But, of course, the NHS is not OURS at all, it never has been and never will be. Like every other state capitalist organisation it was created in the interests of Capital in General, like every other state capitalist organisation it is under the control of the same elite of bureaucrats, the highly paid executives that come from the same privileged backgrounds, that run their other businesses, and run the state itself for and on behalf of the capitalist class. The only shame we should feel in relation to the NHS is that we allowed ourselves to be conned into believing that the Capitalist State was in some way class neutral, that it even acted in our interests rather than those of the capitalist class.
State capitalist organisations like the NHS, or the education system, are instruments of class rule the same as all the other arms of the capitalists' state, such as the police, the armed forces, the judiciary and the civil service. There is no more chance that the entrenched power of capital will simply hand over control of any of these instruments of its rule over us, than there is of Al Assad handing over control of the Syrian state to the Syrian workers. And the British capitalist class and its state are far more powerful, far more entrenched than Assad could ever be. If we ever wanted that kind of control, it would require a revolution far more thoroughgoing than that started in Syria. It would require overwhelming numbers and determination on the side of the British working-class to bring about.
No one seriously believes that workers could obtain democratic control over the police or the army, or that any time short of the revolution the judges are suddenly going to start representing the interests of workers, so why on Earth would anyone believe that other arms of the state such as the NHS, or education would be any different? Of course, that doesn't mean we shouldn't demand at least some basic elements of democracy for all these aspects of the state. Even the US has elected judges, and other state officials. Workers in the armed forces have as much right to Health and Safety protection, and so on, and other democratic rights, including election of their superiors as anyone else.
But, in reality, we know that in order to exercise control you need ownership, and for so long as its not our state, none of these things will be allowed to be under our control. Instead of some elusive democratic control over the police and armed forces, we know that what we need are workers defence organisations and workers militia. Again, even the US Constitution calls for a Militia. In the same way, if we want workers control over health and education, we will need to build our own alternative provision to that owned and controlled by the capitalists state.
But, the failure of the NHS is only the latest example of a series of such failures of state capitalism. Marx and Engels set out the way that capitalism developed. From the first, small scale, individual capitalists developed bigger capitalists, that became smaller in number, and bigger still in size as the smaller capitalists were squeezed out. In the end, this monopoly of private capitalists could go no further. As Marx describes it there then took place an expropriation of the expropriators, as these large private capitalists were themselves replaced by social capital in the form of the joint stock companies financed by credit, which in turn developed into the giant trusts.
As Engels says, the development of state capitalism was merely the logical extension of that process. In “Anti-Duhring”, Engels describes how this process establishes the basis for a transformation to socialism, because such a situation, where the means of production were in the hands of the capitalist state, which in turn operated on behalf of the capitalist class, who were now reduced to a class of rentier's, 'coupon clippers' who simply drew their surplus value in the form of interest payments on their government bonds, would be so obviously unjust, so patently exploitative, so manifestly parasitical, that the workers would quickly sweep it away, and replace it with their own ownership and control of the means of production. If only!
As Kautsky pointed out, In the 'Erfurt Programme'
“If the modern state nationalizes certain industries, it does not do so for the purpose of restricting capitalist exploitation, but for the purpose of protecting the capitalist system and establishing it upon a firmer basis, or for the purpose of itself taking a hand in the exploitation of labour, increasing its own revenues, and thereby reducing the contributions for its own support which it would otherwise have to impose upon the capitalist class. As an exploiter of labour, the state is superior to any private capitalist. Besides the economic power of the capitalists, it can also bring to bear upon the exploited classes the political power which it already wields.
The state has never carried on the nationalizing of industries further than the interests of the ruling classes demanded, nor will it ever go further than that. So long as the property-holding classes are the ruling ones, the nationalization of industries and capitalist functions will never be carried so far as to injure the capitalists and landlords or to restrict their opportunities for exploiting the proletariat.”
There are no shortages of such examples, the most striking, in Britain, being the way the nationalised col industry, backed by the entire might of that capitalist state was used to smash the miners in 1984-5, and thereby to inflict a devastating defeat on the working class as a whole. But, the experience of all the other nationalised industries was no different. Every nationalised industry was compelled by law to sell its output at prices equal to the marginal cost of production. No large scale capitalist business does that, even though bourgeois economic theory says they should. They all set prices higher than that. In effect, the nationalised industries were giving direct subsidies in their pricing to large non-state capitalist enterprises. Those subsidies amounted to a direct transfer of the surplus value created by workers in the nationalised industry to the non-state companies. On many occasions they also amounted to a subsidy from workers in general who provided the money to cover those subsidies.
The NHS was no different. A rational health service would focus its resources on preventing ill-health as much as possible. That would require tackling the causes of ill-health in workers poor working and living conditions, in the way they are encouraged to consume things that make them ill and so on. It would focus on Primary Care, to spot ill-health at an early stage and deal with it. All of these things are not only better for workers, who thereby avoid chronic ill-health, but they are also low cost solutions, thereby costing workers less to achieve.
Ultimately, for that reason they are rational solutions for capital too, because they reduce the value of labour-power and thereby boost relative surplus value. But, capital does not act rationally, even in terms of achieving its own ends, because capital also exists as “many capitals”. Powerful individual capitalist enterprises benefit to the tune of billions of pounds a year from selling drugs to the NHS to treat illnesses that have been allowed to develop; from selling hospital buildings, technology, computer systems and so on required for the extensive range of highly expensive forms of healthcare required to deal with chronic illnesses. Moreover, the state bureaucrats who run the NHS and Department of Health, who like all such bureaucrats flit from the state to non-state employment, themselves have a vested interest in building their own empires on the back of these forms of healthcare sold as a commodity, as opposed to a rational system of primary healthcare and prevention. And once that method has developed, it is no wonder that it spreads throughout the organisation. Responsibility for the failings of the NHS rest with its top management whatever the individual failings of nurses and others. As the saying goes a fish rots from the head down.
In many ways, its like what Marx said in relation to agriculture.
“The moral of history, also to be deduced from other observations concerning agriculture, is that the capitalist system works against a rational agriculture, or that a rational agriculture is incompatible with the capitalist system (although the latter promotes technical improvements in agriculture), and needs either the hand of the small farmer living by his own labour or the control of associated producers.” (Capital III, Chapter 6)
Going back to the hand of the small doctor is certainly not something any Marxist would propose. But, a rational health system does require an alternative to the NHS, one under the direct ownership and control of workers themselves.
In reality, of course, workers themselves have recognised what Engels hoped they would about state capitalism. The trouble is that their leaders, including those within the supposed revolutionary organisations have not. The reformists would always present the state as class neutral. For the Stalinists, Socialism was state ownership and control by state bureaucrats. But, the supposed anti-Stalinist Left has been no better. It has acted as cheerleaders for state capitalism itself, with only the ridiculous calls for Workers Control tagged on to provide revolutionary cover for a reformist demand, in a way that Marx would have labelled “revolutionary phrase-mongering”.
Workers have had to scrabble for an understanding themselves. Every 20 years, the number of worker co-operatives rises significantly, and the number of people involved in co-ops continues to rise. Slowly, quietly they have been far more successful than has been the workers parties that have continued to decline. But, without the kind of guidance that a Workers Party could provide, without the coming together of those Co-ops with the workers parties and trades unions, and the creation of a large co-op federation, even their progress must be fitful. What would once have been called the Left is now not distinguishable from the Tories; the revolutionary left has ceased being revolutionary, if it every really was, and instead is reduced to trade union style activism, economism, and the reformist ideas and politics that arise from it. Its height of real political ambition is only to recreate the failed Labourist model that previously developed on the back of trade union politics, but even that has no resonance within the working class. At home its politics is reduced to old style social democracy, and abroad it is reduced to old style radical Liberalism, acting as cheerleaders for one or other faction of the bourgeoisie alternately under the mask of democracy or authoritarianism.
Its understandable that Stalinists should adopt this approach to the State. In many ways the NHS is no different from the huge bureaucratic monstrosities it created, which makes the actions of those that refused to defend the USSR, because it was “state-capitalist”, all the more hypocritical, in being uncritical defenders of the actually state-capitalist NHS! But, its also understandable why the revolutionary sects adopt this approach rather than actual worker ownership and control, which usually they not only do not support, but vehemently oppose!
The reality is that those sects, whilst proclaiming the role of the workers as the agent of revolutionary change are as dismissive of the real working class as the Stalinists. The workers are fine provided they know their place, and provide the foot soldiers the “professional” revolutionaries need to implement their plans. But, their ultimate view of socialism is one in which they are the ones making the decisions that the workers rubber stamp. That is why they are as happy as the Right to engage in the kind of machine politics seen in Falkirk to obtain a majority, be it to pass a resolution or to win a position. It is only the same kind of machine politics that the left sects have engaged in in trade union “Broad lefts” and “rank and file” groups for decades. The function was never to build a real mass rank and file organisation, but only to build sufficient votes to obtain a majority. The problem being, of course, that a mandate, from an insignificant minority of the working-class, is, in practice, a mandate to be able to do absolutely nothing!
If the working class is to move forward it has to move beyond these kinds of toy town politics, beyond the romantic fantasies of the student revolutionaries, and return to the ideas of Marx and Engels and others that starts with the real working-class, warts and all, and the need for it to develop its own organisations separate from the capitalist state. The more the Left seeks to defend the indefensible in the form of state capitalism in its various guises, the more it will simply make itself even more irrelevant.
Workers faced with the reality of bureaucratic and oppressive, state capitalist housing provision, and offered no socialist alternative, jumped at the chance provided by Thatcher to create their own alternative by buying their houses. Other than for railways, there has been no great desire by workers to demand the restoration of the old bureaucratic state capitalist enterprises either. Even in the case of railways its hardly as though workers are rioting in the streets demanding it be carried out either. Faced with only a tweedle-dee, tweedle dum alternative of state capitalist provision or some other form of capitalist provision, workers at best sway between the two, just as they sway between voting Tory or Labour.
To build Socialism will require that the working class in its vast majority feels far more committed to a different solution, and one it can create and control itself from the beginning.
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