Having never experienced food rationing myself I cannot say what it is like, but I am assuming the experience is not as bad as images suggest. My reasoning is straightforward and can be put in the form of an argument as follows: (1) The National Health Service (NHS) is good; (2) Food is more important than health; therefore, (3) A National Food Service (NFS) would be good. Is there anything wrong with this argument?
Let’s look briefly at the truth or falsity of the premises, before elaborating. A supporter of an NFS, along with many millions of others, would affirm with confidence that the NHS is a ‘good thing’. That is, it is a desirable if not indispensable institution, at the beating heart of our national life, a support and a lifeline for all of us, relatively free at the point of use, providing the full panoply of basic medical services, from care for minor ailments to treatment for serious illnesses and conditions such as cancer, heart disease, broken limbs, disfigurement, deadly infections, and so on. Yes, it is currently in the worst shape it has been in for decades, to the point that in the current election campaign the major parties do not even pretend to mouth slogans such as ‘Twenty-for hours to save the NHS’, so far gone is the patient.
That does not mean the NHS is undesirable, though, does it? Anyway, just suppose it is a good thing for the sake of argument and let’s revisit the premise later. Premise (2) says that food is more important than health, and the truth or falsity of this depends on what we mean by ‘important’. Think of it this way. Although both food and health are quite basic human goods, there is an asymmetry. Without food – by which I mean adequate nutrition, not simply fasting for a bit or going on a diet – you are guaranteed to be unhealthy. But if you are unhealthy, it is not guaranteed you will lack adequate nutrition. Some illnesses make it hard to keep food down. Some illnesses deprive a person of their appetite. But these are exceptions. You can be seriously unhealthy, headed for the grave, and yet still not be suffering from malnutrition. If you are malnourished, however, you will be unhealthy there and then, with no further steps required, no exceptions to be made.
Ask yourself this admittedly remotely hypothetical question: faced with the choice between inadequate food and inadequate health (short of death!), which would you choose? I’d go for inadequate health, thinking that with inadequate food I’ll be unhealthy anyway, so why not just have ill health but at least plenty of food, hoping that I can maintain my strength and give myself a fighting chance against my illness? Again, as a general rule if you have zero food you are dead in a few months. You’d have to have a pretty rare condition – pancreatic cancer, say – to be dead in a few months. If you add not having water to not having food – and I do want to add that since I am classing food and water together when I hypothesise about a National Food Service – you are dead in a few days. Very few illnesses or combinations of conditions kill you in a few days – maybe bacterial meningitis or necrotizing fasciitis.
So yes, of course health is important, but food is just that bit more important. That said, by ‘important’ in premise (2) I am packing a little more into it than the asymmetry just outlined. I also mean that if there is such an asymmetry, then however society is structured so as to make health care readily available should be similar in key respects to how society should be structured so as to make food readily available. This is how the conceptual connection between ‘good’ in (1) and ‘important’ in (2) should be interpreted. (I could split the argument into sub-arguments to make this crystal clear, but it’s not necessary).
Now, does our conclusion (3) – ‘A National Food Service (NFS) would be good’ – follow from the premises? If so we have a valid argument, and if the premises are true then we have our ultimate goal, a sound argument – to lapse into philosophy-speak. Well, I’ve gestured at the truth of (1) but also said we should just assume it for the fun of the argument. A full defence of (1) would come from the endless literature doing just that – defending the goodness of the NHS. I’ve argued at greater length for the truth of (2) and its connection to (1). Suppose I’ve done the job. Then how could the conclusion not follow? It must, of logical necessity. There is no escape. We need a National Food Service.
Er, do we? The title of this article refers to ‘rationing’. Actually, food rationing is really not something you’d want to experience. Nobody in their right mind wants food rationing, except the crooks who make money off it and are not subject to the rationing themselves. I think I’d rather emigrate than have food rationing – at least as a way of life. So what I really think – and I’m sure you agree – is that food rationing is not something we’d want brought back. And so the prospect of a National Food Service should fill me – and you – with utter dread. If that is the case, then we must do what we philosophers call a modus tollens: I give you an argument pointing inexorably to a certain conclusion. But that conclusion is on its face absurd. You and I won’t accept it. So we are forced by logic to deny at least one of premises (1) and (2). Having already made a pretty good case for (2), we have to deny (1) after all, contrary to the initial ‘for the sake of argument’ assumption. The NHS is not good – not in concept any more than in current execution.
Wait a minute, you might object: I’m comparing apples and oranges. There is no rationing in the NHS! But there is, I insist. True, we don’t all walk around with health care ration books with quotas of medicines or treatments printed on each ticket. But health care is rationed nonetheless, as any fule kno. You get a precious ten minutes with your GP, then you are politely expected to leave (unless things are serious as judged by that GP alone). You cannot get any treatment you want, no matter how effective or promising; it all depends on cost and the voluminous guidance of the National Institute for Clinical Excellence (NICE). Ultimately, who gets what is for the government of the day, acting on the advice of – sorry, I can’t resist – Twenty-First Century Science.™ The details of NHS rationing are there for all to see. This leads to very bad consequences for patients in a multitude of cases, with the example of breast cancer drug Kadcyla being instructive.
A critic of my argument might insist that food and health are dissimilar in important ways that undermine premise (2), the claim that food is more important than health. Recall that my argument is not just that food is prior to health in terms of human well-being, but that because of this its allocation in whatever way society allows should be the same as the way health care is allocated in that society. All things being equal, perhaps that is true. But all things are not equal, says the critic. There is a whole side to food provision that has no health care parallel. There are restaurants, gourmet dining, eating for pleasure, eating as a cultural pastime. Whereas health care is about meeting needs, there is more to food provision than simply meeting needs.
It is not clear to me that there is a disanalogy. Health care also has its niche, exotic, cultural, aspirational side. Think of purely aesthetic surgery – nose jobs, teeth whitening, skin lightening, Botox, hair removal, hair transplants, body modification, and so on. These are all far more about satisfying desires than meeting real needs. They are generally not necessary for health. The critic retorts: ‘then they are not about health care, so why are you bringing them into the discussion?’ My reply: ‘then neither is fine dining or wine tasting part of food provision, so why are you bringing them into the discussion?’ In other words, cheek filler and fine dining stand or fall together. Either both are on the table or neither are. I think it’s more plausible to say they are both on the table as quite remote parts of health care and food provision, respectively. Now, cosmetic surgery is not routinely available on the NHS, except for mental health reasons or if the cosmetic aspect is accompanied by a real functional need (e.g. to breathe clearly). This is well and good. Similarly, in my National Food Service regime, oysters and crab-flavoured ice cream would also not routinely be available (except perhaps if they were essential to nutrition!). These would have to be purchased on the private market.
The critic might try this gambit: health care, the kind of care that doesn’t just maintain health but that keeps you alive, can be astronomically expensive. People can’t generally afford it. Adequate nutrition can be had very cheaply. So people need help from the state with the former but can pay for the latter themselves. My reply is that if this point is a good one, it only favours restricting the NHS to the really expensive treatments, not retaining the kind of all-encompassing, womb-to-tomb NHS we have now. So the critic’s point undercuts their own idea that an NFS is not desirable but the NHS is. Moreover, some staple foods, which millions require for nutrition, are particularly expensive to produce, e.g. rice; these rely heavily on government subsidies, loans, and other price support mechanisms. So why not go the whole hog with food, so to speak, and bundle it into an NFS? Anyhow, the overall cheapness of food argues in favour of an NFS because it is really, truly, hard to believe that an NFS would cost more than the NHS – which is pushing £200 billion in annual cost, that is to say, about £3000 annually for every human being in England. I am having to stretch my credulity beyond breaking point to suppose that universal food rationing would cost anywhere near that much. But I have no method of estimating it. (The last I looked, by the way, £3000 would buy every human being in England a helluvalot of health insurance. Just saying.)
OK, how about the ‘black market’ objection? This says that just as we saw a lot of illegality during wartime food rationing, we would see the same the minute an NFS came into existence. And we don’t want that. In reply, this presupposes we do not see illegality as a result of having the NHS. I’m not talking about dodgy tattoo and piercing parlours or lunchtime liposuctions. I’m referring to ‘medical tourism’, where thousands upon thousands of UK citizens go abroad for medical treatment (234,000 in 2021, with 34,000 foreigners coming to the UK for treatments, stats here; gets the noggin joggin’ doesn’t it?). That in itself is legal, of course, but it is surely the case – data are hard to come by – that at least hundreds, if not thousands, of people are injured by negligent doctors, in dodgy or uncertified clinics, or by illegal procedures abroad. I am not thinking of cosmetic surgery (which is the number one reason for medical tourism) since that is not available on the NHS anyway, but rather of things like orthopaedic surgery and dental procedures (it being notoriously hard to get on the books of an NHS dentist).
It is tough to see a significant disanalogy between health care and food provision when it comes to the idea of a nationalised service – socialism, effectively. If there is none, then either we should go with food rationing or we should dismantle and privatise the NHS. As I said, I’m not a fan of food rationing and I doubt you are. I like my private supermarkets, the abundance of choice, the full range of pricing, the efficient delivery, and the reasonably pleasant shopping experience. (Things are going downhill, to be sure; thanks a bunch, America.) But that’s only the supermarkets. I live near an award-winning cheese shop, an award-winning butcher, an overpriced organic shop, and can get pretty much any food online that I can’t find locally. All in all, I can’t complain. Do I want all this to be turned into a bunch of Stalinist showrooms with tasteful lighting illuminating a few mouldy potatoes? All right already, I’m exaggerating. But you can bet that an NFS would be a sodding awful experience without end (unlike post-World War 2 food rationing, which ended in 1954).
There is no room to rehash the endless debate over privatised health care. That said, I am not advocating for a fully privatised system anyway. Not even our private food system is without government supplementation, for example free school meals and financial assistance to food charities, not to mention government subsidies for agriculture. In a private medical system, there would be similar government assistance, safety nets, and the like. In addition, just as private food is heavily regulated so as to reduce the risk of contamination, food poisoning, and waste, so a private medical system would also be heavily regulated to ensure basic standards from top to bottom.
The worry that is perhaps most often raised is that whereas food products are commodities and hence subject to commodity pricing, many life-saving medicines and treatments are the result of decades of high-cost research and development, require intellectual property protection, and need to have their costs recouped through high pricing. The hope that I and many others have is that as long as technology progresses, prices will trend downwards and affordability will increase. This is particularly so with the mass production of generic medicines. A hundred years ago, hardly anyone ate steak. And hardly anyone had access to antibiotics. Still, there is a long way to go in light of the Big Pharma quasi-cartel, corrupt regulators and legislators (the old ‘revolving door’), and the artificial stimulation of demand due in large part to a woeful lack of government or private interest in preventive health care – the best health care of all.
No, I don’t want to stand in a queue outside a state-run food dispensary. And I want more than ten minutes with my GP. The logic of not bothering about the latter leads to not being fussed about the former, at least if my reasoning is correct. I think we should reject rationing altogether, outside of war and national calamity. If I want a National Food Service, I’ll head over to North Korea. Thanks but no thanks; I’m off to Tesco for a sirloin.
Bring Back Food Rationing!
Having never experienced food rationing myself I cannot say what it is like, but I am assuming the experience is not as bad as images suggest. My reasoning is straightforward and can be put in the form of an argument as follows: (1) The National Health Service (NHS) is good; (2) Food is more important than health; therefore, (3) A National Food Service (NFS) would be good. Is there anything wrong with this argument?
Let’s look briefly at the truth or falsity of the premises, before elaborating. A supporter of an NFS, along with many millions of others, would affirm with confidence that the NHS is a ‘good thing’. That is, it is a desirable if not indispensable institution, at the beating heart of our national life, a support and a lifeline for all of us, relatively free at the point of use, providing the full panoply of basic medical services, from care for minor ailments to treatment for serious illnesses and conditions such as cancer, heart disease, broken limbs, disfigurement, deadly infections, and so on. Yes, it is currently in the worst shape it has been in for decades, to the point that in the current election campaign the major parties do not even pretend to mouth slogans such as ‘Twenty-for hours to save the NHS’, so far gone is the patient.
That does not mean the NHS is undesirable, though, does it? Anyway, just suppose it is a good thing for the sake of argument and let’s revisit the premise later. Premise (2) says that food is more important than health, and the truth or falsity of this depends on what we mean by ‘important’. Think of it this way. Although both food and health are quite basic human goods, there is an asymmetry. Without food – by which I mean adequate nutrition, not simply fasting for a bit or going on a diet – you are guaranteed to be unhealthy. But if you are unhealthy, it is not guaranteed you will lack adequate nutrition. Some illnesses make it hard to keep food down. Some illnesses deprive a person of their appetite. But these are exceptions. You can be seriously unhealthy, headed for the grave, and yet still not be suffering from malnutrition. If you are malnourished, however, you will be unhealthy there and then, with no further steps required, no exceptions to be made.
Ask yourself this admittedly remotely hypothetical question: faced with the choice between inadequate food and inadequate health (short of death!), which would you choose? I’d go for inadequate health, thinking that with inadequate food I’ll be unhealthy anyway, so why not just have ill health but at least plenty of food, hoping that I can maintain my strength and give myself a fighting chance against my illness? Again, as a general rule if you have zero food you are dead in a few months. You’d have to have a pretty rare condition – pancreatic cancer, say – to be dead in a few months. If you add not having water to not having food – and I do want to add that since I am classing food and water together when I hypothesise about a National Food Service – you are dead in a few days. Very few illnesses or combinations of conditions kill you in a few days – maybe bacterial meningitis or necrotizing fasciitis.
So yes, of course health is important, but food is just that bit more important. That said, by ‘important’ in premise (2) I am packing a little more into it than the asymmetry just outlined. I also mean that if there is such an asymmetry, then however society is structured so as to make health care readily available should be similar in key respects to how society should be structured so as to make food readily available. This is how the conceptual connection between ‘good’ in (1) and ‘important’ in (2) should be interpreted. (I could split the argument into sub-arguments to make this crystal clear, but it’s not necessary).
Now, does our conclusion (3) – ‘A National Food Service (NFS) would be good’ – follow from the premises? If so we have a valid argument, and if the premises are true then we have our ultimate goal, a sound argument – to lapse into philosophy-speak. Well, I’ve gestured at the truth of (1) but also said we should just assume it for the fun of the argument. A full defence of (1) would come from the endless literature doing just that – defending the goodness of the NHS. I’ve argued at greater length for the truth of (2) and its connection to (1). Suppose I’ve done the job. Then how could the conclusion not follow? It must, of logical necessity. There is no escape. We need a National Food Service.
Er, do we? The title of this article refers to ‘rationing’. Actually, food rationing is really not something you’d want to experience. Nobody in their right mind wants food rationing, except the crooks who make money off it and are not subject to the rationing themselves. I think I’d rather emigrate than have food rationing – at least as a way of life. So what I really think – and I’m sure you agree – is that food rationing is not something we’d want brought back. And so the prospect of a National Food Service should fill me – and you – with utter dread. If that is the case, then we must do what we philosophers call a modus tollens: I give you an argument pointing inexorably to a certain conclusion. But that conclusion is on its face absurd. You and I won’t accept it. So we are forced by logic to deny at least one of premises (1) and (2). Having already made a pretty good case for (2), we have to deny (1) after all, contrary to the initial ‘for the sake of argument’ assumption. The NHS is not good – not in concept any more than in current execution.
Wait a minute, you might object: I’m comparing apples and oranges. There is no rationing in the NHS! But there is, I insist. True, we don’t all walk around with health care ration books with quotas of medicines or treatments printed on each ticket. But health care is rationed nonetheless, as any fule kno. You get a precious ten minutes with your GP, then you are politely expected to leave (unless things are serious as judged by that GP alone). You cannot get any treatment you want, no matter how effective or promising; it all depends on cost and the voluminous guidance of the National Institute for Clinical Excellence (NICE). Ultimately, who gets what is for the government of the day, acting on the advice of – sorry, I can’t resist – Twenty-First Century Science.™ The details of NHS rationing are there for all to see. This leads to very bad consequences for patients in a multitude of cases, with the example of breast cancer drug Kadcyla being instructive.
A critic of my argument might insist that food and health are dissimilar in important ways that undermine premise (2), the claim that food is more important than health. Recall that my argument is not just that food is prior to health in terms of human well-being, but that because of this its allocation in whatever way society allows should be the same as the way health care is allocated in that society. All things being equal, perhaps that is true. But all things are not equal, says the critic. There is a whole side to food provision that has no health care parallel. There are restaurants, gourmet dining, eating for pleasure, eating as a cultural pastime. Whereas health care is about meeting needs, there is more to food provision than simply meeting needs.
It is not clear to me that there is a disanalogy. Health care also has its niche, exotic, cultural, aspirational side. Think of purely aesthetic surgery – nose jobs, teeth whitening, skin lightening, Botox, hair removal, hair transplants, body modification, and so on. These are all far more about satisfying desires than meeting real needs. They are generally not necessary for health. The critic retorts: ‘then they are not about health care, so why are you bringing them into the discussion?’ My reply: ‘then neither is fine dining or wine tasting part of food provision, so why are you bringing them into the discussion?’ In other words, cheek filler and fine dining stand or fall together. Either both are on the table or neither are. I think it’s more plausible to say they are both on the table as quite remote parts of health care and food provision, respectively. Now, cosmetic surgery is not routinely available on the NHS, except for mental health reasons or if the cosmetic aspect is accompanied by a real functional need (e.g. to breathe clearly). This is well and good. Similarly, in my National Food Service regime, oysters and crab-flavoured ice cream would also not routinely be available (except perhaps if they were essential to nutrition!). These would have to be purchased on the private market.
The critic might try this gambit: health care, the kind of care that doesn’t just maintain health but that keeps you alive, can be astronomically expensive. People can’t generally afford it. Adequate nutrition can be had very cheaply. So people need help from the state with the former but can pay for the latter themselves. My reply is that if this point is a good one, it only favours restricting the NHS to the really expensive treatments, not retaining the kind of all-encompassing, womb-to-tomb NHS we have now. So the critic’s point undercuts their own idea that an NFS is not desirable but the NHS is. Moreover, some staple foods, which millions require for nutrition, are particularly expensive to produce, e.g. rice; these rely heavily on government subsidies, loans, and other price support mechanisms. So why not go the whole hog with food, so to speak, and bundle it into an NFS? Anyhow, the overall cheapness of food argues in favour of an NFS because it is really, truly, hard to believe that an NFS would cost more than the NHS – which is pushing £200 billion in annual cost, that is to say, about £3000 annually for every human being in England. I am having to stretch my credulity beyond breaking point to suppose that universal food rationing would cost anywhere near that much. But I have no method of estimating it. (The last I looked, by the way, £3000 would buy every human being in England a helluvalot of health insurance. Just saying.)
OK, how about the ‘black market’ objection? This says that just as we saw a lot of illegality during wartime food rationing, we would see the same the minute an NFS came into existence. And we don’t want that. In reply, this presupposes we do not see illegality as a result of having the NHS. I’m not talking about dodgy tattoo and piercing parlours or lunchtime liposuctions. I’m referring to ‘medical tourism’, where thousands upon thousands of UK citizens go abroad for medical treatment (234,000 in 2021, with 34,000 foreigners coming to the UK for treatments, stats here; gets the noggin joggin’ doesn’t it?). That in itself is legal, of course, but it is surely the case – data are hard to come by – that at least hundreds, if not thousands, of people are injured by negligent doctors, in dodgy or uncertified clinics, or by illegal procedures abroad. I am not thinking of cosmetic surgery (which is the number one reason for medical tourism) since that is not available on the NHS anyway, but rather of things like orthopaedic surgery and dental procedures (it being notoriously hard to get on the books of an NHS dentist).
It is tough to see a significant disanalogy between health care and food provision when it comes to the idea of a nationalised service – socialism, effectively. If there is none, then either we should go with food rationing or we should dismantle and privatise the NHS. As I said, I’m not a fan of food rationing and I doubt you are. I like my private supermarkets, the abundance of choice, the full range of pricing, the efficient delivery, and the reasonably pleasant shopping experience. (Things are going downhill, to be sure; thanks a bunch, America.) But that’s only the supermarkets. I live near an award-winning cheese shop, an award-winning butcher, an overpriced organic shop, and can get pretty much any food online that I can’t find locally. All in all, I can’t complain. Do I want all this to be turned into a bunch of Stalinist showrooms with tasteful lighting illuminating a few mouldy potatoes? All right already, I’m exaggerating. But you can bet that an NFS would be a sodding awful experience without end (unlike post-World War 2 food rationing, which ended in 1954).
And a privatised health service? I admit, my own experience with the NHS has been pretty positive. Our local surgery is clean, neat and friendly, the local hospital likewise, so again I can’t complain. But that’s my area. Stories abound of shoddy service: paint peeling off the walls, DNRs on anyone over 70 (at least during COVID), old people lying on trolleys in corridors for hours and days on end, people sleeping on the floor, half a day to get seen by accident and emergency, botched maternity care, murderous nurses, sepsis here and sepsis there, often woeful food, radical discontinuity of care, hospitals rated inadequate, a culture of cover-up, bullying, endless negligence payouts, bloated bureaucrats on golden pensions, and so on and on. The word on the street these days about the NHS is not exactly positive.
There is no room to rehash the endless debate over privatised health care. That said, I am not advocating for a fully privatised system anyway. Not even our private food system is without government supplementation, for example free school meals and financial assistance to food charities, not to mention government subsidies for agriculture. In a private medical system, there would be similar government assistance, safety nets, and the like. In addition, just as private food is heavily regulated so as to reduce the risk of contamination, food poisoning, and waste, so a private medical system would also be heavily regulated to ensure basic standards from top to bottom.
The worry that is perhaps most often raised is that whereas food products are commodities and hence subject to commodity pricing, many life-saving medicines and treatments are the result of decades of high-cost research and development, require intellectual property protection, and need to have their costs recouped through high pricing. The hope that I and many others have is that as long as technology progresses, prices will trend downwards and affordability will increase. This is particularly so with the mass production of generic medicines. A hundred years ago, hardly anyone ate steak. And hardly anyone had access to antibiotics. Still, there is a long way to go in light of the Big Pharma quasi-cartel, corrupt regulators and legislators (the old ‘revolving door’), and the artificial stimulation of demand due in large part to a woeful lack of government or private interest in preventive health care – the best health care of all.
No, I don’t want to stand in a queue outside a state-run food dispensary. And I want more than ten minutes with my GP. The logic of not bothering about the latter leads to not being fussed about the former, at least if my reasoning is correct. I think we should reject rationing altogether, outside of war and national calamity. If I want a National Food Service, I’ll head over to North Korea. Thanks but no thanks; I’m off to Tesco for a sirloin.
David S. Oderberg is Professor of Philosophy at the University of Reading; [email protected]; www.davidsoderberg.co.uk; davidsoderberg.substack.com. All opinions expressed are personal and not associated in any way with my employer.
Photo Credit.