How to Dismantle a National Health Service: Lessons from the NHS, Part 4
This week, Splinter is interviewing experts on what advocates for a universal healthcare in the U.S. can learn from the U.K.’s National Health Service (NHS), the system under which I was born and raised. Here are parts one, two, and three.
Today, we’re speaking with Allyson Pollock, director of the Institute of Health and Society at Newcastle University and author of NHS plc: the Privatisation of Our Health Care.
Libby Watson: What are the main problems with the reforms to the NHS by Labour and then the Conservatives?
Allyson Pollock: One of the things is we’ve never had a single payer system; we’ve had an integrated publicly-funded and publicly-provided system, so this government has never uncoupled, until the 1990s, funding from delivery. So it’s under public ownership and it was integrated; we had no pricing or billing, or contracting. In 2012—well, earlier than that, in the 1990s, the Conservative government brought in the internal market, and then by 2012 they brought in the act that abolishes the NHS, the Health and Social Care Act of 2012. It abolishes and dismantles the NHS, and they’re now bringing in new structures which are mirroring the structures of the U.S., so we’re having accountable care organizations, HMO-type structures are being put in place.
LW: What did those Conservative reforms, like bringing in Clinical Commissioning Groups, do?
AP: What the (Conservatives’) Health and Social Care Act did is abolished the fundamental duty of the Secretary of State for Health to provide universal healthcare throughout England. That’s a duty that’s been put in place since 1948. It abolished the duty to provide. It made commercial contracting virtually compulsory. So these clinical commissioning groups are the practicers of services in England and they practice medicine for the persons for whom they are responsible. So that’s really turning it into like a public payer system, they’re buying the services for the people that they’re responsible for.
LW: If you were to advise single payer or universal care advocates in the U.S. on the big things to avoid in designing that system, what would you say?
AP: The problem is the US is a multi-payer system; it has self-insurers, a public payer system, and it has copayments so individuals even have to pay on top even if they’ve got Medicaid. It limits entitlements. The U.K. has always had an open-ended system until very recently, and it’s been paid out of the public purse with very few people having voluntary private health insurance. But the key to our efficiency has been that our legislation, until the 1990s, locked out private for-profit corporations, there was no room for profit and all the market transactions that go with it.
So our legislation was constructed to lock out profiteers and shareholders and property management companies, and lawyers, and accountants; it just locked them all out, because it was all under public ownership. It’s a paradigm that nobody in the U.S. can understand because they have never had it, and it’s a paradigm that we’re about to lose, because the government is moving very quickly in the last 20 years to put in place the market paradigm of the U.S.. So what we’re going to be doing is moving very quickly not just to single payer but to multiple payers—we pay anyway, through taxation—but out-of-pocket, which are the most unfair forms of regressive forms of funding, and then health insurance.