Message to Reykjavik mini conference 14 June 2007

I am extremely sorry that I have had to miss your important meeting.  I had already promised to go to Canada to accept an award from my old school on the same day. 

I appreciate the honour you do me by considering seriously The Political Economy of Health Care: a clinical perspective.  Like any work in a field either new, or very long neglected, it certainly contains ideas which will have to be modified in the light of current and future experience, and some which will eventually have to be discarded.  However, I am equally sure that some of its ideas are new and have substantial explanatory and predictive power, which could help to rebuild a worldwide movement for human solidarity from its present apparent ruin, to a size and power greater than ever before.  It is slowly acquiring critical recognition in the UK medical press (favourable reviews in the Lancet, British Journal of General Practice, and in the near future the British Medical Journal and International Journal of Epidemiology), but has been completely ignored by our entire lay press, including journals still claiming to advocate socialist ideas.

We are probably all agreed that our central problem is the still accelerating global offensive by investors, mainly from USA, aiming to penetrate public services hitherto planned by elected and accountable governments to meet social needs, and to shift these step by step into market-driven services protected by commercial confidentiality, and thus accountable mainly to shareholders, with governments sidelined to a regulator role, always stigmatised as “bureaucratic interference”.  Though this offensive has been crudely adapted to the politics of each target country, its most striking feature is uniformity.  This includes the Quisling role of virtually all target governments, either willingly (as in the case of the UK New Labour government), or more or less reluctantly, as in under-developed economies indebted to the World Bank, which long ago displaced WHO as guide to global health care policies. 

I do not think it is useful to spend much time rehearsing the evidence for these defeats, or wringing our hands in despair as we watch hitherto liberally-inclined colleagues capitulate.  We need not more descriptions of retreat, but more effective strategies for resistance, based on the still overwhelming evidence that none of these marketising “reforms” have been led by public demand or by ordinary members of any mass political parties.  In every case they have been imposed from above, developed by self-interested lobbyists, and civil servants encouraged to prepare for future business careers by insider trading, using every sort of deception and casuistry.

Instead, I suggest the following four key issues for discussion:

·        Though it originated in USA, the US care-system has been a market failure if judged by delivery to its whole population.  This has long been obvious to everyone except its own commercial lobby and the politicians it pays for.  The medical global market ideology has therefore been funnelled through the British National Health Service (NHS), so that retreat from social solidarity can be presented as a necessary advance, justified by experience in what was once generally regarded as the world’s most equitable and cost-effective care system.  The English language, replacing Latin as the lingua franca of science, gives a huge advantage to the aggressor, disarming defenders of solidarity systems by marginalising their most powerful weapon, vernacular language and the common experience this alone can express.  There seems no alternative to use of English at the initial stage of development of a well-informed and co-ordinated world strategy for counter-attack.  However, to shift from our hitherto largely ineffective role as dissident courtiers seeking allies among our peers rather than our patients and public, we must as soon as possible return to vernacular speech and common experience.  Only thus can we develop mass resistance of the sort pioneered first in Galicia, later in Catalonia, against the privatising policies of the Aznar government in Spain.[1]

·        We do not need to waste much time comparing the details of privatisation programmes in different countries.  They share obvious common objectives, and in every case, want to confine so-called public debate to the details of their “reforms”, and marginalise or eliminate any debate for or against the solidarity principle itself, or about who gains from its attrition.  What we do need is detailed study in each country of its own historical development of its own patterns of solidarity.  In Political Economy of Health Care I have tried to do this for Wales.  One reason for the very successful counter-offensive in Spain is probably that development of health care as a national service is a relatively recent memory, linked both with attempts by the Franco dictatorship to create a wider social base, and with the new opportunities opened up by its demise in 1975.  Each nation needs to develop its own memory of how solidarity systems were in fact developed through collective struggle, with liberal voluntarism always a consequence of that struggle rather than an initiating cause.

·        By rebuilding historical literacy in the communities we serve, we could acquire a powerful weapon now falling from the hands of the aggressors – patriotism.  Big employers who export jobs to the far East are losing all credibility as patriots, but what for them will soon be a spent force, could become a huge additional power for rebuilding solidarity as a national and international force.  British citizens have few convincing reasons to celebrate their history in the ways traditionally approved by our rulers.  Our unique priority in industrial development was built on capital acquired through enslavement of other peoples, and our somewhat less unique priority in free thought was built upon free trade which smashed every other culture it penetrated.  Every war we ever fought was waged in the interests of property.  If these ever coincided with the interests of our common people, that was a subordinate byproduct.  On the other hand, the British NHS, as it was before the so-called reformers started their work, was, and will one day be again, an immense source of national pride, a real foundation for patriotism, and a material base for internationalism.  For effective continuing care, doctors have to love their patients (even those they find initially unattractive).  To stay their full course where they are needed, they need to love their locality and their country.  For politicians and professionals who are selling off the solidarity built by generations of struggle to lecture Scandinavians with even richer traditions of struggle and solidarity is an international insult.  We in the UK need you in Scandinavia to teach us, not the other way round – to help us regain confidence in solidarity, and a proper contempt for profit as motivation for our work.  For the past quarter century our leading politicians and professionals have travelled to USA to have their brains washed and their pockets filled in the socially most primitive, but technologically most advanced nation on earth.  Only a trickle of pilgrims has travelled to Scandinavia.  We need to reverse this by work at both ends.

·        Raymond Williams (1921-1988) probably had more influence on thoughtful socialists in the UK than anyone else in the second half of the 20^th century.  His ideas were presented almost entirely through literary and cultural criticism, which few if any have seemed to associate with science.  Interviewed a few years before his premature death, he said: “If I had one single ambition in literary studies it would be to rejoin them with experimental science.”[2] Despite the profoundly damaging hypocrisies imposed on the first generation of Marxist scientists in the 1930s, they succeeded brilliantly in linking recognition of the social functions of science with the renascent socialist and antifascist movements of that decade, resulting in a broad popular alliance between social and scientific advance.[3] [4]  This was notably absent in the next great socialist renaissance following 1968, which consequently ended in self-indulgent clouds of mysticism, hedonism and post-modernist chatter.  Increasingly obvious market failure in public services handed over to private investors, together with the rising global crisis of extreme polarised wealth and destabilised nature, is now creating a new wave of socialist thought.  To be effective, this must differ profoundly from its predecessors.  Health care and public education may offer the greatest of all opportunities to develop effective new theory inseparable from effective new practice, leading to entirely different modes of production within a nascent gift economy.  This is presented only in crude outline in my book, but it is by far the most important idea in it, badly in need of much wider discussion and criticism from many different perspectives.  Among the most important possible outcomes of such discussion would be precisely that recombination of scientific with cultural and political thought conceived by Williams, resulting in transformation of all three.  Judging from my experience, this will initially meet resistance from most established academic professionals.  They seem unaware of their isolation within their separate departments, no longer capable of presenting ideas in vernacular language, and indifferent to anything developed from practical work in the real world.  Sadly, this seems especially true of those on the Left of the traditional political spectrum.

I am sure your meeting will be successful, and look forward to hearing about its consequences.

Yours ever

Julian Tudor Hart

20 April 2007