World Socialist Web Site, May 10, 2003


Britain: Parliament backs plans to privatize health care

By Julie Hyland

The Labour government's proposals to further open up National Health
Service (NHS) hospitals to the private sector were passed by
parliament on May 7.

Through the establishment of Foundation Hospitals the government aims
to end the system of centralized control and accountability, enabling
individual hospitals to raise finance from the private sector and
determine their own wage rates and clinical priorities.

The proposals, contained in a new Health and Social Bill, are a clear
break with the system of universal health provision established by the
post-Second World War Labour government and are widely recognized as
such.

Yet the measures were passed for second reading by 304 votes to 230,
after a rebel amendment was defeated by 297 votes to 117.

The government's victory was even greater than the votes suggest. The
Conservative Party abstained on the amendment, arguing that the
government's plans did not go far enough in privatizing health care,
whilst the Liberal Democrats said they favored the plans in principle
but objected to certain aspects of the bill.

Within the Labour Party, just 65 MPs voted against the government on
the amendment, and even this fell by more than half, to 31 MPs, in the
second vote on the Bill proper.

For weeks the media had claimed Blair would face an unprecedented
rebellion by his own party. Just weeks ago some 130 backbench MPs had
signed a parliamentary motion against the bill, whilst the left-wing
Campaign Group and trade union leaders had called on Labour dissidents
to "wreck" the plans.

The actual denouement was, by any accounts, pathetic. Although some
trumpeted it as the "third biggest Commons revolt" of Tony Blair's
premiership, it was in fact one of the smallest by his own side-down
from 139 who had opposed the war against Iraq and even the 67 who had
voted against government cuts in state benefits back in 1997.

In parliament, former foreign secretary Robin Cook, who had spoken out
against Blair's support for the US-led war in the Gulf, came to the
government's defense-praising Foundation Hospitals as the wave of the
future.

Attempting to explain the dismal show of opposition, the media claimed
variously that it was the outcome of extensive cajoling, a fear of
being seen to vote with the Conservatives or the result of government
concessions, i.e., the decision to set aside an additional £200
million to enable more hospitals to reach Foundation status and so
counter the charge that the proposals would create a "two-tier" health
system.

Above all, the media claimed that the parliamentary vote reflected
Blair's increased personal standing in the aftermath of the successful
war against Iraq. Many were simply reluctant to go against a prime
minister who had built up such a level of prestige and influence, the
press insisted.

In truth, the fawning before Blair by the media and his party is not
repeated amongst the population at large. His support for the US-led
war in the Middle East provoked the largest demonstration in British
history on February 15 as 2 million people took to London streets to
show to the world that the prime minister's stance lacked any popular
support. Blair acknowledged this fact, cynically citing public
hostility to his policy as proof of his willingness to "stand firm"
and go against the stream.

The prime minister's open display of contempt for democratic
accountability has only deepened the revulsion felt towards him. Just
days before the parliamentary vote on the health proposals, Labour
suffered one of its largest falls in support in the May 1 elections
for local authorities in England, the Scottish parliament and the
Welsh Assembly. Some two-thirds of the electorate stayed away from the
polls, causing Labor's share of the vote to plummet to just 30
percent, behind that of the moribund Conservative Party.

The result indicates that the majority of the population remain
hostile to Blair on a host of questions, including the war and his
attacks on the welfare state. Any genuine challenge to Blair on an
issue as fundamental as an attack on universal health provision would
draw significant popular support that would immediately expose the
cult of invincibility that Labour's big business backers have
attempted to build up around the prime minister.

Government ministers often complain of the affection in which the NHS
is held by many in Britain-citing it as an example of the kind of
backward-looking nostalgia that must be overcome if the country is to
step into the twenty-first century. Their own ire is directed not at
the very real failings of the NHS-the long waiting lists, overworked
staff and poor facilities that have resulted from decades of
underfunding-but the progressive principle on which health care has
been organised in Britain since the Second World War.

As the "crown jewels" of the social reforms enacted by the postwar
Labour government, the NHS was deemed to be an example of
egalitarianism in practice, guaranteeing health care to all regardless
of their financial status and free at the point of use.

In capitalist Britain, the ideal could never match the reality. Not
even the most egalitarian structure could compensate for, much less
overcome, the health problems generated by a system built on social
inequality. The private drug companies continued to milk the system
and add enormous costs in terms of taxation, while the rich could
still utilise private treatment that occupied a parasitic relationship
to the NHS-using staff it had trained and usually renting access to
facilities bought from the public purse.

But under conditions where prior to 1948 more than 50 percent of
Britain's population had no access to health care, the NHS was
correctly regarded as a significant advance and eminently preferable
to the system of health care in the US, for example, which was seen as
outdated and barbaric.

In line with the right-wing monetarist policies that have come to
dominate official politics in Britain over the last 20 years,
successive Conservative and Labour governments have carried out a
policy of deliberate sabotage against public health care-starving it
of the necessary funds and introducing numerous "reforms" aimed at
resurrecting the profit principle and forcing people into privately
funded insurance-based schemes, creating a financial bonanza for the
corporate sector.

Utilising the poor state of public provision that their policies have
caused, the official parties have sought to ridicule any notion of
equality as simply meaning the right of all to suffer equally.

The plan has not been a success. In a country with one of the lowest
wage rates in Europe, the high premiums demanded by the private sector
are simply unaffordable for most. The private sector covers just 10
percent of the British population. When some are forced to seek
treatment for debilitating conditions privately-as in the case of
joint replacements-they remain dependent on the NHS for virtually
every other aspect of health provision.

Through measures such as the creation of Foundation Hospitals, Labour
hopes to facilitate the takeover of hospital provision by the private
sector and finance providers by the back door.

Not for nothing has Blair decreed that a failure to implement his
health proposals would be a mistake of "historic proportions"-the
equivalent of Conservative premier Margaret Thatcher not pursuing her
policy of selling off public housing in the 1980s.

Blair's intent is clear. Just as Thatcher's "right to buy" policy
symbolised her government's determination to "roll back the frontiers
of the state" and inaugurate a new era of "popular capitalism" and
private ownership of everything from industry to housing, so Blair's
health care bill signifies Labour's efforts to tackle areas that even
Thatcher was unable to touch.

The one difference is that Thatcher did at least enjoy some popular
support for her housing policies, whereas Blair appeals only to big
business and the media. Labour's dissenters have no stomach for a
fight with Blair because their appeal is to the same constituency.
Though some may feel the need to distance themselves from an unpopular
measure, even the dwindling number of "rebels" had no stomach for a
genuine struggle that of necessity must challenge the entire thrust of
government policy and not merely aspects of the proposals of
Foundation Hospitals.