Astrophysicist and cosmologist Stephen Hawking was globally renowned as a brilliant scientist and tremendously courageous and heroic human being; and these attributes were expressed through his life-long political activism as well. A citizen of the UK, he was a supporter of the bourgeois-reformist Labour Party.
His Wikipedia entry lists his political interests as encompassing everything from nuclear disarmament and environmentalism (he supported Al Gore in 2000) to opposing the Gulf War to supporting the academic boycott of Israel. During the 2016 presidential elections in the US he opposed Donald Trump. And in the final year of his life he was preparing to participate in a legal case in which he planned to defend the UK’s National Health Service (NHS) against moves by the Tory government of Theresa May to privatize it.
Last August, Hawking gave the keynote address at London’s Royal Society of Medicine as part of a symposium called “Talk NHS: A Public Debate on the Past, Present and Future of the NHS”. In it he described the long, debilitating progression of the disease (amyotrophic lateral sclerosis or ALS) which robbed him first of his ability to walk, then to feed himself and eventually almost completely paralyzed him and left him unable to talk – and how, thanks to the UK’s NHS, he was able not just to survive but to take a leading role in making the many tremendous discoveries in cosmology that made him famous.
We publish here our own transcription of the last third of his 19 August 2017 Royal Society of Medicine keynote address in which he defends the NHS and states his principled opposition to the privatized health care system of the United States. (In the video we linked to above, this part of his speech starts at approximately 22:22).
In an effort to “prove” to US workers in favor of it that “socialized medicine doesn’t work”, the US capitalist “Investor’s Business Daily” published an article claiming that Stephen Hawking had denounced the NHS. The IBD’s plan misfired when Hawking responded angrily and publicly against this falsification of his actual political stand in favor of univesral health care.
At the time of his death he was preparing to defend the NHS against Tory health minister (and serial Hawking nemesis) Jeremy Hunt in a court hearing.
As socialists, we agree with Professor Hawking that a for-profit health care system is inherently less efficient and cost-effective than a “socialized” state-run system, due to the fact that, as he says, “the more profit is extracted from the system, the more private monopolies grow, and the more expensive health care becomes.” Under a truly socialist system, even greater efficiencies can be obtained as all large-scale enterprises would be democratically run for the benefit of the entire working class, rather than for the financial benefit of a tiny minority of capitalists. Not only the hospitals need to be “socialized” but the pharmaceutical industry as well as all the companies that manufacture everything needed for patient care, from syringes to MRI machines. “Universal health care” programs must always exist under capitalism at the mercy of the willingness of the capitalist class to fund them; only while the working class can maintain sufficient political pressure to force the capitalists to do so will those programs remain in existence. As capitalism goes through its inevitable “boom-and-bust” cycles, workers will be forced by the capitalists to suffer cuts to the health care programs and other vital social programs in “bad” economic times, and must then fight like hell in “good” economic times to have the cuts restored. This pointless back-and-forth toying with the vital needs of the working class will continue until it is resolved permanently in favor of the working class majority through a socialist revolution that places the working class permanently in power.
Professor Stephen Hawking – ‘Talk NHS’ Keynote Lecture
Transcript starts at 22:22
So you see that I have had a lot of experience of the NHS; and the care I received has enabled me to live my life as I want, and to contribute to major advances in our understanding of the Universe.
Sometimes I have had to challenge medical opinion to get the care I need; but the important thing is that the principles of the NHS mean that there is good care available and that it is provided at the point of need to everyone without regard for personal circumstance or ability to pay. These are the principles of universal and comprehensive provision on which the NHS was founded.
It is important that care is available without any of the added burdens for people that come with private health insurance. To be able to access that care from doctors in hospitals without having to go through an intermediary in the form of an insurance company, or deal with massive amounts of paperwork – before and after – is crucial to good health. [Applause]
My team and I have had experience of dealing with health insurance companies in the U.S.; and that experience shows that a health insurance company will try its best not to pay.
As well as my direct experiences, I have medically-trained nursing staff in my care team; and so I hear about changes in the NHS through them. I am aware of the increase in private provision of care – and the inefficiency that causes. The huge increase in the use of private agency staff, for example, inevitably means that money is extracted from the system as profit for the agency, and increases costs for the whole country.
Personally, I have had an unhappy experience with an American-owned, profit-driven nursing agency. They were eager for my custom, but made a number of errors and withdrew their service at short notice after eight months.
In September 2016, together with Professor Robert Winston and Professor Neena Modi, President of the Royal College of Pediatrics and Child Health, I co-signed a letter to the Guardian newspaper calling for health care policy to be based on peer-reviewed research and proper evidence. [Applause]
The specific issue on which the letter was based was the so-called “weekend effect”. Secretary of State for Health Jeremy Hunt had claimed that thousands of patients die unnecessarily because of poor hospital care at the weekend. He used this as an argument that we need to implement a “seven-day-a-week NHS”.
I had mixed feelings about the issue. Having spent a lot of time in the hospital, I would like there to be more services available in hospitals at weekends. It has been frustrating for me personally when everything slows down at the weekend in hospital. Also, it seems possible that some patients spend more time in hospital than is necessary because certain diagnostic tests can only be done on weekdays. So, in principle, a seven-day service could be of benefit to patients, and to the NHS as a whole.
However, any change like this must be properly researched, its benefits over the current system must be argued for and evidence for them presented, and the implementation properly planned, costed, and the necessary resources provided. If there are no more doctors and nurses, for example, then a seven-day NHS will necessarily mean fewer staff and a worse service on weekdays.
There has been no proper due diligence done in the case of the so-called “seven-day NHS” – and that was the whole point of our letter and the reason I signed it. Let me quote from the letter, as it illustrates a further point I want to make. We wrote:
“The evidence for these claims is not supported by reliable research. Of the eight papers cited by Hunt, only four are peer-reviewed […] Three use data from the same population and are not independent, with just two from the last decade. The remainder are not peer-reviewed medical literature, [and are only] opinion pieces […] Critically, when his claims began, at least 13 independent, peer-reviewed papers were available to the Secretary of State that refute his definition of a ‘weekend effect’.
“Hunt has ‘cherry-picked’ research…”
Speaking as a scientist, “cherry-picking” evidence is unacceptable. [Applause] When public figures abuse scientific argument – citing some studies but suppressing others to justify policies that they want to implement for other reasons – it debases scientific culture. One consequence of this sort of behavior is that it leads ordinary people to not trust science at a time when scientific research and progress is more important than ever given the challenges that we face as a human race.
There are two ways to think about a national health care system: one is that the most humane and civilized system is one in which all people are provided for equally based only on their needs no matter who they are, rich or poor, young or old. I believe this and have made public statements that we must prevent the establishment of a “two-tier” system with the best medicine for the wealthy and an inferior service for the rest.
The other way to think is that a health care system needs to be organized in the most efficient way, so that there is as little waste of labor and resources as possible.
International comparisons indicate that the most efficient way to provide good health care is for services to be publicly-funded and publicly-run. [Applause] The more profit is extracted from the system, the more private monopolies grow, and the more expensive health care becomes. For that reason I have also made public statements that the NHS must be preserved from commercial interests and protected from those who want to privatise it.
So, these two things coincide: the most humane system is the most efficient system. This means that when politicians and private health care industry lobbyists claim that “we can not afford the NHS”, this is the exact inversion of the truth. [Applause] We can not afford not to have the NHS. A publicly-provided, publicly-run system is the most efficient and therefore a more cost-effective way to provide good health care for all.
What is to be done? A physicist like me analyses a system in terms of levels of approximation. The NHS and the question of how to provide good-quality health care to everyone is hugely complex; that doesn’t mean that we can not understand it in broad terms.
To a first approximation, then, one can see the situation facing health care in this country in terms of forces with different interests. The future will be determined by the relative strength of those forces. On the one hand there is the force of the multi-national corporations which are driven by their profit motive. In the U.S., where they are dominant in the health care system, the corporations make enormous profits, health care is not universal, and is hugely more expensive for the outcomes than in the UK. We see that the direction in the UK is towards the U.S.-style insurance system, run by the private companies – and that is because the balance of power right now is with the private companies.
On the other hand, there is the force of the public and of democracy. Opinion polls consistently show that the majority of the public agrees with me and is in favor of a publicly-provided NHS, and opposes privatisation and a “two-tier” system. So the public already supports the core principles of the NHS as the fairest system; and so what the public needs is the knowledge that this is also the most efficient and cost-effective system.
As I understand, many here today – including a group called “Bring Back the NHS” – are part of a growing movement to empower the public with exactly that knowledge as the NHS reaches its seventieth birthday next year.
Thank you for listening.
[Applause. Standing ovation.]