Alexander Smith: The best health care is in the public sector

The Government's proposals will involve the abolition of primary care trusts and the devolving of control over health spending to GPs. The speed of these reforms has caught many off guard and there has been strong criticism from many doctors, nurses and other healthcare professionals.

But the Government argues that these reforms will deliver efficiencies in health care spending by bringing the discipline of the market to frontline care.

For some time, politicians from all sides have argued that Britain can no longer afford to subsidise the NHS from tax revenue alone, particularly in an age of austerity when significant funding cuts are being made across the public sector.

And yet, during last year's general election, no political party dared propose reforms to the NHS on the scale now being considered.

Rightly, most people remain deeply committed to the principle that healthcare should be universal for all our fellow citizens and that such care should be free at the point of use. And to be fair, the Government is not proposing otherwise.

But its attempts to extend the market deep into the very heart of the NHS risks normalising the idea that private companies trying to make a profit can run healthcare better than the public sector. Sceptics have branded the coalition proposals a massive gamble that will likely result in the privatisation of the NHS through the back door.

You only have to look across the North Atlantic to question the wisdom of leaving healthcare in the hands of private companies.

As Westminster was debating the biggest reforms to the NHS in over 60 years, the Republican-controlled Congress was repealing President Obama's landmark bill – passed last year in the face of unrelenting opposition from the Tea Party movement – to counter rising medical costs and guarantee that all Americans received some form of health insurance cover.

Throughout its history, the US has had a privatised system of health care that, infamously, failed to provide cover to all of its citizens. Those in work usually (but not always) rely on their employers to purchase, on their behalf, private health insurance policies. But in 2008, the US Census Bureau estimated that more than 46 million Americans – mostly the poor and unemployed – had no health insurance at all.

In addition, many more millions of Americans are under-insured, for the simple reason that their employer cannot afford the private health premiums charged for more expensive forms of cover. People who find themselves under-insured often discover too late that their private health insurance policy will not cover the costs of a life-saving procedure.

As a result, Americans individually fork out thousands of dollars to pay for their own care. And unsurprisingly, half of all personal bankruptcies in the United States result in part from rising medical costs.

In contrast to the UK, the root causes of the funding crisis in the American system lie in the private market. If this is a system coalition MPs are keen to emulate in Britain, then healthcare professionals are right to be cautious.

There is, in fact, very little evidence to suggest that privatised healthcare is more efficient than a properly – and publicly – funded NHS. After all, in 2007, the US spent an eye-watering $2.2 trillion on health care. That figure equated to over 16 per cent of America's GDP. In comparison, NHS expenditure came to a little over eight per cent of UK GDP that year. This is in line with average health care expenditure across most OECD countries.

American critics of publicly-funded healthcare usually describe the NHS as an example of "socialised medicine" where care is rationed. This misleadingly implies that most people who require medical treatment in the UK receive sub-quality care or, indeed, no treatment at all.

But the evidence of the above statistics points us in the opposite direction entirely. Contrary to the argument being put forward by coalition MPs, it could be argued that the best way to provide efficient health provision for all is to keep the private sector out of the NHS altogether. There is no better health care system than one firmly within the realm of the public sector.

And as anyone who lived during the 1940s will tell you, whether you are fighting a war for national survival or seeking to provide healthcare for all, rationing works. This was well understood by Lord Beveridge, the Attlee Government and others involved in the founding of the NHS during our country's last Age of Austerity. We ignore such a truth to our collective peril.

Dr Alexander smith is a Lecturer in sociology at the University of Huddersfeld.