Only a few months ago there was much Labourite back-slapping of the NHS, in response to attacks on it by right-wingers in the US. The fact that it was “Labourite” back-slapping, of course didn’t stop large sections of the Left, including the supposedly Marxist Left from joining in. Instead of fulfilling the role that Marxists should perform of putting forward an independent working class alternative to Capital, and its State, most of the Left has become little more than cheerleaders for State Capitalism, and its measures of state intervention and welfarism. Any Marxist should have realised the woefully inadequate nature of State Capitalist provision in the arena of health and social care. I have blogged about it here, and even those who have retained some attachment to the idea that there is no immediate laternative to reliance on the state have been forced to reconsider their views in the light of their own direct experience, as did Charlie McMenamin in his blog On Spending 31 Hours In A&E With An 87 Year Old.
In the last few weeks, there have been many reports from the Patients Association, The Care Quality Commission, and from the Dr. Foster Group, blowing the cosy view of State Capitalist Health and Social Care out of the water. Indeed, reports from the Office for National Statistics, on that other major area of State Capitalist provision - Education – demonstrate that the outputs obtained there too, fail to measure up to the massive amounts of money pumped into it over the last ten years. In fact, all of these reports grossly understate the real level of inadequacy of these services. Just as the Police are allowed to investigate themselves through the Police Complaints Commission, so too these reports, as with the bodies set up to monitor provision, are carried out by people who are professionally and personally tied to those services and those who work in them. Only when ordinary workers themselves reliant on these services are the ones doing the investigating, the monitoring and the controlling could we even begin to get a fair picture. Even then the power of the Capitalist State is such that even were it to concede such a measure – which it will not do short of something approaching a situation of dual power – it was so circumscribe the role and power of such workers inspection as to make it meaningless. It would insist on providing its own professional advisors to “assist” the workers in these functions, the workers would find their investigations frustrated at every stage, and find themselves becoming bogged down in reams of paperwork and jargon, designed to hide the true picture, and baffle them with science.
As the BBC put it,
“In truth, the NHS is such a vast and complex monolith that no single monitoring body can get a completely accurate picture of everything that goes on…”
During my last period as a County Councillor, I witnessed that first hand. Just a few examples will suffice. I was Senior Vice Chair of the Health Scrutiny Committee. Its role was to scrutinise the decisions not just of the NHS within the County, but anything else that related to Health, including Social Care, the Leisure polices of local Councils, Environmental Health matters etc. In other words a huge area of activity. Consider that a normal Council Department in even a small District Council will employ around 100 administrators, and several tiers of supervision and management. A large County Council Department will employ several thousand people, many of them being administrators, supervisors and managers. How many Staff did we have to assist with scrutinising this vast area of work? Just one single person, and a budget of £20,000!
I have also previously referred to my experience on the Social Services Committee where myself and the Committee Chair month after month complained at the lack of education being provided for Children in the Council’s Care. Month after month we were frustrated that nothing had been done, and yet some other excuse was provided. A similar thing occurred with the Chair of the Highways Scrutiny Committee who wanted to push a simple policy of getting white lines painted on the sides of rural roads. For months we were given excuses as to why it would cost too much money, and every excuse under the sun, and when those providing the information have a monopoly over it, it is very difficult to challenge their position.
I have also referred previously to my experience of actually working in Local Government as well. In reality, those tasked with conducting the oversight normally Auditors, are so concerned with trying to protect their own backs by trying to catch people who have acted in some way illegally that the last thing on their mind is looking at whether things are being done efficiently or not! Moreover, Auditors are normally tied into the most powerful Department in the organisation the Finance Department. As the Finance Department also often has control or at least considerable influence over Council policies its unlikely to criticise too strongly those policy’s efficiency. On one occasion I saved the Council around £25,000 in buying computers from an alternative supplier to the one the Council had traditionally dealt with. As this put the noses out of joint of the Finance Department who had argued for retaining that relationship – the IT Department came under the Finance Department and they did not like the idea of their Empire being threatened by Departments being able to make their own decisions – I found myself facing three months of Internal Audit investigation to justify my decision, at the end of which they concluded that the decision was okay, but criticised me for not saving £25 (!) by buying the software for the machines (which was pre-installed!) from another supplier.
The various reports on the inadequacy of state Capitalist provision – See:
BBC On Dr Foster
Dr Foster
Hospital Boss Sacked
Patients Association On Dirty Hospitals
Another Hospital Boss Sacked
Hospital Kit Covered in Blood
No One Should Go Through That
Councils Warned over Social Care
for example,massively understate the problems. As many people have said this last week in relation to Social Care, the real situation in many homes is far worse than the picture of “adequacy” painted in the report.
But, why should any Marxist be surprised at any of this, let alone why should any Marxist cover it up out of some misplaced desire to “defend” State Capitalist provision as being in some way “socialist”? After all it was Marx, who, in the Critique of the Gotha Programme, criticised the Statists and Lassalleans who fell into that trap. In relation to State Capitalist provision of Education he wrote,
“"Equal elementary education"? What idea lies behind these words? Is it believed that in present-day society (and it is only with this one has to deal) education can be equal for all classes? Or is it demanded that the upper classes also shall be compulsorily reduced to the modicum of education — the elementary school — that alone is compatible with the economic conditions not only of the wage-workers but of the peasants as well?
"Universal compulsory school attendance. Free instruction." The former exists even in Germany, the second in Switzerland and in the United States in the case of elementary schools. If in some states of the latter country higher education institutions are also "free", that only means in fact defraying the cost of education of the upper classes from the general tax receipts. Incidentally, the same holds good for "free administration of justice" demanded under A, 5. The administration of criminal justice is to be had free everywhere; that of civil justice is concerned almost exclusively with conflicts over property and hence affects almost exclusively the possessing classes. Are they to carry on their litigation at the expense of the national coffers?
This paragraph on the schools should at least have demanded technical schools (theoretical and practical) in combination with the elementary school.
"Elementary education by the state" is altogether objectionable. Defining by a general law the expenditures on the elementary schools, the qualifications of the teaching staff, the branches of instruction, etc., and, as is done in the United States, supervising the fulfillment of these legal specifications by state inspectors, is a very different thing from appointing the state as the educator of the people! Government and church should rather be equally excluded from any influence on the school. Particularly, indeed, in the Prusso-German Empire (and one should not take refuge in the rotten subterfuge that one is speaking of a "state of the future"; we have seen how matters stand in this respect) the state has need, on the contrary, of a very stern education by the people.
But the whole program, for all its democratic clang, is tainted through and through by the Lassallean sect's servile belief in the state, or, what is no better, by a democratic belief in miracles; or rather it is a compromise between these two kinds of belief in miracles, both equally remote from socialism.”
Critique of The Gotha Programme
Yet, it is precisely this “servile belief in the State” (even in the Capitalist State let alone the “State of the Future”) which characterises the politics of most of the supposedly Marxist Left today.
And what Marx describes here is what we see today, even when the development of Capitalism has been such as to enable it to provide free universal education. On the one hand there is Eton and Harrow for the toffs, and on the other a failing Comprehensive for the workers. There are top quality private hospitals, clinics etc. for the rich and dirty, unsafe NHS hospitals for the rest of us. Even within the NHS itself there is a vast disparity of provision. In the more affluent parts of the country provision tends to be better than in the more deprived. IN the more affluent areas there is little problem attracting GP’s, whereas GP’s are more reluctant to set up in deprived areas.
Capital does not provide socialised Health and Social Care nor Socialised Education out of the goodness of its heart. It does so in order to reproduce Labour by the most effective means for its needs. That is why the Democrats, as representatives of the more enlightened Big Capital in the US have been attempting to introduce Healthcare reform. The most inefficient aspect of private healthcare is insurance, and its administration. Not only are vast armies of administrators required by a host of insurance companies to compete for and collect insurance contributions and to make judgements on whether treatments comply, and then to make payments to providers, but the healthcare providers themselves also then require even more administrators to deal with these claims, and the attendant insurance companies. As many of the most organised workers in the US have their Health Insurance paid for by employers, the high cost of such a system falls on the employers. That is why they are looking to cut that cost by the introduction of something approaching the European model of socialised Healthcare of some kind of single payer insurance with healthcare provision remaining in the hands of competing providers, competition then ensuring that costs are kept down, and quality is kept up. Faced with the inefficiency and inadequacy of the NHS, its no wonder that the British Government has been looking to adopt a similar model.
The European model of socialised provision, certainly does provide lower cost, and better quality healthcare provision than does the NHS, but that is no reason why socialists should advocate that as an alternative either. The fact is that we have no reason to go back to privatised healthcare even where it does provide something better. On the contrary, our interest lies not in going backwards, but going forwards, taking the general principle of socialised healthcare of free at the point of use, and covering all workers irrespective of their ability to pay, and making it real and effective in the only way it can be. That is by bringing it completely under the ownership and control of the working class itself collectively. Indeed, that is our argument in relation to all aspects of life. There is no reason why we should put that process off until some time in the distant future – after the revolution – because the best way of bringing about that very revolution is by beginning to transform aspects of our daily lives here and now, and thereby demonstrating, as Marx suggested, by deed rather than argument, the very basis of our socialist ideas and programme, demonstrating in practice how a different, better form of society can work.
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