Commodification is one of the most important, all-pervasive social changes taking place in the world today. Products and activities that used to be produced or engaged in for their own sake are constantly becoming transformed into things and activities produced or undertaken for profit. Public services in the UK are now undergoing this transformation on a larger and larger scale. The justification given is usually that they will be carried out more efficiently. In reality this result is seldom shown to be true. What is clear is that commodifying them changes the services in three main ways: it changes the purpose for which they are undertaken, the way in which they are provided, and the effects they have on other aspects of life.
The NHS is now being subjected to this process on a large scale. The conversion of health care services into something done for profit changes the quality and scope of services, reducing staffing and curtailing what is offered to patients. Subjecting them to market competition tends to make them more costly, not less; it introduces a conflict of interest between the provider and the patient, since the provider has a financial interest which may be different from the patient’s; it opens the door to a distinctive kind of large scale corporate fraud at the taxpayer’s expense; it leads to a loss of trust in doctors. In turn, these changes affect the wider society. Equality of access to the best possible health care is one of the foundations of the social system we have come to take for granted. Losing it will have consequences for democracy that we will come to bitterly regret.
Honorary Professor, Goldsmiths University