Tuesday, January 8, 2013

Thatcher haunts Europe's healthcare 'reforms'

Shoulder pads are less prominent. Filofaxes have been replaced by iPhones. And a whole generation has grown up without being subjected to Kajagoogoo.

So why I am worried that 2013 will feel like the 1980s?

This year will result in a fundamental transformation of European healthcare. By October, all EU countries are required to put a new law on "patients' rights" onto their statute books. At first glance, the law seems laudable. People who travel from one state in the Union to another for treatment will be entitled to have their medical bills reimbursed by their home country.

The small-print to the law is more revealing. Because it has been introduced as a "single market" initiative, it paves the way for healthcare to be treated primarily as a business. This is a retrograde step; it runs counter to the philosophy on which a welfare state should be based, namely that everyone should receive the same quality of treatment regardless of his or her income. The reference to "patient's rights" is Orwellian: those who can afford to go abroad for an operation will be accorded more rights than those who can't.

Where does the idea of a "single market" or "internal market" in healthcare come from? In 1984, the American economist Alain Enthoven spent a month in Britain on the invitation of Nuffield, a group of private hospitals. He recommended applying "internal market" principles to the National Health Service in an attempt to "capture some of the virtues we generally associate with the private sector and combine them with the social responsibility and concern for equity we associate with democratic government".


Enthoven also complained that the British system of medicine lacked the elements of "consumer choice" and "competition" found in America. Although Margaret Thatcher didn't get around to implementing all these suggestions, many of them were found in a policy paper on NHS "reform" published by Ken Clarke, health secretary in her government, in 1989.

Supporters of the EU's "patient's rights" law have used the same terminology and arguments as Enthoven. Graham Watson, then head of the Liberal grouping in the European Parliament, told me in 2009 that "the best way to improve services for all" is "to ensure that there is a healthy competition among suppliers so that patients and authorities are free to choose the best offer among several".

That same year, a study was published by the American Journal of Public Health, stating that almost 45,000 people died per annum in the US because they have no medical insurance. This is what happens when legislators decide the provision of medicine should be determined by "choice", rather than need.

We should not kid ourselves into thinking that we are immune from these problems in Europe. Greece used to treat its jobless citizens without charge. Cutbacks introduced as a result of pressure from the EU and International Monetary Fund have meant that the unemployed now have to pay for treatment once benefits linked to their old jobs expire. Similar changes have been made in Spain.

"Tough love"

Even though 1.2 million Greeks are now uninsured, these measures have gladdened the denizens of think tank land. The Lisbon Council, an outfit committed to "competitiveness" is headquartered in the Residence Palace, a former luxury hotel in Brussels. It recently published a "state of the Union" assessment written by two economists from Berenberg, Germany's oldest private bank. Holger Schmieding and Christian Schulz, the two analysts in question, cited the austerity measures imposed on Greece and as an example of "tough love" in that "close-knit family of nations" called the euro-zone. While the analysts warned that the "love" risked being a little too "tough" at times, they broadly approved of it. The Athens government, they concluded, had made "exceptional progress" on "adjustment" towards "competitiveness" (a byword for destroying the welfare state).

Bruegel, another Brussels "tank tank", has been striving to make satire redundant. It has been busy lately promoting a book by its one-time chief Mario Monti. In the book, Monti addresses the need to enhance democracy. Few people are less qualified to make this case: Monti spent a year between 2011 and 2012 leading an unelected government in Italy, where one of his first acts was to announce that health spending would be cut by 5 billion euros.

The UN's World Development Report for 2010 ranked countries based on public satisfaction with their healthcare systems. Five of the top ten - Austria, Belgium, Luxembourg, the Netherlands and Britain - belonged to the European Union.

This finding indicates that Europe has made enormous strides towards providing high quality and affordable (in some cases, free) treatment. The achievement is all the more remarkable when you realise that Europe's welfare states were founded following the destruction of the Second World War. As there is no demand for health "reforms" (another despicable euphemism) among voters, it's no wonder that they are being undertaken by anti-democratic means.

Nye Bevan, the Labour Party politician who was instrumental in setting up Britain's NHS, once said that no society can call itself civilised if it deprives a sick person of care because he or she is poor. The US remains uncivilised, partly due to the unflagging efforts of Alain Enthoven. At the age of 82, Enthoven continues to urge that public spending on health be "curtailed".

His inhuman thinking has caused immense suffering in America. His vision should not be realised in Europe, too.

•First published in Our World in 2013, special edition of New Europe, January 2013.

No comments:

Post a Comment