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In 1948, the creation of the UK National Health
Service initiated a metamorphosis of medical
care from trade in human desperation, toward
science-led and evidence based public
service.This social contract offered the
option of a public-service system operating as a
gift economy, based on social solidarity and
funded from progressive taxation.Adam Smith
warned that without investment in this parallel
economy, capitalism would at best reduce men and
women to machines.At worst it would produce a
demoralized population of wreckers.By casting
patients as consumers who are concerned only with
their own gain, marketised health care fails to
recognize the role of patients as responsible
citizens.For health care (as for any other
commodity), the market promotes individual demand
irrespective of collective needs. Finally, it
makes rational allocation of resources virtually
impossible, marginalizes public-health skills,
corrupts public serviceand impairs trust at
every level between staff and patients.---
Julian Tudor Hart, THE LANCET, 3711883-1885, May
31, 2008
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