Theresa May may include the NHS in a trade deal with Donald Trump, it has emerged as she flies to meet the new US president for trade talks. 

May pointedly declined to rule out the inclusion of the NHS in such a deal, despite being repeatedly pressed by reporters to do so yesterday. She would answer only that she was committed to an NHS that remained “free at the point of use” (of which, more in a moment).

As Molly Scott-Cato MEP wrote on OurNHS last week: “what an irony faces those on the Left who voted to leave the EU because of TTIP and now find they are fast-tracked into a very similar treaty kindly offered by Trump, even as TTIP dies!”

The “free at the point of use” assurance yesterday is one we’ve heard many times. You may feel that this is just another politicians’ lie – like the Leave campaign’s infamous red bus promise of £350million a week.

But May’s cleverer than that. She’s making a promise that is worthless, without another promise, that ‘the NHS’ will provide comprehensive & universal healthcare.

And that’s a promise our Prime Minister hasn’t made.

In other words, ‘the NHS’ may stay free – but become much more like a low grade, Medicare style service.

A look at recent developments suggests that the NHS is being slowly reconfigured into just such a system – one that private health firms can profit from. Into a system that offers public healthcare only in a dwindling number of locations round the country, that denies healthcare for people considered ‘undeserving’, rations it for the particularly sick and needy, and eventually – after Ms May has gone, probably - restricts it severely for anyone who can’t pay a ‘top up’ fee or ‘co-payment’.

In other words, into a system a bit like the American one (both pre- and post- ObamaCare), where the real profits are to be made from providing islands of luxury for the rich – and as few treatments, to as few people, with as high a ‘co-payment’ (ie excess fee), as possible, for everyone else. This latter system is called ‘Accountable Care’. It sells itself as being about ‘prevention rather than cure’, with hospital/insurer hybrids commercially incentivised to keep patients out of hospital and prevent them from having ‘unnecessary’ treatment. But it’s a system where only the richest (who have far better insurance than ‘Accountable Care’) know they’re getting the best care available.

Sadly even ObamaCare – heavily lobbied and watered down by the mega-health firms like UnitedHealth into a system of compulsory insurance for poorer people along Accountable Care lines - didn’t change this flawed system enough. Even though it made some vitally important changes – particularly about women’s access to reproductive care - it’s chances of becoming a national treasure like our NHS were strangled at birth. And of course Trump is now rolling the clock back.

Could never happen here?

Well – let’s set aside for a moment that the man currently running England's NHS was himself a major player in this very watering down of ObamaCare, when he led the lobbying efforts of his former employer, UnitedHealth. And let’s forget for a moment that he was also involved in lobbying efforts by US health firms to ensure global trade deals included healthcare. It seems churlish to have a go at NHS Chief Executive Simon Stevens right now, seeing as he’s finally started pointing out to Theresa May that the cuts are damaging the NHS.

But it’s important to understand that the plans that Stevens, Jeremy Hunt and his predeccessor Andrew Lansley, David Cameron and May herself have set in motion over the last few years, are already starting to transform the comprehensive, universal NHS into a much more limited organisation that doesn’t have to treat everyone, certainly not for everything – and thus is easier to make a profit from, somewhere along the line.

Exactly how the cuts are affecting NHS services varies from area to area. But as we heard this week, if you’re not in so much pain you can’t sleep you may not get your hip op. Already, if you’re not so blind you’re falling over, you may not get your cataracts done.

If you need mental health treatment, hearing aids, physiotherapy, a vasectomy, treatment for erectile dysfunction, if you need help with dressing your wounds, or other long term help as a result of poor health - of if you simply need timely treatment - these may increasingly find you being told ‘sorry, not on the NHS’. (You may also already be told ‘we do have a private ward, if you can pay...’ or asked ‘do you have medical insurance?’).

This isn’t comprehensive healthcare. And no amount of over-selling of screening and checks and gizmos to the ‘worried well’ will make it so, either.

Universal healthcare (ie healthcare that treats everyone) is under threat too. Having picked off migrants (posters across hospitals now read ‘do YOU need to pay for your healthcare’), NHS England has turned its attention to other politically unpopular groups that can be used to undermine the vital principles of risk pooling and universalism. NHS England recently sanctioned a York NHS ban on fat people and smokers from having any routine NHS surgery (from hip ops to tonsils) for periods of up to one year, ignoring the outcry from the Royal Colleges and the BMA who said this was not clinically appropriate. Other areas are expected to follow suit with bans - even as they simultaneously cut their stop smoking and weight loss clinics.

We all know its the poorest and sickest (and least amenable to profit-making) who are likely to lose out. Some hospitals are even asking would-be patients to sign a waiver to allow them to share patient information with debt collection agencies. What can be the justification for this, apart from to discourage poor people from seeking the treatment they need?

As the NHS becomes harder to access, is the priority reconfiguring it into an NHS that maximises opportunities for private profit?

Last night as the news broke of May’s suggestion that the NHS is on the table for a US trade deal, various pundits were trying to reassure us that the NHS is too difficult to make a profit from. Companies like UnitedHealth and Circle Hinchingbrooke have already tried to take over NHS services – and then withdrawn in ignominy, they said. US firms aren’t interested in the cash strapped NHS, we’re told.

Perhaps they haven’t noticed, but UnitedHealth (and its subsidiary Optum) is back over in our NHS, except for now, it’s making its money behind the scenes - the data segmenting, deciding what services can be kept and which cut, analysing which patients are expensive, ‘helping’ to manage decisions about referrals and medicines, and much more.

And shedding poor and unprofitable patients, and ever-more services, is just one aspect of the reshaping the UK’s health system to make it more profitable and appealing to private health firms.

Accident and emergency departments and maternity units – both too unpredictable to run for profit – are under severe threat in the Sustainability and Transformation Plans, that are the local version of Stevens’ ‘Five Year Plan’, affecting every part of England. These plans will leave plenty of small and medium units that – free of their A&Es – could focus on the more profitable stuff – predictable diagnostics, low grade care beds, or private elective operations. Or – of course - be sold off to the developers for housing or PFI schemes (many of the STPs mention ‘3rd party developers’).

And the new NHS cuts plans are full of mentions of “co-production”- by which they say they mean patients and carers taking “more responsibility” for looking after patients at home, thousands fewer nurses and other skilled staff, and a heavy reliance on gadgetry to “manage your own care”. Ali Parsa of privatised Circle Hinchingbrooke infamy, is back on Newsnight, now selling his ‘doctor in your pocket’ app’ to NHS buyers - and deregulating the sale and promotion of these unproven gadgets has been a key battleground in trade lobbyist talks on both sides of the Atlantic.

In fact, many of the local STP plans are explicitly modelled on the US ‘Accountable Care’ / 'managed care' model mentioned above – Jeremy Hunt admitted that this was the direction of travel in parliament last year when he approvingly name-checked their key exponents, Kaiser Permanente.

The deepest irony in these supposedly cash-strapped times, is that a private sector friendly, twin track health system is grossly expensive and wasteful. US citizens spent the same amount of tax as their UK counterparts just to get the grossly inadequate Medicare service – and then the same amount again in insurance premiums, to get any kind of proper coverage. As Nye Bevan said, with the NHS, generosity means expediency – a system both cheaper and beloved.

But the U.S. firms May is courting right now are only interested in an NHS that can exclude the poor & 'undeserving' – or just offer them something very low grade, while the rich are whisked away into their separate wards. And that’s what's coming. It’s been a long game – but we’re now in the late stages, and it’s accelerating.

Perhaps when the Leave campaign put ‘£350million a week more to the NHS’ on the side of a bus, they didn’t lie. They just forgot to add ‘in sweeteners for transatlantic buyers’.

And it’s up to us to stop it. Over the next days and weeks we'll be sharing ideas on how to do that from a variety of campaigners - for now, please share this article widely so people understand the risks we face.