The NHS in britain is now actively under threat comparable to what is the usa is called-"clear and present danger"-and i dont jest in the use of that comparison.
despite the huge gains from the nhs for the capitalists-the state still seems dead set on a "slash and burn"rather than"root and branch reform".i do not doubt that the con-dem regime,who only seem able to condemn do have a mandate from a ruthless ruling capitalist class,for instripping away any welfare from the state they hope to enable an increase in profit,rate of profit and accumulation,although this is increasingly difficult in decadent if not actually decaying capitalism.i also do not doubt that the particular virulent demands of a section of that class within within and without the tory party have particular intentions.
i acknowledge that the compromise that is the nhs was developed and built at a particular conjucture in the class struggle and that in some senses these are different times.it might have been very difficult in the late 1940s for anyone to predict the health and needs of the population in 2010 or further forward.it might have been diffficult even for a committed revolutionary workers decision making structure.but if this is a failing in the nhs it is a failing of its own success,considered warts and all.life expectancy is considerably increased over that time,and the age and demographic structure of the population and its social expectations are different.prediction of changes in ill health and disease are themselves very difficult to predict,not least i suspect because the so called natural processes remain to be further explored and are themselves changed by sociasl conditions and class struggle.i suggest that in social relations not driven by profit and the extraction of value from labour,the amount and types of industrial ill health and accidents and disease would be lower.the nature of the ageing population is such that aging itself will raise new issues to be addressed.i would guess that cancer,diabetes type 2 and many other conditions reflect more about class society than of individual choice.yet i suuggest that a genuine socialist society would have done more planning and innovation,for it is categorically not true that capitalism is the best of all options that generates the best of all choices.what is (most)profitable is not what is best.
yet this situation is used as a stick with which the careless(they dont care)critics beat the nhs.
it is also said to be the largets employer in europe,which amkes it an inevitably vast sprawling organisation.i would argue that its overbureaucratisation is indicatative that it is part of the capitalist state,and that it could be a different way under different sociasl relqations.if british capitalism privaties it or changes the dynamics and dimensions under capital,nothing truly psoitive in the interests of workers will happen.we dont need or want more say,more choice as consumers,we want more control as workers who generate all wealth and value.as the anarchists would say,"we don't just want more bread,we want the whole bloodyuy bakery".
having said the con-dems have a mnandate for this attack,they dont have the one that should count.and they dont have a mandate.it is undoutedly primarilly a tory initiative,though it was not in either manifesto,and if it is in the con-dem "stitch-up"then the only pay off for the "social defectives"lib dems)is gerymandering with the voting system.that is a fools gold that could easily slip through their fingers in the referendum on 05/05/2011.whatever,the dems are facillitating this arbitrary,opportunist,ideaologically driven class attack.the dems should never be seen to the left of anything.to the genuine left they are "tories with velvet toe caps"who will like the associates of a bully will join in the thugs attack,and then run ansd hide with their feeble excuses.
the bais of this hi-jacking is that all the problems can be solved if consortia of gps(general practitioners)will gain control to commision services.this is privatisation which forces the nhs into the market.the market in capitalism is not comparable with the bazarre or street market where thers is some coming together of those who choose to buy and sell(this is only and entirely free process in abstraction,but in the real world the stret market is comparably freer that wage-labour set against capital itself in an inevitably combative and compuksoiry relationship).some,indeed most of the gps see if only from aprofessional perspective where this is going and do not want to get on the bus.
i suspect and hope that most of the service users,who will be more of less the same as most workers as most of the labour force(a theoretical abstraction explicitly to slice up reality,so that it appears not to be reality)are likely to be opposed to it.even some of the dems.see it as a disproportionate approach-that what is proposed is not the right one for the problems identified and it will literally be a haqmmerf to crfack nuts.it is in direct contradiction to the cuts in public service.how can either the referendum on gerry mandering(the trade off)or such a vast reform itself come free.the only way is by resorting to the tommy cooper style of economics(a now decesaed comedian and magician)
many people here used to and probably still do believe that the nhs was the best health service in the world.this may or may not be an objective fact,but in a sense even if it is only idealogical fact,as seen by louis althusser it doesnt matter-its about how a social order presents and sees itself.ideaology does however raise other problems.what does matter is that some and proably major fractions of capitalist,inclduing fiance capital which is always particvularly greedy and irresponsible,and the extreme libertarian free marketeers have broken rank.
so the ideaolical self image moves down one or more notches.at worst the service is decsribed as not fit for purpose,a failure in terminal condition,or the claim is modified,so that the usa susytem is seen as highly generative of innovation because it is entirely free,and soable to deal with the leading edges of health care,the rarities and extremities,whilst the uk is seen as a mass health service with the implication that mass is somehow of itself inferior.
we cannot allow the capitalist lie that its own tricks will resolve this difficulty,nor to attack the whole system at root.only a service designed to meet need and not profit could innovate to find that solution.
its interesting that in britain my own family experience shows me that at last 3 members of mhy family have benefitted from social medicine.had they not done so the quality of my family life would have been drastically reduced oif not different.when i lived in the usa,i saw and knew people whose life conditiions and choices were seversly limited alongside their improverishment and/or redundancy.i do not know anything about the libyan health service but notice that injured resistance fighters and civilans run to hospitals for help,only considering whether they would be handed over to the quaddafi gang.i also notice hospital staff from bombed facilities heading towards the front line!i suspect in the usa doctors are directly constrained by insurance asnd profit driven medicine away from the critical experiences of working people and towards the rich and priveleged.when i lived innthe usa during the clinto era,many ordinary americans seemed mystified by nhs,whicdh somehow was seen as literally free,rather than paid for by taxes.if the clintons understtod the realities they entirely failed to explain it,as their early health care plans became afailed illusion.iam equally horrified that apparent popular resistance to social medicine in the usa wasa portrayed as virulent communism,which weaked the already soemwhat llusory provison of the obama presidency.
the nhs is not without difficulty,but these tend to be in some senses limited rather than fundamentally undrmining flaws.some reflect the nature of the compromise which allows international drug conglomerates to milk and suck out vast resources from the system.the power structure and bureacracy provides this with a cover.there was a compromise with the power of the professions which again might be refought out in the current plans which would be destabilising for workers and expensive,risky and positively destructive elswhere in the health system.
the con-dems are also building key elements of their reforms in advance of legislation and will undoutedly build on this before testing any pilots.this is both an erosion of democracy and is already creating further practical problems for inevitably competitive commsioning.one hospital closure/development is put on hold because of adamaging report aboiut another where reform development has aready begun.outside the realm of competition-which i view as destructive-no one can win,any and every result would be destructive.
a brief period of reflection has been granted.if this is anything other than vacuous we have to work towards halting all these plans.to build maximum unity for the defence of a health service which we can defend and develop-that meets our needs and not their profits,political or financial.
there are also local needs and issues to which there is almost an inevitability.even a workers health system would have toadapt,change and grow,but is hiughly unlikly to be threate3nding or destabilising.,there is also human error,and problems at the extremes-extreme cases and at the frontiers of medicine or development.
some research indicates form example that huamn error is soem kindf of constant,wher new ways or new staff pose risks because they are untried or untested.the counter to this is the greater care and vigilance applied.on the other hand experienced staff,using tested qand proven systems and procedures can make mistakjes through over familiarity.
workers coulld however put further procedures in place when not distracted bhy their own alienation and exploitation on the one hand or profit motive on another.i know that the same system that appoints managers as a control mechanism also attacks management and support services when cutting and shaving and looking for efficiency.this is an easy but illusory target,and actually think that in a workers health care system managers might be exactly the staff to bring together,seek out,encourage,monior and develop exactly the growth and innovation neccessaqry,and which does not simply jand instructions down by builds on the very real and obvious skills available in the health service,from cleaing,catering,compouters,potering and administratiion,through the specialist services and facilities right along to the medical and nursing staff.failures at any level is damaging to all.workers are usually very eager and willing tokiin together not just in their own defence but in developing gthe success and satisfaction of their work.mangers could easily be the cordinating,generalising glue in a collective process here.
for it strikes me that revolutionary change could result in some relatively easy and speedy changes in the health service.job security and developoment within a service clearly and only directed at human need would grow in confidence and competence.i do not doubt theiur abilities to innovate and serve because they do not currently work in a system that doe encourage those things qand they still serve us generally well.they are after all engaged in some of the nastiest,basic,demanding actvities in the service of people largely unknow to them(ot colleagues,friends or family)
it is not entirely an aside to end with the following:i carried a book into hospital with me-an edition of the journal historical materialism,which started at least 3 conversations.it was a good advert for the journal,which i recommend highly.but i also had brief discussions with ambulance staff who talked about targets and systems in their jobs,whilst demonstrating and giving me a high quality of service,sensitive to my needs.later i spoke with a doctor who was gently reassuring and helpful in his manner,and began to express concerns about management.i also spoke with a "leading nurse",whose rank i do not know but worked with warm authority and treated me like a person.
all of them and many others presented as highly committed,caring an competent people,working effectively under qa loyt of relentless pressure.patients are oen thing,systems another.once again i want to reapeat that i felt safe in their hands.all of them qand me sharfe a concern for the life blood of the nhs,not just central to the lives of each individual patient and worker but to the health of britain in the literal and political sense.i salute threm all.
i am happy to stand with them in the defe3nce of a health service which should be fully ours and beyond the grasp of those who think they are or really are in power.
defend the health service,dedicated to human need not systemic greed!
in a sense with all its problems