Editorial
The centre left cannot hold
What could you read into this scenario? The leading policy advisor on health care in the prime minister’s policy unit leaves to join United Healthcare, an aggressive for-profit American health care corporation. At the same moment the energetic and successful editor of the British Medical Journal leaves to head a British off-shoot of the same US corporation.
Some politically minded people will note the prime minister’s current troubles and see one of his protégés making his escape before a change of leadership. Others will notice the mid-life changes of direction that successful people often make, because they have the opportunities to do so. And some will detect a step change in the mood of the political class, which is now committing itself to a market-based health service with actions, not words.
healthmatters is in this last group. The defection of Simon Stevens from Number 10 and Richard Smith from the BMJ shows key players changing sides. In the past the great and the good of the centre-left moved on to run important charities like Shelter and Child Poverty Action Group, but now they go to market.
United Healthcare is a powerful profit-seeking company that intends to penetrate the UK health economy, first through the national roll-out of ‘Evercare’ – a case management approach to older people who make high use of health services – next by ‘supporting’ under-staffed primary care trusts in their commissioning, and later by organising primary care itself.
The leading figure of its UK operation is Lois Quam, whose ideas about the differences between retail markets in health care (fiercely competitive, destructive, bad) and industrial markets (slow, mutually supportive, good) attracted the attention of trades union and Labour activists in the nineties. If United Healthcare succeeds it will break the mould of the NHS and lead to a series of tightly managed, protocol-driven public health services along the lines of US managed care. Richard Smith sweetly described this in a Guardian interview as a win for everyone – but then he would, wouldn’t he?
