Issue 191 of SOCIALIST REVIEW Published November 1995 Copyright © Socialist Review
The argument that we cannot afford the current welfare state was put most clearly by the Healthcare 2000 report published in September. This asserted, 'Finite resources are under pressure from demographic change, scientific and medical advance and rising consumer expectations.' It concluded the solution lies in rationing, forcing more people to go private and making patients pay for more of their NHS provision.
It is no impartial report. Healthcare 2000 comprises a committee chaired by Sir Duncan Nichol, knighted for introducing the market to the NHS and who now works for private health company Bupa. And the report was sponsored by a consortium of drug companies.
Healthcare 2000 dismisses as irrelevant the fact that Britain spends less on health than any other leading industrial economy. Then it effectively suggests the NHS be reduced to a 'safety net' for the poor, ignoring the evidence of the US where such a system already exists.
The fact is that 7.1 percent of GDP goes on health care-- 5.9 percent to the NHS, the remainder to private companies like Bupa. The US spends twice as much, France half as much again. In Europe only Portugal and Greece spend less.
The meat of the report lies in its claims that developments in science and techonology, allied to the growing proportion of elderly in the population, are leading to demands that cannot be met. Is this true?
The claim that technology is putting unbearable strain on the NHS is ludicrous. Advances in medical technology hold out the prospect of treating more people, more quickly and cheaply. The equipment is often expensive. But this is not a question of the technology itself--rather, of who controls its production and use.
Kidney dialysis has been possible since the 1940s, for example. Yet there have never been enough dialysis machines. There is no shortage of computers. Why aren't kidney machines knocked out on a production line in the same way?
The advances in understanding disease, the 'medical imaging' that will allow long distance consultations, the miniaturisation of equipment and of new surgical techniques are things to welcome.
There is no bottomless pit of demand, as the 'experts' insist. The overwhelming majority of us will never need a hip replacement or heart by-pass operation. The waiting list of those in need of transplant surgery, for example, is double the annual number of operations. Yet there are only 6,000 on the waiting list 'demanding' a transplant.
What there is, instead, is a reservoir of untreated ill health. A report by the government's own chief medical officer in September warned that escalating shift work, overtime and weekend working--along with short term contracts and casualisation--are causing rising rates of heart attack and other stress related illness.
The area of NHS spending with the fastest rising budget, however, is not high tech equipment. It is drugs. Around 13 percent of NHS cash goes on pharmaceuticals, and prices are consistently rising faster than inflation.
The big pharmaceutical firms are among the most profitable section of world capitalism. The government officially allows them a 21 percent profit on their 'investment' in dealings with the NHS. Yet the real profits are concealed by a scam called 'transfer pricing', whereby companies overcharge their own subsidiaries.
In 2041 around 24 percent of the population will he over 65 and there will he fives times as many people in their 90s as today. At current rates of health spending, this would require a 17 percent increase in the NHS budget--equivalent to 3.8 percent of GDP. So slowly increasing health spending over 50 years to the level of France today would take care of the old for the next half century.
The salaries of general managers in the NHS came to £498 million in 1993, double the total in 1991 and 16 times that in 1989.
In 1993, £369 million went to private health firms and business consultants. Some £1,699 million went in interest payments to banks on mortgages and loans for buildings and equipment.
A deal like that of Eurotunnel, which has suspended all interest payments for two years, would equip the entire NHS with a year's clinical supplies and build 20 hospitals.
Ian Taylor