In the news

It's about the current coalition's assault on the NHS, FFS!

Tiswas wrote:

What's the point in being partisan about this?
So, since the writer is criticising the coming privatisation under the
current government coalition, that criticism is invalid because she
doesn't address Labour's marketisation of the NHS via the creation of
foundation trusts?

She's hardly going to contest that the NHS is a socialist organisation,
despite working class activity leading to its inception, it was the ruling class
which created it and have always controlled it.

/* From a review by Gill Westcott on CLASS STRUGGLE - THE STATE AND MEDICINE, by Vicente Navarro [1] */
The Dawson Report of 1920 advocating a regionalised and integrated
national health service is often seen as a pioneering document. Navarro
relates it however to the groundswell of working class dissatisfaction
in the wake of the first World War and the 1917 Soviet Revolution, and
to a more radical Document published earlier by the State Medical
Services Association (later the Socialist Medical Association, SMA).It
was in this period that the Labour Party adopted its most radical
programme ever, enshrining the famous 'Clause 4' on nationalisation in
its constitution, and the Dawson report is seen as an attempt to
forestall the unrest springing from this mood. Navarro also links the
1926/56 Royal Commission on National Health Insurance to the political
situation surrounding the General Strike of 1926. The fact that neither
report was acted upon he attributes to the waning of impetus of the
Labour Movement due in the latter case to the breaking of the Strike by
threats to call in the army, and the channelling of discontent by Labour
leaders into the less effective Parliamentary channels.

Navarro at this point shows that leading Parliamentary Labour Party
figures espoused a political viewpoint which they expected to appeal to
all sections of society, all 'men of good will' on grounds of social
justice and morality.

The Wall Street Crash of 1929 and the ensuing depression led once more
to increasing militancy among workers, and to disillusionment with the
'evolution into socialism' doctrine of the parliamentary leaders. The
Labour Party programme of 1934 called for nationalisation of key
industries and a completely integrated (preventive and curative)
publicly provided national health service. The response of the British
Medical Association (BMA, the organ of general practioners) was a report
in 1938 advocating the extension of National Health Insurance to all
sections of the working classes through subsidising schemes with
commercial agencies. It was during this period that the very similar
Blue Shield Scheme was established in the US by the American Medical
Association. One writer comments that the BMA was more concerned to
ensure the patients' ability to pay them to insure them against the high
cost of medical services.

The Second World War however had a deep radicalising effect on British
society, partly from the need to plan a better tomorrow to sustain
wartime solidarity, and partly through the experience of much greater
effective government control of the economy on the major services.
Specialists sent to provincial hospitals were appalled at conditions
there.

Several blueprints for reform were prepared. The most famous, the
Beveridge report of 1942, advocated Keynesian full employment policies
and national free provision of health services and education. Again,
Navarro sees this report not as a radical departure but strongly tarred
with the capitalist brush, (due partly to Conservative dominance in the
Wartime coalition). He finds its proposals on medical services very
similar to a previous report on the Medical Planning Commission (MPC) in
which the BMA and the Royal Colleges (the Specialist bodies) were
represented, the specialists being more numerous. This report accepted
the central planning and regionalised co-ordination which had occurred
during the war, though it did not favour total integration of voluntary
hospitals into the national system. It recommended expansion of National
Health Insurance to the entire population, except the top 10% (from whom
the Consultant specialists draw most of their clientele).

The final NHS scheme, though said to be 'similar', nationalised all
hospitals and did not accept the exclusion of the top 10% of population.
A comprehensive free health service was introduced, financed out of
general taxation and local rates. GP's still provided the bulk of
primary health care and were paid by the state according to the size of
their patient lists, receiving considerably improved incomes.
Consultants, however, were rewarded extravagantly for joining the NHS:
in Bevan, (the Labour Minister's words), he 'choked their mouths with
gold' with a secret tax-funded system of rewards and the weighing of
salaries in favour of consultants working only part time for the NHS.
Private beds in hospitals were still available; though an insignificant
proportion of total patients, they allowed consultants to augment their
income. Moreover the consultants were permitted key positions of control
on the Regional Hospital Boards. Crossman wrote "what chance is there of
a shift of money to the community health services or long stay
hospitals?... (the consultants) are the most ruthlessly egotistical
administrators I have ever met in my life. They know nothing of what
goes on outside the hospitals. These vast new palaces are justified for
the convenience of the consultants" (1971).

This would have been avoided if, as the SMA had proposed, the health
services had been controlled by the democratically elected local
authorities.

Thus, Navarro argues, the Labour Government responded with far less
radical measures than the working classes then wanted. (He does not
comment on the subsequent election of a Tory government for 13 years).
He blames the Labour leaders' support of the capitalist system, visible
in their electoral claims in the early '60s.

Since its inception, Navarro notes that in line with the rest of the
economy, central management of the health services has been strengthened
by subsequent reorganisation. Responsibility was shifted yet further to
ad hoc bodies leaving still fewer (mainly public health) functions to
the local authorities. Strengthening the regional boards reinforced the
dominance of hospitals in the system and the increasing proportionate
allocation to teaching hospitals reflected this. He notes the strong
class structure in the medical professions, and its legitimation through
the control of technology and medical knowledge.

To conclude, Navarro looks at three main areas of debate in health care
in the UK today:

i) The rapid growth of expenditure on health care, which he attributes
to growth in the social demands of labour (complementary to their
demands for higher direct wages).

ii) The continuance of regional inequality. Although he regards this as
something of a diversion from the underlying issue of continued class
inequality, Navarro discusses the procedures adopted by the Medical
Practices Committee (made up of doctors) to control the placing of new
doctors so that underdoctored areas were better served.

This practice ceased in 1961, leaving only financial incentives to
operate in these areas. He argues that redistribution of doctors has
failed partly due to the strengthening of academic medicine under the
NHS, allowing it more effectively to control the numbers of doctors
trained. He states that while financial incentives were used to induce
reallocations, a more democratic production of health resources in the
NHS was not considered.

iii) The ineffectiveness of medical expenditure to reduce mortality and
morbidity. As well as the bias towards curative hospital medicine,
Navarro notes that three major health problems alienation of workers,
occupational diseases and cancer - all have origins outside the health
sector in the working and living environment and are not susceptible to
control by medicine; they are related to the class control of production
and consumption.

While she's at it, perhaps she should also write a critique of political
power with particular reference to Marx's quest for party hierarchy (the
dictatorship of the proletariat) and Bakunin's opposition (the invisible
dictatorship), leading to the latter being ousted from the First
International?

She could also get into agriculture, the ability of malnourished farmers
to overwhelm fitter hunter-gatherers by dint of numbers, attributable to
an increase in carbs (grain storage), division of labour, standing
armies, the exploitation of farmers and workers, the rise of the priest
and ruling class and NATO's regime change contravention of 1973 in
Libya.

Would that satisfy you?

Half of what this person writes is utter bollocks.
In the context of the article that she actually wrote, which of those ten points is wrong?

1 - http://www.disa.ukzn.ac.za/webpages/DC/LaMar79.0377.5429.004.009.Mar1979.14/LaMar79.0377.5429.004.009.Mar1979.14.pdf