Events have confirmed all the main trends suggested in the first edition of this book, published in 2006. The worldwide drive to reshape health care away from public service towards commercial models, with varying support from the state and participation by for-profit corporate providers, has become a dominant government strategy virtually throughout the world.

The US has been the prime mover, but as its own commercial health care market becomes an ever more spectacular failure, its salesmen have had to look elsewhere for evidence to support their claims. UK governments, first Conservative, then New Labour, offered our National Health Service (NHS) as the most influential site for their experiment. This would, they believed, surely demonstrate the immense gains, in quality of service, value for money and staff productivity, to be expected from market competition, consumer choice, industrialisation and motivation by profit. Unfortunately commercial secrecy, and the natural reluctance of governments to admit even the possibility of error, precluded any systematic collection of data to provide conclusive evidence either way. So we must judge as best we can, from the medical, public health and administrative literature, from the more responsible parts of our news media, and from colleagues we know and trust. Judging from these, spending money on health care by putting it into the pockets of commercial providers has at best not improved care any more than we might have expected from spending the same money directly on previously existing public service. At worst, it has inflicted serious damage on staff morale, and on patients’ understanding of care processes. Commercialised, competitive, marketed care still has powerful advocates, who assure us that their medicine will eventually work, if only we would swallow a bit more of it. They hold political power which they will continue to use as long as they can.

Early in 2008 deregulated financial markets collapsed, starting in the US and the UK, the countries whose rulers had been most devoted to solving all problems through market competition. Blind faith in the profit motive, which sets simple personal greed as proxy for complex social wisdom, caused that collapse.