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Visions of utopia: markets, medicine and the National Health Service

Published online by Cambridge University Press:  02 January 2018

John Harrington
John Harrington*
Affiliation:
University of Liverpool
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Abstract

Legislative restrictions on the sale of organs, gametes and surrogacy services are often seen as having no basis other than mere prejudice or taboo. This paper argues instead that they can be read as instances of a broader decommodification of healthcare provision established in Britain with the creation of the NHS in 1948. Restrictions on the marketisation of medicine were justified by Aneurin Bevan, the founder of the NHS, and by Richard Titmuss, one of its chief academic defenders, in distinctly utopian terms. On this vision, the NHS would function as a utopian enclave prefiguring an idealised non-capitalist future. This commonsense of post-war medicine was fatally destabilised by fiscal crisis and social critique in the 1970s. Influential commentators like Ian Kennedy developed an anti-utopian account of the real NHS and proposed legalistic and market-based reform. These reforms sought to dissolve the enclave, assimilating medical work and the NHS as a whole to broader systems of accounting and accountability. Insofar as they have been realised, they achieve a recommodification of medicine in Britain. The paper concludes by examining recent studies of the ‘new NHS’, which see in the latter-day idealisation of market processes a novel form of self-denying utopianism.

Type
Research Article
Information
Legal Studies , Volume 29 , Issue 3 , September 2009 , pp. 376 - 399
Copyright
Copyright © Society of Legal Scholars 2009

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