The NHS and the Election

In the general election campaign, the National Health Service is being featured prominently by the politicians. On both sides of the Atlantic, the last few months have seen various supposedly alternative models for health care inside capitalism being explored.

Socialists recognise the benefits the NHS brings to workers who otherwise would not have access to healthcare, they are far from the ardent uncritical supporters that the membership of the Labour Party tend to be.  They see that although the NHS suggests possibilities for how a service free at the point of use and based on needs could be organised, fundamentally, it is not free from the market system and a long way from being the fount of joy Labour supporters proclaim it to be.

Of course, the NHS has had serious funding/allocation problems. In its early days demand was much higher than anticipated, and so consequently it cost more. Since the 1980’s successive governments have tried to rectify its perceived shortcomings through creating psuedo-markets. Although more patients are being treated on the NHS with more operations being carried out, more drugs being prescribed and the population enjoying better health, the rise has failed to match the increase in investment.

It must buy hospitals and premises from commercial builders and landowners.  It has to pay the form of rent known as a patent to the drugs manufacturers. And it has to have the payroll clerks, the accountants, the procurement officers, the lawyers and the whole array of staff specifically to manage all of this market activity, adding greatly to its cost. Further, as with any other industry, capitalism is constantly revolutionising the process of healthcare.  More and better results can be achieved with more and better machinery – that is with ever greater capital investment. technical innovation comes with a market drive. All the new machines becoming available for health care cost a fortune.

This interweaving with the market system also nullifies some of the wilder claims that the NHS is a massive benefit to the working class – many capitalist states manage to exist without such a system.  Health costs are, for the most part, not optional, you either need treatment or you don’t (though the poor are long adept at putting up with ailments it’s too dear for them to pay to relieve).  By hook or by crook, if the employers want to have a workforce fit to perform their role, it’s going to have to pay for health care.  This can either be done through wages directly, or as a workplace benefit or through the state.  If provided as a state or private benefit, it simply has the effect of lessening the upwards pressure of wages by workers who need to pay for their and their loved one’s treatment.  If it was paid directly through wages, employers would have to risk paying those sums to workers who might never need health treatment: i.e. they’d be paying them (in the employers’ eyes) too much.