Attempting to Justify “Choice” in the Health Service by Fraudulent Means

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John Reid’s Lecture:
Attempting to Justify “Choice” in the Health Service by Fraudulent Means

On Friday, January 28, John Reid, Secretary of State for Health, delivered the Brough lecture at Paisley University on the topic of Social Democratic Politics in the Age of Consumerism.

            The aim of John Reid’s lecture was to “reconcile” social democracy with consumerism, thereby giving justification to the government’s declared focus of providing the population with “choice” in social services. The government calculates that it needs to tackle this issue head-on because there is a movement to reject the government’s programme of “choice” as being a fraud, and to demand that social programmes such as health and education be straightforwardly provided to meet the needs of the people and the claims that people have on society. For example, if they fall sick, the health service should be geared to cure them, irrespective of any other factors (such as location, or ability to pay, for instance). Where on earth, then, does the issue of “choice” come from or fit in? This is what John Reid sets out to address, and he attempts to do so in a quasi-theoretical fashion.

            After a preliminary feint in the direction of distinguishing New Labour’s policy on health and public services from that of the Conservatives so that it will be seen as the “lesser evil” at the next general election, John Reid first feels obliged to define “social democracy”. He then links it with “consumerism” in a way that, as he says, “is probably a provocation” to some. How does John Red pose the issue of social democracy, and what is his purpose in dwelling on this issue?

            First of all, although New Labour was at pains to bury socialism and communism before the 1997 election, John Reid is concerned that there should be no whiff of a resurrection. John Reid sets the context of his lecture in the antithesis between Marxism and social democracy, but asserts that social democracy developed in opposition to the “vanguardism of communist parties”. He stresses the “importance of a broad and real democratic approach to socialism” interchangeable with the term "Democratic Socialism" that he uses for New Labour’s political ideas on present day society in Britain.  Underpinning this idea he asserts: “As socio-economic circumstances encouraged aspiration among the mass of people to rise above the status of mere ‘producers’, and aspire to the status and means of consumers, so elements of the left political institutions developed in that direction.”

            And secondly he wishes to emphasise the theme that New Labour’s values are not at odds with traditional Labour values, but that the Third Way develops conceptions that were latent or not very explicit in Old social democratic Labour. This is consistent with the premise of New Labour that the “Third Way” is a modernised or renewed social democracy. In actual fact, this argument cannot be sustained. The essence of social democracy was and is conciliation, a compromise or compact between the working class and the capitalist class. John Reid argues at length in his lecture to the effect that consumerism is not synonymous with the production of commodities for the capitalist market, but is consistent with the rights of citizens in civic society. But he cannot conceal that the aim of the Labour government is to pay the rich, and that far from investing in social programmes for the benefit of human beings in society, “investment” is connected with “reform”, and that this “reform” is what should be unthinkable, namely to deliver social programmes to make money for the rich.

            In this regard, he says that; “The Labour Party will, therefore, maintain the founding principle of the NHS that people should have equity of access to health care, free at the point of need.   But in this he aims his remarks at those who support what he describes as “subordinate politics” and here he is clearly appealing to the left to unite with the centre, i.e. New Labour. Running through the whole lecture in the context of “equity of access to health care, free at the point of need” is the assertion, as if it exists in Britain, that the issue is one between the values of the “consumer” society and the values of the “citizenship” society and applying those to public services.  John Reid says:

             Recently, the fashion has been to counter-pose the experience of consumerism to that of citizenship. The role of the consumer is seen to be derived from the development of a capitalist economy. The development of citizenship on the other hand is seen to be driven from the left and associated with the collective political role of the state. Therefore so it goes the two must be in opposition, and the left must side with the citizenship against the consumer.

            These assertions are disinformation in that the “collective political role of the sate” that John Reid is trying to hide is that it represents the capitalist economy from which consumer society derives.   The point of this lecture is his thesis that New Labour “must find a way of harnessing consumerism, with its values of self-expression and enjoyment, in pursuit of the broader twenty-first century public good. Our chosen vehicle is the public services.”  In other words his whole lecture is aimed at justifying the introduction of consumerism into public services as  “equity of access to health care, free at the point of need”.

            But consumerism is not based on meeting the needs of the people for anything let alone health care. Meeting the needs of all human being for food, shelter, health, education, culture and material abundance is not served by capitalist consumer society.  Turning health care into a commodity will not aim the direction of the economy in preventing ill health and providing the best diagnostic and treatment when people become ill.  It will only serve to get people to consume what is profitable to provide.

            Health care is not a commodity to be consumed. Its commodification is merely a way of justifying the unjustifiable, namely the making of “profit” by big business and the enrichment of individuals through being involved in the NHS. The whole of PFI fits into this category, but so do the drug companies, the providers of expensive equipment, and private health care. The argument for “consumerism” in health care is an argument to turn patients into “consumers” of what is most profitable to big business and private health companies.

            John Reid reveals his own guilty conscience when he says:

            Of course, the ideal for most people is to have the best treatment available, in the quickest time, at the nearest hospital. That's not news, and it is not the real question. The real question is two-fold. Firstly, if that is not available locally, should patients have the choice, the right and power to go elsewhere. And, secondly, will this right of patients to go elsewhere if they choose make it more likely that their local providers will strive harder to give them a better service. The answer to both questions is, in my view, yes.

            But why pose a so-called “choice … to go elsewhere”? The fact is if investment in health does not meet the needs of the people what is its purpose? Why introduce “consumerism”, which is the “right of the patient to go elsewhere”?

            What kind of “equity of access to health care” is it when the right of the patient “to have the best treatment available in the quickest time, at the nearest hospital” is not part of the “choice”.    Is there a choice as John Reid claims that in his view “their local providers will strive harder to give them a better service.”?   But what John Reid doesn’t say is that his government’s policy is that the investment is not only inadequate to provide the best treatment available but that local providers will be in further financial crisis as a result of the patient being forced to choose another provider.    So, there is no choice, and there remains the “equity” of bourgeois right not the right of all to the health care they need.

            It is quite astonishing how much John Reid sings a paean of praise to “consumerism”. He says, for example, “Consumerism becomes a vessel through which one can become an author of one’s own life narrative.” This is a parody of the truth that the revolutionisation of society is necessary for the liberation of the individual so that each is empowered to live their lives through their own decision. The Health Secretary wants to claim the “politics of consumption” as progressive politics, and in this regard promotes the conception of the “consumption of public services”. Unbelievably, he even goes to far as to assert that the “key is to recognise that a politics of consumption can be a politics of empowerment”, and explicitly trashes the notion that people should become political. To New Labour a coherent “public” is a “public” to whom the highest good is to consume.

            Nowhere, does John Reid recognise that everyone has a right to health care at the highest level that society can provide.