How is the NHS on its 65th birthday today? There are no celebrations as there were for its glorious 60th, when years of plenty brought good results and record public satisfaction as private insurance plummeted alongside falling NHS waiting times reached. Now the leanest years collide with Cameron's explosive £3bn re-disorganisation. How the NHS looks at 75 depends more on the future of politics than on economics.

Once the bill staggered through, the Westminster charivari moved on, though opposition to the Health and Social Care Act remains as fierce. Can the coalition get away with the chaotic fragmentation and commercialisation of this national treasure? Jeremy Hunt has made it his task is to shift blame elsewhere. Any bad practice, such as the Guardian's Tameside revelations this week, can be turned to his advantage. Standing outside as a scourge of the service, he encourages distrust. Raising unreasonable expectations is a clever ploy; as the CQC crisis shows, it's impossible to monitor the treatment of a million patients a day. But every incident exposed becomes a useful sign the NHS is bust, the state-run model always intrinsically "unsustainable".

As pressure on the service grows, even the Telegraph and Mail blast away at queues of ambulances stacked up outside bursting A&Es, with emergency admissions up by 35%. The loss of 4,000 nurses doesn't look good. Public anger makes closure of A&E and maternity services impossible when beds are full to capacity. Patients waiting over six weeks for diagnostic tests are up by 88%. Hunt turns the blame on GPs, but they are seeing 40 patients a day with their appointments systems gridlocked. With two tough winters to survive before the election, he may not succeed in diverting blame to the NHS and its staff.

Forces unleashed by the Act are already at work. Section 75 requires almost everything to be tendered out to Any Qualified Provider. An overview of how much is turning private is hard to come by, but there are snapshots. NHS Direct is broken up among 46 bidders for local 111 services, paid only 30% of the old cost per call, so already many contracts are going bust. Meanwhile, unqualified call-centre operators pour extra patients into A&E with trivial complaints. The London ambulance service is using 10 times more private ambulances, at a cost of £4m a year. Between a quarter and a half of all community services are now run by VirginCare.

It's said that 5% of all their contracts is paid to head office for using their brand name: the Guardian tried to check this, but was told it was "commercially confidential" – so much for transparency in the new NHS.

The perverse effect of competition is already emerging. Bournemouth and Poole are smallish district general hospitals needing to merge to share services and stay solvent. But their overseer, Monitor, has the new duty to "prevent anti-competitive behaviour". Monitor say the hospitals should be competing for patients, so they referred the merger to the Office of Fair Trading – unknown in the NHS.

The cost is mounting: an FOI by Fiona Mactaggart MP found the hospitals have already spent £1.67m on legal advice from costly competition lawyers. Every element of NHS competition will require these lawyers, alongside the huge cost of tendering everything out or defending against legal challenges if they don't. Four other trusts wanting to merge are stuck in the Monitor competition machine, with more to follow – a bonanza for lawyers. PFIs emerged with contracts like Wonga loans, so why should all the myriad new NHS contracts be any better drawn?

One London teaching hospital in the forefront of integrating itself with local community care to treat more people at home, has just been told this too is "anti-competitive". Torbay, pioneer of integrating health and community care, is warned this is an anti-market "monopoly" that should be tendered out in bits.

The act allows hospitals to sell up to 49% of services to the private sector, so most hospital business plans include a big increase in private use of their beds. Clatterbridge Cancer Centre in the Wirral has gone into partnership with a private cancer clinic offering chemotherapy and radiotherapy and "two unique therapies for bowel and eye cancers". Profits go to Clatterbridge NHS, but what are patients to think if offered either NHS or "unique" treatments?

Finally, a small gem: the excellent Health Service Journal finds the Department of Health spent £73,000 on consultants to coach officials before appearing in front of the daunting Margaret Hodge of the PAC – the body that hunts down waste.

The next birthday? Almost everyone – except the competition lawyers – thinks driving integration between services needs to be relentless. Andy Burnham maps a plan for total merger of health and social care, (Osborne just gave a bung to social care out of the now un-ring-fenced NHS budget). No amount of efficiency saving will rescue the NHS from many hard years ahead – and people need to be told. On the right, political noise swells for "co-payments", with patients paying for many services. McKinsey predicts UK healthcare will be a "£200bn industry by 2030".

Yet we know that letting health slide towards private payment will cost everyone more: the US spends 18% of GDP, twice as much, for much less care, while the NHS is one of the world's most efficient ways to pay. With a hypothecated tax or by levering in the property value of the retired, however it's done, people need to know they will have to pay more for a good enough NHS. "More for less" is Toryspeak for less and private.

• This article was amended on 10 July 2013. The original referred to the Clatterbridge Cancer Centre as the Clatterbridge hospital, which is a separate healthcare facility run by a different NHS trust. Further, Clatterbridge Cancer Centre NHS Foundation Trust would like us to clarify that the "two unique therapies" referred to are unique to the trust, not to the private clinic with which it has gone into partnership; the trust says the therapies have been available to all NHS patients for 20 years and will remain so.