From the April 1985 issue of the Socialist Standard
We have all heard about "uneconomic" pits. These are the coal mines which could be operated for social use, but must be closed because economists have decided that there is insufficient profit to be milked from them. Now, let us meet another concept in the lunatic asylum of capitalist economics: uneconomic hospitals. You don't believe that a hospital which is running efficiently to provide vitally needed cures for ill people should be closed down? Well, perhaps you need to be educated in the stupidity of the profit system.
In London there is a hospital called Guy's. Within the hospital there is a heart unit—one of the most technologically advanced in the whole of Europe, according to heart specialists. Last year the unit treated 712 adult patients and 73 babies. Many of them would have died without treatment. Waiting lists mean that most patients requiring treatment must wait for about eight months before receiving it—even urgent cases (defined as those who will die if not operated on within a year) have to wait for about four months. In short, the unit is under pressure from the demand of patients with real needs. The doctors in the unit, not wanting people to die for lack of treatment, have been working as quickly as is safe to ensure that they can operate on the maximum number of patients. One would expect no other response from sane and caring people. But the doctors find themselves in conflict with capitalism, which is not a sane and caring system, and so we encounter the problem of the uneconomic hospital.
In February of this year the heart specialists at Guy's were informed by the Lewisham and North Southwark Health Authority (the important people who control the money) that they were treating too many patients. Too many, by what criterion? Are we to assume that the surgeons at Guy's are dragging in people off the streets and giving them coronary surgery when they don’t need it? No; the "Health" Authority—which should really be called a Money Authority—has said that the doctors have exceeded their annual quota of operations and that if more are carried out in the current financial year it would cost the Authority £80-£130,000 more than they can afford to pay. Between February, when the order to stop operating was given, and April, when the new financial year begins, the Guy's heart unit would have carried out 51 operations, some of which were to have been on people who would otherwise die. But they have been ordered to "cease production" (to use an economist's phrase) and let people die while the heart unit stands idle. Patients will not be able to receive treatment in the other London cardiac units because they are working to capacity and cannot afford to treat extra patients. If some of the patients who would have received treatment are now dead, it would be reasonable to state that they have died as the victims of capitalism, for it was the economic system and not the technology of society which failed them. Even before the closure was decided on, the director of the heart unit, Mr. Alan Yates, stated that five adult patients had died waiting for treatment in the previous six months.
What sort of a social order do we have which orders a surgical unit to be closed down for six weeks because there is plenty of human demand for it, but not enough money? Doctors do not need money to save lives, but skill, technology and a desire to put them to social use. But under capitalism skill, technology, the will to help other people and the needs of ill people are nothing in the face of the profit and loss balance sheet. If you gave £130,000 to an unskilled person he would not be able to cure patients dying of heart illness; money is simply a social interference in the really important process of human activity. And time and time again it stands between life and death.
Last year the government received a report on heart transplants which it had commissioned from economists at Brunei University three years ago. Not from doctors, who know a thing or two about heart transplants, but from economists, who know a thing or two about investing money. No person who examines the fact that human lives have been saved by heart transplant surgery can deny that research and practical work in this area is of immense medical use. But economists are the slaves of profit, not the observers of use, and their concern is not "How useful?" but "How much?" The report states that "at a minimum of £12.500 a go, and with 900 patients a year waiting for a new organ and new life, hard choices will have to be made". (As paraphrased by the Guardian, 20 February 1985.) The report states that heart surgeons at Harefield and Papworth (the two British hospitals where heart transplant surgery takes place) have had to watch 68 of their patients die because they did not have the money to treat them. The two hospitals have had to turn away 65 donated hearts "because they did not have the resources to give them to patients". The problem which has been imposed by capitalism's economic priorities was well stated by Professor Christopher Dickinson of St. Bartholomew's Hospital. London:
Present needs for medical services simply cannot now be met by present resources. The gap between reasonable demand and actual supply is rapidly widening. (Editorial, British Medical Journal, February 1985.)
The British government spends £1.5 million every hour on paying for the costs of its armed forces. There is "economic demand" for the skills and technology for killing people. A fraction of one hour's military expenditure would keep the Guy's heart unit open for six weeks and save lives. But the priorities of the market are not based on sentimentality and the reformist cry that money on weapons "should" be spent on health care is as futile as that of the sincere, but hopelessly naive, vicars who request generals commanding armed thugs to act in line with humanitarian ethics. The hard fact is that capitalism is not in existence to satisfy the needs of the working class, and those who hold out the hope of reforming it so that it will are deceiving themselves and others. Members of the Labour Party say that the present state of the NHS is the fault of Thatcherism. If that is so, why was it that there were countless demonstrations to Fight the Cuts under the last Labour government? Indeed, every time the reformist windbag, Neil Kinnock, rises in the House of Commons to bemoan what the wicked Tories are doing to the NHS, the wicked Tories stand up and read out the record of the last Labour government, which was as energetic as was economically necessary in closing down hospitals and cutting health services. To believe that the election of a Labour government will change the perverse economic priorities of the profit system is as foolish as to believe Margaret Thatcher when she says that "the NHS is safe in my hands".
So-called uneconomic pits mean that thousands of workers are prevented from doing useful work because there is no market demand for their product, even though there is social demand. Uneconomic hospitals mean that tomorrow morning a reader of this article may receive a letter from a doctor saying that he or she or one of their children is in need of vital heart surgery. But they'll have to wait. They might die waiting. If they do not die waiting they will probably be in pain. Imagine having to wait outside a heart unit which is standing empty, suffering from acute pain, but the doctors and nurses who want to help you have been issued a command from the economic experts: No help to be given to your patients until the new budget comes into effect. What a stupid way of organising a society which has developed medical technology to unprecedented levels.
The socialist solution is too simple to require elaboration. Produce for use. Utilise the skills and technology of society to satisfy the needs of the people of the world. Abolish money and all of the useless features of this crazy system. It is simple to understand. Something to think about while you're waiting to see the doctor, perhaps.
Steve Coleman
Since this article was written, the unit has been reprieved for a time by a donation of £272,000 from a Florida millionaire. Our argument is not affected by this example of a capitalist giving a fraction of the fortune he has amassed from the exploitation of the workers to help keep some of them in better working order The regional manager of the Southeast Thames Health Authority pointed out that the money " . . . only provides a breathing space" After that? Well, the head of Guy's cardiology unit realises that "Ultimately we have to look at what sort of health service we are willing to afford'
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