Britain’s Conservative/Liberal Democrat government has set out plans for the destruction of the National Health Service as a universal and comprehensive service free at the point of delivery.
The NHS Bill introduces a competitive market-based system, in which health care will be rationed. Health care will no longer be centrally controlled. Each hospital or NHS Trust will be able to set up joint ventures with the private sector. The bill also abolishes the duty to provide a comprehensive health service and to ensure equality of access. Instead, consortia of General Practitioners will arrange for such services as they deem necessary, based on their budget. GP consortia can enter into arrangements with private providers and will be able to charge patients. Twenty-three for profit companies already run 227 GP practices.
Local authorities can also be required to take over NHS functions, at a time when their budgets are being slashed to the bone.
The bill exposes the Conservative/Liberal Democrat government’s lies--centred on the assertion that the NHS is “ring-fenced” from the impact of its draconian cuts in public spending. Workers will soon find themselves entitled only to a basic menu of treatments, as under the US system of managed care, and ultimately will have to depend on an insurance-based system. These measures will cost tens of thousands their good health, even their lives.
Like every attack waged on working people, the frontal assault on the NHS has been conducted with the active collusion of the Labour and trade union bureaucracy. The privatisation of the NHS began under Margaret Thatcher’s Conservative government in 1989-90, with the introduction of the “internal market”. But this process went far further under the last Labour government.
Under the banner of “modernisation” and “patient choice,” Labour set up Private Finance Initiative hospitals, privately run clinics for specific treatments and other measures that funneled vast sums of money to the health businesses. As for the trade unions, a few one-day strikes were held for the first time in nearly 20 years in 2006 and then not much else. A three-year no-strike agreement was reached in 2008.
The shared aims of the Tories and Labour was highlighted by the comments of Mark Britnell, the head of health at accountancy giant KPMG, at a conference in New York organised by the private equity company Apax. Britnell stated that the NHS will be transformed into a “state insurance provider, not a state deliverer” of care. This offered a “big opportunity” for big businesses: “The NHS will be shown no mercy, and the best time to take advantage of this will be in the next couple of years.”
Labour attacked the Tories because Britnell was a member of Cameron’s “kitchen cabinet” on health-care reform. But Cameron was able to counter that Britnell was previously involved in drawing up the Labour Party's NHS plan in 2000, “including the role of the private sector”, and was appointed the director general of NHS commissioning under the Labour government.
The working class is involved in a fight unlike any other in living memory. The creation of the NHS by the 1945 Labour government was viewed as crucial in slaying one of the “five giants” identified in the Beveridge report that became the template for the post-war welfare state—Want, Disease, Squalor, Ignorance and Idleness. Its destruction heralds a major step along the road to a society where these giants are again crushing working people under their heel.
The NHS bill stands at the centre of the £100 billion cuts package that constitutes a social counter-revolution setting out to obliterate all of the gains made by working people over the past century. Driven initially by the determination to claw back the billions upon billions handed over to the banks in the aftermath of the crash of 2008, the aim of Britain’s rulers and their parties is to engineer a fundamental shift in relations between the classes in favour of the super-rich.
This is an international phenomenon. The austerity measures in the UK are matched by similar programs in Greece, Ireland, Portugal and Spain. These and other European countries face bankruptcy in order to feed the rapacious demands of the bankers and speculators, whose criminal activities plunged the world into an economic nightmare without parallel since the Great Depression.
Along this road, there is no end in sight. Each blow suffered by workers of one country only whets the appetite of the world’s ruling elite for more.
The Tory cuts programme will leave the UK with a lower proportionate level of public spending than the United States—a country whose rudimentary welfare system has long been viewed in Europe as a disgraceful example of unfettered, brutal capitalism. But the Obama administration, with Republican support, is making gargantuan cuts, including slashing trillions of dollars in Medicare and Medicaid, the already minimal health programmes for the elderly and poor. Already almost one-third of Americans under the age of 65 have been without medical insurance at some point during the past two years. After Obama’s cuts, this is set to top 50 percent.
The working class has no choice but to rise to the challenge it now faces. Combating these attacks poses fundamental questions of perspective and programme. The necessary starting point is recognition that the ruling class has broken irrevocably with the previous policies of social compromise and is waging naked class warfare. Workers have to respond in kind.
The NHS and the entire panoply of welfare measures enacted following World War II were portrayed by Labour, the trade unions and the Stalinist Communist Party as proof that capitalism could be made not only into a more humane system, but reformed to such an extent that society would eventually arrive at a peaceful, parliamentary road to socialism.
This claim served to hide the basic truth that all the reforms won by working people in Britain, Europe and throughout the world were the product of huge social and political struggles. Ultimately, they testified to the fear within ruling circles of the spread of social revolution and a repeat of the events unleashed by the First World War that led to the 1917 Russian Revolution.
It is a claim, moreover, that now lies in ruins. The decades-long domination of the working class by these rotten bureaucracies is, in fact, directly responsible for creating the political conditions for the offensive now being waged with such ferocity. This offensive began in earnest following the destruction of the Soviet Union and the restoration of capitalism at the hands of the Stalinist apparatus. This was to be the signal for the proclamation of the “death of socialism” and the embrace of market-fundamentalism by the parties of the so-called “left” and the trade unions, which has to this point left workers with no means of fighting back.
The working class must now consciously reorient its struggles based upon the revolutionary socialist perspective that inspired the October Revolution. There is no solution to the present crisis outside of the mobilisation of a mass political and social movement of the entire working class against the profit system and its defenders—the Tory/Lib-Dem government as well as the Labour and trade union bureaucracy and their appendages in the various ex-left groups.
This is an international struggle, demanding a unified offensive against globally-organised capital by the workers and young people of Britain, Europe, the United States and the entire world. The goal must be the creation of workers’ governments that will ensure the democratic management of the economy to meet the essential social requirements for decent and well-paid jobs, healthcare, education and housing.
Above all else, the working class requires a new and genuinely socialist leadership that will defend its interests with the same radicalism and determination that is presently only evidenced by the political agents of big business.
Chris Marsden