As Aneurin Bevan, the creator of the NHS in England and Wales in 1948, said, “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.” We apply the same principle of solidarity to state education or welfare payments and the arguments for a national health service are more or less the same as for other forms of solidarity within a community.
Margaret Thatcher famously said that there is no society, only individuals. Were this true, it would be a sad and depressing reflection on humankind. But it is not true: we are social animals and become dysfunctional the more isolated we are.
Most people in favour of private health care pay at least lip service to the notion that the national health service should be maintained.
But...
The very existence of private health care undermine the principle of solidarity, one of the most precious foundations of our coexistence with other beings. Do we really want to return to having to avoid others in the street for fear of their carrying dangerous diseases that they cannot afford to have cured?
Bill Gates used to have a huge public image problem, arising from his unattractive personality, his criminal undermining of all competition to Windows (and its awful browser), his sullen and shifty performance in the the US anti-trust court case against him, and his ubiquitous and horrible OS and browser. That was until he took advantage of the neoliberal creed that the wealthy managed to foist on us of hardly taxing the very rich. His soaring wealth allowed him to reinvent himself as a health expert and philanthropist. Luckily for him, all that giving was mostly to his own organisations or those he controlled, and it always worked towards his own interests (of gaining power over 99% of the world) so that, although Microsoft is only 20% of his portfolio, his wealth has doubled during these years of "giving", from $50 billion to $100 billion over the last decade.
There are Irish companies belonging to Inditex that report millions of euros in turnover, but do not have a single employee on the payroll and paid no corporate tax at all.
Ortega is worth more than 62 billion euros, and his yearly dividend is around 270 million euros per year or, if you like 739,726€ per day. Just 514€ per minute, every minute of every day of the year! He donates from time to time to the health service in specific machines - mostly inappropriate for the public health service and requiring expensive maintenance - or surgical masks, gaining huge popularity. His donation, made possible by starving the Spanish state of the taxes it should receive and by ensuring that Spain's unemployment rate is never mitigated by his company, is always specific, never in cash, and never democratically accountable. It gives him an incalculable value in cheap publicity at an insignificant cost.
Worse still, as these donations reduce his tax bill, a substantial sum of money comes out of the public purse to pay for these generally useless so-called gifts, should they be accepted. As they say - and, pertinently, was first documented as being put into common parlance in the 1930s during the Great Depression -, there's no such thing as a free lunch (TNSTAAFL).
Philanthropy does not, and cannot, substitute for a proper, solidaristic State. State institutions, when they work, when they have not been undermined and infiltrated by rich, vested interests, protect against the venal interests of particular individuals. Both Gates and Ortega have no medical nor medical research training, yet are able to use their tremendous wealth in order to pressure governments into buying into their agenda. Neither support, either ideologically or economically, the national health service. Gates has received huge pledges of money from most western governments in order to fund the vaccine he intends to use on the entire world population against Covid-19 (excluding his own family, I have no doubt). They will start with Africa, I suspect, although Africa really does not have a problem with the coronavirus. Yet.
As we have just seen, the private health services do NOT generally cover serious new infectious diseases, be they Covid-19, Sars, Mers, Ebola, HIV, tuberculosis..., nor do they cover pre-existing illnesses. New minor ailments are covered but the yearly premium quickly becomes prohibitive once they become serious or chronic. Private health services scrimp on personnel costs, often employing trainees and insufficient qualified staff. When things go wrong, as they often do, patients are frequently transferred to the public hospital, at public cost, never the other way round, and the public sector ends up with patients who may need very expensive life-long treatment, often as a result of mala praxis or incompetence while in private care.
For years, governments have been stealthily selling off the NHS, sending patients for minor treatments to private clinics and paying these clinics for the service. The private clinics make a profit (that is what they are there for), money that should have been saved or invested into the public sector. The public sector increasingly ends up with a disproportionate number of poor, very ill, or chronic patients, making its cost per patient far higher than the private sector's. This leads it to be criticised by unscrupulous people who can then justify further privatisation.
The Centre for Health and the Public Interest claims that post-operative care is generally carried out by a junior doctor, one who is working up to 168 hours a week without supervision.
The criminal surgeon Ian Paterson, who treated more than a thousand patients fraudulently at private hospitals under Spire Healthcare and carried out useless, life-changing operations where many of his patients died and hundreds were mutilated, cost the NHS more than £17m in compensation to victims. Patients were referred to him due to the NHS's long waiting lists, following decades of intentional mismanagement of the NHS, despite Ian Paterson having a dubious background and previous suspension. He was ultimately sentenced to 20 years' prison, and his motive is assumed to have been simply to earn more money.
As Noam Chomsky famously said, "That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital."
Such is the incentive to make a profit and line some specific pockets that in Madrid during the Covid scare the authorities dolled out free masks, overalls, gels and the like to the private care homes, valued at 3.2 million euros; and sent many patients to these private centres although there was room in the public ones, costing another million euros. At the same time the overwhelming proportion of deaths was in the private care homes, where many patients were isolated, abandoned, and purposefully not given treatment for illness, nor water, nor food. These deaths tended to be of old people over 70 years of age, in private macro-'care' homes, while the small public sector homes had much better outcomes. Private 'care' and hospitals cost up to six times more than public sector ones.
Other surgeons, like Dr Arackal Manu Nair who carried out unnecessary prostate operations at Spire Parkway private hospital in Solihull, have also been suspended after years of abusing patients, years too late for their victims, due to lack of oversight and the way that doctors are outsourced and allowed to have private practices elsewhere.
In small, fragmented clinics, consultants, who carry out the surgery, do not hang around to look after their patients afterwards but disappear home. Private clinics often do not have intensive care facilities and, if they do, they may well not have sufficient qualified staff permanently on hand. The transfer to a public hospital also transfers a large cost to the public sector and, at the same time, further endangers the patient's life by the transit.
In 2018, a report by the CQC into the independent sector was scathing. It found two in five private hospitals were failing to meet safety standards. In particular it raised a major concern into the lack of effective oversight of consultants "working" for the hospital but not formally employed by them. It also said there was not enough reporting of serious incidents or transparency when something went wrong.
Mr Patterson worked independently, the private hospital he worked at did not employ him (clinicians are effectively freelance) and he had his own insurance.
So, when something went wrong, as it so cruelly did, the hospital was able to claim it was not liable (though Spire healthcare has paid out some damages to some patients as has Mr Paterson’s insurance company, but the victims had to fight tooth and nail to get it).
The public health system often seems expensive not only because it treats the most expensive patients (and continues to do so even when extensive private healthcare is available), but also because it incorporates safety and quality procedures and maintains permanent in-house staff. The private sector charges far more in fact but will always end up cutting corners, because it exists in order to make a profit, the larger the better. The US has a highly privatised healthcare system that per capita is the most expensive in the world, yet the US is ranked number 38 in life expectancy.
But far more insidious is the fact that private healthcare starves the public sector of its resources. Imagine if $9,892 per person were used for a public sector healthcare budget in the US. Instead, the biggest cause of personal bankruptcy in the US is medical treatment, despite the country's huge healthcare cost. And yet, over 6 decades, surveys have repeatedly shown that the US population is overwhelmingly in favour of a public, single-payer healthcare system; yet, the private industry's lobbyists ensure that this never happens.
A near-universal single-payer public service can negotiate cheap medicines and supplies, due to the fact that its very size makes it a match for negotiating with any laboratory. Witness the cost of medicines in the US compared to Canada: an Epipen (for serious allergic reactions) typically costs $100 in Canada and $300 in the US. In the UK you will be charged £8.80 ($11). However, the NHS buys them for around £45 ($58).
The last reason why a private system will never coexist in harmony with a public system is that the current system is now out of date. Covid-19 and other recent pandemics shows that infectious diseases, which have been long on the back foot, are perhaps coming back, for whatever reason. Possibly the reliance on vaccines for decades has allowed viruses to mutate and, together with increasing poverty and precarious health for a significant part of the population, allowed them to get a new hold on us.
These infectious diseases must be kept separate from chronic diseases and, indeed, Covid-19 has been shown to be on a practical level dangerous only for those who are chronically ill, who should have been kept away from the Covid-19 patients, but were not or - equally worryingly - have not been able to receive their customary treatment due to hospital saturation with Covid-19 patients.
For any area with sufficient population to warrant a hospital, at the moment the paucity of the public sector ensures that, although there will also be various private clinics, there will not be sufficient resources for there to be a second public hospital, to treat the infectious patients in a different facility to the chronically ill.
We should realise that health is a communal issue and that other people's health affects ours. For that reason alone we should invest in a first class public health system and ditch the idea that a two tier system can do anything decent for us.
For any area with sufficient population to warrant a hospital, at the moment the paucity of the public sector ensures that, although there will also be various private clinics, there will not be sufficient resources for there to be a second public hospital, to treat the infectious patients in a different facility to the chronically ill.
We should realise that health is a communal issue and that other people's health affects ours. For that reason alone we should invest in a first class public health system and ditch the idea that a two tier system can do anything decent for us.
