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Socialism has been pushed back in many countries; few countries have any regret about it. In India, 20th-century socialists continue to rant against the reforms in their sparsely read rags, but they find no resonance in the national debate. It is not so much that reforms are popular. Although the once-reformer finance minister is prime minister today, his demeanour is that of a pre-reform progressive. Nor are his colleagues any more inspired; they seem to be more interested in gliding smoothly on the clouds of power than in changing India for the better.
The baton has passed from India to the United Kingdom, whose Conservative government is preparing to dismantle the hallowed national health service. It has chosen a less radical path than might have been expected: it does not plan to privatize any of the enormous healthcare infrastructure that has been built up over half a century. Instead, it would introduce private sector competition in a limited set of services. The first entrants, numbering 105, have been chosen; they will provide services in a limited number of areas such as hearing aids, skin ailments and psychotherapy. It is not immediately clear how they were selected. Nor is it the government’s intention to introduce local competition as from pharmacies or clinics. The licences are national; the service providers also would seem intended to be large and well funded.
In consonance with the British penchant for understatement, the licensees have been given “any qualified provider” status. The AQPs are not all private; a number of organizations that were part of the national health service have also been given the nomenclature. This is not an entirely new development; private organizations have functioned for some time as providers of specific services to the national health service. Joint replacement, for which government hospitals have long queues, saw private entry quite some time ago. What is new is the element of competition that is now proposed to be introduced. The problem with that is that medical care is not unidimensional. There are hundreds of ailments, and many of them can be treated with different degrees of completeness and competence. Medical services are a multiproduct industry with considerable scope for quality variation. So there will be concern that private competition will supply less comprehensive treatment or services of a lower quality. If it does, the government will be inevitably drawn into controlling private service providers. While private providers may relieve shortage of certain treatments and procedures, they may eventually lead to the emergence of a new layer of public control. And if it is introduced for private service providers, there will be pressure to extend it to the public sector as well for uniformity of standards. So the national health service may eventually end up more bureaucratic. It would be ironic if the Conservatives eventually conclude that a public health service is best.
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