In this powerful, explosive and revealing guest editorial for nhsManagers, Lucy Reynolds exposes the international trade rules which are driving marketisation, the political collusion behind them and the lack of transparency for the general public.
The privatisers hate the Beveridge system: its value for money makes clear the fact that the privatisers are selling an obvious rip-off, so it is a very undesirable comparator to have around. The trade lobby is keen to transform all Beveridge-style national healthcare systems to US-style healthcare, in which scared ill people and their families are highly motivated to pay through the nose to profit-making intermediaries who are in a position to exploit this to milk them of cash. At the same time, the insurance companies can relieve the “worried well” of thousands of pounds annually, for health insurance coverage that they would not have been accepted for if the company concerned thought there was more than a negligible chance of them needing it.
The current NHS privatisation is the mechanism to effect this transformation in England, with a very clever device, CCGs, invented by John Redwood MP in 1986 as a transitional step to enable this wholesale transformation to an insurance-based system.
The Spanish Beveridge-style NHS has largely been destroyed now as part of the preparation for the TTIP (upcoming US-EU trade merger) and there have been riots over the introduction of charges. The Swedish one has been privatised under competition law, and Sweden’s rural areas now lack medical services. The private sector aren’t interested because it’s not profitable for them so the market leaves gaps there, while the government is no longer allowed to intervene to add services because that’s an interference in the market, illegal for states under competition law rules.
The Italian Beveridge-style NHS is under the same attack but so far their doctors have been clever enough to exploit the chaos in Italian politics to stall it. Until recently, both Israel and Saudi Arabia had Beveridge-style systems which delivered excellent results at low cost; both have been besieged by management consultants promising market miracles, and both are in the midst of privatisation now.
Only the Cuban Beveridge-style NHS, which is by far the world’s most competent health service in terms of value for money, remains safe for now, because the Cubans see the privatisation advisors for the conmen they are.
Our main problem in stopping this destruction in England at present is the lack of public understanding of the all or nothing nature of the trade rules around maintaining free-of-charge public services. All three main political parties are currently misrepresenting this legal position in order to stop the NHS escaping destruction.
What they are suppressing is that the trade rules at EU and global level both contain provisions to exempt public services from the general trade/competition law requirement to allocate funding through competitive markets. These can protect 100% public services, but only where it is not possible to make a profit from them at all. It’s all or nothing – a public service must either benefit for the exemption which covers only 100% publicly-owned, not-for-profit services, or it cannot be exempted from the general commitment to privatise all public services under the global trade regime that our governments have committed us into.
If there has been any marketisation at all in a public service, under trade & competition law the public service concerned is then “on the privatisation ratchet” and is considered to have been committed to full privatisation through a gradual one-way process. All three main UK political parties are signed up to this agenda, though none are honest about that, except privately with the commercial interests that sponsored them to make these changes.
Part of the Labour Party health team requested briefing on this in summer 2011; they knew the danger already but reported inability to alter the Blairite commitment to stealth privatisation. That position persists: there is support for saving the NHS in the LP, except at the leadership level which remains fully signed up to privatisation.
Allowing a market into NHS provision at all renders the NHS ineligible for the public services exemption. Thereafter, trade and competition law can easily be used by commercial interests to take essential funding from public providers by cherry-picking surplus-generating services such as routine surgery. Surplus from those would have subsidised other services from the same NHS hospital and stopped them going into the red: the consequence will be loss of traditional NHS services as they are left without enough income to cover their overheads, especially the vast PFI charges, at above 70% interest per year in some cases, which now look like a deliberate millstone placed by government to sink the NHS and increase the markets for private health insurance and private healthcare by destroying NHS provision.
Thus Burnham’s middle-way of “preferred provider” is not the fair compromise/small backtracking away from privatisation that it looks like, it’s a full-scale betrayal. Though the rank and file are generally unaware of this, the Blairite leaders know perfectly well that championing “NHS as preferred provider” is not a viable option. By refusing to commit to ejecting the market from the NHS, they are giving a strong signal to the trade lobby that the Blairite Labour Party is still fully on side with the NHS privatisation and will do as the City and Wall Street prefer, even if that means betraying their voters.
Any political party which is actually on the side of the NHS and which understands the trade implications will be taking a position of getting the market out of the NHS so as to claim that trade exemption. Only the NHA and the Greens, at present, have committed to that. They are the only parties which truly care about the NHS: the rest are selling it out.
Dr Lucy Reynolds
Dr Lucy Reynolds is a Health Policy Analyst for the London School of Hygiene and Tropical Medicine’s Health Services Research and Policy Team