It’s not a simple matter for a western democracy to lose a public health system. Citizens strongly support tax-funded public systems. In Canada, we believe it to be one of our defining features.
Yet in England the National Health Service (NHS) is being gradually eroded and taken over by giant U.S. health maintenance organizations (HMOs) and run increasingly on market principles.
What is more frightening, is the gradual approach in England has strong parallels to Canada.
UK professor Colin Leys has documented this transition from a public health care system to a market-based one in his new book, “The Plot Against the NHS.”
Meeting with a group of health care activists May 16 in Toronto, Leys pointed out the irony of the U.S. having the most inefficient health system in the world and exporting it now to other countries.
Leys said that current initiatives of UK Prime Minister David Cameron’s government were made possible by a decade of gradual market initiatives under the Labour government of Tony Blair and Gordon Brown. While Scotland and Wales have turned back towards a more public system, England continues the march towards a more Americanized system.
Cameron’s new health care bill would leave it up to consortia of doctors to determine how public health care funding is spent. Many of these consortia are in fact owned by private for-profit companies such as the U.S. health care giant UnitedHealth and Virgin, better known for operating record stores. Given doctors have little or no experience in buying or “commissioning” health care services, private firms are moving in to take up this role.
The ability of these general practitioner commissioning bodies includes discretion over what services they will buy and which should be publicly available.
That includes buying public health services from “any willing provider” approved and registered by the system monitor.
“The bill also removes the duty of the Secretary of State for Health to provide a National Health Service,” says Leys.
What has angered many in England is the fact that Prime Minister Cameron has done this without any discussion of the bill in the UK’s last election.
In fact, “Cameron promised no more top-down reorganizations of the NHS,” says Leys.
Leys says the new bill will mean the loss of comprehensiveness through delisting – something the professor says is already taking place.
It is also likely the bill will pave the way for more user co-payments as cash-strapped health foundations respond to cost pressures.
Leys says that while Cameron “pretends” to exempt the NHS from cuts, the reality is more of the system funding is being siphoned off into “social care,” creating a net real cut.
The new bill also takes a cap off of the number of private patients English hospitals are allowed to take on, shifting the hospital model to focus on raising money through more private patient income.
Many doctors assumed that because their trusts are no longer answerable to the Department of Health that there would be more freedom from bureaucratic control, says Leys. Instead they are now even less free under the new private model.
While many of these shifts to market-based health care were taking place under the labour government, the UK government dramatically increased public funding to more closely resemble their peers in the rest of Europe. The results were improvements in wait times that were mistakenly attributed to increased privatization.
Leys says there are many holes in the new act, including no provision for failing hospitals.
Nor is there any approval process when a private company sells their assets to another.
The debate rages on in Britain. The Royal College of Nurses has passed a no-confidence motion in the plan, which has in turn stiffened the resistance of many of the country’s doctors, says Leys.
Given the complicity of the Labour Party in setting up these reforms, the official opposition has been noticeably muted in its criticism.
Cameron has recently told the media he would not allow private companies to cherry pick the NHS, that there would be no privatization, and that patients would experience no up front costs.
Within days of promising this, news reported that the Labour Party leader would have to pay for surgery on his nose because it was considered to be a low priority for his local health care trust.
The Ontario government has closely followed the path of health care changes in the English NHS. At present Jim Easton is touring the province speaking to groups such as the Ontario Hospital Association and the Ontario Association of Community Care Access Centres.
Easton is the NHS National Director for Improvement and Efficiency. It has been his job to cut billions of pounds out of the NHS.
The timing of Easton’s tour suggests the McGuinty government is seriously considering rolling back health care costs on this side of the Atlantic too.
Given years of Ontario’s own changes to a market-oriented health system, we may be paving the way for similar reforms should Tim Hudak’s Tories come to power.