'Defending the NHS'

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Joseph Kay's picture
Joseph Kay
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Mar 8 2007 10:55
'Defending the NHS'

Discussion of 'defending the NHS' split from 'Is Global Warming ...'

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Demogorgon303
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Mar 8 2007 10:23
JosephK wrote:
but we're not calling "for the bourgeois state to control social assets to defend workers" any more than striking against wage cuts is 'calling for the maintenance of wage labour'

But you talk about defending the NHS which is, by definition, defending the state control of healthcare! In an earlier thread you compare a "marketised" system with the NHS system and say the second is the better of the two. This misses the point. In both systems, the working class is always worse off. In both systems, the provision of healthcare for the working class is being constantly attacked.

The use of "privatisation" is part of the local ideological cover for this universal attack. It's no different to the way workers are always laid off when one company takes over another or even when a company is nationalised.

(As an asideI'm not convinced that the NHS is actually better than the American system anyway. If you're in work in the US (most companies offer health insurance as part of their package or through their unions), you probably actually get much better care than an employed worker here! If you're unemployed, of course you're fucked. I will admit that my evidence for this is annecdotal, though. It's based on comment from Americans I know about our system here, which they found laughable. It would be interesting to compare waiting times for operations, etc. between the two systems.)

JosephK wrote:
the question is how do we go about defending our immediate living standards?

Now this is more like it. Firstly, it's not impossible to strike in the NHS. Ambulance drivers and paramedics go on strike as do firemen, despite all the appalling efforts to paint them as putting others lives at risk or even as murderers! Obviously, the bourgeoisie would arrange its whole psychological arsenal aimed at making striking nurses or doctors to feel guilty and this is difficult to overcome, but it is possible.

For example, nurses in Hawaii in went on strike for over 4 months in 2006! 9000 nurses also went on strike in California in 2005. Libcom has two articles about the nurses strikes that took place in Victoria, Australia in 1985, 86.

I think suggesting "community action" is an unconscious concession to the bourgeois ideology that says nurses can't and shouldn't strike. It is, of course, vital for this group of workers (as with all others) to break outside the sectional boundaries and send delegations to other workers and spread strikes as massively as possible. For example, nurses may still have to care for critical patients and provide skeleton staff for wards but widen the strike to parking attendants and suddenly the hospital can't collect revenue from car parking! They need to link up with cleaning workers, administration workers, etc. and raise common demands. Striking workers also need to explain carefully to patients the reasons behind the strike, but again this is necessary for any group of strikers with a "service" component to their jobs be they call centre staff, bus drivers or postmen.

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thugarchist
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Mar 8 2007 10:39
Demogorgon303 wrote:

(As an asideI'm not convinced that the NHS is actually better than the American system anyway. If you're in work in the US (most companies offer health insurance as part of their package or through their unions), you probably actually get much better care than an employed worker here! If you're unemployed, of course you're fucked. I will admit that my evidence for this is annecdotal, though. It's based on comment from Americans I know about our system here, which they found laughable. It would be interesting to compare waiting times for operations, etc. between the two systems.)

This just isn't accurate. Good jobs have good healthcare plans sure. But most jobs either don't provide healthcare at all or provide it and deduct the costs (to varying levels) from the worker.

This isn't really the critical thing though. The for-profit healthcare market here derives most of its income from medicare and medicaid which are tax supported state run programs. So we have socialized medicine. Its just that its socialized for the profit of huge private companies that are free to turn away anyone that can't pay (except for emergent situations) and send them to a fully public sector hospital that places the economic burden even more on the public and allows companies like HCA and UHS (to name the worst) to maximize profit on the backs of taxpayers.

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Joseph Kay
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Mar 8 2007 10:50
Demogorgon303 wrote:
But you talk about defending the NHS which is, by definition, defending the state control of healthcare! In an earlier thread you compare a "marketised" system with the NHS system and say the second is the better of the two. This misses the point. In both systems, the working class is always worse off. In both systems, the provision of healthcare for the working class is being constantly attacked.

yes, and if our wages are slashed we are being exploited under the control of capital and if our wages are raised we are being exploited under the control of capital - but we defend and advance our wages no? i obviously don't think the NHS is the end-goal, and i hope i'm wrong but i don't think we're in a position to implement a communist healthcare system (necessitating a communist society) at the moment, which means in practical terms we are 'defending the NHS', although this defence is not necessarily anymore a defence of the bourgeois state as a strike against wage cuts is 'defending wage labour.'

Demogorgon303 wrote:
(As an asideI'm not convinced that the NHS is actually better than the American system anyway. If you're in work in the US (most companies offer health insurance as part of their package or through their unions), you probably actually get much better care than an employed worker here! If you're unemployed, of course you're fucked. I will admit that my evidence for this is annecdotal, though. It's based on comment from Americans I know about our system here, which they found laughable. It would be interesting to compare waiting times for operations, etc. between the two systems.)

anecdotal evidence i've heard blows the other way, especially with the extension of casualised labour and the attacks on 'healthcare deficits' at classical blue collar employers like Ford, but yeah i don't actually know.

Demogorgon303 wrote:
Now this is more like it.

indeed ...

Demogorgon303 wrote:
Firstly, it's not impossible to strike in the NHS ... I think suggesting "community action" is an unconscious concession to the bourgeois ideology that says nurses can't and shouldn't strike.

i was repeating what a couple of nurses told me about their concerns over striking ... of course in principle skeleton cover rotas could be provided for, and yes spreading the strike would obviously strengthen it. but how do we work towards something like this? again, on what this couple of nurses said, they don't feel people in general even know what is going on, let alone attend marches/meetings let alone walk out in (unlawful) secondary action, so it seems we need to network with rank and file NHS workers - including the car park attendants etc - to build their confidence in themselves independent of the unions, but also with the 'wider community', by which i mean workers whose social wage the NHS forms a part of, stressing the class nature of the cuts - maybe public meetings with NHS workers, discussing solidarity etc, because if we want something to spread we have to pre-empt the inevitable bourgeois propaganda that would have other workers label striking nurses as 'selfish' etc (as well as communicating with patients the reasons for action etc).

what i mean by 'community organising' is that i don't think such a scenario will come about by an unofficial strike which then spontaneously spreads, but must be immediately social before any unofficial strike action even becomes possible - they'll only walk if they know they have the support of 'the community' (by which i mean 'the wider class') in lieu of the unions and legal cover.

martinh
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Mar 8 2007 11:16

Briefly, I have problems with "defending the NHS", per se, but I think most people recognise it as defending what you've got, however imperfect. Different sectional groups fight for their best interests within it and it is fairly well documented that the NHS as it is fails a lot of working class people, while working well for the more articulate and connected.

In terms of health strikes, I recall one in the 80s or 90s, might have been the ambulance strike, where a striker told me the emergency cover roster had more people on it than normally worked there! Which obviously leads to where the real blame for services being stretched etc lies.

Regards,

martin

* this reminds me I meant to post something on the other thread about how militant class conscious workers resisted the implementation of the welfare state pre WW1. There were certainly articles in the Industrial Syndicalist about this. Workers saw the dangers then, we're just so far from it now that we don't recognise them easily, or dismiss them as concerns of the right.

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Mar 8 2007 11:19

Hi Thugartist

Thanks for your comments about the American health care system.

Quote:
This just isn't accurate. Good jobs have good healthcare plans sure. But most jobs either don't provide healthcare at all or provide it and deduct the costs (to varying levels) from the worker.

So you get your costs deducted straight from wages, whereas we have ours deducted from taxation and filtered through the state. We still pay for it, just in slightly different ways. I'd also be interested in knowing about the attacks on healthcare. I know there have been a lot of struggles over employers trying to cut it back there. I'm guessing more jobs offered healthcare 30 years ago.

Quote:
This isn't really the critical thing though. The for-profit healthcare market here derives most of its income from medicare and medicaid which are tax supported state run programs. So we have socialized medicine. Its just that its socialized for the profit of huge private companies that are free to turn away anyone that can't pay (except for emergent situations) and send them to a fully public sector hospital that places the economic burden even more on the public and allows companies like HCA and UHS (to name the worst) to maximize profit on the backs of taxpayers.

Although the NHS is free at the point of use, so theoretically no-one is turned away, in practice people have to wait months for operations. Some die before they're able to get it. Although hospitals are largely publicly owned, General Practioners (both doctors and dentists) are privately owned. Effectively, each practice is given a captive market by the local health authority (along with heavy regulation) and is paid by the state but it is still, in other respects a business. Most GPs have a mixture of NHS and private services, dentists even more so. So primary healthcare is essentially run on a bizarre cross between the state and small business models.

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Mar 8 2007 11:31
Quote:
So you get your costs deducted straight from wages, whereas we have ours deducted from taxation and filtered through the state. We still pay for it, just in slightly different ways. I'd also be interested in knowing about the attacks on healthcare. I know there have been a lot of struggles over employers trying to cut it back there. I'm guessing more jobs offered healthcare 30 years ago.

We pay through taxation and aren't generally covered by it and if you've got healthcare through work generally pay for some or all of that plan and tens of millions aren't covered by either and for-profits and non-profits send indigent payees to the public hospital. I've spent a number of years in the healthcare sector here and most hospital employees don't even get full coverage from their employers.

Quote:
Although the NHS is free at the point of use, so theoretically no-one is turned away, in practice people have to wait months for operations. Some die before they're able to get it. Although hospitals are largely publicly owned, General Practioners (both doctors and dentists) are privately owned. Effectively, each practice is given a captive market by the local health authority (along with heavy regulation) and is paid by the state but it is still, in other respects a business. Most GPs have a mixture of NHS and private services, dentists even more so. So primary healthcare is essentially run on a bizarre cross between the state and small business models.

I'm not suggesting that the NHS is good or bad. I would have no experiential knowledge. I'm fairly sure though that its better than the nothing most of the lower end of the american workforce has. Which is nothing. By not having a healthcare system for the poor we also overburden ERs because thats the only way people can get taken care of. Then many hospitals sue indigent patients for the bills they couldn't pay in the first place. The Advocate system in Chicago (a non-profit hospital system) was taking elderly people's homes when they defaulted on their ER bills.

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Mar 8 2007 12:07

yeah I don't think it's a good slogan, but defending the situation as it is is worthwhile, resisting any of the current cuts and impositions of charges, etc.

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Mar 8 2007 12:25

Hi Joseph

The analogy with the NHS and wage cuts is a false one. Workers have to defend their living standards, this is part of their class interest and I think we agree on that. Both direct wages and the "social wage" must be defended. But there is a difference between defending workers' health provision and defending a particular form of that provision e.g. state or private. We can thus defend that provision without "defending the NHS".

The "anti-privatisation" movements obviously spring from a certain reality. Privatised companies do immediately attack wages and working conditions! But this is no different to what happens when industries are nationalised. For example, the various nationalisations of British Leyland back in the day were always accompanied by a new round of job cuts. The transference of ownership, in whichever direction, is the trigger for these attacks which spring directly from the nature of capitalism itself.

We have to be especially vigilant against this ideology. Only the other day, the BBC (being objective as usual) was effectively justifying the public sector pay cut by saying how privileged public sector workers are in terms of both wages and pensions. more generally, council tax rises are being blamed on "greedy" and "lazy" public sector workers who go off sick at the drop of a hat, etc. In other words, the public / private "debate" has become a massive ideological attack, both tying us to the conception of state-as-boss or state-as-protector, while also setting groups of workers against each other.

Finally, I'm not convinced by your model for how any strikes will develop. The attitude of the nurses you were talking to is obviously indicative of the hesitancy that still characterises much of the working class, especially their lack of confidence in themselves as a class. But, in fact, the public largely does know about the serious problems the NHS has - this is why it's such a serious mainstream political issue, unlike unemployment (at nearly two million by ILO measures) and chronically low wages which are officially non-existent.

There's simply no way the bourgeoisie will allow spontaneous strikes to develop in the NHS. The sector is too crucial for them to let this happen, not to mention the powerful symbol that striking nurses would be for the working class. Instead, the unions will keep a very firm grip and struggles will probably develop initially through the union in the form of one-day strikes, etc. which will aim to absorb workers' anger and push home the futility of struggle. When these struggles begin, revolutionaries can intervene within them, distributing leaflets and discussing with workers on the pickets, push for extension, etc. Workers' anger is going to have to reach much higher levels before we see any kind of spontaneous action and that won't happen until conditions have got much worse and the union has been exposed through a series of union-controlled strikes.

The confidence workers gain in themselves comes through struggle itself, the will to resist, and I'm not convinced this can be engendered by organising solidarity networks of the sort you describe. Extension of the struggle has to come from the actions of workers themselves - revolutionaries can agitate for it e.g. calling for mass meetings, or demanding that union meetings are opened up to all workers, etc. but they can't actually do it themselves until there's a will to do so in the working class.

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Joseph Kay
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Mar 8 2007 12:48

yeah i wasn't advocating spontaneity - i mean it is very likely if anger is high enough the unions will call some token one-day strikes to let off steam and reinforce the feeling of inevitability etc, and of course we should talk to workers involved in these things etc - of course the initiative has to come from those workers in struggle themselves, coming up against the limits of the union etc, but from the limited discussions i've had with NHS workers they'd need to feel some wider support was there before they did anything 'unlawful.'

Quote:
The analogy with the NHS and wage cuts is a false one. Workers have to defend their living standards, this is part of their class interest and I think we agree on that. Both direct wages and the "social wage" must be defended. But there is a difference between defending workers' health provision and defending a particular form of that provision e.g. state or private. We can thus defend that provision without "defending the NHS".

which is true, but doesn't defending the provision of the social wage, in practical terms mean a qualified 'defending the NHS', so long as we are not in a position to force an alternative? I mean, even if the US model is no worse for workers, which i doubt, as you say 'public-private' transfers of ownership are a pretext for wholesale attacks, so i mean, do we take an ambivalent position on privatisation because it's all capitalism, but just encourage workers to defend themselves regardless, or what? I mean it isn't just an issue for the NHS workers, but all of us workers whose social wage it is - isn't it going to be harder to defend that social wage if it is privatised and individualised in the form of health insurance schemes? i would have thought so, but perhaps i'm harbouring leftist illusions that the welfare state is preferable to the market - i'm open to persuasion.

But most importantly, what are the practical implications of all this? are we to wait for one-day strikes before we do anything, or should we be agitating now, participating in campaigns, talking to workers (both nhs and generally) already? I mean going by the nhs logistics-dhl privatisation, the token one-day strike comes too late in the day anyway, can we afford to let the unions set the pace, should we not at least do some groundwork, accepting of course that we cannot create resistance where there is none?

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Mar 8 2007 13:08
Joseph K. wrote:
...but from the limited discussions i've had with NHS workers they'd need to feel some wider support was there before they did anything 'unlawful.'

Outside support is a very important issue. One demo I went to was for contract postal workers. I thought that I was coming to show solidarity with struggling workers, only to find myself with a bunch of leftists asking the workers to kindly come out to protest. Felt very stupid and counter-productive. Only near the end did it occur to anyone that a more discreet approach would have been less damaging.

Thing is, I can't really blame the workers. They're on sub-minimum wage, most of them with families to support. Those workers would be more inclined to act if they knew they had a "social net" to on, but it doesn't seem like there's much to do until they themselves feel like they can no longer stand it, is there?

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Mar 8 2007 13:15

like i say we can't create their struggle, but the struggle against cuts to the social wage is also ours, so how do we proceed?

magnifico
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Mar 8 2007 15:30

Dr. Cous Cous - re your points to me before the thread was split. I pretty much agree with you (I think) if we were in situation where we were trying to bring about workers' control. But I'm talking about the situation we are in now in which we are suffering defeat after defeat and millions of working class people are in the situation of having their access to basic healthcare drastically reduced. I guess I'm being very pessimistic and saying that the best we can hope for at the moment is to try to defend some of what we've got now, and if we do this successfully hopefully then class consciousness/confidence will increase and we can look at how to change the NHS, and the rest of society, into something we as libertarian communists might dream of. i would say that at the moment criticising campaigns to 'save the nhs' or whatever because they are not revolutionary or critical enough suggests a lack of contact with the reality in which the working class (especially the most vulnerable parts of it which are most likely to get ill and least likely to be able to afford their own treatment) is under serious attack. I'd defend my earlier comparison with it being like criticising a campaign against wage cuts on the grounds that it is a defense of alienated wage slavery. If you are in some kind of revolutionary situation and someone advocates settling for higher wages then yes, this is reformist and should be opposed. But if you are in a situation like the one we are in and wages are being attacked, then I would argue that the critique of wage slavery in comparison to communist modes of production is not particularly helpful to the immediate situation.

which brings me to:-

Demagorgon303 wrote:
The analogy with the NHS and wage cuts is a false one. Workers have to defend their living standards, this is part of their class interest and I think we agree on that. Both direct wages and the "social wage" must be defended. But there is a difference between defending workers' health provision and defending a particular form of that provision e.g. state or private. We can thus defend that provision without "defending the NHS".

I agree with the principle that it is the social wage, rather than the NHS as some fetishised ideal which should be defended. However, if you have a nationalised healthcare system that is comprehensive (including all services) and is free at the point of use then everyone will get healthcare when they need it. If you have a private healthcare system in which providers are free to choose to treat whichever conditions bring them the most return, and which must be paid for by the 'user' up front, then many people will not. The NHS is somewhere in between, and in the process of moving towards the second option, which in my view represents a clear reduction in the social wage, one that should be opposed.

Yourself and others who point out the ways in which the NHS functions like a business are correct, and becoming 'correcter' every day, but I would see this as something to be opposed and hopefully reversed, not as a reason not care either way. You say that the form of healthcare provision should be irrelevant as long as healthcare is provided. But once the NHS is completely broken up and privatised, as the government plans for it to be in a few years' time, of whom will we make the demands* for this increase in the social wage? Who will even know what the healthcare needs of an area are? And what company is going to be interested in or capable of providing expensive, complicated and/or long term healthcare and rehabilitation for people who can't afford it, like the NHS for all its faults does now? I would suggest that until the working class is in a postion to take control of the means of production any post-NHS agitation for improved access to healthcare would have to be directed at the government, and would effectively be calling for it to recreate the NHS. Easier to defend it while it still exists, it seems to me.

I agree with you that healthcare workers can and should go on strike. This has happened many times in history, and indeed happened last month in Manchester's mental health trust. I think that this is the only course of action which can ultimately save the NHS from becoming nothing but a logo attached to various private healthcare providers.

*when I say make demands, I mean ones that are backed up with direct action or the threat of.

magnifico
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Mar 8 2007 15:41
Joseph K. wrote:
like i say we can't create their struggle, but the struggle against cuts to the social wage is also ours, so how do we proceed?

I'd say increase awareness, particularly amongst health workers, as to what is actually happening to healthcare provision in this country, the various forms of direct action which have been/are being used to oppose cuts and the role the union national (and, in most cases, branch) leaderships are playing to dampen the struggle. General hospitals are much easier for the public to get into and agitate among the workers than most workplaces are, and there are a few good publications like London Health Emergency's paper www.healthemergency.org.uk , the IWW Healthworker newsletter http://www.iww.org.uk/industries/health/healthworker1/index.html, a non-IWW healthworker www.healthworker.co.uk newsletter and hopefully something coming out of solfed before too long. And when industrial action does occur, support it as best you can, supporting pickets, hospital occupations and whatever. Anything you do on this issue will have more legitimacy and seem less like 'parachuting' than in most other cases of agitating amongst workforces you aren't a member of, since as you say the link to your own social wage is more obvious.

baboon
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Mar 8 2007 16:07

Admin - off-topic derailing snipped

On the NHS, the working class fought for better health care from the mid1840s on, but there was never a slogan for "the NHS", which is a thoroughly capitalist institution. It is paid for by workers for decades, and we are still paying big time directly out of our wages, let alone the amount of over the counter cash that must be stumped up of "the free national health". There's no denying that a big part of the development of the welfare state was the result of positive struggles of the working class (as well as the needs of capital) and as such it forms part of the indirect wage. I'm certain that struggles of the class during the 19th c., struggles that were positive for cohering the class, reinforcing the consciousness of itself and its solidarity, and its tendency to push for the greater good, involved fighting for better health care (and safety, issues closely related under capitalism's nightmare rise). But the NHS is a capitalist institution, just like the DHSS, the Department of Trade and Industry and the unions. The development of state capitalism centralises all, including the ability to regulate the social wage of all workers. The bourgeoisie manipulate the NHS in this way, along with all other aspects of the social wage. One thing is for sure, they are going to cut jobs and conditions even further. I agree with an earlier post that the working class produces everything but capitalism rules. The deepening of the crisis means these attacks on health are global: France (the health care "example"), Germany, Austria, Holland, the health care system for the ex-Russian bloc has collapsed. The USA? China? This isn't to say that workers should burst into struggle with an international programme. But the answer is the same everywhere: the need for self-organisation is paramount in fighting back. As the recent BA non-strike showed, the unions are very powerful and shouldn't be underestimated. They are a real weapon of the ruling class against workers both inside and outside the NHS.

fort-da game
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Mar 8 2007 17:51

working to rule

Joseph K says:

Quote:
what i mean by 'community organising' is that i don't think such a scenario will come about by an unofficial strike which then spontaneously spreads, but must be immediately social before any unofficial strike action even becomes possible - they'll only walk if they know they have the support of 'the community' (by which i mean 'the wider class') in lieu of the unions and legal cover.

Agreed, a temporary ‘for-others’ consciousness facilitates a later and more widespread for-itself subjectivity.

The point, or so it seems to me, is not to defend the NHS but attack its management, and force the service to do its job. These conflicts are occurring all the time anyway but because we all have ‘defend the NHS tattooed on the inside of our eyelids we don’t recognise them for what they are: ie the struggle to provide a service no matter what against the restrictions placed by cost. The strategy is not to call for more capital investment (even as a transitional demand) but to impose the imperative of a patient-centred service, and thereby attack the form of capital investment. What is needed is a recognition that provision/implementation does not coincide with the interest of the institution. Human needs must be imposed as a contradiction of the strategy of ‘holding things together’ and not rocking the boat.

The NHS is a (supposedly) non-value producing government service, it is bound by certain commitments which ordinary capitalist organisations are not. It is an institution that is designed to implement policy, therefore, if it is to be seized and realised as a vehicle for human emancipation, its point of contestation with capital is located at the level of ‘policy implementation’ rather than directly in terms of a struggle for wages. There is a huge amount of slack within the NHS for autonomous (and also non-clinical) action directed towards ‘working to rules’. The object is always to increase costs and defend your corner.

Workers’ control can be implemented through imposition of existing rules or the autonomous development of new rules and practices. These measures would articulate a ‘for-others’ consciousness in keeping with the ethos of service provision but often in contradiction with management imperatives. It is true that this somewhat mystifies class analysis in much the same way that bus or train driver disputes which take the form of running the service ‘for free’ are slightly mystifying. But I would argue that the wider class struggle is actually developed by such measures, as is class consciousness, and more open conflicts would inevitably run alongside such experiments(which are useful preparation for a crisis situation). We saw how, in the ‘60’s and ‘70’s a more experimental ‘people-centred’ healthcare coincided with industrial militancy.

For the professional classes employed within the NHS, the way is open to generate oppositional ‘policy’ models and redirect resources into them, via the instituted authority of their expertise – they must set up specialist journals and experimental practices and they must connect these to openly revolutionary politics precisely by connecting ill-health to the social relation.

For the lower paid workers, there is a huge space, which I have some experience of, for tying management to policy commitments which otherwise would be left to drift. The day that cleaners close a ward down on grounds of hygiene due to lack of resources will mark some sort of turning point.

I have some reservations with this post but I think it could be something that could be broadly agreed with without adopting a defensive position.

pil

PS. Magnifico: I haven’t read all your post yet, but I am talking about what already happens... ‘natural’ resistance and subjectivity, but which remains at the moment in false consciousness/bad faith locked into defending something/believing in something which does not (yet) exist.

ernie
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Mar 8 2007 19:35

Joseph K the question you raise about how can health workers defend their pay and conditions and also the provision of at least some form of health provision is very important. Clearly all workers expect to be able to access an A&E department and even a hospital, but in the coming period this provision which has been an accepted part of the social wage until now is going to be undergoing a well planned systematic plan of dismantling. The state plans to reduce staffing levels by 100.000, to freeze posts, increase work loads and cut pay. This attack is having a direct impact on the whole working class because not only is its already meager health care under attack but it knows family members or friends who work in the NHS. Thus, the potential for this attack to generate important struggles is obvious.
However, history shows us that the unions and state have used this solidarity with health workers to drown struggles in struggles to defend the NHS or to support health workers i.e., to keep a struggle separated from wider struggles. These are real dangers and make the waging of effective struggles difficult for health workers.
A very informative example of this was the wildcat health workers strike in February 1988. This struggle was potentially a very explosive struggle and one which drew on the lessons of the miners' strike.
It began when the government start to tested out the waters about cutting unsocial hours payments. Workers at one of the main Leeds hospitals heard about this and walked out on unofficial strike. This struggle spread to other hospitals and areas like wild fire. We heard of nurses going to car plants and pits to call out workers. The unions were left speechless for a while (the true nature of the struggle was hidden in the media). Finally the union got a hold of the situation and called a demonstration in London and called on workers to return to work, the government also dropped the idea of cutting unsocial hours like a hot potato. The demonstration was called by one of the unions and was aimed at being a passive walk through London. However, there was great anger on the demonstration and also real expression of solidarity from other workers; delegations of postal, local government and other workers joined the struggle. However, the movement had passed its peak by the time of the demonstration and the union had put a stop to the efforts to call out other workers.
The conditions for the explosion of this struggle was the general discontent in the class, the widespread strikes and a memory of the miners and printers strike. This was the 'social preparation' that prepared this struggle. As it was with the recent movements of Students in France and engineering workers in Vigo Spain or the wildcat strikes around the lay-offs at Airbus.
We are seeing similar situation in Britain with a real discontent in the working class faced with attacks on every aspect of work and life., also struggles by signal men, other train workers and others. Health workers are part of this general atmosphere of an increasing sense of being not prepared to take yet another round of attacks. It can only be by seeing the struggle against job and wage cuts in the NHS as part of this wider movement that an effective struggle can take place.
In many ways it is a question of health workers rejecting the idea of being a special case, of having to link their struggle with the defence of the NHS -something the unions are endlessly pushing- and seeing the attacks they are under as part of the wider attacks that will be crucial to the development of the struggle.
The unions are already mounting campaigns to tie any struggles against job loses etc to the defence of the NHS and these will become every more intense in the coming period.
The only effective struggle against these attacks is to seek to link it to the wider attacks on the working class. There is no question that other workers will support any struggle by health workers, the main question is how to most effective unite this solidarity with the health workers desire to defend themselves. This means mass assemblies of health and other workers to discuss how to defend themselves and demonstrations that enable other workers to join them, to go to other workers to the car plants, factories, sorting offices etc.
Joseph, this is a rather long and a bit rambling reply, but there is no clear cut answer to the question you pose, apart from to say that it is essential that health workers defend their autonomy as workers and seek to unite their struggle with that of other workers.

ernie
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Mar 8 2007 19:44

And nastynred ned, I doff my hat and offer you a big smile.
It cannot be that bad that we agree on something as important as the state capitalist nature of the NHS, can it!!!!
I look forwards to finding other things we can agree on and even may be convincing you to look more kindly upon Left Communism

magnifico
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Mar 8 2007 19:45

I'd say that linking defence of health workers' jobs with defence of the NHS does make it part of a struggle for the interests of the wider working class. I think the unions certainly are doing their best to diffuse things, but this seems to me to be more through making lots of radical statements so that angry workers will look to them for leadership rather than getting on with self-activity, but then doing the bare minimum or nothing at all. Unison leadership are even doing their best to prevent there being a national demo on this, as it would embarass the government too much, never mind industrial action.

magnifico
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Mar 8 2007 19:48
ernie wrote:
It cannot be that bad that we agree on something as important as the state capitalist nature of the NHS, can it!!!!

I think everyone here agrees that the NHS is state-capitalist, the question is whether or not it represents an increase in the social wage in comparison to the free market healthcare system we are moving towards. I would argue that the NHS is worth defending in the same way as my wages are worth defending from a pay cut. It doesn't mean that I agree with state-capitalism or wage slavery.

ernie
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Mar 9 2007 15:35

Glad we all agree on the state-capitalist nature of the NHS.
On the question of the NHS v market provision, the discussion has already shown that the NHS has not marked a real improvement in workers health beyond the state's provision of the most basic care. If I remember correctly you are better off being treated in Munbai for lung cancer than in the NHS! As for other respiratory diseases treatment rates are better in Eastern Europe than here. Market provision does not mean bad care, health care in Europe is based on private insurance and from personal experience if I have a serious illness I would rather be in Belgium or Germany than the NHS. For example, in France if one has a stroke patients get daily Cat Scans, here a patient will get one on admission to A&E and maybe another if they are lucky. The argument of market v NHS is a false one. The real question is the level of provision of healthcare.
This provision is determined not by some ideological concern for the health of the working class as expressed through the NHS, but by the ability of the state to pay. This is the nub of the question and it is the same everywhere not matter what form healthcare takes. Throughout Western Europe healthcare is being cut back for the working class and this has been doing so for several decades. Thus across Western Europe whilst life expectancy has increased over the course of the 20th century:

Quote:
It is less clear, however, whether inequalities in mortality have also declined in relative terms, i.e. in terms of the percentage excess death rates in lower as compared to higher socio-economic groups. In the long run, the relative risks of dying for those with a low as compared to those with a high socio-economic position seem to have remained very stable, and have even unexpectedly increased during the last decades of the 20th century in many European countries. Particularly in Western Europe, with its high levels of prosperity and highly developed social security, public health and health care systems, this was a disturbing finding.

(Health Inequalities: Europe in profile, Professor, DR J P Mackenpark, for the EU).
The only difference is how brutal the attacks have been. The NHS has been rationing and cutting back care since its very foundation, but these attacks have increased over the past 40 years faced with the deepening economic crisis. The present marketisation of the NHS is just another way of imposing these attacks and their brutality is an expression of the depth of the economic problems facing British capitalism.
In this context to say that one is for the defense of the NHS as an improvement of the social wage is not the same as defending wages. Wage labour is the basis of capitalism, and unless one sees a difference between being employed in the state or private it is what we are faced with. Healthcare is not the same, the question facing workers is not whether they should support state run health care against private, but that capitalism is no longer able to offer even the most basic care no matter who its provision is organised. The NHS is simply the means for disguising this situation with all sorts of confusions about it being better than other systems. Thus to say that the struggle to defend wages and jobs in the NHS means defending the NHS does mean that one ends up defending one form of capitalist organization -or lack of organisation- of health care against another.
Magnifico even though we agree on the state-capitalist nature of the NHS, you seem to be saying that some how the present marketisation of the NHS marks some form of break with the past methods of providing care, is this correct? I would say that it rather a more systematic carrying out of the attacks that have been raining down on health workers for years.
This is an excellent discussion because it is forcing everyone to really think through what is the best way to struggle to defend jobs etc. In the coming period this is going to be a very important question for the working class and those defending revolutionary positions. The question of how to develop the struggle of health workers is a minefield of ideological traps, the ruling class was very clever to place the biggest concentration of workers in Britain -and workers who are guaranteed the solidarity of the rest of the class- in such a minefield. This discussion has shown what a difficult minefield it is to cross.

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Joseph Kay
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Mar 9 2007 16:55
ernie wrote:
Market provision does not mean bad care, health care in Europe is based on private insurance and from personal experience if I have a serious illness I would rather be in Belgium or Germany than the NHS.

but surely, pace the US, "market provision does not mean bad care" for those who can pay, whereas in principle and with waiting lists, the NHS treats the poorest workers too? so while it's just one form of capitalism against another, they can't be collapsed into the same. i mean, a mass struggle 'to defend the nhs' always has the potential to spread, given as such a struggle would have to be outside of the unions, rely on solidarity from other workers - (which as you say is more likely than any other sector) - and such a struggle is when the potential to go beyond the NHS appears - although to break with capitalist healthcare means to break with capitalism, and whilst i'm all for revolution, i think the possibilities are a little more complex than 'revolution or the market,' not least because if a struggle became revolutionary, we'd very quickly be offered an all-singing-all-dancing health system, which may appease those workers who were only struggling for the narrowest 'gain,' and become the basis of a new (temporary) compromise despite our efforts. even writing this seems wildly optimistic sad

booeyschewy
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Mar 9 2007 17:27

Just for reference in the US 50% of people have no healthcare coverage at all (I'm one of them). Of those who do, a lot of it hardly covers anything. Just to put things in context, people die on the steps of hospital for want of coverage. In LA they were dropping poor patients in skid row rather than get them where they need to go or deal with them, and lots of working class folks in the US die of totally preventable conditions for want of basic health care. The theoretical points remain, but I just wanted to give some contrast when people are talking about the differences in local conditions.

magnifico
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Mar 9 2007 18:24
ernie wrote:
Healthcare is not the same, the question facing workers is not whether they should support state run health care against private, but that capitalism is no longer able to offer even the most basic care no matter who its provision is organised.

Whether or not the bosses can afford it is none of our concern - we should still demand it. Given the opportunity I would certainly point out to anyone interested that capitalism doesn't provide healthcare properly and that we should get rid of it, however that doesn't mean that the working class can't improve its position under capitalism, or resist attacks.

ernie wrote:
Thus to say that the struggle to defend wages and jobs in the NHS means defending the NHS does mean that one ends up defending one form of capitalist organization -or lack of organisation- of health care against another.

I'd say that defending universal healthcare free at the point of use does, in light of the current lack of revolutionary alternatives, involve defending the NHS. A fully marketised system would not provide any health care to the large section of the working class which could not afford it - booeyschewy's post above is a good illustration of this. I find it very hard to believe that the Mumbai health system would treat anyone who walks through its doors as the NHS does/did (albeit not always as well, or as quickly, as one would want - noone's saying it's perfect). All the reports I've heard of India talk of loads of sick families dying in the streets, in the UK tramps can walk into A&E and be patched up, if they require emergency attention they will receive it. An improvement over what booeyschewy describes, is it not? And if it's an improvement is it not worth defending?

The job I'm currently training for will most likely involve long-term rehabilitation of chronic disabilities, centred around improving quality of life rather than saving life. As a non-emergency service which is labour-intensive and not well-suited to turning a short term profit what private company is going to want to employ me, aside from those whose customers can afford to pay for such 'luxuries'? I think the marketisation of the NHS will hit rehabilitation jobs and services very hard.

Just to clarify things, I'll say again I'm not suggesting we should defend the NHS as some fetishised perfect system, which it has clearly never been - our focus should be on combining defence of jobs with defence of services. However I don't see why we can't say that keeping a health service which has at least a theoretical duty to provide health care to all is not an improvement on having a health service which could and would quite happily leave people to die in the street or suffer from easily preventable disabilities.

At risk of derailing this thread a second time, what is your view on council housing? At the moment rents and evictions are lower than in the private sector, is this worth defending or would you argue that we should condemn tenants' campaigns against sell-offs of their homes on the grounds that they are defending one form of capitalist organisation over another?

ernie
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Mar 9 2007 18:30

Joseph K I take your point about not collapsing everything. The point I was trying to make was that no matter who provides the care -in the context of Western Europe- it is being attacked. In Britain there is the NHS, in France workers pay health insurance -which is basically what we do with National Insurance-, In Germany I think it is the same. However, what ever the system it is under attack. In Britain this is being done through the framework of the NHS, in the rest of Europe it is being done though increases in health insurance, cutting back services etc.
It is not a question of choosing whether to have private or state, the British bourgeoisie used and use direct state control of health. There is the possibility that in the future they will dismantle the NHS under the pretext of 'modernising care' but that would only be an expression of the fact the state could not afford to offer health care and in order to allow massive attacks on health workers and to get them through via diverting any struggle into one to defend the NHS.
The slogan of defend the NHS has a long history in the defeating and isolating of the struggles of health workers in the NHS. It is like the slogan of coal not dole that was used to isolate the miners. The slogan of defend the NHS offers no potential at all for developing the struggle.
It is not a matter of reducing it to a question of NHS or revolution but of seeing that the only way to defend health workers jobs is for health workers and other workers to break out of the ideological prison of seeing the NHS as something special, and seeing that they are workers first and foremost with the same interests as others. In relation to the closure of hospitals it is a question of struggling against the lose of a hospital and A&E department i.e., the provision of care.
Clearly the fact that we have a state controlled health system that gives care 'free' of charge is different to the system in the US,. But workers in Britain are not being posed the question of NHS or nothing, rather they are faced with draconian and ever mounting attacks on healthcare through the NHS. The NHS is the most efficient way the British bourgeoisie have of attacking health care and health workers, they start off with their opponents with one arm tied behind their backs because of illusions about the NHS, why on earth would they want to get rid of this advantage?

magnifico
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Mar 9 2007 18:38
ernie wrote:
In relation to the closure of hospitals it is a question of struggling against the lose of a hospital and A&E department i.e., the provision of care.

I agree with this, but would point out that it is national-level marketisation reforms which are the method the government are using to shut down hospitals and A&E departments - they make them responsible for their own finances, then don't provide enough money for them to function, then put their closure down to abstract 'market forces' so it's not really anyone's fault. If the NHS was integrated as it is in Scotland and was in the rest of the UK pre-Thatcher then this would be much more difficult. So by ignoring the national marketisation policies we allow the ruling class to use an important weapon against us in our struggle to retain hospitals and A&E services - we oppose the symptoms rather than the underlying policy which is making these attacks possible.

magnifico
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Mar 9 2007 19:00
ernie wrote:
But workers in Britain are not being posed the question of NHS or nothing, rather they are faced with draconian and ever mounting attacks on healthcare through the NHS. The NHS is the most efficient way the British bourgeoisie have of attacking health care and health workers, they start off with their opponents with one arm tied behind their backs because of illusions about the NHS, why on earth would they want to get rid of this advantage?

This is a valid point, I suppose you could argue that since the government is intending to retain the use of the NHS as a brand name or logo for privatised healthcare commissioners and providers to put on their headed notepaper that it is not actually abolishing the NHS. You are right that they are trying to use the name as a smokescreen to hide their attacks behind. I'd say the slogan 'Keep our NHS Public' addresses this issue though.

ernie
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Mar 9 2007 19:04

Magnifico, on the Munbai it was from an article I read about a report comparing international survival rates. I was pretty taken aback by this as well, given the horrors of absolute poverty in India, but I did not write the report. The problem is we are conditioned from a very early age to believe the NHS is the bees knees when it comes to health care, the envy of the world etc.
The present attacks on working condition under the guise of introducing modernisation etc are the contuation of those that have been going on for years. In the 1980's attacks were carried out under the guise of introduction of private firms to carry out cleaning and catering, the unions told workers to take pay cuts in order to stay in the NHS, but on worse conditions. In the early 1990's there was the introduction of different pay contracts and working conditions for those joining the NHS. This was especially so in long-term care for learning disabilities, mental health etc . In some work places you could find 4 different pay schemes by the mid 1990's. Most recently there was the introduction of Agenda for Change, which was a savage attack on working conditions and pay, basically introducing individualised pay and with the long-term aim of getting rid of unsocial hours. Health workers used to accept this shit because even if it was low paid it was a job for life with a pension, well that is now going up the swanny. No health worker knows if they will keep their jobs, if they will get a pension -there is a whole process of introducing new pensions going on-, what new attacks tomorrow will bring, if they will have to reapply for their crappy job or their job will simply disappear and they will be forced into a lower paid one. Is this anything different to what a private health care employer would do?
As for council housing, the same trick as with the NHS is being used by the ruling class, one is either for or against council housing, private bad, public good: and all they time rents go up and the condition of housing gets worse. Capitalism has used social housing as an ideological trap for the working class since WW1 when it was introduced to give the idea that capitalism had something to offer, and it was develop further after the war on the one hand, because there was fury amongst returning soldiers about the bad state of housing and also to push the idea of the welfare state offering the working class a stake in the continuation of capitalism. This state support of housing could only go on as long as the state could afford it, from the late 60's it became ever more difficult. The great sell off of council housing in the 80's and 90's was a means of reducing this burden and introducing a new ideological poison, property ownership. The campaigns to sell of housing estates are not different to two gangs taking over an area and offering the inhabitants a choice between them, Going with either side means workers losing, if they accept housing associations rents will increase etc and if they stay with councils rents will go up -may be less rapidly- but the housing stock will be left to deteriorate. The point is capitalism can no longer afford to offer housing. This is the central point that needs to be put across by communist, to get involved in taking sides means to support one form of housing against another knowing that all that this will mean for workers is worse housing conditions but only under different names. Workers cannot stop the deterioration of the housing stock, nor the fact that their children cannot afford or get housing ether private or public, it is a question of drawing the lessons and understanding that it is only revolution that will enable us to better housing (and health)
This does not answer your question really, because it is not really a question of what can we do now to stop the housing crisis, and unlike attacks on wages workers do not really have a means of struggling against such attacks, as they do against wage cuts -but even then we have to have no illusions that if we stop wages cuts the bosses will not be back for more-.
There is a very interesting article in our Spanish paper on the question of housing, our comrades took part in a conference of different groups etc about the housing crisis facing the young in Spain. I will try to summarise it some time next week. What we underline is that it is vital that those effected, their friends and relatives get together to discuss this terrible problem, but that there is no immediate solution to it, unfortunately.

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Joseph Kay
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Mar 9 2007 19:22
ernie wrote:
In Britain there is the NHS, in France workers pay health insurance -which is basically what we do with National Insurance-, In Germany I think it is the same. However, what ever the system it is under attack. In Britain this is being done through the framework of the NHS, in the rest of Europe it is being done though increases in health insurance, cutting back services etc.
It is not a question of choosing whether to have private or state

i agree, but doesn't this mean that defensive struggles over healthcare in the UK, take the de facto form of 'defending the NHS' - even if we should reject that as a slogan for the raft of reasons discussed? i mean we may be in fact defending workers conditions and our social wage, but while our struggle remains defensive, surely this is inseparable from the form in which it is administered, as the attacks are in the form of privatisation/marketisation?

i mean, here by 'de facto form' i'm talking of practice, whereas you're talking of an 'ideological prison' - so is what is at stake our propaganda as much as our praxis? i mean, leftists may support healthcare workers striking from a 'defend the NHS' viewpoint - we'd do so from a class viewpoint, stressing that the NHS per se is not what's important - presumably what is crucial is which view prevails amongst the workers in struggle, both NHS workers and those in the wider 'community'? the point i'm trying to make is that it seems to me the praxis of a defensive struggle over health/conditions is only distinguishable from 'defending the NHS' in terms of it's theoretical content, which may well imbue the praxis with the potential to become more than a defensive struggle 'for the NHS'. but doesn't that just mean it's some shit-hot leaflets that distinguish our praxis from leftists in a defensive struggle? (in other words, i'm trying to draw out the implications of this discussion for what we actually do, both in advance of tokenistic union strikes/wildcats/mass assemblies(!) and as and when they happen).

magnifico
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Mar 9 2007 19:24

Thanks ernie,

I don't think we have that much of a different analysis on these issues, and where our analysis differs I think it basically comes down to decadence theory (ie I reckon the ruling class could afford to provide us with decent health and housing if we were in a position to force them to).

I think our differences are more in terms of our attitude towards defending what we have - I'd argue that a 'public' NHS does provide rather better basic healthcare than a private one, and you yourself admit that staying with council housing would result in rents and evictions increasing at a slower rate than they would under private landlords (I agree with this - I don't think council housing is exactly the shizzle either, though the private rented flat I used to live in with my gf was smaller than my mate's council flat but twice the rent). I just disagree with you when you say that any argument for staying with 'state-capitalist' providers over private ones involves lining up with one gang of bosses against the other - isn't it possible to argue for sticking with state-capitalism as a tactical, defensive measure not because you particularly support it but because doing so allows you to retain certain concrete gains in the social wage ('free' healthcare, lower rents) which the alternatives currently on offer would abolish, or at least abolish more quickly?

ernie
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Mar 9 2007 21:52

Magnifico I think you hit the nail right on the head, we do have a lot of agreements but it is the question of decadence that is central. It certainly is fundamental to how you see the struggle to defend health and housing. As you say you think that the bourgeoisie can afford to give some health care and housing, whilst those who defend decadence say they do not and more than that they have to keep on attacking it.
On the question of staying with state owned housing because it is a benefit, no matter how small, because what is currently on offer is worse, well, again the question of decadence comes in here. What is on offer at the moment is attacks on housing state or private the only difference being the way it is applied. The only perspective for both is worsening conditions no matter who owns housing. That does not really answer your question and it will be necessary to ponder on this over the weekend to try and come up with a convincing answer.
It is excellent that things are moving forwards in the discussion, it is very interesting and poses a lot of very interesting questions.