ABSTRACT
Nevertheless, privatization has still had an important impact on the delivery of health care in Britain. The purpose of this chapter is consequently threefold: to analyse the explanations put forward for privatization, to consider the material and ideological impact of privatization and to discuss likely future developments, especially in the aftermath of the White Paper. In doing so I draw on analyses of the political economy of the welfare state, which seek to explain policy developments, not simply in terms of secular trends, party competition or pluralist negotiation and bargaining, but in terms of the wider economic and political pressures on the capitalist state. Thus Gough (1979:138) identified several ways in which the welfare state could be ‘restructured’, against a background of economic recession and political pressures to reduce public expenditure. Gough’s analysis, written
before the 1979 election, was merely pointing to tendencies and options; the precise way in which these work out in individual states is a contingent matter. In addition to a consideration of wider political and economic changes affecting the welfare state, a full explanation of privatization would also have to focus on the political strategies pursued by the Conservatives, the reasons for their adoption, the interests served by them and their intended and actual impacts. Thus, the chapter rejects explanations which stress the role of the free play of market forces, as well as those emphasizing the role of the New Right, and instead relies on interpretations of Thatcherism’ as a political phenomenon.
