By Colin Leys Allyson Pollock
Tuesday, May 3, 2005
Globe and Mail Update
Living next door to the United States, where half of all personal bankruptcies are caused by medical expenses, Canadians know what a market in health care implies. The Canada Health Act, giving comprehensive and equal coverage to all, was modelled on European, and especially British, principles. And because it effectively bans for-profit hospitals, it gives all Canadians, including the affluent, an incentive to support Canada’s public system. The system has its flaws and imperfections, like everywhere else, but polls consistently show that the vast majority of Canadians value it highly and will defend it.
So no wonder Canadians are astonished that Britain should succumb to pressure from the U.S. government and corporations and turn the much-loved British National Health Service (NHS) into a laboratory for privatization.
For the (mainly U.S.) global health-care industry, Britain posed the ultimate challenge – how to privatize a system that was still mainly under public ownership and control, with strong political accountability. The first breakthrough was into the physical plant and infrastructure.
Back in 1948, all hospitals and most clinics were taken into public ownership. Now, through public-private partnerships (PPPs), public buildings and assets are being transferred to an unaccountable private sector. Instead of building new ones with money borrowed cheaply by the government, the British are building hospitals with money borrowed more expensively by private companies, for which the public nonetheless pays, by leasing back the buildings over 30 years.
The New Labour government of Tony Blair represents this as “extra” investment, money that would not otherwise be available, but its own backbenchers have described it as going to a loan shark. Media commentators have called it mortgaging your future – and your children’s and grandchildren’s.
Emotive stuff – but then the issues are emotive. The impact of financing PPPs, with their heavy extra costs, has been like that of a killer plague, highly contagious and catastrophic. The first wave of PPP hospital schemes required average reductions of 30 per cent in bed numbers as well as 25-per-cent reductions in nursing staff – in order to meet the extra financing costs out of the hospitals’ operating budgets.
The next stage is the privatization of clinical services. The companies bidding for PPPs are teaming up with health-care transnationals to provide clinical services – mainly routine elective surgery (such as cataracts and hip replacements), and diagnostics and radiology. Like all market actors, they operate by selecting the most profitable treatments and patients. This is why routine elective surgery is the first thing to be put into the marketplace.
There is already huge unease about the consequences. Doctors and nurses and other health professionals are beginning to mobilize against the growing role of health-care transnationals. Last month, 95 per cent of the surgeons attending the annual conference of the Association of Surgeons of Great Britain and Ireland opposed privatization and voted for expansion to take place only within the NHS. In their view, the privatization of elective surgery was already adversely affecting the quality of surgery, training standards and access.
Netcare, a large South African company now treating NHS patients, has been found to be turning away 20 per cent of the patients referred to it because of the risk they posed – cherry-picking twice over. Even so, Netcare’s complication rate is higher than that of NHS hospitals, prompting concerns about standards and quality of care.
The implications for future standards are even more serious, because the private companies don’t pay for training. Their profitability depends on operating as fast as possible on “quick and easy” cases – precisely those that trainee doctors need to train on, but which will be seen less and less in NHS hospitals.
There are major concerns, too, about costs – the private companies get five-year contracts for a guaranteed number of patients at a price per treatment 40-per-cent higher than the NHS price, and are paid regardless of how many are actually treated. Recent reports show that that they won’t achieve their contracted numbers.
The privatization of routine elective surgery is a prelude to the creation of a full health-care market, to be regulated by an independent regulator on the basis of purely financial criteria (a banker has already been appointed to the job). The present government envisages private companies providing a steadily growing share of clinical services. The U.S. health-care industry is working hard to see that future governments go further still. For example, Tony Blair’s senior health-policy adviser, and the architect of many of New Labour’s pro-market health policies, quit last year to join United Healthcare, a major U.S. HMO, as president of its European subsidiary, with a mandate to break into Europe’s publicly-financed health-care systems.
British voters are broadly opposed to the privatization policies being imposed on the NHS, but they can’t register this electorally so long as the leadership of both major parties is in thrall to business-school ideology. Canadians should learn from Britain and not let their health-care system be hijacked in the same way.
Colin Leys is emeritus professor of political studies at Queen’s University and an honorary senior research fellow at University College, London. He is the author of Market Driven Politics: Neoliberal Democracy and The Public Interest. Allyson Pollock, a physician, is director of research and development at University College Hospitals Trust, London, and professor of health policy at University College, London. She is the author of NHS plc: The Privatisation of Our Health Care.
