Corbyn ‘deeply suspicious’ of Boris Johnson’s NHS plans

The NHS is good context in which to trash neo-liberal assumptions even though that pernicious doctrine might not gain explicit mention. The reason is twofold. First, almost every citizen (sorry, I meant subject of the crown) has general understanding of what the NHS does and has come into contact with the NHS. Second, tensions between profit motivation and servicing societal needs are easily drawn out, particularly when comparison is made to USA arrangements for healthcare provision. Once the principle is grasped it is transferable to discussion of public services (e.g. welfare and libraries) in general, and public utilities (e.g. gas, electricity, rail, and the Internet) specifically. Although knowledge and reasoning skills are in short supply in the general population (in part an unintended consequence of Labour policies) it does not mean the public is ineducable.

I favour a mixed economy similar to that before Mrs Thatcher took office. Private enterprise, kept within bounds, offers innovation and possibility of quality goods and services when subject to competition; in that setting, return of investment and profit are motivators in keeping with human nature. Lest I be misunderstood, excluded from that rosy view are conglomerates, banking and financial services (as nowadays configured), most multi-national enterprise, and rent seeking based upon so-called ‘intellectual property’ in context of monopoly distribution.

Profit motivation, when there is competition, is benign so long as business recognises general obligations to the society hosting it and takes responsibility for undesirable ‘externalities’. Unfortunately, the current mantra in business schools is ‘profit maximisation above all else’; this being partly responsible for, or a concomitant of, market-capitalism being moribund and in need of rebooting along lines Adam Smith would have understood.

Publicly owned services ought be under a regimen of attaining clearly stated goals using their resources as efficiently as practicable. Yet, ‘practicability’ need not entail ruthless financial efficiency; for example, the NHS cannot cherry pick services on basis of cost-efficiency (and profit maximisation) in the manner of the private healthcare sector; it must offer what to the private sector would be loss making services. Argument that socialised healthcare is inherently inefficient because of lacking profit motivation is arrant nonsense; its allocated resource does not require topping up with a ‘margin’ to be distributed among share holders. Nevertheless, during the past forty years the NHS has been burdened by practices, and incentives to individuals styling themselves CEO, inappropriately borrowed from the world of big business; those stultifying influences pervade other tax payer dependent institutions too e.g. universities.

However, none of the above precludes a role for private enterprise in healthcare delivery. The NHS buys equipment, general consumables, and pharmaceuticals from the private sector. Bought-in services with direct patient contact, e.g. diagnostic, may sometimes be justified because they enable overall more efficient use of NHS resource. Yet, there must be no presupposition of the private enterprise route being preferable. Moreover, diagnostic and treatment services must be highly specific in nature; precise aims, objectives, and quality control must rest with the NHS; otherwise an outside contractor may juggle a host of responsibilities in order to maximise profit.

It’s argued socialised healthcare need not ‘own’ plant and staff in order to deliver quality healthcare. Whilst logically plausible there remains the fact of meeting middleman margins; this especially pronounced when access to care is mediated by insurance schemes, this despite premiums being met by central government. That said, in context of the USA it would be financially and politically infeasible to take all care delivery organisations under public ownership; despite that, if overall funding were to come from federal and state budgets, and somehow cutting out the insurance industry, there could be considerable gains in cost-efficiency; these enhanced greatly if individual states or the federal government used buying power on behalf of contracting healthcare provision services for purchase of ancillary consumables (e.g. pharmaceuticals).

Mention of the USA was made to drive home a key point of difference between the USA and UK should the former adopt socialised healthcare. The NHS already owns most of its plant and staff. It would make no sense to privatise that and introduce a tier of profit: the USA has little choice. The UK private finance initiative (PFI) is widely regarded as disastrous. Foolish politicians, perhaps with their hands in the till, negotiated ruinous terms for private funding input to NHS plant. That is a matter for Mr Corbyn to address; maybe by taking back into public ownership without further payment plant for which the private sector has cumulatively made what by normal standards would be considered handsome profit i.e. profit not commensurate with the zero risk taken.

The NHS shall be a key issue at the general election. Fortunately, it serves well as an object lesson in the malign potential of neo-liberalism and the grasping anti-social nature of its proponents.

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Released under the Creative Commons Attribution 4.0 international license (sic).

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Author’s email: [email protected]

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