SOCIALIST UNITY

Monthly Review

 Barack Obama is a fanatical believer in the imperialist capitalist system imposed by the United States on the world. “God bless the United States,” he ends his speeches.

Some of his acts wounded the sensibility of world opinion, which viewed with sympathy the African-American candidate’s victory over that country’s extreme right-wing candidate. Basing himself on one of the worst economic crises that the world has ever seen, and the pain caused by young Americans who lost their lives or were injured or mutilated in his predecessor’s genocidal wars of conquest, he won the votes of the majority of the 50% of Americans who deign to go to the polls in that democratic country.

Out of an elemental sense of ethics, Obama should have abstained from accepting the Nobel Peace Prize when he had already decided to send 40,000 soldiers to an absurd war in the heart of Asia.

The current administration’s militarist policies, its plunder of natural resources and unequal exchange with the poor countries of the Third World are in no way different from those of its predecessors, almost all of them extremely right-wing, with some exceptions, throughout the past century.

The anti-democratic document imposed at the Copenhagen Summit on the international community – which had given credit to his promise to cooperate in the fight against climate change – was another act that disappointed many people in the world. The United States, the largest issuer of greenhouse gases, was not willing to make the necessary sacrifices, despite the sweet words of its president beforehand.

It would be interminable to list the contradictions between the ideas which the Cuban nation has defended at great sacrifice for half a century and the egotistic policies of that colossal empire.

In spite of that, we harbor no antagonism toward Obama, much less toward the U.S. people. We believe that the health reform has been an important battle, and a success of his government. It would seem, however, to be something truly unusual, 234 years after the Declaration of Independence in Philadelphia in 1776, inspired by the ideas of the French encyclopedists, that the U.S. government has passed [a law for] medical attention for the vast majority of its citizens, something that Cuba achieved for its entire population half a century ago, despite the cruel and inhumane blockade imposed and still in effect by the most powerful country that ever existed. Before that, after almost half a century of independence and after a bloody war, Abraham Lincoln was able to attain legal freedom for slaves.

On the other hand, I cannot stop thinking about a world in which more than one-third of the population lacks the medical attention and medicines essential to ensuring its health, a situation that will be aggravated as climate change and water and food scarcity become increasingly greater in a globalized world where the population is growing, forests are disappearing, agricultural land is diminishing, the air is becoming unbreathable, and in which the human species that inhabits it – which emerged less than 200,000 years ago; in other words, 3.5 million years after the first forms of life emerged on the planet – is running a real risk of disappearing as a species.

Accepting that health reform signifies a success for the Obama government, the current U.S. president cannot ignore that climate change is a threat to health, and even worse, to the very existence of all the world’s nations, when the increase in temperatures – beyond the critical limits that are in sight – is melting the frozen waters of the glaciers, and the tens of millions of cubic kilometers stored in the enormous ice caps accumulated in the Antarctic, Greenland and Siberia will have melted within a few dozen years, leaving underwater all of the world’s port facilities and the lands where a large part of the global population now lives, feeds itself and works.

Obama, the leaders of the free countries and their allies, their scientists and their sophisticated research centers know this; it is impossible for them not to know it.

I understand the satisfaction in the presidential speech expressing and recognizing the contributions of the congress members and administration who made possible the miracle of health reform, which strengthens the government’s position vis-à-vis the lobbyists and political mercenaries who are limiting the administration’s faculties. It would be worse if those who engaged in torture, assassinations for hire, and genocide should reoccupy the U.S. government. As a person who is unquestionably intelligent and sufficiently well-informed, Obama knows that there is no exaggeration in my words. I hope that the silly remarks he sometimes makes about Cuba are not clouding his intelligence.

In the wake of the success in this battle for the right to health of all Americans, 12 million immigrants, in their immense majority Latin American, Haitian and from other Caribbean countries, are demanding the legalization of their presence in the United States, where they do the jobs that are the hardest and with which U.S. society could not do without, in a country in which they are arrested, separated from their families and sent back to their countries.

The vast majority of them immigrated to Northern America as a consequence of the dictatorships imposed on the countries of the region by the United States, and the brutal policy to which they have been subjected as a result of the plunder of their resources and unequal trade. Their family remittances constitute a large percentage of the GDP of their economies. They are now hoping for an act of elemental justice. When an Adjustment Act was imposed on the Cuban people, promoting brain drain and the dispossession of its educated young people, why are such brutal methods used against illegal immigrants of Latin American and Caribbean countries?

The devastating earthquake that lashed Haiti – the poorest country in Latin America, which has just suffered an unprecedented natural disaster that involved the death of more than 200,000 people – and the terrible economic damage that a similar phenomenon has caused in Chile, are eloquent evidence of the dangers that threaten so-called civilization, and the need for drastic measures that can give the human species hope for survival.

The Cold War did not bring any benefits to the world population. The immense economic, technological and scientific power of the United States would not be able to survive the tragedy that is hovering over the planet. President Obama should look for the pertinent data on his computer and converse with his most eminent scientists; he will see how far his country is from being the model for humanity he extols.

Because he is an African American, there he suffered the affronts of discrimination, as he relates in his book, The Dreams of My Father; there he knew about the poverty in which tens of millions of Americans live; there he was educated, but there he also enjoyed, as a successful professional, the privileges of the rich middle class, and he ended up idealizing the social system where the economic crisis, the uselessly sacrificed lives of Americans and his unquestionable political talent gave him the electoral victory.

Despite that, the most recalcitrant right-wing forces see Obama as an extremist, and are threatening him by continuing to do battle in the Senate to neutralize the effects of the health reform, and openly sabotaging him in various states of the Union, declaring the new law unconstitutional.

The problems of our era are far more serious still.

The International Monetary Fund, the World Bank and other international credit agencies, under the strict control of the United States, are allowing the large U.S. banks – the creators of fiscal paradises and responsible for the financial chaos on the planet – to be kept afloat by the government of that country in each one of the system’s frequent and growing crises.

The U.S. Federal Reserve issues at its whim the convertible currency that pays for the wars of conquest, the profits of the military industrial complex, the military bases distributed throughout the world and the large investments with which transnationals control the economy in many countries in the world. Nixon unilaterally suspended the conversion of the dollar into gold, while the vaults of the banks in New York hold seven thousand tons of gold, something more than 25% of the world’s reserves of this metal, a figure which at the end of World War II stood at more than 80%. It is argued that the [U.S.] public debt exceeds $10 trillion, more than 70% of its GDP, like a burden that will be passed on to the new generations. That is affirmed when, in reality, it is the world economy which is paying for that debt with the huge spending on goods and services that it provides to acquire U.S. dollars, with which the large transnationals of that country have taken over a considerable part of the world’s wealth, and which sustain that nation’s consumer society.

Anyone can understand that such a system is unsustainable and why the wealthiest sectors in the United States and its allies in the world defend a system sustained only on ignorance, lies and conditioned reflexes sown in world public opinion via a monopoly of the mass media, including the principal Internet networks.

Today, the structure is collapsing in the face of the accelerated advance of climate change and its disastrous consequences, which are placing humanity in an exceptional dilemma.

Wars among the powers no longer seem to be the possible solution to major contradictions, as they were until the second half of the 20th century; but, in their turn, they have impinged on the factors that make human survival possible to the extent that they could bring the existence of the current intelligent species inhabiting our planet to a premature end.

A few days ago, I expressed my conviction, in the light of dominant scientific knowledge today, that human beings have to solve their problems on planet Earth, given that they will never be able to cover the distance that separates the Sun from the closest star, located four light years distant, a speed that is equivalent to 300,000 kilometers per second – if there should be a planet similar to our beautiful Earth in the vicinity of that sun.

The United States is investing fabulous sums to discover if there is water on the planet Mars, and whether some elemental form of life existed or exists there. Nobody knows why, unless it is out of pure scientific curiosity. Millions of species are disappearing at an increasing rate on our planet and its fabulous volumes of water are constantly being poisoned.

The new laws of science – based on Einstein’s theories on energy and matter and the Big Boom theory as the origin of the millions of constellations and infinite stars or other hypotheses – have given way to profound changes in fundamental concepts such as space and time, which are occupying theologians’ attention and analyses. One of them, our Brazilian friend Frei Betto, approaches the issue in his book La obra del artista: una vision holística del Universe (The Artist’s Work: a Holistic View of the Universe), launched at the last International Book Fair in Havana.

Scientific advances in the last 100 years have impacted on traditional approaches that prevailed for thousands of years in the social sciences and even in philosophy and theology.

The interest that the most honest thinkers are taking in that new knowledge is notable, but we know absolutely nothing of President Obama’s thinking on the compatibility of consumer societies with science.

Meanwhile, it is worthwhile, now and then, to devote time to meditating on those issues. Certainly human beings will not cease to dream and take things with the due serenity and nerves of steel on that account. It is a duty – at least for those who chose the political profession and the noble and essential resolve of a human society of solidarity and justice.

Fidel Castro Ruz
March 24, 2010
6:40 p.m.

by Byron DeLear, courtesy of Politics in the Zeros

After a long arduous journey of being half-way there, the Senate finally passed a health care insurance reform bill on Christmas Eve.

How is it that throughout the entire health care debate the issue of job creation and economic stimulus has not been brought up?

The simple fact is, adding 30 million people into the health care system will translate into an abundance of economic activity and opportunity for millions of Americans: jobs such as doctors, nurses, technicians, administrators and new jobs in research, information technology, medicine — not to mention the positive impact all this fiscal solvency will have on supporting industries and professions.

Not to be a sidewalk superintendent, but it has been frustrating to see this law-making process unfold when obvious political messaging such as “Medicare for All” or “Health Care for New Jobs” has been missing from the Democratic playbook. Yes, I’m aware of Von Bismarck’s famous observation, “Laws are like sausages, it is better not to see them being made,” but even so, does anyone else feel as if this campaign was waged with one arm tied behind our back?

Job creation and rebuilding our economy is the prevailing social issue of the day; it is a political Holy Grail and it makes me wonder why this aspect of health care reform has not been brought to light. Adding ten percent of the entire US population into a system of continuous preventive care will undoubtedly lead to job and infrastructure growth in an industry that definitively embodies the best way to improve the general welfare of our national family.

In short, a trillion dollar ten-year health care reform package serves double purpose — not only does it begin to take the steps necessary to provide accessible and affordable health care for everyone, but it also acts as a massive jobs program and stimulus to uplift an economy struggling to recover.

It is beyond me why these two political dots have not been connected; they are so interrelated, and it seems that emphasizing the economic benefits of health care reform would have had a favorable impact by bringing many of the vocal naysayers — at least — into a place of neutrality; it may have even brought in a few Republicans to do the unthinkable, vote “yes”.

by President Barack Obama

Tonight, I return to speak to all of you about an issue that is central to that future, and that is the issue of healthcare.

I am not the first president to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for healthcare reform. And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell, Sr., in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session. Our collective failure to meet this challenge year after year, decade after decade, has led us to the breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle class Americans. Some can’t get insurance on the job. Others are self-employed and can’t afford it since buying insurance on your own costs you three times as much as the coverage you get from your employer.

Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover. We are the only democracy, the only advanced democracy on Earth, the only wealthy nation that allows such hardship for millions of its people.

There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job or change your job, you’ll lose your health insurance, too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it. Another woman, from Texas, was about to get a double mastectomy when her insurance company cancelled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America. (more…)

The purpose of devolution for Scotland and Wales, from the perspective of the Labour Party was to strengthen and preserve the union. As government minister, Douglas Alexander, who ran Labour’s campaign for the 2007 Scottish Parliament said: “The great outcome of devolution is it allows people to demonstrate their identity within the United Kingdom and, at the same time, not break up the United Kingdom.” Labour Party figures as diverse as Tony Blair and Tony Benn oppose Scottish independence.

But is we look at how the dynamic of devolution has actually worked in practice, we can see that this reform designed to save the union, has started a seemingly irreversible dynamic towards further separation. The very different political context in Wales and Scotland is largely overlooked by a London based media, and Westminster politicians.

Michael Keating, Professor of Scottish Politics at the University of Aberdeen, has examined the growing policy differences between England, Scotland and Wales: “The Labour Party may be the dominant political force in London, Edinburgh and Cardiff. But Scotland and Wales have stuck more to the traditional social democratic model of public service delivery. This has led them to stress non-selectivity, professionalism and uniformity, while rejecting foundation hospitals, star-rated hospitals, school league tables, beacon councils, elite universities and selective schools. Scotland also scrapped up-front university tuition fees and rejected top-up fees. At the same time, free care for the elderly has been introduced north of the border.”

In Wales, from 1st April 2007 prescription charges became free of charge. The “One Wales” agreement between the Welsh Labour Party and Plaid Cymru, which underpins their coalition government, is designed in the words of First Minister Rhodri Morgan, to put “thick red water” between Cardiff and London. For example, it includes a commitment that: “We firmly reject the privatisation of NHS services or the organisation of such services on market models. We will guarantee public ownership, public funding and public control of this vital public service.”

So far the differences have largely been driven by Cardiff and Edinburgh resisting policy initiatives originating from Westminster, that aspect is likely to become more pronounced if the Conservatives form a Westminster government based upon English votes, but with no mandate from Wales and Scotland.

So it is worth looking at one particular policy area, and seeing how far the process of devolution has created a dynamic of difference. In a recent article in Health Service Journal by Graham Clews, examines the differences in Health care administration after ten years of devolved government.

He makes the following interesting comparison:

In contrast to the devolved countries, it is greater freedoms for foundation trusts and local commissioners that have shifted power away from the centre in England. And unlike in Scotland, Northern Ireland and Wales, the focus of the English service has changed frequently to concentrate on at first standards, then targets and governance, followed by competition and choice, with the focus now being on the patient experience and quality.

Marking the 60th anniversary of the NHS last year, former NHS Confederation chief executive Gill Morgan suggested the NHS in England is now about contestability driving improvement and greater choice, while Scotland’s system is “collectivist”, with very little competition.
The key feature of the system in Northern Ireland meanwhile is greater integration between health and social care, while Wales is widely believed to enjoy a better working relationship between health and local authorities than is commonly enjoyed in much of the UK.

It is worth quoting at length his description of the political and administrative approach to health care in Scotland and Wales:

Scotland
In 2003, 15 NHS boards were introduced, now reduced to 14. This reorganisation reduced the purchaser-provider split. The NHS Reform Bill 2004 abolished trusts, absorbing them into the health boards.

The Scottish government was aiming for partnership within the NHS. At the same time, it unveiled headline grabbing initiatives, such as its intention to abolish prescription charges by 2011 while parking charges at hospitals have also been scrapped, except at private finance initiative hospitals.
Scottish health secretary Nicola Sturgeon (SNP) says she wants a stronger relationship between the NHS and the people it serves. Her aim, she says, is to run the Scottish NHS as a “mutual”, in which patients and the public are “co-owners”.

The Scottish government’s 2007 strategy document Better Health, Better Care develops this model, outlining how health boards and community health partnerships will work more closely with local authorities, and this will “distance NHS Scotland still further from market oriented models”, says Ms Sturgeon.

Ms Sturgeon regards hitting a series of “challenging” targets as the Scottish health service’s biggest success since devolution. At the end of last year, she says, there were just 664 patients waiting longer than 15 weeks for inpatient day case treatment in Scotland, a figure she compares with the 28,000 plus patients in England still waiting for more than 15 weeks for such treatment in February. But she also argues comparisons between the different systems will become increasingly difficult to make as they diverge further.

“For example, our focus on shifting the balance of care towards outpatient, primary and community care means more patients in Scotland can be treated for less complex procedures without an acute setting and nearer to home,” she says. “This impacts on [our] average length of hospital stay by increasing it relative to the English average.”

NHS Highland board chair Gary Coutts says an acknowledgement that several rural communities need different types of hospitals “has drawn a line in the sand over a perceived threat to these hospitals which has dominated our relationship with communities served by them for years and is allowing us to develop them in a much calmer environment”.

The lack of a purchaser-provider split, with unified health boards planning, commissioning and providing the range of healthcare in Scotland, is the biggest obvious structural difference between the health services in England and Scotland.

Ms Sturgeon says the integrated model in Scotland enables “a simpler context for financial flows within the system”, with managed clinical networks serving as “Scotland’s unique service delivery vehicle”.

Wales

The biggest post devolution structural change so far was prompted by the 2001 publication of Improving Health in Wales, which replaced health authorities in 2003 with 22 local health boards. Twelve regional trusts, each matching local authority areas, were made responsible for primary, secondary and mental healthcare, while one national trust, Health Commission Wales, an executive agency of the Welsh Assembly government, commissioned and funded tertiary care. A single national Welsh Ambulance Service was created while a Health and Social Care department with three regional offices was responsible for performance management.

Then, last year, Welsh health minister Edwina Hart unveiled bold proposals to wipe out the internal market completely. Instead the NHS in Wales will be run through seven autonomous local health boards. A National Advisory Board, chaired by the health minister, and a performance monitoring delivery board will be created. A “unified public health organisation” will have executive responsibility for public health through the local health boards.

With their chairs and six chief executives already announced, shadow boards are due to start work in July and the boards to begin work on 1 October. Although free prescriptions, introduced in 2007, and free hospital parking, due in 2011, might be expected to resonate most strongly with the public, Welsh NHS Confederation director Mike Ponton says structural overhauls hit the headlines. Intended as a blueprint for shifting care into the community, the 2005 publication of the 10 year strategy Designed for Life generated the biggest rumpus since devolution.

A spokesman for the Welsh Assembly says it has strengthened local analysis and action, and moved “decisively” to eliminate the market from the NHS. The 2003 reorganisation improved joint working, strengthened the relationships with primary care and improved the focus on local health improvement. He adds the new system will give staff and managers greater access to senior officials and ministers and offer them a greater role in forming policy and improving care.

Clearly the broadly social democratic ethos towards health care administration in Wales and Scotland is out of kilter with the market driven mechanisms in England. Health is a devolved matter, and so there will be no direct conflict with a Tory government in Westminster, but the social democratic consensus that is manifested in health also affects the whole outlook of the Welsh and Scottish political landsacpe, and is reinforced by these successful institutions that they run under devolved powers. The potential for the Welsh Assembly and Scottish Parliament to be bastions of resistance to a Westminster Ccnservative government is very great, and the option that Marageret Thatcher took of abolishing the Great London Authority would not be available, as the devolved powers cannot be taken away without the consent of the nations of Wales and Scotland.

As we prepare for Tiddles to wear a muzzle next time she/he goes out alone my local paper local carried a full back page article headed “Zona libre de besuqueo” - “Kissing free zone”. I read with the article tongue in cheek however it wasn’t a local joke but a serious (?) article from London about the station at Warrington Bank Quay where kissing has been banned on the forecourt and near to the taxi rank. Apparently the Cabbies are a bit ‘pissed off’ (my own liberal translation) with couples snogging next to the taxi rank, so amongst the the plethora of signs prohibiting smoking, dropping litter etc. etc. there is know a sign of a couple with pouted lips with a red circle and diagonal line forbidding kissing. Now I am not liberal enough to support Andy’s plea to bring back hunting but to forbid a quick snog before your partner jumps into a taxi and disappears from your life for a period of time? I have checked as far as possible and I can find no reference to a ban on snogging in the new anti-terrorist legislation, but then taking photo’s now has its limits so what next I ask.

The ban is supported by the Warrington Bank Quay Chamber of Commerce, the president Colin Daniels justified the ban by saying that the station was a very congested area and it was important that people are able to come and go without unnecessary delays. Apparently a ‘kissing space’ is under consideration. So next time you go to wave granny off in a taxi that peck on the cheek is not permitted - you will I suppose just have to shake hands (for the time being anyway).

As yet I haven’t had time to look at this from a marxist perspective but in my experience comradely greetings are not normally hidden away but expressed openly  by all. On a more serious note who will police this new crrime and what will be the consequences, will there be instant fines, will it become another task for the beleaguered traffic warden? I think that when Home Sec Jacqui Smith has finished counting the thousands of pounds she has made out of ‘her first home’ we should be given some answers.  

Not sure what catergory to post this under I have selected fascism and health care and welfare reform 

According to some of the right wing press, Gordon Brown has abandoned New Labour. Some trade union leaders agree, roaring their approval. Derek Simpson reckons that “Gordon Brown has thrown off the shackles of New Labour to reveal the real Labour”. Dave Prentis welcomed the Government’s “courage and determination in facing the economic crisis head on”. He wants the government to “hold firm to its commitment for increased public sector investment to create and sustain jobs”. For Tony Woodley the government has “shown that it is listening to people’s fears and is helping the people of this country weather the economic storm”. It has also shown itself “willing to embrace progressive politics”. Whilst these comments are made with one eye on the next General Election union officials are seeing what they want to see. In a situation where their members are faced with a growing wave of redundancies they should be raising their voices for action to save and create jobs rather than painting these changes as the abandonment of the politics of New Labour. Judged by the criteria of how the government is tackling the economic crisis, the pre-budget report fails the test of our members’ interests.

What has the government done? Facing an unprecedented crisis it has manoeuvred. It has been forced to do things which contradict its neo-liberal ideology. It has, after a fashion, nationalised Northern Rock and Bradford and Bingley and taken a 58% share in Royal Bank of Scotland. It has abandoned the out-sourcing of the pensioners card from the Post Office. It has been forced to put a stop to redundancies in the Department of Work and Pensions because, as a result of increased redundancies throughout the economy, there are insufficient staff to cope.

The government is, in fact, caught in a web of contradictions, yet it has not broken with the ideological framework on which it has operated for the last 11 years. It does not even have the “courage” to concede free prescription charges to people in England in line with Wales and (being phased in) in Scotland and Northern Ireland. Union members in the public sector will suffer the consequences of the crisis as the government presses for savings of £5 billion in 2010-11.

The minor and temporary decrease in VAT is directed at increasing consumer spending on which much of the “success” of the past decade has been based. But it is such a marginal increase that it is unlikely to have much impact. In any case, since the current crisis is the result of unprecedented high levels of debt, it is lunacy to expect people to carry on spending what they cannot afford. It would have been far more sensible to have put money into the pockets of the low paid by significantly raising personal allowances. For instance, raising the start of tax from the current £6,035 to £15,000 would have taken 10 million people out of tax and only cost £8 billion a year.

The “real Labour” which the delusional Derek Simpson sees is continuing to privatise services and is still acting in the interests of the rich. Its market in the NHS remains in place, with self-standing Trusts competing with each other and private companies for patients. Darling’s report says the Treasury’s “public value programme” has identified £100 million that should be saved by “improving” use of NHS “estates” in order to “reduce the use of new hospital space”.

It also paves the way for the entire Primary Care Trust estates to be transferred to public-private partnerships, to be known as PropCos. Assets that are managed in contracts such as these will belong to the private ‘partners’ at the end of the contract period. The Department of Health has been told that these entities do not have to appear on NHS balance sheets. Isn’t this off-balance sheet accountancy? The Health Service Journal estimates that the NHS share of the £5 billion cuts will be between £1.3 – 2.5 billion.

Darling is also looking at the privatisation of the Met Office, Ordnance Survey, the Forestry Commission, the Driver and Vehicle Licensing Agency and the UK Hydrographic Office.

The incredibly timid measure of raising the top rate of taxation from 40 to 45% has been delayed until 2011, and it will only affect those earning £150,000, the top 1% of earners. The government could not bring itself to accede to the demand of trades unions for a 50% rate of tax on those earning over £100,000 even though this would only effect 650,000 out of 31 million tax payers. This delayed and timid increase may be “symbolic” and marks a breach with their long held policy but it hardly marks a significant shift towards a progressive tax system. The means test remains in place for all benefits and the low paid people who lost out as a result of the end of the 10% tax rate have still not been fully compensated.

Any “progressive politics” would have to centre on the question of jobs. The VAT cut will not create jobs. Much consumer spending is based on buying imports since the government has watched the decline of manufacturing and welcomed the growth of financial services. If the government had really abandoned the New Labour programme it would have spent the £12.5 billion from the VAT cut on a programme of Council House building which would address housing need and put people in the building industry back to work as well as those in the building supplies industry. This industry comprises 11% of businesses in the country. Yet such a step would mean a genuine abandonment of New Labour’s discrimination against Council tenants. It would mean ending their effective ban on Council house building.

Although not given prominence in the media we see that the government seems to want to return to business as usual. They are seeking EU approval for a scheme that would provide guarantees for mortgage-back securities “to help banks lend more”. There is also a commitment to consider helping to securitise new mortgages, an attempt to “tempt lenders to lend more”, and get the wholesale financial markets working again. Staggering. It is these derivatives, the “toxic loans”, that have been a central reason for the freezing of inter-bank lending. Yet the government appears to want to build up these markets again!

Another thing which has not been picked up by most newspapers relates to buying extra years towards the state pensions. Darling has announced a 50% increase in the cost of buying an additional year’s contribution from £421 to £627 in April.

Suffice it to say that the declarations of the death of New Labour are premature. The government is fighting for its political survival (and the power and well paid jobs of its members). It is incapable of self-criticism which would lead to the abandonment of its political philosophy, rooted in its belief in the benefits of competition, globalisation, its support for financial capital, its abandonment of collectivism and its worship of (personal) “aspiration”.

The trade union leaders quoted above have picked up the wrong message from the pre-budget report. They should have seen the changes which have been forced on the government by the crisis as an opportunity not to praise the government but to step up pressure on it and demand that the breaches in neo-liberal policy are deepened. At the Defend Council Housing conference recently, Jack Dromey, Deputy-General Secretary of Unite said:

“Britain must build its way out of recession with the government investing in a new deal for council housing. Tens of thousands of new council homes every year would help meet the demand for affordable housing and generate much needed work for construction workers and those who produce the bricks, glass and cement that go into building homes.”

This would be a good starting point, together with moving away from a regressive taxation system. At the same time the unions need to defend their members’ jobs rather than accepting the dictates of ‘the market’. As I have discussed elsewhere (http://martinwicks.wordpress.com/2008/08/05/sixty-years-on/ ) the current situation demands a campaign for social ownership. Moreover, the current crisis surely poses the need for the unions to consider what sort of economy we want and how we might move towards it. I’ll consider this is a forthcoming article.

http://martinwicks.wordpress.com

Last week, an article in the Wall Street Journal spelled out an extremely important policy difference between Barack Obama and John McCain.

Both candidates want to reform the health care system – the US health care sector is in crisis, with medical insurance premiums having doubled since the year 2000, and the US spending 40% more per capita on health than other countries such as Canada and Switzerland, without better medical outcomes. This is quite apart from the millions of Americans – often people working fulltime, sometimes with even two jobs – who have no health care.

By the standards of the British NHS, the reforms promised by Barack Obama still fall short. But nevertheless, would bring better, affordable health care to many who currently don’t have it.

Reforms to the system will include merging smaller health schemes, prioritising patient outcomes instead of procedures, and providing national guidance on what the best procedures and treatments are.

It is anticipated that this more regulated health sector will remove a lot of hidden health costs: after all a private sector paid for by insurance has an institutional bias against efficiency and patient outcomes, and will often inflate costs and lead to decisions being taken on grounds of profitability not medical desirability. The reform are expected to lower premiums by $2,500 for the typical family, allowing millions previously priced out of the market to afford insurance. In addition, tax credits for those still unable to afford private coverage, and very importantly the option to buy in to the federal government’s benefits system, will ensure that all individuals have access to an affordable, portable alternative.

Obama’s scheme would still be based upon private medical insurance, but the threshold of affordability should be lower.

It still isn’t Cuba, or even Canada, but it is a step forward.

What about John McCain? His plans would be a disaster, that will actually exaggerate further the worst aspects of the current system, while forcing millions out of their current company schemes:

His plan is to raise taxes on workers who receive health benefits, with the idea of encouraging their employers to drop coverage. A study conducted by University of Michigan economist Tom Buchmueller and colleagues published in the journal Health Affairs suggests that the McCain tax hike will lead employers to drop coverage for over 20 million Americans.

He then proposes to give them a small tax credit, $5,000 for a family and $2,500 for an individual, and tell them to navigate the individual insurance market on their own. These credits are way too small. They are less than half the cost of policies today ($12,000 on average for a family), and are far below the 75% that most employers offering coverage contribute.

Those already sick would have their coverage discontuned - as individual insurers would be free to deny coverage due to pre-existing conditions.

Finally McCain’s plan does nothing to address the inefficiences of the US health care system, which spends huge amounts of money but still excludes millions from even basic provision.

The announcement by the One Wales coalition government that parking charges will be abolished at NHS hospitals in Wales is very interesting.

Firstly, it clearly shows the divergence with a more progressive political agenda being pushed in Cardiff and Edinburgh, while the British government relies upon Labour MPs representing Welsh and Scottish constituencies to impose more reactionary policies on England.

Even with their limited powers the Welsh and Scottish governments are making real improvements. Prescription charges have been abolished in Wales for nearly a year now.

But some criticism has been raised that no additional funds are being made to the hospitals to make up for the lost revenue. However, this just shows another weakness of the current constitutional settlement, that the Welsh government has no tax raising powers, which limits their ability to put more funds towards health. Car parking charges are a back-door tax on health service users that flies totally against the NHS principle of treatment being free at the point of delivery.

Another anomaly has been exposed by Bethan Jenkins, Plaid Cymru Assembly Member for South Wales West, who points out that:

Patients in Neath Port Talbot will not benefit from [the] One Wales Government announcement abolishing hospital car park charges. The realisation of this One Wales commitment is very welcome indeed, but I feel compelled to question the competence of Bro Morgannwg NHS Trust, who have signed a contract with car parking companies that means patients in Neath Port Talbot will continue to be charged for parking at our hospitals.

We are not discussing a contract lasting a few months or even a few years. Bro Morgannwg are in a binding contract with car parking companies until 2032 which means that they are now unable to respond to the change in direction provided by the new Government of Wales.

This exposes how New Labour’s reliance on the private sector is fundamentally undemocratic, as it takes those the privatised services out of democratic control.

On Monday our Socialist Film Club in Swindon showed Michael Moore’s “Sicko”, there were about 15 people there including two GMB officials, and three members of the Green Party.

I was very impressed by this film, which is Moore’s best work to date. Liberal critics of Michael Moore criticise his techniques of doorstepping corporate suits to make them look shifty, and using tabloid presentational techniques and emotive arguments. But in truth, Moore is merely subverting the expectations and habits of mainstream film-making.

Spokespeople in organised press conferences in plush corporate settings have their words sanctified by the context, and they therefore exclude discordant voices. Although there is rarely meaningful content in the doorstepping approach Michael Moore uses, when confronting corporate spokespeople, he is taking them out of their context, and the real message that comes across is the truthful one that corporate power is inaccessible and unaccountable.

Similarly, Moore’s use of emotive examples is exactly what the corporations and government do, and only when it is used against them do they describe it as propaganda.

Illustrated throughout with heart-rending personal cases, and with whistle blowing individuals who have worked in the US health care system, Sicko shows an utterly rancid system, where insurance companies seek to minimise the amount of health care provided to Americans.

Particularly moving was the testimony of a a young women whose husband died of cancer despite the fact that his brother was a perfect match for a bone marrow transplant that could have saved his life. He was not one of the 50 million Americans who have no health cover, but the insurance company weaseled their way out of paying.

Moore then goes on to compare the US system with the socialised health care systems of Canada, Britain, France and Cuba. This includes interviews with Americans living in France and Britain, and taking American patients denied health care to Cuba for treatment.

The interesting thing here is Michael Moore’s very firm grasp of the potential of progressive patriotism. The common collective identity that Americans feel was illustrated in a positive way by showing the charity work and community spirit, and then this was contrasted with the selfishness of the Health companies. Similarly the strong and positive identification that Americans have with their state owned fire service, postal service and education system was used as an example of how a state owned health service could be compatible with American values.

The battle for values is at the heart of how socialists should relate to national identity and patriotism. Michael Moore brilliantly argues a case in the film for how other countries have a national culture of caring for each other in their socialised health care system. He then argues that American society instinctively has the same values, but that the private health care system and pharmaceutical companies betray those ideals, and that the rich are anti-social and un-American. In this way liberal and patriotic opinion can be channelled and shaped into a progressive direction, strengthening and consolidating the position of the left.

The highlight of the film is when he takes the patients to Cuba, some of them volunteers who became ill after working at ground Zero following 9/11, but who have been denied health care. Promising that they would receive no better and no worse treatment than Cubans, the American patients are overwhelmed by the quality of care and compassion, and that drugs they pay $120 for are available for 50c.

Brilliantly, the film ends with the 9/11 volunteers being received as honoured guests by a Cuban Fire station, and the international solidarity of working people is celebrated.

Here is a very unexceptional occurence in the US health system, which takes the breath away.

Friday, March 30, 2007
San Francisco General Hospital is the only trauma center …David Lazarus

There are 47 million people in this country without health insurance. Richmond resident Joey Palmer is one of them.He learned how costly this can be after fracturing a rib in a relatively minor motorcycle accident and subsequently being hit with a bill for more than $12,000 from San Francisco General Hospital.

“There’s no way I could pay something like that,” Palmer, 32, told me. “I’m not a bum, but I’m not making a lot of money right now. How is anyone supposed to pay a bill like that?”

Iman Nazeeri-Simmons, director of administrative operations at San Francisco General, said she sympathizes with Palmer’s situation.”It’s not us,” she said. “It’s the whole system, and the system is broken. We need to look closely at making changes and at how we can deliver care in a rational way.”

Palmer’s story illustrates the broader problem of runaway health care costs in the United States and a system that leaves millions of Americans to fend for themselves.It also underlines the importance of universal coverage that guarantees affordable health care to anyone, anywhere — a goal that’s become a central issue in California and in the current presidential campaign.

“We are the only developed country that doesn’t cover all its people,” said Stan Dorn, a senior research associate at the nonpartisan Urban Institute. “We also spend a lot more than the rest of the developed world.”

The United States spent an average of $6,102 per person on health care in 2004 (the latest year for which figures are available), according to the Organization for Economic Cooperation and Development.

Canada spent $3,165 per person, France $3,159, Australia $3,120 and Britain a mere $2,508. At the same time, life expectancy in the United States was lower than in each of these other countries and infant mortality was higher. But those are just statistics. When you talk about America’s health care crisis, you’re really talking about people. And Palmer’s experience speaks volumes. He was riding his motorcycle through San Francisco’s Presidio on Sept. 19. It was late afternoon. Palmer was heading toward the Golden Gate Bridge and then home to Richmond. Suddenly his brakes locked, sending the motorcycle into a slide. Palmer slammed into a guardrail. He was pretty shaken up, but he could tell he wasn’t badly hurt. A passer-by saw the accident and called for help. An ambulance arrived within minutes. Palmer said he told the paramedics that his ribs felt banged up, possibly broken, but that he was basically OK. He said he preferred to be treated in Contra Costa County, where he lives and would probably qualify for reduced hospital rates because of his income level.

Palmer is a woodworker who specializes in the decorative touches on wealthy people’s yachts. He said he made only about $7,500 last year, getting by primarily with the assistance of relatives. Palmer said the paramedics were concerned that he may have sustained internal injuries and insisted that he be treated immediately at a hospital. So he was driven by ambulance to San Francisco General, the only trauma center in the city.

Palmer got lucky here. The ambulance was from the Presidio Fire Department, which is run by the federal government and doesn’t charge for ambulance service. Had the trip been made by a private ambulance company, it likely would have cost Palmer between $700 and $1,000. On the other hand, what Palmer didn’t know is that as soon as the paramedics radioed ahead to say they were bringing in an accident victim, San Francisco General, as per the hospital’s procedures, issued a trauma alert to its staff.

Basically, that means a page was sent to doctors and anesthesiologists on call at the time. That page alone cost Palmer $4,659, and he hadn’t even set foot yet inside the hospital. The actual hospital experience was, to put it mildly, a nightmare. After blood was drawn for a variety of tests (the cheapest of which cost $44 and the priciest $107), some X-rays were taken ($423).

Then, Palmer said, he was left in a room ($2,070) with a junkie “who was having a real bad trip.” He asked to be moved elsewhere but was told no other rooms were available. So Palmer ended up on a gurney in the hallway. And he waited there for five hours.Palmer’s bill indicates that he was twice given Vicodin ($22) to ease his pain during this interval, but he insists he took no medication.

“I finally saw someone and asked if I could check myself out,” he said. “The guy said they were still waiting for the results of my CT scans. I said that I hadn’t had any CT scans. It turns out they forgot to put me on the list.” So Palmer was put on the list for CT scans. And he waited another hour.At last the CT scans were taken ($3,334) and then another round of X-rays because, Palmer said, the first batch apparently hadn’t been done correctly.”

Finally a doctor came to me — it’s now almost 2 in the morning — and said, yes, I had a fractured rib and some bruised muscles,” Palmer recalled. “That was that. End of conversation.” Shortly afterward, he said, a clerical staffer approached with discharge papers for Palmer to sign.” She asked how I intended to pay for everything,” Palmer said. “I told her I didn’t have any insurance. She looked at me and then asked if there was anyone I could sue.”Several weeks later, he received a bill for $11,082 in hospital charges and a separate bill for $922 in doctors’ fees.

Palmer’s hospital visit was expensive and time consuming, but it wasn’t unique. Many people could cite similar (and similarly costly) experiences in receiving “emergency” medical care at U.S. facilities. “We view health care as a chance to make as much money as you can,” said Dorn at the Urban Institute. “The goal of health care should be improving people’s health.”

San Francisco General’s Nazeeri-Simmons was unable to comment on Palmer’s lengthy hospital stay because she didn’t have access to his medical records. But with Palmer’s permission, she was able to examine his billing file. “These charges are comparable to the entire health care market,” Nazeeri-Simmons said. “They aren’t out of line with what other hospitals are charging. They’re actually lower.”Not always. Trauma activation charges, for example, typically range from about $2,000 at some Bay Area hospitals to $7,000. At Marin General Hospital, the charge can run as high as $12,636.Nazeeri-Simmons said a sliding scale is offered for low-income San Francisco residents. But Palmer, as a resident of Contra Costa County, wasn’t eligible for the program. “If you were uninsured and making less than $10,000, you would pay nothing,” Nazeeri-Simmons said. “But that’s only if you live in the City and County of San Francisco.”After receiving his bill, Palmer complained to the hospital about how much he was being charged. Nazeeri-Simmons acknowledged that a second look was given to the bill at Palmer’s request “and we decided to eliminate the trauma activation charge.” That reduced the amount due by $4,659. But Palmer still owes more than $7,000 for an eight-hour hospital visit that involved, by his estimate, only about 15 minutes of actual care.”It’s unfortunate that he’s in the situation he’s in,” Nazeeri-Simmons said. “But what is an individual hospital to do? Are we supposed to eat the costs?”

She said a government-run program similar to systems in place in all other developed democracies would almost certainly keep costs in check while ensuring that everyone has access to treatment (without being impoverished in the process). “Universal coverage would mean that a Joey Palmer doesn’t get left out in the cold just because he was in the wrong county,” Nazeeri-Simmons said.

For his part, Palmer said he’ll try to pay off his hospital bill as best he can. And then, if he can swing it, he’ll leave the country. He’s thinking seriously about moving to France. “If you get sick over there,” Palmer mused, “you can go to any hospital and it won’t cost a fortune.” He said that with a tone of quiet disbelief.