Labour became New Labour under Tony Blair in the UK. When Brown stepped in a few months ago, he seemed to promise a new New Labour.
But nothing of that sort is happening. Privatization, of the healthcare services especially, is all set to resume with a vengeance, say critics. And that means serious problems for people at large, a la the huge crisis faced by the Americans under George W Bush.
AdvertisementOne of Alan Johnson's first moves as the new health secretary under Brown was to announce that there would, after all, be no "third wave" of controversial private surgery and diagnostic units, known euphemistically as independent sector treatment centres.
But the award of a framework primary care contract to the 14 privateers - only mildly watered down from an earlier incarnation - and Johnson's backing for a key private-sector role in 150 new health centres and 100 new GP practices, have set the seal on the Brown government's commitment to the continuing market-driven reconstruction of Labour's greatest social achievement.
Primary care trusts, which control most of the NHS's Ģ90bn budget, will now be encouraged to buy in advice from 14 selected companies on health needs, contracts and local provision.
And among the 14 are some of the most notorious US insurance companies that have been charged with of cherry-picking patients and treatments, squeezing costs and restricting benefits through various stratagems. They have been fined too for seeking to cheat patients and for indulging in Medicare fraud.
Potentially, these corporations could even take over the management of the heart of the NHS, under the new plans announced by the Gordon Brown government.
Under the banner of choice and reform, New Labour has struggled to create an artificial market in health and turn an integrated system of universal provision into a tax-funded insurance system tailored to the private sector.
The move to outsource service commissioning will now pave the way for private companies to decide the range of services provided and use their access to information to pick the most profitable services to bid for in other areas. Allyson Pollock, head of Edinburgh University's international health policy centre, calls it the "last piece in a jigsaw" that opens the door to a US-style healthcare management.
Ministers have always insisted that using private companies is all about improving services and value for money. But the evidence is that far from making better use of the extra cash pumped into the health service, privatisation has been expensive, inefficient, destabilising, unaccountable and led to closures, cuts and job losses, notes Seumas Milne, writing in the Guardian.
The costly and underfunded private finance initiative (PFI), which has landed the NHS with a total bill of Ģ50bn for new hospital buildings, is already milking Ģ700m a year from NHS trusts and fuelling the financial crisis across the service.
The private treatment centres used for elective surgery are not, as the Commons health select committee found, more efficient than NHS units, nor have they mostly increased capacity; they are in fact more expensive, have heavily underperformed their contracts and often ended up taking over NHS staff.
Add to that the huge transaction costs of administering the new market system and it's hardly surprising Labour's own conference last year declared that the "major cause" of the financial crisis in the NHS was the "move to a competitive, market-based system" and "the continued use of PFI." Meanwhile, it's become clear that bargain-basement contract cleaning has been a key factor in the rise of hospital infections. In Wales, where cleaning is now carried out in-house rather than by contractors, methicillin-resistant staphylococcus aureus infection, or MRSA, plaguing hospitals, is less than half the English rate.
Given the evidence on cost and inefficiency, and its unpopularity among medical staff and voters, the government's determination to press on with privatisation and marketisation might seem baffling. Why insist on heading off in the direction of a health system with the highest per capita cost and inequalities while courting its main beneficiaries? The only sensible explanation has to be that what New Labour derided as the influence of producer interests has been replaced by corporate capture: a mixture of market dogma, business lobbying and a revolving door syndrome that saw Simon Stevens, former adviser to Tony Blair and a succession of New Labour health secretaries, move effortlessly on to become European president of the UnitedHealth, one of the most tainted US medical insurance firms.
The risk is now that with a continuing patchwork privatisation and cash squeeze, public support for the principles of the NHS could erode, opening the way to charges, top-up fees and private insurance. And this has to be fought back, urges Seumas Milne.