From Socialist Review, No.191, November 1995, pp.16-17.
Copyright © 1995 Socialist Review
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‘The National Health Service is the envy of the world.’ Who said that? Enoch Powell, minister for health in 1962. ‘The National Health Service is safe with us.’ Who said that? Margaret Thatcher, prime minister in 1983. When a drugs company-financed commission produced a recent report calling for more private money in the National Health Service, who leaped into the media to defend the NHS against the report? Stephen Dorrell, secretary of state for health.
The Tories have always been equivocal about the NHS. Even when it was set up, they did not oppose it very forcefully. In office from 1951 to 1964, they left it pretty well intact. In 1960, Enoch Powell raised prescription charges by a shilling-5p – and was very apologetic. Stephen Dorrell recently expressed the basic argument for the NHS very forcefully. He argued only slightly disingenuously that Britain leads the world in health care.
Naturally, Mr Dorrell does not want to surrender that reputation. His problem comes with the main reason for it – that Britain’s NHS treats people according to their health, not according to their wealth. The success and popularity of the NHS, in other words, is entirely attributable to the fact that it bucks the market. The priorities of the NHS have no bearing on what patients can pay – only to what they need.
This is not merely philanthropic. It doesn’t just mean that sick people get treated more urgently than anywhere else. It is also more efficient. Capitalist ideologues who tell us that buying and selling with money is the best way of matching demand and supply are utterly confounded by the NHS, whose central principle is that nothing is bought or sold, that everyone insures themselves against sickness according to their means (income tax etc) and get treated according to their needs. Largely because of the capitalist world in which it survives, the NHS is very far from perfect, but it works far better than in the US, where almost all health care is bought and sold in the market place.
Unfortunately, while the NHS may indeed be the envy of the world, the market system in the US and other countries is the envy of lots of top people in Britain who work in health. They can’t help admiring the basic efficiency and fairness of the NHS – but most of them can’t help salivating at the huge sums of money which disappear into the pockets of so many physicians, drug peddlers, private health providers, quacks and charlatans that prey on rich people’s legendary hypochondria.
Aneurin Bevan, who was minister of health when the NHS was set up in 1948, recognised this contradiction at once. Indeed, the doctors’ organisations, then linked much more closely to the Tory Party, never stopped telling him about it. He compromised by allowing top consultants to practise privately. From the beginning of the NHS leading surgeons and physicians were able to get the best of both worlds: to have access to outstanding equipment in the NHS and to the money of private patients who consulted with them in Harley Street.
The attack on the NHS today takes two forms. The first is the outright demand for privatisation of the entire health service and a return to market barbarism where people who can’t afford medical fees don’t get treated. This propaganda is peddled by the Thatcherite think tanks, the Centre for Policy Studies and the Institute of Economic Affairs, but it cuts little ice. The NHS is so popular and works so well that outright privatisation is not a credible political option. More insidious and effective is the apparently equivocal propaganda which pretends to favour the principles of the NHS and then argues for the gradual erosion of those principles. This has been the line of successive Tory secretaries of state, of whom Kenneth Clarke was the most energetic and the most destructive.
More recently the erosion arguments have seeped into the left, and now reach right into the Labour leadership. The Social Justice Commission, under Sir Gordon Borrie, for instance, which pretended to be independent of the Labour Party but effectively sought to lay down new principles for new Labour, snapped at the heels of the basic principle of the NHS: its universality. The commission arguments were extended by the Healthcare 2000 report.
The two commissions had in common Patricia Hewitt, a former Labour candidate, who was chief aide to Neil Kinnock (1983-1992). Hewitt was deputy chair of the Borrie Commission and deputy chair of Healthcare 2000.
The arguments of both borrow heavily from the new right. Health care must be rationed, and the obvious and sensible way to ration health is to throw more services into the money market and make people pay more for what they want.
All this is stated as though it were perfectly obvious, and that anyone who doesn’t accept it is living in an old world of cloud cuckoo land. The inference is that this dream ‘old world’ was somehow better and richer than the stark, realistic new world, and that in those soft days of yore much more could be afforded. Yet in 1948, when the NHS was set up, and when all medical services, even false teeth and spectacles, were free for everyone who needed them, the national income of Britain was only slightly more than a third of what it is today. There was no golden age. A very much poorer country was able to afford a very much more universal health service.
Of course, there has to be some system of priority. The point is: how is the rationing carried out? The NHS rations on the basis of need. He or she who needs more gets priority over him or her who needs less. The new health reformers, on the other hand, want to ration by pocket. He or she who can pay more gets priority over him or her who can’t pay more. The more these arguments prevail, the more people go to private hospitals and take out private health insurance; the more resources of skill and technology get sucked into the market, the more the foundation of the NHS is eroded. However equivocal they may sound, the new ‘common sense’ demands for ‘a more realistic’ approach to the National Health Service are deeply subversive of it.
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