A very un-British Miracle

75 years ago, this week a miracle happened in my country.  On July the 5th, 1948, the National Health Service was launched.  It was a truly incredible achievement, a significant slice of socialism in the birthplace of capitalism.  A tax funded, publicly delivered, universal healthcare system, bringing the most modern care to everyone in Britain, from the poorest people living in bombed out houses in East London, to the middle classes in their safe suburbs, to the richest rattling around in their country estates. The poisonous link between treatment for illness and money was broken.

The poisonous link between health and money

Sadly, 75 years later, this poisonous link is still alive and well in the majority of countries in the world. This I think is in large part because of the continued pursuit of deadly, failed, market based, and private sector driven ways of providing health. These are promoted actively by many different actors, but perhaps most powerfully and influentially the World Bank.  It is one of histories greatest missed opportunities, and greatest failures in my view, and has led to immeasurable suffering and pain.

A few years ago, in Kenya my good friend Micah came to see us distraught one early morning. His grandmother, who lived out in western Kenya where he originally came from, had been attacked in her home by a thief, and hit over the head. She had been rushed to hospital, where she had been kept for a few days before sadly dying from her injuries.

Micah was obviously deeply upset and distressed by the death of his beloved grandmother, but his reason for coming to see us that morning was because the hospital that had treated her was refusing to release the body for burial until the bill for her treatment was paid. The family had been landed with a bill of 5.4 million Kenyan Shillings, or $54,000 dollars. This is the equivalent of six years of Micah’s earnings. The hospital refused to release the body until they were paid, whilst charging him for every day the body was being held in the morgue. He suspected, and indeed some at the hospital had hinted, that much of the treatment given to his grandmother was in fact never given and that she was never going to recover from her injuries. She was kept there longer to drive up the costs. Of course, nothing could be proved.

Private hospitals locking up babies and bodies.

We published two papers last week, written by my brilliant colleagues Anna and Anjela with the help of many others. They are the result of years of painstaking investigations in multiple countries into the appalling treatment of patients in private hospitals. We uncovered many stories like Micah’s one, and of patients themselves being imprisoned in hospital until bills are paid, including a child of 11 kept for months. In one example, a child badly hurt and left unconscious by a traffic accident was denied treatment by a CARE hospital in Delhi unless the family paid US$1,200.

Maputo Private Hospital reportedly charged COVID-19 patients an upfront deposit of over US$6,000 if they needed oxygen, and over US$10,000 if they needed a ventilator. In Nigeria 9 in 10 of the poorest women give birth with no medical care yet childbirth at the private Evercare Hospital would cost those same women 12 years’ entire income.

The thread that brought these violations of peoples’ right to health together was that they were all funded or supported by money from the governments of the UK, France, or Germany, together with the European Union and the World Bank.  What our investigation showed most clearly is that the transparency, accountability, and oversight of these investments is so poor as to make Lehman brothers’ audit department look assiduous. In over 25 years of investing in private hospitals in India, the World Bank’s International Finance Corporation has not published a single evaluation.

If it doesn’t work…. just keep doing it.

It does seem that the World Bank has one plan for financing healthcare in the Global South. This is to get every citizen to get insurance to pay for care provided in large part by the private sector. Unlike private insurance, this is intended to be social insurance, regulated, and backed by government. This system is what is used in a number of rich countries, like Germany and France, where it works pretty well. Yet in those nations it took over a hundred years to get to universal coverage, with the poorest, the women, the people in insecure employment the very last to be covered.  The National Health Insurance Fund in Kenya, which was launched in 1967, still only covers 16% of the population 56 years later.

The successful experiences of tax based, publicly provided schemes at getting to universal health coverage far faster has been largely forgotten it seems. Not just those of the UK and other rich nations like Norway or Spain, but more recent experiences in the Global South like that in Thailand who created a Thai NHS in a few years in the early 2000’s. The Thai government employs 180,000 nurses and 50,000 doctors and over 80% of all care is delivered by the state. Funded by progressive taxation, quality health services are available free to everyone, and benefit the poorest people most.

(Nurses in Thailand- Photo from Public Services International)

Removing the link between money and the most important things in life

It seems to me there are two ways to reduce economic inequality. One is to make the poor richer and the rich poorer, so people’s incomes are closer together, through taxing the rich more for example. But another is to take money out of the provision of various services, and to provide them on the basis of need instead of ability to pay.   This directly reduces inequality in access to the things that people need to survive and thrive, whether it is health, clean water, education, housing- by making these in large part public and democratically distributed based on need, the impact of economic inequality is reduced directly.

Conversely, I think neoliberalism is arguably the worst of all worlds- it seeks to put a price on everything, including healthcare, whilst remorselessly driving down the money available to the majority of ordinary people in favour of concentrating wealth at the top. 

Here in the UK, the fight to keep our NHS public is a visceral and vital one, with our current government of the last 13 years very much in favor of more and more private sector involvement in our health system.  The huge pressure on the NHS during Covid-19 saw waiting lists rise. But nevertheless, despite these attacks it remains the most trusted public institution in the country and an incredible tribute to those who set it up 75 years ago.

Author: Max is the Head of Inequality Policy at Oxfam International & EQUALS Podcast co-host. He is also Chair of the Global People’s Vaccine Alliance.

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