[Thread]
I am becoming concerned that the future of the NHS is imperilled by fundamental misunderstandings about what it is as an institution. This has disturbing parallels to threats to democracy across the world. 1/

There is, as far as I can tell, v little public support for 'privatising' the NHS and certainly almost none for abolishing it. However, if you understand the NHS simply as an institution that provides free healthcare, then you might misunderstand what privatisation means 2/

A privatised NHS would not necessarily be one in which healthcare is no longer free. Rather, it would be an NHS run by a constellation of private companies that would need to extract a surplus from their fees in order to pay shareholders. 3/

This would be a threat to the NHS, as it would produce the consequences seen in rail privatisation: inefficiencies, lack of coordination, huge layers of further bureaucracy and poor service accompanied by profiteering. BUT it would still be free to use. 4/

An inevitable consequence would be that those who could afford it would bypass the NHS as much as possible, leading to it becoming a 'sink' service. BUT it would still be free so alerting people to the dangers would be very very difficult. 5/

Here's the analogy to the undermining of democracy: Just as defining the NHS purely in terms of it being free to use can blind people to its undermining, so defining democracy primarily in terms of free speech can blind people of threats to democracy. 6/

Contemporary post-democratic authoritarians, and the Trump regime, are hollowing out judicial freedom, suppressing the vote and independent sources of expertise BUT in the US, Hungary and you can usually say what you like without being imprisoned - they are not N Korea 7/

The political technologists of the contemporary right have got smart: they are leveraging incomplete understanding of what institutions like democracy and socialised medicine actually mean, in order to hollow them out without being held to account. 8/

All this highlights the need for civic education that would help people develop a more sophisticated understanding about what institutions are and how they work. Ends/