As Jeremy Hunt accuses hospitals of endangering patients lives one wonders can ‘compassionate care’ really flourish in the ‘new’ economics of health and social care? Will NHS reform result in less compassion rather than more?Michael Sandel argues markets are not a mere mechanism designed to deliver goods, they also embody certain values, and the problem is these values ‘crowd’ out non market values which are really worth caring about and preserving, such as compassion’.
The Nobel prize winner for economics, Jospeh E.Stiglitz, suggests the current neo-liberal approach favoured by government is undermining a fundamental value many support, a sense of fair play. Stiglitz argues if financiers that lay at the heart of the current financial crisis felt such a basic value their actions should have led to feelings of guilt as they engaged in predatory actions that damaged individuals lives. He suggests few felt any sense of shame or guilt and that where making money is concerned there is ‘moral deprivation’, meaning something is wrong with the moral compass of so many working in the financial sector, and that this has changed the norms of society, allowing what might once have been deemed as unacceptable as acceptable when justified by financial gain. However, such moral deprivation is not confined to the financial sector, we just need to think about ‘Big Pharma’. The Independent reports an influential group of cancer experts warn high prices charged by pharmaceutical companies for cancer drugs are effectively condemning patients to death, claiming drug companies are “profiteering” using unethical methods.
However, faith in the free market is unshakeable across government, and is seen by many as the only way forward to address future resourcing issues. However, the re-branding of healthcare as a commodity ignores some simple ‘free market’ truths, pointed out by the economist Adam Smith several hundred years ago; the purpose of the free market is to generate wealth for those who own the means of production, or the ‘masters of mankind’ as Smith christened them, it is not a charitable endeavour but a single-minded system driven by cash not compassion, who Smith suggested had a ‘vile maxim‘ of “all for ourselves”. The ‘masters of mankind’ in Smiths time were the merchants and manufacturers who supported policy that enabled them to make more profit, they were not concerned with how such policy and their actions might impact on others. Today the ‘masters of mankind’ appear to be ‘big pharma’, financial institutions; banks, insurance companies, private healthcare providers and international management consultants, such as McKinsey and Company who wrote many of the proposals contained within the Heath and Social Care Act, and stand to makes several millions from their implementation.
We have already seen some of the potential problems that can arise in the marketisation of social care. At a macro level those private institutions who have already taken over some areas of care provision have been found lacking, which does not bode well for extending this strategy accross healthcare. Take, for example, HSBC who were fined £10.5 million last year for mis-selling care bonds to older people. The Financial Services Authority found unsuitable sales had been made to 87% of customers, with the average age of those who purchased bonds being 83 years of age, many of whom having already died before the scandal came to light. Whilst £10.5 million might sound a lot it’s not for a company who was recently exposed as allowing the laundering of at least 7 billion dollars of drugs money through its bank and has set aside 700 million dollars to cover fines.
The selling of care related products by the private sector can leave individuals vulnerable in a variety of ways, look at the doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision. Latest reports in The Independent suggests nothing had changed as the bailiffs are set to move in on some care home providers.
Arguably, the ‘free market’ is anything but ‘free’. A favourite of Mrs Thatcher, economist Friedrich Hayek compared the free market to a ‘game’ where there are winners and losers suggesting trying to regulate the market in the name of social justice was a waste of time. Arguing it is not governments place to even the odds because we are all free to make choices, and should live with the consequences of those choices and not try to displace them onto others, such as government or other taxpayers. Which in many ways I support, however, the market is not free and appears more comparable to a casino where the ‘house’ always wins.
The current government, and opposition, appear to believe there is only one game in town when it comes to the future of our health and social care sector, they are wrong. Call me old-fashioned but for me an active State should be about taking a lead, collective action and solidarity, setting a high bench mark for all in society, not running away and hiding behind the financial sector and an outdated mantra of ‘private sector good, public sector bad’ where ‘money is the anthem of success’ like some National Anthem (Lana Del Rey). Stiglitz suggests this is an ideological battle, because economic science -both theory and history – provides a quite nuanced set of answers, and the battle plays out in every sector of the public realm.
The question is, are we prepared to engage in this battle to protect values such as care, compassion and fair play in our health and social care system or will we settle for values measured against cost and profit alone?