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Tallis in Wonderland

Emergency Reflections on Political Philosophy

Raymond Tallis exposes a disintegration of democracy.

I was tempted to call this piece ‘How I Became Radicalised’, but in the present climate it would be unwise. Two strokes of a search engine by those charged with watching over us, and Bingo! the offices of Philosophy Now might have some unwelcome visitors. The sad truth is that your mild-mannered columnist has, for the first time for decades, taken to the streets, marching with others equally incensed, chanting slogans, waving arms and banners, exercising the right to freedoms of assembly and of expression before it is too late.

Behind this mighty distraction from the my customary philosophical preoccupations is a big story, and I want to share it with readers of this column, as I have done with anyone who will listen in the pub, because it is relevant to political philosophy and Edmund Burke’s ‘little platoons’ – of whom more presently. Although most of what I will say is triggered off by the selling and breaking up of Britain’s National Health Service (NHS), international readers please do not stop reading here, for behind this ideologically-driven vandalism is something affecting us all in Western democracies: the ever-increasing political power of the greedy, and the increasing greed of the political classes. The barriers between Big Business and Government, and between corporate interests and political decision-making, have all but collapsed.

Democracy and Lies

The NHS is melting like a polar ice cap as it is being sold off piecemeal to healthcare multinationals. If this not halted and reversed we will get less and less healthcare at ever greater cost. Consider the USA: it spends twice as much as the UK per head on health, and in a recent survey of twelve developed countries, has the worst outcomes. Just under a million, or 62%, of all US bankruptcies last year were due to medical bills. Four fifths of those who were ruined by falling ill were fully insured, but were foolish enough to get the wrong disease.

But this is not the only reason why your columnist has taken to the streets. Even more disturbing is the process by which the NHS has been put up for sale. The lies and corruption behind the Health and Social Care Act (HSCA) 2012, the key piece of legislation, would make Transparency International blush. Let me explain.

All the political parties know that the British people are opposed to privatisation of the NHS: 87% in the most recent poll. So the privatisers had to lie.

First lie. Before the 2010 election, Conservatives and Liberal Democrats promised ‘no more top-down reorganisations’ of health care. In power, however, they imposed the biggest reorganisation in the history of the NHS. This cost £3 billion pounds and incalculable amounts of doctors’, nurses’, managers’, and others’ time – money and time that could have been spent on healing the sick.

Second lie. They said the aim of the HSCA was to put the NHS budget in local doctors’ hands and place patients at the heart of decision-making about the choice and development of services. In fact the bill removed all democratic accountability. Doctors and patients are marginalised; and the Secretary of State for Health is no longer responsible for ensuring comprehensive free services.

Third lie. They said reorganisation was necessary because the NHS was a basket case. Independent international comparisons showed the opposite. In 2011, and again in 2014, the Commonwealth Fund, a respected New York think tank, reported that the NHS was the best in the world for quality of care, access to care, value for money, and safety. Instead of shouting this from the rooftops, Jeremy Hunt, Secretary of State for (or against) Health, has attacked the NHS relentlessly, threatening to name and shame those working in the service who do not deliver more with fewer resources. (Yes, they lied about funding as well.)

Fourth lie. They said the HCSA had nothing to with privatising the NHS. In fact, this was its primary aim. In 2013-14, £10 billion of contracts, or 70% of those out to tender, went to the health privateers. (The other 30% went to internal NHS bidders). Cancer and end-of-life services are up for sale. Local GP surgeries have always been private partnerships, but their contracts are with the NHS and big conglomerates are circling, bidding for the right to manage those contracts.

Fifth lie. It doesn’t matter, they said, who provides health care, so long as it is free at the point of need. Oh yes it does. Privatisation replaces cooperation for the benefit of patients with competition for the benefit of shareholders. Taxpayers’ money is siphoned off by multinationals pocketing huge profits to be stored in offshore havens out of the reach of the taxman. British healthcare will be fragmented into separate elements run by different for-profit organisations that have no interest in working together at a time when we have a largely elderly patient population who need closely integrated services. There have already been sickening examples of private providers blocking cooperation between hospitals, with expensive litigation putting the fear of God into anyone whose primary aim is to make poorly people better. Billions are already being squandered in tendering processes and administrative costs (31% of health expenditure in the US). Doctors and nurses will change from public servants for whom the needs of patients are paramount into loyal company men and women keen to sell products; and professional covenants will be replaced by hard-headed contracts. Some ill people will be denied the care they need, whilst others will be sold profitable treatments they don’t. Public accountability will be buried under ‘commercial confidentiality’.

You may think that I ought to grow up. Politics & lies go together like gin & tonic. The reason I won’t ‘just get over it’ is because the selling of the NHS has exposed the extent of Britain’s progression to a banana republic. A shocking proportion of those who shaped the HSCA, and of those who voted it onto the statute books, stood to gain personally from the expansion in private health care. This included dozens of the peers and MPs who supported the Act through its difficult passage into law. Parliamentarians and advisers morphed into lobbyists for, and executives of, companies selling healthcare. Ministers and civil servants glided back and forth through revolving doors connecting public and private sectors.

There could be worse to come. The Transatlantic Trade and Investment Partnership (TTIP) – a huge treaty between the EU and the USA – is being negotiated. TTIP will make competition for all services mandatory. Not one bit of the NHS will be safe from privatisation. A key part of TTIP is the Investment State Disputes Settlement,which will allow healthcare entrepreneurs to sue governments if they believe their profits have been harmed by government decisions. Under the terms of a similar treaty, a tobacco giant whose products have killed millions of people and harmed many others is currently suing the Australian government for the plain packaging legislation which they believe has damaged their sales, particularly to young people – which is true, and was the whole point of the legislation.

And that is why your columnist has taken to the streets and even (God help us) Twitter (something that I fear Wittgenstein would not have approved of); why he is writing and distributing leaflets, filling envelopes, knocking on doors, and generally being a pest. But, you will be glad to know, he has not entirely given up philosophical thinking. And so I want to share with you some thoughts I had when, with several thousand others, I joined the Darlington Mums on the last leg of their ‘March for the NHS’ from Jarrow to London – marching near the Department of Health, where much of the dirty work has been done. (Look up the March – it’s inspiring.) I was deeply touched by this raggle-taggle army and by the spectacle of so many people willing to stand up for values unknown to our political masters and the money men who run them. But I also felt a crushing sense of impotence. The City financiers and the neo-liberal privatisers were not there to argue their case. They didn’t need to: their case was proceeding smoothly. They let the money do the talking. We were pitchforks against the invisible machine-guns of the hedge fund managers who (contrary to Shelley’s famous assertion) are the unacknowledged legislators of the world.

Shaking the Philosophical Foundations

By the time we entered Trafalgar Square (for some great speeches – Owen Jones was magnificent) I was having a blazing argument. My interlocutor was Edmund Burke, the Eighteenth Century conservative political philosopher who is a darling of the Tory party and in some sense the godfather of the idea of David Cameron’s ‘Big Society’ (the initials say it all). Big Society is opposed to Big Government, and one passage from Burke is endlessly quoted by the Tories:

“To love the little platoons we belong to in society is the first principle… of public affections. It is the first link in the series by which we proceed toward a love to our country and to mankind.”

The Darlington Mums seemed to me a paradigm of the little platoons; an association formed to serve a common cause of defending something they value and which itself expresses these values. But faced with a government that has used the rhetoric of ‘getting the state off people’s backs’ in order to pave the way for privatisation of the public sphere (against the will of the people), the Darlo Mums have little chance of changing things. The self-interested neoliberal dogma that unfettered markets and the privatisation of everything will deliver the best outcome for all still dominates the thinking of the political class, notwithstanding the worldwide catastrophe of 2007-8 which that dogma brought about, and the dismal results of other privatisations in Britain (gas, electricity, railways). Money talks and its voice drowns out all others. The lobbyists lunching with venal legislators have a quiet word, and the deal is clinched.

Burke’s opposition to top-down reorganisation of society in favour of grassroots local action was fashioned in the wake of events in France that he meditated on so brilliantly in Reflections on the Revolution in France (1790). He saw that trying to build up society from scratch according to apparently rational principles would inevitably lead to disaster. He was right; but his ideas have been hi-jacked by those who loath any collective action, particularly if it involves them paying taxes. (Hence Big Society rather than Big Government.) The breaking up of the NHS has thus been presented as a liberation of the people from a monolithic, Stalinist organisation. The little platoons disagreed. The NHS represents one of the most fundamental British values: a decency that acknowledges that we should share the risks that come from the lottery of life. Hence the commitment to publicly-provided, universal healthcare, free at the point of need.

Neither the privatisation of the NHS, nor the values that are being trampled on in the process, have been properly discussed in the mainstream media. Most journalists (or ‘churnalists’) swallowed and regurgitated government press releases. The publicly-funded BBC has avoided probing too deeply, for fear of reprisals when the licence fee renewal has to be approved by government. These failures of what Burke named the Fourth Estate (the news media) have contributed to what (to change philosopher) Friedrich Engels described as ‘false consciousness’. It explains why many will have voted for parties that may bring about their financial ruin, or that of their children, if they are foolish enough to fall ill.

The money men, who know the price of everything and the value of nothing, rule more and more of our lives. Democracy is dying. Hence my radicalisation. If my impotent rage lands me in jail, I might, like Bertrand Russell, see it as an opportunity to spend more time on philosophy.

Raymond Tallis was a professor of medicine for 20 years and an NHS doctor for 38 years. Along with Jacky Davis he co-edited the book NHS SOS: How The NHS Was Betrayed And How We Can Save It (Oneworld 2013).