I had an interesting conversation with my fiancés dad recently, he was saying something about a news spot that was on TV at the time. I, with my usual blunt instrument of a perspective, wished to get into it further. I often do, because what interests me is not the phenomenon, but what enables it. What are the social conditions that allow for a thing to be as it is currently?

The NHS is a favoured subject of mine, I am such a fan of the idea of free healthcare and a welfare state, that I’ll defend it in any circumstance and against any odds.

I asked him “what is it like to see the news media echo, with such certainty and confidence, and without any critical examination, that the NHS is unsustainable, when you were born shortly after its foundation (the 1950s), and have seen it at its best, before modernity and the inclusion of private interests?”. Delwyn, her dad, like many people of his era, remembers an NHS that provided healthcare to all regardless of circumstance and lifestyle. One that wasn’t perfect, but worked quite well, and was a definite improvement on the personal finance and charity based previous system. His memory is of people not having to wait too long to be seen, getting appointments within days not months, having operations when needed, and having their eyes and teeth looked after as part of the service too. It is strange for him to hear that what did work, is mediated now to not be able to work. He also remembers elder care when they didn’t take most of the value of your house, when it was a local council thing.

I wondered if it was strange for everyone of his generation, so I’m going to ask them as much as I can. For now I, as usual, might speculate a bit…

Changing economic circumstances changes social circumstances, and the economics of a nation is the monopoly board of interested and invested powerful persons and corporations. If you have followed my blog at all you’ll know that I believe the government to be a body of people that represent private interest groups, not of the people. Corrupt I would contend, others may not go that far. I say this because it is overtly verifiable that politicians have personally profitable (not just in money terms) relationships with business interests that more than seem to influence their decision making than the voters can. When you see a think-tank of advisors that forms policy for MPs to push in parliament, and that think-tank is funded by a corporation, then there can be no doubt that there is more influence exerted by that entity than from let’s say a protest group with banners.

Politicians say the NHS has to change because it is not sustainable, they say this because the think-tanks are funded by pharmaceutical companies, to me it is that simple. Follow the money and you find the motivations. I actually heard a representative of a think-tank say recently on Radio 4, when talking about the NHS, that hiring more doctors would not solve the problem of availability… now that’s amazing… that’s like saying more men with shovels could not dig a bigger hole in the same time frame as less. What ridiculousness it is to hear the defence of the proposed reforms when they are blatantly a misinterpretation of the facts, possibly even a fabrication. There is less availability of healthcare and I personally believe that this not an accidental happenstance. Yes there is record spending, but it is not on getting patients in to see GPs, it must be making its way to folks in suits (at least that’s what I think).

A nurse I know recently quit her full time job to become a bank nurse, then went to work for the very same company, in the very same role, but for more money. Now how is that for wastage? The body that employed her must imagine that this gives them greater employment flexibility, but since there is need for her labour, and there will continue to be, why would they allow this to happen? This business is growing we are told, this means that seasonal, agency, and fixed contract employment types are not necessary in this case because there is little to be gained by the flexibility they offer (allows for dynamic management of the workforce based on the market fluctuating).

Is it unsustainable? Well yes it is, and so it should be, and so it should stay. I’ve covered the details of why in another post.. For this piece I am just speculating as to the why, and I’m not ruling out legitimate reasons as that would make me biased and more limited than I wish to be. I am a Gas and Water Socialist yes, but not an out and out anti-capitalist.

I wonder if the reasons are maybe that healthcare in general is strained by people not dying at the age they are expected to, living a longer and more unwell existence. That certainly is a legitimate factor, but is it the crux? Also the burdens on healthcare from immigrants, do they have more needs per person in comparison? I’m not sure since they were well enough to trek all the way across Europe, and if the TV footage is anything to go by they don’t look overweight or ill. I think, and this is just a personal opinion, that these folks are potential contributors to the NHS through labour and taxation. What of the influence of better medications and treatments, is it now necessarily, or incidentally, more expensive per person treated? It must be true that surgery is more successful, that machinery is more effective, so is that where the costs come from? Or could we contend that with better machinery and better procedure then efficiency should be higher and overall costs should fall, or am I employing business thinking where it does not fit?

I think we have made a mistake, we have listened to the wrong persons. There are people, and they are often found in the field of economics, that believe that the objects in the world that are created by small groups for the benefit of large groups need to have a return on their primary purpose that generates revenue so that some other people, investors, will provide the funds that build them. There are three of these objects that immediately spring to mind where this seems impossible, the first is the military, the benefit of having a military is not apparent to the common man, there is no initial return for having a military, it’s value is realised in the negation of potential harm but it’s constant cost is born by the public. It is not cost effective to have a military. The second is public works, beautiful places like parks and beaches and woodlands, these benefit us all but they do not make primary returns, so they are not cost effective either, yet they are worth funding I think we mostly agree. The third is healthcare because you don’t get to be more sick if you are more wealthy, in fact there is quite an inverse relationship between personal wealth and personal health. So medical care is not cost effective.

I suspect that it has always been so, it’s just that now in this era we are thinking about it more because they that want the profits want us to think about it more.

Paul S Wilson