by rhodri evans
The Government is on the road to converting the Health Service from a provider of health care into an insurance system. In the future, according to Blair and Brown, health care will be “bought in”, more and more of it from private hospitals and clinics, and the NHS will just be an insurance policy, providing cover for health care costs in return for our tax contributions.
Health minister Patricia Hewitt, vainly trying to stop the Labour Party conference condemning this privatisation policy, stated New Labour’s philosophy: “Haven’t we learned that profits are not a dirty word? They are part of a dynamic economy and they are helping build 100 new hospitals...”
The capitalist market is a cruel system in all its workings. It is doubly cruel in health care.
A market system will mean the better-off getting more health care (sometimes more than is good for them, with unnecessary but lucrative operations and treatments) and the worse-off being patched up with whatever is cheapest in the short run and gets them back on the streets quickest.
Competition between hospitals and clinics will lead them to drive down health workers’ wages and conditions, and skimp on unglamorous essentials while pumping resources into higher-profile “market-leader” activities. It will drive some hospitals and clinics out of “business”, disrupting their patients’ treatment.
Patients don’t and can’t have the information to choose “best buys”, even in the limited way we can for other goods and services.
Because it operates, and has to operate, without the “buyers” having much information, a market system involves huge administrative overheads. In the USA’s market-based health system, one quarter of all spending is administrative overheads. The NHS’s overheads used to be much lower. They are creeping up towards the US figure.
A market system might not be so bad if all health care were about who can deliver the slickest, quickest, cheapest appendectomy. But most of it is not. Some 70% of NHS resources are spent on long-term ailments, most of which cannot be cured, certainly not by quick ring-it-up-on-the-till procedures. Treating those ailments, making them controllable for the sufferers, requires cooperation, not competition.
Once the NHS shifts over into “insurance” mode, then, as with all insurance business, there will be constant pressure to limit the cover. Already the NHS has abandoned responsibility for long-term care for the over-70s. Next down the line will be the idea that less vital or smaller treatments should be paid for cash-in-hand rather than covered by the insurance. The current high prescription charges, introduced by the Tories and maintained by New Labour, are a first step there.
In July the Government announced that it would reduce the Primary Care Trusts to commissioning, rather than providing, treatment. Many of the 250,000 health workers now employed by Primary Care Trusts will lose their jobs.
Between now and 2008, the Government will push through a “second wave” of contracted-out medical treatment. By 2008, it expects private clinics to do 10% of NHS elective surgery. And private contractors will not be confined to elective care. Private companies are already being allowed to poach NHS doctors, nurses, and premises.
In anticipation, one entrepreneur, Ali Parsa, has already raised £100 million to build a chain of 20 private “health campuses” across England.
Where new NHS premises are being built, they are being done on the Private Finance Initiative, which means big money siphoned off to give profits to private contractors.
Our job now is to organise in the unions to make sure that they deliver action to match their leaders’ fiery talk against this destruction of the NHS.
