The welfare state and NHS

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The welfare state and NHS
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Last weekend I was a bit confused by a discussion I had with a comrade there, I think from the CWO. If I understood his argument right (which I may not have) I think he was saying that the NHS and welfare state were not gains for the working class, I thought that after the war the bourgeoisie introduced these because they were scared of the threat of revolution and the influence of communist ideas, and all the returning soldiers were a real threat to the "social order".

Can someone go into a bit of detail on the ICC's (or the left communist in general) position on these reforms?

here's a place you can start.....
I read the article Alf, and I

I read the article Alf, and I agreed with a lot of it. However surely much of the reason why the NHS is failing today is as a result of privatisation, and some of the reforms which have been introduced to it which introduce a competitive element to the service, such as for example the growth of private firms which are subcontracted to provide services. Successive governments have introduced a steadily growing private sector element to the NHS haven't they (although I agree that this was there since the start). 

Would you say that the NHS needs to be defended from privatisation, or would you say that it is just the workers' terms and conditions etc which need to be defended? Surely privatisation is "worse" for the healthcare service as a whole because it means that eventually people will be having to pay for healthcare as it is in the USA, and it also means that terms and conditions for the workers are vastly worsened (although the government are trying to narrow this "gap"). It will also mean that the service is run wholly for profit rather than it is now.

It is undoubted I think that the NHS has made a huge difference to the lives of working class people in Britain? And when you say to defend healthcare but not the NHS are you making the point that the NHS is like any other capitalist employer?

I did agree with a lot of the article though, in that workers shouldn't identify their interests with their employers. However I am not sure what can be done instead? How do you defend the idea of free healthcare without defending the NHS and those in charge itself? The people who are campaigning against privatisation only (rather than capitalism) would say that they're defend the NHS from people at the top who want to run it into the ground and sell it off.

The NHS doesn't provide free

The NHS doesn't provide free healthcare but healthcare that is free at the point of use. This is a very important distinction. In no way does it represent a transfer of wealth from the bourgeoisie to the proletariat. Instead, healthcare is part of the "social wage" i.e. the part of wages that is distributed by the state rather than provided directly by the employer.

In that sense, like any other wage demand, we absolutely should defend healthcare. But defending state capital against private capital, is to pick one system of exploitation over another.

Privatisation is part of a strategy to reduce the overall (social) wage bill. Incidentally, the demands for the NHS to find £10 billion in savings ("efficiencies") has nothing to do with the current reforms being pushed through by the Tories but was put in place by Labour. You can, of course, have an opinion about whether the Tory reforms make sense even in their own terms, hence the debate on this question within the state. But that is window dressing for the overall imperative for the whole state-business nexus to lower its overall labour cost.

The same thing is happening in the US where the erosion of healthcare benefits for those in employment proceeds apace. The form of the arrangement may be different, but the underlying trajectory is the same and cannot be resolved by changing those formal arrangements.

The question is how do workers respond politically to such cuts. When healthcare is provided as a benefit through employment relations, it is possible for workers to oppose such cuts through traditional measures of struggle i.e. the strike. When state healthcare is eroded, this kind of struggle becomes somewhat mutated:

  • on the one-hand, it is becomes more difficult for workers to develop an autonomous struggle as their demands become mixed up with other social strata who may or may not use the NHS (not so much the case nowadays of course);
  • on the other hand, the struggle when it occurs, has the potential to become much more openly political as it takes on the form of a struggle against the state itself.

Because of the danger of this latter factor, the bourgeoisie uses ideological distractions to disguise the fact that the state is the enemy of the working class. Privatisation, while also pursued for economic and internal ideological issues (i.e. some parts of the bourgeoisie really believe their own propaganda), has the useful function of pushing the class into defending the state instead of attacking it.

As for the point about the NHS improving the lot of the working class, again this has to be looked at in its wider context. Wages (along with relative exploitation!) rose consistently during the post-war boom (when the NHS was largely established in its modern form) in most countries and healthcare (along with company pensions, etc.) should be seen as part of the overall package. When the long expansion came to an end, all aspects of wages began to be attacked including health.

To sum up, the key to understanding the attacks on health is not to understand it in its own terms or in terms of state vs. private provision but through the question of wages and especially the crisis cycle.

the free national health

I agree with the above. I retired a few year ago after 50 years at work. For the first half of my working life I was on just under average workers' wages and for the second, just over. So average wage for 50 years. Looking at my last national insurance payment and extrapolating that back over 50 years, I estimate that at prices when I retired, I have paid in £160,000 towards the "free" national health. Though some of this money could qualify for retirement pension this doesn't of course include PAYE taxation which is a much greater figure. So there's nothing free about the national health and particularly when you remember that teeth, eyes, prescription charges and the like all add up to further direct payments that make the NHS anything but free. And what element of the social wage that there is to it, that itself is being cut by both Labour and the Tories.

Perhaps some discussion to

Perhaps some discussion to the U.S. situation can help. Obama's (actually a Republican plan for years before he took it up) so-called health "reform" has two basic parts: First, there is an expansion of  benefits by expanding "Medicaid," the joint federal/state program that provides meager health benefits to the very poor and forbiding private insurance companies from excluding people with pre-existing conditions. This is part of the state's strategy to attempt to "rationalize" the health care system by lowering costs through bringing more people who would otherwise not get care until they were very sick into the system and try to keep them a little healthier and out of the emergency room. However, this is paid for by a giant tax on younger workers by forcing them to buy insurance from private companies, paying hundreds of dollars for plans that don't really cover anything other than catastrophic injuries.

So is this a reform? From the point of view of the people who might get Medicaid or who have pre-existing conditions, you might say so. But at the level of the system, this is paid for by the rest of the working class through the individual mandate (and higher premiums). One hand giveth, the other taketh away. Of course, this gives the state the ability to play a game of divide and conquer pitting the very poor against the working not quite so poor.

Demogorgon, thanks for that

Demogorgon, thanks for that explanation. I understand what you are saying a lot better now. But I don't know what the answer is, or if there's anything we can do about it now. I suppose another point about privatisation is that it is privatisation led by the state rather than companies asking to buy up pieces of the NHS, the privatisation is being led by the government and companies are being encouraged to buy into it by the government.

On another forum where I asked this question the reply is that part of what the NHS and the welfare state does is that it makes the working class more dependent on the state and ties everyone into state bureaucracy and also erodes pre-existing forms of mutual aid, so for example the benefit system replaced some of the help that members of the community would give to each other when they are in need, and now that is being cut with nothing to replace it, so it increases the individualistic/atomising tendencies in society.

Would that be accurate as well?