The NHS and “junior doctors”
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YMS and SP,I read your answers with interest.YMS, I struggle with economic concepts and usually have to keep things very simple, with clear, straight forward examples. If I understand you correctly, you are saying that there is a certain “cake” to be shared out among workers; this can be distributed via wages or via state services like the NHS. Currently they are shrinking the health service and in theory they could increase our wages to buy these services in a private market place – and we would be no worse off. I’m not disagreeing with this analysis.However, as we know, they are not increasing our wages, instead they are hitting workers from all angles – wages as well as services provided by the state are cut back.SP said: “Medical expectations in Britain are high. An ageing, disease ridden population being kept alive beyond economic usefulness is very expensive. From a economic perspective it makes no sense for capitalists to provide costly, long term health care to unproductive workers. That's why the changes are taking place.”Very starkly put, but very true. Certainly, in the case of the disabled, they are achieving their aim from many directions – lowering of benefits, the bedroom tax, awful work capability interviews, increased hospital waiting times, pitiful mental health provisions – the net effect is that suicide among the dispossessed and the desperate is going up. A deliberate plan?SP said: “I see this issue as one in which it could be possible for the SPGB to connect more with the public, via an issue important to us all. Yet statements like "Is the NHS a benefit?", shows how disconnected the SPGB are with other workers.”Yes, unfortunately, I don’t think the SP is talking the language of the street. I am not sure how this can be remedied. Could not people of a SP mind set passionately defend the NHS, the same as they would using unions to defend living standards? Be down on the picket lines with the doctors and the nurses and the cleaning staff? It’s all kicking back at an attempted reduction of the cake after all, is it not?
SocialistPunk wrote:"Is the NHS a benefit?"Not sure what planet that statement belongs to. For an answer I guess we'd have to go back in time to a place before the NHS was set up and try to compare health care provision for us working class?I see this issue as one in which it could be possible for the SPGB to connect more with the public, via an issue important to us all. Yet statements like "Is the NHS a benefit?", shows how disconnected the SPGB are with other workers.SP, this is a discussion forum where the views of one member are not necessarily the views of all members or of the Party as a whole. A discussion took place on the NHS at the SPGB 2010 Conference. Here's the Report of the Proceedings on this item which shows a variety of views:
Quote:Item for Discussion from West London: “What is our attitude to the NHS?”Bond, West London In the forthcoming election, all the major parties have pledged to safeguard the NHS from public expenditure cuts, and the TUC is organising a rally in support of the NHS. Many workers value this public healthcare service. When the NHS was introduced in 1948, the Party regarded it as a capitalist scheme to save money, to get workers fit for military duty, and to appease workers’ demands for a better society. Since then the Party’s position seems to have softened. We now recognise that there is popular support for it, and that the workers do benefit from it, despite its inadequacies. What do other delegates think on what our attitude to the NHS ought to be?Martin, Central London Some American politician recently said that their recent healthcare reforms would impact their military effectiveness and spell the end of American imperialism. The NHS is commonly pointed to as a model of free access, though it still contains elements of private ownership, and some people are trying to bring it under greater influence of market forces. We don’t support the NHS; we support a world of free access. If you accept the idea of a national health service, why not a national food service, a national food service, and a national clothing service? And why not worldwide rather than national? We have to be clear in our propaganda that the NHS is still very much enmeshed in the world capitalist system. Perhaps we should put out a leaflet with the title “We don’t support the NHS”.Allen, East Anglian Regional I am extremely grateful to the NHS, as their only concern is my health. I also support the anti-smoking reforms. I know this isn’t socialism, but these reforms make capitalism much more pleasant to live in. I think the NHS is a wonderful institution.Buick, non-delegate We are prepared to concede in theory that some reforms can be in the interest of workers, and the NHS can be given as an example of this. Many party members applauded Michael Moore’s film Sicko as it indicted America’s private health care industry. We shouldn’t participate in pro-NHS demonstrations, but we should be present to hand out our literature.Corey, non-delegate Surely the Party is not being challenged over this issue. The capitalist system needs a healthy working class and healthy army recruits. I get necessary treatment under the NHS, but this is irrelevant. We want socialism, not the NHS under capitalism. The working class may be compelled to avail themselves of benefits offered under capitalism, but we should be demanding the whole cake.Kelly, non-delegate We’ve all used the NHS. In many parts of the world basic preventative medicine is not available; here we take it for granted. Any improvement in our health should be recognised, and we don’t want to alienate people by disparaging it.Shodeke, non-delegate I agree fully with Cde Martin’s statement. We want free access to goods and services for the world, not just health care here in England.Hart, South London We shouldn’t make a point of claiming opposition to the NHS, though we should recognise its limitations and restrictions. Americans are completely gobsmacked when you tell them you can walk into a doctor’s surgery here without paying money.Bond, West London I agree with Cde Martin that the NHS is enmeshed in capitalism, that doctors’surgeries and pharmacies remain in private ownership, and that the NHS is a capitalist rather than socialist institution. But for all its limitations, the NHS does benefit workers in capitalism.Personally i often use the NHS free service at the users end to explain socialism as free access as a practical possibility.I know in the past speakers often used water supply in similar arguments because the water and sewage charges were mostly hidden in the small print of the old rates. And we could use as much water as we wished. Metered water and privatisation of water companies has changed things a lot and has become a political topic such as with Ireland's water tax I think there is a red-herring on this thread. No-one is suggesting that the NHS workers are vying against one another in dog-eat-dog for its resources in wages and hours. That's the employers position. Over the decades unions have merged and 'moderate' unions have grown in militancy as a reflection of increasing awareness of employee position in the health system. The Junior Doctors strikes had and still have the overwhelming support of their colleagues. Difficult for me to digest is also that NHS administration and control is forever changing with health trusts and GP surgeries turned into businesses and one time local health boards relegated to history but the basic idea of socialised medicine is one i think all socialists understand as examples of rudimentary socialist principles…to each according to medical need and notupon how much you can pay ….and when it comes to staffing , from each according to ability…porters, nurses , technicians, junior doctors and consultants etc. all co-operating as a teamFor sure we still have a stratified career structure…private schools dominating the higher professions If we are to discuss health care as a wider topic then our focus (and it has been in numerous SOYMB posts) is the position of the pharmaceutical industry, still a in the grasp of private multi-national corporations exerting powerful leverage over universities and their research and steering government policy on health – shamelessly still in the name of profit and dividends. If the right wing Republican accusations of death committees existing in the NHS is true i.e. NICE then the executioners is Big Pharma. We can aso discuss the out-sourcing of care for the elderly from local council homes to private business and then understand why standards have fallen and abuse inscreased. This part of Bill Martin's contribution to the 2010 debate is on track.."If you accept the idea of a national health service, why not a national food service, and a national clothing service? And why not worldwide rather than national? "
SocialistPunk wrote:"Is the NHS a benefit?"Not sure what planet that statement belongs to. For an answer I guess we'd have to go back in time to a place before the NHS was set up and try to compare health care provision for us working class?I see this issue as one in which it could be possible for the SPGB to connect more with the public, via an issue important to us all. Yet statements like "Is the NHS a benefit?", shows how disconnected the SPGB are with other workers.It's not that straight forward, we'd also need to consider the post-war boom, and the rise in living standards generally that occurred then; it's a question of whether there would have been a greater wage for workers through the labour market than it was administered through the state (I suspect it would be impossible to tell, but we can't give all the credit to the NHS, it was the postwar boom what done it).The element of the social wage that comes through the NHS is under attack, but, again, I'd suggest our position should be to concentrate on the quality of care, and the overall spent on it, rather than whetehr it's in state hands or not.
Meel wrote:YMS, I struggle with economic concepts and usually have to keep things very simple, with clear, straight forward examples. If I understand you correctly, you are saying that there is a certain “cake” to be shared out among workers; this can be distributed via wages or via state services like the NHS. Currently they are shrinking the health service and in theory they could increase our wages to buy these services in a private market place – and we would be no worse off. I’m not disagreeing with this analysis.It's more simple than that. The only way we get health care is if our employers pay for it — we have no other source of money. They pay for it, eitehr through the taxes they pay, or through our wage packet. It's not about a share of the cake shared among workers (the cake is in fact divided between our share and the emplyers share, if our share goes upm, theirs goes down, so they are tryingt o minimise what they spend on our health care, and w're tryign to push it up. It's not charity, or benevolence, its the gains fo class struggle). Neverbe 'grateful' for the NHS, just as you should never say thank you for a pay check, we've earned it and fought for it.The point is to continue the struggle, and not get blinded by the state/private flim flam.
Here's a good leaflet on a typical "Save the NHS" campaign:http://www.worldsocialism.org/spgb/forum/world-socialist-movement/whittington-hospital
Free health treatment in various other countries take different forms. Worth exploring. Some are free front-up, others based on charges that are re-imbursed. While we all talk about NHS as the ideal model, some will say other nation's schemes are better and produce better results.https://en.wikipedia.org/wiki/Universal_health_coverage_by_countryThe UK ranks 18th in the rankings of countries health services and 26th in per capita expenditurehttps://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000Bill may be again on the right track….The NHS could be a lot better, (but again the elephant in the room is private medicine – the pharmaceutical companies.)Yes, i'm all for advocating socialism by highlighting the short-comings of the health-care provided to people, regardless of method and why millions die needlessly each year of avoidable illnesses and curable diseases, here in the UK, the EU and the rest of the world. We have health inequaities between rich and poor and since 1948 the NHS has failed to solve that. And the changes taken place within the NHS has often exacerbated the probems.(As a personal anecdote, i once had an appointment with a Mr. (a consultant) at a private hospital in India for a cost less than what i pay for parking my car in a UK hospital car-park)
ALB wrote:SP, this is a discussion forum where the views of one member are not necessarily the views of all members or of the Party as a whole. A discussion took place on the NHS at the SPGB 2010 Conference. Here's the Report of the Proceedings on this item which shows a variety of views:Quote:Item for Discussion from West London: “What is our attitude to the NHS?”Bond, West London In the forthcoming election, all the major parties have pledged to safeguard the NHS from public expenditure cuts, and the TUC is organising a rally in support of the NHS. Many workers value this public healthcare service. When the NHS was introduced in 1948, the Party regarded it as a capitalist scheme to save money, to get workers fit for military duty, and to appease workers’ demands for a better society. Since then the Party’s position seems to have softened. We now recognise that there is popular support for it, and that the workers do benefit from it, despite its inadequacies. What do other delegates think on what our attitude to the NHS ought to be?Martin, Central London Some American politician recently said that their recent healthcare reforms would impact their military effectiveness and spell the end of American imperialism. The NHS is commonly pointed to as a model of free access, though it still contains elements of private ownership, and some people are trying to bring it under greater influence of market forces. We don’t support the NHS; we support a world of free access. If you accept the idea of a national health service, why not a national food service, a national food service, and a national clothing service? And why not worldwide rather than national? We have to be clear in our propaganda that the NHS is still very much enmeshed in the world capitalist system. Perhaps we should put out a leaflet with the title “We don’t support the NHS”.Allen, East Anglian Regional I am extremely grateful to the NHS, as their only concern is my health. I also support the anti-smoking reforms. I know this isn’t socialism, but these reforms make capitalism much more pleasant to live in. I think the NHS is a wonderful institution.Buick, non-delegate We are prepared to concede in theory that some reforms can be in the interest of workers, and the NHS can be given as an example of this. Many party members applauded Michael Moore’s film Sicko as it indicted America’s private health care industry. We shouldn’t participate in pro-NHS demonstrations, but we should be present to hand out our literature.Corey, non-delegate Surely the Party is not being challenged over this issue. The capitalist system needs a healthy working class and healthy army recruits. I get necessary treatment under the NHS, but this is irrelevant. We want socialism, not the NHS under capitalism. The working class may be compelled to avail themselves of benefits offered under capitalism, but we should be demanding the whole cake.Kelly, non-delegate We’ve all used the NHS. In many parts of the world basic preventative medicine is not available; here we take it for granted. Any improvement in our health should be recognised, and we don’t want to alienate people by disparaging it.Shodeke, non-delegate I agree fully with Cde Martin’s statement. We want free access to goods and services for the world, not just health care here in England.Hart, South London We shouldn’t make a point of claiming opposition to the NHS, though we should recognise its limitations and restrictions. Americans are completely gobsmacked when you tell them you can walk into a doctor’s surgery here without paying money.Bond, West London I agree with Cde Martin that the NHS is enmeshed in capitalism, that doctors’surgeries and pharmacies remain in private ownership, and that the NHS is a capitalist rather than socialist institution. But for all its limitations, the NHS does benefit workers in capitalism.Hi ALB,I take your point. I guess I also forgot I'd just rejoined, meaning I'm once more one of a number of Party members with differing views on this issue.
SocialistPunk wrote:I take your point. I guess I also forgot I'd just rejoined…Welcome back…
I take a probably non SPGB position, but in my opinion a Marxist theoretical one, that healthcare is part of necessary labour time or is theoretically funded from it. If anything reproduces labour power then healthcare does. Therefore cuts in healthcare are effectively cuts in wages and working conditions. The fund for healthcare should be viewed as deducted from wages at source and should not be viewed as coming out of taxes; which is theoretically deducted from surplus value. If the capitalist effectively plunder the part of wages that has gone towards healthcare by introducing cuts; they are using workers ‘wages’ towards the reallocation of funds to reduce general taxation that does come out of surplus value. Therefore fighting healthcare cuts is an economic issue and not a reformist one. And the bollock brained and stupid workers have a better understanding than ‘we’ do. The efficiency savings for the capitalist class in general of having nationalised and/or for that matter ‘free’ systems for generating and maintaining a high quality workforce should be neither here or there. Personally these doctors, who 150 years ago used to have servants, have had it coming. Secondly, because the necessary training, knowledge of commercial practices, languages, etc., is more and more rapidly, easily, universally and cheaply reproduced with the progress of science and public education the more the capitalist mode of production directs teaching methods, etc., towards practical purposes. The universality of public education enables capitalists to recruit such labourers from classes that formerly had no access to such trades and were accustomed to a lower standard of living. Moreover, this increases supply, and hence competition. 2How well this forecast of the fate of the commercial proletariat, written in 1865, has stood the test of time can be corroborated by hundreds of German clerks, who are trained in all commercial operations and acquainted with three or four languages, and offer their services in vain in London City at 25 shillings per week, which is far below the wages of a good machinist. https://www.marxists.org/archive/marx/works/1894-c3/ch17.htm#2 On Indian doctors etc there is quite a lot of ‘medical tourism’ now particularly when it comes to cosmetic healthcare.There is for instance a lively industry on myopic people going to India for eye lazer surgery at bargain prices which you can done for a song apparently. I think education now is quite interesting as it is being turned into capital itself, and social capital, embodied in workers with legs and passports. One suspects it is capital when it returns interest payments re student loans. Education, like capital in general requires investment with the objective of improving productivity and demands a return. All these educated young Polish workers over here now didn’t grow on trees, much. All this Tory lets keep the Johnny foreigners out is just for the less than 25K per annum people. The over 25K people are more than welcome as a steal with another set of national capitalist class public education capital embodied in them. It is particularly obvious in the IT industry in the UK; not me but I have lots of friends who do that stuff. It is not even just EU its Cubans! and people from south America; as well as south east asia eg Pakistan. Ha ha! ; English IT people got paid too much as well in my opinion. People seem to complain that the rich are getting richer and the ‘middle class’ or better paid workers are getting poorer. Well good! Learn the hard way then; and get back to you later.
Dave BYou said: "If anything reproduces labour power then healthcare does. Therefore cuts in healthcare are effectively cuts in wages and working conditions. The fund for healthcare should be viewed as deducted from wages at source and should not be viewed as coming out of taxes; which is theoretically deducted from surplus value."I think my thoughts were going along these lines, but I probably didn't express it as clearly. The way I see it – and all ends up – the rich are rich because they have plundered their wealth from the rest of us. This simple understanding gets me through and I'm not sure I'll ever understand the full extent and all the intricacies of their conjuring tricks. You also said: "Personally these doctors, who 150 years ago used to have servants, have had it coming."The proletarisation of the upper echelons of the working class? :o)Most doctors of course still come from the wealthier sections of society. Those who have battled to qualify and who come from poorer groups are more likely to be burdened with debt and stress.
Hi Meel I was being a bit flippant about doctors and I do appreciate that junior doctors are being over worked now. But until very recently there was gold at the end of tunnel if 100K per annum is an incentive to stick at it. http://www.telegraph.co.uk/news/uknews/11856441/Average-GP-pay-dips-below-100000-for-first-time-in-a-decade.html I know of two doctors from working class backgrounds who did their training in the 1970’s to become GP’s and they are both pretty loaded having earned in excess of 100K. Way outside my bracket. There was a couple of guys from my sixth form that went on to do it and that was a inner city comprehensive ; don’t know what happened to them. Michael Moore did a really interesting film on healthcare in the UScalled ‘Sicko’. I think maybe in that he drew attention the falling wages of airline pilots as well. I think high wages can ‘corrupt’ the ‘politics’ of individuals even if they did come working class backgrounds eg John Prescott, who used to serve drinks before he got two Jags so his wife’s hair didn’t have to get wet in the rain and David Blunkett of the Sheffield city council politburo. It is the same with these trade union officials; http://www.telegraph.co.uk/news/politics/10176757/Union-leaders-enjoy-bumper-pay-hikes-and-golden-goodbyes.html I, or we, went on a wildcat strike once at the factory I worked at and the local Apparatchik from the GMB turned up in his Merc and told us to go back to work. I think working class solidarity works through understanding based upon reflection of personal understanding otherwise known as empathy that I believe is or should be part of the healthy human condition or human nature. No longer just dingbat philosophy but now real science with all this brain scan mirror neurone stuff. Although it can be trans generational in a way where you learn about the sufferings and experiences of your parents and grandparents directly I suppose; and carry that with you etc. There was a interesting case recently I think with Russell Brand- Jeremy Paxman- ‘who do you think you are’. Jeremy Paxman burst into tears, or became lachrymose according to Russell, at hearing of his ancestors being shipped out from Suffolk? poor houses to work in satanic mills in Yorkshire? What made it interesting for me is that it was described in detail in volume one of Karl’s Kapital. Although Karl, two faced as ever and always , dodged the cursed moralist bullet by quoting from bleeding heart liberal’s reports. As a ‘humanist’ and human nature bod, I think most Marxists are full spectrum moral cowards. And capuchin monkey communism and exchange values? http://www.liveleak.com/view?i=e82_1345278829
Interesting development in the dispute. Following industrial action a deal is negoriated by their union and put to a vote of those affected (as, ideally, should always be the case) but is rejected (by 58% to 42% on a 68% turnout). I'm not sure what happens next. Logically, a new deal should be negotiated (and put to a vote) but it looks as if the employer is going to impose the rejected one. In any event, so far the workers involved and their union have conducted their campaign in an exemplary manner.
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