Fabian Authors on the Tories’ Inability to Understand the NHS

I found the following passage in an old Fabian pamphlet from 1989, Does Society Exist? The Case for Socialism, by Brian Barry. It discusses the psychological reasons why the Tories hate the NHS, and why they are so keen to wreck and burden it by introducing market forces and private enterprise. They simply don’t understand how any public institution, which isn’t run as a private enterprise, works. And they despise the NHS because it is, and does. Barry writes

I can best illustrate what is at stake here by showing the two ides at work in analysing a particular institution – the National Health Service, which I take it to be (in its general principles if not its detailed operation) an exemplary socialist institution in that it replaces profit with service as the rationale of its activities.

No doubt that is enough to make the NHS highly distasteful to Mrs Thatcher and her more ideologically-driven colleagues. But it would be too simple to suppose that the only explanation for the Government’s proposed revamping of the NHS is the desire to destroy a stronghold of values alien to those of the market. A complementary explanation is that the denizens of the think-tanks whose advice the Government listens to really cannot imagine that an organisation can possibly work effectively unless incentives are rigged so that decision makers find it in their interest to do whatever they ought to do. They are so besotted by the rational-choice paradigm in this form that they just deduce from first principles what a health service driven by self-interest would be like and put that forward without feeling any necessity for looking in detail at the strengths and weaknesses of the existing system.

This seems to be precisely the case. The Tories and their think-tanks really don’t understand anything that works outside market forces and the profit motive. We’ve seen that in the various pronouncements they’ve made over the years about how public services run as state industries are inefficient, because they’re not run as private firms. And when Thatcher and Major began to reform the NHS along the lines of private industry by introducing the disastrous internal market, they did so arguing that making the NHS more like a private firm would improve performance and make it more efficient.

In fact none of this is remotely true. The internal market was a disaster, and repealed by New Labour. Blair, however, was a true-Blue Thatcherite, and continued Thatcher’s programme of privatising the NHS piecemeal. But the privatisation of public services has only made them more expensive and inefficient. It’s been estimated that we’re paying 10 to 20 per cent more for our electricity now than we would be if the electricity grid had remained in the hands of the state. The railway network is similarly falling apart. We’re paying far more in subsidies now to the private firms that run the railways than we did when it was British Rail. And the service is worse. The ‘I; reported in its business pages that Grayling was under pressure to renationalise the East Coast line, one of the latest of the train companies to fail. The NHS is failing precisely because the market reforms and privatisation of services introduced by Thatcher, Major, Blair, Cameron and Tweezer eat up the funding for it. Private hospitals and healthcare providers spend less of their money on actual healthcare than the NHS, and more on administration. Quite apart from the fact that the Tories are privatising the Health Service anyway to give it to their friends and donors in private industry.

Thatcherism is a complete failure. The only solution is to get the failed market out of the utility industries and renationalise the NHS, the electricity companies and the railways.

Advertisements

Tags: , , , , , , , , , , , , , , , , , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.


%d bloggers like this: