NHS - health rationing

The State-capitalists and reformers dream comes to an end ? The National Health Service is trumpeted as the finest achievement of the Labour Party throughout its entire history. For years Labour supporters when tackled on the non-socialist and pro-capitalist nature of the Labour Party would reply with the one riposte, ‘Ahh , but what about the NHS?’ Its chief architect , Aneurin Bevan , was very sure of his aims, it was to be an institution which would take care of all the medical needs of the working class for evermore without charge. No matter how expensive the treatment might be , medical attention would be obtained for all. For free!

"Faced with limited budgets, the NHS cannot indefinitely continue to afford to fund free care for all." the Royal College of Physicians of Edinburgh conference , "Rationing, Charity and Private Support: How Much Longer Can We Afford the NHS?" , will hear.

Dr Rodger, a kidney specialist based in Glasgow, said the NHS faced growing expenses in a number of areas, including the new generation of increasingly expensive drug treatments coming on to the market, on top of growing population needs."It is clear this situation is not sustainable financially, particularly when taking into account the anticipated impact of the recession on the NHS, and that something will have to give if the NHS is to survive," he said.
Dr Rodger said doctors wanted clinical decisions to be based on need, not money, but a debate was required.

The ugly realities of capitalist economics has always reared its head throughout the history of the NHS . No reform is secure under capitalism. In fact, the workings of capitalism continually undermine any reform that has been introduced. We pointed out in 1991
"All services within the NHS are being priced and sold within an internal market: GPs must buy services from hospitals, hospital departments specialising in one area from those specialising in another, and so on. These new contracts for services can only be entered into if the buyer has the money in the budget. No money to buy, no contract; no contract, no provision of service. The original aim of the NHS was ostensibly to provide free health care paid out of state funds; now each sector of the NHS must rely on its own budget and constantly think in terms of the market. This is just making explicit what was already implicit in the financing of the health service."
In 2006 a new rule was introduced into the NHS requiring GPs when recommending elective surgery to provide at least four choices of hospital, one of which must be a private institution (with the operation to be paid for out of NHS funds). GPs themselves are supposed to operate as semi-independent companies, with competition within the NHS being provided by the Primary Care Trusts (PCT). The need to control their budget and to meet their targets is meant to promote a pseudo-market within the NHS and improve efficiency.

The NHS has to be paid for, and the money has to come from the capitalist class. Ever since its inception the history of the NHS has been a story of trying to provide adequate funding. Every government has looked for ways to find the money and cut the costs, and every government has failed. The original set-up has been modified, tinkered with or altered repeatedly, all, we are told in the interests of efficiency. And every government produces a fresh plan with a fanfare of trumpets that promises to solve all problems.

Contrary to popular belief, the NHS is not dedicated to satisfying the human need for health care, or the eradication of disease. Medical practice and research in capitalist society is strongly influenced by its role in maintaining a healthy labour force, and in socialising and controlling people in a class-divided society. The NHS keeps us fit for work so we can produce profits for our bosses. It is an integrative mechanism that helps hold class-divided society together.The need of individual bosses to make as much profit as they can from us has to give way, to a certain extent, to the long-term needs of capitalist society as a whole.
One cannot understand the NHS by looking at a snapshot of it at one point in time, but by looking at how it came into being, the social context within which it operates, in whose interests it operates, and so on. Hospitals don't fall from the sky.
In Marxist terms, medical care is important for the reproduction of the forces and relations of production. The reproduction of labour power is provided for through the payment of wages - which enables us to feed, clothe and house ourselves at a historically and culturally specific level - but also through the state, which has, to an extent, taken responsibility for the collective reproduction of labour power by providing education, social security, and other welfare services. The development of the NHS was in part a recognition that a shift away from unskilled manual work to other forms of employment would require a healthier workforce and a more stable and qualitatively superior one. To put it more plainly, the NHS helps keep us fit for work so that we are forced to keep on selling the only thing of real value we own - our creative abilities - to our employers.

To some extent , socialists have to acknowledge that NHS made the living standards for some sections of the working class better than they had been under rampant capitalism and its early ideology of laissez faire ( although these ends should never be confused with socialism ). But Socialists also argue that all reformist activity is subject to the changing nature of capitalism. To fight the same old welfare reform battles over several decades is demoralising enough, but when previous reforms are put into reverse the case against the system which puts profits before needs is stronger than ever. The NHS decline would support the argument that capitalism cannot sustain meaningful reform.