Healthcare under Capitalism

Published on Global, by Prof. Colin Leys and Greg Albo, November 21, 2009.

Socialist Project recently asked Greg Albo to interview Colin Leys about the book and about current healthcare struggles.

… Colin Leys: Given the crucial importance of health in people’s lives it struck us that there was a major lack of critical left thinking about it – about how neoliberalism was undermining the health gains of the postwar years, about what was happening to healthcare as a field of employment, and above all how healthcare was becoming a massive new field of capital accumulation, with dire implications for population health – and for democracy – everywhere. The best contribution the Register could make, we felt, was to help develop a historical materialist analysis of health under capitalism. Over the last 30 years a handful of progressive health experts, such as Vicente Navarro in the U.S., and Lesley Doyall and Julian Tudor Hart in the U.K., have laid the groundwork for this, but the Left in general has not taken it on board as much as we should have. And the extent to which the mainstream health policy literature fails to confront the neoliberal agenda is frankly shocking. Dependence on government funding for research plays an obvious role there. With some honourable exceptions everything is presented as if the political-economic determinants of ill health are a (regrettable) given. We wanted to break decisively with this pattern, foregrounding the centrality of the capitalist health industry in policy-making, and showing how ruling-class interests are served by it.  

And yes, my own previous work in Africa and on development did give me a special interest in the theme. The routine normality of painful illness and early death in the global ‘south’ is so shameful, when we know that it is largely preventable; we also know that no amount of ‘aid’ is going to prevent it under the existing power relations of global capitalism. The determinants of poverty and ill-health, and of the lack of healthcare for all in the ‘south,’ are the same ones that are now driving the restoration of inequality and the dismantling of social protection in the ‘north.’ My work on British political economy under Thatcher and Blair took health policy as a test case of the way global market forces were driving domestic policy. What this revealed was a process that has ended in an amazing phenomenon – the British Labour Party, which 60 years ago set an example of universal and comprehensive healthcare that was followed all over the world – including in Canada – is now busy dismantling the integrated National Health Service and recreating a healthcare market – relying heavily on U.S. advisers and U.S. health multinationals to make it happen … //

… There are really two core issues. One is the need to focus on the militant campaign that is now being waged by capital – the health insurance industry, the pharmaceutical and biotechnology industry, and big healthcare provider companies – to break up state-funded and provided healthcare systems in every country that has them, and turn them into fields of accumulation. In middle- and high-income countries we are talking of potential markets worth from 7 to 12% of national income or even more. The power of the corporations moving in on public health services is huge, and growing. In Canada and the U.K. and other advanced capitalist countries they are major actors in the restructuring of states on neoliberal lines that has been pushed through to a greater or lesser extent in all countries over the past 30 years. They are increasingly installed at the heart of government policy-making. Health ministries and departments have been downsized and policy development has been handed over to private sector personnel as consultants, or appointed to government posts, while ministers and career civil servants leave to take lucrative jobs in the private health sector. The boundary between public and private interests is increasingly blurred, especially in relation to health. This is not nearly as well understood as it needs to be … //

… The principles that a socialist health programme should rest on come across clearly enough from the volume. In general, a socialist health policy would aim at making economic policy serve the goal of making everyone as healthy as possible, rather than making a few people as rich as possible. As Hans-Ulrich Deppe, an eminent German professor of medicine, says in his essay on the nature of healthcare, health is a universal need that should be a universal right, and this means that every aspect of health policy must be grounded in the principle of social solidarity. What this means in practice will vary widely, depending on the health system that already exists, public attitudes to health and medicine, country-specific variations in need, etc. And it can only be worked out in practice; blueprints made in advance are not going to help much. But a more democratic health policy, which must be the starting-point, will always imply some striking changes. For instance Julian Tudor Hart’s powerful closing essay in the volume points out that in advanced capitalist countries an amazing third of all adults experience a mental health problem of one kind or another, but only a tiny fraction of the misery that this represents is even acknowledged, let alone treated – even in health systems that are supposedly equally accessible by all. A socialist health policy must obviously confront this, implying some major shifts of attitudes and resources, and a radical change in the social conditions that cause so much of the problem. It would aim to bring medical priorities into line with the findings of medical science – a very different thing from the priority now assigned to high-tech medical care for conditions that represent a tiny fraction of the burden of disease among the population at large (not to mention the populations of the global ‘south’).

Thinking through what a socialist health policy would look like in any given society in fact opens up several extremely exciting vistas. It also opens up the possibility of new alliances in the struggle for socialism generally. For example, once it is recognised that good health depends more on social and economic equality than on healthcare – crucially important though healthcare is – healthcare activists thinking about the kind of politics needed to secure good health for all find they have natural allies in a whole range of movements struggling for equality – for labour, for women, for the unemployed, for undocumented people, and for minorities of many kinds. In the same way, envisaging the kind of state, and the kinds of democratic accountability, that could ensure that maximizing people’s health became and remained a core commitment of society, is a powerful way of focusing on the kind of state needed for achieving other solidaristic goals.

Health is a deeply emotive matter, and the Left has every reason to make it a core issue of its own. And not just in defending publicly-provided, universal-access healthcare, but in a more radical sense too, as Leo and I suggest in the Preface to the book: “the contradiction between capitalism and health should become a pivotal dimension of a revitalized socialist strategy.” (full interview text).

(Colin Leys, in addition to co-editing the Socialist Register is the author of various books including Underdevelopment in Kenya, Politics in Britain: From Labourism to Thatcherism, The Rise and Fall of Development Theory, and Market-Driven Politics: Neoliberal democracy and the public interest).

Link: The Socialist Register: The Socialist Register was founded by Ralph Miliband and John Saville in 1964 as ‘an annual survey of movements and ideas’ from the standpoint of the independent new left. It is currently edited by Leo Panitch, Colin Leys, Greg Albo and Vivek Chibber, assisted by an editorial collective of eminent scholars in Africa, Asia, Europe and the Americas. Each volume is focused on a topical theme and characterized by the inclusion of relatively long, sustained analyses which cut across intellectual disciplines and geographical boundaries … (full text).

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