Post by Anita moved from 'industrial relations reform' thread to start this new thread:

 Hi Cyberman,
I don't agree that it's much of a weakness for us as a tiny site to have not concentrated on getting together comprehensive statements about a huge range of policy areas. 

I disagree that the way forward for the left is in defining whether we support the principle of socialised medicine or not.   I saw what happened when the new left party NLP tried to adopt this approach and it was disastrous.  I think we need to start from the concrete not the ideal.  What exactly do you mean by socialised medicine?  I think it is rather cliche and that we need to drop these cliche's because what we really need to do is look at the system as it stands and see where change is required and what is possible.  When we use cliche we all think we are talking the same language and nod at all appropriate moments but the devil is in the detail so to speak.

I have wanted to raise some issues about the health care system in Australia - mainly to warn people.  It's my view that in some areas we are too dependent upon so-called surgical fixes and the surgical complication rates are way too high.  Hospital Drs are over-worked and we are training too few medical professionals.  Also, there is a problem with cost shifting and some of the industrial/government turf wars that arise.  I've thought a lot about this but don't know what is the correct way forward.  There is no doubt that there needs to be a VAST IMPROVEMENT by hospitals in relation to medical mistakes in particualr related to infection control and the provision of post-operative care.

I had my first baby in Victoria and others in South Australia and the standard of post natal care was vastly superior in Victoria than SA.  There needs to be more integration of services offered to new mothers - and don't get me started on general maternity care!... In general i disagree with anyone who is going on about how there are just too many unnecessary C sections occurring but think that outcomes would improve if there were more midwives helping to case manage pregnancy and delivery.  When it comes to delivery i don't go for the au natural approach at home, i think that the closer one is to a hospital with surgical and other facilities the better off mother and baby are.  I do like the idea of the more informal birthing unit within major hospitals.  The bottom line is that in Australia women receive varying care and services depending upon what state they reside in and so 'nationalisation' seems a reasonable idea. 

The internet is a big help to patients i have a rare condition i practically had to diagnose myself - it was eventually confirmed by tests GP.  Most DRs however are very wary about the 'quality' of information available the real problem i think is because it erodes DRs status as the expert and puts the 'patient'/client in a more proactive position.  

I'm banging on, off the top of my head in a thread that is supposed to be about industrial relations reform keza will tell me off again so i better stop now.  If anyone wanted to discuss any of this we could start a new thread 'socialising' medicine.

Well I certainly support a health system that is free to all who use it, and that provides the highest standards of modern care. This is, I suppose, an 'appropriate moment' for us all to 'nod our heads', as Anita suggests.

Two things strike me about health policy:

1) The bureacratic nature of the medical system

2) The cost

These are both linked, and go to the difference between a free system where people greatfully accept health care from a benevolent government, and a free system controlled by people.

On point 1), the bureaucratic nature of the system, one excellent example is Dr Jayant Patel, nicknamed 'Dr Death' by the mass media after a scandal  in Queensland where he is believed to be linked to at least three deaths.

The issue here is not that mistakes can (and will, I think) be made in hospitals. The issue is the authoritarian nature of the health care system, where whistleblowers are in great danger of losing their jobs. This report from ABC's 'PM' outlines allegations against Dr Patel -  in particular it alleges that he would use his position to stop any questioning of his decisions.

It's clear that even if the health care system was 100% socialised today, these sort of power relations would still be a problem.

On point 2), the cost, I think this is a real opportunity to get people talking about the sort of health care system they want and discussing how much they would be willing to pay. Health care is one government policy that people feel deeply about - even after eleven years of office, Mr Howard still dares not attack Medicare directly.

I would like to see a nationwide series of small-ish (to start with) public meetings where people discuss the health care system. To start off, people could talk about some of the problems they have found. To start with, anyone who has waited several hours in an emergency ward because their local doctors don't bulk-bill will have a story to tell there.

Then the discussion would need to be pushed onto what people would like to see - what they want from the system. To be meaningful, this would have to be closely linked to an idea of how much that would cost. People would have to understand just how much in tax the system they want would cost them. This is not about demanding dreams, but taking responsibility for juggling priorities.

This would be slowly built into a national plan that the political parties would have little choice but to adopt.

Although this is not in itself revolutionary, I think it would start to develop the sort of habits that a revoutionary working class would need.

It's good that I find myself agreeing for once! The principle of free , or highly subsidised medicine to make it easily affordable is, or should be, very close to the heart of anyone who might consider themselves to be left leaning. I supposed what I mean is that everyone gets the same level of medical care irrespective of their ability to pay. And yes, Medicare does need to be improved. And yes, I would agree that the system needs to be more democratic and accountable. There has been too much 'business speak' applied to the medical system with patients being the 'consumer' and the system itself the 'industry'. The medical profession is quite conservative , not to mention the 'business' managers. It might not be easy but the whole issue should be opened up for general discussion. It is something that people do care about.

You've opened up a new thread but I would have thought that that this could fit into the 'capitalist welfare state thread'. Not that I agree with the title. My line on all this is that the welfare state, for all its faults, is essentially the creation of the left and the principle of socialised medicine is no different.

The alternative to making Medicare ( the Australian socialised medical system) work is clear for all to see in the American system. There are many on the right who would like to move to that system. In fact they have already been doing it slowly,  they know have to,   it would be electorally very difficult and unpopular to move at the speed they would like.

This issue is definitely part of the class struggle. Its not necessarily revolutionary but its worth fighting for nevertheless. The people are with us on this so its not difficult politically. Its a good opportunity to explain what socialism is about and to explain in practical terms the principle of 'from each according to their abilities, to each according to their needs'.

Moved to the 'What to do about high incomes?' thread.

For non-Australian readers i shall try and explain the Australian health system. We have the Medicare program which aimed to provide 'free' health care but which has been amended to provide relatively well subsidised services.  As youngmarxist pointed out the number of DRs bulk billing (providing services without asking a co-contribution) has dropped and people are attending hospitals to get services for free. 

To explain the government regulates what they think is a fair price for Drs to ask for the provision of particular services and pays that upon the presentation of an account by the DR.  (bulk billing)  However in recent years most services have attracted a gap payment (co-contribution) which patient's need to pay for most Specialist and GP services. 

Given my circumstances my GP bulk bills me once every 4 visits - if i don't pay the account on the day there is an additional $10 added to the fee.  Needless to say i have re-arranged things so that i pay medical accounts on the day.  Having paid the account i then have the option of taking the account and receipt to the Medicare office and presenting it and receiving back the scheduled fee in cash, or allowing the medical practice to submit the account on my behalf in which case Medicare forwards a cheque for the scheduled fee.

There are also arrangements where medical insurance companies pick up some of the out-of-pocket expenses related to medical services.  I haven't looked into the cost of packages in many years but i found they invariably seem to supply what is not required and not supply what is required and so membership to private health funds has declined in recent years.  These also  provide  payment for the services of private Specialists at private hospitals. 

(Note to readers - ironically it is safer to have procedures done in the state subsidised hospitals than the private hospitals, this is because life saving equipment is just a floor or two away in a state hospital whereas if complications occur at a private hospital it is often an ambulance trip away, and time is of the esence.  All of the very sick private patients are transferred for treatment to state run hospitals.  There are some exceptions to this, for instance in SA Flinders private hospital is attached to Flinders state run hospital thereby making private hospital treatment much safer)

So if an individual doesn't  have private health coverage but needs treatment there is the option of obtaining Specialist assistance privately and paying the gap, or waiting to receive treatment via the state hospital system. I have found that in SA there is generally about 4-6 months after referral (except maternity care) to the hospital before an appointment is allocated possibly 6 weeks hence.  Apparently this time can be reduced if the GP stipulates that the case is urgent.   I have experienced a four month wait for an appointment only to find that this was a wait for an assessment of treatment rather than the actual treatment itself.  Having been notified that i fit the criteria i wait a further 4-6 months for an appointment for treatment!!!

So there are long waiting lists if one does not have private coverage this is definitely a political issue in SA.  Here it has been necessary for the state government to make funds available to have public patients processed in the private facilities (eg Flinders private) in order to reduce the waiting time.  These aspects of service provision will vary from state to state.

So, when being treated in state run hospitals the state government picks up the tab and so we see cost-shifting practices onto the Commonwealth.  for instance my GP says he gets as many tests as possible done at the expense of the cwlth before referring to the hospital - the problem with this is that the results of the tests can be quite out-of-date by the time one finally gets the appointment and they need to be repeated.

With regard to state hospitals they are staffed by all level of hospital employees as well as visiting specialists and i'm not sure how the pay arrangements operate for these.  Also, there are inefficient anomalies - when i was pregnant and requiring a sick certificate for Centrelink purposes hospital Drs could not write them and so i was required to see my GP in order to get a Centrelink certificate.  This is definite duplication and adding unnecessary costs for the purposes of establishing criteria for Cwlth benefit! 

In addition, state hospital Drs cannot issue prescriptions for cwlth benefit pharmaceuticals and so this means that after discharge from hospital patients are sent home with only a few days  medication and  are required  to see  their  GP within days of being discharged in order to obtain scripts for further medication. 

This inefficiency probably helped save my life (well at least vastly improve the outcome) as after my last caesearean section i was required to visit the GP after only 3 days from discharge in order to get a prescription and it was then that they picked up an infection.  If i'd had the medication i required i would have taken to my bed thinking no wonder i feel like shit and the infection would have progressed untreated for a much longer time.  As it was the infection was nosocomial (hospital borne) and was anti-biotic resistant and required me to be re-admitted for IV anti-biotics within 1 week. 

So public patients admitted to state hospitals are provided medication free but private patients admitted a to state hospitals are charged for medication and the private health fund pays the bill.  Other wise medication is provided at the expense of the Cwlth government and is subsidised to one degree or another.  For instance people on a low income are eligible for prescriptions at the cost of 4.90 while normally most scripts cost about $21.00 this is for items scheduled and listed on the
PBS. (Pharmaceutical benefits scheme)  Not all items are listed and there are numerous medications which are not covered and for which patients have to pay full cost price.  The price of these vary from chemist to chemist with as much 50% variation - Chemists marking up what they think their market can bear.  This is where Internet chemists have made a big difference to bringing the prices down. 

Some chemists are actively contributing to lower prices in order to stop these items being provided in a supermarket setting.  An item i need that is not listed on the PBS is available on the Net for $25 my lower price chemist charges $29 my mother's chemist charges her  $39!   A recent talk back contributor  highlighted there was a $40 price difference between the same medication between my lower price chemist and the 'uptown' chemist that he had fill the prescription the first time he used it.  This appears to be some kind of rip off of the insurance funds as these costs are refundable under private coverage and people in the wealthier areas are more likely to have this kind of fund.  

There are pros and cons with the PBS as it stands because it does not necessarily supply people with what they need but with what the government says they can have.  Some things are only available under certain circumstances which is very limiting for DRs and patients.  Also there is no incentive to try and treat first with non-prescription options ie by supplements etc. 

I will do some research about how the American system operates, also about forthcoming changes to the TGA which is going to affect companies which make supplements and post that soon so that we can get an overview of what is going on.  

I think there is an urgency to come up with some kind of plan for providing high quality low cost pharmaceuticals to the  developing countries.  I saw a documentary a while ago  where  people in  African countries  are ripped off by fake pharmaceuticals - it was heart-breaking seeing families scraping up the money to purchase anti-biotics for their child who was being treated in a hospital and finding that there was no active ingredient in the tabs she was given.  For all the faults of the current system at least we are not suffering those circumstances.  There is a very brave woman Dr Dora Akunyili who fights the countetfeiters as much as possible and they fight her back with attempts at assassination etc but really it is only when these items are readily and inexpensively available that this will stop.  So maybe the focus ought to be on internationalising medicine rather than socialised medicine! 

On the question of "socialised medicine" (or "socialised education") we know that most people believe on some level that "free"  access to these things is "a right".  Very few (probably no-one) would take the position that access  should be restricted to the wealthy.  We can all nod and agree on that one. There is just nothing "radical" about it.

The question becomes one of how much health care should/can be provided free rather than whether everyone is entitled to at least some free services.    (Actually the idea of "entitlement"  and "right" is something which also has to be fleshed out.   It's really only with the rise of capitalism that these notions have had any real clout.)

I object to the use of the term "socialised medicine" within a capitalist system.  What we are really talking about here is a system in which the capitalist state foots the bill for health. There is nothing "socialist" about that.  Using the  term "socialised" contributes to the misconception that socialism =  (bourgois) state control  of various industries and services. 

The slogan "make the rich pay" is often used in conjunction with demands for better social services and conditions.   What does this  mean?    I think that this is a confused slogan which is tends to be aimed at the more wealthy sections of the working class rather than at the capitalist class itself (which is largely invisible).  It amounts to a demand to redistribute income from better off sections of the working class to the poorer sections. 

Certainly the level of productive forces in a modern capitalist society like ours is sufficient to provide a level of health care that at the moment we can only dream of.  But that would require actually dispossessing the capitalist class and running things ourselves.  It's an entirely different proposition from one that involves redistributing the small amount of the cake which is currently allocated to those who work for a living.  And attempting to "partially disspossess" the capitalist class by forcing them to devote a greater portion of their profits to health care or education is no solution.   That would just  amount to pushing up the price of labour and increasing unemployment.


These things do need to be made clear. The capitalist class will continue to provide only a subsistence standard of living (provided it isn't hit by a severe economic crisis). ("Subsistence" these days entails a far higher standard of living than in Marx's time - but it is still only what is required under current conditions for workers to survive, reproduce, be able to perform adequately in their jobs and remain compliant with the system.) We can force them to fund some things only at the expense of others. 

David (youngmarxist) wrote:

I would like to see a nationwide series of small-ish (to start with) public meetings where people discuss the health care system. To start off, people could talk about some of the problems they have found. To start with, anyone who has waited several hours in an emergency ward because their local doctors don't bulk-bill will have a story to tell there.

Then the discussion would need to be pushed onto what people would like to see - what they want from the system. To be meaningful, this would have to be closely linked to an idea of how much that would cost. People would have to understand just how much in tax the system they want would cost them. This is not about demanding dreams, but taking responsibility for juggling priorities.

This would be slowly built into a national plan that the political parties would have little choice but to adopt.

Although this is not in itself revolutionary, I think it would start to develop the sort of habits that a revoutionary working class would need.

I can certainly see some benefits in people discussing how to improve our current health care system  and especially in getting them to seriously consider the issue of cost.  We need to get right away from the pseudo-left approach which is mainly based on complaining about how oppressed and powerless we all are (and making abstract demands for the authorities to fund one thing or another)  rather than looking at reality and working out what is possible.  The relationship between the working people and those in authority won't change until there is a general realisation that we aren't looking for more benevolent masters but have real ideas about how to run things ourselves.

In doing this we can win some victories on the level of rationalizing the ways in which things such as health and education are provided.  In many ways these public sector aspects of capitalism are just deeply inefficiently  and stupidly run.  They don't make
 sense even from a capitalist perspective.  And getting involved on this level is good experience for eventually taking over altogether.   We also have some distance to go in ridding modern capitalism from backward feudal remnants. (and at the same time we have a struggle to wage against those elements of the pseudo-left who think we need to cut back on our material prosperity in order to serve a new God (ie "the planet"). 

And as  Anita pointed out,  most people on the planet are still engaged in a life and death struggle for basic bourgeois democracy and modernity.  Even basic health care and education is still a dream for nearly everybody outside the developed world .   (And here again we have the pseudo-left maintaining that this is because we in the developed world have too much, that "resources are finite" and that modernity is largely negative).

Comrade Keza,

You say: The slogan "make the rich pay" is often used in conjunction with demands for better social services and conditions.   What does this  mean?    I think that this is a confused slogan."

 I don't think that Marx actually used the words " make the rich pay" but nevertheless he called for pretty much the same sort of thing in the Communist Manifesto:

" Free education for all children in public schools"

I think he might have been aware that nothing really comes for free. He also suggested a "A heavy progressive or graduated income tax. " to pay for it all.

Would say that Marx was equally confused?