Recently, on the Jeremy Vine Show, Andrea Jenkyns – the Reform Mayor of Greater Lincolnshire – admitted that she was “pro-private healthcare”.  The leader of Reform, Nigel Farage, has also used similar language about healthcare, presenting private provision as a way to empower patients through consumer choice.

At first glance, this sounds appealing. Choice is widely associated with freedom, autonomy and dignity. But when applied to healthcare, it rests on a profound misunderstanding of how illness, inequality and public services actually work. Healthcare is not a consumer market in any meaningful sense. In classical economic terms, consumer choice assumes relatively equal purchasing power, the ability to defer or refuse a product, and access to clear information about quality. Healthcare satisfies none of these conditions. People do not fall ill on schedule, comparison-shop during medical crises, or enter care relationships as rational, detached consumers.

As Albert O. Hirschman famously argued, markets rely on the possibility of exit — if you dislike a service, you can leave and take your money elsewhere. But in healthcare, exit is unevenly distributed. Those with money can exit the NHS for private care; those without cannot. What is framed as “choice” therefore becomes a mechanism through which inequality is reproduced rather than reduced.

This is what makes much contemporary political rhetoric around healthcare revealing. When politicians speak of choice, they are rarely talking about improving universal provision. They are talking about legitimising a two-tier system in which faster access is purchased privately, while everyone else waits. Choice, here, is not expanded — it is rationed by income.

The sociologist, Marianna Fotaki, has shown how the marketisation of healthcare reframes patients as consumers while quietly shifting responsibility away from the state. Long waiting lists, staff shortages and crumbling infrastructure are no longer treated as collective political failures, but as individual problems to be solved through personal decision-making. If you are still waiting, the implication is that you failed to choose differently.

Creating the conditions for healthcare provision to be handed over to the private sector typically follows a recognisable and deliberate political choice to shrink the state rather than a spontaneous failure of public services. Seen in this light, the growing reliance on private healthcare is not simply a pragmatic response to a crisis, but part of a broader process through which public institutions are allowed to deteriorate and then presented as unfit for purpose. As services decline, frustration grows and public trust erodes.

This strategy is not confined to the political right. Senior Labour figures, including Wes Streeting, have argued for making greater use of private healthcare capacity to reduce NHS backlogs. While this is usually presented as a temporary, pragmatic measure rather than an ideological commitment to marketisation, it nonetheless risks reinforcing the same logic: that access problems are best solved through outsourcing rather than sustained public investment.

The danger is that once private provision becomes normalised as a solution to public failure, it reshapes expectations. What begins as an emergency measure can harden into a permanent feature, quietly entrenching a system in which speed and convenience are increasingly linked to private providers, even as the NHS remains formally universal.

But most people do not want “choice” in this sense. They want timely treatment, competent care and reassurance that illness will not push them into debt. They want healthcare to be dependable, not competitive. In moments of vulnerability, being forced to choose is not empowering — it is an additional burden. There is also a deeper moral issue at stake. Healthcare markets do not distribute trivial goods; they distribute time, pain and life chances. A system in which the wealthy can bypass queues while others deteriorate on waiting lists is not neutral. It encodes class inequality directly into the experience of illness.

From a sociological perspective, “choice” functions here as a euphemism — a way of moralising inequality while denying its structural causes. It turns collective responsibility into individual burden and reframes social rights as lifestyle options. When politicians invoke consumer choice in healthcare debates, we should ask a simple question: choice for whom? Because a system that delivers speed to those who can pay does not empower patients – it normalises inequality and calls it freedom. Healthcare was never meant to work like a market. Treating it as one does not increase autonomy; it quietly teaches us to accept unequal care as common sense.

References
Hirschman, A.O. (1970) Exit, Voice, and Loyalty. Harvard University Press.