Big health flexes its lobbying muscle. Democracy quivers

In finance as in health, public interest is tamed by unaccountable corporate interest. It was meant to be the other way round

No American who voted for Barack Obama last November could have been in much doubt that he supported healthcare reform, that it would include a public scheme, and that he would make it a priority of his presidency. So why is the fate of the bill to realise his campaign promises now in such doubt, and why does it no longer, according to polls, command support from a majority of Americans?

The answer tells us a great deal not just about American politics, but about our own. The most determined, coherent and organised voices in any contemporary political debate are those of the corporate sector and its allies. It can afford the PR and advertising to change the terms of public discourse and it well knows that lies and half-truths – for example, that the NHS leaves the old and chronically ill to die, that 40% of British cancer patients don't see an oncologist, that Edward Kennedy would be left untreated in Britain for his brain tumour – can sow doubt in people's minds even if they are easily disproved. The corporate sector can also intimidate and compromise elected politicians.

In the first three months of 2009, healthcare companies donated $5.4m to the political funds of members of Congress, 60% of it to Democrats. Over the past six years, Max Baucus, head of the crucial Senate finance committee – which has not so far looked kindly on Obama's proposal for a public insurance option – has received $3.9m from the health industry. Though Baucus said in June that he would refuse further such contributions while the bill was going through, he still takes donations from lobbyists who represent healthcare firms.

Against such lobbying muscle, democracy is overwhelmed, as the former US labour secretary Robert Reich argued in his book Supercapitalism. Washington crawls with corporate money, and a politician or public official may turn out to be just a future lobbyist making contacts. According to Reich, more than 30% of retiring Congress members – as many Democrats as Republicans – become lobbyists. More than half the senior officials of Bill Clinton's 1993-2001 administrations became corporate lobbyists, including his deputy chief of staff.

In Britain, too, we are increasingly familiar with corporate donations to political parties, and with ministers, officials and aides becoming "consultants", "advisers" or company directors. Former health secretary Alan Milburn became a director of Covidien, a healthcare product provider, and adviser to Bridgepoint Central, a venture capital firm involved with financing private health firms. Patricia Hewitt, another former health secretary, became "special consultant" to Alliance Boots and adviser to Cinven, a private hospital and healthcare group. Sally Morgan, a Tony Blair aide, was subsequently a director of Southern Cross, the UK's largest care home operator, and an adviser to Lloyds Pharmacy. Is it any surprise that the arguments for greater private-sector involvement in the NHS get a better hearing in Westminster and Whitehall than most voters would wish?

Also, former home secretary John Reid is a consultant to private security firm G4S. Stephen Byers, a former trade and industry secretary, has advised Consolidated Contractors, a multinational oil and construction company. Anji Hunter, another Blair aide, later became director of communications for BP. Sir Michael Barber, head of Blair's public services "delivery unit", is now an "expert partner" with McKinsey. Sir Kevin Tebbit, Ministry of Defence permanent secretary until 2005, later joined the boards of two companies that make helicopters for the MoD.

In office, they and others may honestly claim they are acting in the public interest. But, to a remarkable extent, politicians now identify the public interest with the corporate interest. Taking on powerful corporations is a thankless task at the best of times; to do so when a corner of your mind must know the implications for your future career prospects requires exceptional courage and determination.

Whether present Labour ministers look forward to richly remunerated positions in the financial services industry I cannot say, but Jonathan Powell, Blair's former chief of staff, now works for Morgan Stanley. Given an unprecedented opportunity, ministers have utterly failed to bring the industry to heel. They have tolerated, with weak protests, the return of multimillion-pound bonuses for bankers. They have not acted on proposals to separate risk-taking investment banks from retail banks handling savings and mortgages.

Peter Mandelson let it be known that, during his week in charge, he would lobby the European commission to modify a directive forcing hedge funds to maintain higher levels of capital, cap debts and disclose more information.

As Reich puts it, "Democracy and capitalism have been turned upside down." Our democratic institutions do not regulate capitalism; rather, market institutions regulate democracy, setting the limits of the possible.

The point of democracy is to tame unaccountable concentrations of power. Yet, while governments are under constant scrutiny, banks can wreck the economy (and then demand taxpayer bailouts), supermarkets can kill town centres, oil companies can pollute the planet and, it seems, there is little we can do about it.

The failure to contain corporate power – or even, apparently, to want to do so – is New Labour's greatest failure. Mandelson can talk all he likes about trying to get more state schoolchildren from poor homes into university, but he remains – as his easy socialising with the Rothschilds and their set shows – intensely relaxed not only about the wealth of the filthy rich but also about their unaccountable power.

Now that nationalisation has been rejected, even as an aspiration, the left has no language and no ideas for dealing with corporate power.

For the sake of the 47 million Americans who lack health insurance, and the millions more who find their policies do not cover the most serious conditions, we should hope Obama gets his way. But there is no cause for complacency on this side of the Atlantic. As the chairman of the British Medical Association council put it in a letter to this paper yesterday, while Obama tries to move America towards the British system (albeit by a mere fraction), we risk "marching steadily away from a system of free, state-provided healthcare" towards the US model. The price of democracy is eternal vigilance against the encroachment of corporate interests.


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  • hermionegingold hermionegingold

    14 Aug 2009, 10:15PM

    our main political parties have 'outsourced' the running of ukplc to big business & quangos. quite frankly if all 645 mp's fell under a bus tonight would anyone actually notice?

    if mandy is our defence against global greed & malpractice we are well & truly stuffed. i really do despair.

    my only hope is a big win on the lotto so i can go loco in acapulco.

  • rockinred rockinred

    14 Aug 2009, 10:20PM

    nmtb

    If you'd actually bothered to read the article, you'd have seen that it is in fact about the influence that corporations have in the UK. Or was it all too much trouble for you? You need to be careful about calling others 'ignoramus' - glass houses and all that...

  • colourfulsocks colourfulsocks

    14 Aug 2009, 10:25PM

    what does the UK really care about the US healthcare system?

    as long as the NHS is protected

    sigh...we will never get free healthcare over in the US the way Americans get it free when they visit here!!!!

  • 13thDukeofWybourne 13thDukeofWybourne

    14 Aug 2009, 10:28PM

    In finance as in health, public interest is tamed by unaccountable corporate interest. It was meant to be the other way round

    Interestingly, Theodore Roosevelt identified this way back in 1906:

    Behind the ostensible government sits enthroned an invisible government owing no allegiance and acknowledging no responsibility to the people. To destroy this invisible government, to befoul the unholy alliance between corrupt business and corrupt politics is the first task of the statesmanship of the day

    We have been sold the big lie: That unfettered capitalism is conducive to democratic principles. Britain and the USA are oligarchic states, run exclusively for the benefit of the few, not the many.

    The Govt and ministers work for corporations ignoring the needs and interests of the people,either being cowed by the threats of big business or legislating on behalf of them to get the cushy post ministerial position.

    Indeed, Aristotle recognised this tension between wealth and democracy a couple of thousand years ago:

    The real difference between democracy and oligarchy is poverty and wealth. Wherever men rule by reason of their wealth, whether they be few of many, that is an oligarchy, and where the poor rule, that is democracy

  • hermionegingold hermionegingold

    14 Aug 2009, 10:31PM

    @ colourfulsocks

    we don't. and the quite frankly hysterical debate going on over in the us is adding to the gaiety of the nation when we are sorely in need of a good laugh.

    if i collapse onto my keyboard (quite likely, with the wine) i know i'm only a phonecall away from top notch care. it's just about the only thing the uk can still be proud of.

    x

  • ThePrompter ThePrompter

    14 Aug 2009, 10:31PM

    So money talks, but we already know that - the question is - what are we going to do about it?

    My hunch is nothing, we'll stupidly vote in the Tories, cut of our noses to spite our faces, and make it much easier for the money to run our lives.

    We really are a bunch of idiots.

  • MediaFrenzy MediaFrenzy

    14 Aug 2009, 10:33PM

    Our democratic institutions do not regulate capitalism; rather, market institutions regulate democracy, setting the limits of the possible.

    Yes, given that people here keep claiming that they know this, it is remarkable that, at the same time, they keep taunting New Labour politiciains with the prospect of the dole queue and fondly imagine that things are going to change under the New Tories.

    Let's get this straight. Politicians do not occupy the same world as the rest of us.

    If they lose their seat, they seamlessly shimmy into a better paid sinecure through the methods described above. Losing the election holds no particular fear for them.

    As for Dave and the gang offering to hold the line between us and the slavering, rapacious fangs and claws of big business, you will find that they will simply dice us up, stuff us into tins and sell us in a crate marked "Slaves for Your Sirships" along with their grandmothers.

    No political party is going to ride over the horizon to fanfares and fluttering banners and swirly rainbows to save us.

    Politicians are simply the Kapos.

  • 300Spartans 300Spartans

    14 Aug 2009, 10:37PM

    As Reich puts it, "Democracy and capitalism have been turned upside down." Our democratic institutions do not regulate capitalism; rather, market institutions regulate democracy, setting the limits of the possible.

    'Setting the limits of the possible' is what they've done to the media as well. Of course it's all been done with the mindless complicity of an American people too addled to resist.

  • 300Spartans 300Spartans

    14 Aug 2009, 10:39PM

    Over the past six years, Max Baucus, head of the crucial Senate finance committee – which has not so far looked kindly on Obama's proposal for a public insurance option – has received $3.9m from the health industry.

    Last I heard most of the money this blockhead gets is from out of state. It's the typical end run corporations love to make.

  • Digiridoodoo Digiridoodoo

    14 Aug 2009, 10:45PM

    This comment has been removed by a moderator. Replies may also be deleted.
  • 1caro 1caro

    14 Aug 2009, 10:50PM

    After deregulation we started reading about corporations with the same annual turnover as some countries annual budgets. Now we realise they've been privatising once political space along with their cheap shares in formerly nationalised industries. They want the as much of the power as nation states, & probably believe, if they're "internationals", that they deserve it. Some exercise huge influence (if not control) in some smaller countries, why not back in their home, or main, base?

    It's not Reich's "supercapitalism" but ubercapitalism. We haven't had "New" Labour, but "Corporate" Labour. The Tories are no more or less corporate tools, as are the Democrats across the pond. The outstanding leader though has to be the Repugnant Party. Corporate control is the "New World Order" Bush senior trumpeted after the Gulf War, describing the role of government on the eve of Junior's selection as "The business of government is Business".

  • Samsson Samsson

    14 Aug 2009, 10:52PM

    You are, of course, spot on again, Mr Wilby.
    We have known ever since Bernie Ecclestone where our 'socialist' NuLab government's affiliations lay.

    For a time I was foolish enough to believe that a disillusioned workforce aided by our trades unions would act as a counterbalance to the drift to the right: How naive to believe that this excuse for a government would not have wrapped up the TUC with its own placemen. And how naive to believe that we, the electorate are anything but a bunch of supine sheep (make that flock!) to accept such a dysfunctional and dishonest bunch of freeloaders as our leaders.

    And now, most depressing of all, Peter, is that neither you nor I or anyone else of a social democratic inclination, is able to offer a way out of the immoral stranglehold that capitalists now hold over the aspirations of ordinary decent people - And that makes me really afraid about the future.

  • Freedomfighter Freedomfighter

    14 Aug 2009, 10:57PM

    NeverMindTheBollocks It's guardian.co.uk, can we place stop with the non-stop postings about the United States of Ignoramus??

    In the 1930s, before Germany and Italy capitulated to fascsism, it would have been immeasurably positive to reach out to peoples on the edge.

    This is your second chance.

  • MediaFrenzy MediaFrenzy

    14 Aug 2009, 11:01PM

    Samsson

    We have known ever since Bernie Ecclestone where our 'socialist' NuLab government's affiliations lay.

    Someone said on these pages recently that at the time of the Bernie Ecclestone affair, Tony Blair ("People think I'm a pretty straight kinda guy") thought that his political career could easily be over. By the time he left office, he knew he could do whatever he wanted with impunity.

    Now that capital has got through the banking crisis unscathed, surfing on a wave of money stolen from the poor and the politicians have got through their pilfering scandal unharmed and with no intention of reforming anything, why should business or politics have anything to fear from us ever again?

    As for us, yes, be very afraid.

  • JohnDStone JohnDStone

    14 Aug 2009, 11:21PM

    Not, of course, to mention the present swine flu scam being treated naievely - or cynically - by both the British and US administrations, at our expense, and the pharmaceutical industry's profit.

  • chiefwiley chiefwiley

    14 Aug 2009, 11:42PM

    Perhaps I'm the only elected politician hereabouts, but frankly if you think you can do all this better, pass around some petitions and get on with it! All of you who love to trash hospitals, pharmaceutical companies, insurance companies and the like: learn to count. Pick up the commercial pages of your phone book and count the number of organizations involved in some way in health care. Pick an average number of people employed in each type of business. Take a wild guess at how many spouses and adult children of these people also vote.

    Total it all together.

    Tell them, all of them, that your particular gaggle of especially clairavoyent (mostly lawyer) mob is going to radically adjust their way of doing business, while at the same time never touching the not-so-peripheral activities of trial lawyers in the medical tort industry.

    Then count the ones who will vote for you.

    Then take the 80% of people who have health insurance who actually like their health insurance company and the service it provides, and tell them that you are either going to radically adjust their relationship with the company , including taxing their employee health benefits, so that you can provide free health care to a bunch of freeloaders, illegals, and other people you generally like better than them.

    Then count those in that group who will vote for you.

    Do you have any votes yet?

    Some might disagree with you and actually show up to tell you so. Or e-mail you or call your office. Call them an unruly mob.

    If ever there was a way to lose friends and influence voters for the opposition, this campaign to rush through radical change -- in something many people find useful and beneficial as it already --- might take the prize.

    I'm an elected Democrat of the bluer persuasion. Unless and until the effect of lawyers is factored into the discussion, and the specifics of elder care is honestly touched upon in a way that doesn't scare the crap out of them, and the effect of any bill on the few remaining decent corporations in my retirement portfolio (and everybody else's portfiolios) --- pharmaceutical companies are publically traded companies hugely owned by retirement systems and mutual funds -- unless some honesty is applied,

    the voters can and will kick a whole lot of politicians to the curb next election.

    People vote their own self interests.

    As they see them. Each is an expert in his/her own self interests.

    You might think they are influenced by lies and inuendo if they disagree with you. They don't care what you think.

  • skipissatan skipissatan

    14 Aug 2009, 11:59PM

    Good article-but now i'm left feeling scared and contemplating learning swedish...but it sounds hard and it would annoy my finnish flatmate...

    Seriously though what is to be done- a ban on corporate donations to political parties and state funding for them would be a start. Electoral reform too. How we're even going to acomplish that is beyond me... ideas on a postcard...

  • MoveAnyMountain MoveAnyMountain

    15 Aug 2009, 12:05AM

    Actually the author has got it exactly backwards. He, and most of the comments, also confuse power and influence. Britain is not an oligarchy because the rich do not rule. They may try to buy influence, but they have no power. That is why we had so much nationalisation from 1945 to Thatcher.

    What is going on is that the politicians are shaking the businesses down. The boot is on the other foot. If these companies wish to go on doing their business, if the rich wish to be left alone, they have to buy off the powerful. We see this in South-East Asia where the ethnic Chinese are regularly shaken down by the powerful. That is not to say the ethnic Chinese run places like Indonesia and Malaysia. They do not. But they have to pay protection money.

    The same with British companies. And here's a simple thought test to prove it. Suppose that the Government deregulated a sector of the economy and regulated another. Does anyone think that, say, the pharmaceutical companies would continue to pay off politicians if their sector was suddenly deregulated? If they could continue their business without lobbyists? How about if, say, internet blogs were regulated. Does anyone doubt that the bigger ones would take to wining and dining civil servants and talking to Ministers (if they could)?

    The solution is for the Government to stay out of business and so end this corruption. They won't, of course, and the sort of people who get angry about this are vital for the shake down - if the politicians cannot threaten them with anything, they will not pony up.

  • Snapshackle Snapshackle

    15 Aug 2009, 12:20AM

    chiefwiley
    14 Aug 09, 11:42pm

    the voters can and will kick a whole lot of politicians to the curb next election.

    People vote their own self interests.

    As they see them. Each is an expert in his/her own self interests.

    You might think they are influenced by lies and inuendo if they disagree with you. They don't care what you think.

    Morals and ethics don't enter into it then.

    Yes we know that our NHS treats freeloaders and illegals. It also treats visitors like you when you come here. We know it costs us, but we do it anyway.

    We do it because it is the moral thing to do, the civilized thing to do, the thing to do that two and a half thousand years of philosophical thinking have taught us is the right thing to do.

    My wife works in the NHS, she tries to provide the best service she can. She works twice as hard as her colleagues in private practice, and yes the NHS does not provide all the superficial fripperies and baubles that impresses the feeble minded, but it does provide comprehensive and competent clinical care. My wife understands the ethos and knows she could command a higher salary in the private sector - but she chooses not to work there.

    You - you execute minors and force people to make the invidious choice between risking bankruptcy or paying for their life saving treatment. The US is NOT a civilized country. You are country that knows the price of everything and the value of nothing.

  • Chesney01 Chesney01

    15 Aug 2009, 12:35AM

    I'm guessing this is all because the US dont want to copy our flawed health system. Well OK, Im sure that corporate America is weilding some power but wouldnt it make more sence for American employers to have their employees covered by State care if that was better?
    And isnt it a case of the pot calling the kettle black when our own vested interests on the left prevent the NHS being reformed and actually delivering a good health service?
    If we want better health care then we usher in transfer funding and health contracts for companies but its the unions who stand in the way of that.
    So lets not go on about American corporations when our own vested interests are every bit as bad - if not worse.

  • chiefwiley chiefwiley

    15 Aug 2009, 1:02AM

    You - you execute minors and force people to make the invidious choice between risking bankruptcy or paying for their life saving treatment. The US is NOT a civilized country. You are country that knows the price of everything and the value of nothing.

    Excuse me? You have absolutely no health care worth paying for yourself? Everything that happens to you medically must be somebody else's (or the collective's) responsibility?

    I don't recall executing any minors, lately, but I've noticed that a few of your minors occasionally execute other minors.

    Morals and ethics tell you that somebody else owes you your health care. Morals and ethics tell you that you must support freeloaders and illegals, and when somebody chooses not to, they are uncivilized.

    My thoughts are that people cannot be "blackmailed" into supporting your high-minded opinion as to what their political choices say about their morality. You would probably not get elected in todays climate, and if you held office, you might have your career shortened. People are not responding to the absolute panic to push the multi-thousand page piggy bank of special interest health services just because others (who seem to have their own opposing financial interests in them ---see AARP) will judge them as uncivilized.

    Vote for whatever you want. They will vote for whoever they want. Count the votes.

    Don't get cocky if you win now and again. There are elections every year in one form or another. That's how the system works here.

  • chiefwiley chiefwiley

    15 Aug 2009, 1:13AM

    Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

    If the state, in the form of a political figure, does something to harm an individual or business, do some of you propose that that individual or business should not have the right to seek the election of his or her opponent in the following election? State funded election campaigns of state approved candidates would leave people with little effective recourse to negligent, stupid, biased, or evil governments.

    Everything you see about you which is impacted by government, whether it is a slum down the road or an indifferent or uncaring health service, is that way because some politician actually prefers it or profits from it.

  • fortyniner fortyniner

    15 Aug 2009, 5:22AM

    Reading chiefwiley, he comes from a completely different political culture from our own. Britain and the US are indeed two nations separated by the same language.

    All this trashing of our healthcare system by US politicians is all for domestic consumption in a debate where there are very big corporate interests at stake. Change, proposed or actual, brings out frenzied reactions in people who feel threatened by what they think is going to happen. Americans tend to get rather more excitable than we do - no stiff upper lip, I suppose.

    If you read the history of Nye Bevan's struggle to set up the NHS in 1948, you'll see he had various vested interests to overcome, not least the doctors, who were of course key to the whole plan. Thankfully, he succeeded and for all its faults, most people receive first class care from the NHS. It enjoys wide public support here in Britain, and no public figure of any standing dares to suggest it should be dismantled.

    The US will decide what it decides about its healthcare system. That's its business not ours. Our NHS works for us, and this side of the pond that's all that matters. I'm not a fan of the "special relationship", and this spurrious not to say furious debate is ample reason why not. We are two nations separated by the same language and I'd prefer to be separated thank you.

    So to all those Americans reading this, best of luck with your healthcare debate, but leave our NHS alone. We do things differently here and hopefully always will.

  • IndigoTaxpayer IndigoTaxpayer

    15 Aug 2009, 6:30AM

    Corporations have become far too large, for which we can thank globalisation.

    Picture this cosy little scenario:

    Global pharmaceutical corporation develops an antiviral for the deadly avian flu and proceeds to hype up the possibility avian flu crossing DNA boundaries from bird to human. But it never happens.

    Now the corporation has masses of anti-virals but no market for them.

    Along comes mild swine flu, hyped up to be contagious enough to bring economies to a halt via a pandemic - and governments are urged to innoculate their nations.

    The corporation's sales soar, along with its share price, and government collects stamp duty and capital gains tax on share transactions, as well as VAT and other taxes on the corporation's sales.

    Neat, huh?

    The global corporations win either way. We need to prevent corporations from becoming so large and to break up those which are too large already. Then we need to ensure that backroom deals are not done between business and government and if they are, all parties are prosecuted for subversion of democracy / bribery / whatever.

    The status quo is dangerous.

  • Snapshackle Snapshackle

    15 Aug 2009, 7:04AM

    chiefwiley
    15 Aug 09, 1:02am

    Excuse me? You have absolutely no health care worth paying for yourself?

    You really must stop watching Fox news and listening to your own propaganda.

    The NHS works pretty well, which is why we are all prepared to defend it to the hilt. I know that is an uncomfortable truth for you free marketeers over that side of the pond, but nevertheless that is the case.

    Everything that happens to you medically must be somebody else's (or the collective's) responsibility?

    Yes healthcare IS the collective responsibility, as are a few other things like making sure everybody is fed and housed. I know this is a difficult concept for Americans to grasp, but it is part of being a civilized society.

    I don't recall executing any minors, lately, but I've noticed that a few of your minors occasionally execute other minors.

    Yes very regrettable, and unfortunately a symptom of our politician's slavish drive to turn us into a mini America. However in the modern world, minors have not been executed in the UK by the State. We left that behind many, many years ago. However when we have your murder rate I will really worry.

    Morals and ethics tell you that somebody else owes you your health care.

    No, morals and ethics tells me I owe somebody else healthcare.

    Morals and ethics tell you that you must support freeloaders and illegals, and when somebody chooses not to, they are uncivilized.

    And we should house and feed them as well. You are getting there.

    My thoughts are that people cannot be "blackmailed" into supporting your high-minded opinion as to what their political choices say about their morality. You would probably not get elected in todays climate, and if you held office, you might have your career shortened. People are not responding to the absolute panic to push the multi-thousand page piggy bank of special interest health services just because others (who seem to have their own opposing financial interests in them ---see AARP) will judge them as uncivilized.

    No, they can't be blackmailed; but they can be educated. We (humanity) have spent at least two and a half thousand years discussing and considering issues like this and what is the correct thing to do. Education is the mechanism by which this wealth of philosophical thought is passed down the generations. Regrettably not so in the US; and increasingly less so in the UK.

    Vote for whatever you want. They will vote for whoever they want. Count the votes.

    Don't get cocky if you win now and again. There are elections every year in one form or another. That's how the system works here.

    So you are a weathervane not a signpost. You went into politics purely to do as you are told by your voters, a mere functionary, not to provide leadership or guidance or to courageously fight for what is right. What sad, gutless people you American politicians are.

    Did any of your great leaders become great by just doing what their voters told them? No, they did it by having a vision, and forcing through that vision against the odds.

  • Kelmscott Kelmscott

    15 Aug 2009, 7:45AM

    chiefwiley

    Self interest does not exclude cooperating with others for a better outcome.
    "Socialised" health insurance, where "all2 pay and all are covered is actually very efficient despite the free loader element.
    For half the price the UK has, arguably a better health system than the Us 8% of GDP against 16%
    And you think we are mugs.

  • rogerhicks rogerhicks

    15 Aug 2009, 8:41AM

    By focusing on the details, which he describes with a refreshing degree of knowledge perspicacity, Peter Wilby, is overlooking the larger picture, which to recognize, one has to take several steps back from.

    The state has never been anything other than an instrument dedicated to facilitating the self-exploitation of human society itself, to the advantage of its dominant and privileged elites.

    When it was first created, by a coalition of aristocracy and clergy, back in the Middle Ages, the mass of the population was organized and exploited, as an ENVIRONMENT, as much as "society", almost exclusively to the advantage of these two elites, or classes, although the MYTH of society, and of the state representing the legitimate heir to one's original TRIBE (which human nature and behaviour evolved in and are thus adapted to), had to be created and maintained, in order to facilitate social control.

    The original two elites (classes) have now been largely displaced by countless others, which tend to interdigitate and are all but impossible to define, especially since general access to education, and "social mobility", means they are no longer determined by birth.

    However, although today's dominant and privileged elites are not rigidly defined, they tend to be associated with particular industries (e.g. film and media) and professions (e.g. bankers, lawyers), and, of course, as ever, with private property, i.e. capital, which now anyone (not just members of the aristocracy and clergy) might have. It is no coincidence that the principal role of the STATE is to define and enforce property rights.

    What I'm saying here, questions the legitimacy of the state, which, ever since its creation, there have always been massive taboos (and perceived self-interests) against doing - until very recent times, on pain of severe punishment, including death. So it is no wonder that few, even now, are prepared to, or perhaps capable of taking my point seriously.

  • Anomie83 Anomie83

    15 Aug 2009, 9:01AM

    Fantastic article. The linkage between corporations and government should be central to so many issues and examined under a microscope. Can all of the other blogs dealing with the moral tittle tattle of heatlhcare, defence, education etc please contain a link to this one?

    Bought politicians and fatalism in the face of lobby groups are the achilles heel of our so called 'democracy'.

  • EuropeanOnion EuropeanOnion

    15 Aug 2009, 9:53AM

    It must be a slow news week. What is really unfortunate is that the events this week, small earthquake in Chile: not many dead, have excited the brains of Rowson and Hyde to focus their keen minds on such gossipy trivia. The Duncan tape has been around for yonks and as for the excitedly referenced treasonable statements of some, definitely not front bench, Tory, well, good on him. Not that the NHS is bad, I do not know what it is except for wasteful, of such a massive scale as to be bound to be such.

    When subjects such as the NHSgo beyond criticism then we are heading for trouble. Much has been said of the word 'progressive' this week, is it progressive to adopt an imperfect paradigm and attribute to it the golden glow of rite, or law? If we are progressive we are constantly searching and questioning and seeking-out those people who will recognise that the King has, in fact, not got any clothes on, rather than a rag-bag of consenters of an incendiary nature that will ignite in hyperbole every time a question is raised simply because they have no alternative rather than an understanding of the status quo.

    We need the question, we need the understanding, we must invite the rebuttal, for only in that way will we find the truth; when we hear the response and test its validity. If we do not do this then the NHS becomes as a Pharaoh, a living God, attributed with ultra powers beyond common man who is suddenly and dramatically brought low by war and adversity and shown to be a shadow. The NHS is of this proportion.

    The NHS is not one man or a single unity of purpose as the Government would have it, it is a collection of wide ranging disciplines to which one single style of management and control should not be attributed, it is inappropriate. There are other formulations of internal structures that would make the whole sleeker and competitive; the dispersal of the giant would encourage better practices and better outcomes; diversity and not similarity will move medical science forwards and local misappropriation of care and responsibity would be just that, local.

    Are we such clods that we will fall for this distraction, this none-issue? That the minds of sensate here should be so disposed to use so many column inches on contrived dudgeon is one thing, that the BBC should make the Hannon tale and the Duncan tirade eligible for number one spot is little more than chicanery. If the same principals of desperation would be applied to the NHS then the story would be the replacement of office suites in hospitals rather the record of cures. Hannon is a Euro MP bent by the awful European system of glad-handing and rivers of cash, Duncan is a bit of a Mandelson but with less self-control.

    The NHS, beyond its actual responsibilities, is a political football. Already Mandelson has scared Cameron into promising cash that Cameron may not have; the game may not be played-out in the next election but will undoubtedly become a cause celebre in the next Parliament. Labour are playing the long game now; they have given up on policy and control and are concentrating on saddling the Tories with massive debt and constricted pathways of activity, ensuring that on a range of topics there will be a string of 'lies' to snipe at and the corrolary, 'you were better off under Labour'.

    We should all be really worried. At the moment it is a bit of drollery, semantics, a convoluted argument, an airy referral, a little bit of barbed malice, great fun. But at the end of it we will have a massive debt and no go areas in the Tory legislation that will look and feel like a continuation of Labour power by other means. It will be possible for Labour to be the 'guardians' of the NHS although living in the aftermath of the electoral rout! Labour are firmly convinced that they are well liked by the electorate, they have made mistakes but with tweeks...they will make a good standing at the next election and power will only elude them for a while. This is the strategy and the modus operandi under which they are manoeuvring.

    In truth, the current brand of Labour is not working, has abused the system and its powers and has brought it to the pretty pass if recalling a twice reviled conspirator to run the show. He is busy creating mischief and casting aspersions, muddying the waters, playing with our minds. All we have to remember is that parliament is currently undemocratic, a neutered, sclerotic place, a mere platform for grand-standing while the business is conducted either in the media or elsewhere. As for the NHS, are we sure that this is the best formulation, should we not at least talk about it? As for Hannon, let us not have attack and euphemisms, let us have a studied, quiet refutation and let us judge how that sounds.

  • globallyhooligans globallyhooligans

    15 Aug 2009, 10:47AM

    MoveAnyMountain 15 Aug 09, 12:05am

    This is only partly true, since for things to operate in this way would depend upon the system being something like a game with strict rules and players who were so morally rigorous that they never strayed from the framework of those rules or the penalties for breaking them being so severe that it would never be worthwhile.

    Unfortunately, the system is far more morally porous and the sanctions much more elastic.

    It is actually more like the poor, frazzled parent and the child high on pester-power.

    Most parents do not really know what they are doing and make it up as they go along to the best of their ability. Politicians are much the same, inventing policies on the hoof and reacting to events like startled insects suddenly exposed beneath a damp protective rock.

    The child will plead and cajole to get what he or she wants and if it appears not to be forthcoming will threaten or actually employ a tantrum to up the ante. Once the parent gives way on this one for peace and sanity, the child knows that variations of the same method can be used again.

    The parent is still notionally in charge. He or she holds the purse strings and has the authority, both physically and mentally, but the wheedling child may still win the game.

    Once these new rules become entrenched and the child has learnt that his parent can be squeezed and squashed like a balloon for fun and entertainment and for material benefits, the only way it ends is when the balloon finally pops.

    The problem is that in the real world, the politicians in the shape of the balloon derive as much fun and profit as the sticky-fingered child who is prodding and palpating them.

    The only losers are the people who end up paying for both sides in the game, but never participate, even as true spectators, since everything happens behind wonderfully locked and bolted doors because it is such a dirty little secret.

  • TREDEGARtom2 TREDEGARtom2

    15 Aug 2009, 11:01AM

    Excellent article. The similarities between Obama's struggle and that of Nye Bevin are striking. The BMA did exactly the same thing . They used the press to scaremonger and accuse Bevin of "socialising" medicine. We would all be living in a Soviet style Gulag with KGB midnight knocks on the door if Bevin's health reforms came to pass. It was corporate bollocks then and its corporate bollocks now. Britain's NHS is by no means perfect but its better than an insurence driven health system. "Third Party Fire and Theft or Fully Comprehensive sir". One means you get treated like a king the other like shit. Anyway, the American healthcare system is good enough for brainwashed, selfish, gun-toting, flag-waving, burger-guzzling, world-destroying, neocon shitwits "socialised" in a country built on greed, violence, exploitation and genocide. Its what they deserve. "It goes well the rest of the outfit sir".

  • Chesney01 Chesney01

    15 Aug 2009, 11:04AM

    Snapshackle
    The NHS works pretty well, which is why we are all prepared to defend it to the hilt. I know that is an uncomfortable truth for you free marketeers over that side of the pond, but nevertheless that is the case.
    ** **
    Pretty well? Compared with what?
    The NHS is pretty mediocre and will remain so unless we are willing to address the problems which it has. You may be OK with mediocre but I am not.
    ** **
    Snapshackle
    Yes healthcare IS the collective responsibility, as are a few other things like making sure everybody is fed and housed. I know this is a difficult concept for Americans to grasp, but it is part of being a civilized society. …
    morals and ethics tells me I owe somebody else healthcare. …
    ** **
    Charity is a part of a civilized society and if you want charity then it should be voluntary. Why should tax payers pay the health costs of those who do not contribute or for those who have only just moved here? Thats not civilization its robbery.
    If you want YOUR morals then YOU pay. Dont use my tax for charity work, I should chose where my charity money goes.

  • NickBristol NickBristol

    15 Aug 2009, 11:13AM

    Parts of our NHS are crap other parts brilliant. The problem is that the crap parts do not improve because they are unaccountable to the patient.
    Ever been to an othopaedic clinic appointment in the UK. Absolutely appalling customer service - but they have no incentive to improve. "you have been waiting over 2 hours for a fixed time appointment. Sorry mate."
    If we could move our custom elsewhere that clinic would improve or die but at the moment both good and bad in the NHS do not get what they deserve.
    The good are taken for granted and the bad continue in their complacent, crap way because nothing is making them change.

  • princesschipchops princesschipchops

    15 Aug 2009, 12:48PM

    Excellent article!
    CheifWiley You mistake what 'socialised healthcare' is in the US. In fact your country does have it already - for your vets. Alas you are the only developed nation that does not provide some sort of universal coverage. A pretty dire state of affairs I think. Now you are a 'blue' democrat you say - well why are you not out there debunking the myths being peddled around re healthcare elsewhere?

    Why dont you state - clearly - we are the only developed nation that does not provide universal healthcare. Universal healthcare does not have to mean socialised medicine. Japan has privately run healthcare in the main but the non profit sector ensures all have cover yet the hospitals are private. In the UK many hospitals are now partly run by PFI initiatives. In the UK people can still choose to have private insurance.

    Most important of all - over there in the US people ARE paying for freeloaders - because as you all keep saying people without cover do get treated - well the cost of that has to be covered somewhere in the system, somehow. Either by higher taxes, or loaded insurance premiums or the hospitals charging those that can pay more!

    Professor Reinhard says this on the subject:
    Other countries view health care as a social service that should be collectively financed and available to everyone on equal terms. My wife and I just interviewed the German minister of health, and it was an exhilarating experience, because [it was a] totally different language. It was obviously important that everyone should have the same deal in health care. That was one; she mentioned that at least five times.

    And the other word she mentioned you don't hear here is "dignity." In fact, I finally interrupted her and said, "Do you notice that you have said 'dignity'" -- Würde is the German word -- "five times?" It's a [word] that's not in the American vocabulary. Here, the president will go on TV and says: "Oh, if you're uninsured, that doesn't mean you don't get health care. Just go to the emergency room of your hospital." But you go there as a health care beggar. You don't have insurance.

    And the German minister of health would say, "But that's not a dignified experience." ... And that drives their health policy, because they have 200,000 uninsured in Germany -- that's 0.2 percent of the population -- and she thought it was a huge social problem, and she solved it. And we were asking her: "Why is that a problem? We wouldn't even notice that here. We've got 47 million, or 16 percent." And she says, it had to do with dignity. ...

    May, can I ask you, in most countries, do they take it as a given that everyone should have a right to some basic level of health care?

    Cheng: Yes, I would say so. America is the only country, ... among the developed countries, that does not have universal national health insurance.

    Professor William Hsaio of Harvard says this:
    .. I think you're telling me that the term "socialized medicine" is kind of a scare tactic used by American politicians who oppose change, but it's false.

    I definitely agree with you on that. It's a pejorative term used, actually creating fear. It [connotes] that the doctors are employees of the state, nurses are employees of the state; hospitals are owned by the state, run by bureaucrats; people have no free choice. But that's not true for all the countries you mentioned: Canada, United Kingdom, Germany, Japan, Switzerland.

    So you're saying that America could borrow ideas from Germany, Japan, Switzerland, U.K. and Canada and not become socialized?

    That's correct. Taiwan borrowed ideas from all these countries, and I don't think anybody will say Taiwan has a socialized medicine. And the Taiwanese themselves certainly do not believe they have socialized medicine.

    Why not start using some facts to counter the myths being bandied around in your great nation?
    Finally this from Karl lauterbach - health economist and member of the German parliament.

    Would you say that Germany has socialized medical care?
    No, it's not a socialized system, because you can pick your insurance, public or private. Many people can even opt [out], and the sickness funds compete for members. You have free hospital or physician choice; there are very few limits on choice in the system. ... In a socialized system, everything is planned; in Germany, basically everything is open for nonprofit competition.
    For me, another definition would be, who owns the facilities? Are the hospitals private?
    Roughly 10 percent of the hospitals are private and for profit, 90 percent are nonprofit hospitals, and about 100 percent of all office physicians are for a profiit.

    If you really are a democrat you should be ashamed letting Fox news style scaremongering about commies get in the way of ensuring millions of your citizens get some form of healthcover.

  • diarmidwp diarmidwp

    15 Aug 2009, 12:50PM

    Contributor Contributor

    Now that nationalisation has been rejected, even as an aspiration, the left has no language and no ideas for dealing with corporate power.

    This seems true. And it is why 'Old Labour' lost out to 'New'. But the language is there none the less. The 'stakeholder' idea that briefly flared in 1997 contains most of it. Democracy must operate at different levels according to context, and two levels at which it must operate are banking and business. We must realise, and be prepared to elect politicians who understand, that these social constructions exist to serve us and not us to serve them Otherwise, people and capitalism will remain stuck in a crisis-punctuated dance of death. For more depth see http://www.diarmidweirphotography.co.uk/pdfs/no_10_seminar_paper.pdf.

  • princesschipchops princesschipchops

    15 Aug 2009, 12:59PM

    Chesney01 it is not robbery it is just recognising that there is such a thing as society.

    If we reverted back to 17th century provisions for health and the poor I dont think many in UKplc would be too happy to be accosted by toothless prostitutes outside Waitrose or one armed beggars outside M&S - and having to pay private security guards to protect them in case some of the 'lower orders' decided to take what they wanted from them even if that meant killing or maiming them in the process.

    The provisions we have in this country were put in place by the rich - because the world used to be a dangerous place for them (hell even Queen VIctoria was shot at numerous times you dont have to go too far back in history). Now of course the rich think they are powerful enough not to have to worry so can let the plebs rot - hence the extreme neo-lib rhetoric - but of course there are millions more of the plebs than the extreme rich and if they were truly left to rot it would not take long before society started to collapse and the well off became vulnerable once again.

    That is if some sort of ism did not rear its ugly head first. It is interesting to note that the great transfer of wealth from all of us mere mortals to the uber rich that has taken place via the great bank bailout (TM) is similar to what happened in Europe in Germany and Italy especially, in the thirties. THe collapse was worsened by the elite who actually profited from the collapse in the Marc - of course it eventually wrecked a nation and drove it into the arms of a mad man.

    Going back to some sort of hard faced society where the have nots are just left to wither and die will not produce anything of any good.

    Oh and Chesers it may interest you to know that although the well off pay more tax they also take a lot more out of the system (not less as some think) - streets are cleaned more in well off areas, lighting is kept up, they use the doctors more, many use the best and most funded state schools, policing is heavier and if they do educate privately the massive tax breaks given to private schools have to be taken into account.

  • Constituent Constituent

    15 Aug 2009, 1:07PM

    Do US citizens get to hear as much about what our people say as we hear about what their people say?

    Might this debate enable Obama to introduce a system that avoids the problems of both existing systems?

  • diarmidwp diarmidwp

    15 Aug 2009, 1:09PM

    Contributor Contributor

    Oh and Chesers it may interest you to know that although the well off pay more tax they also take a lot more out of the system (not less as some think)

    Quite so - as Adam Smith recognised, they benefit disproportionately from the infrastructure of the state. Without the financial system, legal system, the roads network, and so much else, there could be no capitalism.

  • OldGreen OldGreen

    15 Aug 2009, 1:29PM

    Where is the pressure for health privatisation coming from?
    Do we have commitments to privatise health, under international treaties?
    Would a future government be compelled to privatise health, due to commitments already made?

    It appears that, yes, we do have commitments to privatise health, and its the fault of the EU.

    The arrangement is complex. The GATS Treaty (General Agreement on Trade and Services), which comes under the WTO, regulates contracting-out of public services. Nations are not compelled to contract out services under this treaty - they are allowed to define reserve designated public services.
    The problem is that the EU has defined which services shall be open to competition, and it has defined health as being open to private sector services, not reserved for the public sector. This has been designated collectively under the EU GATS ‘services schedule.

    Under GATS, once these services are open, they have to stay open.
    If services are open to the private sector, they have to be open to anybody, internationally, not just ones own nation, or just the EU.

    So, when you hear about EU ‘Cross-border health plans, this means privatisation.

    Once we have entered into this, there is no going back - we are frozen into this forever.

    The reasons why the EU has done this have been ideological. The EU believes that this will lead to more efficient delivery of services.

    This isnt just about health - it also involves privatisation of delivery of social services, public safety, waste management, water distribution, public service broadcasters, transport, social housing, postal services, etc.

    There may also be legally binding and enforceable rules on how much can be spent on public services, under the 'Altmark Package'.

    Take for example the EU '15 year programme' (their words) to push through postal privatisation, which has been unknown to overwhelming majority of the public.

    You may wonder how we just had a European election without anyone mentioning all of this.

    Here are some useful links for EU-sponsored sites: -

    Conceptualising approaches to trade in health care
    http://www.euractiv.com/en/health/conceptualising-approaches-trade-health-care/article-175485
    Published: Thursday 18 September 2008
    Lucy Davis & Fredrik Erixon, European Centre for International Political Economy
    "Great benefits can be made by opening health sectors to trade and investment integration, but very few countries have undertaken such reforms," write Lucy Davis and Fredrik Erixon in a policy brief for the European Centre for International Political Economy (ECIPE).
    They argue that the fiscally untenable situation of national health services as well as recent technological and medical innovations are now making trade in healthcare services both feasible and desirable. Yet, they add, the potential for trade in health care has so far been under-exploited due to continuous opposition.
    European Centre for International Political Economy: The health of nations: conceptualizing approaches to trade in health care
    http://www.euractiv.com/29/images/Health%20of%20nations_tcm29-175510.pdf

    Cross-border health plan set to pass despite opposition
    http://www.euractiv.com/en/health/cross-border-health-plan-set-pass-despite-opposition/article-180874
    Published: Wednesday 1 April 2009
    A controversial directive on cross-border healthcare is expected to pass through the European Parliament at the end of this month, despite continued divisions between political groups and disagreement among member states.
    Parliament backs EU cross-border healthcare plans
    http://www.euractiv.com/en/health/parliament-backs-eu-cross-border-healthcare-plans/article-181618

    Services in the Internal Market
    http://www.euractiv.com/en/innovation/services-internal-market/article-132241

    Scaled-down public services proposal under fire
    http://www.euractiv.com/en/transport/scaled-public-services-proposal-fire/article-168577

    Mixed reaction to EU's social package
    http://www.euractiv.com/en/socialeurope/mixed-reaction-eu-social-package/article-173878

    Social service providers call for protective regulation under EU Treaty
    http://www.euractiv.com/en/socialeurope/social-service-providers-call-protective-regulation-eu-treaty/article-169940

    Postal services liberalisation
    http://www.euractiv.com/en/transport/postal-services-liberalisation/article-161377
    Published: Thursday 1 February 2007
    The EU is entering the final stages of a 15-year process to open up its postal services to competition, having overcome differences of opinion regarding the speed of liberalisation and how to ensure a universal service for consumers. The real test will however come with the implementation phase as of 2009.

    The Water Framework Directive - experiences and future challenges
    http://www.euractiv.com/en/Agenda?tcmuri=tcm:29-184450-16

  • Chesney01 Chesney01

    15 Aug 2009, 1:34PM

    princesschipchops
    Chesney01 it is not robbery it is just recognising that there is such a thing as society.
    ** **
    Two different things Princess. A good society is one where every member contributes what they can. Get that right and you can start offering universal provision.
    ** **
    princesschipchops
    If we reverted back to 17th century provisions for health and the poor I dont think many in UKplc would be too happy to be accosted by toothless prostitutes outside Waitrose or one armed beggars outside M&S - and having to pay private security guards to protect them in case some of the 'lower orders' decided to take what they wanted from them even if that meant killing or maiming them in the process. Etc etc
    ** **
    Why do people have to invent things which were never said?
    Are you under the impression that without a health system identical to the NHS then there is NO health care? Is it that you cant address the points raised so you have to make up ones you can answer? Point out where I, or anyone else, suggested what you said above.
    ** **
    princesschipchops
    Oh and Chesers it may interest you to know that although the well off pay more tax they also take a lot more out of the system (not less as some think) - streets are cleaned more in well off areas, lighting is kept up, they use the doctors more, many use the best and most funded state schools, policing is heavier and if they do educate privately the massive tax breaks given to private schools have to be taken into account.
    ** **
    Street cleaning comes under local taxes, health care is funded by national taxation. Stick to the point please.
    Here is a nice one for you to address though;
    Why should people who contribute, or have contributed all their lives only get the same care as those who havent? Shouldnt the health care system get the workers back to work as a priority?

  • Chesney01 Chesney01

    15 Aug 2009, 1:39PM

    diarmidwp
    Pricessthingy
    Oh and Chesers it may interest you to know that although the well off pay more tax they also take a lot more out of the system (not less as some think)
    diarmidwp
    Quite so - as Adam Smith recognised, they benefit disproportionately from the infrastructure of the state. Without the financial system, legal system, the roads network, and so much else, there could be no capitalism.
    ** **
    Without capitalism there would be no health system and we would all be huddled in caves.
    By the way.
    The key word is disproportionate but consider it in net contribution terms and you see the problem with that way of thinking. If your ideas about tax and returns were true then the country would be better off if we all earned less. Think about it before posting stuff like that.

  • Snapshackle Snapshackle

    15 Aug 2009, 1:40PM

    Chesney01
    15 Aug 09, 11:04am

    Pretty well? Compared with what?

    Compared to the rest of ther world. Clinical outcomes in the NHS are very similar to everywhere else, and better than most. Yes there is always anecdotal evidence that this was missed that didn't happen, but that is the same for all healthcare systems I haven't noticed many unemployed healthcare litigation lawyers in the US.

    The NHS is pretty mediocre and will remain so unless we are willing to address the problems which it has. You may be OK with mediocre but I am not.

    On what evidence? As I said above clinical outcomes are very comparable. In fact because of the litigacious nature of Americans they are actually DENIED cutting edge healthcare, because the doctors think anything unproven or cutting edge is too risky. Europeans actually lead the way in advancing medical science with Amricans lagging behind.

    It is YOU who have, in general, mediocre inefficient healthcare, and pay though the nose for it as well.

    Charity is a part of a civilized society and if you want charity then it should be voluntary. Why should tax payers pay the health costs of those who do not contribute or for those who have only just moved here? Thats not civilization its robbery.
    If you want YOUR morals then YOU pay. Dont use my tax for charity work, I should chose where my charity money goes.

    Individual charity has its place but does not a civilized SOCIETY make.

  • diarmidwp diarmidwp

    15 Aug 2009, 1:59PM

    Contributor Contributor

    Chesney01

    The key word is disproportionate but consider it in net contribution terms and you see the problem with that way of thinking. If your ideas about tax and returns were true then the country would be better off if we all earned less. Think about it before posting stuff like that.

    Think about it? I have a PhD in it - do you?

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