[Marxism] Marxism Digest, Vol 180, Issue 38

hari kumar hari6.kumar at gmail.com
Fri Oct 26 12:24:23 MDT 2018

 [Marxism] The-Opportunity-Costs-of-Socialism.pdf [not

Regarding the health care systems - and whether interim solutions short of
a fully communist health care systems are of any benefit to the working
I have now worked in 4 health care systems as an academic intensive care
physician for children.  Having basically been left jobless as Thatcher cut
the NHS dramatically, I was forced to travel unless I went private.
In my own working life, I have no doubt that a capitalist system sponsored
'socialised' health care is infinitely superior. I do not think any one
working in the health care services, with any dual experience of a national
insurance plan (e.g. UK; Canada; much of Europe) versus a fully privatised
system (USA), could doubt that the first is superior - for the working
1) Objective data; on adult mortality; on infant mortality; there can be no
doubt that despite the reformist aspects of the health care systems in the
former - confirms this. Myriads of data has supported this, much of it
adduced by PNHP and in the USA, Woolhandler and Himmelstein; and in Canada
by Guyatt.
2) No doubt that especially on issues of public health-prevention (Perhaps
for us, most importantly initially championed by Engels, then the great
physician Rudolph Virchow; and then by for , e.g., Henry Sigerist and of
course many, many others since), the capitalist health care systems
generally do not pay attention to this.
3) Nonetheless, capitalist systems have varied in their penetration of
prevention. For e.g. the Scandinavian systems, even now, with their
increasing concerns with cut-backs, have good (excellent) he alt care
preventive strategies for prematurity, for maternal benefits,
peri-pregnancy leaves etc.
4) The primary reasons for capitalist systems to introduce the health care
systems in general were, partly identified by Engels in his path-breaking
"Condition of the WC etc".  Namely (i) the scourges of contagion do not
restrict themselves to the workers alone, but - being infectious - 'travel'
- and thereby affect the ruling class also. Hence - the bourgeoisie
protects itself by reforms. Such as Jeremy Chadwick's immense sanitation
works in the middle of the Industrial Revolution. (ii) To enable a health
working class gun-fodder - witness the improvements post Boer War (iii) To
defang revolutionary ferment (iv) Finally, a heath work force by and large
increases dividends to an industrially inclined bourgeoisie (of less
importance as far as I can see to the financial capitalist sections). So -
objectively - many of the more far-sighted capitalist classes have accepted
that a decent helot care system overall - benefits they themselves.

I guess the point of this post is to just simply agree with Meeropol - that
it is worth protecting a 'socialised' system, and attempts to move towards
that. Albeit they are 'reformist'.  A single payer system is undoubtedly
better than otherwise, as it does reduce at least a couple of non-rational
drivers: The insurers and physicians tendency to bill for profit; and it
also potentially enables reducing drug expenditure.
Hari Kumar

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