WHEN DONALD TRUMP grabbed news headlines in June by insisting that the NHS – and of course its budget of £120 billion a year – should be “on the table” in any trade negotiations, some Tory leadership hopefuls hastened to distance themselves from his demands. Johnson, Trump’s favoured candidate, not only stayed silent, but later told a meeting that the NHS “needs reform”.
Trump later appeared to retreat slightly from his original statement, but it would be a mistake to take anything he says at face value.
Since then one unthinkable event has happened. Johnson has been ‘elected’ leader, and thus also as Prime Minister, by just 90,000 rightward-lurching Tory Party members, and has purged his government of all but the most servile and extreme Brexiteers.
Nonetheless Johnson has felt obliged to deny in Parliament that the NHS would be included in any US trade negotiations: his intellectually challenged Treasury secretary Liz Truss has said the same. Their word is as inconsistent and unreliable as Trump’s.
Preparing the ground for an election, Johnson has promised almost £2 billion from the ‘magic money tree’. What Johnson insisted was “new” money turns out, predictably, to have been old money that has been saved through cutbacks already imposed by trusts, and the £1 billion now released to be spent on maintenance is a small contribution towards the £6 billion backlog bill that has grown since 2010.
So where do things stand with a US trade deal?
The NHS has been open to private companies to bid for contracts for almost 20 years. New Labour’s controversial experiments from 2000 onwards opened up a competitive market in clinical care. On doing so they squandered hundreds of millions of the extra funding they pumped into the NHS on “independent sector treatment centres” and other measures to expand private health providers at the expense of NHS trusts.
Since 2010 the annual increases in funding have been thrown into reverse by austerity measures that have effectively frozen NHS budgets in real terms while the population and pressures on services have increased, but the pressure for privatisation has been increased by the 2012 Health and Social Care Act, which was pushed through by David Cameron’s government with Lib Dem backing.
So the door has been wide open, but up till now American health corporations have shown little interest in bidding for under-funded contracts to deliver patient care. Nor are the major US insurers significantly engaged in Britain, even as nine brutal years of austerity have meant growing gaps have been appearing in our NHS.
It’s not American-owned hospitals who recently offered “self-pay” operations to NHS patients denied routine treatment in Warrington, but a British NHS Foundation Trust.
Far from wanting to take over the whole of the NHS, those US companies which have sought British contracts, like UnitedHealth subsidiary Optum, have focused on specific, profitable opportunities, notably selling technology, IT expertise and back office systems.
The main driving force behind Trump’s latest demands, and the biggest potential money-spinner for the US medical-industrial complex, is the big drug companies, especially if Trump could strip away existing regulations and NICE guidelines, and force British drug prices up to the inflated levels they are able to charge in the US market.
President Trump and senior members of his cabinet have said they are tired of “foreign freeloading,” and argue that any new trade deal should bring prices into line with those in the US. The world’s top 20 best selling prescriptions are over three times more expensive in the US than in the UK, with some asthma and diabetes drugs six and seven times more.
Up to now British governments, reinforced by European regulators, have resisted US demands, especially the drug price hikes, which would push up public spending. But post-Brexit Britain will be on its own: and our main problem has always been British governments.
It was Britain’s New Labour government, not Brussels bureaucrats, that first opened up the NHS to EU competition laws; the Tory 2012 Act made things worse, and has left our health system more exposed to private intervention than any other EU country. France and Germany have protected their much bigger health care systems against competition laws and have little if any US penetration.
The British government would also be to blame if any concessions are made to the US in order to secure a trade deal; the Canadian government, right next door to the USA, has consistently rejected and avoided any US involvement in its health care system, even after signing the NAFTA free trade deal.
As the NHS Confederation’s Kate Ling has pointed out, even operating on World Trade Organisation (WTO) terms after leaving the EU would not force NHS commissioners to invite bids from overseas companies to provide NHS services: “It will be for the government of the day to choose, when negotiating, what kind of services foreign providers can bid to supply.”
Labour has made a clear break in policy from the New Labour subservience to competition and markets, and committed to ending the privatisation of clinical and support services. But how many people can feel confident that a Johnson government, or any Tory government, will not be more than happy to offer up prime slices of the NHS for US and other companies?
British governments and predominantly British companies like Virgin have privatised sections of our NHS. South African, Australian and other private firms have played a bigger role than the USA.
To keep our NHS public we need a British government committed to doing just that – and that means ensuring Johnson becomes the shortest-serving PM of recent times.
is editor of Health Campaigns Together