At the heart of socialism: proletarian public health, universal comprehensive care and effective disease prevention!

Original post – December 8, 2018 ISKRA

The theme of health is popular among the proletariat and the working masses. This is perfectly understandable: during his life, every proletarian will inevitably need medical care at one time or another, in one form or another. The bourgeoisie constantly uses this theme to position itself well in front of the people, obviously working, in so doing, to mask the existence of social classes and the struggle that takes place between them. We often hear representatives of the bourgeoisie – managers, executives, ministers – speak out wrongly about public health problems; on the radio, in newspapers and on television, the supposed experts on the health system regularly speak out on the new issue of the day. However, all these so-called experts forget to mention a small “detail”: it is capitalism that is responsible, directly or indirectly, for most of the ills and health problems. As with all important issues in society, the bourgeoisie, through its ideologues and specialists, seeks to divert attention from the main cause of the problems by regurgitating us with pseudo-analyses, partial explanations and short-sighted perspectives that do not exceed the narrow limits set by its class economic interests.

Unlike bourgeois power, the power of the working class will put an end to the vast majority of current health problems through socialist prevention and scientific and proletarian public health management. In the history of humanity, when the people took power and began to advance towards communism, there were immediate and profound changes in the way society dealt with these problems. Here are four that will occur with socialist revolution in a country like Canada:

1) The complete disappearance of private ownership of medicine

The proletarian power will achieve the socialization and collectivization of the means of production in society. This transformation will affect the relationship of workers to ownership and the distribution of society’s wealth and work product. This will also affect the ownership of medicine and its concentration. This concentration is the monopoly of the bourgeoisie on all the components of medicine: tools, instruments, knowledge, capacities and means to develop medicine (care, remedies, prevention, research, diagnostics, prescriptions, etc.). The concentration of these components in the hands of a social class and its agents will be broken by the new popular power and the social transformations it will trigger.

It should be noted that, in the narrowest sense, private ownership of medicine refers to the private medical practice in which doctors – general practitioners or specialists – who operate outside the public management of the State and who have a medical company on their own account engage. Social Democrats and other reformists usually focus only on this aspect of the problem. The socialist revolution will obviously attack these bourgeois aberrations, but it will not stop there. In a broad and comprehensive sense, private ownership of medicine encompasses the entire process leading to the concentration of capacities, knowledge and management of the means and instruments necessary for medical practice in the hands of a parasitic and exploitative social class. To put an end to it, the proletariat will therefore have to appropriate medical knowledge and learn to master medicine, which until then in history will have been reserved for the closed circles of bourgeois specialists and will have been only an instrument in the hands of exploiters. The historical transformations of socialism will thus affect all branches of the current health system. In particular, the revolution will attack the processes of medical training by massively integrating the proletariat into them – whether this training takes place at the university or in technical training centres. Similarly, socialism will transform health management organizations, which will come under popular control.

The revolution will also have the task of transforming the economic conditions that indirectly allow the bourgeois concentration of medicine. For example, it will fight against capitalists who invest their capital in the construction of private clinics or private surgical centres; it will attack capitalists who buy land and organize the generalized rental of premises to doctors and private clinics; it will collectivize the large companies that dominate the production of state-of-the-art medical equipment and instruments; and so on.

2) Transformations in the social division of labour: the entry into action of health workers with multiple training and whose potential is currently little used

The end of the bourgeois monopoly on medicine also means the end of the monopoly of doctors on knowledge and technology as well as the end of the strict direction they exercise over the rest of the healthcare workers.

To do so, the revolution will have to succeed in stimulating transformations in the social division of labour within all branches of the current health system. Physicians will increasingly be less and less the only ones with specialized knowledge and training. Today, there is a huge pool of caregivers who could, starting tomorrow morning, contribute much more to society than they can currently do. The reasons given to justify this state of affairs are only bourgeois pretexts that only reflect the limits of the capitalist mode of production to scientifically and politically organize work and health care in society. This currently unused potential could be used with an overall plan and a polyvalent training that would not only focus on the production of bourgeois experts, as is currently the case.

The rational and optimal use of this entire pool of workers will result in a higher overall health care capacity. To give an idea of the transformations that will take place, this rational use of the labour force will require in the short term a greater participation of nursing assistants and attendants. This will be followed by the gradual creation of new titles and functions that will reflect the new social division of labour that is emerging. The potential and available capacities will be increased tenfold while aligning correctly, for the first time, with the objective reality of society’s needs. Among other things, we will see the end of the bourgeois conception of a hierarchical health system headed by doctors and the various representatives of the capitalists. On the contrary, multi-purpose teams of workers with multiple functions will be set up. The leadership of these teams will be based on the policy and application of proletarian power. The entire social division of labour will be gradually modified as the bourgeois borders between the current titles and positions fall. New dynamics in the accumulation of medical knowledge will emerge, as well as progress in general polytechnic and scientific education in society.

In the history of socialism, we have already seen phenomena of this kind happen. One of the most famous examples is the barefoot doctors who emerged during the course of class struggle and socialist revolution in China. The doctors of the revolution, in contrast to the doctors in white coats, were true heroes who put themselves at the service of the people, unlike those who did not want to give up the colossal salary offered by reactionary power and capital. They have gradually built a succession around them from other caregivers. For peasants who had never seen a hospital in their lives and who had never received care, it was a revolution in itself. Many of these illiterate farmers were subsequently trained in their first medical knowledge and in effective disease prevention. The experience gained momentum during the period of socialism in China, even leading to the emergence of health care teams composed mainly of poor peasants.

3) The general increase in productive forces, hospitals and medical technology

Socialism will considerably increase the productive forces in society by freeing them from the chains of capitalist production relations. It will be the realization of the real potential of workers and of the knowledge, resources, means and instruments developed within bourgeois society, but whose rational use and full development had hitherto been hindered by the economic laws of capitalism. The full use of the entire labour force available in the territory, centralized and scientific planning and the political mobilization of the masses are the means by which the socialist revolution will accomplish this task. The development of productive forces will result in a dramatic increase in our ability to produce all the goods, tools and services we need. This will be the case for hospitals and medical technology, among others.

Access to health care will increase as socialism progresses. New hospitals and hospitals will be built in large numbers. When the need arises, new forms of hybrid health service organization will emerge. Access to care in the regions will also be improved. New forms of medical practice will develop in areas far from major urban centres. These developments will be accompanied by prevention campaigns throughout the country. They will make it possible to put an end to the dynamics of unequal development specific to capitalism. Even today, entire sections of Canada’s territory still suffer from the unequal distribution of access to care (think, for example, of small towns in the regions, Canada’s North and Aboriginal territories). The tendency to create megacities next to completely neglected areas without access to health care will be broken by proletarian, centralized and scientific economic planning.

Medical technology will also develop greatly with socialism. The necessary medical tools and equipment will be produced in sufficient quantities to meet the needs of the entire population; those that do not yet exist and are missing will be developed. The capacity to provide health services that are now considered “state-of-the-art” will increase, as will their access. For example, surgeries to treat simple eye problems such as myopia will be more and more accessible to everyone. Concerning medical research – particularly that aimed at finding cures for diseases that are currently incurable or difficult to treat – it will be handled by the proletarian state, according to the needs of the people and the need to overcome obstacles to cure this or that disease, rather than by the big pharmaceutical companies and research chairs dependent on capital as is currently the case.

4) The development of socialist prevention and the transformation of the people’s habits and material living conditions

The truth is that health care, although obviously necessary, is only a fraction of the solution to the public health problem, and even the smallest and least effective part when we consider society as a whole. Under socialism, we will be based on the principle that it is necessary to combat first and foremost the initial conditions that cause and produce a large number of diseases and health problems. Prevention is the central issue of proletarian and socialist public health. While there are many tragedies and serious illnesses whose origin is not mainly in social relations, the fact remains that, apart from very specific and statistically minority cases, the majority of health problems in society are relatively benign, easily preventable or are the result of an accumulation of dangerous and irrational habits. More often than not, these evils are linked to the unequal and harmful material living conditions of the proletariat as well as to the abandonment of a large part of the ageing proletarians.

Socialist prevention will take many forms. A first wave of measures will target diseases and illnesses directly related to lack of access to commodities. For example, access to sufficient and healthy food and hygiene products will be guaranteed for all. Such a measure will have a direct impact on the growth of children and the health of poor proletarian families. Proletarian public services such as daycare centres and canteens will also be developed to simplify the daily lives of workers. A second wave of measures will aim to eradicate harmful habits, such as the consumption of products harmful to health, abusive consumption and dangerous practices. A third wave of measures will specifically target the problems of dependency among the masses. The main objective of these measures will be to undermine the material basis that generates dependency, which is more often than not a reflection of the misery and suffering induced by capitalist society. The transformation of this material base will take place, among other things, with guaranteed access to socially useful work, immediate access to housing and access to resources to survive during withdrawal periods.

Socialist prevention will also involve public policy actions aimed at putting the masses into action and educating them. The proletarian power will develop a universal health education program with a large permanent campaign register. The objective of this public education program will be to promote an understanding of what is beneficial to society in terms of health. It will be based on the idea that we must start from the large numbers in society rather than from individuals and their personal decisions to solve health problems. One of the characteristics of capitalism is to isolate ourselves in our distress and to make decisions that affect society as a whole based on individuals rather than on the community. Public mobilization campaigns will aim to reduce and ultimately eliminate dangerous individual behaviour. These campaigns will be complemented by education to demystify biology and by the scientific knowledge that workers will accumulate during multi-purpose and polytechnic training.

Behind all these modifications is obviously the continuous transformation of the material living conditions of the whole proletariat. Socialist prevention will largely involve eradicating the conditions that allow diseases to reproduce and easily infect large population basins. Historically, major epidemics have been caused by the concentration of proletarians in unhealthy slums, where the multiplication of disease vectors was almost instantaneous. Healthy working hours and clean, parasitic-free and properly heated housing will help to reduce the incidence of massive infections. Similarly, the fact that workers will have adequate rest time and access to healthy and sufficient food will greatly reduce the likelihood of the spread of disease, as the number of those in a weak and vulnerable state will be greatly reduced.

The one and only health project for the proletariat is socialism!

The greatest disease to fight for our class is capitalism!