Posts Tagged ‘Private Healthcare’

Fabian Blueprint for a Socialist Britain

June 11, 2020

Sidney and Beatrice Webb, with an introduction by Samuel H. Beer, A Constitution for the Socialist Commonwealth of Great Britain (Cambridge: London School of Economics/ Cambridge University Press 1975).

I got this through the post yesterday, having ordered it a month or so ago. The Webbs were two of the founding members of the Fabian Society, the others including George Bernard Shaw and H.G. Wells. The idea of the NHS goes back to their minority report on the nation’s health published in the years before or round about the First World War. First published in 1920, this is their proposal for a socialist Britain.

The blurb for it on the front flap runs

The Constitution for a Socialist Commonwealth is a book that helps us understand the ‘mind of the Webbs’. Of all their works, it is the most general in scope – Beatrice called it a ‘summing up’ – and it does much to reveal the ideology of the great partnership. And since the mind of the Webbs was also the mind (though not the heart) of British socialism, an appreciation of this ideology, considered not only with regard to its confusions and blinds spots, but also its insights and intellectual sensitivities, helps one understand the Labour Party and what is still sometimes called ‘the Movement’.

But the book also has a broader importance. The problems that prompted the Webbs to write it still plague Great Britain and other, advanced societies. In 1920, the year of its publication, the modern democratic state was being sharply confronted by a syndicalist challenge based on the rising economic power of organised producers’ groups. Hardly less serious were the political difficulties of giving substance to parliamentary and popular control int eh face of growing bureaucratisation and a mass electorate. With regard to both sorts of problems, the Webbs were often prescient in their perceptions and sensible in their proposals. They concentrate on economic and political problems that are still only imperfectly understood by students of society and have by no means been mastered by the institutions of the welfare state and managed economy.

After Beer’s introduction, the book has the following chapters, which deal with the topics below.

Introduction

The Dictatorship of the Capitalist – The Manifold Character of Democracy.

The book is split into two sections. Part 1, ‘A Survey of the Ground’, contains

Chapter 1 – Democracies of Consumers

Voluntary Democracies of Consumers – Obligatory Associations of Consumers – The Relative Advantages of Voluntary and Obligatory Associations of Consumers – The Economic and Social Functions of Associations of Consumers.

Chapter 2 – Democracies of Producers

The Trade Union Movement – Professional Associations of Brain Workers – The Relative Advantages and Disadvantages of Obligatory and Voluntary Associations of Producers – The Economic and Social Functions of Associations of Producers: (i) Trade Unions; (ii) Professional Associations.

Chapter 3 – Political Democracy

The Structure of British Political Democracy: (a) the King; (b) the House of Lords; (c) the House of Commons and the Cabinet – Cabinet Dictatorship – Hypertrophy – A Vicious Mixture of Functions – the Task of the M.P. – the Failure of the Elector – The Warping of Political Democracy by a Capitalist Environment – Political Parties – The Labour Party – The Success of Political Democracy in general, and of British democracy in particular – The Need for Constitutional Reform.

Part II, ‘The Cooperative Commonwealth of Tomorrow’, begins with another introduction, and then the following chapters.

1 – The National Government

The King – the House of Lords – The National Parliament – the Political Parliament and its Executive – the Social Parliament and its Executive – the Relation between the Political and the Social Parliaments – Devolution as an Alternative Scheme of Reform – The Argument summarised – the Political Complex – The Social Complex – The Protection of the Individual against the Government.

2 – Some Leading Considerations in the Socialisation of Industries and Services

Three Separate Aspects of Economic Man – The Relative Functions of Democracies of Consumers and Democracies of Producers – Democracies of Citizen-Consumers – Democracies of Producers – ownership and Direction – The Participation in Management by the Producers.

3 – The Nationalised Industries and Services

The Abandonment of Ministerial Responsibility – The Differentiation of Control from Administration – The Administrative Machine – District Councils – Works Committees – the Recruitment of the Staff – Discipline Boards – Collective Bargaining – Advisory Committees – The Sphere of the Social Parliament – How the Administration will work – Initiative and Publicity – The Transformation of Authority – Coordinated instead of Chaotic Complexity – The Price of Liberty.

4 – The Reorganisation of Local Government

The Decay of Civic Patriotism – The Chaos in the Constitution and Powers of existing Local Authorities – Areas – The Inefficiency of the ‘Great Unpaid’ – The Principles on which Reconstruction should proceed – The Principle of Neighbourhood – The principle of Differentiation of Neighbourhoods – The principle of Direct Election – The Principle of the General Representatives – The Correspondence of Area and Functions – The Local Government of Tomorrow – The Representation of the Citizen-Consumer – The Local Councillor – Vocational Representation – Committees of Management – Machinery for Collective Bargaining – The Practicability of Vocational Self-Government in Municipal Government – The Industries and Services of Local Authorities – Emulation among Local Authorities – The Federation of Local Authorities – The Relation of Municipal Institutions to the Social and Political Parliaments.

5 – the Sphere of Voluntary Associations of Consumers in the Socialist Commonwealth

The Co-operative Movement – The Limitations of the Cooperative Movement – Constitutional Changes in the Cooperative Movement – Other Voluntary Associations of Consumers – Adult Education – The Future of the Country House – The Extension of Personality – The Problem of the Press – The Safeguarding of the Public Interest.

6 – The Reorganisation of the Vocational World

The Trade Union Movemewnt as the Organ of Revolt against the Capitalist System – The Right of Self-Determination for each Vocation – What Constitutes a Vocation – The Right of Free Enterprise for Socialised Administrations – Vocational Organisation as a Stratified Democracy; (a) How will each Vocation be recruited? (d) The Relative Position of Obligatory and Voluntary Organisation in a Vocation; (e) The Function of Vocational Organisation; (f) Subject Associations; (g) The Development of Professional Ethic; (h) Vocational Administration of Industries and Services; (i) Is there any Place for a National Assembly of Vocational Representatives?

7 – The Transitional Control of Profit-Making Enterprise

The Policy of the National Minimum – The Promotion of Efficiency and the Prevention of Extortion – The Standing Committee on Productivity – The Fixing of Prices – The Method of Expropriation – Taxation – The Relation of Prices to the National Revenue – The continuous Increase in a Socialist Commonwealth of Private Property in Individual Ownership – How Capital will be provided – The Transition and its Dangers- The Spirit of Service – The Need for Knowledge.

I’ve been interested in reading it for a little while, but finally decided to order it after reading in Shaw’s The Intelligent Woman’s Guide to Socialism, Capitalism, Sovietism and Fascism that the Webb’s included an industrial parliament in their proposed constitution. I’d advocated something similar in a pamphlet I’d produced arguing that parliament was dominated by millionaires and managing directors – over 70 per cent of MPs have company directorships – working people should have their own parliamentary chamber.

The book is a century old, and doubtless very dated. It was republished in the 1970s during that decades’ acute trade union unrest and popular dissatisfaction with the corporative system of the management of the economy by the government, private industry and the trade unions. These problems were all supposed to have been swept away with the new, private-enterprise, free market economy introduced by Maggie Thatcher. But the problem of poverty has become more acute. The privatisation of gas, electricity and water has not produced the benefits and investment the Tories believed. In fact electricity bills would be cheaper if they’d remained in state hands. Ditto for the railways. And the continuing privatisation of the NHS is slowly destroying it for the sake of expensive, insurance-financed private medical care that will be disastrous for ordinary working people.

And the growing poverty through stagnant wages and welfare cuts, seen in the growth of food banks, is also partly due to the destruction of trade union power and the exclusion of working people from the management of their companies and industries.

I haven’t yet read it, but look forward to doing so because I feel that, despite Tory lies and propaganda and no matter how dated, the Webbs’ proposals and solutions are still acutely relevant and necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Boris Isn’t Churchill, He’s Neville Chamberlain

May 21, 2020

Okay, it’s finally happened. I think people have been expecting this, but were hoping that somehow it wouldn’t come true. But it has. Mike today has put up a piece reporting that the death toll from the Coronavirus has hit 62,000. 51,000 people are known to have died, according to some of the people, whose tweets about this tragedy Mike has reproduced in his article. That’s more than those killed during the Blitz.

How do I feel about this? Absolutely furious and bitterly ashamed. Britain is one of the wealthiest countries in Europe, but we now have the second worst death rate from this foul disease in the world. And it can all be put down to our leaders’ incompetence, their doctrinaire pursuit of neoliberalism and private industry at the expense of the res publica, the commonweal, the public good. And their willingness to sacrifice the health, safety and lives of the great British people for the sake of their corporate profits and the narrow interests of their own class.

Mike, Zelo Street and a host of other left-wing bloggers and activists have published article after article minute describing the Tories’ culpable negligence. They were warned in advance by scientists and medical experts that a fresh pandemic was coming sometime. As you know, I despise New Labour, but Blair, Brown and the rest nevertheless took the threat seriously. They prepared for it, setting up appropriate government and NHS departments. What did the Tories do? Shelve all these plans, because they were committed to austerity and they didn’t think the money spent on these precautions were worth it. 2016 the government wargamed a flu pandemic, and this pointed out all the problems we’ve subsequently experienced with the Coronavirus. And what happened after that? Zilch. For the same reasons the plans were shelved and weren’t updated and the specialist departments closed down.

And the Tories’ commitment to austerity also meant they prevented the NHS from being adequately prepared for the outbreak. It had too few intensive care beds, the supplies of PPE were too small, and underlying it is the plain fact that the NHS has been criminally starved of proper funding for years. Because, for all that they’re praising it now, the Tories are desperate to sell it off and have a private healthcare system like the one that works in America. You know, the one country that now has a worse death toll than ours.

Austerity has also exacerbated the impact of the disease in another way. It hits the poor the hardest. Which is unsurprising – the poor often suffer worse from disease, because they don’t have such good diets, jobs, housing and living conditions as the rich. In this case, poorer people do jobs that bring them more into contact with others, which leaves them more exposed to infection. I really am not surprised, therefore, that Blacks and Asians are therefore far more likely than Whites to contract Covid-19. There are other factors involved, of course – ethnic minorities as a rule tend to live far more in multigenerational households than Whites, which increases the risk of infection. But Blacks and some ethnic groups also tend to do the worse, most poorly paid jobs and that’s also going to leave them vulnerable.

And Boris is personally responsible for this debacle. He was warned in November that the Coronavirus was a threat and January and February of this years the scientists were telling him to put the country into lockdown. But he didn’t. He was too preoccupied with ‘getting Brexit done’. He also didn’t want to put this country into lockdown, because it would harm the economy, which meant that the big businesses that donate to him and his scummy party would take a hit. And he and Dominic Cummings and certain others also subscribe to the Social Darwinist view that the disease should be allowed to take its toll on the weakest, because they were useless eaters holding back all the biologically superior rich businessmen the party idolizes. It was a simply just culling the herd, nothing to worry about. And apart from that, Boris was just personally too damn idle. He doesn’t like to read his briefs, he didn’t turn up to the first five meetings of Cobra, and rather than working shot off back home at the weekends. And he was also far too interested in pursuing his relationship with his latest partner.

Johnson fancies himself as Winston Churchill. A few years ago he published a book about the great War Leader, that was so execrable it was torn to shreds by John Newsinger over at Lobster. In this, the Blonde Buffoon resembles Jim Hacker from the Beeb’s comedy series, Yes, Minister and Yes, Prime Minister. Whenever Hacker had some grand idea that would raise him or his administration above mediocrity, he’d start posing and speaking like Churchill. Boris hasn’t quite done that, or at least, not in public. But he certainly shares Hacker’s vanity in this respect.

But he isn’t Churchill. He’s Churchill’s predecessor, Neville Chamberlain. Churchill hated Nazi Germany and was determined to destroy it. Chamberlain, on the other hand, wanted to avoid war. Hence he came back from Munich waving a worthless piece of paper, which he proclaimed as ‘peace in our time’. He was thus absolutely unprepared for Hitler’s invasion of Poland. But the Tories got rid of him, and replaced him with Churchill.

Johnson was unprepared for the Coronavirus. He should have been removed long ago and replaced with someone, who could do something about it. But that would mean replacing the entire Tory party, as none of the Prime Ministers since Brown have been serious about preparing for this threat.

And thanks to them, more people have now died than in the Blitz.

What an under, damnable disgrace!

See: https://voxpoliticalonline.com/2020/05/20/uk-coronavirus-deaths-hit-62000-no-wonder-johnson-only-appears-for-pmqs/

 

Despite the Fullsome Praise, BoJob Still Wants to Privatise the NHS

April 13, 2020

Yesterday the news reported that Boris had finally been discharged from hospital. He will not be starting work immediately, but has gone to Checkers to recuperate after his battle with Coronavirus. But before he did so, he gave fulsome to praise the hospital staff, including two nurses, who cared for him. The NHS, he made clear, had saved his life, and we would beat the Coronavirus because it was the beating heart of Britain.

I’m very glad Johnson has recovered. I don’t wish, or anyone else’s death, and I’m very glad that he is showing his sincere, genuine gratitude to the nursing staff and the great institution that has saved his life. He’s not the only Tory politico to owe his life to the NHS. Back in the 1980s the Fabian Society published a pamphlet arguing very forcefully against privatisation of the NHS, and made very telling comparisons about the US system, which is funded by individual insurance. The pamphlet quoted a Tory politician, who stated that the NHS had very definitely saved his life when he had suffered heart problems, and that there is no way he could have afforded such treatment in America.

But you’ll forgive me if I say that I found such praise coming from Boris a tad hypocritical and hollow. Right-wing governments since Thatcher – and that includes Tony Blair’s – have been doing their level best to privatise the NHS piecemeal by stealth. And the series of Tory governmental trainwrecks since Labour lost the 2010 election are no different. Cameron went on with the privatisation, passing Andrew Lansley’s wretched Health and Social Care Bill, which absolves the Health Secretary from his or her historic role of having to make sure that everyone has health care free at the point of use. NHS trusts and doctor’s surgeries, organised in Community Care Groups, are enabled and required to consider commissioning services from private healthcare companies. More and more contracts – it is now more than half – have been awarded to private healthcare companies. Despite the lies and smooth assurances to the opposite, this privatisation is for the private sector’s benefit, not ours. On its own, private healthcare can’t compete with that provided by the state. Private hospitals are smaller, and don’t offer the range of services the NHS provides. Private health insurance works well for the affluent, young and largely well, who don’t require long term or complicated treatment. It does not work for the old, the poor, the disabled or the long term sick. Which is why Lyndon Johnson had to introduce Medicare and Medicaid for those groups in the US. Despite this, 40,000 people still die through lack of affordable healthcare in the US, and the top cause of bankruptcies over there is medical costs.

But over here the Tory drive for privatisation continues. I noticed a Torygraph headline reproduced on one the blogs, which very graphically showed this. This proclaimed that it was due to the NHS’ cumbrous bureaucracy that PPE equipment weren’t getting to NHS staff. The Tories have been very keen to tell everyone that introducing the private sector is going to cut bureaucracy. And this is another example of the truth being the direct opposite of anything Johnson, Cummings and any other Tory will tell you. The Tories’ privatisation has actually increased the bureaucracy through setting up organs within the NHS to ensure competition and value for money. Also private healthcare firms have larger management bureaucracies that the NHS. In extreme cases, these can account for 40 per cent of the companies operating costs. But there were over 100 MPs in Cameron’s government, who had connections to private healthcare firms. And so, despite rising costs and inefficiencies, it’s immensely profitable to them and the heads of those companies.

Treatment by the NHS is supposed to be free at the point of use, but the Tories have been introducing charges, or expanding the range of services for which charges may be made. One of those supporting this move is Jacob Rees-Mogg.

But despite their determination to sell it off, the Tories give their unstinting praise to it. One recent Tory health secretary even declared that they ‘treasured it’. This was after the fact it was revealed that he, or one of the other Tory MPs, had written a book advocating the incorporation of private healthcare into the NHS to such an extent that the NHS would cease to exist. Which is privatisation.

With this in mind, I see absolutely no reason to take Johnson’s praise at anything like face value. No, I don’t deny he’s grateful – now. But this gratitude will wear off a soon as he steps back through the doors of No.10 and starts listening once again to his Tory friends and fellows, and although the advisers that have trooped into government from private industry.

Then, whatever Johnson said yesterday, he’ll go back to privatising the NHS.

So no one else will be able to get treatment for a disease like Coronavirus without paying for it. And heaven help the poor if they can’t.

Matt Hancock’s Telegraph article Shows He Really Doesn’t Understand the NHS Ethos

March 17, 2020

On Sunday, the current malign incompetent currently posturing as NHS secretary, Matt Hancock, issued a statement of the government’s current policy regarding the Coronavirus. This contradicted Boris Johnson’s previous statement, which was that we shouldn’t be afraid of catching it, because this would confer on us all herd immunity. The Tory party, like the Republicans in America, hate experts. This rather cavalier attitude owed something to the massive ignorance in the Republican party over the other side of the Pond. They had been loudly denouncing it as a scare dreamed up by the Democrats, until one of their number came down with it at CPAC after meeting and pressing the flesh with several of their leading politicos and activists. The result was complaints that the American public weren’t being told enough about it. Johnson here obviously didn’t know what he was talking about, and outraged people who did – doctors, epidemiologists, virologists, and informed laypeople – weighed in to put him right.

Both Buddyhell and Martin Odoni have put up excellent pieces shooting down Johnson’s spectacularly ignorant comments. They point out that herd immunity means that everyone, or at least the vast majority, would have to come down with it. Only a very few would become immune, and that immunity would only last a couple of months, not years or a lifetime. And because nearly everybody would have to contract the disease, even if the mortality rate is low, the result would be that a large number of people, perhaps as many as 200,000, would die for the rest to acquire this short-lived immunity. It’s an immensely callous attitude from a Prime Minister, who obviously doesn’t know what to do. Worse, as the French philosophical feline and Martin rightly pointed out, it shows the eugenicist thinking underlying Boris’ and Cummings’ response to the disease. Eugenics hold that the biologically unfit, which means the inferior lower orders, should not be allowed to breed. The handicapped should be sterilised to make sure they don’t. At the same time, health care should not be extended to the poor, and certainly not racial groups specifically held to be inferior, like Blacks, because this will interfere with the proper natural process by which inferior stock is weeded out of the population. Eugenicist arguments were invoked in America by the corporate rich in the 19th century to prevent the state passing legislation to improve standards of workers’ health and safety. Because if workers and their families contracted disease and had shorter lives, it wasn’t because living conditions were worse than their employers. It was because they were biologically unfit. Cummings seems to hold eugenicist views, as did Andrew Sabisky, before the latter’s unpleasant opinions meant that the Tories had to get rid of him. But you can bet that the attitudes still there. Maggie Thatcher’s mentor, Sir Keith Joseph, caused outrage in the mid-70s when he declared that single mothers were a ‘threat to our stock’. And that does seem to be how the Tories regard the British public – as stock, to be cultivated or culled according to the whims of their masters.

See: https://thegreatcritique.wordpress.com/2020/03/12/herd-immunity-is-your-answer-johnson-truly-the-lunatic-has-taken-over-the-asylum/

https://buddyhell.wordpress.com/2020/03/12/wait-what-herd-immunity/

Hancock’s article seems to me to be partly an attempt by the government to allay some of the outrage Johnson’s comments caused, and to show that the government really does have a sensible policy to tackle the emergency. Despite all appearances to the contrary. But Hancock’s article also showed that Hancock and his masters have no understanding of or sympathy with the public service ethos underlying the NHS. This was shown not so much by what Hancock said, but how he said it. His statement was released as an article in the Torygraph behind a paywall. This caused more justifiable outrage. Zelo Street made the point that Hancock should have made his announcements publicly, not just in a single newspaper, and certainly not tucked away behind a paywall so that only Torygraph subscribers could read it. The Torygraph seems to have taken the hint, and made the article free, as it should be.

https://zelo-street.blogspot.com/search?updated-max=2020-03-15T16:12:00Z&max-results=20

But this attitude, however, makes perfect sense from the Tories’ ideological basis in private enterprise. Private industry operates by offering a range of services for the consumer, priced according to what they can afford or are willing to pay. The poorest only get the basic package, if they can afford that. As you pay more, so service improves. Now this works fine if you’re buying a washing machine or computer, but it’s no way to run public services that have to be accessible to all. Like the NHS. When that’s left to the private sector, as it is in America, it means that millions of people can’t afford proper healthcare. It means that 40,000 people a year die because they can’t afford their medicines, and the poorest hoard what medicines they have or use veterinary medicines for animals. A similar situation existed in this country before the establishment of the NHS by the Labour party under Clement Attlee and Nye Bevan. Before then, healthcare varied according to how wealthy you were. You got excellent care if you were well-off or were one of the few occupations that was covered by government health insurance schemes. If you were poor, you either had to make do with the charity hospital, the municipal infirmary, where standards varied immensely, some being extremely poor and basic, or you went without.

What changed attitudes to produce a broad consensus in favour of a socialised medical system was the Second World War. German bombs during the Blitz didn’t distinguish between rich and poor, who were hit alike and often in the same locations, so that the same healthcare had to be offered to everyone, regardless of personal wealth and class. But that was over 75 years ago, and the underlying lesson that made the NHS possible seems to have been forgotten by the Tories. If they ever learned it in the first place.

And so we had the unedifying spectacle of Hancock responding to the Coronavirus in the pages of the Torygraph like a private entrepreneur responding to increased demand. The announcement was made in a broadsheet paper aimed at and read by the top ranks of British society. It was hidden behind a paywall, so that only paying customers could access it. You get what you pays for, and this was premium service for valued customers. Which means the rich, whom eugenicist doctrine holds are biologically superior than everyone else.

This attitude is incompatible with running the NHS and tackling the coronavirus. Progress will only be made through properly funded state health provision and a government that genuinely has a public service ethos, rather than just pays lip service to it. 

Trotsky on the Failure of Capitalism

January 16, 2020

I found this quote from Trotsky on how capitalism has now outlived its usefulness as a beneficial economic system in Isaac Deutscher and George Novack, The Age of Permanent Revolution: A Trotsky Anthology (New York: Dell 1964):

Capitalism has outlived itself as a world system. It has ceased to fulfill its essential function, the raising of the level of human power and human wealth. Humanity cannot remain stagnant at the level which it has reached. Only a powerful increase in productive force and a sound, planned, that is, socialist organisation of production and distribution can assure humanity – all humanity – of a decent standard of life and at the same time give it the precious feeling of freedom with respect to its own economy. (p. 363).

I’m not a fan of Trotsky. Despite the protestations to the contrary from the movement he founded, I think he was during his time as one of the leaders of the Russian Revolution and civil war ruthless and authoritarian. The Soviet Union under his leadership may not have been as massively murderous as Stalin’s regime, but it seems to me that it would still have been responsible for mass deaths and imprisonment on a huge scale.

He was also very wrong in his expectation of the collapse of capitalism and the outbreak of revolution in the Developed World. As an orthodox Marxist, he wanted to export the Communist revolution to the rest of Europe, and believed that it would be in the most developed countries of the capitalist West, England, France, and Germany, that revolution would also break out. He also confidently expected throughout his career the imminent collapse of capitalism. This didn’t happen, partly because of the reforms and welfare states established by reformist socialist parties like Labour in Britain and the SPD in Germany, which improved workers’ lives and opportunities, which thus allowed them to stimulate the capitalist economy as consumers and gave them a stake in preserving the system.

It also seems to me that capitalism is still actively creating wealth – the rich are still becoming massively richer – and it is benefiting those countries in the Developing World, which have adopted it, like China and the east Asian ‘tiger’ economies like South Korea.

But in the west neoliberalism, unregulated capitalism, certainly has failed. It hasn’t brought public services, like electricity, railways, and water supply the investment they need, and has been repeatedly shown to be far more inefficient in the provision of healthcare. And it is pushing more and more people into grinding poverty, so denying them the ability to play a role as active citizens about to make wide choices about the jobs they can take, what leisure activities they can choose, and the goods they can buy. At the moment the Tories are able to hide its colossal failure by hiding the mounting evidence and having their hacks in the press pump out favourable propaganda. But if the situation carries on as it is, sooner or later the mass poverty they’ve created will not be so easily hidden or blithely explained away or blamed on others – immigrants, the poor themselves, or the EU. You don’t have to be a Trotskyite to believe the following:

Unfettered capitalism is destroying Britain – get rid of it, and the Tories.

Private Medicine and the Demand for the Privatisation of State Medical Care

December 17, 2019

The book Health Reform: Public Success – Private Failure also makes it clear where the demands for NHS and the privatisation of other systems of state healthcare come from: the private medical sector, including the insurance industry. The book states

Arguments for private markets in health care are not only persistent, and resistant to both analysis and evidence, but they also come forward from the same groups of people. Again over the decades, and across countries, one finds the same arguments for private organization and funding coming from spokesmen for private practitioners’ associations – physicians, dentists, pharmacists – as well as from private insurance companies and drug manufacturers. In addition they tend to come, as noted above, from representatives of ‘business’ and, more recently, from ‘ideological entrepreneurs’ that support themselves and their organisations by championing the interests of the wealthy, cheerleading for the private marketplace. Indeed, they are simply taking advantage of the general ideological climate, currently more favourable to re-open old issues. (p. 28).

‘Ideological entrepreneurs’ seems to be another term for right-wing thinktanks and astroturf pressure groups.

The book states that in contrast with hospital workers, who want to see cheap or free medical treatment provided to the poorest, the private sector is interested in maximising its income.

Hospital workers, whose patients/clients tend to be very ill and/or have very limited resources – the unhealthy and unwealthy – are generally very supportive of public payment systems. Their opportunities in a private marketplace would be quite limited. But they do not support hospital ‘downsizing’ or containment more generally; the ideal policy would be more money from public sources, to hire more highly trained and better paid staff….

The loud voices for privatisation, by contrast, come from those who believe that they could do better, in the form of increased sales of or higher prices for their products and services, in a more entrepreneurial environment. It is not clear how many, if any, of these would support a truly private system, with no direct or indirect contribution of public funds. The economic mayhem among providers would be truly awesome. Instead what seems to be contemplated is a continuation of public support on a large scale, but without limits on private fee setting or delivery, or private insurance – rather like the United States, in fact, before more widespread ‘managed care’. 

This sounds very much like the thinking behind the privatisation of NHS services – private healthcare providers supported by the state – and Trump’s intention to open up the NHS to American private healthcare firms and remove the NHS’ price fixing mechanism keeping drug prices as low as possible.

NHS privatisation is all about private profit, not public care or the provision of health services at minimal cost. Don’t fall for the rhetoric of the Tories or Blairites in Labour. Get rid of it, and them.

Private Clinics Are Not Better Than Those Run by the State

December 17, 2019

Here’s another vital little snippet on the failure of private healthcare to give adequate provision to society generally from the book Health Reform: Public Success – Private Failure, by Daniel Drache and Terry Sullivan, eds. This discusses the Canadian experiment in expanding healthcare provision by including private clinics. It states

Advocates for private clinics argue that they enhance access and supplement an over-strained public system. The evidence for such claims is mixed to dubious; they tend to reduce to ‘more is always better’. If government cannot or will not pay for more, then private individuals must. Our concern here, however, is to emphasize that whatever the effects of ‘more’ on the health of Canadians, all the privatization initiatives and supporting arguments involve a transfer of income, through higher prices as well as higher volumes of care, from payers to providers. But even if there were no restrictions on extra billing or private facilities, there are likely to be limits on ‘what the market will bear’ in private charges, particularly in the presence of a free public system. Denigrating or inhibiting access to that system can assist in recruiting private patients, but could also trigger a political backlash if people begin to see ‘their system’ as being sabotaged. (p. 38).

Blair wanted to expand the NHS through the construction of health centres or polyclinics, which would be privately run. And the Tories are running down the NHS in order to privatise services at one level and encourage more people to go private at another. Hence Boris Johnson’s 2002 speech lamenting that 200,000 people had given up their private health insurance because Gordon Brown had ended tax exemption for it, in which he angrily denounced the ‘monolithic’ NHS and called for its abolition.

But the next sentence in that paragraph states very clearly that for private clinics to function properly, it has to be accompanied by private health insurance.

For really significant increases in total system costs and incomes, it is probably necessary to introduce private health insurance…. out of pocket charges provide something for private insurers to cover, and that coverage permits increase in the level of such charges. Private medicine and private insurance are symbiotic. (My emphasis).

Don’t be misled by the Tories or Blairites. The inclusion of the private sector in NHS provision will lead to its total privatisation and an insurance-based system like the US.

Don’t allow it.

NAFTA, and Boris Johnson’s Trade Agreement with Trump Are Threats to State Healthcare

December 16, 2019

One of the chapters in the book Health Reform: Public Success – Private Failure, edited by Daniel Drache and Terry Sullivan, is by Barry Appleton, ‘International agreements and National health Plans: NAFTA’. NAFTA  is the North American Free Trade Agreement, a free trade zone that was set up in the 1990s which included America, Mexico and Canada. Appleton states that it is too early to fully appreciate the impact of the agreement, but states that ‘The NAFTA affects health care in two ways. first, acts as a general limitation on the ways that governments can deal with public policy. Second, the agreement acts to lock in market liberalisation in the health sector’. (p. 87). 

The treaty includes clauses like the following that prevent governments from nationalising the property of other nations:

No Party may directly or indirectly nationalize or expropriate an investment of an investor of another Party in its territory or take a measure tantamount to nationalization or expropriation of such an investment (‘expropriation’), except:

(a) for a public purpose;

(b) on a non-discriminatory basis;

(c) in accordance with due process of law and Article 1105 (1); and

(d) on payment of compensation in accordance with paragraphs 2 through 6. 

Now the renationalisation of hospitals and doctors’ surgeries taken over by the Americans would, I believe, come under ‘public purpose’, and so be permitted, but there would be objections to this. I remember at the time when the Americans were setting the system up there was real concern amongst the left that if the Americans were allowed to buy up British industries, including parts of the NHS under a NAFTA-trade deal, we would find it impossible to renationalise them.

This should still be a major concern with Boris Johnson’s negotiations with Trump, in which, despite Boris’ denials, the NHS is very much on the table. In fact Johnson, Liam Fox and Daniel Hannam set up the Institute for Free Trade in 2017 in order to push for a deal with the Americans, in which private American companies would be allowed to run British hospitals.

If this goes through, we may find it impossible under international law to get them, and other important businesses, back.

Don’t let Boris privatise the NHS.

 

Nationalised, State Healthcare Gives the Poor More Money and More Power

December 16, 2019

One of the arguments Conservatives on both sides of the Atlantic have been pushing to attack state healthcare is that, as it’s funded through public taxes, it somehow leaves people worse off. I came across a recent right-wing video on YouTube that seemed to be pushing that line. It proclaimed that American university students were all in favour of Bernie Sanders’ Medicare For All – until they were told what it would cost them. I didn’t watch it, because I knew it would annoy me. Similarly, over here the Tories and Blairites have been telling people that the inclusion of the private sector will bring costs down, thus allowing government to make savings and cut taxes. In fact, private healthcare is wastefully bureaucratic, far more so than state healthcare. But the Tories just want to cut taxes for the rich without making the lives of the poor any better. Indeed, they are determined to make them worse through savage welfare cuts, wage freezes, and further attacks on workers’ rights and employment conditions. And by encouraging more people to take out private health insurance in order to avoid their manufactured problems in state healthcare, the costs are transferred to the consumer. For the rich this is no problem. For middle income groups, it means having to pay thousands for operations and procedures that should be routine and free. They are worse off.

The book Health Reform: Public Success – Private Failure, Daniel Drache and Terry Sullivan, eds., (London: Routledge 1999) makes the point that Lord Beveridge, the architect of the modern welfare state, believed the contrary. State welfare provision which actually leave the poor and working people better off. Without doctors’ and hospital bills to pay for their illness, they would have more disposable income. The book states

It is not sufficiently recognised that by removing the financial burden of catastrophic illness from their wage packets, their disposable incomes would rise. No longer would they have to pay doctors from their pockets when their children were born or they fell sick and when they went to hospital; lack of money did not constitute a barrier to good care. These reforms, along with the spread of collective bargaining in advanced industrial economies, enabled people to enjoy the benefits of an expanded notion of social citizenship. Healthcare and full employment thus constituted a forward-looking framework for social health and not simply clinically provided health care. 

(p. 10).

Which means that the prosperity given to working people through free medical care, full employment and strong trade unions can act as proper citizens, able to make political and economic choices that will affect government.

Which is why the Tories and the Republicans in America have attacked trade unions and scrapped the idea of full employment, because they give working people too much power. And what’s the odds that similar thinking also isn’t one of the factors in their attacks on state healthcare. Oh, they do honestly believe that private enterprise is always better than state provision, but the threat of medical bills in a private healthcare system as well as general poverty is a good way of keeping the workforce cowed and fearful.

NHS privatisation will not make healthcare cheaper and more efficient. It will just make working people poorer and allow more bullying and exploitation from their employers.

NHS Privatisation Means More Expensive Bureaucracy

December 16, 2019

The Tory election victory on Thursday prompted me to buy a book, Health Reform: Public Success – Private Failure, edited by Daniel Drache and Terry Sullivan, which I had seen in one of the secondhand bookshops in Cheltenham. The book was published in 1999, and examines the inclusion of the private sector in the healthcare systems of America, the UK, Canada, Australia and elsewhere. It isn’t necessarily against this inclusion, but does treat it critically. And one of the points it makes is that private healthcare companies are as wastefully bureaucratic as the state planning system of the former Soviet Union. And because they’re run for a profit, they’re keen to inflate prices, not keep them down. the book states

But private insurance, as the American experience shows, brings in a whole new group of very powerful income claimants – a major expansion in the Z term. Large-scale private coverage is a horrendously expensive way to pay for healthcare. A huge private bureaucracy must be established to assess risks, set premiums, design complex benefit schedules, and review and pay (or refuse) claims. A corresponding financial apparatus is then required in hospitals, nursing homes, and private practices to deal with this system, in a form of ‘administrative arms race’.

Far from trying to minimize the cost of administrative overload, and match premiums as closely as possible to benefit payments, private insurers refer to the rate of benefit payment as the ‘loss ratio’ and try to maximize the difference between premium revenue and payout. That difference is the income of the insurance sector.

Yet, as we know from the experience of the single-payer system in Canada, all this financial paper-pushing turns out to be as unnecessary and wasteful as the old Soviet planning apparatus. These are not functions that anyone needs to perform once a decision has been made to cover the whole population. In the United States, bureaucratic waste by and in response to the private insurance industry now adds more than a hundred billion dollars per year, over 10 per cent, to total health care costs.

(pp.38-9).

Yet the Tories push privatisation, including that of the NHS, as a way of reducing costs and increasing efficiency, while the opposite is true. And I know true-blue Tories, who are shocked to hear that it does. They simply accept the neoliberal doctrine that private industry is someone how more efficient and cost-effect than state provision, even when it manifestly isn’t.

This point is made by Jacky Davis and Raymond Tallis in their polemic against NHS privatisation, NHS – SOS, but despite the newspaper headlines about the crisis in the NHS, I don’t think it’s properly appreciated. And the Tories are determined to privatise the NHS, which is why I bought the book, so I could put up more information about the effects of the piecemeal privatisation of the NHS on this blog.

NHS privatisation and the inclusion of private healthcare means greater costs and worse healthcare for those who can’t afford it. Which means the poor, the disabled, and the old. This is what Tory health policy means.