It has become overwhelmingly clear that the Coalition government is using the deficit and the claimed need for “austerity” as a pretext to greatly boost the power of the private sector vis-à-vis the public sector. The main battlefield in their assault is the NHS. The Guardian reports that “[p]rivate health companies are … expecting to earn billions of pounds from the planned overhaul of the NHS”, a “bonanza” for these primarily US-based health giants, for example, UnitedHealth, which has recently faced a series of law-suits charging overpricing and malpractice in the US.

The government has made repeated assurances that such reforms will provide better value for money and will improve efficiency, though the evidence strongly suggests otherwise. A parliamentary Health Committee report released earlier this year noted that since the introduction of internal markets and private finance, management and administrative costs in the NHS have soared, going from a traditional low of 5% to about 14% of overall expenditure by 2005, probably more by now. In the United States, which essentially has a privatised healthcare system, administrative costs are over 30% of overall expenditure, though much lower in the state-run Medicare system. There is also no evidence that the private sector in the UK is more efficient than the public sector; in fact, where detailed studies have been done, such as in Australia, the conclusion reached is that “hospital care in the public sector is provided at higher levels of technical, allocative and dynamic efficiency than in the private sector”.

However, private-run healthcare is not all bad news. There are vast benefits — for those who run the system. The American media reported earlier this year that, in the middle of a severe economic recession, US health insurance companies posted record profits, the five major insurers making a combined profit of over $12 billion. The advocacy group whose report uncovered this story, Health Care for America Now, attributes the record earnings to the fact that the insurers cut 2.7 million people from their rolls in 2009.

If the Conservative-LibDem government gets its way, the British health system could be headed in this direction. Allyson Pollock and David Price of the Centre for International Public Health Policy at Edinburgh University paint a disturbing picture:

The vision of the future is one in which corporate interests will be given incentives to select patients, time-limit care, sell top-up insurance, and introduce charges for some elements of care no longer provided by the NHS. We may even see the development of practices competing against one another for members (patients), just like US health insurers. That’s a chilling prospect for the elderly, those with chronic illness and people with mental illness and long-term needs, who are often of no commercial interest to the corporates because of their high healthcare costs.

In effect, the policies are aimed at ultimately abolishing the NHS as a nationalised institution.

It is important to note that Coalition government’s plans are diametrically opposed to public opinion. Public support for the NHS is principled support. The 2010 State of the Nation poll found that 87% of the public think that the right to hospital treatment on the NHS within a reasonable time should be included in any Bill of Rights for the UK — just one example from a whole range of socio-economic rights with strong public support. The most progressive Conservative on this issue, Attorney-General Dominic Grieve, has stated that socio-economic rights as a category are “definitely not under consideration” for inclusion in a Bill of Rights. The same State of the Nation poll suggests a plausible explanation for why government policy and public opinion differ so sharply on these, as well as many other, matters: When asked how much power “ordinary voters” have over government policy, 72% responded that they had only “a little” or “none at all”, whereas when asked how much power “large companies” have, 73% said they have “a fair amount” or “a great deal.” Highly perceptive, given the dearth of media attention to this issue.

Cameron’s talk of the “Big Society” is, pretty transparently, a rhetorical mask used to deflect public disapproval as his government cuts public sector jobs, outsources local government contracts, and extends private sector infiltration of the health system. Furthermore, it does not appear to be a particularly effective bit of rhetoric: the Financial Times likened it to “one of those bright ideas that come up in marketing meetings … which a seasoned executive will shoot down with a gently humorous phrase”. If only the Tory PR managers had the acumen to come up with such profound and inspirational slogans as “hope” and “change”, perhaps they too could have enjoyed the remarkable praise that Barack Obama’s electoral campaign received from the marketing industry, beating Apple computers to win “Advertising Age’s marketer of the year”.

More seriously, as Hilary Wainwright notes: “Cameron says nothing about the power of private corporations – financial and industrial – or the devastating consequences their actions can have for wider society”. Corporate power is not benign: private companies are virtually unaccountable (even to shareholders), and their overriding duty is to maximise profit and market share, not to bring about positive social consequences. Wainwright further observes that “[w]ithout economic democracy, decentralisation of political power will reinforce inequality, shifting power not ‘from the state to working people’ but to those who already have the money, social networks and time to make the system work for them.” That should be an obvious corollary of an important observation made by one of the leading American social philosophers of the 20th Century, John Dewey. Dewey said that politics is “the shadow cast on society by big business”, and that “attentuation of the shadow will not change the substance”.

Both the Conservatives and the Liberal Democrats pretend that the shadow can be lifted from society by altering the relationship between the government and the people. But Dewey knew better: as long as politics is determined by big business, the substance will not change.

James Arnold will be a doctoral researcher in Philosophy at King’s College, London as of September 2010. He holds degrees from both Oxford and Cambridge Universities.