Don’t Let Theresa May Privatise the NHS

This is the text of one of the self-published, table-top produced pamphlets I created a few years ago, and which are advertised on one of the other pages of this blog.

As you can see, it was written a year or so ago when David Cameron was in power. Nevertheless, it is still as valid now as it was then. Theresa May has not changed the Tory policy of privatising the NHS one whit.

So, please, read this article, and then vote for Jeremy Corbyn to preserve this most precious of British institutions.

Don’t Let Cameron Privatise the NHS
David Sivier

Visiting our local health centre the other day, my parents, along with the other local people enrolled there, were handed a letter, explaining that due to funding cuts the health centre was having to cut back on services. It also advised its patients that if they wanted to raise their concerns about the restriction in their service they could contact:-

1. NHS England at FAO Linda Prosser, Director of Assurance and Delivery, NHS England South West (BNSSG), 4th floor Plaza, Marlborough Street, Bristol BS1 3NX
2. your local MP at the House of Commons, Westminster, London SW1A 0AA

Unfortunately, this is happening to the NHS and GPs’ services all over the country. It is no accident, and it is certainly not the fault of the many dedicated doctors, nurses and other health professionals working in the NHS.
It is the result of over 30 years of privatisation begun with Margaret Thatcher. Thatcher and her former Chancellor, Nigel Lawson, denied that they wanted to privatise the NHS. They merely stated that they wanted to include more private provision in the NHS. This is a lie. Released cabinet minutes showed that Thatcher and Geoffrey Howe wanted to privatise the NHS along with abolishing the rest of the welfare state. They were only prevented from doing so because the rest of the cabinet realised that this would be the death knell for the Tory party. And a fact-finding mission to the US to see how their private healthcare system worked by Patrick Jenkin showed that it was massively inefficient.

Nevertheless, the amount of private healthcare in the NHS was expanded, and state provision duly cut by successive governments. It was Maggie’s government in 1989 that ended the state support for care for the elderly in nursing homes. As a result, the families of those, who need this kind of care, are forced to fund it themselves, often through selling or remortgaging their homes because of the immense expense. It was also Maggie’s government that ended free eye tests, and picked a feud with the doctors that saw the majority of them leave the NHS.

This privatisation has continued under Tony Blair, Gordon Brown and now David Cameron and Jeremy Hunt. Blair and Brown were deeply impressed with American private healthcare firms such as Kaiser Permanente, and wished to reform the NHS on their model. The ultimate intention was to replace the publicly owned and operated NHS with private healthcare funded by the state, but administered by private health insurance companies. As a result, NHS work has been given to private hospitals and clinics, and private healthcare companies have been given NHS hospitals to manage. Alan Milburn, Blair’s health secretary, wanted the NHS to become merely a kitemark – an advertising logo – on a system of private healthcare companies funded by the government.

This has been carried on the current Conservative government. And they have used the same tactics Margaret Thatcher did to force private healthcare on this nation. The dispute with the doctors over contracts a few years ago was part of this. It has left the majority of NHS GPs wishing to leave. Yet elements within the Conservative networks responsible for foisting these demands have seen this as an opportunity for forcing through further privatisation. Penny Dash, of the National Leadership Network, and one of those responsible for the NHS privatisation, has looked forward to the remaining GPs forming private healthcare companies. Furthermore, an report on the Care Commissioning Groups now in charge of arranging healthcare in the NHS by one of the private healthcare companies also suggested that they could form private healthcare companies, and float shares on the stockmarket.

Further privatisation has come with Andrew Lansley’s Health and Social Care bill of 2012. This exempts the state and the Secretary of State for Health from their statutory duty, as the ultimate leaders of the NHS, to provide state health care. It is carefully worded to disguise its true meaning, but that is what has been intended by the bill. Dr David Owen, one of the founders of the SDP, now part of the Lib Dems, has tabled amendments trying to reverse this despicable bill. He and many others have also written books on the privatisation of the NHS. One of the best of these is NHS SOS, by Jacky Davis and Raymond Tallis, published by Oneworld.
This process cannot be allowed to continue, and I strongly urge everyone to resist the creeping privatisation of the NHS, Britain’s greatest public institution.

In the last government, there were 92 Conservative and Lib Dem ministers, who advocated the privatisation of the Health Service, and who stood personally to gain from it. They included Iain Duncan Smith, the minister for culling the poor, the sick and the old. Andrew Lansley, the health minister, openly stated he is in favour of privatising it. So has Nigel Farage, and the Unterkippergruppenfuhrer, Paul Nuttall.

Farage in particular follows the Tory policy going all the way back to Thatcher of promising to defend it while secretly plotting how to sell it off. Thatcher ‘s review into the NHS and its funding in the 1980s. so alarmed Labour’s Robin Cook, that he wrote a Fabian pamphlet, Life Begins at 40: In Defence of the NHS, attacking possible proposals to privatise the Health Service.

Previous reviews had given the NHS a clean bill of health. The extremely high quality of the NHS and its doctors was recognised by the heads of American healthcare firms: Dr Marvin Goldberg, chief executive of the AMI health group, told a parliamentary select committee that the Health Service Provides ‘outstanding health care and British NHS hospitals are at least as good as those in America while British doctors are better.’

The then Conservative MP for Newbury, Michael McNair-Wilson, also testified to the effectiveness of the NHS. He had suffered kidney failure. He had private health insurance, but it did not cover operations such as the one he needed because of the expense. He said ‘I have cost the NHS tens of thousands of pounds – much more than I could have afforded privately … Had my treatment depended on my ability to pay, I would not be alive today.’

Pre-NHS Britain: Some Areas Completely Without Hospitals

Cook’s pamphlet also graphically described the patchwork state of healthcare in Britain before the NHS. In London, where there were plenty of paying customers, there could be hospitals in neighbouring streets. Out in the poorer British provinces, there were hardly any, and many operations were carried out not by surgeons but by GPs. He cites Julian Tudor Hart’s book, A New Kind of Doctor, to show how bad this could be. Hart described how he joined one of those practices in Kettering. One patient was left under anaesthetic as the London specialist operating on him was called away to continue a stomach operation on a London patient, which the operating GP had been unable to complete.
Cook was deeply concerned that the Tories’ review would not be at all interested in improving quality, only in opening up the NHS to the market and privatisation.

Cook on Private Health Insurance

One of the issues he tackled in the pamphlet was the possibility of the introduction of private health insurance. This covers two pages and a column and a bit in the original pamphlet. This is what he wrote, though emphases and paragraph titles are mine.

The mechanism proposed to square the incompatibility of health care with the market is insurance. All market approaches to the NHS submitted to the Review stress the case for much wider private insurance and almost as frequently propose subsidies to boost it.

Insurance-Based Systems Encourage Expensive Treatment

The first thing to be said is that private insurance does not offer
to health care the alleged benefits of the discipline of the market place. At the point when the individual requires treatment he or she has already paid the premiums and has no incentive not to consume as expensive a treatment as can be reconciled with the policy. The position of the doctor is even more prejudiced in that he or she has every incentive to obtain as much as possible from the insurance company by recommending the most expensive treatment. Both patient and the doctor are in a conspiracy to make the consultation as costly as possible, which is a perverse outcome for a proposal frequently floated by those who claim to be concerned about cost control.

Insurance-Based Systems Encourage Unnecessary Surgery

The compulsion in an insurance-based system to maximise the rate of return is the simple explanation why intervention surgery is so much more often recommended in the United States. For example, the incidence of hysterectomy there is four times the British rate. This is unlikely to reflect higher morbidity rates but much more likely to reflect the greater willingness of doctors on a piece-work basis to recommend it, despite the operative risks and in the case of this particular operation the documented psychological trauma. I can guarantee that an expansion of private insurance will certainly meet the objective on increasing expenditure on health care, but it is not equally clear that the money will be spent effectively.

Insurance-Based Systems Require Expensive bureaucracy to Check Costs

One direct diversion of resources imposed by any insurance-based scheme is the necessity for accountants and clerks and lawyers to assess costs and process claims. The NHS is routinely accused of excessive bureaucracy, frequently I regret to say by the very people who work within it and are in a position to know it is not true. Expenditure in the NHS is lower as a proportion of budget than the health system of any other nation, lower as a proportion of turnover
than the private health sector within Britain, and come to that, lower than the management costs of just about any other major enterprise inside or outside the public sector. I am not myself sure that this is a feature of which we should be proud. ON the contrary it is evidence of a persistent undermanaging of the NHS, which is largely responsible for its failure to exploit new developments in communication, cost control and personnel relations. Nevertheless, there is no more pointless expansion of administrative costs than the dead-weight of those required to police and process and insurance-based system. These costs would be considerable.

Forty per cent of personal bankruptcies in the US are attributable to debts for medical care

Part of this additional cost burden is incurred in the task of hunting down bad debts, which does not contribute in any way to the provision of health care. Forty per cent of personal bankruptcies in the US are attributable to debts for medical care, a salutary reminder of the limitations set to insurance cover. These limitations have three dimensions.

Insurance Cover Excludes Chronic and Long-Term Sick, and the Elderly

First, insurance cover generally excludes those conditions which are chronic and therefore expensive or complicated and therefore expensive. Standard exclusions in British insurance policies are arthritis, renal dialysis, multiple sclerosis or muscular dystrophy. Most people do not require substantial medical care until after retirement. Most insurance cover excludes the very conditions for which they are then most likely to require treatment. Short of retirement, the most expensive health care required by the majority of the population is maternity care, which is also excluded by the majority of insurance policies.

Private Healthcare Limits Amount of Care due to Cost, not Need

Secondly, insurance cover is generally restricted by upper limits which are arbitrary in every sense other than financial. I recently met a psychiatric consultant to a private clinic, who was prepared to discuss candidly the ethical dilemmas of treating patients whose financial cover is fixed at five weeks of residential care, but whose response to treatment may indicate that a longer period of hospitalisation is desirable.

Private Health Care Geared to Selling to Healthy not Sick

Thirdly, insurance cover is further limited by exclusion of those most likely to claim on it. I am often struck at the sheer healthiness of the patients who illustrate the promotional literature of BUPA and PPP who appear in such pink of good cheer and fitness that it is difficult to figure out why they are in a hospital bed. These models are though in a sense most suitable for the purpose as the objective of insurance companies is to attract the healthy. They therefore claim the right to screen for the unhealthy and reject them from cover. This discriminatory approach was defended earlier this month by the managing director of WPA, Britain’s third biggest health insurer, on the principled grounds that it meant ‘essentially healthy people are not penalised by unhealthy people.’ This statement has the advantage of originality in that it perceives healthy people as the vulnerable group and proposes a market remedy that protects them from the inconvenient costs of the unhealthy.
Given this limited character of health insurance in Britain, the private sector is patently not in a position to substitute for the NHS and to be fair most directors of BUPA or PPP would be horrified at the notion of accepting the comprehensive, open-ended liabilities of the NHS. It is therefore perplexing that so much effort in and around the Review appears to be addressed to the issue of how the private sector may be expanded rather than how the public sector may be improved. Two major devices are being canvassed to boost private cover-tax relief on private cover or opt-out from public cover, or for all I know both of them together. Both would be a major mistake.

Tax Relief on Private Healthcare

Tax relief is open to the obvious objection that it targets help most on those who need it least – the healthy who are most likely to be accepted for private cover and the wealthy whose higher tax rates make relief most vulnerable. These are curious priorities for additional health expenditure.

Tax Relief Does Not Create Higher Spending on Health Care

Moreover, even in its own terms of stimulating higher spending on health, tax relief is likely to prove an ineffective mechanism. If for example the average premium is £200 pa the cost of tax relief for 6 million insured persons will be £300 million. The numbers under insurance need to increase by a third before the increased spending on premiums matches the cost of the subsidy and provides any net increase in health spending. Up to that point it will always produce a larger rise in health spending to increase the budget of the NHS by a sum equivalent to the cost of tax relief.

It is apparently being mooted that these objections could be circumvented by limiting the tax relief to the elderly. At this point the proposal moves from the perverse to the eccentric. This restriction targets help for private insurance on the very group for whom private cover is most inappropriate as their most likely health needs are the ones most likely to be excluded from cover. Only a moment’s reflection is required on the multiple ways in which we need to expand our health provision for the elderly to expose the hopeless irrelevance of tax relief as the solution for them.

Opt-Out Penalises those who Remain in the System

Opt-out is even more objectionable. The basic problem with opt-out is that it requires the payment towards the NHS of every individual to be expressed in a manner that gives him or her something to opt-out from. The principal attraction to Leon Brittan of his proposal for an NHS insurance contribution appeared to be precisely that it paved the way for opting out (A New Deal for Health Care, Conservative Political Centre,, 1988). Nor is this inconvenience confined to the need for a whole new element in the tax system. If one in ten of the population chose to opt out, it would be remaining nine out of ten who would have to prove they were not opted-out when they went along to seek treatment. With the new contributions comes a requirement to maintain a record of payment of them, and presumably a mechanism for credits to those not in work but who do not wish to be counted has having opted out of the NHS.

Private Healthcare Undermine NHS as Universal System

The more fundamental objection both these proposals is they explicitly threaten the NHS as universal health service catering for everyone. Moreover, they threaten its universality in the worst possible way, by encouraging those with higher incomes and lower health needs to get out, leaving behind the less affluent and the less fit. In this respect such an approach to the NHS would be a piece with the Government’s strategy of erosion towards the rest of the social services-housing, pensions, and now education, where the Government has encouraged those who could afford it to opt-out of public provision, leaving behind the poor who could be expected to put6 up with a poor service.

This is the reality of the private healthcare system which Cameron, Clegg, Farage and the rest of the Right wish to introduce. It is expensive, bureaucratic, does not stimulating further spending, and excludes those with the most acute and expensive medical need, especially the elderly.
And the Tories and their counterparts in UKIP and the Lib Dems know it. Why else would the Tories spend their time trying to deny what they’re doing? Why does Farage appear to be advocating retaining the NHS, while arguing for an insurance based system, like America? It’s because they know that private medicine does not provide the solutions they claim. It is only source of further enrichment to them and their corporate donors.

And since Cook wrote that pamphlet, more than 20 per cent of all Americans can no longer afford their healthcare. It’s why the firms are trying to get their feet under the table over here. Don’t let them. Ed Miliband and now Jeremy Corbyn have promised to reverse the privatisation of the NHS. Please support them.

Hope Not Hate on the Disgusting Views of Kipper Lee Harris

As Britain tries to come to turns with the assassination of Jo Cox by a committed, Nazi, Lee Harris, the Kipper candidate for Shotton and South Hefton in the council elections last year, abandoned any attempt at maintaining a tactful silence. While expressing his own disgust at Cox’s murder, Harris posted on social media a strongly worded condemnation of everything Jo Cox stood for. He wrote on social media

Let us not forget that it is cultural Marxist, PC, Europhilic MPs like her we have to thank for the sorry state this nation is in.

Her ideology was cancerous to this nation, and now her comrades shamelessly milk her death in a desperate attempt to shame us into staying in a corporatist dictatorship.

I’m sure some will be offended by this post, and those who are, I know will be the virtue signalling SJW [Social Justice Warriors] that are milking her death in a last ditch attempt at shaming us into staying in the EU.

See: http://www.hopenothate.org.uk/ukip/ukip-continue-their-overbearing-sensitivity-4925

This is pretty much typical of some of the verbiage and jargon coming from the extreme Right. Anti-racist activists and those on the genuine Left are attacked as ‘Social Justice Warriors’ and ‘cultural Marxists’. Right-wingers like Harris think that ‘cultural Marxism’ means the Frankfurt school and the tactics formulated by the Italian Communist, Antonia Gramsci, of attempting to change the nature of European and American capitalist society by attacking its culture. It isn’t. ‘Cultural Marxism’ was the term coined by British Marxists when Maggie Thatcher passed a law purging them from teaching in Higher Education. They got round this by making the fine distinction that they weren’t ‘Marxist’, but ‘Marxian’ – that is, they were Marxists by culture, not politics. It’s a very tenuous distinction, but it did manage to allow them to keep their jobs.

As for being called a ‘Social Justice Warrior’, while it is a term of contempt, the fact is that since that social justice – anti-racism, anti-sexism and attitudes to combat poverty and improve the circumstances of the working class, disabled and unemployed, are still under threat. There have been enormous strides made since the 1970s in tacking racism and sexism, but these are still extremely powerful issues where discrimination is very much present. As shown by the fact that Harris and many of the Brexiters haven’t been able to reconcile themselves to the fact that Cox was murdered by someone with a very long commitment to the Nazi Right.

Harris himself has a particular hatred of the Labour party. Hope Not Hate a few piccies of election pamphlets in the above article, in which he promises ‘to continue the failings of the Labour Party. It has let our communities down for too long!’ He also says, ‘Labour once stood for the working class, defending our way of life, defending our jobs, but now all they care about is pandering to big donors and big business. They are the party that started to privatise the NHS after all’.

This is a fair description of the greed and neoliberal economic policies at the heart of Blairite ‘New Labour’, but it doesn’t represent either Ed Miliband or the party’s new leadership under Jeremy Corbyn. As for the EU being a ‘corporatist dictatorship’, there’s a reasonable point mixed in with a gross lie. I’ve put up material discussing the massive power the EU constitution does give to corporations, and there are indeed several points in European commercial law that strongly protect and promote neoliberal economics. However, the EU is not a dictatorship, and it is a gross distortion to say that it is. This line seems to come from the old Eurosceptic idea that the EU is merely Napoleon’s Empire or Adolf Hitler’s Nazi-dominated Europe resurrected and marketed to Europe’s peoples in a more palatable form. It isn’t. It was set up by European statesmen, including Winston Churchill, after the War in the hope that by promoting European unity, such extreme nationalist movements and the drive by individual countries to conquer and dominate the country would be successfully combated. I don’t think it’s been entirely successful. Unfortunately, EU policy does represent too much the interest of the big EU nations, like France and Germany, at the expense of the smaller nations. But I do think that it has done much to promote international peace and reconciliation after the War, and so has done much to calm international tension, even if it has not succeeded in altogether eradicating it.

As for Harris’ comments about the Labour – if Harris was serious about them from a left-wing perspective, he could have joined a number of alternative Socialist groups and organisations. Buddy Hell, over at Guy Debord’s Cat, was so disillusioned with the Blairite takeover the Labour party that he joined Left Unity, if I recall correctly. I think one of the small, alternative Socialist parties was formed from all the trade unionists and Labour party members, who were thrown out of the Labour party because they did not back Bliar and Broon’s austerity campaigns.

But Harris hasn’t done that. Instead he’s moved to the Right, and shown how he despises much of the ideology of the Left with his attacks on ‘social justice warriors’. If you look through many of the classic statements of Socialism, several of them make the point that Socialists champion the working class in order to bring about a classless society, and as part of a general campaign to establish greater social equality. Marx, Engels and the early Fabians had some vile attitudes to what they considered to be less developed, backward nations, but as early as the 1920s the Labour party adopted a policy of granting the colonies their independence at the earliest possibility. Even when they were committed to the British Empire, such as in the book Empire, Your Empire, published by the Left Book club, they were critical of the way Britain’s imperial possessions around the world were being exploited. The author of that book wanted these countries developed, but in the interest of their indigenous peoples. As indeed did the veteran Socialist thinker and writer, G.D.H. Cole.

As for Labour privatising the health service, unfortunately, much of this was done by Bliar and Broon. But they were following policies established in the 1980s by Maggie Thatcher. Thatcher and Geoffrey Howe had looked at ways of abolishing the NHS and replacing it with a private medical service such as that in America. They didn’t, because they knew that it would lose them the next election. Also, Patrick Jenkin, the Health Secretary, reported just how awful American medical care was after he went on a fact-finding mission to the US. Nevertheless, she wanted more private medical care in and outside the NHS, including tax relief for people with private medical insurance. She also introduced further charges for hitherto free medical treatments in the NHS. One of these was eye tests at opticians. She stopped that, and then had one of her cabinet ‘vegetables’ try to con the nation into believing that after charges had been introduced, demand had actually gone up. It was Thatcher, who removed compulsory state funding for the elderly in nursing homes, with the result that many people now have to mortgage or sell their elderly relatives’ houses to pay for the tens of thousands of pounds it costs a year to keep them in such homes. She also picked a fight with the dentists, so that the majority left the NHS. And then Peter ‘I’ve got a little list’ Lilley introduced the Private Finance Initiative specifically as a way for big business to make money out of the health service under John Major. Bliar and Broon expanded this cruddy system, but they didn’t invent it.

Despite appealing to working constituents, Harris is, like the Kipper leadership, a Tory. He wants to capitalise on many people’s genuine disaffection from the Labour party due to neoliberal leadership of the Blairites. But he himself is very much a man of the right, and his stance is shown by the fact that he is not concerned with defending the NHS from its privatisation by Cameron and the Lib Dems. This has been going on for over half a decade now. Even last year he could not plead ignorance of it, not if he was serious about defending the NHS or his constituents against austerity and the cuts.