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A MONTH ago, I stirred a hornet’s nest when the Morning Star published my piece titled “It’s time to call out Integrated Care.”
It seems simply highlighting the influence of unpopular US policy was enough to visibly rattle some of Britain’s influencers of public opinion on healthcare.
This “health establishment” backlash involved no attempt to discuss the evidence presented — much of it taken from their own archives — instead resorting to ad hominem attack on the mere idea of raising the issue.
In my article, I cited evidence showing how primarily (though not exclusively) US health interests and those close to them are quietly institutionalising a system that rewards “providers” — not for providing healthcare, but for pruning back local GP and general hospital services, as we’re seeing with the Leicester General Hospital in my constituency of Leicester East.
This system, at first termed “Accountable Care Organisations” (ACOs), has now been rebadged as “Integrated Care Systems” (ICS).
Under its perverse incentives, providers receive a cut of the money “saved” by not treating people.
This is masked by a narrative that claims the primary issue in the so-called “sustainability” and performance of our NHS is lack of funds or resources.
In fact, the issue is one of intentional and strategically managed destruction of the NHS and the universal service it is meant to provide, while what’s left is hoovered up by private health corporations.
This explains why when the Tories throw another few hundred million pounds at the NHS — it goes straight into the pockets of their donors.
The purpose of this policy is to leave people increasingly deprived of the care they need, rationing the NHS to increase profits while the public, like the slowly boiled frog of the parable, sits for too long unaware of what’s being done.
In the US, this arrangement has long been baked into law, ensuring healthcare business growth in a system that is outrageously expensive for the little care it provides and that leaves human misery, poverty and death in its wake.
Distinguished Harvard physician and professor of health policy David Himmelstein has explained that institutionalising such corporate rewards has “driven corporate control of our healthcare system rapidly ahead.”
Himmelstein says the US needs a system similar to our original NHS. A few years ago, he warned Britain that it was going down the same road as the US — and that the ACO/ICS system is how it is being perpetrated, saying: “If that’s the success that one wants, ACOs [now called ICSs] are the way to do it.”
If you’re a campaigning organisation dedicated to removing private business from our healthcare, here is the cold truth: those assisting in the rollout of this deadly system — including MPs — may not even know they are growing the private healthcare industry. They just need to get on board with the carrot-and-stick principle.
At the same time, many have absorbed and regurgitate a narrative that makes money the key issue — far above the people, the system is meant to serve — making health services a problem to be solved not an intrinsic good to be protected and expanded.
This crucial narrative battle led to those online reactions to my article a month ago — a battle that many on the left are unaware has even been fought and a narrative many have swallowed, one that redefines the most controversial, popularly hated aspect of privatisation, bulldozing local NHS services for the sake of cost and profit, as somehow “not privatisation.”
This dry narrative allows the enemies of the NHS — and some of its supporters — to portray the for-profit closure of services as some kind of public-spirited response to unavoidable circumstances.
Those who spin this line throw cold water on the righteous anger of health campaigners who know what is really going on.
The reactions to my article have been standard when anyone raises this subject. When the late Stephen Hawking joined a judicial review against this “Americanisation” of the NHS, the same talking heads rolled out the same tactic to mock and intimidate anyone paying attention to the evidence.
The condescension of the health establishment saw it portray even Hawking as intellectually and evidentially “outgunned,” telling him essentially to “put a sock in it.”
Then, as now, there was no attempt to engage with the fundamental issue: that the system rewards the destruction of our services and claims it is desirable for the public.
Even though, in my article, I pointed to primary evidence and even the health establishment’s own sources, the reaction was not to debate, but to indulge in an attitude of ridicule, which appears to be driven by fear.
The two overriding ideological postures were to deny privatisation — in ICSs and in general — and to deny that we’ve copied the US government at all, again with no attempt to address the evidence of both that had been provided.
To this was added, with the tone of the condescending academic, that privatisation — which supposedly isn’t happening, remember — isn’t the important factor anyway.
Nothing to see here, just move along and believe that the major problems of the NHS are a range of technical issues that transcend politics, so we should let the technocrats get on with it.
Many of these respondents’ own websites show they are heavily involved in helping private healthcare companies find NHS contracts, or that they have an enthusiastic history of encouraging England to imitate the deliberate limitations of US government provision, from Health Maintenance Organisations (HMOs) in Nixon’s 1973 legislation or the renamed “ACOs” of Obamacare.
Some of these critics had even co-hosted high-level US-UK talks on the subject; another think tank, in an earlier incarnation, brought in people behind Nixon’s HMO legislation to successfully influence Thatcher, then Major’s, internal NHS marketisation — a move that culminated in last year’s ICS legislation.
With a scoff and a pat on the head, we were being told to ignore the evidence — from their own publications — of US policy influence and the revolving door from private healthcare to “NHS” bodies created by Andrew Lansley’s 2012 Act. Solid data that their own organisations openly share was dismissed or denied.
And this was not done just by the “usual suspects” of shadily funded lobby groups, but by “serious” sources that elected officials often base their judgements on.
Let’s be charitable about the motives of some politicians: if you are told by apparently impartial sources, heavily involved in key areas of healthcare research, that a programme of hospital closures, designed to keep the lucrative areas of care and jettison as much as possible of the rest, is in fact a response to a crisis of old people supposedly clogging A&Es, who are you to say any different?
This selective narrative reflects government policy, and is also in tune with how that policy is framed to NHS managers and councillors — and because of who the sources are, the left, including some NHS campaigners, may buy into it.
That is a huge strategic and tactical error. Right-wing politics is hegemonic in Britain and their form of the NHS must be fought and exposed, not adopted.
It cannot be allowed to be treated as common sense, with too few voices from the left or from the public majority that backs the NHS’s original purpose, challenging corporate influence as the core problem it is.
The question is simple: do we want underestimated problems and sticking plaster solutions, or do we explicitly demand the full rights our original NHS gave us?
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