“Britain’s NHS, which established healthcare as a right, has been progressively dismantled and privatised by successive governments over the past quarter-century. The story is of course not unique to Britain. Universal healthcare systems are being dismantled and privatised across the world. Making healthcare once again a commodity to be bought, rather than a right, has become the standard prescription of the World Bank, the International Monetary Fund, the World Trade Organisation, and even the World Health Organisation ..."
With these opening words, Allyson Pollock introduces her study, NHS plc, which analyses in detail the accelerating process of health privatisation and the corrupt relationship between the government (which never tires of issuing its hollow claim to represent the interest of ‘its electors’ and hence be ‘democratic’) and big industrial and finance capital seeking to make a killing from the massive tax revenues formerly dedicated to financing key social services.
Much of the material in this pamphlet is drawn from this very useful work in which the author fiercely defends public and universal provision of health, pointing out that “the real costs of privatisation are both dramatically increased financial costs of using private enterprise, which is really so much less efficient in providing healthcare, and the costs in terms of lost services, lost universality and lost equality”.
The market is, of course, the natural state of the capitalist economy, which gave rise to gigantic monopoly over a hundred years ago, concentrating at one pole vast wealth and power for a tiny minority and at the other poverty for the vast majority. Finance capital does not seek equality, it seeks domination. As such, there can be no real talk of 'equality' between the multibillionaires, the emperors of finance capital, on the one hand and the working masses on the other.
When the spokesmen of finance capital (the Gordon Browns and Tony Blairs) talk of ‘maximum efficiency’, they mean squeezing maximum profit for their sponsors rather than providing the best products or services to ‘consumers’ (as patients have been rebranded). Contrary to the all-pervasive free-market fundamentalist dogma they push, the two aims (profit and service) are usually mutually exclusive.
By extension, the criticism of the market in health is really a criticism of the market in general, which is indeed “profoundly anti-democratic and opaque”. Healthcare is, of course, an emotive issue, one that highlights the severe consequences of poverty, inequality and exploitation of capitalism in the ultimate black and white terms: life or death.
While Professor Pollock laments the betrayal of “principles” of the founders of the NHS, we must look further and see the NHS and the entire ‘social safety net’ of the Keynesian consensus for what it is: a product of dynamic social forces – more specifically, a product of the struggle between opposing classes: between the bourgeoisie, which inevitably seeks to maximise profit by decreasing wages (including the social wage, ie, national insurance contributions, social benefits, pensions, housing, NHS etc) and lengthening working hours, and the proletariat, which has only its concerted social action to wrest a greater share of the national wealth from the ruling class.
So long as the capitalist system survives, social services, the social wage, like wages in general, will reflect the organisation and militancy of workers. Any concessions won today can be taken back tomorrow. While fighting to defend the NHS and other services that so greatly improve workers' lives, we must remember that we are fighting a holding battle, with the effects rather than the causes of our insecurity.
We cannot protect the health of the nation or of the wider world without taking up the struggle against this rotten, parasitic, decadent and moribund system of exploitation itself.