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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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The politics of the NHS in England and the US. Good times for the left.

Filed Under (Health Policy, Public Health, Public service reform, Reform of the NHS, US opinion) by Paul on 18-08-2009

At the moment, if you are on the left, you rarely get the chance to play a role in developing the political climate of a European country, so to find your politics simultaneously playing a developmental role in the US feel s like the icing on the cake. Then to find reverberations from the US having a positive impact on the politics of England puts the cherry on the top! But such has been the politics of the NHS on both sides of the Atlantic in mid August 2009.

To recap. In the US Obama won an election campaign that called for change. During the election campaign health care reform didn’t just become a significant social issue, but also a significant economic issue. Rising health care costs are not simply an issue of taxation but impact on the very high cost bases of all major employers in the country. If you look at the relative costs of health care provision and steel for US automotive industries, firms such as General Motors and Chrysler appear to be organisations that provide health care for their employees – and as a sideline manufacture cars. The US health care crisis has become an economic one. Under these circumstances electing a President with a clear majority committed to change looks like the springboard for reform.

But in the US the politics of the right see losing elections as being merely a setback to their financial ability to mobilise opinion against reform. Immediately Obama won, the money that would be lost by reform was mobilised against it, and given that the US misspends 17% of the biggest economy in the world on health care costs, the amounts of money they are playing with here is enormous. Under the previous administration tax and private costs had spiralled and the potential for organisations to make money out of this expensive chaos has become the stuff of legend.

So the last 8 months has seen a growing organisational hysteria among the US right to set aside the election and to reembed a majority against reform in Congress and Senate. This hysteria paints the outcome of health care reform as heralding the total end of freedom and the ability of the state to tell every American what they can and cannot spend on their health care. No fear is left unturned.

It demonstrates how massive, in the US, is the amount of money there is to make out of a non system. For the left, it shows that the prize of reform is that reform can provide both better health care a slower growth of expenditure than non reform. We are in one of those odd political tussles where the right are arguing to allow the freedom of greater public expenditure on a chaos than the left could create with a system. But the chaos has created super profits for a small group of institutions, and this is what would  have to stop.

So far, so normal for US politics. All the left can really do is sit on this side of the Atlantic and cheer on reform and answer any detailed questions our colleagues want answered. There is no way that the US is going to ‘create an NHS’ over there, so their political struggle is a different one from ours.

But that’s where right wing hysteria in the states interacts with right wing hysterics in the politics of the UK. One of the best aspects of the politics of the left in this country in the last 12 years has been the fear that the politics of the NHS has instilled in the right. The last election saw small reforms from the Tories proposed to the  “equal access for all, free at the point of need” principle of the NHS. The loss of this election  finally demonstrated to the Tory party that if they wanted to win power then they had to be seen to support this principle. So David Cameron has set out to make that point to his Party and to the country.

The difficulty for him is that most of the right, and nearly all of the right wing opinion formers, fundamentally disagree with the principle of “equal access for all free at the point of need” with the NHS paid for out of taxation.  For most of the last 60 years they have been mildly amused that anyone would think that you could organise a part of a modern society behind such a principle. It’s so odd that its  funny. Those folk don’t really use the NHS but as long as it doesn’t really interfere in their lives and their institutions, then it can carry on in its funny way.

Two things have changed that attitude. First, increased NHS expenditure has meant that it now takes a significant part of the GDP and therefore cannot simply be scoffed at. Second, one of the right’s traditional institutions, the Conservative Party, now has a leadership that has said they support this principle. This has transformed for the right what was a sort of mild amusement at an anachronism of our country into accelerating fury.  Why on earth should they have to pretend to support this thing when it is so obviously outside their world view?

You can see this anger leaking out through right wing columnists who can’t really believe that David Cameron really intends to do this. The normal discourse of their dinner parties about the horrors of the NHS and its principles are beginning to show.

Then the beauty of it is that the far right is of course international. A political battle of the right in the US against health care reform believes that it can use what it sees as the horrors of an egalitarian tax funded system in the UK to frighten the US public. And wouldn’t it be a good idea to get some of their right wing mates in the UK to help the US right with some of their dinner party diatribes? The phrases sound so good over the phone –  come on over and join our campaign.

That happened, and suddenly in the US we have a public exposure of what everyone on the right really wants to say – that the NHS does not just have a few problems, but is evil and needs abolition. That all sounds like good supportive fun. Right wing “hands across the sea” talking their common sense etc etc.  However the transfer of normal right wing politics back across to the UK has real political cultural clashes. What sounds good on drive time radio in Tennessee, what looks a knock out phrase attacking socialist socialised medicine there, looks bonkers to a public where well over 80% support the principles of the NHS.

When right wing “common sense” about the NHS leaks out into the public domain it rings big crisis bells for David Cameron. He knows that the day by day incomprehension about the NHS in the right wing chatter that comes from his core vote lies at a considerable distance from the view of the British electorate – and he then has a problem.

So Obama’s political tussle for reform has succeeded in uncovering what the English right wing opinion formers really think about the NHS, in a way in which present UK politics has not. The politics of health care has become truly international.


2 Responses to “The politics of the NHS in England and the US. Good times for the left.”

  1. Hi Professor Corrigan,

    Enjoyed your blog so much I used and credited part of it in a blog of my own.

    All the best, Neil Durham.

  2. Excellent article!

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