19 Aug 2014
The 'tragedy of the NHS'
THE NHS is being dismantled before our eyes. Since the 1990s it has been forced to mimic the market with competition between NHS providers.
This has created a less efficient and more chaotic system of health provision.
The last Labour government introduced private finance inititives, where private companies built hospitals but saddled the NHS with appalling debt in return.
The Con-Dem government has massively accelerated the process of NHS destruction.
Services are increasingly being auctioned off to private healthcare companies. Think tanks are floating the idea of charging for more and more NHS services.
So when it is owned by private companies and we find ourselves charged for services, can we even call it a National Health Service?
The process of destruction is aided by the media, political parties and academics. Most commentators suggest that if the Conservatives are re-elected in 2015 the NHS will totally disappear. However, even if they lose, the NHS looks far from secure.
Politicians increasingly accept a neoliberal approach which, they argue, means that only the market works. State intervention always, so the consensus goes, fails.
What we have is a kind of “tragedy of the NHS.” I don’t mean the situation is “tragic” simply in the sense of bad. The planned extinction of the NHS will make the most vulnerable pay for expensive healthcare and increase inequality and human misery, while reducing life expectancy.
I mean “tragic” in the original use of the word that can be traced back to ancient Greek tragedies — something that is inevitable (or at least seems so).
I fear that in the future, in the same way we are familiar with the term “tragedy of the commons” the phrase “tragedy of the NHS” will also become common currency.
It will be said, in the future, perhaps, that in 1945 the great reforming socialist government of Labour’s Clement Attlee established a brave experiment to promote equality and social justice.
Yet this great experiment, while well-intentioned, did not work. Free healthcare was abused, people took more and more from the system, which became progressively more expensive. Planning made it inefficient and without market-based incentives performance dropped.
Increasing demand for healthcare, rising costs and chaos meant that by 2015 the NHS had to be shut down.
The brave attempt to provide free healthcare for all was tragically doomed, it will be claimed.
In fact “the tragedy of the NHS” is just like “the tragedy of the commons.”
In 1968, the biologist Garrett Hardin argued in an article in the journal Science that common land was bound to be over exploited.
If no single individual owned a resource, say a forest or pasture land, no-one had an incentive to conserve it. There was a “free rider” problem, as laid down in free-market economic theory, that if one person fished less or took their cattle off the common to preserve it, others would just fish more or put their livestock on to graze more intensively.
The commons was “tragic,” ie doomed. Sharing, in Hardin’s eyes, always leads to disaster.
As in many free-market logics, a mathematical axiom is connected to a metaphor, to show that anything other than private property and self-interest will lead to disaster. Good intentions always lead, tragically, to the worst outcome for all.
However, when we look at the “tragedy of the commons” we find a quite different tale of woe. Professor Elinor Ostrom, the first woman to win a prize in economics, won it for showing that the commons, far from being “tragic,” quite often worked well.
She did research into hundreds of commons, forests, fisheries and pastures all around the world.
She found that sometimes they did get degraded and fall apart but often local people got together, agreed rules to conserve them and found ways of enforcing them.
Some of the commons she looked at, for example, the Torbel commons in Switzerland, had worked well for over 1,000 years.
I am a bit of an Ostrom obsessive, so I will avoid going into detail about her interesting work, but you can easily find out more about her by looking on the net.
Historians like the great EP Thompson also found that far from the commons failing, they often thrived.
In Britain, commons allowed users to raise animals, gather firewood and collect food, a kind of primitive welfare system. The commons were often taken from the people by force, using violence or the law, or a combination of both.
Karl Marx wrote extensively about the enclosure of the commons, and he was perhaps at his most passionate and exact in chapter 27 of Das Kapital Volume One, which I would highly recommend reading.
The “tragedy of the NHS” is about the fact that we actually have a really good model of healthcare, which has served us well but is being dismembered because of ideology and greed.
The vultures are circling and coming down to feed on our collective assets, absorbing resources from a government committed to the rich and powerful. The media is silent about the enclosure and destruction of our health commons, the NHS, but every day reports on its real or imagined failings.
We all have to fight in solidarity to defend the NHS, working with trade unions and those few MPs, like Caroline Lucas and John McDonnell, who are really committed to a publicly owned socialist healthcare system.
We also need to be aware of how ideas like “the tragedy of the commons” are used by the rich and powerful to seize resources.
Free-market economists like Friedrich von Hayek argued that a planned socialist society was impossible — without the market chaos would reign.
The very existence of “socialised” medicine appals them. After all, if we can do free healthcare, why not free public transport or free housing? If the NHS works, why not banish the market from other areas of society?
Yes, the NHS has failings and yes there are problems with public planning, but remember, far from being doomed to fail, the NHS can be made to work for all of us.
We should, like Ostrom might suggest — and indeed, she has researched health commons — take a hard-nosed look at what works and what doesn’t work in the NHS. However we need to note that critics of the NHS come not to heal it, but to kill it, because health for all, free to those in need, offends their ideological point of view.
Derek Wall is international co-ordinator for the Green Party of England and Wales.
Elinor Ostrom’s pragmatism:4:30pm, May 29th, 2018 Bush House North East Wing, Kings College, University of London
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