There are many innumerable reasons why it feels great to back up North and at university, one of them being the free advance preview of Michael Moore’s new film Sicko at the student union meeting hall last night. The film is one of his best – informative even for those of us who’ve already worked out (or who’ve got the hint from Scrubs) that a system of both privatised healthcare and privatised insurance might not work in the patient’s best interest – and I’d forgotten just how funny Moore can be, but it does have the flaw of looking at non-American health systems through somewhat rosy spectacles – especially Britain’s NHS.

Were the film made ten or fifteen years ago, I’d not have disputed his praise. The NHS is one of very few things we Britons can be justifiably proud of, and for decades it has cared for us all, across all the cultural and economic divides. However, the NHS is in serious danger. Our last four Prime Ministers – and the interests that have guided them – have all had sinister designs on public healthcare, and by now it is in serious danger of ceasing to be anything more than a subsidy for profiteers in white coats.

This isn’t a matter of privatisation per se. Notice, no-one’s saying the NHS will simply be floated on the market and left to make a profit. Disengaged and cynical as the Great British Public undoubtedly are, we would never have let that happen. Not even Thatcher would have dared – but she did get the ball rolling with her internal market, whereby the NHS was divided into trusts which, along with a few privileged GPs (those not familiar with UK terminology, read: family doctors) nominated as “fundholders”, traded and leased services between each other.

Thus were market forces introduced into healthcare. Naturally, this was supposed to be more efficient, but it’s another example of conclusions drawn from a model whose hypotheses have not been fulfilled in reality (two weeks into my course, incidentally, and I’m suspected that that may be all there is to the “science” of economics). In Plain English, what I’m saying is that the factors that promote efficiency in private entreprise did not apply to the NHS internal market. Fundholders, it’s true, now had an incentive not to waste money, but they had little incentive to provide a better service to the customer. One cannot simply choose a hospital in the same way that one chooses a tin of beans, and without real consumer choice there is no real competition; the internal market became a cartel.

Incidentally, I am not advocating an NHS ruled by consumer choice and market forces, I’m merely pointing out that Thatcher’s internal market did not work in this way. It lacked the drive for effectiveness, but did incorporate the drive for cost-cutting, forcing an artificial miserliness upon hospital administrators who probably started out as quite public-spirited individuals, but it did more than that. For, when all’s said and done, this wasn’t quite as shiny and new an idea as Thatcher and company made out.

As far as I can see, reducing the human aspect of management to maximising profits and, increasingly, meeting targets – to the playing of artificial games, in other words – just seems like a more advanced application of Scientific Management – that is, in the words of Wikipedia, “the division of labour pushed to its logical extreme, with a consequent de-skilling of the worker and dehumanisation of the workplace.” We must see the internal market, then, not merely as a source of stinginess, but as a great disenfranchisement of health professionals. Instead of empowered, connected doctors, we get lonely robots.

This was not all lost on the public of the time, and even those who didn’t follow the detail saw it as an attack on the National Health. The internal market was immensely unpopular, and when Tony Blair’s government was elected in 1997 it was on a platform that included the reversal of Thatcherite policies like these and resistance to any privatisation of healthcare. That’s when things get confusing.

In truth, the Blair government actually accelerated what they called “NHS reform“, but they did so in an immensely confusing way. Public opinion is now starting to wake up to the fact that slowly, subtly, by many increments over the past decade, New Labour have taken away more of our civil liberties than we would ever have given up in one go; we now have to wake up to the fact that the same thing has been happening to the NHS, and just as slowly, just as subtly, just as confusingly.

The main culprit has been the Private Finance Initiative (PFI), a concept actually introduced by John Major’s government in 1992 but whose usage has been vastly expanded by Blair and Brown. Now, most of us have heard of PFIs, but how many of us know what they actually are? Exactly. The best explanation I have found comes from KeepOurNHSPublic.com (pdf), but as union representative Karen Reissman (more of whom later) confesses, they take ages to get your head round. That’s the whole point. I will explain as best I can.

New investments (and now virtually all new investments) are made by consortia of private companies. The example most often given is of a new hospital to be built, run and financed by companies with the appropriate expertise, within a newly-formed consortium. These put up the initial capital themselves, and then lease it to the local NHS trust for terms of, usually, 30 or 60 years. They are free (indeed, compelled by the market) to generate as much of a profit for their shareholders as possible in addition to the rent payed by the public Trust.

Obviously, the penny-pinching aspect of the internal market is replicated in the PFI – but within the PFI there is also far less accountability than within the hospital. In addition, the rent imposed on the public Trust only intensifies the latter’s financial burdens, and the Trust too must be miserly in the extreme if it is to stay anything close to solvent. All this penny-pinching obviously affects the quality of care provided, but the division of the national system into all these distinct entities in competition with each other makes cooperation and coordination so much harder, and indeed companies are likely to cherry-pick the profitable operations while neglecting the more mundane.

So what, given all these problems, can the PFI possibly bring to public healthcare? Well, it allows hospitals short of capital to rely on the private sector for an initial investment, and pay back a larger amount by installments over a very long time. And that’s all there is to it; in a word, usury. A government willing to spend billions on (illegally) renewing the part of America’s nuke-toting submarine fleet that happens to fly the Union Jack, to fund its participation in America’s (illegal) invasion of Iraq with a blank cheque, is actively encouraging the NHS to undermine basic care by selling out to loan sharks!

And so, here we are, en route to an NHS still technically public, but whose role will be limited to shuffling money round an internal market, sending it out into the external market, and leaving the ever-decreasing amount of actual healthcare provision to the private sector. Privatisation, then, in all but name.

And why would the government – and their corporate backers – risk such public anger for what are, compared to the blank cheques of war, such paltry sums of money? Well, while their behaviour bears witness to a complete and utter contempt for our ability to organise and resist, and while I’m always suspicious of anything that sounds like a conspiracy theory, there is clearly much truth to Tony Benn’s line in Sicko:

I think there are two ways in which people are controlled – first of all frighten people and secondly demoralize them… An educated, healthy and confident nation is harder to govern.

So, the sicker we are, the less inclined we are to demand democracy. The big question, ultimately, becomes “How do we make ourselves harder to govern?” This is obviously a broader issue than the NHS; mobilising popular resistance to the neoliberal and imperialist agenda of the political and capitalist class has been harder than anyone could have possibly imagined. And so do the usual answers apply: demos, pressure groups (like the aforementioned KeepOurNHSPublic) and activist coalitions, lobbying MPs, and trying and hoping and praying for a serious political party to the left of the big three (for now, vote RESPECT).

However, in the fight for the NHS, there’s no denying the preponderent role played by health professionals themselves, via public sector unions like Unison. But of course, the bosses are fighting back. Manchester Royal Infirmary, the enormous hospital complex next door to the university, is frequently picketed by union officials. In addition to privatisation and the subsequent cuts in service, wages, health and safety provision, they must now fight back against the harrassment that the trust and its corporate “partners” are bringing upon them.

Unfair dismissals of union activists have, over the past two years, been overturned by the tribunals, but the recent suspension of activist and mental health nurse Karen Reissman was justified with a ludicrous, if apparently sufficient, excuse: she was bringing the Trust into disrepute. Brought in by the students union to follow the Sicko screening with a talk of her own, Karen retorted that the Trust was doing a good enough job of bringing itself into disrepute without any help from her. She has been threatened with the sack if she talks about her suspension and the circumstances surrounding it; rather than be bullied into submission, the staff have been striking in solidarity.

To join the fight, I suggest you look into any campaigns in your local area – there are sure to be some – and, in particular, get involved and show support at the picket lines of any industrial action. The demonstration in London on the 3rd November isn’t to be missed either, and you wouldn’t be going too far wrong in recommending Sicko to all your friends. Our pride in the NHS is justifiable; letting it slip away would not be.