AILING SOCIALIZED MEDICINE

...FROM BRITAIN RILING SOCIALIZED MEDICINE Liberal-minded Americans have long felt a special admiration for the British health service ("socialized medicine"), and it must therefore be worrying and disappointing to them to see it apparently disintegrating...

...There is no doubt that the junior doctors have had a rough time, in terms of hours of work and low pay: though it has to be said that their eventual prospects are of course much better than the average for the population...

...The legacy of the nineteenth century, in terms of obsolete buildings, very poor pay for the non-medical staff, gross regional disparities and general shortages of all sorts, was so enormous that such issues as "pay-beds" seemed to be, for the time being, marginal...

...But the claptrap is not all on one side...

...What this conflict shows is that the dispute is not really about patients' choice, for the options are not fairly set out...

...Some junior doctors have actually broken away from the official British Medical Association, and formed their own union to protect their own interests...

...Of course, there have been numerous occasions in the past twenty years when bits of the edifice have been eroded...

...And of course, the whole thing was built upon a compromise with the medical profession, whereby doctors were allowed to use beds in national health hospitals, and the ancillary equipment that went with them, for the treatment of their private, fee-paying patients...

...If road users themselves had to pay for the provision and maintenance of die roads they use, just as the railways have to do for maintaining their own track, then the enormous advantage at present gained by the motorist who uses roads that are paid for out of public funds would disappear...

...But behind the government's stand also lies the attitude of the trade unions that organize the non-medical workers in the hospitals...

...The government's case is not only that it is unfair, and wrong in principle within the health service, to allow people to "jump the queue" for treatment: it is also that to give over the present private beds to the health service would be the equivalent of building four large new national health service hospitals-no mean consideration in an era of economic contraction...

...The dispute is thus partly the result of a certain "democratization" of the profession...

...It would be easy to suppose that the basic conflict is simply between the socialist conception of a community health service free and open equally to all, and the conservative "private enterprise" mentality of a medical profession that wishes to retain its status, its money-making potential and its freedom of clinical action...

...Nevertheless, the edifice still, in all essentials, remains standing...

...The "pay-beds" issue is essentially a conflict between a government that is committed, by its election promises, to phase-out private fee-paying medicine from the health service, and the medical hierarchy, which wants to retain such provision...

...As everyone knows, the health service was one of the great legacies of the postwar Labor government in Britain, and was in a special way the child of that government's most dynamic member, Aneurin Bevan...

...The second dispute is quite different It is partly between the junior hospital doctors (newly qualified doctors working in national health hospitals, and doing most of die spadework) and the government: but it is also between them and the senior members of their own profession...

...The arguments on both sides are full of the usual deliberately misleading claptrap...

...This is because as long as the economy as a whole was expanding, the service was able to progress sufficiently to keep the various opposing factions within it reasonably happy...

...That is to say, it was possible to focus attention on the improvement of services and the working out of priorities, rather than on conflicting basic principles...

...The doctors' argument for the retention of fee-paying beds is based on two overt premises: one is their own clinical freedom of action, the other is the freedom of patients to choose the kind of medical care they want, and to pay for it if they wish...

...But this argument carefully leaves out one essential point: namely that in the medical case the same driver is required for both vehicles...

...But it is also a conflict with the government, because the junior doctors-no doubt as part of their "democratization"-have waked up to the fact that they too can "hold the nation to ransom" like any other trade union in a key sector, in order to get what they want-i.e., more money for less hours of work...

...This is not to say that the issue is simple...

...But the dispute is an interesting one in the long term, because it is partly a case of an old-established profession awakening to its power (and its responsibilities) as a trade union, capable of much militancy when roused...

...it will only consider ways of sharing out what is already permitted to them under the pay policy...

...And so it is fundamental to Labor orthodoxy that the health service must be preserved at all costs in all its essentials...

...There is an analogy here to rival claims of rail and road transport in Britain...

...These are quite different kinds of dispute...

...BRIAN WICKER (Brian Wicker is Commonweal's regular correspondent in Great Britain...

...But I think Barbara Castle is right all the same to say that the Royal Commission just set up to look into health service problems, should not be allowed to by-pass Parliament in the search for a solution for this particular problem: for it is a political problem of power and national priorities, and as such a matter for Parliament to decide...

...For example, a senior spokesman for the doctors recently gave the following analogy to the "pay-beds" principle...

...But this situation is partly the result of the hierarchical nature of the medical profession itself and the excessive power wielded in it by the senior people...

...But the present disputes are not as simple as that There are two main problems in the news just now: the first is the issue of fee-paying medical facilities within national health hospitals, and the other is the pay and conditions of junior hospital doctors...

...I'm not sure how far the troubles we have run into over here, in the health service, have penetrated the news media on the other side of the water...

...In other words if the bus driver had to get out of his bus to drive the taxi, then of course the people in the queue would have a grievance...

...Whatever happens, the future implications are going to be very interesting...

...It is a conflict between the interests of an entrenched professional minority and the community at large...

...These workers (cleaners, porters, cooks etc...

...have already put pressure, by various sorts of industrial action, on the government to keep to its promises and they are just as capable as the doctors of bringing the service to a halt if they use their power fully...

...But unluckily for them, they've done so just at the time when the government's anti-inflation pay policy is beginning to bite and the government certainly won't give them any more money...

...It is the finest flower of that Fabian-inspired large-scale social democracy which was at the root of the postwar rebuilding program in Britain...

...It may therefore be worth while offering a few reflections on the background to the current disputes...

...Similarly, the private patient in a national health service hospital is not really paying for the full cost of his treatment: and if he were asked to, he would have to be very rich to be able to do so...

...for example charges for medical prescriptions (with exemptions for pensioners and the very poor) came a long time ago...

...There is a particular kind of concern, therefore, especially among Labor supporters, whenever the health service comes under challenge...

...Bat, as the doctors point out, private medicine without the equipment that health service hospitals provide would become impossibly expensive, especially in remoter areas, and for practical purposes the choice of private treatment would disappear there...

...Talk of the death of the health service focuses the mind wonderfully well on the essentials...

...But now, with the contraction of the economy and the prospect of a standstill in investment, the conflicts of principle that were held at bay in the fifties and sixties have now come out into the open...

...On the government side, it is claimed that there is no intention to ban private medicine: only to eliminate it from health service facilities...

...but I feel sure that many Americans who have looked to the British solution to the problems of communal health care through rose-tinted spectacles are now finding their faith sorely tested...

...If people are queuing for a bus, and one of them decides to hail a taxi and pay for it in order to get home quickly, there is no reason for those who choose to wait to feel cheated...