Raiders of the Public Good.

Private Vices reap Public Benefits. 

Since the resurgence of market liberal thought in the late 1970s, we have seen the rise of neoliberalism as social democracy was "rolled back" toward the end of the Cold War by Margaret Thatcher and Ronald Reagan. This served at first as an answer to the failure of institutions, public services and the welfare state to provide people with a better life. The ultimate aim being to tear down old bureaucracies, hand over the parts to the people and the forces of the market in order to liberate the individual and to produce a highly competitive market which automatically responds to the demands of the individual. Not society you notice, but the individual. For society did not exist according to the Thatcherites and in effect the Reaganites bought into this as well. The theories underlying the radical transformation of society that followed were based on a pessimistic view of human nature which it sought to predict through rational equations. The assumptions of human nature were a product of the paranoid climate of the Cold War in the 1950s and 60s.

In the late 1980s Thatcher sought to fundamentally alter the National Health Service and overhaul the medical establishment before replacing it with a brand spanking new system of efficient management. It would be a system in which all subjective values, which may corrupt the system, are stripped away and replaced with strictly rational methods along with mathematically defined performance targets and incentives to reward efficiency. The system was designed to push public servants to strive for efficiency and compete with one another by engineering the conditions of the free-market within organised medicine. Competition was created within the NHS through incentives combined with performance targets to recreate the pressures of the free-market. This would "liberate" the public servants from the control bureaucrats and mobilise self-interest in public health. The Thatcherites saw to it that the health-care system underwent a thorough process of marketisation, which would initiate the stealth privatisation of the NHS.

At the expense of society as a collective whole and notions of the public good were thrown out of the window with a cynical ferocity that identified all idealism as naivety. In the place of society a utopian vision was to arise, it would be an atomistic arrangement of free individuals interacting in the market place out of self-interest and whereby the flaws of democracy would be supplemented by market forces. In theory the market, as a medium of consent, would adjust to the consumers and produce what the public demanded. This would make the captains of industry not cold-hearted capitalists, but men of the people who had been "chosen" above the masses to such privileged status by the market. It would be the meritorious man and woman who would be elevated in this way. Just like the corporate raiders of the 1980s the Right acted to tear apart the post-war settlement and take us back to the halcyon days of the free-market in the 19th Century for the sake of Hayekian progress.

Alain Enthoven was the principle architect and theorist behind the early reforms to the NHS. Though Enthoven's ideas had first been applied in the US military-industrial complex at the height of the Cold War. Robert McNamara overlooked the transformation of the Pentagon which Enthoven initiated to replace patriotism with an analytical system of rational understanding rooted in mathematics. The view of human nature on which these equations depended originated in game theory as drawn up by John Nash, who worked at the RAND Corporation. By relying on the assumption that all human behaviour is embedded in the Cold War, the self-interest of each individual could be balanced in an equilibrium as the actions of every individual is perfectly adjusted to the actions of others. Nash was a paranoid schizophrenic at the time and believed he was part of a secret group sent to combat a Communist conspiracy. According to the analytical system McNamara attempted to run the Vietnam war with performance targets that led to American troops killing civilians and lying about the number of dead to sway the Body Count - a measure of the success of the war.

John Major took power after the fall of the Iron Lady in 1990 and the Grey Man promised the British people "nothing less than a revolution in the way public services are delivered, it will be the most comprehensive quality initiative ever launched." At the heart of Major's reforms was the same cynical liberal wisdom that saw the human being as a self-interested and manipulative unit. All the noise about the public good in the old institutions of the welfare state was hypocrisy, for Major it needed to be transformed into a strenuous and dynamic form of service. Major sought to utilise the public servants "liberated" by Thatcher and harness the power of self-interested individualism with the understanding that "private vices reap public benefits". To accomplish this the Major government set additional mechanisms to ensure a high standard of service and such standards were raised. All of these mechanisms and "tougher" standards were based in mathematical equations which were presupposed by the simplistic and dark view of human beings that came out of the RAND Corporation.

These market reforms were intensified under Tony Blair and were applied to every area of public service and government. As in the case of war the market reforms have proven to be unsuccessful in always resulting in the desired outcome. When targets were introduced to slash waiting lists the management of hospitals began to hire consultants to perform the easiest operations first whilst complicated operations were no longer prioritised. In some cases the management would even time an operation at a time when a patient were not present, this was done purely to cut waiting lists. The job of the "Hello Nurse" was invented to greet patients in casaulty which officially meant that the patients had been "seen" and could be removed from the waiting list. When the government then set a target to cut the number of patients waiting on trolleys, hospital management swiftly redefined trolleys as "beds" and the corridors as "walls" to justify removing the patients from the list. This kind of behaviour was incentivised as pay was attached to performance.

On both sides of the Atlantic the conservative and liberal administrations of the last 30 years have "rolled back" the welfare state in the name of unleashing individualism and the forces of the market. Power has been transferred from public servants to unaccountable bureaucrats in private companies for the sake of efficiency. The pressures of the markets were recreated within the internal market of public services through performance targets and incentives, which were calculated according to equations that were based on a simplified and bleak vision of human nature. The shift to supply-side economics and monetarism led to a mixed economy in which costs are socialised and profits are privatised. Finance became a central aspect of the economy and taxes were slashed for the wealthy whilst regressive taxes raised in many cases. Ultimately the ratio of public spending to GNP has increased since the 80s and all of these administrations have not actually decreased the size of government. The actions of these administrations are similar to that of the corporate raiders, who would buy the majority of shares in a company only to fire the workforce and sell it off bit by bit.

The UK coalition government are currently implementing a set of reforms, on top of the spending cuts, to public services and health-care. These reforms will transfer greater power from the state to the market, whilst new pressures are introduced into public work to drive for greater efficiency and competition. Public spending is being cut in the UK in order to cut taxes and taxes are being cut in order to cut spending in the US. The NHS is not being ring fenced, the reforms are not only about enhancing the marketisation of the Service and a stealth privatisation is underway. Just as there was talk of a Community Vibrancy Index under New Labour there is similar talk of a Happiness Index under the Con-Dem Coalition. David Cameron wants to end the state-monopoly on public services by giving the private sector the power to bid for the bulk of public work. These reforms amount to a "battering ram to break open monopolies" to quote the Prime Minister. If the market reforms to the NHS are allowed to pass the Service will be subject to greater pressures and the state bureaucracy will be replaced with an unaccountable bureaucracy in the private sector.

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