Basu and Stuckler on the Privatisation of the NHS

Earlier this week I put up a piece about The Body Economic: Why Austerity Kills, by the medical researchers David Stuckler and Sanjay Basu (New York: Basic Books 2013). The book shows, using examples of recessions from the Great Depression of the 20s and 30s, to contemporary Britain and Greece, and the massive privatisation of the Russian economy after the Fall of Communism, how recessions and the austerity programmes that Conservatives use to try and correct them, also cause health crises. Conversely, welfare states that support people, not only give their peoples good health, but also create prosperity.

The two authors are also very much aware that the British National Health Service is being privatised, and are very critical of this. They write

Today the NHS’s founding principles are being forgotten, as the conservative Tory government seeks to make the NHS more like the American profit-driven, market-based system. When the Tory government came to power, they revisited a pamphlet developed under the previous Tory government of John Major that called the NHS a “bureaucratic monster that cannot be tamed” and in need of “radical reform”. In 2004, Oliver Letwin, the pamphlet’s lead author, said the “NHS will not exist” within five years of a Tory election victory. Indeed, after the Tories came to power they proposed the Health and Social Care Act, which embodied the free-market principles of the radical pamphlet.

It was difficult for us to understand this decision. Overall in 2010, before the Tory government began dismantling the NHS, the UK spent less of its GDP on health (8 percent) than Germany (10.5 percent), France (11.2 percent) or the United States (19 percent). Ultimately, the Tories’ position was not based on evidence but ideology-the idea that markets, competition, and profits would always be better than government intervention.

A highly divisive public debate over the Health and Social Care Act ensued. Over staunch opposition from the Royal College of Nursing and almost all of the medical Royal Colleges (the UK equivalents of the American Medical Association), Parliament approved the Act in 2012. Thus began what many regard as a major move towards privatization of the NHS. Repeatedly, David Cameron promised the British public that the Act was not “privatising the NHS” and that he would “cut the deficit not the NHS.” The Liberal-Democratic leader Nick Clegg said, “There will be no privatisation.”

The Department of Health website even stated that “Health Ministers have said they will never privatise the NHS.” But the data tell a different story: increasingly, the government is transferring large swaths of healthcare provision to private contractors.

Private profiteers are replacing dedicated doctors. In October 2012, the government awarded 400 lucrative contracts for NHS services, worth a quarter billion pounds, in what was called “the biggest act of privatisation ever in the NHS.” Virgin, for example, won lucrative contracts to deliver reproductive care (no pun intended). But the result was not the efficiency of private enterprise, but what had already been seen in the US market model-profits at the expense of patients. One journalist found this to be the case at health clinics in Teesside, northeast England. After Virgin won contracts to take over the services, the clinic repeatedly missed targets for screening people for chlamydia. It was a simple task that the NHS fulfilled easily. The journalist found a memo that revealed “staff were asked to take home testing kits to use on friends and family to help make the numbers up.” In Oxford, patients complained about increasing wait times to see their doctors after Virgin took over a local practice. Virgin responded that the practice had been underperforming when it was taken over, and that “there are still improvements to be made but we’re pleased that progress so far was recognised and applauded by councillors.” And so began what continues to be a highly sophisticate public relations campaign.

The UK’s next step toward US-style market-based medicine is moving forward at the time of this writing. It encourages patients to spend out of their pockets for healthcare rather than use the government-funded NHS. The Tory government is extending pilot projects to offer those with chronic illnesses “personal budgets” so that they themselves can make choices about how to manage their care, with few safeguards against profit-seeking swindlers or predatory insurance companies despite a government evaluation that highlighted many problems with this approach.

Early evidence suggests the Health and Social Care Act may in fact be hazardous to the health of the citizens and residents of the United Kingdom. Just before the Coalition government came into power, the NHS had the highest patient approval ratings in its history, over 70 percent. Within two years, approval fell to 58 percent, the largest decline in three decades. There are already warning signs that the healthcare situation in Britain may come to resemble that in the US before Obama. Patients are being turned away from privately managed clinics, some of which simply close their doors after meeting a daily quota to fulfill their contractual obligations. And in the first year of reform, emergency room visits jumped to the highest in the decade- perhaps because more people are neglecting preventive care, like Diane. As the editor of the Lancet warned, “people will die.”

Whether the British people will fully accept this radical privatisation of their healthcare system remains unclear. But once market incentives take hold of a public system, it becomes difficult, if not impossible, to reverse course. In the UK, the recession-fueled combination of austerity-and-privatisation seems to be creeping into every dimension of the social protection system. But evidence of its harms should give us all pause. (pp. 105-7).

Part of the way the government is selling its privatisation of the NHS to the public is through artificial funding crises, in which hospitals develop massive budget deficits. They are then amalgamated with another hospital under a PFI scheme, or given over to a private healthcare company to manage. Points West, the local BBC news programme for the Bristol region, last night revealed that Southmead hospital was also in the red to the tune of £48 million. And I suspect a similar fate is being lined up for it here.

This privatisation must be stopped, and those who support it – the Conservatives, and the Blairites in New Labour, must be thrown out of office immediately. Only Jeremy Corbyn has said that he will reverse the NHS privatisation. It is up to us to support him, regardless of the smears from the media and the Right.

Jimmy Carter on the Corporate Corruption of Regulatory Authorities

I found this very pertinent piece from former US president, Jimmy Carter, in the collection of pieces by Hunter S. Thompson, The Great Shark Hunt (London: Picador 1980). It’s in Carter’s 1974 Law Day address to the students at Georgia University.

We had an ethics bill in the state legislature this year. Half of it passed – to require an accounting for contributions during a campaign – but the part that applied to people after the campaign failed. We couldn’t get through a requirement for revelation of payments or gifts to office-holders after they are in office.

The largest force against that ethics bill was the lawyers.

Some of you here tried to help get a consumer protection package passed without success.

The regulatory agencies in Washington are made up, not of people to regulate industries, but of representatives of the industries that are regulated. Is that fair and right and equitable? I don’t think so.

I’m only going to serve four years as governor, as you know. I think that’s enough. I enjoy it, but I think I’ve done all I can in the Governor’s office. I see the lobbyists in the State Capitol filling the halls on occasions. Good people, competent people, the most pleasant, personable, extroverted citizens of Georgia. those are the characteristics that are required for a lobbyist. They represent good folks. But I tell you that when a lobbyist goes to represent the Peanut Warehouseman’s Association of the Southeast, which I belong to, which I helped organise, they go there to represent the peanut warehouseman. They don’t go there to represent the customers of the peanut warehouseman.

When the State Chamber of Commerce lobbyists go there, they go there to represent the businessmen of Georgia. They don’t go there to represent the customers of the businessmen of Georgia.

When your own organisation is interested in some legislation there in the Capitol, they’re interested in the welfare or prerogatives or authority of the lawyers. They are not there to represent in any sort of exclusive way the client of the lawyers.

The American Medical Association and its Georgia equivalent – they represent the doctors, who are fine people. But they certainly don’t represent the patients of a doctor.

Obviously, there are some differences between the situation Carter and Thompson describe. I think we do have legislation in this country, which requires gifts to ministers and civil servants to be declared. And some of the most determined opposition to the Tories’ campaign to privatise the NHS has come from the ranks of the British Medical Association.

But the substance of what Carter said is as true today as it was when Carter said it. If you read Private Eye in the 1990s, you saw fortnight after fortnight yet more news of someone from one of the industries getting a job in the body that was set up to regulate it. And it’s gone on. Private Eye are still running stories about banks and the leading accountancy firms, who were most notorious at dodging tax sending senior staff to act as interns or advisors to the Inland Revenue and the financial regulatory authorities. Or else a former managing director or chairman of the board from one these industries him- or herself gets a place there.

As for the lobbyists, Mike over at Vox Political the other year ran many pieces describing the Tory act that was supposed to limit their influence. Except it didn’t. What it did instead was try to cut out the influence of smaller, grass roots activist groups campaigning against some injustice or piece of misgovernment, and try to limit the ability of trade unions to campaign against particular issues. The lobbyists themselves were left largely untouched. As you can expect from a government, whose annual conferences are paid for by the big corporations, and which is headed by a PR spin merchant: David Cameron himself.

Carter was right to attack the corruption of the regulatory bodies by the very corporations they were meant to be overseeing, and his remarks on the pernicious influence of the lobbyists is still very timely. It’s time to clean up politics, and get rid of them and the Tories.

Roy Porter on Rising Cost of American Medicine

The historian of medicine, Roy Porter, devotes a couple of pages to the development of medicine in America in his book Blood and Guts: A Short History of medicine. He notes that the development of private medical insurance and the fees-for-service system in America caused medicine to become a highly developed and lucrative industry. Competition was at the heart of this system, with doctors and hospitals competing to offer better medical service, such as better tests, a fuller range of elective surgery, more check-ups and so on. However, the costs of these procedures became correspondingly expensive, so that President Truman in 1948 mooted a national health service for America. This came to nothing, however, as the American Medical Association campaigned against it.

Part of the American system of private health care are the HMOs, the Health Maintenance Organisations, which began with the Kaiser Foundation Health Plan in California. These arose as a cheaper alternative to ordinary medical insurance like Blue Cross. Porter states that health costs have continued to rise, not just in terms of medical personnel and equipment itself, but also in the growth of hospital bureaucracy, administrative and marketing teams – including corporate finance, lawyers, medical insurers, public relations firms and accountants. He states ‘Expenditure has continued to rise, quite disproportionately to measurable improvements in health.’ (p. 167). The result is that by 2000 40 million Americans had no medical insurance. That’s almost one in six people under the age of 65.

This is the system that Cameron, Clegg and Farage wish to import over here. Meanwhile in America, Conservatives are attacking the soaring costs of medicare and Medicaid, introduced by Lyndon B. Johnson to allow the state to pay for the medical care of the poor and elderly, who couldn’t afford it.

There are 92 Tories and Lib Dems, who have links and positions on the private health companies waiting to profit from the Tories’ privatisation of the NHS. Andrew Lansley, the current health minister, is a supporter of the privatisation of the health service.

If they win, and get another term, we will not see the NHS survive. The poor will be deprived medicine, but the Tory, Lib Dems and Kippers will profit immensely.

We mustn’t let them.