A medical-industrial complex operates on the same principles as the military-industrial complex. It ties together powerful vested interests within the Department of Health bureaucracy, the NHS, University medical science departments, and large-scale pharmaceutical, biotechnology and medical technology industry. Huge monopolies and bureaucracies and elites exist, in each, with overlapping interests. The Department of Health channels huge amounts of money into the drug companies and other medical equipment industries, via the the NHS purchasing budgets. Last year the DHSC spent £70 billion on procurement, up from £68.3 billion the previous year. To give an example of current spending with these private companies, £12 billion has already been spent on test and trace, equivalent to about 16% of the procurement budget. Yet, it has been completely useless, whilst no penalty clauses were even put into the contracts for its provision! Its no wonder powerful interests from within the medical-industrial complex have kept insisting that only large-scale testing and tracing can provide a solution, when clearly it has not, and cannot.
The state also channels large amounts of funding to universities to engage in pure research, as well as targeted research in a range of areas including health sciences. But, the research work done by universities also feeds directly into the large health sciences industries, who frequently do the commercial development of the products first created in university labs. Since the 1990's, and the development of large science parks on the campuses of most universities, that has become increasingly important. Many of the new biotechnology, gene technology and other such cutting edge firms have come out of such science parks, with academics bleeding over into the creation of these new firms. Often, these firms are then bought up for billions of pounds by large pharmaceutical companies. But, in the same way that the large defence contractors funded scientific research in universities that led to the development of new weapons systems, so the huge pharmaceutical and medical equipment producers also fund university research, with the resultant products then being commercially developed by the big companies. A lot of the funding, for research in these spheres comes from the big companies.
In the 1970's, local, “cottage hospitals” were closed, and attention focused on the development of large hospitals that patients now had to travel to.
“It was argued that effective treatment required a high level of skilled manpower and the best in technological hardware that was available, Only a large hospital could support the skilled workers – and by skilled workers, consultants are generally meant – by giving them enough cases to be fully occupied without having to waste their expensive time travelling from hospital to hospital. Similarly, the high technology machines – generally even less mobile than consultants – needed frequent use to justify their high cost.”
(Health Policy and the Cuts, by Tom Manson in Capital & Class 7, Spring 1979)
Even for things like laundry services in these large district hospitals this argument applied, providing a market for private machine producers in that area too. Manson describes the way this focus on high cost systems had resulted in other areas of medicine being denied funds, for example in geriatrics and mental health. It resulted in patients on a production line being pushed out of hospital early, placing greater stress on other elements of health and social care. But he also notes another critique.
“This critique is based on the fact that in societal terms, all the successes in medicine have not made much difference to the health of the population. Instead of spending money on heart transplants (for instance) money should be spent on those social factors that affect the health of the whole population, such as environmental factors and indeed the distribution of wealth.”
(ibid)
Huge amounts of health spending goes to deal with the consequences of obesity, for example, a factor that is also involved in susceptibility to COVID19. But, instead of dealing with the causes of obesity to begin with, which requires education and intervention not even at the level of Primary Care, but in schools, and as part of a programme of health education and monitoring, the NHS seeks to cure the problems arising from the obesity after it has arisen. Drug companies make huge sums from selling people slimming aids, or medicine for high blood pressure, for Type II diabetes, and so on. The NHS spends large amounts treating the consequences of the diabetes, performing heart operations, as well as surgery to implant gastric bands and so on.
The introduction of large socialised healthcare systems was designed to ensure that healthcare was provided efficiently, so as to reduce the costs of reproducing labour-power for capital as a whole, but the existence of the medical-industrial complex means that it does not even do that, because the monopolies and bureaucracies that it generates result in policy and expenditure being skewed into channels that benefit the individual interests of the drug companies and other medical supplies companies, and that facilitate the development of large bureaucratic empires within the NHS and Health Departments, and which, thereby, leads to unnecessarily high costs compared to health outcomes. The last Labour government trebled spending on the NHS, for example, but its own performance monitoring showed that it did not even double the health outcomes resulting from it, meaning that instead of economies of scale, it resulted in diminishing returns.
Of course, its not just the vast bureaucracies within the Department of Health, or in the hospitals where this applies. Go to any GP's surgery and you will notice the steady flow of salespeople from the drug companies that tread their path to the doctor's office. GP's are bombarded with a barrage of advertising from drug companies, in particular, but also other medical supply companies, all out to increase their sales. With the NHS paying for all of these prescription drugs, the pressure is always on for hard pressed GP's to get patients through their waiting rooms by prescribing them the latest pill for this that or the other. Its why we have seen the growing resistance to antibiotics that have been grossly overprescribed, not to mention the level of over-prescription for anti-depressants and so on. All of this is symptomatic of a health service based not upon wellness, but on treating illness. Talking about the discussions inside the Politics of Health Group, of the Conference of Socialist Economists, Mick Carpenter wrote,
“In particular those concerned about work hazards, and the relationship between health and anti-imperialist struggles in the Third World, looked beyond health services. The former saw the need to remove the fundamental cause of ill-health in the places where people wok, rather than to patch them up in shiny new citadels of technological medicine; the latter knew that the export of western models of medicine had proved patently inadequate to deal with the health problems caused by neocolonial economic and social relations – indeed were a significant feature of them. Finally, the group contained radical epidemiologists who were able to show that the improvements in health made in the last century had more to do with improvements in social conditions than health services.”
(Left Orthodoxy and the Politics of Health, in Capital & Class 11, Summer 1980)
Carpenter was writing at a time when the NHS was under right-wing attacks from Tories seeking to make public spending cuts. But, he rightly states that some of the Right's critique of the health service was justified. If we allow our politics to be defined by the Right, but simply place a minus sign where they place a plus sign, then it becomes impossible for our own analysis and politics to advance. In that case, it would mean simply defining yourself only in terms of opposition to health cuts. The modern equivalent is the idea that any kind of sustainable unity or progress can be achieved simply on the basis of opposition to “austerity”.
“Instead we allow the right to make all the running, and at best fight a rearguard action.”
(ibid)
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