Posts Tagged ‘Dialysis’

William Blum on Socialism vs. Capitalism

September 19, 2017

William Blum, the long-time fierce critic of American and western imperialism, has come back to writing his Anti-Empire Report after a period of illness. He’s an older man of 84, and due to kidney failure has been placed on dialysis for the rest of his life. This has left him, as it does others with the same condition, drained of energy, and he says he finds writing the report difficult. Nevertheless, his mind and his dissection of the ruthless, amoral and predatory nature of western capitalism and corporate greed is as acute as ever.

There’s a section in the Anti-Empire Report, where he discusses the advantages of socialism versus capitalism. He notes that there were two studies carried out under George Dubya to see if private corporations were better than federal agencies. And the federal agencies won by a huge margin every time. He writes

Twice in recent times the federal government in Washington has undertaken major studies of many thousands of federal jobs to determine whether they could be done more efficiently by private contractors. On one occasion the federal employees won more than 80% of the time; on the other occasion 91%. Both studies took place under the George W. Bush administration, which was hoping for different results. 1 The American people have to be reminded of what they once knew but seem to have forgotten: that they don’t want BIG government, or SMALL government; they don’t want MORE government, or LESS government; they want government ON THEIR SIDE.

He also states that the juries’ still out on whether socialist countries are more successful than capitalist, as no socialist country has fallen through its own failures. Instead they’ve been subverted and overthrown by the US.

I think he’s wrong about this. The Communist bloc couldn’t provide its people with the same standard of living as the capitalist west, and the state ownership of agriculture was a real obstacle to food production. The bulk of the Soviet Union’s food was produced on private plots. Similarly, Anton Dubcek and the leaders of the Prague Spring, who wanted to reform and democratize Communism, not overthrow it, believed that Czechoslovakia’s industrial development was held back through the rigid structure of Soviet-style central planning.

However, he still has a point, in that very many left and left-leaning regimes have been overthrown by America, particularly in South America, but also across much of the rest of the world, as they were perceived to be a threat to American political and corporate interests. And for the peoples of these nations, it’s questionable how successful capitalism is. For example, in the 1950s the Americans overthrew the Guatemalan government of Jacobo Arbenz after he dared to nationalize the banana plantations, many of which were own by the American corporation, United Fruit. Benz was a democratic socialist – not a Communist, as was claimed by the American secret state – who nationalized the plantations in order to give some dignity and a decent standard of living to the agricultural workers on them. The government that overthrew Benz was a brutal Fascist dictatorship, which imposed conditions very close to feudal serfdom on the plantation labourers.

Which leads to a more general point about the emergence of capitalism, imperialism and the exploitation of the developing world. Marxists have argued that capitalism had partly arisen due to western imperialism. It was the riches looted from their conquered overseas territories that allowed western capitalism to emerge and develop. Again this is a matter of considerable debate, as some historians have argued that the slave trade and plantation slavery only added an extra 5 per cent to the British economy during the period these existed in the British empire, from the mid-17th century to 1840. More recently, historians have argued that it was the compensation given to the slaveowners at emancipation, that allowed capitalism to develop. In the case of the large slaveholders, this compensation was the equivalent of tens of millions of pounds today. At the time the plantation system was in crisis, and many of the plantation owners were heavily in debt. The slaveholders used the money given to them by the British government – £20 million, a colossal sum then-to invest in British industry, thus boosting its development.

This system has continued today through what the Swedish economist Gunnar Myrdal termed ‘neocolonialism’. This is the international trading system which the former imperial masters imposed on their colonies after the end of imperialism proper following the Second World War. High tariffs and other barriers were imposed to stop these countries developing their own manufacturing industries, which could produced finished goods that would compete with those of Europe and the west. Instead, the former subject nations were forced through a series of trade agreements to limit themselves to primary industries – mining and agriculture – which would provide western and European industry with the raw materials it needed. As a global system, it’s therefore highly debatable how successful capitalism is in providing for people’s needs, when the relative success of the capitalist west has depended on the immiseration and exploitation of countless millions in the developed world.

And in the developed west itself, capitalism is failing. In the 19th century Marx pointed to the repeated crises and economic slumps that the system created, and predicted that one of these would be so severe that it would destroy capitalism completely. He was wrong. Capitalism did not collapse, and there was a long period of prosperity and growth from the late 19th century onwards.

But terrible, grinding poverty still existed in Britain and the rest of the developed world, even if conditions were slowly improving. And the long period of prosperity and growth after the Second World War was partly due to the foundation of the welfare state, Keynsian economic policies in which the government invested in the economy in order to stimulate it, and a system of state economic planning copied from the French.

Now that Thatcherite governments have rolled back the frontiers of the state, we’ve seen the re-emergence of extreme poverty in Britain. An increasing number of Brits are now homeless. 700,000 odd are forced to use food banks to keep body and soul together, as they can’t afford food. Millions more are faced with the choice between eating and paying the bills. In the school holiday just passed, three million children went hungry. And some historians are predicting that the refusal of the governments that came after the great crash of 2008 to impose controls on the financial sector means that we are heading for the final collapse of capitalism. They argue that the industrial and financial elite in Europe know it’s coming, are just trying to loot as much money as possible before it finally arrives.

The great, free trade capitalism lauded by Thatcher, Reagan and the neoliberal regimes after them has failed to benefit the majority of people in Britain and the rest of the world. But as the rich 1 per cent have benefited immensely, they are still promoting neoliberal, free trade policies and imposing low wages and exploitative working conditions on the rest of the population, all the while telling us that we’re richer and generally more prosperous than ever before.

Back to Blum’s Anti-Empire Report, he also has a few quotes from the American comedian Dick Gregory, who passed away this year. These include the following acute observations

“The way Americans seem to think today, about the only way to end hunger in America would be for Secretary of Defense Melvin Laird to go on national TV and say we are falling behind the Russians in feeding folks.”

“What we’re doing in Vietnam is using the black man to kill the yellow man so the white man can keep the land he took from the red man.”

For more, see https://williamblum.org/aer/read/150

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Robin Cook’s Attack on Private Health Insurance for the NHS

March 15, 2015

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I’ve blogged several times about the threat to the NHS from the Tories and the Lib Dems. There are 92 Conservative and Lib Dem ministers, who advocate the privatisation of the Health Service, and who stand personally to gain from it. They include Iain Duncan Smith, the current minister for culling the poor, the sick and the old. Andrew Lansley, the current health minister, has openly stated he is in favour of privatising it. So has Nigel Farage, and the Unterkippergruppenfuhrer, Paul Nuttall.

I blogged earlier today about the Fuhrage’s forked tongue about the NHS, and how he follows the Tory policy going all the way back to Thatcher of promising to defend it while secretly plotting how to sell it off. In the 1980s, Thatcher set up a review into the NHS and its funding. This so alarmed Labour’s Robin Cook, that he wrote a Fabian pamphlet, Life Begins at 40: In Defence of the NHS, attacking possible proposals to privatise the Health Service.

Previous reviews had given the NHS a clean bill of health. The extremely high quality of the NHS and its doctors was recognised by the heads of American healthcare firms: Dr Marvin Goldberg, chief executive of the AMI health group, told a parliamentary select committee that the Health Service provides ‘outstanding health care and British NHS hospitals are at least as good as those in America while British doctors are better.’

The then Conservative MP for Newbury, Michael McNair-Wilson, also testified to the effectiveness of the NHS. He had suffered kidney failure. He had private health insurance, but it did not cover operations such as the one he needed because of the expense. He said ‘I have cost the NHS tens of thousands of pounds – much more than I could have afforded privately … Had my treatment depended on my ability to pay, I would not be alive today.’

Pre-NHS Britain: Some Areas Completely Without Hospitals

Cook’s pamphlet also graphically described the patchwork state of healthcare in Britain before the NHS. In London, where there were plenty of paying customers, there could be hospitals in neighbouring streets. Out in the poorer British provinces, there were hardly any, and many operations were carried out not by surgeons but by GPs. He cites Julian Tudor Hart’s book, A New Kind of Doctor, to show how bad this could be. Hart described how he joined one of those practices in Kettering. One patient was left under anaesthetic as the London specialist operating on him was called away to continue a stomach operation on a London patient, which the operating GP had been unable to complete.

Cook was deeply concerned that the Tories’ review would not be at all interested in improving quality, only in opening up the NHS to the market and privatisation.

Cook on Private Health Insurance

One of the issues he tackled in the pamphlet was the possibility of the introduction of private health insurance. This covers two pages and a column and a bit in the original pamphlet. This is what he wrote, though emphases and paragraph titles are mine.

The mechanism proposed to square the incompatibility of health care with the market is insurance. All market approaches to the NHS submitted to the Review stress the case for much wider private insurance and almost as frequently propose subsidies to boost it.

Insurance-Based Systems Encourage Expensive Treatment

The first thing to be said is that private insurance does not offer to health care the alleged benefits of the discipline of the market place. At the point when the individual requires treatment he or she has already paid the premiums and has no incentive not to consume as expensive a treatment as can be reconciled with the policy. The position of the doctor is even more prejudiced in that he or she has every incentive to obtain as much as possible from the insurance company by recommending the most expensive treatment. Both patient and the doctor are in a conspiracy to make the consultation as costly as possible, which is a perverse outcome for a proposal frequently floated by those who claim to be concerned about cost control.

Insurance-Based Systems Encourage Unnecessary Surgery

The compulsion in an insurance-based system to maximise the rate of return is the simple explanation why intervention surgery is so much more often recommended in the United States. For example, the incidence of hysterectomy there is four times the British rate. This is unlikely to reflect higher morbidity rates but much more likely to reflect the greater willingness of doctors on a piece-work basis to recommend it, despite the operative risks and in the case of this particular operation the documented psychological trauma. I can guarantee that an expansion of private insurance will certainly meet the objective on increasing expenditure on health care, but it is not equally clear that the money will be spent effectively.

Insurance-Based Systems Require Expensive bureaucracy to Check Costs

One direct diversion of resources imposed by any insurance-based scheme is the necessity for accountants and clerks and lawyers to assess costs and process claims. The NHS is routinely accused of excessive bureaucracy, frequently I regret to say by the very people who work within it and are in a position to know it is not true. Expenditure in the NHS is lower as a proportion of budget than the health system of any other nation, lower as a proportion of turnover than the private health sector within Britain, and come to that, lower than the management costs of just about nay other major enterprise inside or outside the public sector. I am not myself sure that this is a feature of which we should be proud. ON the contrary it is evidence of a persistent undermanaging of the NHS, which is largely responsible for its failure to exploit new developments in communication, cost control and personnel relations. Nevertheless, there is no more pointless expansion of administrative costs than the dead-weight of those required to police and process and insurance-based system. These costs would be considerable.

Forty per cent of personal bankruptcies in the US are attributable to debts for medical care

Part of this additional cost burden is incurred in the task of hunting down bad debts, which does not contribute in any way to the provision of health care. Forty per cent of personal bankruptcies in the US are attributable to debts for medical care, a salutary reminder of the limitations set to insurance cover. These limitations have three dimensions.

Insurance Cover Excludes Chronic and Long-Term Sick, and the Elderly

First, insurance cover generally excludes those conditions which are chronic and therefore expensive or complicated and therefore expensive. Standard exclusions in British insurance policies are arthritis, renal dialysis, multiple sclerosis or muscular dystrophy. Most people do not require substantial medical care until after retirement. Most insurance cover excludes the very conditions for which they are then most likely to require treatment. Short of retirement, the most expensive health care required by the majority of the population is maternity care, which is also excluded by the majority of insurance policies.

Private Healthcare Limits Amount of Care due to Cost, not Need

Secondly, insurance cover is generally restricted by upper limits which are arbitrary in every sense other than financial. I recently met a psychiatric consultant to a private clinic, who was prepared to discuss candidly the ethical dilemmas of treating patients whose financial cover is fixed at five weeks of residential care, but whose response to treatment may indicate that a longer period of hospitalisation is desirable.

Private Health Care Geared to Selling to Healthy not Sick

Thirdly, insurance cover is further limited by exclusion of those most likely to claim on it. I am often struck at the sheer healthiness of the patients who illustrate the promotional literature of BUPA and PPP who appear in such pink of good cheer and fitness that it is difficult to figure out why they are in a hospital bed. These models are though in a sense most suitable for the purpose as the objective of insurance companies is to attract the healthy. They therefore claim the right to screen for the unhealthy and reject them from cover. This discriminatory approach was defended earlier this month by the managing director of WPA, Britain’s third biggest health insurer, on the principled grounds that it meant ‘essentially healthy people are not penalised by unhealthy people.’ This statement has the advantage of originality in that it perceives healthy people as the vulnerable group and proposes a market remedy that protects them from the inconvenient costs of the unhealthy.

Given this limited character of health insurance in Britain, the private sector is patently not in a position to substitute for the NHS and to be fair most directors of BUPA or PPP would be horrified at the notion of accepting the comprehensive, open-ended liabilities of the NHS. It is therefore perplexing that so much effort in and around the Review appears to be addressed to the issue of how the private sector may be expanded rather than how the public sector may be improved. Two major devices are being canvassed to boost private cover-tax relief on private cover or opt-out from public cover, or for all I know both of them together. Both would be a major mistake.

Tax Relief on Private Healthcare

Tax relief is open to the obvious objection that it targets help most on those who need it least – the healthy who are most likely to be accepted for private cover and the wealthy whose higher tax rates make relief most vulnerable. These are curious priorities for additional health expenditure.

Tax Relief Does Not Create Higher Spending on Health Care

Moreover, even in its own terms of stimulating higher spending on health, tax relief is likely to prove an ineffective mechanism. If for example the average premium is £200 pa the cost of tax relief for 6 million insured persons will be £300 million. The numbers under insurance need to increase by a third before the increased spending on premiums matches the cost of the subsidy and provides any net increase in health spending. Up to that point it will always produce a larger rise in health spending to increase the budget of the NHS by a sum equivalent to the cost of tax relief.

It is apparently being mooted that these objections could be circumvented by limiting the tax relief to the elderly. At this point the proposal moves from the perverse to the eccentric. This restriction targets help for private insurance on the very group for whom private cover is most inappropriate as their most likely health needs are the ones most likely to be excluded from cover. Only a moment’s reflection is required on the multiple ways in which we need to expand our health provision for the elderly to expose the hopeless irrelevance of tax relief as the solution for them.

Opt-Out Penalises those who Remain in the System

Opt-out is even more objectionable. The basic problem with opt-out is that it requires the payment towards the NHS of every individual to be expressed in a manner that gives him or her something to opt-out from. The principal attraction to Leon Brittan of his proposal for an NHS insurance contribution appeared to be precisely that it paved the way for opting out ( A New Deal for Health Care, Conservative Political Centre,, 1988). Nor is this inconvenience confined to the need for a whole new element in the tax system. If one in ten of the population chose to opt out, it would be remaining nine out of ten who would have to prove they were not opted-out when they went along to seek treatment. With the new contributions comes a requirement to maintain a record of payment of them, and presumably a mechanism for credits to those not in work but who do not wish to be counted has having opted out of the NHS.

Private Healthcare Undermine NHS as Universal System

The more fundamental objection both these proposals is they explicitly threaten the NHS as universal health service catering for everyone. Moreover, they threaten its universality in the worst possible way, by encouraging those with higher incomes and lower health needs to get out, leaving behind the less affluent and the less fit. In this respect such an approach to the NHS would be a piece with the Government’s strategy of erosion towards the rest of the social services-housing, pensions, and now education, where the Government has encouraged those who could afford it to opt-out of public provision, leaving behind the poor who could be expected to put6 up with a poor service.

This is the reality of the private healthcare system which Cameron, Clegg, Farage and the rest of the Right wish to introduce. It is expensive, bureaucratic, does not stimulating further spending, and excludes those with the most acute and expensive medical need, especially the elderly.

And the Tories and their counterparts in UKIP and the Lib Dems know it. Why else would the Tories spend their time trying to deny what they’re doing? Why does Farage appear to be advocating retaining the NHS, while arguing for an insurance based system, like America? It’s because they know that private medicine does not provide the solutions they claim. It is only source of further enrichment to them and their corporate donors.

And since Cook wrote that pamphlet, more than 20 per cent of all Americans can no longer afford their healthcare. It’s why the firms are trying to get their feet under the table over here.

Don’t let them. Miliband has promised to reverse the privatisation of the NHS. Support him in the coming election.