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Tuesday, 20 March 2012

The Frightening Reason Why We Shouldn’t Mourn the NHS

So, finally we bid goodbye to the NHS. 64 years of the world’s most progressive and egalitarian healthcare comes to an end. Public anger has been directed squarely at the Liberal Democrats, the Conservatives benefitting from a “we expect this from you” sort of attitude. This though begs a larger question, if we expect the rape of our most important public assets from the party who won most seats in the last General Election, just how did they win most seats in the last General Election? Many political commentators have already had their say on this one, “the country was tired of Labour” they utter between sips of brandy in the Commons bar, “With wars, expenses scandals and cronyism, it was time for a change”. This breathtakingly lazy journalism, while not technically incorrect it is irresponsibly incomplete especially since their competitors were just as guilty of these transgressions.

People are not just weary of Labour (although they are weary of Labour), they are weary of politics and politicians. The 2010 general election saw the first hung Parliament in the UK since 1974, but with a couple of crucial differences. In 1974 there was a turnout of almost 80%, by 2010 this had fallen to just over 65%. Additionally, there has been the stampede for the right among the main stream parties which seen them gradually merge in ideological terms. The most likely reasons for this can be found in the privatisation programmes of the 1980’s which let those who would place profit above all else break free of their leash. These companies are natural benefactors to the conservative party, donating money in the hope for further favourable reform and to prevent the other parties taking away all that they had already won. Political parties need funding to get elected, and the best prospect of increasing funding is through donations. Indeed, it has been estimated that the Conservative party is able to raise ten times as much as its nearest competitor. Labour in particular have had to look for other sources of revenue to compete, and not too many rich individuals or corporations want to donate to you if it states in your party rules that you are going to increase their income tax or nationalise their business at the first opportunity.

Regardless of the stance of the incumbent government, in past decades the effective privatisation of the NHS - the crown jewel of the world’s most progressive welfare state - would have been unthinkable. Why? Because fresh in people’s minds was the exploitation that occurred the last time political and economic power was concentrated in the hands of the wealthy. Times change and memories fade, eventually it becomes politically tenable to suggest that greed is good once more. Enough years have passed in the UK for society to forget the squalor and misery that the greed of a few had caused during the 19th and early 20th century. Already, we debate the costs of vaccines and medicines without giving thought to the fact that a lack of these once meant that 140 babies per 1000 born used to die at birth, the NHS era has helped this figure to fall to just 5.8 per 1000 babies born.  We now overlook the fact that the NHS era has seen life expectancy for both men and women increase by 75%. Your mind will no doubt be leaping to Andy Burnham’s recent speech by now and clinging to his promise to repeal the changes that the government have made. Sorry, that is not what he said. He actually said that he will repeal as many of the changes as he can without having to go through another costly reorganisation of the NHS. Subtly different perhaps, but politicians do subtle very well. Do you remember Cameron’s promise of no more top down reorganisation of the NHS? Or his pledge to cut the deficit not the NHS? (OK, actually that second one just looks like a lie).What Andy Burnham said is Political short hand for “Actually I’m glad the Tories and the Lib Dems are going to take the fall on this one, for my part I shall do my best to look heroic without ever promising to do anything different”. And nothing different he will do, since by the time of the next election the Labour party will be trying to cultivate the donations of the new breed of firms growing quickly in the health sector.

The Health and Social Care Bill is a document the size of a telephone directory and consequently it is difficult to predict the exact shape of what is to come now that the Bill is to become law. The model the government will probably use is to provide some sort of poor patient premium to make sure patients in disadvantaged areas get the same level of care as their more affluent counter-parts. This will mean that the very well paid will have access to excellent healthcare (since they pay their own premium), and the very poor will have access to healthcare (since the taxpayer will pay their premium) but the larger number in the middle will have to make do with the second rate services that are left (since they will be no-ones priority) or scrape together the money to go private? Over time the number of people eligible for assistance will fall (just like legal aid did), as will the number of services available to people free of charge (just like the post offices and the trains). At every stage health companies will scream for greater subsidies since they cannot afford to keep providing treatments for free with the rising costs of drugs and medical procedures. As a result taxes will have to increase as someone has to pay for all of this, and the only real differences from how the system works now will be the lower standards of care available to the vast majority, and the huge sums of money leaving in profits.
Still, if you didn’t see this coming, don’t worry. Don’t lambast yourself if you voted Liberal Democrat or even conservative, it wasn’t your fault. Labour would have done the same as the coalition has in almost every area (compare their manifestoes if you have any doubts) and so had they retained their mandate Labour voters would be feeling just as bad right now. Just look at Labour’s proposed amendments to the ‘Workfair’ scheme: “guaranteed job, but no benefits if you don’t take it” just how is this materially different to what their rivals proposed? This then is why we shouldn’t mourn the NHS. Undoubtedly the changes will lead to the rich getting richer and everyone else getting less. Undoubtedly they will lead to many instances of poorer care, of death or incapacity. But the simple fact is that the changes to the NHS have only been possible because there is no credible practical alternative in our political system. In short, these changes have only been possible because democracy itself has already been privatised!