Why The NHS Cannot Protect Our Health - Part 4

After WWII, with a shortage of labour power resulting both from the number of adult males killed during the War, and the increased demand for Labour arising from the Post War Long Wave Boom, the importance of that became apparent. Capital was led to use a latent reserve army in the form of women workers.

As during WWI, women had been drawn into the labour force during the War. Now, on a scale unlike anything in the past, not just single women, but increasingly married women were drawn into the workforce, and their domestic labour was replaced by the introduction first of a range of new services such as commercial laundries such as that provided by the Co-op, and Laundrettes, and later by the availability of labour saving machines such as washing machines, spin dryers, vaccum cleaners, and so on, as well as the introduction of fitted carpets etc.

Additional labour power was made available by the encouragement of the Tory Government of the 1950's for immigration, particularly from the Carribean.

But, central to this strategy, and the needs of Capital, was that domestic workers who were increasingly being drawn into the more technological, new industries such as motor vehicle production, electronics, and petrochemicals – whilst the low paid, low status, unskilled jobs were assigned to the immigrants – needed to be better educated, and if that education was not to be wasted, enjoy better health. The improvements in Health and Education in the post-war period, including the raising of the school leaving age from 14 to 15, were a part of that strategy. The importance for this strategy of the State Monopoly should not be underestimated. It was important for several reasons. Firstly, as is the case with many major Public Goods – for example the provision of Motorways – the scale on which investment is required, and the uncertainty of demand means that private capital is unlikely to come forward to the required amount. Even in the US, it has to be remembered that alongside private healthcare, a substantial state run health system co-exists.

The investment required for an effective National Health System, including the amounts needed for the establishment of hospitals, the acquisition of the increasing amount of new equipment that was making its way into healthcare, and the training of thousands of nurses and other staff, would not have been done by private Capital. However, the State, not only could mobilise the Capital needed to finance that investment, but because of its legal powers of tax raising, it could ensure that the necessary minimum demand for those services could be guaranteed. In essence, workers were given no choice about the amount of healthcare they wished to purchase compared to other commodities, because the State deducted the requisite payment from their wages. If, workers chose not to visit the doctor, or the hospital etc. then the State did not lose out, because it had already received payment for those services whether they were used or not. But, by making them free, it could be pretty confident that workers would take up their entitlement.

Again, the importance of that should not be underestimated. We have seen the consequences of a total market solution for healthcare, when various charges for services have been introduced. Increases in dental charges led to a significant reduction in the number and frequency with which people visited the dentist. The same was true with opticians charges, which was significant given the number of other illnesses that can be identified by opticians looking into the eyes.

Given that Capital sought to increase the amount of available labour power, by improving workers health, and their longevity, it needed to ensure that workers would at least take up a minimum level of haelthcare, just as they were compelled to undergo a minimum number of years at school, to ensure that Labour Power was adequately reproduced. That is of course, one of the core functions of the Capitalist State.

The idea that Capital has such a strong incentive to ensure that workers health is maintained in this way, might not at first sight seem obvious, especially when we see the kinds of stories such as those at Stafford Hospital, the reports of the Patients Association or the Report of the Health Ombudsman.

But, in fact, what this shows is that in relation to Health all of the contradictions that apply to Capitalism in general operate here too.

In the 19th Century, the nature of Competition as Engels spells out meant that initially, the multitude of small businesses were led to try to make profits by driving their workers into the ground, squeezing every last penny out of them, by short-changing them wherever it could, as well as by all manner of dirty dealing in the selling of its products and relations with other Capitalists.

The Monopoly of the Truck System, meant that they could screw their workers by adulterating the products sold to them, for example. But, as Engels also points out, it was the very development of Capitalism, which created the conditions under which those “penny-pinching” methods not only became meaningless, compared to the much greater increases in profits that could be achieved by increasing relative surplus-value, through the introduction of new machinery, raising productivity etc., but were actually counter-productive. It should be remembered that a fundamental aspect of Fordism, was his recognition of the problems that arose when the workers on his production line kept leaving.

His answer was to increase their wages substantially, and to promote the idea thereby of “Company Loyalty”, with the introduction of other facilities for the worker. The increase in productivity more than covered the cost.

In the 19th Century the Retail Co-ops arose because workers were able to group together, and pool their small amounts of Capital, in order to open their own shops, and by concentrating on selling quality products at low prices were able to quickly develop a huge Retail Co-operative business, that dominated the Retail market by the end of the 19th Century, and had also developed its own Wholesaling business, as well as expanding into a whole range of other services including, Education, Healthcare, Undertaking, Holidays etc. that met all of the workers Welfare needs, decades before the Capitalists decided that they needed to undermine this workers' independent property and provision.

Once workers had been able to establish their own Co-ops, and especially after the Truck System was made illegal, workers could choose to use their own shops, and as a consequence the private Capitalists were forced to respond by raising the quality of their own products. The Co-op, developed its own scientific wing, which not only assisted in developing products for the Co-op, but was also able to test the products of private industry, and those sold in the private retail shops.

As a result it was able to organise campaigns for “Clean Milk”, for example. Although the Co-op had been producing pasteurised and sterilised milk in its own Dairies for a long time, it was not until 1949, that the Capitalist State introduced legislation that made private Dairies follow suit in order to end the damage to workers health due to brucillosis, which caused blindness. Even as late as the middle of the 20th Century, Tea sold in private retail shops was found to be being adulterated with lead filings to make up the weight!

Clearly, as Engels says, the Big Capitalists recognised the short-sightedness of such penny-pinching methods, but the continued existence of huge numbers of small businesses, didn't mean those practices didn't continue. Indeed, the more efficient the larger businesses became, the more the small businesses had to rely on those methods to stay afloat. Once more, as Engels argues the introduction of new laws and controls by the Capitalist State were not directly intended to benefit workers, but did act in the interests of Big Capital, by forcing the small capitalists to conform. In fact, this illustrates the point that Engels makes about those Big Capitalists adopting many of the demands and ideas that the workers themselves had been raising.

Particularly, after WWII, with the onset of the Long Wave Boom, it could be seen that the measures that the “Left-Wing” Attlee Labour Government had introduced, such as the introduction of the NHS, the nationalisation of those old bankrupt core industries such as Coal, Steel, Transport etc. were continued by the incoming Tory Government. In fact, this cross party agreement on these core policies continued into the 1960's, and even early 1970's, under the name “Buttskillism”, being a conflation of the names of Labour's Hugh Gaitskill, and the Tories R.A. Butler.

It was not just in Britain that this held true. In the US, similar developments occurred after WWII, and were reflected in L.B. Johnson's “Great Society”. Similar developments occurred across Europe, and a central part of the development in each case was the incorporation of the Trades Unions into the operation of the State, and of Capital. It was particularly marked in Germany, where the Trades Unions were directly incorporated via the establishment of Works Councils in which workers representatives sat alongside the bosses in discussing ways of raising productivity and profitability. Such “Company Unionism” was well established in the US, and there were attempts to introduce it into the UK too with demands for profit Sharing Schemes, the calls in the Alternative Economic Strategy and the Communist Party's “British Road To Socialism”, for the workers to join with the bosses in putting the interests of British Capital ahead of the workers international solidarity, and the calls for Workers Participation Schemes, or the regularistion of that via the State in the establishment of Planning Agreements.

It was typified by the “Social Contract” drawn up between the TUC and the Labour Government of the 1970's, by which the TUC and its union bureaucracy agreed to police their members on behalf of Capital, and to limit wage demands.

The converse of that could be seen in the early 1980's with the rise of Thatcher in the Tory Party, and the onset of the Long Wave downswing. In the 1920's, Neville Chambelain had developed all of those ideas which were to form the core of the Welfare State. But, the onset of the Long Wave downswing, most notably after the recession of 1921, and particularly in the depression of the 1930's, meant that the conditions faced by Capital, in the Capital-Labour relation were fundamentally changed. With mass unemployment, Capital did not face the problems it had previously of a lack of workers.

In parts of the country, such as in the Midlands and South-east, where new dynamic and profitable industries such as the car industry and consumer electronics were developing, the demand for labour-power remained high, and wages and conditions for workers in them, even during the 1930's improved considerably. But, these were infant industries, whose demand for labour-power was limited, and could be accommodated out of a rising population, of new better educted workers. But, there was no need for Capital to spend money in many parts of the country in improving the health and welfare of workers, when those workers were in plentiful supply. Only in 1938/9, as the preparation for War began, and capital once again found that the privations of the 1920's and 30's had again diminished the stature and physique of those it wanted to send off to die in foreign fields, did it once more begin to address that problem.

The same was true with Thatcher and the onset of the Long Wave decline that by 1980 was in full swing.

It is no wonder that during the whole period of the 1980's and 90's Tory Government, satisfaction with the NHS continued to decline. In fact, then as now, the nature of the Tory Party's membership base, and electoral base shows through.

Whereas, as Engels says, in general the Big Capitalists were happy to deal with the Trades Unions – for large firms with thousands and tens of thousands of workers it is the only rational means of conducting negotiations, and controlling the workers – it is the Small Capitalists, who are the most anti-union. They prefer to continue to squeeze the last drop of blood out of their workers, and with each firm only ever requiring a handful of workers they are always able to look to replenish workers who are not productive and profitable for whatever reason be it, ill-health, or simply a tendency to challenge management. Of course, that is not always true. Small very profitable, very dynamic firms, might treat their workers well, for the reason that they rely on their inventiveness, and hard work to develop the company. On the other hand there are companies such as Wal-Mart, who having developed from a small family business, continue to apply the principles that the family used initially. In Social Science, especially in Marxism, which emphasises the role of the dialectic – the truth is always concrete – there are no absolute laws. The Tory Party reflects that ideology of the small business, and Thatcher was its epitomy. It is no wonder that in the changed conditions that have applied since the 1970's, particularly, the Tory Party, has been the champion of the small business, that it has been at the forefront of demanding an end to all those rules and regulations that should make a civilised society – including now the demand to withdraw from the European Convention On Human Rights! - and which Big Capital has been able to accommodate, but which hits the profits of the small Capitalist.

The problem is that, especially in times such as those we are in now – of a new Long Wave Boom – those kinds of measures are problematic for Capital as a whole. The penny-pinching measures really are counter-productive for Capital as a whole. In the 3 Day Week of 1974, it was found, for example, that workers were producing as much output in 3 days, as they were previously in five.

That was not because they were being worked harder by Capital during the three days. It was down to the fact that having longer rest periods, they were able to work more productively during the other three days. The US, frequently criticises France, because where in the US there is a culture of long hours, few holidays, and work until later life, in France there is a much more relaxed attitude to work; early retirement, shorter working hours and longer holidays. But, the reality is that productivity in France is much higher than even in the US's most productive state California. That is the reality that Big Capital has been aware of for a long time, it was behind the introduction of Fordism and Taylorism and other methods of scientific management. But, it is only a reality that applies where production is undertaken on a large enough scale that this higher productivity can outweigh the costs involved.

The attempts to bring in changes into the NHS – and in the healthcare system in the US – are not about those “penny-pinching” measures to save money. There is no advantage for Big Capital in a Health Service that does not produce healthy workers, any more than it is interested in a machine that does not work. The changes are an attempt to reduce the costs that Capital faces in those countries from their existing Health Systems, especially compared with the costs faced by their European counterparts. In the US, it is a wholly privatised healthcare system, which has proved to be costly and inefficient for Big Capital, and led it to look towards some form of socialised system.

In the UK, it is the actual provision of healthcare by a huge, monopolistic, and bureaucratised NHS – as opposed to the Insurance Scheme that funds that provision – which has proved costly and inefficent for capital compared to socialised systems in Europe.

Back To Part 3

Forward To Part 5