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Issue #1505      15 June 2011

From health service to health care industry

IN November 2010, a US think-tank, the Commonwealth Fund, published a report that stated that Britain is the only one of 11 industrialised countries where wealth does not determine access to health care. Perhaps this is why the National Health Service (NHS) is under attack from the Conservative/Liberal coalition government in Britain, a coalition which has staked everything upon “deficit reduction”, but is, at the same time, undertaking the most far-reaching “reforms” of the health service since its inception in 1948.

The health service in Britain became a major part of the welfare state, that historic compromise between capital and labour following the war against Nazism and Fascism in 1945. The welfare state was a pledge that “never again” would the inflation and insecurity that seized Germany in the 1930s give rise to the extremism and violence that led to conflict and left Europe in ruins, strewn with bones and ashes.

Such a noble endeavour did not go uncontested. Those of us old enough to remember, recall fierce objections to the introduction of health care free at the point of delivery; and Aneurin Bevan, the radical Labour politician responsible for it, admitted it had been achieved only by “stuffing the doctors’ mouths with gold”. A poll of members of the British Medical Association in February 1948 found 40,000 opposed the service and only 5,000 in favour. The Conservative popular press published dire warnings that the poor would rush to furnish themselves with the amenity of spectacles, and have all their teeth drawn for the sake of free dentures.

These benign publications gave little publicity to the backlog of untreated sickness and undiagnosed disease, much of it a consequence of industrial life – cancers, consumption and lung diseases caused by exposure to hazardous materials, years of malnutrition that stunted bodies and deformed limbs, and left a legacy of disability and early death among industrial workers and their families; a legacy which still remains, since life expectancy in parts of Glasgow is still 12 years less than that in southern England.

Improvement in health care

Over the years, the National Health Service became one of Britain’s most cherished institutions. Set up at a time of extreme austerity in the late 1940s, it nevertheless addressed harsh inequalities of health care, and led to an unprecedented improvement in the growth and nurture of a new generation, an extension of life expectancy and the relief of debilitating and painful conditions which the poor had stoically borne in the past.

I can remember the women of my childhood, afraid to consult a doctor, hoping that the lump they had discovered in their abdomen or breast would pass with the use of patent medicines bought from the chemist; and in due course, they died, often in great pain, without even speaking of their symptoms to those they loved.

We always passed the monumental bulk of our local infirmary (the very word implied debility) with apprehension, for it was common knowledge that hospitals were places where people went to die. We held our breath as we walked by “the fever hospital”, site of the casualties of Victorian industrial life, abridged by insanitary conditions and outbreaks of cholera, diphtheria and typhoid well into the 19th century.

It is significant that the “compromise” between capital and labour reached in the Western world after the Second World War lasted only as long as the power of organised labour. With the erosion of that power, decay of the Soviet Union and the ideology of a single global economy that poured into the vacuum, the labour of the world entered into fierce competition for the privilege of serving a capitalism to which “no alternative” was triumphantly proclaimed.

This has permitted those who have bided their time, waiting for the balance of global power to tilt away from labour, to embark upon a dismantling of the welfare state in the West, and to embark upon a profane pilgrimage of return to a capitalism that knows nothing of human need, and everything of the necessity for profit.

They have been patient, these enemies of human well-being. Even Margaret Thatcher, whose great project was the demolition of manufacturing industry in Britain, did not openly attack the health service, although she was content to see it wither from lack of support. Indeed, the mass unemployment engendered by her successful attempt to “integrate” Britain into a global division of labour – including the “big bang” which deregulated the finance industry – depended upon the welfare state to mute the human impact of the disemployment of millions.

Tony Blair, Labour’s messiah, as it were, to the Tories’ prophet, Margaret Thatcher, introduced aspects of the market into the National Health Service. Under the Private Finance Initiative, a program of hospital building was initiated, whereby capital would be provided by the market and repayment deferred to the decades to come. Although he was also an enthusiast of “Competition”, “choice” and a plurality of “health care providers”, his government tripled investment in the health service. The people of Britain insisted they didn’t want competition or choice: they just wanted good, reliable health care when they needed it. At the end of Labour’s period in power, almost 90 percent of the people of Britain said they found the health service “good” or “excellent”.

Of course the society in which the health service exists is quite different from that in which it was set up. No one imagined in 1948 that the cost of alcohol- or drug-related disorders would consume so many resources, nor that traffic accidents and criminal injuries would make such demands, nor even that life expectancy would have stranded so many people in hospital wards at the end of their days.

These changes have placed strains on a service where demands have risen and thousands of people now routinely visit Accident and Emergency hospital departments for minor ailments, while the emergency ambulance service last year had to deal with trivial calls – a woman who had a problem with her knitting, a car-driver who wanted to know the time, a man who complained about the birdsong that kept him awake at night, Elvis sightings, UFOs and requests for taxis.

Sabotage

During the period of Labour government, their Conservative opponents were busily working away at ingenious means to sabotage a health service which it was their highest ambition to transform into a “health care industry”. This quiet work of demolition became headline news in August 2009, when a Conservative Member of the European Parliament, Daniel Hannan (former speechwriter for past leaders of the Conservative Party), described the NHS in a US TV interview as “a relic” and a “60-year-old mistake”.

Other prominent Conservatives called the NHS “a national sickness service”, and accused it of being “no longer relevant to the 21st century”, and “failing to meet public expectations”. David Cameron, who has shown himself a master of dissimulation, rendering plausible his mendacity by means of indignation whereas Tony Blair relied on righteousness, was quick to distance himself from these remarks, saying that he stood “four-square” behind the NHS. He has also invoked his gratitude to the NHS for the care it gave to his six-year-old son who died of cerebral palsy in 2009.

This personal tribute appeared to have been reinforced in the 2010 election campaign, when Cameron promised “no more top-down reform” of the health service. Immediately after the formation of the coalition, he announced the most sweeping reorganisation since 1948, whereby consortia of doctors, general practitioners, would receive 60 percent of the health budget to commission care.

They would be “free” to buy in treatment from “any willing provider”, private companies, charities, not-for-profit companies or existing health service employees. That this simple expedient is a prelude to privatisation is obvious: general practitioners will require advisers, experts and advocates to ensure they are getting the best treatment, or “value for money” (a tautologous piece of commonsense on the tongue of every politician). This opens the way to large-scale US and other private interests, not a few of which have made significant contributions to Conservative Party funds. Providers will be paid “according to performance”, as though health care were some kind of cabaret act.

The present government has adopted so many policies which appeared in no election manifesto – indeed these were peppered with denials that any such policies were even contemplated – that the issue is no mere matter of “broken promises” (all parties do that), but of deception so blatant that they are close to forfeiting their claim to have been legitimately elected; a serious breach of those very “democratic processes” which the whole world is exhorted to emulate.

The justification for all this depends upon an abuse of the language of “modernisation”, “radical reform”, the meaningless declaration that “doing nothing is not an option” – a political idiolect unintelligible to most people.

The Liberal Democrats, junior partners in the coalition, have been under pressure from their supporters to block the “reforms”; and such has been the outcry of professionals in the health service – who are of a different order from those who resisted tooth and nail the introduction of the NHS 63 years ago – that the government has said it will “pause, listen and engage” and modify some of the more extreme passages of the current Bill passing through Parliament. They will insert some democratic control over “consortia” which will commission treatment for patients whom we may expect any time now to see re-branded as “customers”.

Free-market ideology

David Cameron has taken on the task of completing a process initiated with such panache by Margaret Thatcher, extending to the public sector the privatisations and free market ideology which resulted in the de-industrialisation of Britain in the 1980s and 1990s. While promising to increase spending on the health service “year on year”, he has simultaneously demanded £20 billion in “efficiency savings”, which have already led to significant cuts in services.

It is an epic project. The world is watching; for at the very moment when it is clear that India, China, Brazil, Indonesia and other advancing economies (are they economies or countries? – the words have become interchangeable) must introduce some form of protection for their most vulnerable people against the ravages of global capitalism. The West – the model supposed to inspire them – is busy destroying by guile and subterfuge the very shield their people required against the violence of free markets.

It would be a great irony if, far from creating the “level playing field” with its upstart competitors which it claims, the West should clutch in its dotage at the discredited dogmas of laissez-faire, an ideology it was obliged to abandon as a result of the human wreckage with which it littered the 19th century, even as the “emerging” world overtakes it, both in economic success and in humanitarian protection for its people.

If the present administration incessantly invokes the future, modernisation and reform, this is precisely because it is hurtling Britain backwards into the familiar, but far from comforting, embrace of an ideology which makes people captive once more, hostages to markets, whose freedom is the highest law.

Third World Network   

Next article – Book Review – Malcolm X: A Life of Reinvention

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