Chris Burford cburford at
Fri Feb 17 00:32:55 MST 1995


I work in the British National Health Service, which
right wing strategists for the British Conservative Party
used to call the largest state sector economy this side of
the iron curtain. It certainly was a command economy of
enormous size.

Now as a result of a series of cunning administrative and
financial levers it is being broken up into a number of trusts
which are being made to compete in a market place for the
funds given to the "purchasers". The trusts cannot yet raise
capital on the open financial market but that is coming I
would predict by comparison with other parts of the former
state sector in Britain. Commodity exchange is therefore eating
into the whole structure of the delivery of healthcare by the

This relates to the debate about who defines efficiency a few
weeks ago. The British NHS has been vastly more efficient than
the US health delivery system, producing substantially better
results on major indicators of health provision on only just
over half the percentage of a much smaller gross national

But it has been inefficient in delivering individualized
packages of care as a commodity with a "quality" feel about
them to individual patients. Ante-natal clinics are efficient
but not discrete.

In mental health the system (in real crisis at the moment)
batches people by diagnostic label (with a cumbersome civil
rights monitoring procedure on top).

There is quite a vigorous resistance movement to the
privitization changes but it is not clear to me it will win.

It is wiser for an analysis that is suspicious of the pinky
flesh tones of privatization to examine why right wing
governments may be able to point to some advantages from
certain points of view, and then to take a perspective that
compares points of view.

The only Achilles heel to their strategy that I can see is this.
While working people of all countries are constantly reminded
of the lash of international competition, it is not clear that
we have to respond to the right wing call for more efficient
commodity production in ***all*** sectors of human life, but
only those that need to be competitively traded internationally
in order to earn foreign exchange. It is thus quite possible
for some sections of capital to see the advantages of a well
organised educational system.  I understand that the
fine print of World Bank Reports on the Little Tigers of
South East Asia, notes the strategy of high educational level.

Thus it could be more competitive to have the basic health care
of the population centrally co-ordinated so that there are
not resource pressures on the sectors that are more
aggressively tradable.

[Jon - I felt a little more comfortable leaving off personal
identifiers from this posting in case you wish to forward some of
it. No doubt people in Turkey would think twice before directly
subscribing to a list called marxism.]

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