This article analyses the changing NHS, and in particular both Conservative and New Labour reforms since the 1990s, from the viewpoint of political economy. It is argued that the publiclyfunded NHS can be functional for the capitalist economy, especially in the age of globalisation; but that this raises worries about equity in access to healthcare and priorities within health services. Such a ‘neo-Marxist’ view of the healthcare state is founded on the diminished progressiveness of general taxation, increased tendency to invest in the ‘productive’ and increased ‘exploitation’ of public health services and their workers. Health sector reform is viewed comparatively, with reasons for the ‘private’ USA contrasting with the ‘public’ UK reassessed. European health sector reform is seen to be at a crossroads vis-a-vis these two models
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