The case for a socialist alternative
"A free health service is pure socialism and as such it is opposed to the hedonism of capitalist society." Aneurin Bevan, ‘In Place of Fear’
The pioneer of the National Health Service (NHS) in Britain, Aneurin Bevan, was the health minister in the first majority Labour government between 1945 and 1950. He drove the bill through parliament to establish what became a treasure of the British people, particularly for the working class and the poor, who had suffered terribly in the past from the lack of proper healthcare.
He only achieved this in the teeth of bitter class opposition from the Tories – then, as now, the representatives of the wealthy, greedy minority who had their own ’health service’ in the form of private clinics and hospitals. They had no need for a ’national’ health system and they do not today.
But the NHS was not the model of "pure socialism" imagined by Bevan. Alongside private healthcare, the pharmaceutical industry bled and continues to bleed the NHS through extortionate charges for medicine and drugs. Pharmaceutical products cost the NHS about 10% of its budget annually, about £11 billion.
As with other industries that were nationalised at the same time, the capitalists made a virtue of necessity. The bosses had ruined them and then the state stepped in, took over various industries and paid the bosses lavish overcompensation. The bureaucratic model for managing and running the nationalised industries – with pro-capitalist management, often former owners and managers installed in power – was far from the ideal of a system ’of popular and democratic control’, for which the Labour Party then officially stood.
The result was the establishment of ’state capitalist’ forms of ownership and management of what were nominally ’publicly owned’ industries, which provided cheap services to the bosses.
The majority of consultants only reluctantly acquiesced after Bevan "stuffed their mouths with gold", making concessions which allowed them to continue to engage in lucrative private healthcare, some of them using the resources of the NHS to practise privately.
Despite this, the establishment of the NHS, alongside the other nationalised industries, such as steel, coal, etc, was met with great enthusiasm, both by the broad mass of the working class as well as the more politically aware. The majority of doctors subsequently swung over to support the NHS with the concept that a publicly owned health system is superior to one dominated by private interests.
This was seen as just the first step; as with the nationalisation of the coal industry where the miners viewed this as the dawn of a new era for them and the whole working class. Steel and other industries were taken over until the ownership of at least 20% of industry – one fifth of a ’revolution’ – was taken out of the hands of former capitalist owners and placed in the hands of the state.
This was widely seen by the labour movement as a payment on account, until the majority of industry became democratically state-owned. In the battle over the Labour Party’s Clause 4 in the late 1950s, its then leader, Hugh Gaitskell, tried to eliminate it from Labour’s constitution and was roundly defeated, largely because the trade unions objected and opposed this – even with right-wing leaders.
They were Labour reformists, and by hints and innuendo suggested that society could be changed gradually and incrementally over time to achieve the goals of Clause 4, Part Four of the Labour Party’s constitution. Clause 4 was for the nationalisation of the commanding heights of the economy. We argued this should be with compensation only on the basis of proven need. But Clause 4 was completely expunged by Tony Blair, with Ed Miliband following behind.
Socialists and Marxists argued that there’s no such a thing as ’a quarter of a revolution’. Where 80% of industry is owned by the private sector and 20% is state owned, the 80% will dictate to the 20% and not vice versa.
Unless the process of taking control out of the hands of the capitalists is carried through completely by the nationalisation of the commanding heights of the economy and run through democratic workers’ control and management, then inevitably the capitalists and their representatives would seize the first opportunity to turn back the wheel of history.
And this is what happened through the triumph of Thatcherism and the brutal programme of privatisation. The NHS has, as a consequence, suffered.
However the ground was laid further for this by recent Labour governments that presided over a programme of privatisation and Gordon Brown’s infamous Private Finance Initiative.
The current Labour leader, Miliband, is no different from Blair and Brown as he pledges to stick to the Tories’ cuts if he comes to power.
Former Tory Health Minister Lansley, the architect of the dismantling of the NHS, initiated a widespread programme of cuts of at least £20 billion, closures of Accident and Emergency departments and even the total closure of hospitals. NHS hospitals can now earn up to 50% of income from private work.
The mass opposition to this has been shown by virtual citywide uprisings in areas such as Lewisham in south London and Staffordshire. The government is prepared to ride roughshod over these protests, unless the labour movement, through the trade unions, demonstrates the maximum determination through national strike action to defeat them.
But this in turn raises the question of the alternative to cuts and the wholesale dismantling of what has been gained in the past, including the NHS. It is not possible to begin to formulate a programme unless we understand the crisis we are confronting.
This is the most serious capitalist crisis in living memory. When Miliband speaks of supporting progressive "responsible capitalism", we are entitled to ask, where is the model for such a strange beast?
Capitalism in its youth – the 19th century and the first part, perhaps, of the 20th century – demonstrated colossal vigour and power in transforming industry through the huge development of the means of production: science, technique and the organisation of labour. Therefore, socialists recognised that it was relatively progressive. Despite all the horrors of this system, by developing industry, technique, etc, it was preparing the way for socialism.
It was always a system for the production of profit – the unpaid labour of the working class – and not for social need. But during ’booms’ and upswings of production, the working class did gain some crumbs from the rich table of capitalism. However, this was only made possible by the creation of powerful organisations of the working class, which extracted concessions from the bosses, sometimes at the cost of bitter struggles.
But now ’modern’ capitalism has been transformed into a colossal machine for destroying wealth and shattering working people’s dreams. Young people are being forced away from their families, their friends and even their homelands in a frantic scramble, mostly futile, in a quest for jobs, any job.
In Greece, 56% of young people are officially unemployed; the real figure is much higher than that. The same in Spain, Italy and Portugal. It is estimated one million people will leave Portugal because there is no future for them where they were born. They will be the flower of Portugal, the very future of the country, young people in the main, many with degrees.
It is a living death to be unemployed, particularly if you’re young. But it is a different kind of living hell if you’re on a zero-hour contract which forces millions of young and old workers to become virtual wage slaves, subject to the beck and call of the bosses and their hirelings.
George Osborne’s fanfare for a ’recovery’ from the crisis is completely fake. The only recovery that is underway is in the pockets of the bosses, not in the living standards of the working class. Frances O’Grady, the head of the TUC, pointed out that in the last five years the reduction in wages is the greatest recorded for a five-year period since the end of World War Two.
We could fill the whole of this issue of the Socialist with the facts and stories of increasing misery for working class people, which the continued existence of crisis-afflicted capitalism means.
The Child Poverty Action Group has declared: "It’s a national scandal that more families are being referred to food banks in the summer holidays – a time when children should be having fun and parents should be enjoying life." Literally the very poorest workers in Britain are either already starving or on the verge of this, with charities at their wits’ end trying to provide safety nets.
The fear that the cold cruelty of the Coalition towards the poor and particularly children is a common perception has forced the government – through the opportunist mouthpiece of Nick Clegg – to announce free school meals for infant schoolchildren. All school students should receive free school meals.
The capitalists say that theirs is the best system – despite its drawbacks – possible for humankind. But we say to them, your own newspapers clearly demonstrate that your system is wasting the treasure and resources of society and threatens to drag working people further into the mud.
This system has drained to its last drop the cup of historical progress by not being able to provide the minimum of jobs, homes and adequate incomes. It should make way for a more efficient and sane system.
Crises of the kind we see now are not possible in a planned economy. If established it would eliminate the phenomenon of capitalist ’overproduction’, particularly if a planned economy was under workers’ control and management.
If the full potential of the economy was used then the £81 billion in cuts which Osborne is implementing would not even be considered. We would then not be facing what the Guardian called a descent into "chaos" with benefit cuts that will cost an extra £1.4 billion because of delays, extra claims, waste and complaints.
The Tories, led by the unspeakable Grant Shapps, were outraged at the plain speaking of the Brazilian UN rapporteur on housing. She had more fire in her belly than all the New Labour leaders put together when denouncing the bedroom tax and the suffering which this has inflicted.
The government prefers to hail the mostly fictitious recent increase in housing starts, even though it is only half of what is needed to begin to tackle the UK’s housing shortage. Housing charity Shelter says the coalition is building fewer than half of the 250,000 homes needed annually to meet extra demand.
"But your socialist schemas have failed, shown by the collapse of the Soviet Union and Eastern Europe, and the move towards capitalism in China. This proves that socialism is a utopian project," intone the capitalist ideologists.
To the bosses we say: "What you call the failure of ’socialism’ is nothing of the kind. What collapsed in these countries was a caricature of real democratic socialism. It was Stalinism that fell with the Berlin Wall, the rule of a greedy wasteful bureaucratic elite. But the planned economy, upon which the bureaucratic elite rested, was also scrapped."
But is this not always what happens? The argument runs that socialism can be established but then degenerates into the rule of a wealthy elite, who pretend to be socialists and Marxists. But we have to look at the concrete circumstances which led these countries to break from capitalism. Clearly that system failed and they took to the road of socialism.
That was the case in Russia, in which the greatest single event in human history, the October 1917 revolution, took place. The workers there initially established a planned economy but which was crucially accompanied by democratic workers’ control and management.
They understood that they would not be able to maintain a real democratic socialist society in Russia in isolation. ’Socialism in one country’ is not possible, particularly in an economically and culturally backward country.
That is why the Russian workers saw the revolution as an overture to world revolution, in Germany immediately. They well understood that this was the precondition for them to move towards socialism.
If a similar socialist overturn was carried out in Britain or in any other advanced industrial country, the future would be entirely different. Workers and the population generally are more educated, have access to modern technology. They would not allow a greedy, inefficient elite to usurp power by establishing a totalitarian and bureaucratic system.
Workers’ democracy would mean the election of all officials, the right of recall and no official to receive more than the average wage of a skilled worker. These are essential measures to prevent corruption and bureaucracy. There could also be the rotation of duties in the management and organisation of society. The cutting of the working day would facilitate this. These measures would be essential in the transition from capitalism to the beginning of socialism.
Moreover, no parties will be illegal – perhaps apart from the fascists who wish to destroy democracy. There would then be a peaceful struggle for influence and support. The pro-capitalist Tories would not make much headway if they called, as they will, for the return to capitalist mass unemployment, hunger and war!
The battle to save the NHS involves raising the idea now of a new kind of society organised and planned on socialist lines. This idea has not yet gripped the minds of the majority of workers, largely because the pro-capitalist leaders of New Labour and the trade union leaders have not raised the sights of working people to what is possible on the basis of a clear socialist programme.
The battle to defend the NHS is a vital struggle because it does signify, at least in outline, an alternative to the dog-eat-dog philosophy of capitalism. You only have to look at the US and the monstrous system which passes for a ’health service’ there.
We must step up the campaign in defence of the NHS, but we should also see this as part of the process leading to the development of new forms of organisation of society, through a democratic, socialist planned economy.
Waste under capitalism: More estate agents but no more housing
Better kidney care could save up to 42,000 lives a year, says the National Institute for Health and Care Excellence (NICE). Acute kidney injury costs the NHS more than it spends on breast, lung and skin cancer combined.
And kidney machines could be afforded just by cancelling the huge amount of waste under capitalism, exemplified by the revelations on the number of estate agents in Britain.
When Osborne claims to be on the way to solving the unemployment problem, he will gloss over the fact that the recent increase in employment is because of temporary, short-term jobs or the 77,000 extra estate agents who have been employed in the last year, reaching a grand total of 562,000 in Britain today! This, while only 1,000 extra construction workers found jobs building homes, and real jobs in manufacturing industry actually fell by 14,000! The Guardian comments, ironically: "This is what Mr Osborne terms a ’broad-based recovery’."
Food and hunger
About two million tons of food is lost every year: much of the crop never gets to the market in the poorest countries, while food is scraped off the plate and into the bins of the richest nations. Almost one billion people still go to bed hungry at night.
"Food banks across Britain are being inundated with requests for emergency meals as families struggle to feed their children through the school holidays," reported Emily Dugan. [Independent, 10 August] In Grantham, Thatcher’s birthplace, there has been a 61% increase in those seeking help from food banks in just one month. This story is repeated throughout Britain, with a 71% increase in Redcar, Teesside, while in Dundee, a 43% increase was recorded.
Tower Hamlets in East London, on the other hand, has the highest proportion of pupils on free school meals in the country. Yet in the last month it has undergone a dramatic change. In June, 111 people received emergency food parcels but in July this rocketed to 202 in July and 107 in the first week of August alone!