It is safe to say that, far from being overstated, the Americanization of the NHS is very nearly complete, write Stewart Player and Bob Gill.
By Stewart Player and Bob Gill
Special to Consortium News
One of the recent roles of the Parliamentary Healthcare Committee has been to reassure the British public that any claims regarding the ‘Americanization’ of the National Health Service (NHS) were wildly overstated, “creating a climate that risks blocking the joining up of services in the interests of patients.”
In fact, the penetration of the healthcare system by the giant U.S. insurer UnitedHealth reveals the opposite to be true, with the full extent of its influence capable of surprising even seasoned NHS watchers.
The Health and Care Bill making its way through official channels simply reinforces this, with the bill’s centerpiece, the 42 regional-scale Integrated Care Systems (ICSs), aimed at bringing together GPs, hospitals, mental healthcare and council services. It is being effectively designed and fast-tracked by the private UnitedHealth.
The U.S. healthcare system is of course a thing of nightmares. Insurance payments extract almost half the income of an average family, in return for which the nation consistently ranks last for access, equity, and outcomes of care in periodic studies by the Commonwealth Fund.
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Not content with employer — or individual-based customers — giant insurers now see as much as 50 percent of their revenues coming from federally-funded services, with studies from Texas revealing the greatest profits within the privatized Medicaid system resulting from denying care to medically fragile children and the severely disabled.
Fraud, scandal, bloated executive salaries and minimal care constitute the norm, yet, owing to the state-capital symbiosis that defines the U.S., the cyclical clamor for reform only sees the industry emerge stronger every time.
This was nowhere more evident than the Affordable Care Act (ACA) of 2010 – also known as Obamacare. Less one thinks this is a digression, it is arguable that one can’t understand the position of the British NHS without also understanding the ACA.
According to BusinessWeek, the leading role in ensuring that ‘reform’ doesn’t happened and that ACA proved a bonanza for health insurers was played by the largest of them, UnitedHealth.
While superficially progressive, those newly insured under Obamacare were all channelled either to subsidized marketplaces or to privatized Medicaid to the extent that within a few years these programs had become the main artery of corporate profits.
The Role of Simon Stevens
Serving as point man in the process was the Briton Simon Stevens. Newly promoted as UnitedHealth’s vice-president, he was also charged with leading the company’s “strategic positioning for national health reform.” The company was nothing if not forward thinking when it also appointed him head of UnitedHealth’s Global Health Division.
With capital’s position secure in the heartland, United began to think of further expansion. In his new role, Stevens first helped set up in September 2011 the Alliance for Healthcare Competitiveness, a high-level lobby group with the aim of deregulating trade laws and forcing other nations to open up their health systems to U.S. for-profit insurers, hospitals, pharmaceutical firms, IT companies and other investor-owned firms.
However, it makes little sense to open up national systems unless these conform to standardized templates, and within the year, Stevens was acting as project steward within the World Economic Forum’s (WEF) project on sustainable health systems.
Advocating new care models – though in effect rebranded U.S. Health Maintenance Organizations (HMOs) – the WEF envisaged a climate where “health schemes and insurance markets boom as people seek to cover their health costs,” while governments “focus on regulating large integrated health providers in a complex expanding global marketplace.”
It only remained for Stevens to return to Britain – “my heart is in the NHS and in U.K. public services,” he said – and in October 2013 he was duly appointed as chief executive of NHS England. Since then he has pursued to the letter the aims of the World Economic Forum and U.S. capital’s.
These include the Five Year Forward View, the New Care Models Programme, the Sustainability and Transformation Partnerships, and, ultimately, the 42 Integrated Care Systems.
A Mixed Economy of Care
In the process, UnitedHealth’s influence has extended across the board. Take commissioning of NHS patient care, for example. Under the terms of the 2012 Health Act, this was to be led by general practitioners but few family doctors had a clue (why should they?) and those that were involved were in it for the extra income and to rubber-stamp decisions made by the commissioning ‘support’ market. (The health care act removed responsibility since 1948 for running the NHS from the health secretary to clinical commissioning groups (CCG), providing an entry for private insurers.)
Serving as chair of the Commissioning Support Industry Group from May 2013, and also providing its secretariat, was UnitedHealth. The group also involved U.S. consultancies, KPMG, McKinsey, EY and PWC. UnitedHealth paid for an annual trip for “senior-level executives from across the U.K. health system” to find out how the company operates in the U.S. and to “explore their applicability in the U.K.”
Since then, this has meant amassing major contracts not only in commissioning support, but also in clinical governance, communications, human resources and workforce development, medicines management, and in implementing Personal Health Budgets.
Groomed By US Capital
As well as bankrolling the largest primary care network, Modality, it has also meant a near-monopoly in data analytics for United, particularly those relating to population health management and the risk stratification of patient cohorts – all exercises in assessing insurance risks and their subsequent costing as the system moves to a mixed economy of care.
But most importantly it has meant United playing the lead role in both defining and fast-tracking ICSs as they await formal legal status. Launched by NHS England in January 2018, the Optum Alliance – consisting of United and PwC – delivered a “major capabilities building programme” to “facilitate the move to whole system working” for the most advanced ICSs.
This included those in Birmingham, Warwickshire, Northumbria, West Yorkshire, Devon, Dorset, and Cumbria, and involved developing capabilities in care redesign – including “radical transformation of outpatient services” and developing primary care networks – financial management, effective leadership, integrated contracting, governance and delivery, as well as building sustainable, value-based, strategies.
For the program, UnitedHealth fielded its most senior partners and directors, all of whom were “experienced leaders in complex business systems.” Under the lead of ICS and clinical commissioning groups, hospital CEOs, finance officers, and local authority chief executives, worked alongside the Optum Alliance and NHS England. But as the director of commissioning for the West Midlands, Alison Tonge, pointed out, it was “UnitedHealth and PwC, who led the sessions.”
As such, despite the talk in policy circles of emerging leaders being brave, innovative, and capable of “high learning agility within new healthcare ecosystems,” it would instead appear they are dutifully being groomed by U.S. capital. Indeed, it is safe to say that, far from being overstated, the Americanization of the NHS is very nearly complete.
The Harm Caused
The Health and Care Bill will essentially provide legislative lock-in for the changes already embedded throughout the NHS. Patients will be denied care to generate profits for the ICS, over which their family physician or hospital specialist will have no influence, while the growing unmet patient need will have to be serviced either through out-of-pocket payments, top-up private insurance, or not at all.
The inevitable harm and suffering endured by patients without the money to pay for treatment will affect their families, carers, clinicians and society as a whole. Healthcare professionals working in this two-tier system will themselves be exploited, made to work beyond the competence, offered perverse incentives to act against the interests of patients to generate profits and in doing so fundamentally betraying the healing relationship.
The NHS will, in the immediate future, resemble ‘Medicare Advantage’ or ‘Medicaid Managed Care’, a basic, publicly funded, privately controlled and delivered corporate cash cow repurposed to make profit, though in time the full range of the organizational options found in the U.S. will follow.
All this will increase the total cost of healthcare, deliver less, harm thousands, enrich foreign corporations and destroy what was once Britain’s national pride.
Stewart Player is a public policy analyst and co-author (with Professor Colin Leys) of The Plot Against the NHS (Merlin, 2011).
Dr. Bob Gill is a GP and producer of the feature length documentary The Great NHS Heist.
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So sorry for your situation, Dianne, of needed health care and having to wait months and drive so far from your home. What state (and county) do you live in? I’m in northern California and go to Kaiser health care. (Medicare covers part of that, but is taken out of Social Security). Health reform is needed in the U.S. and U.K. Since the Democrats control Congress now, they ought to act boldly for such reforms now! May you be well. sincerely, Carolyn Grassi p.s. in my poetry I try to awaken readers to injustices
To fully appreciate where you may be heading read “CODE BLUE: Inside the Medical Industrial Complex” – the “most authoritative and well-documented history of the origins of America’s profit driven health care enterprise.” hXXps://groveatlantic.com/book/code-blue/
I never had the slightest doubt that Brexit was intended to hand over the UK’s choicest parts to America’s tender embrace. Remember Ms. Mays assuring everyone that the Brexit changes would not mean bringing in America’s horrid meat products? In fact, that’s exactly what it meant, what it always meant, along with everything else. Amazing that the flag-waving Tories were so anxious to “Get Brexit Done” so they could hurry up an sell off the UK to America. I guess profit is the new and true nationalism. Long live the empire…
This Bill has not yet been passed and the Lords have yet to debate it. Readers can join the campaign to prevent passage of the Bill, and to protect the NHS in general, with:
6/5/2019, BBC: “Donald Trump has rowed back on his remarks that the NHS should form part of a future trade deal between the UK and US. The comment, made during his state visit to the UK, prompted a backlash from Conservative leadership candidates, Labour and trade unions.
But on Wednesday, the US president told ITV’s Good Morning Britain: “I don’t see it being on the table.” He added that the NHS was something he would “not consider part of trade”.
Current rules allow foreign firms to bid for NHS contracts and a subsidiary of the US company United Health is among private groups which have already successfully done so….
At a press conference in London on Tuesday, Mr Trump was asked whether he believed the NHS should be part of a trade deal between the UK and US after Brexit.
He told reporters: “When you’re dealing with trade everything is on the table, so the NHS or anything else, or a lot more than that.””…”Trump state visit: President rows back on NHS trade remarks”
When the US involved, it makes everything worse, as commenter above stated.
Sorry 2 see KPMS in the mix…
Just as I began frequently comparing the NHS
to our (US) crap, I learn that it’s turning into our crap!
Can our reformers borrow your notes on what you had
to help get rid of what we’ve got?
no surprise. Health care is a deeply held giant vampire squid, sticky fingers plan to extort money from the ill and ailing, the “insurance” is insufficient so we are forced to buy supplemental ins to cover the gaps and be safe from co-pays etc.
Social Security no way covers it.
Health Care, they say. Health is not the goal, care is whimsical.
This is very scary and corrupt stuff, but, not surprising! Our media must be sitting on this information, which
should be available to everyone, but, once again, we will be the last to learn, of this huge betrayal of judgement
by NHS and Government!
Our grandchildren will never know what the NHS was, as they pay the huge sums for private healthcare and maybe, one day, ask, why we had allowed this to disappear and deny them, the the privilege of a Health Care, free at the point of delivery, to everyone! This is so huge, yet only Consortium News tells this sad story!
thank you CN
What about the film made by John Pilger on the NHS a few years ago? Did that have any impact on public knowledge and discussion? How have people really been unable to stop this terrible situation??
Not only has the USA managed to cause destruction in so many countries by pretending it is somehow beneficial to overthrow democratically elected governments as in Venezuela and Nicaragua time after time, but poses as a democracy and bastion of freedom. To follow or allow such “leader” to replace a system beloved by its population and when funded fairly, able to help all the people to reach a reasonable level of well-being without the stress of huge medical bills, is a crime.
Unfortunately, this is not news for a lot of us in the UK. Thatcher started the process and lap dog Blair continued it. The real push through to completion began with Cameron’s government and has accelerated via May and Johnson. Stevens and Hunt were major players and covid has emboldened the privateers.
The British public were warned what was going on by Jeremy Corbyn but he wasn’t believed and his credibility was undermined by dark forces. The British public chose to believe the word of a proven liar, chancer and philander, they will reap what they have sown.
The NHS has been sold off in broad daylight, if people think it is bad now then they are going to be in for a real shock very soon.
It feels as though you are blaming the propagandized victims for the effective nefarious plots against them!
The masses of psychological science employed for profit includes New Yorker “Father of Propaganda” Edward Bernays stealing his Austrian Uncle Freud’s healing genius insights into the workings of our subconscious minds to entrap people into funding Wars & selling cigarettes! Nazis built on Bernays’ stolen Freudian insights and this mind-controlling science is expanded for more evil every year on the public dime!
I mourn for the vast majorities, friends & family, who have been caught in this powerful system of nets! BuI know that I too have been caught, yet knowing the evil power, do my utmost to break free.
“his credibility was undermined by dark forces” led by Keir Starmer. The Labour party must share the blame for this utter catastrophe for British people. When Labour was in power from 1997-2010 it worked hard to accelerate the privatisation of the NHS as well as to push forward the Tories’ Private Finance Initiative which gives massive public funds to private corporations to lease public facilities which we should own.
Thank you Mr. Player and Mr. Gill.
Truly the US and UK governments are no more than gangs of the most corrupt.
We await the courage of the angriest to begin their destruction.
My heart goes out the the average Brits: first they get screwed by their own government and now they will be screwed by the Yanx too. The so-called ‘health’ department should be called the WEALTH department.
Indeed, people in Britain won’t know what hit them. I just had my own run-in with the American health care system this morning–at least the part that should (but doesn’t) serve seniors, disabled, and poor people, and I can say that without a doubt the only priority is to fill the pockets of the wealthy who own the system. Patient care doesn’t even appear on the radar. My two choices for seeing a gynecologist for a long-standing problem were to wait 18 months for an appointment and travel 45 minutes, or wait 9 months and travel an hour. No other gynecologists in the entire county would accept my poor people/old people insurance. That is just one tiny example of the sort of thing that Britons will wake up some day and find out, when the NHS is Americanized. People. Will. Die.