Academic journal article Capital & Class

Capitalist Care: Will the Coalition Government's 'Reforms' Move the NHS Further toward a US-Style Healthcare Market?

Academic journal article Capital & Class

Capitalist Care: Will the Coalition Government's 'Reforms' Move the NHS Further toward a US-Style Healthcare Market?

Article excerpt

Introduction

For almost three decades, the NHS has moved away from what Hart (2006: 1-9) described as a 'gift economy', in which care was free on delivery and no market dictated priorities, along a route he described as the 'relentless subordination of the NHS to industrialisation on business lines'. Yet even stern critics of this process, such as Pollock (2005), Hart (2006) and Lister (2008), admit that the NHS has not yet approached the market-centred, profit-driven, model that dominates the US healthcare industry. Despite its internal market, provider-purchaser division, increasing fragmentation and 'payment by results', the NHS remains to date a state-funded public service rather than a capitalist industry. Medical services remain free on delivery for everyone, and competition from the private providers remains more or less marginal. Healthcare provided by the NHS is not yet a true capitalist commodity, despite the commodity chain structure behind it.

The Coalition government's White Paper, Equity and Excellence: Liberating the NHS (Department of Health 2010), however, promises to take the NHS, at least in England, substantially closer to a true market system in which hospital foundation trusts become free standing, competing 'social enterprises', GP's are organised in consortia which are free to 'buy in support from ... private and voluntary sector bodies', and 'there will be no bailouts for organisations which overspend public budgets' (Department of Health, 2010:11, 29, 36). State funding will continue, but the growing emphasis on purchasing private care and seeking private customers raises the question of whether capitalist market-relations will, in fact, erode the state 'single-payer' nature of funding that prevents UK healthcare provision from becoming a capitalist commodity.

In order to answer this question, this article will look at what makes healthcare a true commodity; examine in some detail the US healthcare industry, with emphasis on its hospital sector, before and after the Obama reforms; look at how far the NHS has moved toward privatisation and market relations to date; and examine the Coalition government's 'reforms' in more detail to determine the extent to which the potential exists for healthcare services to become true commodities in the UK. The research is based on numerous academic, research institute and government studies, analyses and statistics.

Healthcare as commodity

Healthcare is not inherently a commodity, any more than are scores of other goods and services that capitalism has subsumed. But as Braverman (1974:188) has argued, 'the capitalist mode of production takes over the totality of individual, family, and social needs and, in subordinating them to the market, also reshapes them to serve the needs of capital.' Hart (2006: 235) argues, 'Marketable commodities can include health care, education, sport and every other cultural and creative activity.' Marx agreed when, in Theories of Surplus Value, he criticised Adam Smith for confusing the 'corporeal reality' of a commodity with the 'materialisation of labour' in the commodity 'as a definite quantity of social labour' (1963: 171-172). What is fundamental in Marx's analysis of commodity production is that the commodity conceals its social essence: the relation of capital and labour. The ordinary consumer, like the neoclassical economist, sees only the use value and exchange value. The universal content of socially necessary labour time is invisible. But it is precisely this that produces a value beyond that required to reproduce the labour power expended that makes the commodity a capitalist commodity. Providing, of course, that it can be successfully exchanged for money in a market. How does healthcare become such a commodity--or rather, how do the many forms of labour that produce various medical services become commodities?

Obviously, it is more than the simple exchange of money or in kind services for medical services, which has gone on for centuries. …

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