Yet Another Blow for the National Health Service in England: A Doctors’ Strike, The New York Times, Jan. 3, 2024, by Mark Landler
Thousands of young doctors walked off the job in England, dealing another blow to the country’s already-reeling National Health Service and raising concerns about a cascade of cancelled medical appointments and surgeries.
The junior doctors have been seeking a 35 percent wage increase, which they say is needed to counteract a more than 25 percent cut in real wages since 2008.
The waiting list for procedures at N.H.S. hospitals has reached 7.7 million people, up from 4.6 million people before the coronavirus pandemic. Prime Minister Rishi Sunak pledged last year to cut waiting times, making it one of five bedrock goals of his conservative government. Instead, the list has lengthened by 300,000 people.
The doctors complain about long hours, relentless pressure and pay that has failed to keep pace with double-digit inflation, though that has eased recently – issues that have afflicted other health systems, including those in the United States.
Comment:
By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.
For the past few decades, we have recognized that the health system in the United States is the most expensive of all nations, while falling far short on measures of quality, comprehensiveness, equity, and universality. Many studies show that we could greatly improve coverage and access while saving money by enacting single payer financing. Health care would be affordable and available to everyone. Single payer models include Canada’s public insurance approach with mostly private providers, and Britain’s National Health Service, built largely on government ownership of care delivery.
However, the news of the UK doctor strikes reminds us that there is a major roadblock to adopting and effectively implementing single payer: the nexus of conservative politics and corporatization of medical services. Two nasty, interacting c’s.
We’ve reported on how conservative, corporate-influenced policies in the UK precipitated the current crisis. Note, this is conservative with a small c, both Tories (the worst offenders) and Labor (seriously complicit). Neo-liberalism undermines the public orientation of the NHS.
In the US, while we may dissect why we have not enacted single payer, it is largely due to conservative political opposition and to both conservative and moderate political support of market over government approaches to health insurance and care provision. Tragically, this preference for the market created the severe deterioration in health care services that we see today.
Those paying attention are painfully aware of the harm done by using health care dollars for the primary mission of personal wealth enhancement rather than improving the health of our population. This is exemplified by private equity’s leveraged purchase of delivery system sectors (e.g., physician groups) to capture wealth for the investors – patients and providers be damned.
Unfortunately, widespread corporate for-profit ownership of health care delivery will likely undermine single payer functioning. Thus, single payer alone would be inadequate. Far too large of a percentage of our health care delivery system is now owned by those motivated primarily by profits rather than by patient care.
So, instead of private, for-profit control of the delivery system, what about non-profit community ownership? Community hospitals and primary and multi-specialty clinics, dialysis clinics, and long term care. Couldn’t we do this on a community basis yet have it funded equitably via national single payer? Functioning like a national health service but with more local control.
What lesson does the current British NHS boondoggle provide for us in today’s fraught political environment? The UK experience demonstrates that public insurance and public ownership together are inadequate, if politicians don’t sustain it. Also in the US, even with a Democratic President, the private actors have too much sway. Biden, who called Obamacare a BFD, strongly supported private health plans in the exchange and in Medicare. Although there are recent baby steps to regulate Medicare drug prices, Medicare Advantage is running amok.
That’s bad enough. But imagine a government health system under the control of Trump appointees. No more constraints on exploitive corporate behaviors. No more attention to real health insurance needs. A deadly free-for-all. Oh, and also – no more democratic governance norms.
Whoa! The first task before us is to elect a government that cares about us – all of us. This may seem like a formidable task before us, but we have to do it! See 13 New Year’s resolutions in pursuit of this essential goal. From there, we must galvanize communities to fight for greater control of health services.
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