Health-care

 Large-scale sanitation in the developed world, vaccines, and even the NHS itself, must be seen as gains for the working class in some aspects. The whole process of the foundation of the NHS was a contradictory one, serving the interests of capital and, as a by-product, that of the workers. The strong sympathy that most workers in Britain have for the National Health Service is after all support for free access, "to each according to needs", for the idea that healthcare is freely available to all regardless of wealth. Some health and welfare services are now available to some people free at the point of delivery or consumption. In socialism, the principle of free access according to reasonable needs will be universally applied. Yet in socialism, there won't be such a widespread demand for health and welfare services. Very different goods could then be manufactured, possibly using alternative technologies, with work organised in different ways, so as to reduce the possibility of ill health arising in the first place. And although it would be absurd to say that all diseases would be abolished, we can assume that a real concern for the health of the population would be reflected in planning and decision making. Such a society is not a pipe-dream, but the logical outcome of the working class taking control of their own struggles. The demand for a healthier society is in effect a revolutionary demand since health-damaging aspects of production cannot be removed in response to political reform.

In an ideal world, the application of medical interventions would be guided by the criterion of scientific objectivity and driven solely by the concern to meet human needs. So would healthcare be any different if socialism were established? Yes, it would. Why? Take one or two minutes out and just think how the non-existence of wages, profits and budgets would change the present situation. Then think about the end of the hierarchies that dominate healthcare at present and no more layers of useless bureaucrats skimming their share. Instead, healthcare would be conceived and administered, democratically by us, the people who brought socialism about.

Globally, doctors, nurses, scientists and everyone at present involved in healthcare at the human level would act as guides, informing people as to where healthcare is capable of going once the artificial barriers of money had been eliminated. The recruitment, training and deployment of committed volunteers will take much organising and administration. The emphasis will be on activities and tasks rather than on occupational labels: nursing, brain surgery, portering, scientific research, and so on, rather than nurses, brain surgeons, porters, scientific researchers. Everywhere we shall treat each other as friendly co-operators.

Although we cannot specify in advance a utopian blueprint for a socialist health policy what we can say about the likely effects on health and illness of future socialist society is that the promotion of good health and the care of the injured and sick won’t be restricted by money considerations. There will be no profit to be made out of employing people in dangerous occupations, supplying them with unhealthy substances or encouraging their harmful addictions. No sales-people will advertise items and services that at best have no good effect on health and at worst damage it. Health and injury insurance and the compensation industry won’t be necessary. The types and incidence of health problems are likely to differ in the early stage of socialism from later stages when the legacy from the money system will have receded. Also, some parts of the world today have different degrees of economic development, commonly referred to as under-developed, developing and developed. We don’t know the extent to which present trends, such as urbanisation and environmental degradation, will continue, accelerate or be reversed. One thing we can say for certain is that socialism will release us from useless and harmful capitalist employment. We shall be free to take up work that will meet the needs of ourselves, others and the community, society and world in which we live. This is not to say that there won’t be problems to overcome. Natural disasters and pandemics won’t end with capitalism, although more effort will doubtless be devoted to avoiding and coping with them. Health and welfare problems resulting from natural disasters like floods or earthquakes will continue to require emergency measures. But the problems won't be as extensive. For one thing, people living in disaster-prone areas will be offered removal to safer environments.

Socialism will be able to provide decent care for the elderly. These now take up half the beds on the orthopaedic, chest and other medical wards. They are seen as a burden. In a socialist society real care – and that takes a lot of time, a lot of people – will be possible. Also, people with learning difficulties – those currently dismissed as mentally handicapped – can be more integrated into the community. A lot of people are currently left in hospitals because the society beyond can't be bothered, or lacks the cash, to care for them. Socialist hospitals will keep patients in for longer periods and not treat still frail and vulnerable patients as “bed-blockers”. At the moment hospitals do their best to throw patients out so that their beds can be filled. There will also be the follow-up treatment of district nurses and community psychiatric nurses engaged in home visits. People need to be properly looked after and capitalism isn't letting us do that as well as we can and should. There will be an increase in neighbourhood medical clinics and a return to rural cottage hospitals providing care and treatment although not performing complicated transplant surgery. Capitalism sees the unproductive disabled as a drain on profits. Socialism will promote a good life and society for all, regardless of health conditions.

The replacement of a society based on production for profit by one based on production for needs will not of course mean the disappearance of disabled people, but it will certainly change for the better the way they are treated. Whether someone enjoys perfect health or suffers slightly or severely from an ailment of some kind will make no difference to the free and equal access they will have to the goods and services society is able to produce. Men and women in different states of health will be able to contribute to the work of society in different ways. They will be in a position to balance the needs of themselves, others, the community and world society with their own physical and mental abilities and tastes.

 In a socialist society where the capacity for wealth production, unhampered by the colossal waste endemic to this one, can be released to the full, human values will predominate and energy can be concentrated on the causes of disease and its prevention. Issues such as the need for pharmaceuticals to make billions of pounds in profit will not exist.

But is there anything to think that socialism has something to offer as an answer to the problem of human misery? In socialism, we will still have some of the problems that make you feel miserable, scared, depressed or demented. Socialism is not a solution to all mental health problems, it is a solution only to those created by capitalist conditions of life, or to class conditions of life. While some of the problems are due to being human beings living within a social setting, others are due to being biological organisms, and as such will break down if we are damaged or just get old. While there could be reduced use of medication and increased use of social therapy, the power to detain people whose condition renders them dangerous to others will still be needed. Capitalism has long produced the potential for such individual development, the task now is to realise it, to persuade working people that there is more to living than the shit of capitalism—we are more than pigs, content with mere physical satisfaction. All the indications are that common ownership and democratic control are the best way to long life and happiness.

Minimising costs so as to maximise profits has harmful consequences. The health and welfare of the workforce and the effects on the environment take second place. That's what cutting costs mean. This is why at work we suffer speed-up, pain, stress, boredom, overwork and accidents. This is why we have to work long hours, shift-work and night-work. This is why the food we eat, the water we drink and the air we breathe are all polluted. So in socialism, there won't be such a widespread demand for health and welfare services.