George Monbiot almost says something sensible

nick cowen, 12 March 2008

But not quite. His latest article on Comment is Free is headlined ‘Making GPs more accessible is just a disguised concession to big business’. Although his ideology is almost unparalleled in its economic illiteracy, it looks on the face as if he might have happened upon something important. He starts off well, pointing out that the government’s move to force GPs to open out-of-hours, lacks the significant public backing that is claimed, with evidence cooked up by a cabinet office report and a CBI poll.

It looks like the only demographic especially bothered about GP opening times are the usually healthy 18-34 year olds, the same group that tend to be busy during normal working hours. But, of course, who else would benefit from allowing workers to have their non-urgent ailments examined outside of working hours? Why it couldn’t possibly be their employers, by any chance? Is cynical big business trying to get primary care to change priorities from the elderly and sick just so that fewer productive hours are lost to GP appointments for the relatively well? Monbiot is devastatingly close to reaching a sensible (if emotive) conclusion here: there is a motive and the Confederation of British Industry are all over this policy. Big business is trying to externalise more of the welfare costs of its workforce to the NHS! But before he can join the dots to this neat little argument, Monbiot veers way off course:

So why is [the government] so keen on this reform? Because it assists a quite different agenda. To avoid the political firestorm big business rains on any government that stands in its way, Brown must make constant concessions. What business wants most is the 40% of the economy controlled by the state. He must find clever and camouflaged means of delivering it that do not prompt us to take to the streets. This means waging a PR war against GPs and the other public sector dinosaurs who impede choice and change. It means a thousand small steps towards privatisation.

It is at the point that Monbiot’s argument departs from this planet and enters the twilight zone. If big business is waging an invisible war for 40 per cent of the economy, it is worth noting for one that it is losing it quite badly! But, of course, it cannot be. Unlike state institutions, the market is not a monolithic beast with ‘policy’ being formed by some central committee. In so far as a collection of businesses is capable of forming intentions at all, it could not care less how big the state is. They have no ideology in favour of privatisation running parallel to Monbiot’s desire for the state to possess more and more things. They care only about their own individual bottom lines and, of course, many businesses if given the option will try and pass on some of their costs to the state or to society if they can get away with it. It is in this practical policy area where NHS priority setting becomes a legitimate concern.
The real, though somewhat less exciting, question is, if some employees find it more convenient to attend GP appointments out of office hours and some employers find that it saves them money, who should pay? Ideally, the people who benefit from it should pay for it. The problem with the way the NHS is funded is that everyone who can has already paid what they see as their fair share into it. In return, they expect a service that is focussed on their needs, as they find when they purchase a service in other sectors of the economy. With those needs unmet, this squabbling over priorities becomes almost inevitable. We might be able to resolve some of these problems when intellectuals like Monbiot come down off Cloud-9 and realise that the question is not whether a system is state or private, but whether the incentives within the system focus on individual patient needs or on bureaucratic obligations generated by lobby groups, including the likes of the CBI.