A HEALTHY ECONOMY
Two years ago, out of the blue, I contracted a severe form of pneumonia. It was diagnosed relatively swiftly and I was admitted to a major hospital in Glasgow for an operation. One of Scotland’s leading specialists in respiratory illnesses performed the operation which was completely successful. Post-operative care was excellent and within a few weeks I was back to normal.
Twenty-three years ago my mother was diagnosed with a virulent form of breast cancer which had to be treated immediately otherwise her life was in imminent danger. She was admitted to hospital and had a radical mastectomy performed on her (this being the standard mode of treatment for rapidly spreading breast cancer tumours in the ‘80s). Again she recovered well and has enjoyed nearly a quarter of a century’s life with us that would have been cruelly curtailed if the cancer hadn’t been discovered and dealt with when it was.
My father suffered a stroke four years ago, a mild stroke but it was the harbinger of a progressive disease called cardiovascular dementia which in essence is an incremental series of small strokes that will become and is becoming increasingly incapacitating. He now receives care and support from care workers four times a day and is able to enjoy a good quality of life at home with his wife despite his deteriorating condition.
My family are not wealthy, but they’ve worked hard all their lives. The simple fact is that without the National Health Service, each one of the aforementioned illnesses that have affected my family, and my family are not exceptional in being struck by ill-health by any means, could not only have had serious health consequences, they could also have been financial catastrophes. For the simple fact is that all the nursing care, medical expertise and aftercare that have saved the lives of three members of my family have been entirely free. If this had been America or some comparable country where healthcare was not free to all at the point of delivery, my family would have been ruined trying to pay for their healthcare. And this would have been the case for millions of families across the UK.
For all it’s manifold and now highly publicised (rightly) shortcomings, the NHS gets it right the vast majority of times and not only saves countless numbers of lives daily in this country, but also prevents the sheer awful anxiety which would envelop anyway who has to worry about how they could afford to pay if they became ill.
The NHS is an example of a service that, by and large, could not be met by the free market. I wrote in last week’s blog about how the attempt to make the market the dominant force in the economy, with virtually unregulated financial institutions as a by-product, has come crashing down in the wake of the credit crunch and the recession.
Now don’t get me wrong. I’m not some unreconstructed revolutionary socialist. There is absolutely nothing wrong with making a buck and to adopt a phrase attributed to the late executed Bolshevik, Nikolai Bukharin, when speaking about the Russian peasantry in the 1920s, go and “enrich yourselves” by filling a demand that no-one else has met. The problem is that free markets are about making a profit from people’s wants, but wants, or desires are not the same as needs which are usually not optional, transitory or frivolous but absolutely essential for health, welfare and security; in short for the maintenance of any decent semblance of life. And when it comes to needs, the private sector is usually pretty lousy at meeting them, especially when it comes to meeting the needs of people with little or no income, especially when they’re ill.
That’s why a decent economy which simultaneously meets both the wants and the needs of its population is one which achieves an optimum mix between the public and the private sector. One possible good outcome of the current economic downturn is to throw doubt on untrammelled faith in the free market. This faith has been found to be based on insecure foundations, not because the market is a bad means of economic organisation, but because it has come to be seen as the only means of economic organisation, either displacing any other means, or whose ethos and values should dominate non-profit driven organisations as with the values of the private sector becoming the main motivating force driving the public sector in countries such as the UK. Western societies, in their eagerness to embrace the market have reduced themselves to a limited range of tools in their economic armoury, all concentrated around the market. The current severe economic recession and the discrediting of sole reliance on the free market allows an opportunity for a reassertion of a mixed economy where the best aspects of the free market can be used to optimal benefit in the private sector, while the public service, non-profit ethos of the public sector can be revived to enhance public services. The resultant combination of the two can produce the most effective and optimal outcome in the two sectors to the maximum benefit of the economy and society at large. It is, to borrow a New Testament analogy, a case of rendering unto the market what it is best able to do and rendering to the public sector what it is best able to do.
A reassertion of the mixed economy will allow for reclaiming the public sector ethos which has been so corroded and discredited in recent years and to cast aside the fallacy of choice and competition in areas such as the public services, especially in dealing with need, where they are both bogus and meaningless. This will necessarily mean redrawing a demarcation between the public and the private sectors that will impact upon government departments, the NHS, the education service, the police force, local authorities and the voluntary sector: the latter of which currently exists in a strange twilight zone between a not-for-profit charitable service ethos and a business ethos which is probably untenable. It will mean the end of the marketisation of public services, but it will also equally imply the end of the wholesale regulation of elements of the private sector that have prevailed outwith financial management
In his book, Global Capitalism, Jeffry A. Frieden describes four phases in the history of the international economy. Phase 1 up until the First World War was largely premised on untrammelled free trade and minimal state interference. Phase 2 in the inter-war period was based on protectionism and the virtual collapse of international trade. Phase 3, post-war, was the high-point of the mixed economy in the west. This last phase came to an end with the triumph of free market economics in the 80s. Now that the credit crunch has discredited an incorrigible faith in the free market, let us hope that we can now add a fifth phase: the resurrection of the mixed economy and with it, the best mix between the public and private sector.
And where needs are concerned that means leaving health and social care for generations as accessible and free as it has been to my family without plunging ordinary people into bankruptcy or premature death through lack of affordable healthcare.