this future requires a two-pronged approach. Maintaining the largely private nature of our health-care system is essential. That means true freedom-centered reform to drive down prices, embracing alternative modes of insurance provision, and keeping medical care as localized and personalized as possible. It also means resisting further encroachments of the state into health care, such as the Medicaid expansion to which so many states have already succumbed, and further state-driven regulation and restriction.
None of this will be easy. Harder still, however, will be the most important step: to take care of ourselves. To counter a surge in preventable diseases, we will need a resurgence of individual agency. The best way to challenge the nanny state is to show that it is not needed. And the easiest way to invite it in is to allow a case for it. “Society cannot exist unless a controlling power upon will and appetite be placed somewhere,” Edmund Burke wrote. “And the less of it there is within, the more there must be without.”
1984 ends with Winston Smith, after being tortured and broken at the hands of the totalitarian state that rules over him, winning “the victory over himself” and accepting that “he loved Big Brother.” To defeat our wannabe Big Brothers, we will have to win a victory over ourselves of a different kind: over our base instincts, our laziness, our disinclination to take care of ourselves. If we don’t, then we shouldn’t be surprised if discipline is imposed on us from above — whether we like it or not.