Part of the problem is that the Left has turned the NHS into a fetish.
“The basic source of left orthodoxy is not hard to trace, It lies in the widespread over-romanticised attachment to the NHS on the left, which derives from a belief that the 'principles of 1948', under which it was set up, form the basis for a socialist health care service.”
(Left Orthodoxy and the Politics of Health, in Capital & Class 11, Summer 1980)
But, of course they don't. The NHS was established to meet the needs of
capital not
labour. As Carpenter says, the Left seemed to have more difficulty understanding this with the NHS than it did even with other elements of the welfare state, such as education. Most of the Left could understand that education is geared to the needs of capital; it concentrates on the kind of education and training required by capital to provide the kinds of workers in demand at the particular time. In truth, large sections of the Left have lost even this understanding. The kind of statism that dogged the Left for a century, based upon the ideas of Lassalle and the Fabians, and promoted by Left
social democrats and Stalinists, but which had begun to weaken in the 1960's and 70's, has grown ever stronger since the 1980's, and for much the same reason that Carpenter identifies here. The Left lost the ability to think critically. It became obsessed with fighting immediate battles over cuts, austerity, privatisation, job losses and so on, and did so simply on the basis of placing a minus sign wherever their enemies placed a plus sign. The obvious manifestation of that was to defend existing state capitalist institutions, to defend the existing capitalist state itself, including, as can be seen today, defending institutions like the BBC, which acts as the propaganda organ of the capitalist state. It completely failed to present, as an alternative, any independent working-class analysis or solution.
“Let us take for granted that the NHS is different. Nevertheless, if we accept the 'socialist' character of the NHS at face value, it leads to the acceptance of a particular kind of socialism, obscures the way in which the NHS serves fundamentally conservative purposes. It has led socialists in this country to think of health services as the 'natural' means of tackling the ill-health effects of capitalism, and it has on the whole led them to accept the medical mandate to define health and ill-health even when criticising aspects of doctor's practice.”
(ibid)
As Carpenter says, any Left critique of the NHS has amounted only to a criticism of its failure to live up to the socialist principles of 1948, not to question whether those principles were themselves socialist in any case. The more the NHS came under attack from, particularly, Tory governments, though the Labour government of the 1970's inflicted cuts on the NHS too, the more the critique has become not of the NHS itself, as a state capitalist institution, but merely of the failure of Tory governments to provide adequate financing of it.
“In capitalism... health and ill-health are both made to serve the needs of capital accumulation.”
(ibid)
Capitalism sought healthy workers to facilitate capital accumulation, but in so far as capital made workers ill, resulted in accidents and so on, a section of capital profited from this too via the provision of drugs, surgical treatment, the provision of devices and so on. The NHS fulfils a useful ideological role in presenting a fiction that everyone is provided with free healthcare on an equal basis, and on the basis of need. But, it never has. Its not free, but paid for out of the
wages fund, as healthcare is a component of
the value of labour-power. Workers buy it collectively from their wages in the form of an insurance payment, or tax.
In the process, by enabling healthcare to be undertaken on massive Fordist lines, they also reduced the cost of healthcare for the bourgeoisie too, who benefit from the production of new drugs and so on at much reduced costs, because of economies of scale. Every survey also shows that the provision of healthcare is neither provided equally across the country nor on demand. There is greater provision in more affluent areas, and many of the workers who require treatment for their particular complaints do not get it. The current decisions to deny treatment to many workers, for cancer or many other life-threatening conditions, in preference to providing treatment for COVID patients, is a case in point. But, it also assumes that every individual starts from an equal position of health, whereas it is always the case that the bourgeoisie, or even just the more affluent, tend to start with better health than do workers.
“Of course, in reality, working class people have sickness problems which the NHS does not deal with at source, or even adequately after the event...”
(ibid)
As Carpenter says, illness is a “profoundly decollectivising experience”. In many ways, its a bit like the way people turn to God when they suffer bereavement, or some other tragedy, because such events always appear as individual, personal events, and lead to a desire for some form of succour, for events that are outside our own individual control. Its no wonder that, in all those decayed urban areas, a similar attachment to the capitalist state, as benefactor, provider of doles and even minimum security, and a paternalistic, more or less feudal, relation of dependency is created from it. Its no wonder that its in those areas that this semi-feudal relationship of dependency to the capitalist nation state manifests itself in the form of a nationalistic desire to keep its bounty for the preserve of the natives, and deny it to foreigners, and leads to reactionary ideas such as Brexit.
Left orthodoxy,
“... helps to foster 'the NHS illusion' that the problem of ill-health in our society can be largely dealt with by more and 'better' health services, the 'better' meaning to a considerable extent 'whatever doctors decide'.”
(ibid)
And, this feeds directly into the mechanisms of the
medical-industrial complex, because individual doctors are under tremendous pressure from those medical-industrial companies to prescribe the latest drug etc.; they are under pressure to conform with the orthodoxy within the medical-industrial complex itself, which has been obvious in relation to responses to COVID, and to the demonisation of any medial scientists or practitioners, such as those that have signed the
Great Barrington Declaration, who dared to point out that the Emperor had no clothes on, when it came to the claims about the existential threat posed by the virus, or the requirements for lockdowns as a means of responding to it.
The proponents of lockdown have tried to use the old Stalinist tactic of the amalgam to defame those scientists that have signed the
Great Barrington Declaration, and who argue for
focused protection of the elderly and vulnerable, not by dealing with their arguments, but by talking about the libertarian ideals of some of its backers. Yet, no one points to the actual medical-industrial complex that channels millions of pounds into universities like those listed in the
FT article cited above, such as Imperial, Cambridge, and UCL, in research grants that, in turn, results in the development of very expensive drugs that produce billions of pounds of revenue for those drug companies, paid for by the capitalist state, out of the NHS budget!
As described above, the current test and trace scheme is useless. It would be useless even if the tests were reliable, and the computer systems to identify contacts, and to trace them worked perfectly. In Germany, which has as close as can be considered to such a system, it has seen the same surge recently in infections that have been seen in Britain, France, Spain and Italy. But, the tests are not reliable. Around 30% of positive infections are missed by the tests, whilst a significant number of false positive tests have been shown up by the fact that people on holiday who had the virus weeks ago, are still showing up as positive, because the tests cannot distinguish between the DNA of dead viruses and those of live viruses.
But, it is useless anyway, because around 90% of the population who have the virus are not tested. They are asymptomatic or not ill enough to seek testing. So, the vast majority of people who are infected are walking the streets infecting others anyway. Testing and tracing would require testing everyone every day, even if the tests were reliable. It is simply a diversion and means of giving a false impression. Yet, the focus put on testing and tracing alongside the idiotic lockdowns has pumped £12 billion directly into the pockets of the tech companies, and consultants responsible for developing the app, on top of that it has pumped billions more into those drug companies that produce the test kits, and those that analyse the tests. The only tests that make sense are those that identify existing immunity, but it is those tests that no priority is being given to.
All of the emphasis is on expensive medical solutions, be it testing, hospital treatment, or the production of a vaccine or other drugs to deal with the symptoms of the virus. All of that channels money into the medical-industrial complex on a vast scale, pumping up the profits of the drug companies and other medical services providers, swelling the personal empires of the health bureaucracies in the department of Health and NHS. Yet, a sensible approach would instead start from the perspective of simply isolating that minority of the population actually at risk from the virus. Compared to the billions of pounds already spent, on useless testing systems, the state could have simply told those over 60, or in vulnerable categories to self isolate, and could have financed that at much less cost. But, it would have provided no revenues to the medical-industrial complex, no addition to the profits of those big companies.
The policy of focused protection immediately protects the elderly and vulnerable, who are being culled in their tens of thousands by the current lockdowns, which have not even provided effective protection for the elderly and vulnerable in hospitals and care homes. And, by allowing everyone else to go about their business normally, it means that not only is the economy not destroyed, but these millions of people develop
herd immunity safely at no cost. It is this herd immunity
at no cost that the medical-industrial complex, of course, is most concerned about, because
no cost means no profits for the big drug and medical supplies companies,
no bigger empire for the health bureaucrats, and so on. Not to mention
no funding for the university epidemiologists that, time and again, have told us that there was going to be some existential threat that, in fact, turns out to be nothing of the kind.
Instead, we have huge sums being pumped into the development of vaccines, with government already ordering tens of millions of them from the drug companies, at a cost of billions of pounds, even without knowing whether they are safe, or will work. In Russia, we have seen that resulting in vaccines being rushed out without proper testing, we have seen vaccine tests stopped in the US and UK, due to the development of illness by trial participants. In order to develop vaccines quickly, genetic modifications are being used, which normally would require extensive testing before any new vaccine was released generally, but governments know they cannot keep populations locked down forever, both because there would be increasing rebellions against it, and because the existing lockdowns are destroying economies, and so they are placing all their eggs in the basket of a vaccine saving their bacon. Even, so the reality is that a vaccine is not going to be ready for at least six months, and it is no wonder that, with all the pressure for it to be rushed out, there are many who will be reluctant to take it for fear of being used as guinea pigs.
We can bet that the first people its tested on will be the old, the vulnerable and the poor. If a successful vaccine is produced that is safe, then, of course, that will be great, but will it be worth all of the death and destruction that lockdown has caused as the necessary consequence of relying on its development, rather than the development of cost-free natural immunity in the intervening period? Once again, we see the consequences of health policy being determined by the interests of the medical-industrial complex rather than the interests of workers and their health.