Nye Bevan, the Welsh Labour Minister was a through and through socialist when he founded the NHS. His argument that “no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means” struck a chord and became the constitutional principle for the institution. With its 60th birthday this year, we are left to ponder upon its respective merits and flaws, and as ever the arguments revolve around resources, human capital and management. Criticism, being what it is, is easy to mete out, while praise is considerably harder. It took the Guardian journalist Will Hutton to put the brakes on and remind us not to flood ourselves with never-ending tabloid hysteria. A more sober appraisal is necessary. Let’s engage in some historical analysis.

Free healthcare, even within modern fields such as psychiatry, is not as new as one may initially presume. In the Middle Ages the Sultan Saladin ensured that Cairo had a functioning state mental hospital, something which the traveller Ibn Jubayr marvelled at, finding it staggeringly farsighted. Saladin, of course, is most famously known in the West for his battling against the valiant Richard the Lionheart while the big bad King John was crushing the mythical Robin Hood. The Sultan had his own system of take from the rich to give to the poor, he was using the Islamicate tax systems (as well as, arguably, the proceeds of a war-state) to cover his costs. Hospitals were not the only charitable institution that Saladin took an interest in, his endowments of educational establishments are especially well noted. Yet those had an obvious motive, they could act as centre of dissemination for his propaganda. His healthcare policy is more intriguing.

What does that Cairene hospital tell us which can inform us about today? I think we can legitimately derive a few things. Firstly free healthcare at the point of delivery, or at least at nominal cost, was a feat performed by the nation state long ago (purists will be upset that I took up the 12th Century when I could have gone back to Haroun al-Rashid’s Baghdad hospital, built some twenty-score years earlier). Granted, hospitals would have, at best, provided coverage to the city population, whilst today the West expects nothing less than full nationwide coverage, yet it should be remembered that the maintenance of the hospital was historically thought of as the (surplus) duty of the sovereign power. Within living memory, Reagan used lingering anti-Communist sentiment to convince his people of the imbalance of allowing healthcare into the hands of Government. Yet, somewhat ironically, the Sultan’s endowment shows us that “socialist medicine” predates socialism. Secondly, healthcare was emerging as a right. To be sure, at the time, the people of Cairo must have regarded it as a favour and not as the Sultan’s obligation. However one only need consider the how the discussion about basic rights has developed. King John’s Magna Carter was extracted at the point of the barons’ blades – but habeas corpus is now enshrined as law. By now we should have matured into accepting the right of healthcare as a basic premise. If not, we are being put to shame by our ancestors.

Nothing brings into sharper relief the difference between British and US domestic policy than healthcare. Citizens west of the Atlantic have difficulty comprehending the rationing out of goods that government administration demands. Drugs not being supplied on the basis of quotas, waiting-lists ever extended, these are intolerable by the standards of the market. Yet is health to be treated as a consumer good? A pill or a potion which offers an immediate cure may well be, but the problems associated with chronic long-term illness cannot be so easily resolved by market forces. After all, ethical issues begin to intrude. Is it morally right to hinge a patient’s cancer treatment on the number of his credit card or the small print of his insurance policy?

For long-term illnesses, good healthcare at the point of absolute need may be virtually perfectly inelastic (a man dying of heart disease is not going to quibble about the numbers). However consumers may still gamble that the point of need will never arise. Not being insured is common as millions (47 as of 2006) leave their health on hold. Whatever the merits of the finite legislation introduced by the Bush administration to attend to immediate healthcare, it is obvious that it is the poor and disenfranchised who suffer the worst.

Yet we should not rush into easy exaggerations. Health indicators in the US are still very good. The key statistic, life expectancy, according to the WHO’s 2006 figures was 78, only five years short of the top figure. Further, the lucrative rewards on offer, which is made available by its peculiar system of healthcare funding, means that the States possesses the best doctors. As a result it also possesses the best training facilities, Harvard and John Hopkins being acknowledged as the world leaders. Meanwhile, in the UK, Blair’s reforms of the NHS (erratic doctors’ pay, over-management but decentralisation) have placed it under such strain that we may well be witnessing the beginning of the end game for Nye Bevan’s vision. What then? Perhaps, in the end, we will have to cede to the American way. Perhaps, but I hope not. After all the NHS is an established equilibrium. It would be foolhardy to increasingly work towards it privatisation. Do we really wish to open it to the forces of creative destruction?