#nhs

Back in America, Obama decided to bail out the banks and not the people. His treasury secretary Tim Geithner told him the banks were headed for a catastrophic crash and could only be saved if he "foamed the runways" with everyday Americans' mortgages. Millions of Americans lost their homes to foreclosure as banks, flush with public cash, threw them out of their homes and then flipped them to investment banks who became the country's worst slumlords:

https://pluralistic.net/2022/02/08/wall-street-landlords/#the-new-slumlords

Americans were understandably not entirely happy with this outcome. So when Hillary Clinton replied to Donald Trump's "Make America Great Again" with "America is already great," her message was, "Vote for me if you think everything is great; vote for Trump if you think everything is fucked":

https://www.politico.com/blogs/2016-dem-primary-live-updates-and-results/2016/03/clinton-america-is-already-great-220078

"Austerity begets fascism" is one of those things that makes a lot of intuitive sense, but it turns out that there's a good empirical basis for believing it. In "Public Service Decline and Support for the Populist Right" four economists from the LSE and Bocconi provide an excellent look at the linkage between austerity and support for fascists:

https://catherinedevries.eu/NHS.pdf

Here's how they break it down. Political scientists have assembled a large, reproducible body of evidence to show that "public service provision is crucial to people’s perceptions of their quality of life and living standards." Good public services are the basis for "the social contract between rulers and the ruled" – pay your taxes and obey the laws, and in return, you will be well served.

When public services go wrong, people don't always know who to blame, but they definitely notice that something is going wrong, so when public services fail, people stop trusting the state, and that social contract starts to fray. They start to suspect that elites are lining their pockets rather than managing the system, and they "withdraw their support" for the system.

Fascists thrive in these conditions. Fascists come to power by mobilizing grievances. By choosing a scapegoat, fascists can create support from people who are justifiably furious that the services they rely on have collapsed. So when you can't get shelter, or health care, or elder care, or child care, or an education for your kids, you become a mark for a fascist grifter with a story about "undeserving migrants" who've taken the benefits that should rightly accrue to "deserving natives."

(This is grimly hilarious, given that the wizened, decrepit rich world is critically dependent on migrants as a source of healthy, working-age workers who pay massive amounts into the system while barely making use of it, many of whom plan on retiring to their home countries when they do reach the age where they're likely to extract a net loss to the benefits system.)

Enter the NHS, a beloved institution that is hailed as the pride of the nation by both the political left and the right. The majority of Britons use the NHS, with only 12-14% of the population "going private," so when the NHS declines, everybody notices (what's more, even people with private care use the NHS for many of their needs).

Britons love the NHS and they want the government to spend more on it. There's "a broad public consensus that the government is not going far enough when it comes to funding." That's because generations of cuts to the NHS have left it substantially hollowed out, with major parts of the service handed over to for-profit entities who overcharge and underserve.

The most tangible and immediate evidence of this slow-motion collapse comes when your local general practitioner ("family doctor" or "primary care physician" in Americanese) shuts down. The UK has lost 1,700 GP practices since 2013.

Reasoning that a GP closure would make people angry at the system, the economists behind the paper wanted to see what happened to people's political beliefs when their GP's office shut. They relied on the GP Patient Survey, a longitudinal study run by NHS England and Ipsos Mori. The survey asks a statistically significant random sample of patients from every GP practice in the NHS and then weights the results "to reflect the demographic characteristics of the local population according to UK Census estimates." It's good data.

The researchers cross-referenced this with various high-quality instruments that measured the political views of Britons, like the U Essex Understanding Society Panel, drawing on 13 years' worth of surveys from 2009-2022, gaining access to a protected version of the dataset with fine-grained geographic information about survey respondents, which allowed them to link responses to the "catchment areas" for specific GPs' office. They combined this data with the British Election Study panel, which has surveyed voters 29 times since 2014.

Most of the paper describes the careful work the researchers did to analyze, cross-reference and validate this data, but what interested me was the conclusion: that people who see a severe degradation in the quality of the services they rely on switch their political affiliation to one of Britain's fascist parties – UKIP, the Brexit Party, or Reform – parties that have called for ethnic cleansing in Britain.

This is what has me scared. We can see the looming economic crises in our near future. If it's not the AI crash that triggers the next wave of austerity, it'll be the oil crisis created by Trump's bungling in the Strait of Epstein. And of course, we could always get a twofer, because the Gulf States that were pouring hundreds of billions into AI data-centers now need every cent to rebuild the LNG shipping terminals and oil refineries that Iran blew up after Trump, Hegseth and Netanyahu started murdering all the schoolgirls they could target. Once they nope out of the AI bubble, that could trigger the collapse.

This is a study about the NHS, but it's not just about the NHS. It's perfectly reasonable to assume that people react this way when they experience cuts to their road maintenance, their schools, their community centers, and any other service they rely on. Fascism – what Hannah Arendt called 'organized loneliness' – can only take root when people stop believing that their society will reward their lawfulness with an orderly and humane existence.

The crisis is coming, but whether we do austerity when it gets here is our choice. Everywhere we turn, political leaders are rejecting generations of failed austerity in favor of "sewer socialism" – the idea that you get people to trust their government by earning that trust. Zohran Mamdani is fixing 100,000 potholes in the first 100 days, despite the multi-billion dollar deficit that outgoing Mayor Eric Adams created by "running the city like a business":

https://prospect.org/2026/04/10/zohran-mamdani-getting-new-york-city-believe-in-government/

In Canada and the UK, party leaders like Avi Lewis (NDP) and Zack Polanski (Greens) are vowing to fight the coming crises by spending, not cutting. Compare that with UK fascist leader Nigel Farage, who says that if he's elected, he'll create a "paramilitary style" British ICE, building concentration camps for 24,000 migrants, with the hope of deporting 288,000 people per year:

https://www.thenerve.news/p/reform-deportation-operation-restoring-justice-data-surveillance-palantir-uk-labour