On both sides of the Atlantic, the last few months have seen various supposedly alternative models for health care inside capitalism being explored. Barack Obama’s review of US health care provision within his first year in office has met a predictably heated response from the paid lobbyists and cheerleaders of the health insurance industry, as well as other sectors of the US capitalist class with something to lose from any change to the status quo.
The costs of individual medical insurance being prohibitive, the poor of this so-called first world nation (46 million of them) are left with Third World levels of care and medical support, and daily “life and debt” decisions.
Whilst there are some differences between the US and UK healthcare system, we shouldn’t over-exaggerate them. Heated though the US v NHS debate may be, it is essentially a phoney war. From a world socialist perspective, these are just alternative capitalist models for rationing healthcare for the working class
The US system places a cash register and swipe card console at the foot of your hospital bed. In terms of the immediacy and impact on the patient, the NHS and similar systems in Europe certainly seem a little more ‘civilised’. But there is of course still a reckoning somewhere down the line. The ‘socialised’ systems just remove that decision from the immediacy of the ward. Instead the decision is made at one remove: by an NHS Trust or the government that allocates its funds. The decision isn’t made for you as an individual patient, but for your class as a whole, the working class who constitute some 90 percent of the population.
The reason the US administration is looking again at how their system is – or isn’t – working, has little to do with how ethical or plain nice it wants its society to be. Instead it is driven by a need to make economies and find the most efficient way to maintain the health of the US workforce. After all, despite the egalitarian claims surrounding it, the introduction of the NHS to the UK had a solid capitalist ‘business case’ behind it and was supported by all main parties. (The cost to the US state per head of population is now approximately twice that in the UK).
The NHS – and the other examples quoted of ‘socialised’ medicine (e.g. Scandinavian countries) – are not socialism, which we would argue means a moneyless and wageless economy as a whole. However at an individual and emotional level (rather than at a political level), it would be churlish of world socialists to dismiss out of hand the strong empathy and support for the NHS that most workers in Britain have. It is after all support for free access, for the idea that healthcare be freely available to all regardless of wealth.
At one level, world socialists entirely empathise with this sentiment. But not to the extent of getting caught up in expressing political support for one type of capitalist healthcare system over another: only a social system based on production for use rather than profit for the few, can truly realise this powerful and fundamentally egalitarian desire.