There have been a series of leaks and announcements in the past few days, as the government prepares to unleash its emergency budget on us on Wednesday. Amidst the rumoured horrors of cuts to tax credits, lowering of the benefit cap, abolition of the work related activity group and a new system of housing benefit that will never cover your rent, I spotted two – seemingly minor – announcements, which give us a clue as to why the Tories are confident enough to be pushing through with this smash & grab on the welfare state.
Printing the cost of medicines on the packaging
Jeremy Hunt has announced that from next year, all prescription medicines will be marked with ‘funded by the taxpayer’ and medicines costing over £20 will also show this price on the label.
The official reason for this move is apparently to encourage people to take their medicine. I’m not sure I understand how this is supposed to work – I guess on the basis that people only value things if they know the price of them – but it doesn’t really matter, as this is of course not the real reason.
Some people have (not surprisingly) interpreted this as a personal attack on them – not only do they have to put up with being chronically sick and dependent on medicines, but now they are expected to feel guilty about it too! The originators of this petition, for example, point out this and several other drawbacks to the plan, and come up with a few better suggestions for dealing with the purported problem of wasted drugs. But that’s not the real reason either.
No, Jeremy Hunt himself told us the reason on Question Time last week. In answer to a question about whether patients should be charged for missing GP appointments, he said:
“I think in practical terms it could be difficult to do, but I’ve taken a step towards that this week by announcing that when people do miss an appointment they will be told how much that’s cost the NHS.”
There you have it, from the horse’s mouth. Telling people the cost of something is a step towards charging them that cost.
This is not the first step towards charging people for their prescription medicines. Prescription charges, introduced by the Tories in 1952, were the first step. Until the late 1970s, these were very low (they were increased to 20p in 1971), but they were increased rapidly under the Thatcher government. Even an administrative charge undermines the whole concept of a free service, as Aneurin Bevan understood very well, when he resigned from the Labour government (in part over this issue) in 1951.
Next, it was important to make sure everything was allocated a price and to put in place all the mechanisms for ‘buying’ and ‘selling’ services between different parts of the same organisation. The Tories introduced an internal market into the NHS in 1991 and New Labour left it there. They even chipped in themselves with a series of reforms in the early 2000s, to promote the idea of patient choice. There’s no evidence that any of this has improved health outcomes, and plenty of reason to believe it is draining the NHS of billions of pounds each year.
As soon as the internal market was in place, a key cultural shift happened. According to a 2010 review of the academic literature by thinktank Civitas,
“Several changes in the organisational culture of the NHS were noted. … There was an increase in cost – consciousness throughout the NHS, and physicians saw their historically unquestioned authority at times equalled by, at times surpassed by, NHS managers. For the first time, it seemed, the concepts of consumerism, value for money, and accountability for output permeated the NHS. While Kirkup and Donaldson (1994) observed early on that many of the reforms failed to realise their full potential to achieve beneficial change … Rudolf Klein considered these changes to be so significant that ‘No future government could return to the pre – 1991 situation’. This cultural shift remains the most unquestioned outcome of the first NHS quasi market.”
Once the idea of a market in healthcare is established – right in the very heart of our NHS – the foundations are laid for expanding the market to new providers and new purchasers.
This is the reason for printing the cost of medicines on the packaging. Jeremy Hunt even said it out loud, and nobody seemed to notice.
Charging higher rents to council tenants on higher incomes
The deliberate dismantling of the system of council housing is one of the most complete achievements of the Thatcher government. The method used – Right to Buy – was a quintessential divide-and-rule move, designed to wipe out in one stroke the idea of council housing as a collectively owned resource, available to anyone.
This mob – perhaps wishing to emulate their heroine, or just to finish off her work – are now planning to put the boot into council housing’s almost lifeless corpse with two further moves, along the same lines. One is the almost laughable (if it weren’t so tragic) idea of extending the Right to Buy to Housing Association tenants.
In order to compensate the Housing Associations, the government plans to force local councils to sell off the most valuable of their remaining stock as it becomes vacant. So the policy will grab housing out of the social sector with both hands, undoubtedly worsening the housing crisis that is already causing so much suffering.
The second move, which I want to discuss here, is the idea of charging higher rents for council tenants whose household income is over £30,000 or £40,000. Here’s another story on it. That one calls it a ‘crackdown’.
Both those pieces – presumably echoing the language used by the government in announcing this plan – talk about council rents as “subsidised” and contrast them with “the full market rent”. But council rents are not subsidised. There is no flow of money from general taxation towards council housing. In fact, for many years money flowed exactly in the opposite direction – there was a ‘negative subsidy’ from council rents into the treasury. That system has since been changed, following the successful and tenacious Daylight Robbery campaign by tenants. But the fact remains that council rents more than cover the cost of maintaining the stock of council housing.
If council rents are not subsidised, why are they so much lower than rents in the private sector? How come people can live in council houses, get their rent paid by housing benefit and be left with more disposable income than people who have worked hard, saved up for a deposit and got a mortgage?
The answer is that house prices (in the south east) are still hugely inflated by a bubble of unsustainable private debt. And private rents are even more out of control. Rather than let slip that it is council rents which relate more closely to the ‘true’ or ‘real’ cost of providing a decent home, the government is desperate to have us believe that these ridiculously puffed up private sector costs are in some way natural (“the full market cost”).
This is a genius policy for the government. Not only does it wipe out the threat of a good example from the public sector. It also throws in a big helping of divide and rule between council tenants and everyone else, and between council tenants who are working and those who are not.
And – most importantly of all – it reinforces the idea that council housing, and all public services, are some form of charity, only to be made available to the most needy and most deserving of the poor. If you can redefine those ‘needy’ and ‘deserving’ categories to be mutually exclusive, all the better!
We have been disarmed
These are Tory ideas, building on Tory foundations. But Labour kept those foundations in place when in government. They never challenged them and they still don’t.
Labour don’t support the NHS Reinstatement Bill. They say it requires too radical a reorganisation of the NHS.
Labour support the Right to Buy in the council housing sector. It is not even certain that they will oppose its extension to Housing Association tenants.
Their silence and collusion with these ideas has weakened those of us who want to oppose these (and all the other) attacks on working class people.
Markets are not the right solution for healthcare, or housing. But in an atmosphere of political consensus, it is hard for voters to see collective solutions based on solidarity as a meaningful alternative. Voting for Jeremy Corbyn is a small part of challenging that consensus.
But much more important is providing practical solidarity for people who are at the sharp end, and creating spaces in which people can start to develop a different way of organising things.
Balls to the Budget! Let’s build something better.