Richard Smith suggests that only communists and fantasists may detect a ‘neo-liberal London consensus’. He goes on to suggest that the BJGP is UK-centric. May I suggest that his US-corporate-for-profit-health-care-tinted spectacles have actually stopped him seeing the UK health systems in the round, from which perspective the English obsession with recycling increasingly surrealist versions of failed ‘market reform’ models is quite striking. First rule of comparative health care: use it to understand yourself better!
‘The London consensus’ was of course my tart take on the well-known coinage, ‘the Washington consensus’. Ironically, at a time when Obama has overcome at least some of the huge odds against humane health reform in Washington, Richard's stay with UnitedHealth may have taken him more Rightwards than he has realised even by Washington standards!
In London, of course, there are enthusiastic neo-liberals (Tony Blair, for example: if you doubt me, just read his political autobiography, A Journey); and then there are fellow-travellers. The latter may or may not be enthusiastic, but they have accepted the terrain of neo-liberalism as the place for debate. I include the King's Fund and the Nuffield Trust in this — pragmatists who have become just a bit too pragmatic.
And as Keynes knew, ‘practical men’ were often slaves to a defunct economist … ‘pragmatists’ in London often fail to see the opportunity cost of both market reform and endless tinkering with market models, of which Lansley's ‘La La Land’ is merely the most absurd yet.
And Richard, yes, power and responsibility should go together, for GPs as well as for all of us. My point was exactly that: if you don't maintain the balance between the two, you're in trouble. The government's dishonesty — selling ‘100% the latter’ as ‘100% the former’ — is a sure way to disillusionment. Some GPs are often too trusting — at first — of reforms that promise to put them in the driving seat yet end up scorching their backsides in the hot seat.
And it's not just this government: Alan Milburn did the same in 2001, in New Labour's heyday. It's called the London consensus, you know!
- © British Journal of General Practice 2012
