The Tory Politics of NHS Charges

The Tories aren't about to introduce a charge for going to see the doctor or a call out fee for ambulances, but that doesn't stop some from wishing this was the case. Take Sajid Javid, for example. Having announced his departure before Christmas and with the bright lights of the front bench in his rear view mirror, he can now say what he really thinks. And among the very important opinions he's been repressing is that something has to be done about NHS waiting lists, and that would be making people pay for treatment. Seemingly unaware people already pay via taxation and National Insurance, Javid is arguing the best way for getting the waiting lists down is by denying treatment. What a lovely chap.

For a lot of Tories, the NHS has always represented a socialist Trojan horse in the British body politic. Free at the point of use on the basis of need? How grotesque. If health care is decommodified, what else might be next? But even more outrageous is the fact the idea of the NHS has remained stubbornly popular. It's no accident that The Tories, from its inception, have sought to hobble it. This has especially been the case since 1979 when the Tories declared open warfare on everything and anything that smacked of "socialism". Their governments have worn it down by denying funding, introducing internal markets, holding down staff pay, and conceding conditionalities around the NHS's margins. The aim, consistent with how the Tories have remodelled social security and public housing, is not the introduction of charges but its residualisation. It suits capital more to have one consumer of medicine underwritten by bottomless pockets of state money than the uncertainty of competition. Though driving more affluent people into private medical insurance is a bonus.

For the likes of Javid, there are other concerns. For most Tories having the state do anything is anathema. Indeed, Rishi Sunak has almost transformed it into performance art. Run institutions down, pretend everything is out of your hands, no one will look to the government to do anything and the Tories can pretty much do what they like. It's a strategy whose desired outcome is a depoliticisation of politics. As long as the NHS exists, however, there is an expectation on the state that it be funded properly. And when it doesn't work, like now, it becomes an axis of accountability the Tories would rather do without.

Despite his weird foray into anti-austerity politics, we know Javid is an avowed disciple of Ayn Rand and her "objectivist" horse shit. Which, like all right wing libertarianism is capital's collective whinge about having any responsibility for the people they exploit. Getting shot of the NHS is attractive because as soon as charges are introduced, the case for reducing National Insurance makes itself. And as NI payments fall on employers as well as employees, in the Javid/Randian imagination another burden on capital accumulation can be whittled away.

A day's worth of media about an exit-bound senior Tory wanting to do the NHS won't win the government points with anybody, including the eroding base. But there's still over a year of Conservative administration to run, and plenty of more opportunities for them to damage the institutions we depend on and, ultimately, us.

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