That reclusive and pessimistic cleric, Thomas Malthus, created a mathematical law to support his contention that population would inevitably outgrow the food supply. The increase in the food supply, it stated, is arithmetic; whereas the increase in population is geometric: thus the population is kept to the level of subsistence by “misery and vice”.
Malthus’ law was bunkum, and it has been argued that he only added it in to give his essay on human population a scientific gloss. The same might be said of the “unsustainable NHS law” repeated by the media and politicians, and set out nicely in a recent Guardian post by Ian Birrell. The increase in the number of old people and their complex demands will always outstrip the taxpayers’ ability to fund the NHS; and just as Malthus argued that providing relief to the poor only added to their misery by allowing them to breed, medical science only increases the demand from the unwell to access new reliefs and cures: indeed, it actually increases the number of unwell by offering treatments for conditions previously untreatable.
Genuinely horrified by the poverty in his parish, Malthus concluded that population should be managed by reducing births among the impoverished: either by ending the Elizabethan Poor Law or by encouraging abstinence to delay and thus reduce procreation. Genuinely offended by a health service built on the principles of shared risk and access based on need, not ability to pay, the Healthcare Malthusians call for “competition”, “choice”, “efficiency savings”, private providers, and charges for GP visits.
What they do not set out – entirely absent from Ian Birrell’s piece – is where they put health as a priority amongst the totality of government expenditure and the intricacies of taxation. Leaving the total government budget unchanged, which should be a priority: tax concessions for higher-tax-rate mortgage payers, subsidising private pensions, or finding more to pay for healthcare? Every penny of government expenditure is a result of political choice. Why do the Healthcare Malthusians never offer other government expenditure to be sacrificed to fund the NHS, given any upper limit to government spending? Why do they never call for avoided, evaded, or delayed taxes to be collected?
Where Malthus essayed a struggle between man and implacable nature, Herbert Spencer described a struggle for survival within society and between societies; and while the Anglican cleric may have prayed for souls of the poor, Spencer’s apostle JD Rockefeller preached the thriving of the robber barons as the consequence of a law of nature and of god, while no-one should mourn the devastation caused by their success.
The term ‘Social Darwinism’ can be misleading, given it was Darwin who interpreted the natural world through Spencerian social views. The struggle for survival derived from Malthusianism, the survival of the fittest from Spencer, who provided a narrative for Empire and for the English middle- and upper- classes, still horrified by the rising numbers of the breeding poor.
“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”
It is not coincidence that Scrooge is a miser. In a struggle for survival, hoarding an unfair share of the wherewithal to live (food for Malthus, money for Rockefeller) would seem a wise strategy. Similarly wise, in a world in which it is deemed that the government has no government money left, hoarding access to healthcare (or education, or jobs, or law, or property)…
Neoliberalism did not spring anew and afresh in the 1950s. Criminalisation of the poor, rejection of social security, belief that governments must not interfere with ‘natural’ laws, forced labour: neoliberalism is a revival of social darwinism. Neither has Malthusianism disappeared: you only have to listen to UKIP sympathisers speak of the UK being ‘full’.
Or you could ask those who say the NHS is ‘unsustainable’ why they wouldn’t find the money for it, or what should happen to those who could no longer access it. Spencer, or Malthus?