Medicine Man

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Last week "Former Naval Person" Winston Churchill spat angry words against a high wind. The Labor government, said he, "has forced the British people to live in a fool's purgatory upon the generous grants of free enterprise, capitalist America . . . If we are to earn our daily bread in the world, it can only be through the strongest possible individual effort and ingenuity arising from conditions of freedom and fair play."

As broad prophecy, this last might turn out to be true. Churchill, however, had designed the statement for use in a by-election at Sowerby. Presumably, it was intended to win votes for the Tories. It was not likely to do so.

If Socialist Britain was a "fool's purgatory," millions of Britons were the fools. They liked it--at least they liked it better than what they thought the Tories would give them. As the anti-Socialist Economist recently said: "Instead of standing forth as the champions of wise and vigorous government [the Tories] have allowed themselves, by talking in generalities about abstract principles such as 'freedom' and 'enterprise,' to be represented as the captious remnant of a bygone social order. . . They have treated the rise of Socialism as an aberration from the normal British way of life, instead of recognizing that the Socialist ideal of the welfare state is very closely in tune with the ideas of a frustrated and war-weary nation."

Not in Britain alone, but throughout the world, the welfare state was on the rise. Even the U.S., which had a more or less undeserved reputation as the last great citadel of individual independence, was entering a new phase of its long debate over socialized services. One of the warmest issues in the U.S. at the moment was socialized medicine.

Long Way from Locke. A few weeks before Churchill's blast, Britain's new socialized medicine scheme had survived its first major test in the House of Commons. Its champion, Aneurin Bevan, Minister of Health, held arrogant and undisputed possession of the field when Churchill walked out of the House (TIME, Feb. 28). This did not prove that Britain's socialized medicine plan was good medicine or good social organization. But the debate's results did prove that socialized medicine was what the British voters wanted.

In Britain, at least, there was no longer any point in warning citizens that they were selling their birthright of freedom for a mess of pottage. Bevan, the bulldog breed's new vet, could reply that Britons could eat tastier, tougher fare than pottage now that they had got new false teeth from the health service. As TIME's London Bureau Chief Eric Gibbs cabled:

"For too long 'free enterprise' seemed to mean only that the British employer was free from responsibility for his employees' welfare. Now the state comes to these undernourished men & women, provides their children with orange juice, cod liver oil and milk, sends the doctor when they are sick. These people won't listen to any man who tells them that the welfare state is a bad thing which robs them of their initiative by all this coddling. They will look at their healthier children and will call that man a liar."

Soon after the Labor victory in 1945, "Nye" Bevan stood amid the tall black blocks of Bolton's cotton mills in Lancashire and told the assembled workers: "Homes, health, education and social security--these are your birthright." That was quite a different list from the one John Locke had drawn up 260 years ago when he summarized man's inalienable rights as life, liberty and property. For better or worse, most Britons today are more wedded to Bevan's list than to Locke's. "Why is it," exclaimed a tall, exasperated Conservative M.P. over a substantial lunch last week, "that whenever I go to speak, the people seem to be interested in nothing but their social security and their dentures?"

Nye Bevan, the hard-eyed lad from the Welsh mines, knows why. The drive for state maternalism is not primarily the work of doctrinaires, Marxist or otherwise; it is a distillation of the bitter experience of Bevan and his comrades. Whether the brew is poison or not, it has been a long time cooking.

Hard Way to Shakespeare. When Aneurin (rhymes with a fire in) Bevan was a boy in Tredegar, South Wales, sickness and disaster were never far from the pithead. His father had been one of the founders of the Tredegar Workingmen's Medical Aid Society. Each member contributed three pennies out of every pound earned; in return, the society hired doctors and dentists to treat the miners or their families when they became ill.

Young "Nyrin" became the society's most vocal member. In a drab little shop, whose dusty windows bore the society's name in proud gilt letters, the committee met each week. Around the bare table sat 30 miners, some straight from the pit, the coal dust still runneled into their sweat-sticky faces. Bevan always spoke precisely and to the point. He had suffered from a bad stammer (caused by an uninformed but successful effort to "correct" his left-handedness), but had overcome it by reciting Shakespeare out loud and forcing himself to speak up in public.

Said Bevan to the Tredegar Aid Society: "I believe that orthopedic surgery can be of great benefit to many miners and I would fight all the doctors of the British Medical Association to prove my point." Or he would cry in his Welsh singsong: "If a specialist is away in Bristol, why should we not be able to send our men to him? Why should not a miner have the right to the best treatment?"

When the stiff-necked British Medical Association boycotted the miners' society, Aneurin Bevan got his chance to fight. "It was wicked, the way those fellows stood in the way of our getting health services to the people," he says, "but we won through."

"A Bad Little Brat." Bevan was born 51 years ago in the Welsh hills which are slag-pocked and crumpled like a tattered old flannel blanket. The names of his brothers & sisters sounded like a Celtic fairy tale--Blodwyn, Myfanwy, Arianwen, lorwerth. There was nothing romantic about the Bevans' tiny four-room house with its sanded floor. "There were never less than seven of us in the house, and an invalid relative occupied one room," recalls Bevan, now the King's minister in charge of housing. He was an avid reader. As he trudged along Tredegar's streets (as an errand boy for the butcher), he was usually absorbed in an adventure story--Rider Haggard or Baroness Orczy.

At 13, he went down into the pit. Carrying his "snaps" (miner's lunch), he rode to the pithead with his mates in the special streetcars reserved for the miners --so that they would not dirty other passengers. He found that miners lived in a segregated world of their own. He began to carry a big chip on his shoulder. Once a supervisor asked him why he did not take off his jacket while he worked. "There's nothing in the Mine Act that says I have to," snapped Bevan.

He soured early and permanently on the idea of opportunity in a capitalist society. A former boss of his remembers Bevan as a young miner in the Welsh seams. "He was a bad little brat," that man recalls. "He'd lie down right there beside the tubs rather than do one stroke over what was absolutely necessary to earn his minimum wage. Aroused other lads to do the same. 'Why should we sweat our guts out to fill capitalist bellies?' he'd say. You could do nothing with him."

"A Dreadful One." Bevan wandered up & down the Welsh valleys, talking to the workers. Sometimes as many as 20,000 would come to hear him, singing hymns as they approached. "Nyrin is a king among men," they said in the Welsh valleys. But others whispered: "He is a dreadful one. He'd stop at nothing."

Bevan's mates collected pennies and shillings to send him to London's Central Labor College. For the first time, Bevan saw the world beyond the Welsh hills. He loved it. He plunged into a crowd of young people who had read, who could talk. They were fascinated by his exuberance, his brash charm, his wit. Bloomsbury apartments, Chelsea studios and Mayfair drawing rooms reverberated with the laughter which came from him in torrents as he threw back his massive head. But he remained true to Tredegar; he nourished his hatreds.

Back home after two years, he was elected checkweighman and disputes agent for his union. During the General Strike of 1926 he first showed his political mettle. In Tredegar the General Strike is still known as "Bevan's Siege." "They had the whole town in a straitjacket," recalls a Tredegar shopkeeper.

The strikers could have done with the town what they pleased. But Nye Bevan was no bullyboy. He told the strike committee : "There must be no violence. This is to be passive resistance, but, my God, such resistance that there is no other course but for us to win. If you run into difficulties--with the police perhaps--you will outwit them. You will never strike them. It is brains that will win this battle for us." But he did not win that battle. When Britain's Tory government broke the General Strike, Nye Bevan viewed that as just another reason to be sore.

"Lower Than Vermin." At 31, Bevan was elected to Parliament from Ebbw (pronounced Ebba) Vale. He attacked the grand old man of British Liberalism, his fellow Welshman, David Lloyd George. A British journalist described the occasion: "Bevan's thought seems to take possession of him . . . He seems to be all gestures, involuntarily turning his whole muscular machine into a means of expression . . . He has the speed, the impetuosity, even the force of the wind . . ." Said one Labor M.P.: "While Bevan was speaking, I think Lloyd George saw a ghost. That ghost was the ghost of his own youth."

Bevan was an immediate parliamentary and social success. Yet he retained a deep, belligerent class consciousness, and a proletarian's inverted snobbery. In 1934, he married Jennie Lee, a girl from the Scottish mining country, who had been elected to Parliament at 24 and was studying for the bar. There was only one obstacle to the romance: Nye found out that Jennie's father was a "deputy" (foreman), a job which in Wales ranked a man with the hated managerial class. A duke, suddenly discovering that his fiancee's father was an ordinary workingman, could not have been more dismayed than Bevan. Jennie had to explain to Nye that in Scotland, the deputies were classed with the miners, and that her father was thus a legitimate member of the proletariat. Nye and Jennie were married at a registry office; there was no wedding ring for the bride.

With a village showoff's swagger and a gush of bile, Nye Bevan tackled Winston Churchill at the height of his popularity. So irresponsible were some of Bevan's attacks on Churchill's war leadership that even his own Laborite supporters were appalled. An epic battle of invective broke out between the two men. Cried Bevan: "The Prime Minister's continuance in office is a major national disaster . . ." He complained that Churchill was "parading around in a ridiculous uniform," that he was "suffering from petrified adolescence." Cried Churchill: "Merchant of disloyalty!" Replied Bevan: "Better than being a wholesaler of disaster!" Churchill rumbled: "Bevan [will] always be as great a curse to this country in time of peace as he was a squalid nuisance in time of war." Churchill, who is not without class consciousness himself, once called Bevan "this gamin from some Welsh gutter."

In a famous speech at Manchester last summer, Bevan matched Churchill's billingsgate: "No amount of cajolery, no amount of ethical or social seduction can eradicate from my heart a deep, burning hatred for the Tory party . . . They are lower than vermin . . ."

"If Thine Nye . .." On such occasions, Bevan's shock of hair falls over his forehead, his pudgy face clouds over and his bright blue eyes smolder with resentment. People who see him thus are apt to think that he is merely a mighty bruiser from the coalfields. Surprises await them if they get to know him better. He has traveled widely in Europe, likes to spend his holidays in Italy. During the war, he was close to many refugee Socialist intellectuals from the Continent. His friends include such diverse characters as Novelist

Arthur Koestler, Press Lord Beaverbrook, Author George Orwell. He reads--next to "shockers"--philosophers: Whitehead, Kant, Bergson. With Jennie, he likes to listen to ballet records on quiet Sundays. For years Bevan edited London's vigorous Socialist weekly, Tribune; when he joined the government, Jennie took over.

Friends claim that Bevan has acquired a new sobriety and caution under the weight of his responsibilities (which include not only health but housing for blitzed Britain). When Britain's doctors violently opposed his health service plan, he did not use his power to ram it down their throats, but made concessions until it was more or less palatable to most of them. These days, when he wants a cabinet decision, he always first consults Sir Stafford Cripps, Britain's overall economic boss, and Bevan's closest ally in the cabinet. He will cajole and wheedle in his sweetest Welsh tones until he gets O.K.s from departmental ministers. "But," says a high British official, "when he does seem like losing a point in the cabinet he fights like a tiger and usually wins."

Bevan has repeatedly rebelled against the Labor Party's leadership; during the war there was even talk of expelling him. "If thine Nye offend thee, pluck it out." was a persistent crack around parliamentary corridors. Even today Bevan has little use for Party Strategist Herbert Morrison's increasingly cautious politics. He fought bitterly when Morrison wanted to postpone nationalization of Britain's steel industry. The fact that the nationalization bill went to Parliament at all is largely due to Bevan's bludgeoning attacks. It is expected to be on the statute books by 1950.

The project closest to Bevan's heart is the British National Health Service.

In 1911 Lloyd George persuaded Parliament to establish compulsory National Insurance. This provided cash benefits for sick and unemployed workers and free medical service (but not specialists or hospital care). By 1941 the plan included workers making less than -L-420 ($1,680) per year--almost half of Britain's population. Virtually all British doctors served "free" patients in addition to their regular practice, the bill being paid by employees' and employers' contributions and taxes.

How It Works. Britain's new social security plan requires everyone to pay for health insurance, but nobody, doctor or patient, has to sign up for the health service. Any Briton who wants free medical care for his tax money simply goes to a doctor of his own choosing. The doctor may turn him away for good & sufficient reasons (e.g., the doctor is too busy). But generally, the applicant is put on the doctor's permanent list of patients. Thereafter, the doctor is obliged by law to treat him any time, and for any length of time, free of charge.

If the treatment requires medicine, the doctor writes a chit for anything from aspirin to penicillin. The druggist hands over the medicine and passes on the chit to the government, which pays him. If the patient needs spectacles, a truss or any other medical appliance, the doctor signs another chit. If in the doctor's opinion a case requires the attention of a specialist, he will present the patient with a list of specialists from which to choose one. If necessary, the doctor also arranges for hospitalization. The plan even provides for domestic help for people too ill to run their own households.

Any patient who does not like his doctor can sign up with another one. If a Briton does not like the idea of "free" treatment and has money to spare, he can ask for private treatment from any doctor who has time and inclination to give it.

How Much Does It Cost? Britons pay nothing directly to the health service. They make a weekly payment (deducted from their salary) which covers all social security, including unemployment insurance, old-age pensions, funeral benefits, etc. For employed men over 18, the weekly contribution is 4 shillings 11 pence (98-c-); for women over 18, 3 shillings 10 pence (70-c-).

This is not the whole bill. The British government now takes, in taxes, almost one-third of the income of the nation. A full quarter of the government income (8.25% of the national income) goes to social service, including the medical plan. The medical plan itself costs about $1 billion a year, of which over $800 million is paid out of taxes. In last month's House of Commons debate, Bevan disclosed that his estimates for the first year had been -L-58 million lower than the actual costs. More doctors, more health centers are needed. For some years, at least, the cost of Britain's medical service seems certain to increase.

Can Britain afford this burden of social service? British leaders, looking at both the budget and the health of the people, ask the questions familiar to every man who has ever confronted an insurance salesman: How much can I afford to carry? How much can I afford not to carry? In Britain, the Labor government's answer is: carry all you need.

The staggering bill for such social services is, in the last analysis, a charge on industry. The cost raises the cost of Britain's export products. As the sellers' market comes to an end, the British may find that the cost of social services has helped to price them out of their chance of economic recovery. On both the credit and the debit side of the ledger, socialized medicine essentially means more medicine --more benefits and a bigger bill.

Who Runs the Show? To operate his plan Bevan has appointed 138 executive councils, each composed of 25 members who serve as volunteers, somewhat as do the members of U.S. draft boards. Bevan insisted, in opposition to some of his Socialist colleagues, that the boards remain nonpolitical, i.e., that Conservatives may serve on them. "We have taken money out of medicine," he said. "I will not let politics take hold." British hospitals, virtually all taken over by the Ministry, are run by special hospital boards, usually composed of the same officials who ran them before. In the whole British health service today there are about 10,000 voluntary administrative workers; Bevan's Health Ministry itself gets along with only 800 paid staffers.

The executive council's job is to review the doctors' list of patients; they have the right to reassign patients if one doctor gets too heavily loaded. If their area is short of doctors, they have the right to keep a physician who wants to move away, from doing so. On the other hand, if their area is "overdoctored," they may refuse to let new doctors move in to practice under the health plan.

Although the majority of British doctors were originally opposed to it, 86% have joined the plan. Not all have done so because they wanted to, but because they could not earn enough money from private practice any more. Few can afford to hold out. Said one fashionable specialist: "Let's not be blind. In a few years, there'll probably be no private practice at all. All you do by not joining the plan is eventually to commit hara-kiri."

The doctors get 17 shillings ($3.40) a year for each patient on their list, regardless of whether they call on him every day in the year or not at all. A doctor can have a maximum of 4,000 patients on his list, which would give him a gross income of $13,600. In a few regions, there are more doctors than necessary (e.g., one to each 1,000 patients along Britain's south coast). The result is that doctors' income there is low. Though Bevan could raise their fees, he refuses to do so in these cases because he wants the south coast physicians to move to "underdoctored" areas.

Ride on the Escalator. Actually, few British doctors now make less money than before the scheme went into effect; many make more. Almost all doctors are overworked, because of the enormous increase in patients and because of the new chit-writing and form-filling they must attend to. Contrary to dire predictions before the plan went into effect, doctors are free at least of one worry: there have been relatively few hypochondriacs. "It's been just like it was when they first put escalators in the underground stations," explains

Bevan. "People then said Londoners would waste their time riding up & down them. Well, perhaps a few did, for the first week. But they soon got tired of it."

There have been some complaints about red tape and delays, chiefly against dentists, who must get an O.K. from their Dental Estimates Board before starting expensive dental work. Said one dentist last week: "Sometimes it's a damned nuisance getting authority from some pipsqueak on the board before you can start a job, but I admit there are some chaps who would yank out a mouthful of teeth for the profit they get on the dentures. So in a socialized service I suppose we've got to put up with some interference."

A housewife in the cotton town of Darwen, Lancashire, expressed the verdict of millions. "It's not so much what the plan saved me in money," she said, "because if I'd had to pay, I wouldn't have had us all done. I couldn't have afforded it. If we had paid, it would have cost us nearly -L-16. Me and the children have all been examined, and the doctor's given me vitamin pills, and ordered two of the children to have specs, and sent another to have exercises for her spine, and I wouldn't have known there was anything wrong with any of us till we got ill."

Look into the Future. Some observers believe that the social welfare state may destroy democracy in Britain and pave the way for Communism. Others say it will provide the best bulwark against Communism, by preventing the want and insecurity on which Communism thrives. That is the way Nye Bevan sees it. Sevan's colleagues say he is one of the party's most active antiCommunists. As a member of the Labor Party's international affairs subcommittee, Bevan engineered the party's appeal to the Italian Socialists against fusion with the Communists before the 1948 Italian elections.

Nye Bevan is pleased with what he has done in Britain. He considers it only a start. Morrison and other party leaders want to sit back and consolidate the party gains. Bevan says the party is like a man on a bicycle: if he stops he will fall. According to his own statement, Bevan will settle for nothing less than "total destruction" of the remnants of British capitalism, including the Conservative Party. He has estimated that completion of his program will take 25 years. Whether or not he and his party will have a chance to finish the job is still up to the people who first sent him to London. They are his judges, and they have not yet relaxed their vigilance.

Every now & then, Nye Bevan gets away from his desk and takes a stroll along the seaside with several old cronies. He will stop at a stall to eat winkles, go wild on the swings, and will not miss a single peep show of the "What the Butler Saw" species. During one of these strolls, recently, Bevan dropped a penny into a fortune-telling slot machine. The note which the machine returned declared: "Not another personality is as sparkling as yours, nor a personality with such inherent righteousness."

One of his former mine mates peered over Bevan's shoulder. "Why, man, that's pretty true, you know," he said. "But by God, mind you live up to it!"

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