Category: Austerity

The Violence of Austerity 2

Rudolph Virchow (1848) argued that ‘medicine is a social science and politics is nothing more than medicine on a grand scale’.

Structural and Institutional violence arises from the implementation of Austerity. Cameron, Osborne, May and Hammond have blood on their hands. Johnson, Gove, Rudd, Grayling…….

In 2013 David Stuckler and Sanjay Basu published ‘The Body Economic – Why Austerity Kills’ and stated that since 2007 the total number of suicides had risen by 10000 across the US and Europe while millions lost access to basic healthcare. Chopra (2014) reviews the book and points out that ‘Mental health outcomes feature prominently in these analyses. For instance, the authors report 1000 excess suicides in the UK due to the effects of this recession and a second wave of ‘austerity suicides’ in 2012‘.

 

Following the Great Financial Crash (GFC) of 2008, the neoliberal project in the UK was given an opportunity to push further on its (class) agenda which had been based on reducing State support for the public sector and social security claimants, encouraging privatisations, establishing financial deregulation, reduction of corporate tax and removing ‘red tape’ (worker’s rights and enviromental protection). The theory was based on ‘trickle down economics’ and Hayekian ‘free markets’. Jobs, growth and investment would follow. Austerity in this context was seen as a necessary corrective to the failing economy. It was not mentioned of course that one reason for the GFC was neoliberalism itself. In effect we have a neoliberal policy being implemented to correct the failures of neoliberalism.

For the sake of argument, lets accept the claim that indeed the UK enjoyed pre crash levels of growth above OECD averages (it has not), produced a high number of well paid secure, high skilled jobs with wage growth (it did not), and that investment significantly rose (it has not) and that productivity has soared (it has not). What is Austerity and what are its founding myths?

If a major tenet of neoliberalism is a reduction in state withdrawal from services and from support for workers and claimants, Austerity turbo charges it in the name of deficit reduction to address the national debt.

Austerity is first and foremost a move to permanently dissemble the protection state (Cooper and Whyte 2017) through reductions in targetted public spending. The view is taken that skivers and shirkers have grown fat on the largesse of the British Welfare State, a State that breeds dependency and since the GFC it is argued is now unaffordable. It is not about reducing state spending per se, as subsidies to the nuclear industry and help to buy schemes attest. Indeed State spending as a % share of GDP has not really moved since 2010. It is this that makes the ‘reduction of state spending’ neoliberalism rhetoric (as ideologically based class war) but not reality for the rich.

 

Austerity is based on the idea of ‘expansionary fiscal consolidation‘ (Alesina and Perotti 1995). Government cuts to public spending will (the theory says) encourage more private consumption and business investment. Not cutting public spending jeopardises investment and competitiveness. The reality is that public consumption in the UK is debt fuelled rather than from higher wages, and investment remains very poor.

Three myths underpin this approach from 2010:

  1. We all played a part in the financial crisis (New Labour caused the crash).
  2. Austerity is necessary.
  3. We are all in this together.

However, this masks real reasons for the policy:

  1. To further ease Capital Accumulation for the rich.
  2. To further extend wealth by growing inequality and through dispossession.
  3. To permanently dissemble the protectionist State.

In short: the violence of class war. Capital v Labour, the irreducible foundational contradiction of capitalism.

The institutional violence meted out by for example by G4S and ATOS is ‘ordinary’ mundane process violence, it is not exceptional but routine as experienced in people’s lives, involving fear humiliation, hunger, shame and early deaths. Using ‘maladaptive coping’ such as eating high fat sugary food, smoking, excessive drinking, taking drugs and having unprotected promiscuous sex, are as much reactions to as causes of poverty and violence. This ‘Moral Underclass Discourse’, which points to poor individual lifestyle choices, ignores the wider determinants of health, the mass of data on the ‘social gradient’ in health and of health inequalities. It also does not understand the complexity of personal agency and social structure in which reflexive deliberations (our inner voices) mediate between objective social structures, cultures and our personal concerns and projects.

We make our own history, but not in the circumstances of our own choosing“.

Institutional violence is pervasive and normalised so that we don’t always see it or feel it for what it is. Food banks, deportations, homelessness, debt, trafficking, evictions, precarity in low wage jobs are becoming part of the social fabric that is getting thinner by the day. This violence is slow violence whose effects may take time to come through. It also provides a pervasive threat of violence for those lacking the financial, social, cultural capital to either protect themselves or to escape.

Richard Horton (2017) in the Lancet (note not ‘Marxism Today’) outlined the arguments well:

Economists are the gods of global health. Their dazzling cloak of quantitative authority and their monstrously broad range of inquiry silence the smaller voices of medicine, trapped as we are in the modest discipline of biology. Economists stepped beyond the boundaries of the body long ago. They now bestride the predicaments of our planet with confident insouciance. It is economists we must thank for the modern epidemic of austerity that has engulfed our world. Austerity is the calling card of neoliberalism. Its effects follow an inverse harm law—the impact of increasing amounts of austerity varies inversely with the ability of communities to protect themselves. Austerity is an instrument of malice. Search under austerity and you will find few countries unaffected. Greece, of course, but also Mozambique, France, Scotland, Brazil, Portugal, Spain, Cameroon, Belgium, the Netherlands, South Africa, and England. Economists advocating, and governments implementing, austerity naturally reject the word. Instead, they call austerity, “living within our means”. But be clear. What is promoted as fiscal discipline is a political choice. A political choice that deepens the already open and bloody wounds of the poor and precarious. The Financial Times, a newspaper usually in thrall to the spectacle of economics, called these policies “inhumane” last weekend.

But austerity is also a social contract. People accept severe restraints in public spending, actively in democracies or passively in autocracies, because they accept the unpalatable prescription of abstinence. Yet the public too has a choice. And they are exercising that choice in countries across the globe. Take the UK. Back in 1991, two-thirds of the British population wanted more taxation and spending. But by 2006, only a third of people backed redistribution of wealth. If not welcomed, austerity was accepted. Not now. In the latest British Social Attitudes Survey, published last week, public opinion had turned against the idea of brutal scarcity. 48% of people wanted taxation increased to enable greater investments in society. 42% supported redistribution of income. And health was their priority—83% of people wanted more spending on our collective wellbeing. After a decade of cutting back the reach of government, the public is now demanding a stronger and more generous state. The contract authorising austerity has been torn up“.

Richard seems to be suggesting we may be at a turning point. I hope he is right, but with a Brexit fixated government backed by 30% of those eligible to vote (the 52%) and the cheerleaders in the right wing press driving politics onwards, I don’t yet see much hope.

The Violence of Austerity

Photo by Samuel Zeller on Unsplash

This is based on the recent 2017 book by Vickie Cooper and David Whyte.

When society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet, its deed is murder just as surely as the deed of the single individual.” Engels (1845) ‘The Condition of the Working Class in England’.

Let us be clear from the outset. This is not about interpersonal violence carried out by one person directly on another using physical or emotional force. This is about Institutional violence, carried out by smartly dressed ordinary men and women in offices up and down the country, who often are merely following orders or who were architects of the policies that kill or cause physical and psychological harm. The malefactors of great wealth stand behind the lines cheering them on, using their propaganda news media to convince the victims that the victims are to blame. The malefactors of great wealth also grow fat on the proceeds of the sales of products designed to dull the senses and anaesthetise the pain caused by institutional or structural violence – high fat, sugar loaded fast foods, cigarettes, alcohol, cheap TV and mass culture in a dystopian miasma of false dreams.

Some may doubt the existence of institutional violence, perhaps arguing that only human beings can directly inflict pain. Johan Galtung (1969) in ‘Violence, Peace and Peace Research’ wrote of structural violence; a violence in which some social structure or social institution causes harm by preventing people from meeting basic needs. This is a model of violence that goes beyond notions that focus only on individual agency. Gregg Barak (2003) in ‘Violence and Nonviolence: pathways to understanding’ argues:

Like interpersonal forms of violence, institutional forms include physically or emotionally abusive acts. However, institutional forms of violence are usually, but not always, impersonal: that is to say, almost any person from the designated group of victims will do.

Yes. “any person” from the sea of faceless ‘skivers, shirkers, unemployed, disabled, sick, mentally ill, low paid and feckless’ who have been systematically stripped of their personhood by bureaucratic processes designed to make their lives hell in order to ‘incentivise’ them to find work.

Barak goes on: “Moreover, abuses or assaults that are practiced by corporate bodies—groups, organizations, or even a single individual on behalf of others—include those forms of violence that over time have become “institutionalized,” such as war, racism, sexism, terrorism, and so on. These forms of violence may be expressed directly against particular victims by individuals and groups or indirectly against entire groups of people by capricious policies and procedures carried out by people “doing their jobs,” differentiated only by a myriad of rationales

People “doing their jobs” using thoughtlessness, banality and cliché to justify their actions or perhaps in fear of joining the ranks of the precariat themselves. The current most important banality and cliché currently in force is ‘Austerity’ and its attendant lies used as justification.

Galtung: “violence is present when human beings are being influenced so that their actual somatic and mental realizations are below their potential realizations”

  1. Violence is a phenomenon which reduces a person’s potential for performance. A distinction must be made between violence and force, since the former breeds negative results, while this is not necessarily so in the case of the latter. This is an important option, because many people consider that violence may have both positive and negative results.
  2. Violence should be objectively measured according to its results, not in a subjective manner. Suicide, mental illness, mortality and morbidity rates, hunger, and poverty.

Felipe, MacGregor and Marcial Rubio refer back to Galtung and provide their own definition of violence:

A physical, biological or spiritual pressure, directly or indirectly exercised by a person on someone else, which, when exceeding a certain threshold, reduces or annuls that person’s potential for performance, both at an individual and group level, in the society in which this takes place”.

Criticism of structural or institutional violence, and the denial thereof, may focus on the need for an actor; an actor who can then be held liable for such action. Personal or direct violence is a violence in which an aggressor can be identified, face to face, whereby the victim can recognise a guilty person through direct confrontation. This is far too narrow a definition with perhaps the paradigm case for institutional violence being Adolf Eichmann who never actually got his hands dirty.

If these definitions hold, current government ministers, civil servants, local authority bureaucrats are complicit in the violence inflicted upon claimants for universal credit, those who died undergoing work capability assessments and those who died in Grenfell Tower.

It is the contention of Cooper and Whyte, along with Stuckler and Basu, that ‘Austerity kills’.

Five giants unleashed

Upon a blasted heath, or in a very dark corner of a smoke filled room, or around the kitchen table in a Cotswolds mansion at ‘kitchen supper’ time, plots have been ruminated over, designed and put into action. Cold stone hearts drive the calculated rationalities of bureaucratised, intellectually bereft mindsets who can not see further than their own bank balances and a slow descent into senility. Horizons of expectation and hope have been so lowered that they barely reach the fetid scum ring line of a misused toilet in a backstreet brothel in Rochdale. Pettiness, fear and misanthropy are the guiding principles of social policy that not so much gets developed as oozes from under a slaughterhouse door like a pool of blood specked vomit looking for a dog. Blank eyes, behind them a vacuity of such sucking force a black hole would be jealous of, stare with barely concealed contempt at the need to think about social responsibility. The only thing they see is a gold coin being held in the hand of a starving child, a gold coin they think is rightfully theirs and therefore the prising of infant fingers from which can be justified. Tears do not move them, anguish is ignored, pain is relished as being good for building self reliance and character building. ‘Top Cornflakes’ rise to the top in the face of such adversity.

And so it is that families are shirkers, and homes paid for over 30 years must be sold. Pooling risk, so that individuals may be spared the trauma and bankrupting expense of personal tragedies, is anathema now. Beveridge’s five giant evils awaken, stir, blink, the reports of their death somewhat premature. They’ve been given new life by the austerity defibrillator and the life giving infusion of Brexit. Squalor surveys the landscape and smiles with delight at both gilded and burning towers; Want is pleased to see repositories for foodstuffs proliferate across the land like pustules on a teenagers face; Idleness delights itself as it transforms into a new form of gig activities which strengthens Squalor and Want’s grip around the citizen’s throat. Sickness revels in its ability to inflict its pain unequally and with increasing force, while Ignorance cannot believe the ease with which it has captured so many Oxbridge educated minds.

Ministerial nightmares pave the way for the dismantling of both Beveridge’s and Bevan’s dream. “I have a dream” has been replaced with “go fuck yourself, you lazy skiving (migrant) peasant”. Another dream, “The British Dream” drifts into our space like a wet vindaloo and Guinness generated fart. The dream only includes nice white people in the Home Counties and bits of Cheshire. ‘I’m alright Jack’ is now ‘I’m alright Rupert’ as Jack is far too working class and is not aspirational enough. Aspiration itself is the new Jerusalem upon a green hill far away, but upon closer inspection only a few have been given the map showing the hill’s location.

The blasted heath is deserted now, the smoke clears and the last supper in the Cotwolds has been eaten. Five giants stomp across the land while the plotters retire to Tuscan homes, comforted by fat pay checks and bonuses for setting them free.

Family ShirkersPhoto by Benji Aird on Unsplash

Photo by Benji Aird on Unsplash

 

Family Shirkers

 

Front page of the Daily Mail October 2017:

 

Britain is a ‘selfish’ society where families shirk their duty by ‘outsourcing’ the care of their elderly relatives, a Government minister has warned. Phillip Lee, a GP, said families needed to face up to ‘uncomfortable’ truths about the demands of looking after elderly parents or grandparents, rather than expecting the state to care for them. He said society had become too ‘selfish’, with help delivered only by workers who were ‘paid to care’. He said the UK was becoming an ‘atomised’ country that failed its most vulnerable – and it could learn from how the Muslim and Hindu communities look after their elders”.

Why did an anti welfare state, pro austerity, patriarchal national newspaper print this in bold on the front page?

Why has a Government minister put this out? Why has Theresa May allowed this minister to say these things? Why is this the latest plank in the Tory strategy?

One reason is Boris of course. We need to be distracted from ‘clearing away bodies’.

Another is fear. They fear a Labour resurgence.

 

Another is that they need to continue to gather support for cutting public spending.

 

Another might be post Brexit concerns that care staff who are EU nationals will not be here in enough numbers.

 

An atomised society? The Doctor however points to the causes of the ills of society to its victims rather than its perpetrators.

 

‘A selfish society’. Who is he referring to? The nurses who work overtime for no pay? The firefighters, alongside many other workers, who have had a pay cut over the past 7 years ? Women who give up an income to look after children? The army of retired volunteers who work across a variety of charitable organisations ? The RCN calculated that unpaid overtime by nurses saves the NHS about £360 million per year. How selfish is that. The bastards.

 

Is he referring to the top 0.01%, many of whom have enjoyed a massive increase in wealth for merely owning stuff, inheritance, luck and engaging in speculation?

 

Those that enjoy the fruits of finance, rentier and crony capitalism?

 

No. He means ordinary people dealing with myriad social and economic pressures who no doubt also include the ‘just about managing’. Except, in his eyes they are not managing well enough by adding neglect to the list of sins they daily commit.

 

If there is selfishness in society it can be found in the unwillingness of many in the capitalist executive (CE) and their friends in the political power elite (PE) to value and pay for caring as labour vital to keeping everything else going. This activity is also known as ‘social reproduction’. Capitalism recognises only two domains: The Public and the Private, in which labour is a commodity to be bought and sold in a market. Strip away the social, political and technological complexity that sits upon ‘cash for labour’, and you are left with this base relationship.

 

Capitalism does not recognise the other two domains: the household or the commons. In the household, labour is expected to be given as a gift. There is no cash nexus in the household. The commons is merely a resource to be used. Care is a commodity in the public and private sectors, but as a product of labour it merely stands as a proxy for labour and therefore is a cost which reduces capital accumulation. Just as capital tries to reduce wage costs, it has to reduce care costs through wage control. If capital can shift care back into the household where it is a gift, then it magics away a cost. Patriarchy assists in the ideological work required to shift care out of the public sector and back into the household. Religion based patriarchy is a powerful tool in this process, in that you can get women willingly to sacrifice themselves to the family in the name of holiness and love. Under capitalism, thus is sacredness made profane.

 

The need to reduce cost requires an attack on graduate professional nursing alongside devaluing what nursing is. Graduate nurses are expensive to employ.  Ideally, and ideologically, what nurses do should be done for free or for minimum wage because it is ‘merely’ care that does not require a degree, and is something all women can do.

 

In order to control the public finances the CE and PE are dismantling structures which have supported people in times of disability, illness and unemployment. This is done because they fear capital accumulation will be jeopardised if the national debt is not paid off. This ‘systemic structural selfishness’ thus places the requirement for capital accumulation above the needs of those requiring care. As a result, care is provided in many cases on low wages, terrible conditions and quite often as a gift freely given, a fact exploited by employers in care homes and hospitals. Health and Social care is conceived of as a capital cost rather than as fundamental to individual and social well being.

 

Underpinning this is the ideology of the patriarchal traditional family, in which the (male) breadwinner supports the (female) carer who looks after children and elderly parent. Social conservatism aligns with the political economy of Austerity. In short, you can cut public spending by getting women back into the home to provide unwaged, unpensionable care work as a gift to themselves, to their family, to society and to the economy. If you can designate nursing and social care as low skilled women’s work, it is easier to push it out of the public sector and back into the household.

 

The good doctor is a patriarch living in an affluent bubble cut off from the social and economic realities of millions of people’s lives. He projects his own values onto everyone else without considering if people are able to take the opportunity cost of lost wages.

 

His reference to Muslims and Hindus is interesting. Put aside that this is a sweeping categorisation, how exactly do these families look after their elderly? The picture is changing as some Asian families respond to changing social and economic realities. I don’t know if it is simply about their ‘family’ values, although it is often reported that this is a key aspect of caring for parents at home. However, do those values operate within large families were there are many children to take responsibility among them, and where women stay at home or work part time? If this is the case, is this the lesson we should be learning – have more children, don’t move away, women to leave the labour force? What if women do not want to pay the ‘motherhood penalty’ (could be 10-14% for maternal leave and taking 5 years to catch up) or in the case of parental care, the ‘daughterhood penalty’?

 

 

I think the narrative behind this ‘shirker’s’ comment is the current long running story: “There is no magic money tree, Labour crashed the economy, we have to pay off the debt”. When you want to pull the plug on financial support for social care you have to come up with a more forceful moral argument other than ‘there is no money’. The Tories realise that more and more people do not believe them when they say there is no money. They have seen for example an instant ‘bung’ to the DUP. The Tories realise that more and more people know that the banks, not Labour, crashed the economy. They also know that more and more people know that a national economy debt is not the same as a Household debt.

 

So, arguing for continuing Austerity is electorally more and more looking like a busted flush.

 

The Tories are getting desperate, they need a new narrative, or more correctly, to reinvent the old one.

 

The answer is to repeat and fall back on the ‘moral underclass discourse’ which asks you to think about strivers v skivers, welfare cheats, benefit scroungers and now add to that list we have ‘family shirkers’.

 

It is part of Thatcher’s ‘No such thing as society’ narrative. The pooling of risk through general taxation and then state spending to spread the financial burden across the whole population is ideological anathema to many, but not all, Tories. They prefer that only individuals and families should provide social care, with a minimal (affordable) input from everyone else.

 

This is not just about money…it is a deeply held ideological belief and moral position about who should care for whom. Of course, how that is paid for cannot be disentangled from this moral position.

 

Watch out for more stories about how ‘selfish’ children are abandoning parents in ‘sink’ care homes to ram home this ‘moral neglect’ narrative.

 

This will be done without referring to issues around geographical and social mobility, precarity in employment practices, house prices and affordability, wage stagnation, the cost of education, the disappearance of pensions, restructured families, family size, gender roles, inequalities in health, social inequalities, parental leave issues, employment attitudes and gaps and the level of consumer debt.

 

Instead, as with benefit cheats, there will be a focus on dysfunctional family relationships, a ’cause’ rather than as also ‘symptom’ of much bigger issues.

Of course families will want to, and do, provide care. Dr Lee knows this. But he is tapping into deeper moral intuitions in order to facilitate the cutting of the social care bill.

 

Andrew Dilnot in the Lancet lays out a less sensationalist argument:

 

“First, there is a fairness argument. In universal health-care systems, such as the UK’s National Health Service, the financial burden of health care does not fall on those unlucky enough to need it. Money is raised through a progressive tax system, and used to provide health care free at the point of use. If it is right to act in this way in the case of, for example, someone with cancer, why is it right to expect someone with dementia or acute arthritis, who cannot look after themselves, to bear the financial burden of their own care?”

 

“Second, there is a market failure argument. In the case of health care, in the absence of universal state provision the alternative is private insurance, which is available in most countries, and is seen at large scale in, for example, the USA. But this alternative is not feasible in the case of social care. The uncertainties surrounding the possible cost of social care provision are so great that private insurers do not and will not make such cover available. Therefore, in the absence of state activity, individuals cannot pool their risk, so that although most of them will not face high and extended costs, they are all left facing that possible worst case scenario. This scenario is terrifying for individuals, and very inefficient. If the private sector cannot pool the risk, the case for the state taking that responsibility, at least in part by providing social insurance, is very strong”.

 

Well in response, the Doctor argues that individuals and families should bear the burden rather than shirking their responsibilities. The real target is not shirking families, it is of course the ‘cradle to grave’ welfare State.

 

 

 

Sex and Thugs and Gun Control

Photo by Thomas Tucker on Unsplash

Sex. Authority. Nanny. Spanking and Masochism.

All traits probably to be found in the breasts of certain Posh and blond Tory spokespersons, and their fellow travellers. These men , and it is usually men, are both architects and victims of the ‘repressive desublimation’ they want for us and themselves. They want to punish themselves and to amplify their autoerotic impulses through punishing the country, for what is austerity but puritanical self loathing and punishment as redemption for unfulfilled, and prohibited, sexual sins.

Through the offer of gratifications, repressive desublimation removes the energies otherwise available for a social critique; and thus to function as a conservative force under the guise of liberation.

In other words, deeper psychosexual tensions within the individual need to find a gratifying release which for some is Austerity for others it is guns, both are touted as in some way providing liberation and freedom in an inversion of morality.

“Suppression of the natural sexuality of the child…makes the child apprehensive, shy, obedient, afraid of authority, good, and adjusted in the authoritarian sense; it paralyses the rebellious forces because any rebellion is laden with anxiety; it produces, by inhibiting sexual curiosity and sexual thinking in the child, a general inhibition of thinking and of critical faculties” (Wilhelm Reich 1933).

Authority, and its fear, are repressed sexual impulses manifest then in obedience and conformity. Love of ‘Monarchy, Military and Middle England’ are manifestations of unfulfilled sexual desires which are both exciting but repressed as dirty. On the outside we are clean, we wear clean uniforms and we conform to then outwardly express cleanliness because we are trying to fool everyone, especially ourselves, and that our inner dirty little secret must stay hidden. In extremis, this is turned into authoritarian control for everyone, because they fear they can’t control themselves.

Scratch the surface of a conformist authoritarian and you will find a dirty little wanker terrified that he has been caught out.

We do have restrictions to protect third parties from the actions of ‘free’ individuals. In the case of guns, apart from a questionable emotional attachment to semi automatic weapons, there is no reason for a civilian to own such military hardware. By all means buy and own sport handguns and sport shotguns but within a strictly licensed and controlled environment. But military hardware? No, I argue you should not own one.

Never.

Not even in rifle clubs.

There is darkness there. Look deep into your soul, really deep and I think you’ll find psychosexual issues at the root of much of gun ownership and gun worship. It’s a penis substitute for weak or bullied people who perceive lack of control in many areas of life, and thus have a deep emotional drive to show to the world and to themselves that they are people to be reckoned with. They then rationalise this psychosexual inner drama by externalising it and referring to spurious notions of liberty, rights and second amendment bollocks. It’s a small wonder this does not happen more often as more and more Americans begin to feel national impotency in the eyes of a laughing world, adding to their sense of personal impotency.

Shooting one off shows ’em eh? Still got it, still got a hard one in my hand.

What turns a person on about a powerful tube that ejaculates material at the stroke of a finger?

Shooting inanimate objects in controlled sporting conditions in ranges is probably not based in sex, but I strongly suspect that is the case for owning an AK47* in Nevada.

So, no, Mr Trump, this is not ‘pure evil’. A category so shorn of explanatory power that it’s as useful as showing a pair of shaved bollocks to a judge in order to support your claim for leniency.

 

 

*insert your favourite grouping of letters and numbers.

The richest 1,000 people have more wealth than the poorest 40% of households (UK)

The richest 1,000 people in the UK have more wealth than the poorest 40% of UK households. The 1,000 richest saw their wealth increase by a staggering £82.5 billion last year, the equivalent of £226 million a day, or £2,615 a second.

The Equality Trust has found that this increase in wealth of £82.5 billion could:

Pay the energy bills of all 25.6 million UK households for two and a half years. Cost = £79.15 billion OR

Provide 5,143,819 million Living Wage jobs , or 2,923,333 million jobs paid at an average salary for a year. Cost = £82.476 billion OR

Pay the grocery bill for all of the UK’s users of food banks for 56 years . Cost = £81.5 billion OR

Pay two years’ rent for 4.5 million households (4,528,000 households) . Cost = £72.1 billion OR

Pay for 68% of the budget for the NHS in England Cost = £81.6 billion
Pay for 4 years of adult social care in England . Cost = £78.8 billion.

This totally unearned bonanza needs justifying somehow. It arises merely from the structure of wealth ownership, tax laws, and property holdings. The beneficiaries had to do little beyond what they currently own or do to enjoy this largesse.

One justification for the support of the current social structure of wealth ownership and control is that these people pay in absolute terms a good deal of tax. If you are destitute at least you don’t pay tax. Consider however that if one paid tax on income on say, £1,000,000, under current tax rates you would still get £540,676 per year. You pay nearly 44% of your income.

The median in the U.K. in 2017 is £27,000. Thus you take home £21, 641. You pay 20% of your income. You take home 4% of what the high earner does.

The millionaire pays as much tax in one year (£458,000) as a the median earner would (£5,200 pa) in 88 years. This is of course ‘inequality’.

So for every 1 person receiving £1,000,000, you’d need 88 on the median. Impossible of course due to what median means. The top 1000 get, receive, not ‘earn’, considerably more than what to them what would be a miserable £1,000,000 pa.

Those who earn up to the £150,000 threshold of 40% take home £90,176. Each extra pound they then get is taxed at 45%. What if that tax rate was 90%? This would mean someone getting £200,000 would receive £90,176 up to the £150,000 threshold and then another £5,000 taking it to £95,176. Someone getting £1,000,000 would after tax get £90,176 + £98,500 = £188,676.

The price of a loaf of bread would be the same.

So even at 90% marginal tax rates over the threshold, a millionaire would not have to worry about paying utility bills. Yes they pay more tax, but what’s left for them is hardly destitution. I digress. Millionaires to the 0.01% are paupers. Billionaires can avoid paying any taxes at all.

A second justification is that they are the ‘wealth creators’ and so deserve it all. I will not unpick this here because the rebuff is as obvious as the claim is spurious.

A third justification is that changing this structure would lead to economic chaos and left wing totalitarianism. This sets up a false dichotomy of either keeping hold of wealth or descent into tyranny.

A fourth justification is that the wealthy need to get ‘rewarded’ as they operate in a competing market, and that pay rates merely reflects market forces at work? Well, indeed but should that really be a plea to hold on to vast amounts of wealth? Are you really saying that you are miffed because someone else gets £5,000,000 pa while you get a ‘paltry’ £2,000,000 ?

There is a fifth technical justification – the Laffer Curve:

“In economics, the Laffer curve is a representation of the relationship between rates of taxation and the resulting levels of government revenue. Proponents of the Laffer curve claim that it illustrates the concept of taxable income elasticity—i.e., taxable income will change in response to changes in the rate of taxation.

The Laffer curve postulates that no tax revenue will be raised at the extreme tax rates of 0% and 100% and that there must be at least one rate which maximizes government taxation revenue. The Laffer curve is typically represented as a graph which starts at 0% tax with zero revenue, rises to a maximum rate of revenue at an intermediate rate of taxation, and then falls again to zero revenue at a 100% tax rate. The shape of the curve is uncertain and disputed.

One implication of the Laffer curve is that increasing tax rates beyond a certain point will be counter-productive for raising further tax revenue. A hypothetical Laffer curve for any given economy can only be estimated and such estimates are controversial. The New Palgrave Dictionary of Economics reports that estimates of revenue-maximizing tax rates have varied widely, with a mid-range of around 70%. Generally, economists have found little support for the claim that tax cuts from current rates increase tax revenues or that most taxes are on the side of the Laffer curve where additional cuts could increase government revenue.

Although economist Arthur Laffer does not claim to have invented the Laffer curve concept, it was popularized in the United States with policymakers following an afternoon meeting with Ford Administration officials Dick Cheney and Donald Rumsfeld in 1974 in which he reportedly sketched the curve on a napkin to illustrate his argument.”

See: Laffer Curve

If all else fails, fall back on classic economic models which are of course nothing more than mathematical representations of actual human behaviour in particular social and political contexts. They do not operate like the laws of physics. Hence they can easily change given different contexts.

With these vacuous and self serving justifications, the 1% keep the status quo going. Every society needs a unifying myth, and the powerful 1% need one even more so. Monarchy, Nation State, and ‘Free Market’ Capitalism (note: not financial/rentier/crony capitalism) are used as unifying myths to merely cover wealth and privilege. It is why right wing politics intuitively support monarchy, church and the flag because if those are dismissed by critics then that only leaves the theory of free market neoliberal capitalism as a defence against ‘the underclass’.

You decide if this level of wealth appropriation is good for social cohesion and health inequalities.

Health and Social Care – the Tory Legacy

Health and Social Care – the Tory Legacy:

 

David Cameron appeared in jovial mood both in the commons and on the steps of number 10 when he recently left office. Cameron joked at his last prime minister’s questions in the House:

other than one meeting this afternoon with Her Majesty the Queen, my diary for the rest of the day is remarkably light“.

He listed his achievements in office and seemed not to be too bothered to be leaving.

It is not clear whether people, especially frail older people, will be so sanguine about his record.

When it comes to health and social care, ‘the nasty party’s’ record is appalling. Following largely on the heels of the Health and Social Care Act 2012 and Osborne’s deficit reduction targets for the public sector, and in the face of increasing demand, we have what Roy Lilley (2013) predicted, and called, ‘The big blue bit of doom’:

His diagram was prescient, as two reports below indicate. This is having an effect on staffing levels and thus on the quality of care people get.

 Jim Mackay, CEO of NHS Improvement, recently was reported in the Health Service Journal (July 2016):

“…Trusts exceeding the 1:8 nurse to patient ratio could be told “we can’t afford that”.  

Trusts, he suggested, should not automatically spend money on new staff or better facilities on the basis of a CQC report or in an attempt to meet Royal College standards.

Janet Davies CE of the RCN stated in reply

This gives completely the wrong message to trusts, whose boards are responsible for the care, treatment and safety of their patients, by suggesting that finances are more important than patient care”.

 I’m afraid in the current context that major decision makers do think finances are more important than the quality of patient care.

 

The King’s Fund (2016) reports:

 

  1. NHS providers and commissioners ended 2015/16 with a deficit of £1.85 billion – the largest aggregate deficit in NHS history
  2. The scale of the deficit signifies a system buckling under the strain of huge financial and operational pressures.
  3. The principal cause of the deficit is that funding has not kept pace with the increasing demand for services

 

The 2016 ADASS (Directors of Adult Social Services) budget survey report states:

 

  1. Funding doesn’t match increased needs for, and costs of, care for older and disabled people.
  2. More people’s lives are affected by reductions in social care funding. The quality of care is compromised: 82% of Directors report that more providers already face quality challenges as a result of the savings being made.
  3. Directors are increasingly unclear where the funding needed will come from.
  4. The continuity of the care market is under threat. Providers are increasingly selling up, closing homes or handing back the contract for the care they deliver to older or disabled people.
  5. Investment in prevention is being further squeezed.
  6. Reduction in funding for social care has wider impact. Directors feel that negative consequences due to budget cuts have already been felt right across health and social care and agreed particularly strongly with statements regarding issue faced by the wider sector:
  • 85% thought that the NHS is under increased pressure
  • 84% thought providers are facing financial difficulty
  • 85% thought providers face quality challenges

 

NICE produced the original safe staffing guidance, centred on the idea that 1:8 was acceptable, provided somebody could wave a ‘red-flag’ and additional staff summoned. The guidance was based on the work of Anne Marie Rafferty et-al, who never said 1:8 was safe, it will not be.

Roger Watson (editor of Journal of Advanced Nursing), wrote for The Conversation UK on a recent study:  https://theconversation.com/youre-more-likely-to-survive-hospital-if-your-nurse-has-a-degree-61838 and thus provides more evidence of the strong correlation between education and outcomes. My worry is that in the UK we have drifted into ‘policy’ based evidence rather than EBP. Safe staffing levels may well be decided by finance directors (what can we afford) rather than sound evidence. This reminds me of the climate change ‘debate’ of which Roger Pielke applies the ‘iron law of economics’:

When policies on emissions reductions collide with policies focused on economic growth, economic growth will win out every time. Climate policies should flow with the current of public opinion rather than against it, and efforts to sell the public on policies that will create short-term economic discomfort cannot succeed if that discomfort is perceived to be too great. Calls for asceticism and sacrifice are a nonstarter.”

So ‘when policies on nurse staffing collide with policies focused on deficit reduction, deficit reduction will win out every time. Staffing policies will flow with the current of finance directors/CEOs opinion, and efforts to sell them policies that may cost them cannot succeed if that cost is perceived to be too great’.

A question is that while there is a perception that degree nurses and lower nurse patient ratios will increase the wage bill, while not providing savings ‘on the bottom line’ then we have a political battle not an evidence battle. The externalities of FDs and CEOs decisions fall onto individuals, families and nurses rather than the organisations balance sheet. Do we have metrics that force the financial externalities back into the equation, or is there evidence that hospitals see this evidence and are changing staffing practice?

The Tory Legacy is that we are still chasing a target of deficit reduction within a wider ideology that is suspicious of public sector provision at best. The drift is towards more private provision with perhaps a base line that the tax payer pays and a system of tops ups and private insurance schemes. This will be sold as “we cannot afford the NHS as it is” to cover for much further privatisation, marketization and a return to individualising, rather than socialising, risk. Health and Social Care as we knew it is over. If you or your parents need caring for in older age, or if you need non urgent surgery, you will need to save more money to pay for it, take out private insurances, top up your pensions or pay more tax.

Crises in health and social care. Who pays/who cares?

Crises in health and social care. Who pays/who cares?

 

Roy Lilley has recently blogged about the provision of social care for older people in the UK. The important point being made is that private providers, Saga in this case, are finding that they cannot make any money out of providing that service. If they cannot make any money then the business is worthless. The question then is who will take this on?

 

Marion Dakers, financial services editor for the Telegraph, reported (in January 2015) that Saga was selling its publically funded care home business. In 2011, Saga took-over Allied Healthcare. This is important because Allied claimed that 93% of local authorities contract with them.

 

The CEO of Saga, Lance Batchelor, said:

 

“…the margins were not enough to justify the investment needed to grow the business…

 

In May 2015, David Brindle reported:

 

“… the Saga group quietly slipped out preliminary annual results recording a loss of £220m on its ‘discontinued’ Allied Healthcare business, largely through writing down its balance-sheet value to nil.”

 

There was more:

 

“… this value has been determined by considering the current asset and liability position of the business; the future profit cash flows and the associated capital investment set out within the management’s five-year plan for the business; the risk attaching to the various cash flows and the costs of disposing of the business,”

 

Brindle also commented that:

 

“In so far as homecare featured in the (2015) general election campaign, it was in respect of the sector’s questionable labour practices: heavy reliance on zero-hours contracts and low, occasionally illegally low, pay. We heard little or nothing about the centrality of the sector to any hope of making our health and social care system sustainable”.

 

Saga said:

 

There are a range of ways of valuing the business and it is our expectation that an appropriate buyer will ultimately value the business higher than nil.”

 

So currently Saga’s homecare business is worth nothing, in a market worth £6 billion. They hope however that a future buyer will be able to value the business above zero. What confidence do we have that a private sector provider will want to enter this business without increased payments from the local authorities who buy the service, or without decreased costs coming from cutting provision, downward pressure on pay or selling off assets.

 

The wider context is that local authorities have faced budget cuts under the last government and therefore they have less money to pay for social care.  A possible way of meeting the shortfall between what the LA pays and the actual cost of provision could come from individuals or families, or private insurance schemes. Efficiency savings in providing care seem unlikely to reduce costs.  Will a private sector company want this business without government financial support? Brindle’s point remains: to what degree is the current system of health and social care financially sustainable?

 

Roy Lilly argues:

 

“Considering the margins and liabilities involved; loss of reputation and brand value if something goes wrong, bad publicity or a serious, sustained quality failure… this is a toxic business. No one in their right mind will touch it. The business is worth nothing”.

 

If this turns out to be the case, who is going to pay for the health and social care needed by an increasing number of older people in the community?

 

Margaret Thatcher once said:

 

there is no such thing as society, only individuals and families”

 

One way of reading this is to think that society will not and cannot provide care, because it does not exist, and so it is up to individuals and families to do so. This is rooted in Edmund Burke’s philosophical conservatism which is distrustful of a big state. It is also rooted in Hayekian free market economics that also sees little or no role for the state in many spheres of social life beyond providing a safety net. ‘Individual responsibility’ for health and social care is a lightning rod, it channels fears about big state socialism which is antithetical to conservative, and neoliberal thinking. The answer is of course for more private insurance schemes if individuals and families want to provide care. The main message being sent out by government since 2010 is that ‘the money has run out’. The implication is that now individuals and families will have to pay more for health and social care because the state cannot.

 

David Cameron, in a speech at the Lord Mayor of London’s Banquet on November 11th 2013, outlined the strategic objective: ‘austerity is here to stay’, he said:

 

“The biggest threat to the cost of living in this country is if our budget deficit and debts get out of control again…we have a plan…it means building a leaner, more efficient state. We have to do more with less”.

 

Efficiency savings will only get us so far. Part of the ‘more’ he refers to is ‘more social care for older people’ with ‘less’ meaning Local Authority spending cuts. Again, how will this be paid for?

 

A 2012 report by the Nuffield Trust and the Institute for Fiscal studies on ‘NHS and social care funding: the outlook for 2021/22’, suggested:

“…only a long term freeze in other public service budgets or large tax rises could enable a return to the 4.0% average annual growth to which the NHS has become accustomed”.

Health and social care are currently split in terms of funding, but care needs, be they social or health, are in reality are part of the same package. The NHS needs increases just to stand still. So we are facing further freezes in public service provision, this may include LA payments for older people in social care and care homes, as large tax rises were not promised by the Tory government in the 2015 election.

 

The recommendations of the Dilnot Commission on Funding care and Support called for major reforms that would, if accepted, increase costs to the taxpayer. So both Dilnot and Nuffield suggest tax increase might be needed. This is antithetical to Cameron’s ‘more with less’ and to the visceral loathing felt by many on the political right for taxes. Cameron and Osborne are not stupid men, they must have been briefed in detail on this issue.  One conclusion is that during elections and in public they talk ‘tax cuts’ but in private know they will have to raise taxes or face down those requiring health and social care?

 

Richard Humphries, at the King’s Fund, gave a stark warning to people in the UK regarding paying for social care:

“I think they can expect very little unless they are very poor or have very high needs, in which case they will get help both with arranging care and with paying for it. But for the majority of people they will be expected to pay for it themselves.”

 

The BBC has set up a ‘costs of care calculator’ – a first step perhaps in understanding in future liabilities for care costs.

And for balance – don’t expect the leadership of the Labour Party to be any more generous on this issue.

Has anything changed? The malefactors of great wealth.

I came across a quote in Oreskes and Conway’s (2014) ‘The Collapse of Western Civilization’ from a speech made by a national leader. At this point, I will not name or date the speechmaker. I thought it interesting as a view on the relationship between a nation state and its wealthy individuals and thus on the nature of democracy. What follows are parts of the speech with some commentary in bold. I think it speaks to us today.

 

“National sovereignty is to be upheld in so far as it means the sovereignty of the people used for the real and ultimate good of the people; and state’s rights are to be upheld in so far as they mean the people’s rights. Especially is this true in dealing with the relations of the people as a whole to the great corporations which are the distinguishing feature of modern business conditions”.

The democratic deficit in both the USA and in Europe is that increasingly voters’ rights are being increasingly limited and bound by the rights of corporations and through the actions of corporate lobbying and political influence. The Transatlantic Trade and Investment Partnership  (TTIP) further threatens nation state and citizen democracy by allowing corporations to sue governments if they implement social and environmental protection legislation that the corporation deems a barrier to trade. Thus, national sovereignty is being eroded by such new legislation that does not recognise the sovereignty of people. Globalised capital flows are also eroding national sovereignty through capital mobility and a lack of a globalised governance in such issues as tax evasion and climate protection.

“Experience has shown that it is necessary to exercise a far more efficient control than at present over the business use of those vast fortunes, chiefly corporate, which are used in interstate business”.

More efficient control is now seen as anti-business and anti-democratic by the corporate class executive and the political power elites within a neoliberal idiocy that wants smaller and smaller state interference.

“But there is a growing determination that no man shall amass a great fortune by special privilege, by chicanery and wrong doing, so far that it is in the power of legislation to prevent; and that a fortune, however amassed shall not have a business use that is antisocial”.

This determination has been somewhat diluted as exemplified in Peter Mandelson’s famous quote that new labour is “Intensely relaxed about people getting filthy rich” and Boris Johnson’s eulogy to the rich as an ‘oppressed minority’. In addition we have Tax laws favouring the 1% and their offshore havens and finance capital that rewards fancy financial products while being socially useless. They argue as an article of faith that if taxes on the rich go up, job creation go down to justify their snouts in trough. Nick Hanauer debunks this idea in this short Ted talk. The rich are not job creators.

“Almost every big business is in engaged in interstate commerce and…must not be allowed…to escape thereby all responsibility either to state or to nation”.

Globalisation. If you don’t like our employment practices and wage structures then we will take our investments elsewhere; we will take advantage of the weakness of global labour and call it flexibility. You should be grateful you even have a job.

“The…people became firmly convinced of the need of control over these great aggregations of capital, especially where they had a monopolistic tendency…”

The people have become blind and disorganised, many have been persuaded to vote against their class interests. Many wish there was greater control, but are unsure of how to do it.

“There is unfortunately a certain number of our fellow countrymen who seem to accept the view that unless a man can be proved guilty of some particular crime he shall be counted a good citizen no matter how infamous a life he has led, no matter how pernicious his doctrines or his practices”.

CEO’s of certain banks, some hedge fund managers, asset strippers, CEO’s in the fossil fuel lobby and industry, climate change deniers…..many who form part of the corporate class executive who view corporate social responsibility either as marketing ploy and as a façade to mask their antisocial and anti-environmental business practices. Their rewards are knighthoods, huge salaries and bonuses, because their activities are legal and increase shareholder value.

“There is a world-wide financial disturbance, it is felt in Paris and Berlin…on the New York stock exchange the disturbance has been particularly severe…it may well be the determination of the government…to punish certain malefactors of great wealth…”

They are conspicuous by their absence in criminal courts and yet no common thief has ever cost the country so much.

“….who shall rule this country – the people through their governmental agents or a few ruthless and domineering men, whose wealth makes them particularly formidable, because they hide behind breastworks of corporate  organisation”.

We know the answer now. Government agents are discredited, lobbied or have become representatives of capital, not the people.

“I…hope that the legislation that deals with the regulation of corporations engaged in interstate business will also deal with the rights and interest of the wageworkers…it will be highly disastrous if we permit ourselves to be misled by the pleas of those who see in an unrestricted individualism the all sufficient panacea for social evils…”

Hayek, Friedman, Reagan, Thatcher, Bush, Blair, Cameron. The high priests of neoliberal individualism who first philosophised and then preside and encourage low wage, part time, zero hours economies and call this ‘labour flexibility’.

“The rich man who with hard arrogance declines to consider the rights and the needs of those who are less well off, and the poor man who excites or indulges in envy and hatred of those who are better off, are alien to the spirit of our national life. There exists no more sordid and unlovely type of social development than a plutocracy for there is a peculiar unwholesomeness on a social and governmental idea where wealth by and of itself is held up as the greatest good. The materialism of such a view finds its expression in the life of a man who accumulates a vast fortune in ways that are repugnant to every instinct of generosity and fair dealing or whether it finds expression in the vapidly useless and self-indulgent life of the inheritor of that fortune…”

We now have demonization of the working class, poverty porn on our TVs and victim blaming focusing on immigrants, welfare claimants and benefit cheats as a way of deflecting public anger on the state of public finances and the accumulation of wealth in fewer and fewer hands. The 1% now blame the poor for their fecklessness and lack of hard work resulting in the poor man increasingly turning to such ‘tools’ as jihadist ideology in reprisals. Meanwhile the middle classes in the UK bleat on about inheritance tax that is set at such a level that most of them will not pay it in any case. Turkeys voting for Christmas, Lemmings searching for cliffs, donkeys asking for whips.

 

This speech was given by President Roosevelt 1907  – the words in bold are mine. There is nothing new under the sun, the same issues regarding wealth and its influence and practices exercised Roosevelt over a hundred years ago. Between then and now various policies and legislation were put in place to deal with those worries. However, we have now reverted back to a time when we can again speak of the ‘Malefactors of Great Wealth’. This time around Obama is aware of inequality as a ‘defining challenge of our time’ but is wary of raising it for fear of being accused of class warfare. Roosevelt had no qualms about calling these people out for what they are.

The NHS in ruins: Small state private medical care is the future?

You would have to have been living on a desert island, celebrity obsessed or just plain ‘not interested’ to know there is an issue with NHS funding. The issue at stake is not that there is a funding gap between demand and provision, although that is certainly the case. The issue is the dismantling of the NHS as a publically funded service based on core principles. These principles are based on progressive, socialist/collectivist values rooted in social democracy. In short, the larger political project currently underway is the shrinking of the state by transferring its core functions of empowerment and protection of the public, to private, often global, corporations. The ‘moral mission’ of government is being eroded in favour of profit and individualising risk and responsibility.

 

Before we briefly examine this claim, it might be a good idea to remind ourselves of the current basis for the NHS:

 

The NHS was a political project founded in 1948 on the following guiding principles to address inequalities in access to medical services. The 3 core principles were:

1. that it meets everyone’s needs.

2. free at the point of delivery.

3. based on clinical need, not the ability to pay.

Since then these 3 have been developed into 7 principles underpinning the NHS constitution.

1. The NHS provides a comprehensive service available to all.

2. Access to NHS services is based on clinical need, not an individual’s ability to pay.

3. The NHS aspires to the highest standards of excellence and professionalism.

4. The NHS aspires to put patients at the heart of everything it does.

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.

6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.

7. The NHS is accountable to the public, communities and patients that it serves.

NHS Core principles

 

These principles derive from a social democratic root, instigated initially by the post war labour government under the guidance of Aneurin Bevan , Minister for Health in the Attlee government of 1945 to 1951 at a time when the UK owed far more as a % of GDP than it does now. Despite this national debt, the Attlee government still found the money to set up the NHS. So from the outset, this was a political project based on collectivist principles and for this reason is now seen by free market conservatives, neoliberals and small state conservatives, as undesirable. However, as the NHS has huge public support, these critics of collectivism use the language of ‘affordability in austere times’ to frame the debate rather than outright argue for the wholesale privateering of the NHS and a move to individual responsibility for health based on health insurance. As part of this process, there appears an almost deliberate softening up of the public for this privateering and abdication of government responsibility for the protection of the public’s health and medical services. As a result of government policy we are being exposed to stories about NHS funding such as:

The Royal College of General Practitioners asks patients to petition the government on the issue of funding cuts”. This was reported by Neil Roberts in May 2014, who writes that a poster showing queues outside a GP surgery, and a claim that up to 100 practices face closure, is being sent to GP practices. Roberts states:

“The poster and petition, which the college is asking patients to sign, are part of the Put Patients First: Back General Practice campaign, run with the National Association for Patient Participation. The campaign calls for an increase in general practice’s share of NHS funding to 11% by 2017”.

Is this a case of special pleading? I don’t think so, the health service is facing a funding issue, including the £20 billion Nicholson challenge. In the context of rising demand, and an increasing gap in the budget to meet that demand, the NHS requires some radical changes or faces a ‘productivity challenge too far’ (Appleby, J. (2013) A productivity challenge too far? BMJ 344 e2416). One report from the parliamentary Public Accounts Committee, suggested that 1 in 5  NHS Trusts were in financial trouble and bankruptcy was a real option, this despite the NHS having an overall surplus of £2.1 billion in 2012-13. This surplus may not last, and the seemingly disorganised, costly management and inspection schemes alongside the disintegration of the providers into an ‘any willing provider’ mix of public and private do not bode well for the financial future of the service. The Private Finance Initiative (PFI) schemes have also locked some NHS organisations into costly long term contractual agreements.

So, yes the NHS is facing many challenging issues that some argue require a solution not yet fully implemented, although started, by the Health and Social Care Act 2012. This solution is to reduce public provision and encourage private sector organizations to tender and compete for services, they would be known as ‘any willing provider’. In theory this means Tesco as well as small social enterprises.

To get to this position, the NHS has to be seen to be not working and the current pressure on reducing public spending assists this process. Lack of funding, allied to poor services, paves the way for further privateering. The argument is that the state cannot provide the funds and also should not provide the funds, but it is the former argument – ‘austerity’ that is being used as a shield for the latter.

David Cameron, in a speech at the Lord Mayor’s (of London) Banquet on November 11th 2013, outlined the strategic objective: ‘austerity is here to stay’, he said:

“The biggest threat to the cost of living in this country is if our budget deficit and debts get out of control again…we have a plan…it means building a leaner, more efficient state. We have to do more with less”.

Debt reduction as an imperative, masks the ideological position for a smaller state.

Let us not forget, for this government will have you do so, that the debt rose as a result of the bank bail out rather than out of control state spending. The successful narrative is that the debt is all Labour’s fault and that big state spending cannot go on. The global financial crash of 2007-8 is a very useful smokescreen hiding conservative wishes to reduce the state’s functions.

Health and medical services in this worldview is not a public good, it is a commodity to be bought and sold in the market. If the NHS can be seen to be failing, to be expensive, then you have a narrative which states that the answer is selling off the services to private companies and introducing competition. So, why not privatise the NHS?

We already have a model for this; it is childcare, the costs for which is seen primarily as the responsibility of the individual and the family, with just a little state support. The private sector is paying so little for so many families with children, and private sector landlords have private rents so high, that the state is subsidizing low pay with benefits. The idea that the whole of society benefits from well educated, healthy children, and thus has an interest in supporting their development, is sidelined when it comes to paying for that care. Childcare costs are largely picked up by individuals and families. The state supports families with tax credits, child allowance and is introducing some measure of support for childcare for parents who are working. This support derives from a collectivist, not an individualist, political philosophy, and as yet has not been fully withdrawn. This is partly meeting the government’s moral mission to empower and protect its citizens. Conservatives argue however that benefits should be cut, and wonder why those who choose to have children are not fully paying for them, after all it was their choice!

We do not know how far Cameron wants to push competition and more private provision for medical services, we don’t yet know how much of the more expensive US health insurance system he wants to copy. We do know that corporate lobbying for state contracts from companies such as Serco, Capita and GE occur for the more profitable services. See this short film on NHS lobbying .

The Free University argues:

The UK government is proposing to privatise yet more public services including Ministry of Defence procurement and the Fire Services. Other institutions such as the Met Office are also being considered for sale. Privatisation of NHS services has been underway for some time and will accelerate under the secret US/EU Free Trade Agreement currently in negotiation. These are all a manifestation of “Liberalisation“.

Linda Kaucher in 2013 stated:

“Liberalisation means offering investment opportunities transnationally and since the 1980’s, successive UK governments have prioritised liberalisation in both private and public sectors. Private sector liberalisation has resulted in overseas ownership of most UK enterprise. Privatisations in the public sector have been simultaneously liberalised, so overseas investors are involved in the public sector sell-offs (e.g. water, rail), private contracting (e.g. waste collection, hospital cleaning) and PFI schemes. Right now, it is the NHS that is at stake, as it is divided up, privatised and liberalised – potentially forever: once overseas companies are involved, it is very difficult to reverse liberalisations, and, inherently, also the privatisations underpinning them. This is even more the case as liberalisations are committed to international trade agreements –  which is precisely the purpose of trade agreements.”.

The drift is towards more privateering of medical services. Will we get a better health service with improved outcomes? Lets not confuse health with medical services; health is largely socially and politically determined, so even if the NHS is fully publically owned, health outcomes are determined elsewhere (socio-economic status, ethnicity, gender….). The NHS is providing medical services to treat illness and disease and to manage chronic long term conditions. So, will private provision improve medical outcomes, will it improve services for dementia, mental health, elderly care?

Nurses for Reform.

A free market nurse think tank:

“NFR has long argued that the NHS is an essentially Stalinist, nationalised abhorrence and that Britain can do much better without its so called ‘principles’ ”. (2008).

 

Health care is part of the ‘moral mission’ of government (Lakoff 2008 ‘The Political Mind p141) to empower and protect citizens. Lakoff argues that other forms of protection, such as the Police and the Fire services, don’t require insurance and health security likewise should be a function of government. Conservatives do not believe this, they feel that you should have health care only if you are willing and able to pay for it. If you are not making enough money then you probably do not deserve it. For conservatives, health is a commodity that should come with a price in the market. The post war consensus between conservatives and socialists in the UK held back this belief. This is now breaking down and conservatives are emboldened and empowered not only to make this argument, but to enact it.

 

Lakoff poses a simple question…will the privateering of the NHS serve the overall moral mission of protection and empowerment, will protection and empowerment be best served or undermined?

 

Those who argue it will not undermine this moral mission are also set to make a very large profit out of it.

 

 

 

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