The A&E area of Birmingham Heartlands Hospital. Photograph: David Sillitoe for the Guardian
What Wednesday's vote on the health and social care bill shows more clearly than anything is that many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy.
The prime minister promised before the 2010 election not to introduce any "top-down reorganisations" of the NHS; to say he, Andrew Lansley and Nick Clegg lack an electoral mandate for the bill is an understatement. It is also an understatement to say that they have not told the truth about the bill's intentions, and that they have reduced Department of Health statements, such as its latest so-called MythBuster document, to a level of brazen mendacity that demeans a once great office of state.
The principle seems to be that if an official lie – such as that the bill does not imply privatisation – is repeated often enough, most people will feel it must be true. And by using existing powers to abolish PCTs and set up "pathfinder" so-called GP consortia, and making arrangements with foreign private companies to take over NHS hospitals, the government has also pre-empted such debate as MPs are inclined to have. The Conservative MP Dr Sarah Wollaston, who originally denounced the bill, now says that changes have already gone too far to oppose it any further – a remarkable statement of political impotence.
Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want "a free hand with staff").
The costs of market-based healthcare – from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multimillion pound executive salaries, dividends and fraud – will soon consume 20% or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) are remotely resourced enough, or empowered enough, to prevent the decline of care quality and the scale of financial fraud that the bill will introduce.
What we are witnessing is the completion of a project begun some 25 years ago to restore healthcare to private enterprise. The key players have not been MPs but private healthcare companies and consultancies like McKinsey and KPMG. The war has been waged by the lavish corporate funding of pro-market thinktanks – the quiet subversion of some of those, like the King's Fund, that are still rather quaintly described as "independent" – and the deep penetration of the Department of Health and Labour's senior ranks. No countervailing argument has come from pro-public thinktanks, because none exists with resources equal to the task. And how many MPs have actually read through the bill they are in the process of endorsing, or even the explanatory notes that accompany it?
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