It’s not a crisis, David Cameron insists. It’s a “short-term pressure issue”. Fifteen hospitals may be on emergency measures; accident and emergency departments may have just recorded their worst ever performance; 21,000 people may have had to wait up to 12 hours on trolleys in the past fortnight, with a tent set up outside Swindon’s Great Western hospital to cope with the overload.

So far as the prime minister is concerned, however, this is all scaremongering and Labour point-scoring. Egged on by an echo-chamber press, Cameron accused Ed Miliband of trying to turn the NHS into a political weapon. But five years into his government, the Tory leader clearly has no one to blame but himself. This has all the hallmarks of a 1979-style “crisis, what crisis?” moment.

It was Cameron, after all, who insisted his priorities could be summed up “in three letters: NHS”. Acutely aware of the public’s unswerving commitment to Britain’s most popular institution, he pledged there would be no more “disruptive reorganisations” and to ringfence health spending.

But in the wake of the NHS’s most destructive reorganisation ever, embedding competition and privatisation at its heart – coupled with cuts, closures and falling health spending as a share of national income – the results can be seen in the pile-up in English A&E departments. No wonder the health secretary Jeremy Hunt has been desperately cajoling chief executives of supposedly autonomous NHS trusts to keep the service afloat until after May’s general election.

A&E is the pressure valve of the system and this week’s meltdown is a measure of the coalition’s failure. The causes are not so hard to find. Cuts to council-funded social care budgets have been savage: the number of mostly elderly people getting state-funded care in the home has fallen by over 28% and many more end up in A&E as a result.

Add to that the fact that GP funding has been cut by almost £1bn, more than 500 GPs’ surgeries have closed or merged, and one of the coalition’s first moves was to abolish the guarantee of a GP appointment within 48 hours – and why wouldn’t people head straight for A&E?

Of course the population is growing and ageing. But the closure of a quarter of NHS walk-in centres and the loss of 2,140 district and community nurses have had a more immediate impact. So has the replacement of the NHS Direct helpline with the cut-price, part-privatised NHS 111 outfit, whose unqualified staff are currently sending 17% of callers off to A&E or booking an ambulance to cover their employers’ backs.

This is the reality of NHS “ringfencing” under an austerity government committed to shrinking the state: cuts to services, staffing, pay and training. Then there are the costs of competition, marketisation and privatisation, enforced by the 2012 Health and Social Care Act, which has been described by senior Tories as the government’s most serious mistake.

Not only is it estimated to have cost an extra £3bn and added layers of administrative costs in an entirely artificial market, while ending the requirement to provide a comprehensive national service and allowing hospitals to raise up to half their income from treating private patients – it is also driving privatisation and fragmentation by enforcing contract tenders across the English service. Far from cutting costs, the evidence is that private markets in health increase them, slash transparency and accountability and widen inequities, sucking private profits out of the system in the process.

The government insists opponents of privatisation are motivated by “ideology”. In any case, they say, private contracts only account for a small part of the NHS budget. Those opponents include 84% of the public, however, which is why ministers have to proceed by stealth. But proceed they are determined to do. At least a third of NHS contracts – other estimates are higher – in England have gone to private companies since April 2013. Private health firms such as Circle, Bupa, Virgin Care and Care UK are lined up to win £9bn worth of existing business.

Given the number of private health companies that have donated money to the Tory party or with Tory links that have won NHS contracts, the corporate feasting overseen by Cameron’s coalition can hardly be a surprise. But Labour has its own record of health privatisation and revolving-door ministers under the Blair and Brown governments to live down.

Miliband and the former Labour health secretary Andy Burnham have at least turned their back on some of that, and promised to repeal the coalition’s privatisation act and start to rebuild an integrated service. Their problem is to convince voters that commitment is credible, with only £2bn extra mansion tax-funded spending earmarked for a beleaguered and increasingly underfunded system.

What can’t seriously be doubted is that if Cameron returns to Downing Street in May the NHS will be dismembered as a national service. The scale of cuts planned by the Tories, combined with the acceleration of privatisation they are evidently committed to, would dwarf the current crisis, with NHS charges an obvious outcome. Far from scaremongering, that’s the choice we face.