Workers Hammer No. 242
Reverse NHS privatisations!
Capitalism: danger to your health
Down with bosses EU!
No illusions in Corbyns Labour
The crisis wracking the overstretched and underfunded NHS was grimly exposed last winter. Despite the best efforts of NHS workers, patients were held for hours in ambulances outside overcrowded A&Es; others lay on bare floors while attached to IV drips. An 80-year-old epileptic with dementia was confined to a trolley for 36 hours awaiting treatment for pneumonia.
NHS workers in Wigan are waging a series of strikes against outsourcing being imposed as part of the carve-up of the NHS. This local struggle has been warmly welcomed as an act of defence of the public health system. The 2016 junior doctors strike was likewise met with an outpouring of support. A class-struggle fight to defend the NHS would have huge resonance. But instead of mobilising workers throughout the NHS in a concerted struggle, the leadership of the unions has kept struggles limited to demonstrations and local, time-limited strikes.
The strangulation of the NHS under both New Labour and Tory governments has gone hand in hand with the slashing of social services, the decimation of trade union rights and the impoverishment of wide layers of the population. In response to this one-sided class war, the union bureaucrats counsel their members to put their faith in electing a Labour government. This line is noisily echoed by a gamut of reformist socialist groups. A prime example is the Socialist, which concludes its 7 June front-page article “Stop the Tory NHS wreckers” by calling to use the 30 June demonstration for the NHS to “build coordinated strike action to get the Tories out”, ie, get Labour in.
The illusion that a Labour government will serve the interests of the working class has been key in arresting the political consciousness of the proletariat for over a century. All previous Labour governments have loyally served the British capitalist class — breaking strikes and imposing austerity at home and waging imperialist wars abroad. This is because Westminster rule, whether under Conservatives or Labour, represents the class dictatorship of the big industrialists and financiers, enforced by the bodies of armed men (police, prison guards, the military, etc) that constitute the core of the capitalist state. To break the power of the capitalist exploiters will require proletarian revolution to sweep away the capitalist state. The working class needs its own state based on workers councils as in early Soviet Russia.
Expropriate the expropriators!
Quality healthcare, free at the point of delivery; top-class government-provided care for children and the elderly; excellent schools, job training programmes and housing — fulfilling the basic needs of the population requires massive investment. The bourgeoisie has racked up enormous wealth from the exploitation of workers. But the ruling class never gives anything up without a fight. Sharp class struggle, not pleading to Westminster, could convince the ruling class to fund the NHS. Such struggles point to the need for the working class to expropriate the productive forces of society and put them at the service of human need instead of private profit.
Jeremy Corbyn speaks compellingly of saving the NHS from “death by a thousand cuts” and “creeping privatisation”. But the “internal market”, management consultancies and PFI schemes that are strangling the NHS were vastly expanded by the Blair and Brown Labour governments. How can Corbyn drive the capitalist parasites out of the NHS when he won’t drive the Blairites out of his own party?
EU apologists like to claim that public healthcare is exempt from EU competition regulations. But in reality, EU directives have been used by private corporations to loot public health services across Europe. For example, in 2002, private care provider BetterCare won a legal challenge against the Northern Ireland health services for violating EU competition law by using its monopoly position to drive down the price of private nursing home beds.
Corbyn’s calls to reverse privatisations are contradicted by his support to the EU. The Blairites and yuppie remainers whinge that Corbyn isn’t trying to reverse the result of the Brexit referendum, but Corbyn’s demands for a “new single market” deal and a customs union with the EU make clear that his programme is as little Brexit as possible. Founded on the free market values of privatisation, austerity and union busting, the EU has served the European bourgeoisies as a massive axe to hack back social services. Down with the EU! Britain out now! For a Socialist United States of Europe!
Even Labour’s campaign promises fell massively short of the mark. Labour’s 2017 Manifesto promised “over £30 billion in extra funding over the next Parliament through increasing income tax for the highest 5 per cent of earners and by increasing tax on private medical insurance” as well as “halving the fees paid to management consultants”. This amounts to a £6 billion increase per year — a drop in the bucket compared to the NHS’s need. It would take £6 billion simply to make up for the loss in real wages suffered by NHS workers in the past seven years. Even the Tories are now promising a bigger increase than this in five years time.
The minimal quality of Labour’s proposed measures is not a personal aberration on Corbyn’s part. It results from the political programme of the Labour Party, a party with a working-class base and a political commitment to work within the framework of capitalism. What is necessary is a different type of party, one that does not limit its demands to what is acceptable to the bourgeoisie but fights for what the working class actually needs, and recognises that those needs cannot be satisfied under capitalism. The Spartacist League, British section of the International Communist League, seeks to win workers and youth to the perspective of building a revolutionary party of the working class.
Myths of the Labour lefts
In an earlier article on the NHS (Workers Hammer no 222, Spring 2013), we observed: “The interest of the capitalist class in the health of the population comes down to maintaining a workforce fit enough to exploit and soldiers to fight their wars and imperialist adventures.” Indeed, the first compulsory national health insurance programme — based on employer and worker contributions — was introduced in imperial Germany in 1883 by the reactionary Iron Chancellor, Otto von Bismarck. While seeking to stymie the growth of the burgeoning socialist movement, Bismarck also understood that a modicum of social welfare, to maintain the health of the proletariat, was in the interests of German capitalism, which was undergoing rapid growth.
In 1911, David Lloyd George, then Liberal chancellor of the exchequer, introduced a similar health insurance programme in Britain. With the Great Powers gearing up for the First World War, Lloyd George commented of his German imperialist competitors: “We should not emulate them only in armaments.” This was not an idle comment. The British bourgeoisie was well aware that around half of volunteers for the Boer War of 1899-1902 had been too ill or malnourished to enlist in the army. When, desperate for proletarian cannon fodder amid the mass carnage of World War I, the British rulers introduced conscription, they found that two-thirds of military-aged men were not healthy enough for overseas deployment.
The Labour government of Clement Attlee that came into office at the end of World War II is lionised by the Labourite left as the paragon of democratic socialism. In fact, Labour’s postwar nationalisations (with the partial exception of iron and steel) amounted to giant bailouts of bankrupt industries, for which the state assumed direct responsibility after generously compensating the former owners. In contrast, the inauguration of the NHS in 1948 was a genuine and far-reaching gain, a product of the turbulent social unrest of the time.
Well before Labour acceded to government in 1945, Britain’s capitalist rulers had recognised that the working class would not be easily forced back to its dismal pre-war conditions. By the end of the war the Soviet Union, a bureaucratically degenerated workers state, had tremendous authority for having borne the bulk of the fighting to defeat the Nazi scourge. A wave of workers struggle was shaking Europe, and Britain was not immune.
The proposal for the NHS (and the “welfare state”) had been laid out in a 1942 report produced by Sir William Beveridge, a Liberal, when Labour was part of Winston Churchill’s wartime coalition government. While Attlee supported Beveridge’s conclusions, he worked with Churchill to sideline the Beveridge report in the interest of pursuing the British capitalists’ chief priority, the imperialist war effort.
While the NHS did transform the lives of working people, it was designed to impinge as little as possible on the prerogatives of capital. Spending projections were kept to a bare minimum. To take one example, £1 million was projected for eyeglasses in the first year of the NHS. As millions of working people flocked to get their first pair of glasses, the actual cost that year came to over £20 million. Within a few years, glasses (and prescriptions) were no longer provided free of charge by the “free” health service. The spending priority for the British government remained the US-led anti-Soviet Cold War.
Meanwhile, private care was allowed to co-exist alongside the public health service and not a hair was touched on the head of the companies that supplied medicines. The formation of the NHS proved to be a bonanza for the drug industry. A 1954 memorandum by Labour’s Socialist Medical Association noted that these industries immediately became “highly profitable and have attracted much foreign capital into the industries” (“The drug, chemical and pharmaceutical industries”, sochealth.co.uk).
The NHS spends more than £17 billion on drugs (out of a total health budget of some £125 billion) and average drug costs are rising at five per cent a year. The pharmaceutical giants make a mint by using their monopolistic patents to demand extortionate prices. Such blackmail poses the urgent need to expropriate the pharmaceutical industry as a step towards overturning the profit-driven capitalist system as a whole.
Those who labour must rule!
Faced with social upheaval, the capitalists may shell out enough to placate the population, but they always attempt to take those concessions back. And they have done so with a vengeance over the past few decades. Scotland, Wales and Northern Ireland are not subject to the 2012 Health and Social Care Act which vastly increased outsourcing in England, but they are not exempt from the logic of the profit system. When a tribunal recently ruled that workers providing overnight care for more than a thousand disabled people in Glasgow were entitled to the national living wage, the SNP-led local council simply decided to scuttle the service.
The Cuban deformed workers state offers a glimpse of what can be achieved once the profit system is eradicated. The rate of infant mortality is lower than in the US or Britain, abortion is free and readily available, and medical school, like all higher education, is free. In the face of a suffocating US embargo, Cuba started to develop its own anti-AIDS medications in the late 1990s, thereby ending the need to import expensive drugs.
Cuba’s renowned healthcare system demonstrates the qualitative superiority of a planned, collectivised economy — even in a poor, economically isolated country ruled by a parasitic nationalist bureaucracy — over the anarchy of capitalist production. We Trotskyists stand for the unconditional military defence of Cuba against imperialism and capitalist counterrevolution, and for proletarian political revolution to establish a regime based on workers democracy and the perspective of international proletarian revolution.
Human progress requires reorganising the global economy on a planned, collectivised basis, using the highest levels of science and technology in order to vastly increase labour productivity. By producing enough to satisfy the wants of the entire population, socialism will provide the basis to do away with poverty, class and social oppression, war and the other scourges associated with class society.
As our comrades of the Spartacist League/ US wrote in “Wealth Care USA” (Women and Revolution no 39, Summer 1991):
“Health means much more than shots and pills and surgical knives: it is a decent place to live; plenty of good food to eat; knowledge of human biology; air clean of pollution; safe, decent working conditions; the principles of public health rigorously applied. Medicine can’t save lives ruined by poverty and malnutrition....
“When we have thrown out the vicious capitalist system which sells human life for dollars, we will be able to build a new socialist society where human life, human worth and human dignity count. Doctors will be servants of the people; hospitals will be havens to heal the sick; research on vaccinations, new medical techniques and improved drugs will be internationally coordinated and to the benefit of all. When the workers of the world are in charge of this planet, the only limits of human health will be scientific — and these will be constantly enlarged by thoughtful, energetic research.”