In my last post, How Private Enterprise Takes Other People’s Money, I discussed how the privatisation of our most cherished public services is taking place by stealth, despite the weight of evidence against its being in the public interest. Today I’m going to show you what Britain would look like if we allow this to continue, using what is happening here already and in other countries to give you an idea of what this would look like. I’ll be looking at healthcare and education.
There is one of two ways this could go: major reliance on a plethora of private healthcare companies or bringing in a mandatory insurance program to pay for services run by private enterprise. Let’s take a look at the Dutch model, then discuss major reliance on private enterprise.
Healthcare in Holland
In Holland, health insurance is mandatory; if you don’t take out a policy you will be fined. It’s actually similar to America’s Affordable Care Act in that respect. The difference is, the hospitals and insurance companies are not run primarily for profit. They still have social insurance but that is for the long term care for the elderly, the dying, the long term mentally ill, etc. It’s the primary and curative care you get the insurance for.
Based on public statistics, patient polls, and independent research the Netherlands arguably has the best health care system of 32 European countries. In 2009, Health Consumer Powerhouse research director, Dr. Arne Bjornberg, commented: “As the Netherlands [is] expanding [its] lead among the best performing countries, the [Euro Health Consumer] Index indicates that the Dutch might have found a successful approach. It combines competition for funding and provision within a regulated framework. There are information tools to support active choice among consumers. The Netherlands [has] started working on patient empowerment early, which now clearly pays off in many areas. And politicians and bureaucrats are comparatively far removed from operative decisions on delivery of Dutch healthcare services!” – Healthcare in the Netherlands, Wikipedia.
This actually sounds very positive, bearing in mind that the poorest people are not excluded from healthcare provision. What worries me is that Tory ideology demands a laissez-faire approach to regulation, which tends to empower the provider, not the patient. Having seen what happens when this approach is put into action I’ve got very little faith in the Dutch approach in Tory hands.
Major reliance on private enterprise: before and after “Obamacare”
Before America’s Affordable Care Act was voted through, working Americans had to rely on private enterprise to provide them with acute, curative, and long-term healthcare. This was typically delivered via employers’ insurance programs, via personal insurance plans, or via one-off visits to providers. Due to the patchy regulation in place at the time, high-risk patients either didn’t get coverage, paid more for their insurance, or had to accept coverage for everything but their pre-existing condition. Medicaid was available to the poor. Now “Obamacare” is an improvement on the previous system because it doesn’t allow insurers to turn away people with pre-existing conditions but the implementation is a bit of a mess and people still fall through the cracks and end up without insurance because they can’t afford to pay for it and don’t qualify for state aid. Needless to say, detractors are piling in on it, complaining that regulation is the problem and forgetting that, under the old system having a pre-existing condition could leave you without coverage. Absent funding from insurance plans, independent providers are advised to seek out philanthropic millionaires and pretty much beg for the money they need.
What will actually happen?
Whether we end up with a state-regulated compulsory insurance scheme like they have in Holland or major reliance on private enterprise like they have in America is not yet decided. That said, the Tories favour the “free market” approach so we’re more likely to end up with the major reliance model they have in America now. This would, of course, be profit-driven, which would result in high costs for everyone even if we didn’t get fined for not having a policy. Why? The healthy pay for the sick, and the sick pay less than they would if they were in a high-risk only pool. It’s hard to make money out of sick people if they can’t afford the treatment they need and the only way for an insurer to make money is if the policy holders never claim. And it’s hard to earn when you’re sick. This is, of course, a point lost on the Tories, who have continued to push their privatisation agenda despite the fact that it doesn’t actually work. When even the NHS Foundation Trusts and Trusts blog complains about deficits due to fines for under-performance (this is what happens when you are expected to do more for less), you know it can’t work in the long term. The NHS will either collapse by degrees or a political coup will result in reforms that abolish the trusts and reverse privatisation.
The privatisation of education continues apace in this country but everyone seems to forget that we’ve always had private education over here. We just didn’t make it available to everyone. State-provided education is a recent innovation that the government is hoping to hand over to private enterprise. Let’s see what happens when you actually do that. There are two types of private education available: religious and secular. These are provided on either a for-profit or non-profit basis.
Liberia: privatised secular education
On 26th April 2016 Liberia’s Education Minister George Werner told the BBC that their education system was failing the country’s children due to the ravages of war and the Ebola virus. It seems he has taken a neoliberal approach in search of a solution since he says that having the government in charge was not going to solve the problems. In pursuit of this he has turned to Bridge International Academies, a multinational corporation providing education services in developing countries. While the government will own and control the infrastructure and pay the teachers, the actual administration costs will be funded by unspecified sources. Werner dismisses any criticism of the plan as the result of talking to teachers’ unions. However, since most of the problems Liberia’s schools are facing are due to teachers having to take other jobs to make ends meet, I’d be surprised to see Bridge do any better.
Even as Bridge gets its chance to prove whether its model works, regulatory hurdles threaten to be its undoing. The Kenyan government is setting out new proposals that would radically recalibrate the financial calculations on which these schools operate. Most sweeping of all is a stipulation that half of all teachers in any one school should have a recognised teaching qualification and be paid accordingly. – Bridge International Academies: Scripted schooling for $6 a month is an audacious answer to educating the poorest children across Africa and Asia, by Catrina Stewart for The Independent
Bridge are making their profit by using unqualified or under-qualified staff teaching from a tablet that provides the lesson plans they use. This is bargain basement education and Africans are being told to accept this or do without. Stewart continues:
The ministry of education says such criteria are long overdue, given the rapid expansion of private schools in the slums, some of which fail to meet even the most basic requirements on staffing, curriculum and facilities.
This is not surprising: the staff are under-qualified and underpaid. That said, compared with state schools where the staff are chronically underpaid and fees and school uniforms are often required, the private option can actually be better, meaning “better than the worst” or “better than nothing.”
Religious schools: madrassas
Madrassas were originally intended to provide a pathway to a career in the clergy or the civil service. The quality of education provision depends on who is running them; the state actually collaborates with them in many cases to provide a more comprehensive curriculum. Millions of the poorest people in India, Bangladesh, and Pakistan rely on madrassas to educate their children because they can’t afford to send them to modern secular schools and madrassas provide a stipend to some students. Many teach English and are a pathway to higher education and lucrative careers. They are usually funded by the community via donations and endowments, etc. but in Pakistan the compulsory Islamic contributions zakat and ushr are being used to fund them. The privately-run ones tend to resist efforts to reform or to modernise them. Some have been linked with terrorism; those were established in the 1980s to combat the Soviets in Afghanistan. American foreign policy failures and local and regional disputes resulted in the Jihadi movements turning against the West, taking their madrassas with them.
What will actually happen?
The academisation drive is in full swing, though a sop has been offered to Tories opposed to the move: Education Secretary Nicky Morgan will consider permitting the best-performing local authorities to manage their own academy chains. This is not a U-turn, this is a feint: academisation will continue but local authorities may be allowed to manage their own chains. And who can run these academies? Individual charitable bodies called academy trusts. They’re not obliged to follow the national curriculum and some of them are a bit dodgy, to say the least. This doesn’t appear to have fazed the government, which is ploughing on, despite many failures and widespread opposition. I foresee that British schools will either be forced into academisation whether they like it or not, with some councils controlling some academy chains unless cross-party political action can reverse this policy.
Healthcare and schools are but two essential services that are currently state-funded. Being conservative by nature I see no problem in permitting private services to exist and compete with state-funded ones on service or as a choice for those whose particular needs are met by a niche provider. What I don’t want is to see standards dropped down a hole in the name of saving money for a private enterprise that’s either being squeezed to do more for less by the government, or is reliant on funding via personal or corporate benevolence. Unfortunately, due to the ideological considerations of our current Government, that’s where we’re headed unless we take action. I’d suggest contacting your MP to complain.