On Monday, the world mourned the passing of Lady Margaret Thatcher, Baroness Thatcher — the first and only woman to serve as prime minister of Great Britain and the longest serving prime minister in the nation’s history. Jokingly nicknamed by a Soviet journalist the “Iron Lady,” Thatcher’s unfailing sense of political assurance and conservatism made her many lifelong fans and enemies.
Among Thatcher’s accomplishments was the reforming of the “Welfare State,” a general term given to reforms undertaken as part of the post-World War II recovery by then-prime minister Clement Attlee. Attlee based his reforms from the Beveridge Report, which called on the government to fight the five giant evils: squalor, ignorance, want, idleness and disease.
In response, the Attlee Labour government introduced a host of reforms, including the Family Allowances Act of 1945, which paid an allowance to families per child in the household — excluding the eldest; the National Insurance (Industrial Injuries) Act of 1946, which offered worker’s compensation for workplace accidents; the National Insurance Act of 1946, which mandated a weekly payroll deduction that paid a wide-ranging series of benefits; the Pensions (Increase) Act of 1947, which raised the rates of pensions established under the National Insurance Act; and the Landlord and Tenant (Rent Control) Act of 1949, which prevents landlords from charging excessively for rent. These measures, controversial at the time and heavily opposed by the opposition — were seen as necessary to rebuild a nation torn down by war and which would not fully recover until the 1960s.
The most important reform introduced under Attlee was the National Health Service Act of 1946 (NHS), which created a single-payer health care system in the United Kingdom. As stated in the provision, “It shall be the duty of the Minister of Health … to promote the establishment … of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention diagnosis and treatment of illness and for that purpose to provide or secure the effective provision of services …”
It was in this that Thatcher committed the majority of her premiership — the replacing of the “welfare state” with free enterprise. She felt that the system was fatally flawed and could not be successfully managed by the government. Her movement toward privatization is known as “thatcherization” and is currently a defining principle in conservative governance. As the Tory government brought in new reforms to the NHS, “thatcherism” lives on, and — as the woman that inspired it regularly did — is creating both fans and enemies.
Problems with nationalized health care in the UK
The realities in the implementation of NHS were daunting. The economics of the system were dysfunctional, and the government was required to bail it out repeatedly. The system of the state running hospitals proved to be inefficient, and it became quickly obvious that the system will never be able to manage the resources to provide full and unlimited access to the latest medical treatments. In response, the Thatcher government established the “internal market,” in which the government “purchased” care for the citizenry from independently-run hospitals. Inefficient and wasteful hospitals would be driven out of the system due to competition.
This was a part of Thatcher’s conservative view on government — that the open market should have dominion in the people’s life. For example, Thatcher pushed through a measure that allowed council tenants to buy their homes from their council at a discount — a move that, in recent years, has been criticized for destroying London’s lower classes and freezing the housing market. Many nationalized businesses that were brought under government control under Attlee were privatized under Thatcher, and the “thatcherization” of England brought the country closer to a private nation in the mold of the United States than it ever been before or since.
Recent austerity movements have threatened to further devolve the NHS further, with primary care trusts being abolished in favor of clinical commissioning groups — run by general practitioners — that many equate to a covering move toward allowing private insurance carriers to control upward of £60 billion of the NHS budget.
More damningly, the commissioning groups — unless satisfied that a single provider can deliver the needed services — must put out to competitive bidding all of NHS services. Many hospitals in the U.K. are privatizing in response; for example, Virgin Care now runs more than 100 hospitals that were formerly NHS. Many other hospitals are taking on a foundation-basis and are reducing bed counts and staffing levels.
Margaret Thatcher and the responsibility of government
Current movements with the NHS can be seen in the light of Thatcherism. What many see as Thatcherism, it is likely: “We have given power back to the people on an unprecedented scale … We have done it by curbing the monopoly power of trade unions to control, even to victimise, the individual worker … We have done it by enabling families to own their homes, not least through the sale of 1.25 million council houses … We have done it by giving people choice in public services … Labour is against spreading those freedoms and choice to all our people. It is against us giving power back to the people by privatising nationalised industries … Labour wants to renationalise electricity, water and British Telecom. It wants to take power back to the state and back into its own grasp — a fitful and debilitating grasp.”
However, many would argue that this current round of NHS reforms do not empower the people, and actually deny them choice. Thatcher was honestly proud of the NHS, as espoused in her book: “I believed that the NHS was a service of which we could genuinely be proud. It delivered a high quality of care — especially when it came to acute illnesses — and at a reasonably modest unit cost, at least compared with some insurance-based systems.”
The current round of reforms diminishes the NHS’ role in the management of health care in the nation, contracting it to private companies. By transferring control of the NHS from the government to private industry, the government is actively excluding the people from decision-making with the NHS.
While Margaret Thatcher believed in small government and the need to eliminate needless rules and bureaucracy — “We want a society where people are free to make choices, to make mistakes, to be generous and compassionate/This is what we mean by a moral society; not a society where the state is responsible for everything, and no one is responsible for the state” — she also believed that humanity must be preserved. “There is no such thing as society,” she once said. “There is living tapestry of men and women and people and the beauty of that tapestry and the quality of our lives will depend upon how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate.”
While the current administration’s move to fully privatize the NHS can be argued as the realization of “thatcherization,” and while recently released memos suggest that the former prime minister wanted to do away with socialized health care, one cannot deny that the NHS is an institution that represents the complicated nature of Thatcher — simultaneously an advocate of the people and a promoter of the free market.