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Flow of Ideas: articles - Co-payment in Hospitals and Schools

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Chandos Book Publishing
Ultra-Blairite, Contra Progress: Co-payment in Hospitals and Schools


Glenn Rikowski, London, 15th February 2007


Clarke’s Unhealthy Ideas

It was no real surprise to see former UK Cabinet Minister Charles Clarke declare himself in favour of charges for hospital treatment when he spoke on the BBC’s Newsnight programme on Tuesday 6th February. His outburst was reported in the Morning Star on Saturday 10th February (Nousratpour, 2007). According to the reporter, Louise Nousratpour:

“Health campaigners called on the labour movement yesterday to unite against “ultra-Blairite” ministers’ attempts to bury traditional labour values of public services free at the point of need. The criticism followed Cabinet Minister Charles Clarke’s declaration that the government should consider charging NHS patients to head off the “tight” financial outlook and increasing demand for health care.”

Clarke argued that payments for the health services he had in view should come either directly from individuals of from their own insurance funds (AOL, Lifestyle, 2007). Furthermore, Clarke had the dimness, audacity and effrontery to argue that voters would “reward” New Labour ‘for having the “courage” to confront the challenge’ of tight health budgets (Nousratpour, 2007). As the Morning Star Editorial (2007) noted:

“If Mr Clarke and the other new Labour zealots want to show real courage, why don’t they suggest that some of the millions that the government hands over as profits to the private sector be used for patient care?”

Indeed. Alternatively, I hope that Clarke’s constituents have the courage to dump this intellectual mediocrity and bombastic bully at the next general election, if not before. He is a disgrace to human progress, let alone socialism, or even social democracy, and even to something as hopeless as the “centre” in politics. It was he, this demi-god of bumptiousness, who, as Minister for Education, noted that students who chose to study subjects such as ancient history or philosophy were embarking on courses that were decidedly ‘dodgy’. Clarke also implied that ‘learning for its own sake’, rather then career-related learning, constituted an indulgence. The hapless students of today ought to be studying subjects of greater vocational worth, according to this great protagonist of the flushed pie. This pompous cabbage, a former Cambridge University student of maths and economics I believe, appears to take great delight in spitting out logically dunged arguments onto those involved in education.

Clarke, of course, is situated in an ignoble line of anti-progressive and pro-capitalist education secretaries under the New Labour regime: David Blunkett (author of the project of schools and LEAs being run by companies), Estelle Morris (capitalist stalking horse and flagellant of the Education Act 2002), Ruth Kelly (of Trust School and Academy expansion fame), and now Alan Johnson (a smooth spin merchant who nevertheless takes on all the above garbage - and then attempts to fool folks via his ‘good intentions’). What a bunch!

Yet Clarke’s latest spouting on health charges need to be put in their place; as does Clarke in all his capitalised personae. First of all, regarding health charges, Clarke was referring only to certain items, e.g. rehabilitation services (see Guardian, 2007). However, the ‘thin end of the wedge’ argument enters in here. If drugs, work and other forms of rehabilitation are subject to charges, then other health services are more vulnerable to the logic of money. Before we know it, charges for visits to our general practitioners (GPs), accident and emergency visits and other health services will be on the cards. Clarke says that main NHS services should be free to all patients, but then he would say that, wouldn’t he! This is the man that helped to engineer top-up university fess, after all. Do we trust this guy? I think that if we look at what he was responsible for when he was Education Secretary we might be a tad sceptical about reassuring answers to this question.


Clarke’s Retrogressive Educational Outlook

When Clarke was Minister for Education he oversaw New Labour’s Five Year Strategy for Education (DfES, 2004). As I noted a few years ago, regarding this tacky document:

“The spectre of ‘co-payment’, or co-funding in the language of the Five Year Strategy, haunts New Labour’s future for schools in England. Co-funding involves users paying a contribution towards the costs of services that were previously wholly paid for by the state out of revenue deriving from taxation” (Rikowski, 2005, p.25).

It’s interesting that Clarke preferred the term ‘co-funding’ to ‘co-payment’; perhaps wishfully thinking that the general populace would believe that the substitution of ‘funding’ for ‘payment’, would incline them to be more sympathetic to forking out on something that was previously free.

A good example of co-funding or co-payment is dental services, where today the majority of the funding comes directly from patients. About 90%, I believe comes from our pockets. This is where New Labour wants to go with schools services in England, though employers are also to contribute:

“We expect co-funding to grow over the period of this strategy, as individuals and employers become readier to invest in better education and training that meets their needs” (DfES, 2004, p.17).

What is amusing here is that employers are expected to pay for schools attempting to meet their labour-power needs. However, whilst traditionally they have resisted this and resented paying for ‘general education’ delivered by schools via taxation on corporate profits and personal incomes, they may be so persuaded if they can see ways of making money out of schools. These ways are opening up in the school system through what I have called the business takeover of schools (see Rikowski, 2005; and Rikowski, 2006).

Of course, we already have co-payment for higher education, and it is interesting to witness what is happening there. With top-up fees coming in last September and the threat of a fees free-for-all in 2010, then it would not be fanciful to surmise that something similar could happen to schools regarding co-payment. However, there is one big difference; people choose to go to university (though there are mega pressures forcing young people into going, as we discovered with our own children, and especially pressures for them to be debt ringers by going for the loan-soaked full-time option), yet kids are forced to go to school. There is the ‘education otherwise’ option (home schooling) but for the majority of school-age children (where both parents work) this is not a viable option. Thus: if co-payment came to schools then, in effect, parents would be forced to pay for a commodity, i.e. their children’s schooling. New Labour could loosen the law on school attendance, but this wistful thought fits uneasily with the role of the capitalist state regarding the social production of labour power. Rather, New Labour’s obsession with hammering parents whose children truant shows where their priorities are forged: kids must attend a form of schooling geared to labour power production for a “knowledge economy” – or else the law is activated.

However, on the basis of what is unfolding before our eyes in the realm of higher education is possible to usefully speculate on what might happen if co-payment came to schools. Presumably the amount parents paid per child would start at some low, nominal sum. Those on various benefits would be exempt from the charges. Then, gradually, the charges would escalate. Finally, there would be a regime of open charges. High-flying schools packed with kids from the middle and upper strata of society would then hike their charges, whilst those in sink estates and lower strata areas and relatively under-performing schools would come over all ‘realistic’ and pitch their charges accordingly. And lo! We would then have an education market fit for private operators to enter more decisively than ever before, especially as charges crept up towards full cost – as what happened in dentistry in the UK.


Conclusion – In Extremis

If all future kites flown in the wind of co-payment would plummet to the ground then it would be most welcome. Yet I fear that the issue of co-payment may become a hardy perennial in the political landscape of the UK. New Labour seems determined to foist it upon us. This business-obsessed administration, bathed in the splendour of visions of the wholesomeness of profit and money-making which are to be inserted into the public services, shall not relent.


References

AOL Lifestyle (2005) Clarke backs extending NHS charges, AOL Lifestyle, 10th February: http://lifestyle.aol.co.uk/clarke-backs-extending-nhs-charges/article/20070209002809990002

DfES (2004) Department for Education and Skills: Five Year Strategy for Children and Learners, Cm 6272, Department for Education and Skills, Norwich: The Stationery Office.

Guardian (2007) Clarke backs charging for non-essential NHS services, Press Association, The Guardian (Unlimited), 9th February: http://politics.guardian.co.uk/publicservices/story/0,,2009467,00.html

Morning Star (2007) Political Courage (Editorial), Morning Star, 10th February, p.2.

Nousratpour, L. (2007) Clarke moots NHS charging: disgraced politician branded an ‘ultra-Blairite’, Morning Star, 10th February, p.1.

Rikowski, G. (2005) Silence on the Wolves: What is Absent in New Labour’s Five Year Strategy for Education, Occasional Paper, May, Education Research Centre: University of Brighton.

Rikowski, G. (2006) On the Capitalisation of Schools, posted to The Flow of Ideas, London, 1st November, at: http://www.flowideas.co.uk/?page=articles&sub=On%20the%20Capitalisation%20of%20Schools%20in%20England




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