In America Obamacare, reforms to the health system of that coutry has been called “creeping socialism” by the free-marketeers and the American public has been barraged by propaganda against any form of “socialized medicine”. The problem of medical costs for people in the United States is a severe and often tragic one. In the UK we possess the much acclaimed National Health Service. The NHS is very far from perfect, but it works far better than the health system in the US, where almost all care is bought and sold in the market place. The NHS is the centrepiece of the welfare state. For over 90 percent of the population it provides their only access to health care. It is immensely popular, despite its inadequacies. The well being of workers concerns the ruling class and, for sure, this is reflected in the priorities of the NHS. Acute medicine for the able bodied of working age is better funded and includes the most prestigious areas of medicine. Those caring for the elderly and the physically and mentally handicapped remain the “Cinderella” services.
The National Health Insurance Scheme started in 1912, it was decided to pay the money to the different health insurance agencies already in existence. Some were cooperative undertakings, some were run by trade unions, and some by insurance companies, so that there arose the anomaly of a national, compulsory insurance scheme being administered through separate, private insurance organizations. The benefits tended to vary. Employed workers were covered by but not their wives, children and other dependents. A sick insured worker had the care of a doctor and free medicine, but none of the ancillary necessities were provided – X-ray, hospitalization, surgery, etc. Low wages and recurring unemployment made even care by a doctor and free medicine a doubtful blessing for the average worker. While the sickness benefit remained fixed by law, some of the wealthier organizations gave additional services, dental care, eyeglasses and so on, while the poorer ones gave only the minimum. There were also local health authorities which were responsible for certain aspects of public health These included clinics, midwifery, maternity and child welfare, water supplies, sewage and refuse disposal, control of epidemics and the provision of domestic help for families unable because of illness to look after themselves. The main difficulty lay in the fact that there were over 400 authorities, many of them too small and too poor to carry out their functions. As a general rule, medical help received by this means was not of a high standard.
In 1942, Sir William Beveridge, a Liberal member of Parliament, proposed a comprehensive health service which would “ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it...”
The Labour party steered the necessary legislation through parliament and in November 1946 the National Health Service Act became law and came into effect on July 5, 1948.
The National Health Service is available to every man, woman and child in the country without any qualification. Everyone is free to choose his or her own doctor and the doctor is free to accept or reject a prospective patient.
The NHS was regarded as a charge on national income in the same way as education and the armed services. It is recognized that it is as necessary to spend money on healthy bodies and minds as it is to provide education for the people. Welfare provision is contradictory. On the one hand it benefits workers but on the other it also reflects capital’s interest in the reproduction of labour power. The state represents capital’s interest in maintaining the conditions for the reproduction of labour power, but this imposes a cost on capital. There is a constant tension between the desire for healthy, well trained workers and the costs of such provision. In 1951 the Labour government, introduced legislation imposing charges on dental treatment. The following year the Conservatives added additional charges to the service. Pricing has been expanded over the decades by both parties but nevertheless remains largely a “free” service available to all. The priorities of the NHS have no bearing on what patients can pay – only to what they need.
“The National Health Service is the envy of the world.” said Enoch Powell, minister for health in 1962.
“The National Health Service is safe with us.” said Margaret Thatcher, prime minister in 1983.
The attack on the NHS today takes two forms. The first is the outright demand for privatisation of the entire health service and a full return to the market where people who can’t afford medical fees don’t get treated. The other attack pretends to favour the principles of the NHS but then argues for the gradual erosion of those principles by moving towards a two-tier system, a private insurance model for wealthier patients while leaving the NHS the unprofitable areas of care, for the chronically sick, the mentally handicapped and the like.
The NHS is a very good example of a past reform vigorously opposed by conservative forces such as the doctors lobby, the BMA, at the time. It was very much in the interests of the great mass of the people, and especially of working class people. It was also, from the beginning, something of a compromise, but a compromise more in our favour than otherwise. Despite all its faults the principles the NHS incorporates are socialist ones. There will always be some system of priority and how is the NHS rations is on the basis of need. He or she who needs more, gets priority over him or her who needs less. It is not rationing by the size of a person’s wallet or purse.
With the deepening crisis of capitalism it is now the National Health Service is fighting for its life. “Saving” money is seen as important, however, reducing the profit level of the multinational drug companies is no part of plans. The NHS continue to allow brand name drugs to be prescribed when generic prescriptions would lower costs. While pharmaceutical company profits have risen enormously the original conception of the NHS has been quietly abandoned.
Attacks on the health service are deeply unpopular. One of the easiest ways of dismantling the NHS is to impose strict budgets and make the working conditions and pay so unattractive and unrewarding that it literally becomes impossible to staff it. Closing a ward here and a ward there, or shutting this or that local hospital and no-one notices that it is gone until it is too late.
As critics of reformism, the Socialist Party are not, of course, opposed to particular reforms. But it has to be understood that no gain is permanently guaranteed so long as the means of production remain in the hands of the capitalist minority. The never ending struggle to protect the benefits of the National Heath Service is proof of the pudding. To permanently achieve a decent society we must break the power of the capitalist class.
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