Friends and family are coming and going from and to Iraq and Afghanistan, not as I did, as a medical volunteer with Medcins Sans Frontiers, but with the armed forces. Like our political leaders I have great respect for their bravery and professionalism in the face of extreme and unpredictable danger.
What they report is of relevance to the subject of this post: the growing replacement of state employed professionals by private contractors. There is a balance between those functions performed by the state and corporate employees. What my friends and family report is that increasingly the balance is swinging away from the state towards the private sector. Their belief is that civilian costs -financial and human- are not counted as they are for the armed forces, which plays well politically because less soldiers need to be paid and civilian contractors are not reported in the press when they are killed in action. Private contractor profits are enormous, and in these times of economic hardship, are an increasing contribution to our ailing economy.
The changing balance means that the time is rapidly approaching when the wars in Afghanistan and Iraq contribute so much to the corporations that influence political policy that our chance of ending these wars is fading. Perhaps we will see the day when they contribute more to our economy than our involvement in the war is costing.
An effective NHS will minimise the demand for medicine by increasing the health of the public, but profit-driven health care needs to increase demand and consumption. There is no other market that doesn’t depend on ever-ending growth. After the economic collapse we were told that we needed to shop more, not tighten our belts.
The more the balance at home changes from NHS providers to private providers the greater the government costs and private profits will increase. The evangelical zeal that our politicians have for market solutions seems to completely ignore the cost of healthcare in other rich countries and the inevitable market need for expansion.
Andrew Lansley has so far committed himself to the continued transformation of the NHS into a competitive market. Perhaps he should look to Iraq and Afghanistan for inspiration.