The Call for the Conversion of the GM Oshawa Plant to a Facility for the Production of Medical Equipment in the Wake of the Coronavirus Pandemic

On April 19, 2020, on the Socialist Project website–Retool Oshawa GM Complex to Combat Covid19–there is a press conference by five individuals–Tony Leah (facilitator), Michael Hurley, Rebecca Keetch, Patty Coates and James Hutt–calling on the Canadian government (and the Ontario provincial government) to take over the GM Oshawa plant, which closed on December 19, 2019, in order to facilitate the production of medical equipment, including masks, ventilators, gloves and tests–all of which are in short supply due to the international competition for such equipment as well as the Trump government’s ban on exporting medical equipment into Canada.

Some of the following is taken verbatim from the five presenters without quotes in order to facilitate reading whereas some of it is paraphrased. After a description of what they say, I make some critical comments in relation to the call for public ownership and other issues.

Mr. Hurley, president of the Hospital Division of the Canadian Union of Public Employees (CUPE), emphasizes the urgency of the need for medical equipment for front-line workers. Medical equipment is in short supply to deal with the coronavirus pandemic,  and such equipment is vital if front-line workers are not to succumb to the virus themselves, as many paramedics did in New York.

Ms. Keetch, a former autoworker at GM Oshawa, calls on the Canadian and provincial governments to convert the closed-down GM Oshawa assembly plant into a publicly-owned site in order to use it to produce much needed medical equipment. She points out that other countries and companies have converted car factories into plants for producing medical equipment: the Chinese capitalist company BYD producing masks and hand sanitizers; GM having its workers produce ventilators at its Kokomo Indiana plant; and Ford Canada having its workers produce face masks at its Windsor Ontario plant. She justifies taking over the plant on the basis of putting social need in general before the interest of profit and the particular health and safety needs of workers who have been declared essential, such as hospital workers and grocery workers. There already exists a skilled workforce available to produce the needed medical equipment–the workforce of the former GM plant and the workers of its former suppliers.

Ms. Coates, president of the Ontario Federation of Labour (representing 54 unions and a million workers) indicates her support for the initiative and points out how the Conservative government of Doug Ford had reduced the health-care budget before the pandemic. Health-care workers, patients and community members need vital medical equipment that are currently lacking. She also supports a proposal for workers having 21 paid sick days so that they can stay home if sick without financial hardship and free healthcare for all regardless of immigration status. Workers themselves are calling for such protective measures.

Mr. Hutt does climate and labour justice with the Leap. On the Leap website, it says:

Mission

The Leap’s mission is to advance a radically hopeful vision for how we can address climate change by building a more just world, while building movement power and popular support to transform it into a lived reality.

Since our launch, we’ve drawn heavily on the ideas and networks of our co-founders, Naomi Klein and Avi Lewis.

Mr. Hutt notes that Justin Trudeau, the Canadian prime minister, called for manufacturing companies to retool to produce medical equipment, but it is not enough to rely on the goodwill of CEOs and manufacturers to produce what is needed at this time. There is a textile manufacturer, Novo Textile Co, based in Coquitlam, British Columbia, that has ordered machinery from China in order to produce masks, but it has not yet received the equipment. What we need now is fast production of medical equipment.

This shows that we need the government to play a strong role in ensuring that we increase production of medical equipment in order to meet the demand for medical supplies in Canada. This is where GM Oshawa can play a role. The auto assembly plant is one of the largest plants in North America, and yet 90 percent of its capacity is currently going to waste. Furthermore, there are available 5,000 workers who lost their jobs directly through the closing of the factory and 10,000 more workers who, indirectly, became unemployed.

The workers should be hired back in good, well-paying unionized jobs. After all, it is they who produce the value and services needed  by society.

What we need is a people’s bailout, which includes both workers and the environment, instead of a bailout of corporations and banks. The people’s bailout contains three components. Firstly, it responds to the immediate life-and-death needs of front-line workers and by all those whose lives have been turned inside out by the pandemic. Secondly, it helps to recover our lives, but in a new way, through government stimulus in creating a zero-carbon and full employment economy. Thirdly, it helps to reimagine our society. The economy must be transformed to ensure that safety and stability are the priorities for all and not just the 1%.

Nationalizing the plant, or converting it into public ownership, would create 13,000 unionized, well-paying jobs to produce the things that we need, initially in the first component or phase of producing medical equipment and, in the second phase, the production of electric vehicles for, for example, Canada Post, the single largest user of vehicles in Canada, and electric buses across Canada.

The third component or phase would involve the creation of a more just society for all, which entails public ownership of the plant, the provision of production facilities in Canada that would involve internal production of medical equipment throughout Canada.

Mr. Leah then points out that there is a petition that viewers of the Conference can sign, which will be sent to Premier Ford of Ontario and Prime Minister Trudeau (Petition–Order GM to Make Needed PPE).

There was then a question and answer session, with Valerie McDonald (? unsure if this is the name) asking the question of how quickly could the Oshawa plant fully employ the former workforce, whether directly or indirectly, and use the plant to capacity. Another question by Kate (I could not make out her last name) was who would paid for the retooling, the federal or provincial governments, and how much would it cost and how long it would take. Mr. Hurley pointed out that China set up factories within two weeks for the production of fiber masks. Given that the Canadian governments have adopted emergency powers, they could start producing almost immediately. As for the cost, currently Canada is paying almost three times the normal price for medical supplies on the open market; consequently, there would actually be considerable savings by shifting to local production. Ms. Leetch added that in the United States, in Warren, it took about two weeks to be converted and a total of a month for thousands of masks to be produced. She also points that, in relation to costs, it would be necessary for the government to provide aid for retooling. Ms. Coates adds that we need to think about the future beyond this pandemic: we need to have the capacity to produce ventilators and other medical equipment. As for the cost, the issue of cost has little to do with the issue since lives are priceless, and the cost of retooling to save lives not just now but also for the foreseeable future–since there will still be demand for personal protective equipment for some time to come even in the case of the current pandemic. We need a permanent solution to the problem and not a temporary one.

Another couple of questions were: The federal government had no problem purchasing a U.S. owned pipeline company, but now that such a company will be idled, why would the federal government not step in and purchase the plant from GM and retool it? A follow-up question is: Is the plant too large, and can it be adapted to produce medical equipment and other things [unclear if this is the exact question]. Another question is whether the machinery already exists in the plant or must it be imported?

Mr. Hurley indicated that neither the provincial Ontario government nor the federal government has responded in an urgent fashion to the pandemic by forcing employers to retool to produce medical equipment despite hundreds and even thousands of Canadians dying due to the pandemic. It is time that the Trudeau government institute wartime measures to force employers to retool in order to save lives by producing tests, ventilators and other medical equipment that are fundamental to the protection of workers.

Ms. Coates added that not only healthcare workers do not have sufficient protection but also grocery workers, bus drivers and municipal workers are still working and need to be protected during this pandemic.

Ms. Keetch points out that what they are demanding is that the government order production because that will then allocate resources that permit things to happen. As for the plant being too big: not really. We can use whatever space is necessary at the plant right now to address immediate needs. In relation to parallels between the federal government purchasing a pipeline company and purchasing the GM Oshawa plant, but the issue now is to prioritize what needs to be done, and the priority should be to protect Canadian citizens, and both money and the political will need to be found to do that. She does not know whether the machinery is on site, but she does know that Ontarians are experts in manufacturing and have been for decades.

For closing remarks, Ms. Keetch pointed out that the pandemic is an interdependent phenomena, with both the public coming into contact with workers and workers coming into contact with the public, so that both need to protect each other through the use of protective equipment. The use of present resources to meet this need is a common-sense approach.

Tony Leah stated that what happened in the United States in Kokomo and other places in the United States, when the government ordered production, shows that medical equipment can be relatively quickly produced, within a week or two, depending on the complexity of the equipment. He judges GM’s inaction to be shameful, especially since GM took $11 billion in Canadian bailout money during the last economic crisis.

As an emergency measure, it makes sense to convert the idle GM Oshawa plant into a plant where workers could produce much needed medical equipment. As a longer-term measure, it also makes sense to convert the idle plant into a permanent facility for the production of medical equipment in order to prevent any future shortage of medical supplies. Alternatively, once the pandemic has past, it could make sense to convert the plant  into an electric-vehicle factory as originally planned.

From the point of view of the workers who lost their jobs when GM Oshawa closed the plant, it also makes sense to try to be employed again; they could resume the same kind of life that they used to live rather than joining the unemployed.

I did sign the petition, but mainly because it makes sense to pressure the governments to convert the plant into a factory to deal with the pandemic crisis. Given the urgency of the situation, however, there could at least have been reference to seizing the plant by the workers. Seizing the plant could easily have been justified as necessary in order to save lives.

Such seizure, it seems, is probably impractical for a number of reasons. Firstly, the workers themselves have probably been demobilized (moved on to other jobs if they can find them), or they may have abandoned any hope of working at the plant again; others may have accepted a retirement package. Secondly, even if they seized the plant, financing for retooling seems to be beyond their collective means–hence, the need to rely on the government for funding.

However, at least the possibility of seizing the plant and the legitimacy of doing so should have been raised in order to highlight the discrepancy between the real needs of people, the lack of action by the governments and the class power of employers. After all, in normal times, the needs of those who cannot pay are neglected, and the needs of workers for safe working conditions are often neglected as well. Focusing exclusively on what is practical in the situation resulted in another lost opportunity to open up a conversation about the legitimacy of the current economic and political structures.Rather than using the situation as an opportunity to at least point out the legitimacy of seizing the plant–they focus exclusively what is immediately practical. Such “realism” is hardly in the best interests of the working class and of the community.

Mr. Hurley is the person who comes closest to showing such discrepancy, but he limits his criticism to the present governments of Ontario and Canada rather than to the limits of an economy characterized by a dictatorial structure and a modern state characterized, on the one hand, by merely formal equality between “citizens” that often assumes a repressive form (by the police and the courts, for example) and, on the other, a hierarchical dictatorship characteristic of the employer and employee relation within government or the modern state.

The presenters did not use the situation as an opportunity to link the particular–and urgent–problem of a society capable of producing needed medical equipment–to the general problem of a society that excludes not only the needs of people for various goods and services–but also the needs of workers to control their own working lives.

It is true that Mr. Hutt does refer to a third component of a people’s bailout–a reimagined society–but it is more like a social-democratic reimagining more than anything else–and it is utopian. To call for a society that is safe would require the elimination of the power of employers as a class. After all, workers are means for the benefit of employers, and as means their safety is always in jeopardy (for the necessary treatment of workers as means for the benefit of the class of employers, see The Money Circuit of Capital; for the issue of safety, see for example Working for an Employer May Be Dangerous to Your Health, Part One).

As for Mr. Hutt’s call for stability, that too would require the elimination of the power of the class of employers since investment decisions are made for the purpose of accumulating more profitable capital, and such an accumulation process often leads to crises in production and exchange (through overproduction and hence unemployment. Employers also introduce machinery into workplaces, reducing the demand for workers. Since workers are the basis for profit, though, the situation is again ripe for an economic crisis since the production of such a profit requires increasing the exploitation of workers who do work while keeping down their wages through increasing unemployment–overwork for those who work and little work for the unemployed.

Furthermore, given the repressive nature of the employers (see, for example, Employers as Dictators, Part One) and the government (see for example Socialism, Police and the Government or State, Part Two), many peoples’ lives are hardly experienced as stable.  Mr. Hutt’s reference to stability rings hollow.

Does Mr. Hutt really believe in the elimination of a class of employers? The elimination of classes would be what is needed to live a safe and stable life within the limits of the natural world and the limits of our own created world, He nowhere says so. In fact, it is probable that Mr. Hutt believes in the reconstruction of a welfare state–capitalism with a human face. His reference to “good, well-paying unionized jobs” is what is probably the aim–“decent work,” “a fair contract,” and “free collective bargaining.” I have criticized these ideas in earlier posts, so readers can refer to them in order to see their limitations.

Mr. Hutt’s reference to a zero-carbon economy also fails to meet the problem of the infinite nature of the nature of the capitalist economy and the limited earth on which we live. Even if the capitalist economy moves to a zero-carbon economy (free of the use of fossil fuels), the infinite nature of capitalist accumulation would undoubtedly continue to rape the planet (see The British Labour Party’s 2019 Manifesto: More Social Democracy and More Social Reformism, Part One).

One final point to reinforce the previous post: nationalization and reliance on the modern government and state, typical of the social-democratic left, are hardly democratic. For real democracy and not just formal democracy to arise, it would be necessary to dismantle the repressive nature of the modern government or state. As George McCarthy (2018) remarks, in his book Marx and Social Justice Ethics and Natural Law in the Critique of Political Economy, page 279:

Following closely the military and political events surrounding the [Paris] Commune, Marx recognised very quickly that some of his earlier ideas about the socialist state contained in the Communist Manifesto (1848) were no longer relevant: ‘[T]he working class cannot simply lay hold of the ready-made state machinery, and wield it for its own purposes’.18 The state is not an independent and neutral political
organisation capable of yielding power for one class and then another; it is not simply an issue of gaining control over the state and then implementing economic
and social reforms. Rather, the republican state, utilising its political and legal apparatus, is an oppressive mechanism of social control preserving the class interests of the bourgeois economic system, and this, too, would also have to be restructured. Continuing arguments from On the Jewish Question (1843), Marx contends that the role of the French state was to maintain the economic and political power of the propertied class: ‘[T]he state power assumed more and more the character of the national power of capital over labour, of a public force organised for social enslavement, of an engine of class despotism’.19 Therefore, with this in mind, the Commune’s first actions were to dismantle the various component parts of the French state, including the army, police, bureaucracy, clergy, and the judiciary. Thus an entirely new form of government would have to be constructed that conformed to the socialist ideals of human emancipation and political freedom.

To talk of “democratic public ownership” in the context of a sea of economic dictatorship both within and outside the modern government or state stimulates high expectations that are bound to be dashed in the real world.

The earlier call by Green Jobs Oshawa was to nationalize the plant and to produce electric vehicles may seem also to make sense, but I will address this issue in another post in reference to the Socialist Project’s pamphlet Take the Plant–Save the Planet: The Struggle for Community Control and Plant Conversion at GM Oshawa. 

Addendum:

The above post was posted at 1:00 a.m., Friday, April 24. In the afternoon, it was announced that the GM Oshawa plant would indeed be retooled to produce a million masks a month for essential workers (see GM Oshawa plant will now produce millions of masks following worker mobilization: CUPE Ontario). The federal Trudeau government and GM signed a letter of intent to that effect. The response from one of the unions that represent front-line hospital workers–the Canadian Union of Public Employees (CUPE):

 “We mobilized our community through a petition and public events and it goes to show that collective action works. This unprecedented victory is now an opportunity to push the Ford Conservatives to also retool private companies to produce what Ontarians need.”

To produce what Ontario needs: What does that mean? They are probably  referring to the production of needed medical equipment:

“The Ford Conservatives need to learn from this example and order the private sector to ramp up production of these supplies – or retool factories if necessary,” said Fred Hahn, President of CUPE Ontario, highlighting feeder plants and other manufacturing facilities across the province. “They’ve had no problem unilaterally issuing orders that override the freely-negotiated collective agreements of front-line workers. They now need to use their power to order the immediate production of PPE for everyone who needs it.”

The use of the abandoned GM Oshawa plant for the production of medical equipment is indeed a victory–this is vital if frontline workers are to be protected from the coronavirus.

It should be noted, though, that this victory is probably a short-term victory. The urgent need for masks for frontline workers, as I pointed out above, could have been used to justify at least theoretically the seizure of the GM Oshawa plant by the workers who used to work there. Since the call for using the GM Oshawa plant and the retooling needed are separated from any reference to the legitimate right of the workers to seize the plant, when the need for the production of masks no longer exists, the plant will probably revert to its former status as an abandoned capitalist factory. The workers will have a difficult time justifying the continued maintenance of production at the plant given their short-term victory. Indeed, given that the form of the announcement is a letter of intent between the federal government and GM, shifting production to masks, in the eyes of many, will probably be viewed as a result of actions by government and employer rather than by workers and unions.

Another problem is that it is unclear who will be rehired to produce the masks, and how many will be rehired.

The urgency of the need for medical equipment is short-term–but it should have been used for long-term gains. Instead, an opportunity for shifting public opinion towards the legitimization of the seizure of workplaces by workers has been squandered.

 

 

The Poverty of Academic Leftism, Part Seven: The Idealization of the Nation State or the National Government and Nationalization in the Wake of the Coronavirus Pandemic, Part Two

In a previous post, I pointed out how Professor Noonan idealized the nation state. This post will expand on this view by showing that Professor Noonan’s proposal to nationalize  the economy by means of the modern state does the same thing–idealizes the modern state.

Professor Noonan makes the following claim:

The alternative is to use this crisis as a basis of legitimacy for the state– under the control of democratic political forces acting in our shared life-interest– to assume control over the productive basis of society and re-orient production to serving life-needs. Nationalization can prefigure democratic socialization, and democratic socialization can re-focus economic life on collective work to provide each and all that which we really need, and freeing our time for the– real-life, multidimensional– experiences, actions, and interactions that make life worth fighting for, protecting, and living.

The call for nationalization of industry by means of the modern state has been typical of many leftists for at least a century and a half. Marx, before, during and a couple of years after the 1848 revolutions, called for the centralization or the appropriation of the conditions of life (factories and other productive facilities, banks, utilities and so forth) by the modern state. Ironically, Professor Noonan, who considers that his view is superior to the Leninist view of the modern state, follows in Leninist footsteps. From Paul Thomas (1994), Alien Politics: Marxist State Theory Retrieved (New York: Routledge), pages ix-x:

Since the 1960s, fierce but turgid [pretentious or windy or laboured or strained] have raged among scholars about Marxist state theory. Participants in these debates were in some respects bitterly opposed. Yet they tended, by and large, to agree on one basic assumption: that the state, or the state as Marx thought of it, is class determined or shaped by the play of class forces outside its boundaries. Disagreements duly proceeded about what this ruling class theory means. (It might mean, for instance, that the state is the instrument of the capitalist class, or that it is an agency structurally tied to ruling class interests or imperatives.) But the theory, in the main, was itself accepted–accepted, in my view, rather too readily and uncritically.

But what did its acceptance involve? It involved, in practice, the often impatient conflation or running-together of understandings of the state that are, in principle, separable: that of the state as being class-determined, and that of the state as an “object,” an instrument, a “finished thing” that is capable of being “seized” and turned to good account once it is seized by the right hands. Theorists–among them Marx himself, for a while, as well as Lenin–can be seen to be given to such impatience under the impress of revolutionary urgency.

But by now, such impatience can be seen to have invited dangerous illusions about what can be accomplished by seizing the state. Seizure of the state can be seen, for that matter, as a dangerous illusion in its own right.

The modern state, as a separate institution, is itself characteristic of the nature of a society dominated by a class of employers and is hardly something external to it. From Thomas, page x:

Because common action and democratic potential find no place in civil society, these are alienated and represented away from its orbit.  Common action and collective concern, which in civil society are subsumed beneath self-assertion and the play of competing self-interests, are fused and concentrated at the level of the state, which arrogates them to itself.

The modern state is similar in some respects to modern money. Modern money emerges as a monopolizer by being the only social object that is immediately exchangeable. The modern state is a monopolizer of the so-called public sphere by being the only social object that immediately constitutes political subjects (citizens). From Geoffrey Kay and James Mott (1982), Political Order and the Law of Labour, page 6:

The political nature of money is evident in its appearance —it always bears the head of the prince, or some other emblem of state. On the side of subjectivity the same
applies: just as money is immediately exchangeable as a universal object whose credentials do not have to be chocked, so every individual is accepted at face value as a persona bona fide. Money is accepted because it is a universal objcct on account of its being political: the individual is universally recognised because he is a
political subject – a citizen.

Just as money is a production relation despite being external to the production process, so too is the modern state a production relation despite being external to the production process.

The call for nationalization and state centralization independently of working-class consciousness of its own general interests may be merely the expression of the immediate interests of workers under specific circumstances without leading anywhere except the absorption of such nationalization into the folds of the capitalist system itself; in other words, such nationalization may be co-opted by the modern state and by certain sections of the class of employers.

Isabelle Garo (2000), Marx: Une Critique de la Philosophie  argues that Marx did oppose, at least later in life, state centralization as a socialist measure (I give my rather freely translated version, followed by the original French. If anyone has a better translation, feel free to make a comment), pages 233-234:

Marx insists on the fact that the Commune [the Paris Commune, an organization that arose in 1871 in the face of, on the one hand, the defeat of France by Prussia during the Prussian-French war and, on the other, the attempt by the French class of employers to take away the arms held by the National Guard in Paris] aims in the first place the emancipation of work. It is the established unity between political tasks and economic organization, “the political form finally found that permitted the realization of the economic emancipation of work.” From this point of view, the idea of a separated political instance is indeed an illusion that masks the functional subordination of the State to the mode of production to its criteria and to its needs. The overthrow of this logic is not the temporary reuse of the State, followed by its suppression: as functional representation, it [the State] concentrates in itself the nature and contradictions of the economic and social formation in general. The withering away of the State is a radical redefinition of politics, its reappropriation by the associated producers as an instance of democratic decision-making and rationalization of a production that cannot possess in itself its own ends. Said in another way, the valorization of value [the increase of money for the sake of the increase of money by way of using human beings and their conditions of life as means to that end–see The Money Circuit of Capital)  and its absurd spiral must cede place to the redefinition of social and individual activity. Political representation, modified in its definition, is turned upside down in its function: far from being a means for dispossession that makes universal suffrage the right to designate who are to be our  “masters,” is the occasion of a specifically political action precisely because it concerns local tasks of organization.

Marx insiste sur le fait que la Commune vise en premier lieu l’émancipation du travail. Elle est l’unité instaurée entre tâches politiques et organisation économique,
« la forme politique enfin trouvée qui permettait de réaliser l’émancipation économique du travail79». De ce point de vue, l’idée d’une instance politique séparée est bien une illusion qui masque la subordination fonctionnelle de l’État au mode de production à ses critères et à ses urgences. Le renversement de cette logique n’est pas la réutilisation momentanée de l’État, suivie de sa suppression: en tant que représentation fonctionnelle, il concentre en lui la nature et les contradictions de la formation économique et sociale dans son ensemble. Le dépérissement de l’État est une redéfinition radicale de la politique, sa réappropriation par les producteurs associés comme instance de décision démocratique et de rationalisation d’une production qui ne saurait posséder en elle même ses propres finalités. Autrement dit, la valorisation de la valeur et sa spirale absurde doivent céder la place à la redéfinition de l’activité sociale et individuelle. La représentation politique, modifiée dans sa définition, est retournée dans sa fonction : loin d’être le moyen d’une
dépossession qui fait du suffrage universel le droit de désigner ses «maîtres3», elle est l’occasion d’une action spécifiquement politique, précisément parce qu’elle
concerne des tâches locales d’organisation.

This does not mean that there would be merely local cooperatives; there could be a federation of cooperatives that united not just economic functions but political functions, under the rule of the producers and the local communities and, at the same time, connected to each other in a cooperative national structure initially (see  the description of a possible scenario in the series Socialism, for example,  Socialism, Part Six: What It May Look Like, or Visions of a Better Kind of Society Without Employers). Universal suffrage would be preserved and control of the executive (state personnel, election of the judicature and other changes in the nature of the state would be required. From Richard Hunt, The Political Ideas of Marx and Engels: Classical Marxism, 1850-1895, volume 2, page 133:

By way of contrast Marx emphasized that “nothing could be more foreign
to the spirit of the Commune than to supersede universal suffrage
by hierarchic investiture.”18 Not only were judges to be elected but, most
of all, administrators at all levels. Marx had always made executive power
his prime concern and set forth its radical democratization as the foremost
political objective of any popular movement. Thus in the First Draft
he declared that the Communards had adapted universal suffrage “to its
real purposes” when they used it to choose “their own functionaries of
administration and initiation.”19 Such functionaries and indeed all the
elected public servants of the Commune would also work under much
closer control by their electors, because of the additional safeguardsencountered
but infrequently in bourgeois democracies- of mandat imperatij,
the right of recall, and open executive proceedings with subsequently
published transcripts. Marx had no patience with any institutional
devices, checks, or balances whose purpose was to curtail popular
influence; he favored a maximum of mass participation in and control
over all branches of government. “Freedom,” he would write four years
later, perhaps thinking of the Paris Commune, “consists in converting
the state from an organ superimposed upon society into one completely
subordinate to it, and today, too, the forms of state are more or less free
to the extent that they restrict the ‘freedom of the state.”’20 Just as bourgeois
democracy could be judged much freer, by this yardstick, than
Bonapartist despotism, so the Commune could be judged much freer
than bourgeois democracy.

Professor Noonan’s implicit assumption that nationalization is somehow socialist definitely needs to be criticized. From Hunt, volume 2, pages 226-227:

Marx made it clear that such leisure included at least the following:
(1) time to be idle (rest, etc.); (2) time for artistic endeavor; and
(3) time for scientific pursuits. Most science was done in leisure time during
Marx’s day, including the social “science” he did himself. A continuing
development of scientific knowledge would have obvious return
benefits in rationalizing the processes of production. The growth of leisure
time in general would produce a more knowledgeable and versatile
work force: “Free time- which is both idle time and time for higher
activity- has naturally transformed its possessor into a different subject,
and he then enters into the direct production process as this different
subject. ” 34 Marx’s last commentary on these matters is to be found in the
Critique of the Gotha Program, written in 1875, a decade after the third
volume of Capital. Here we find the striking passage which confirms
that the radical vision of The German Ideology remained consistent in
Marx’s mind to the end-under communism work will be attractive
(“life’s prime want”), and the division of labor will be totally overcome:
In a higher phase of communist society, after the enslaving subordination
of the individual to the division of labor, and therewith
also the antithesis between mental and physical labor, has vanished;
after labor has become not only a means of life but life’s prime want;
after the productive forces have also increased with the all-round
development of the individual, and all the springs of cooperative wealth flow more abundantly- only then can the narrow horizon
of bourgeois right be crossed in its entirety and society inscribe on
its banners: From each according to his ability, to each according
to his needsf35
For Marx and Engels, then, communism was never equated simply
with nationalization of the means of production. From beginning to end,
their writings stress the transcendence of the division of labor as integral
to the classless society. It was not some queer, extraneous, or easily discardable
part of their system of ideas. It was the division of labor, after
all, that first created private property- not vice versa- along with social
classes, the state, the antagonism between the sexes, alienated labor,
and the separation of town and country. If the dividing of labor was
original sin, its Aufhebung alone would mark the redemption of mankind.
Nationalization of the means of production, in and of itself, overcomes
none of the aforementioned evils, but only enhances the power
of the state, making it a single giant monopoly corporation. Later generations
of Marx’s followers, Communists and social democrats alike, increasingly
misunderstood, trivialized, or simply forgot this aspect of the
masters’ teaching, surrounded as they were by a world in which occupational
specialization gained ground every day in every sphere, quite regardless
whether the local economic system was communist, socialist, or
capitalist. The relentless dividing of labor tasks seemed as inevitable as
death and taxes. Only quite recently have some radicals begun to reconsider
this whole issue seriously.
If we inquire where Marx got the idea of transcending the divison of
labor, at one level it appears to be his reinterpretation of the general liberal
call for “the free development of the individual personality,” especially
in its specifically German incarnation as the ideal of Bildungmaximum
cultivation of the talents of the individual, especially the
“higher” faculties and sensibilities, into a well-proportioned whole. 36 Marx
reinterpreted this ideal first by reminding the liberals that the free development
of the individual personality does not occur on a desert island:
“Only within the community has each individual the means of cultivating
his gifts in all directions; hence personal freedom becomes possible
only within the community.” But mainly he democratized the liberal
ideal which had always tacitly presupposed the existence of “lower orders”
to look after the “lower” needs of each free personality. By transcending
the division of labor in society at large, “the genuine and free development
of individuals ceases to be a mere phrase. “37 In the renowned words of the Manifesto, “the free development of each is the condition for the
free development of all. ” 38 Of course the Bildung ideal itself was based
on Renaissance models and above all on the Greek ideal of personal
well-roundedness, suggesting once again the extent of Marx’s underlying
debt to the values of classical antiquity.

This does not mean that there may be no role for parliamentary institutions in some form. Universal suffrage and some form of central national institution would probably be necessary, and nationalization of key industries may make some sense–but in order for universal suffrage to be an expression of working-class democracy, the working-class itself would have to engage, consciously, in opposing the class of employers. From Hunt, volume 2, page 70:

In 1852 Marx wrote of universal suffrage, as Engels had done so often before, as the very touchstone of proletarian victory in Britain:

Universal Suffrage is the equivalent for political power for the working
class of England, where the proletariat forms the large majority
of the population, where, in a long, though underground civil
war, it has gained a clear consciousness of its position as a class [my emphasis],
and where even the rural districts know no longer any peasants,
but only landlords, industrial capitalists (farmers) and hired laborers.
The carrying of Universal Suffrage in England would, therefore,
be a far more socialistic measure than anything which has been
honored with that name on the Continent.
Its inevitable result, here, is the political supremacy of the working
class.

It is possible that a dual movement of the working class, becoming conscious of itself as a class, could institute nationalization of key industries while simultaneously engaging in the restructuring of the modern state to link political and economic change that expresses its own interests.

Such a situation, though, requires that the working-class becomes conscious of itself as a class. Professor Noonan provides no evidence that this is the case. In fact, part of the purpose of this blog is to demonstrate in many ways that this is not the case–ranging from the silent indoctrination that working-class students receive for at least 12 years in schools (see, for example,  A Case of Silent Indoctrination, Part One: The Manitoba History Curricula and Its Lack of History of Employers and Employees) to the claim by the social-democratic left that there is such a thing, within an economic, political and social system characterized by the class of employers, as “fairness, a “fair share” or “fair contract” for workers (see, for example, The Canadian Labour Congress’s Idealization of the Collective-Bargaining Process.

What is ironic in Professor Noonan’s position is that he accuses some leftists of being Leninists, which he implies is out-of-date. I had a debate–if you can call it that–some time ago. In his reply, he stated:

“I think we need to forget about revolution/reform as a fundamental and meaningful political difference today and start to think about working out a common agenda of structural change that can take us from where we are to a democratic life-economy (where we need to be) The social-reformist left has problems, but the ‘revolutionary’ left suffers from the problem of not existing as in any sense a meaningful political force, and has no model (save archaic Leninist ideas) about how to build. If nineteenth and early twentieth century ideas about revolution were going to work they would have worked 100 years ago. Historical materialism requires new political thinking in new times. The organizational forms that will attract and unify people have yet to be found. Most times I worry they never will be.

Professor Noonan, as a self-proclaimed member of the social-reformist or social-democratic left, has more in common with the Leninist view of the modern state than he realizes. (I leave it open whether Lenin in theory advocated a centralized socialist state. Thomas argues that he was whereas Kay and Mott seem more sympathetic to his views of the modern state.)

Instead of preparing the working-class for real control over its own lives by criticizing the inadequacies of the modern state, Professor Noonan engages in utopian fantasies about the magical world of nationalization.

The immediate question is what can workers and their representatives do to prevent the capitalist state from obliging them to return to work for employers when it is still unsafe to do so. The next question is, once the coronavirus pandemic recedes, what can be done to prevent a rush by the class of employers and the modern state or modern government–a purely political state that arises with the ripping of the conditions of life of workers from the control of the workers themselves–from foisting payment of the crisis on the backs of workers, the unemployed, immigrants and the disabled. These diverse groups of civil society, if they are to resist this and to win more than just temporary gains, need to begin to organize for the overthrow of the alienated, exploitative, oppressive and coercive state or government, along with the alienated, exploitative, oppressive and coercive class of employers–a movement which Professor Noonan considers to be outdated. After all, the magic words “democratic” and “nationalization” take the place of real democracy, with a class conscious working-class explicitly fighting to end the alien power of the modern state and the alien power of the class of employers.

 

 

 

 

 

 

 

 

 

 

which is will be criticized in a further post

but of course  there is an opportunity for

The claim that the nation state can “override capitalist market forces” fetishizes the nation state by treating the nation state as somehow external to those market forces. But how does the nation state override market forces? By, force? The nation state as a focal point of political power is hardly independent of capitalist market forces. Just as money  is money only because commodities do not have the capacity of being exchangeable in their immediate form, so the nation state has the power that it does because citizens do not have the capacity to represent their own interests except in an alienated form, via the alienated state, a state that is representative in an atomized fashion that dissolves class relations into the homogenous situation of being a “citizen.”

Professor Noonan makes the further following claim:

 

 

 

 

As powerful as capital is, it has proven no match for the virus, on the one hand, and state power, on the other. The danger, of course, is that the state is currently acting under emergency powers, but will revert to its standard function of enframing and protecting capital, if we let it. The alternative is to use this crisis as a basis of legitimacy for the state– under the control of democratic political forces acting in our shared life-interest– to assume control over the productive basis of society and re-orient production to serving life-needs.

Professor Noonan’s analysis is rather vague. Firstly, Professor Noonan does not specify how “capital … has proven no match for state power.” Perhaps he means closing borders to non-citizens and non-permanent residents. Such a situation, however, has existed for a long time, and control of “foreigners” became more systematic with the emergence of passports (which did not exist in any systematic way for some time despite the existence of the capitalist state and a class of employers)–and such a move is hardly independent of the power of capital or of employers; passports are a means of control over workers throughout the world (see an earlier post What’s Left, Toronto? Part Six).

to achieve their goals (in the case of private corporations, profit, and in the case of government organizations, their mission statement and the overall operations of government). If employees start dying on mass, the interests of employers are jeopardized. Professor Noonan simply ignores this basic fact of “capitalism.”

His theory of the state (some may find this term confusing. You might prefer to substitute “government” for it in order to make more sense of the following) is contradictory when we compare the above with some of his former writings.

Above, Professor Noonan presents the state as neutral and somehow independent of

 

 

without Professor Noonan simply ignores  for example, in Canada, providing $2000 a month for four months via the

 

Garo, page 231:

The Poverty of Academic Leftism, Part Six: The Idealization of the Nation State or the National Government in the Wake of the Coronavirus Pandemic, Part One

Professor Noonan, a self-declared historical materialist and teacher of Marxism, continues to argue a political position that ignores the reality of capitalist society. In his post Back to the Magic Mountain, he argues the following:

No one should fetishize the nation state, but it remains the dominant form of political society and, when it chooses to, it can marshal the power to override capitalist market forces. The dependence of human life on market forces has been suspended in large parts of the world during this crisis. The state has effectively taken over the direction of economic activity and positioned itself as the guarantor of people’s income. We have been re-acquainted with a truth that capitalism works hard to suppress: our lives depend upon collective labour and nature, not market forces. This truth has to become the basis for post-pandemic reconstruction.

Professor Noonan’s opening part of the first sentence, “No one should fetishize the nation state,” is supposed to prevent any criticism of what follows. Professor Noonan, he implies, does not fetishize the nation-state.” The use of the conjunction “but” then is used to do just that.

In a Canadian context, Professor Noonan, in his statement: “The dependence of human life on market forces has been suspended in large parts of the world during this crisis. The state has effectively taken over the direction of economic activity and positioned itself as the guarantor of people’s income,” can refer to the provisions for workers to receive $500 a week for up to sixteen weeks through the Canadian Emergency Response Benefit (CERB), a federal program. From workers’ point of view, such economic relief is of course welcome–if they qualify (they must have worked a certain number of hours, for example–although some of the gaps are being addressed).

Professor Noonan forgets that workers are means to employers’ ends (see The Money Circuit of Capital). Consider things that you own, use and need. Do you take care for them in some way? They are means to the end of your goals, but you do care about preserving their existence in order to achieve your goals. Professor Noonan idealizes (and fetishizes) the modern state. The Canadian federal government, like other governments, instituted income policies because the workers could not temporarily work for employers–and because they lack their own independent means by which to produce and hence to live.

Employers need employees in one way or another if they are going to continue to be employers. The modern state intervenes in the capitalist market, if necessary, because that market needs the continued existence of workers as employees. The dependence of employers on employees can be seen from the following issue that arose in the 1860s in England in relation to the possible emigration of skilled English workers (from Karl Marx, Marx-Engels Collected Works, volume 35, Capital:

The reproduction of the working class carries with it the accumulation of skill, that is handed down from one generation to another.1′ To what extent the capitalist reckons the existence of such a skilled class among the factors of production that belong to him by right, and to what extent he actually regards it as the reality of his variable capital, is seen so soon as a crisis threatens him with its loss. In consequence of the civil war in the United States and of the accompanying cotton famine, the majority of the cotton operatives in Lancashire were, as is well known, thrown out of work. 471 Both from the working class itself, and from other ranks of society, there arose a cry for State aid, or for voluntary national subscriptions, in order to enable the “superfluous” hands to emigrate to the colonies or to the United States. Thereupon, The Times published on the 24th March, 1863 [p. 12, col. 2-4], a letter from Edmund Potter, a former president of the Manchester Chamber of Commerce. This letter was rightly called in the House of Commons, the manufacturers’ manifesto.2′ We cull here a few characteristic passages, in which the proprietary rights of capital over labour power are unblushingly asserted.

“He” (the man out of work) “may be told the supply of cotton workers is too large … and … must … in fact be reduced by a third, perhaps, and that then there will be a healthy demand for the remaining two-thirds…. Public opinion … urges emigration….The master cannot willingly see his labour supply being removed; he may think, and perhaps justly, that it is both wrong and unsound…. But if the public funds are to be devoted to assist emigration, he has a right to be heard, and perhaps to protest.”

… He [Mr. Potter] then continues:

“Some time …, one, two, or three years, it may be, will produce the quantity…. The question I would put then is this — Is the trade worth retaining? Is it worth while to keep the machinery (he means the living labour machines) in order, and is it not the greatest folly to think of parting with that? I think it is. I allow that the workers are not a property, not the property of Lancashire and the masters; but they arc the strength of both; they are the mental and trained power which cannot be replaced for a generation; the mere machinery which they work might much of it be beneficially replaced, nay improved, in a twelvemonth.’: Encourage or allow (!) the working power to emigrate, and what of the capitalist?”a “…Take away the cream of the workers, and fixed capital will depreciate in a great degree, and the floating will not subject itself to a struggle with the short supply of inferior labour…. We are told the workers wish it” (emigration). “Very natural it is that they should do so…. Reduce, compress the cotton trade by taking away its working power and reducing their wages expenditure, say one-fifth, or five millions, and what then would happen to the class above, the small shopkeepers; and what of the rents, the cottage rents…. Trace out the effects upwards to the small farmer, the better householder, and … the landowner, and say if there could be any suggestion more suicidal to all classes of the country than by enfeebling a nation by exporting the best of its manufacturing population, and destroying the value of some of its most productive capital and enrichment…. I advise a loan (of five or six millions sterling), … extending it may be over two or three years, administered by special commissioners added to the Boards of Guardians in the cotton districts, under special legislative regulations, enforcing some occupation or labour, as a means of keeping up at least the moral standard of the recipients of the loan … can anything be worse for landowners
or masters than parting with the best of the workers, and demoralising and disappointing the rest by an extended depletive emigration, a depletion of capital and value in an entire province?”

Potter, the chosen mouthpiece of the manufacturers, distinguishes two sorts of “machinery”, each of which belongs to the capitalist, and of which one stands in his factory, the other at night time and on Sundays is housed outside the factory, in cottages. The one is inanimate, the other living. The inanimate machinery not only wears out and depreciates from day to day, but a great part of it becomes so quickly
superannuated, by constant technical progress, that it can be replaced with advantage by new machinery after a few months. The living machinery, on the contrary, gets better the longer it lasts, and in proportion as the skill, handed from one generation to another, accumulates.

…the factory operatives are part of the movable fittings of a factory. Their emigration was prevented.1; They were locked up in that “moral workhouse”, the
cotton districts, and they form, as before, “the strength” of the cotton manufacturers of Lancashire.

With millions of workers being sent home in order to prevent damage to human beings as employees–a necessary part of the process of capitalist production and exchange as well as governmental processes– the government’s intervention in being “the guarantor of people’s income” looks much less positive. The government or state (here the distinction is not important) is not the benevolent, neutral institution that Professor Noonan makes it out to be. It is providing income as a stop-gap measure until the capitalist and governmental processes can once again operate normally.

Indeed, Professor Noonan implies as much when he writes:

The danger, of course, is that the state is currently acting under emergency powers, but will revert to its standard function of enframing and protecting capital, if we let it.

Professor Noonan sees the provision of income by the state that is supposedly independent of market forces as something positive–but as we have already seen, the preservation of workers independent of the market in the sense that they can obtain money without having to work for an employer–is only a temporary measure that in no way is in opposition to the interests of the class of employers.

As the pandemic recedes in intensity, at least two issues will arise concerning the opposition of the working class to the nation-state. Firstly, there will be increased intensification of calls for workers to go back to work for employers despite the health risks. After all, around 1000 workers die and 600,000 workers are injured every year in Canada; health and safety are not a priority for the Canadian state.

Secondly, the issue of who will pay for the temporary income of workers and the subsidies for employers during the pandemic will arise. Although calls for cutbacks in health care will undoubtedly be more difficult to justify, cuts in other areas (such as education) will probably intensify.

Without a movement that expressly or consciously opposes the treatment of workers as things to be used by employers, the temporary measure taken by the Canadian (and other capitalist) government(s) is just that–a temporary measure. There will likely be opposition from the labour movement and from communities to the treatment of such measures as temporary, but since the labour movement and communities, for the most part, share Professor Noonan’s view that the state can somehow overcome its own nature as a capitalist state, the tasks required for converting such temporary measures into permanent measures cannot be addressed.

Professor Noonan refers to “we.” But who is this “we?” The “we” is a figment of his social-democratic imagination. In order for there to be a “we,” there would have had to have been much prior preparation. Has Professor Noonan engaged in such preparation? Not at all. He has engaged in the idealization of the collective-bargaining process and promoted class harmony (see earlier posts, such as  The Poverty of Academic Leftism, Part Five: Middle-Class Delusions).

Surely an essential part of the process of our preparing for a society where we all have our biological, social, intellectual, emotional and aesthetic needs met is a negative process–a process of coming to understand that the present social relations inside and outside work are in opposition to our interests and nature and that we therefore need to organize to change the situation by abolishing all class relations and relations of oppression.

However, my experience here in Toronto has been that most of the so-called left simply do not want to deal with the issue and attack those who do, such as calling them “a condescending prick,” ridiculing them and so forth. Alternatively, they ignore the issue by remaining silent over the issue. For example, John Clarke and other so-called radicals here in Toronto opposed calling for a basic income; I called for a radical basic income in opposition to Mr. Clarke’s rejection of any consideration of a basic income (see Basic Income: A Critique of the Ontario Coalition Against Poverty’s Stance). It has been largely ignored by the left here in Toronto; there has been no real discussion or movement for establishing a radical basic income here in Toronto.

Professor Noonan’s reference to “if we let them” is, therefore, utopian thinking. My prediction is that at best there will be some pressure from the organized social-democratic left for the maintenance of some kind of improvements in the welfare state, but that is all. Of course, there will be counter-pressure by the government or state and the class of employers to such improvements.

Professor Noonan’s further utopian social-democratic thinking can be seen in the following:

The alternative is to use this crisis as a basis of legitimacy for the state– under the control of democratic political forces acting in our shared life-interest– to assume control over the productive basis of society and re-orient production to serving life-needs.

I certainly share the goal of having “the productive basis of society…serving life-needs,” , but Professor Noonan has not shown how he or other members of the so-called progressive left have engaged in the preparatory work necessary to take advantage of a crisis.

Professor Noonan’s reference to using

“this crisis as a basis of legitimacy for the state–under the control of democratic political forces acting in our shared life-interest–to assume control over the productive basis of society and re-orient production to serving life-needs”

follows in the footsteps of another post by Professor Noonan, a post that assumes the present existence of certain social relations that are required if other social relations are to arise. In the previous post already referred to above, I pointed out how contradictory Professor Noonan’s theoretical position is with respect to the interests of most workers at universities; Professor Noonan assumed that there was already democracy at universities and thereby assumed what in fact needs to be accomplished.

The same logic applies here. If we already have democratic control of forces “acting in our shared life-interest,” then we already have “control over the productive basis of society” and have already “reoriented production to serve life-needs.” The reconstruction of the economy is democratic control. We need to reconstruct the political and the economic simultaneously and not the so-called political seizure of power occurring before and then democratic control of the economy somehow following afterwards.

Professor Noonan’s call for nationalization by the present state ignores this problem altogether by assuming that nationalization by the modern state will somehow magically lead to control over our own life process and life needs:

 Nationalization can pre-figure democratic socialization, and democratic socialization can re-focus economic life on collective work to provide each and all that which we really need, and freeing our time for the– real-life, multidimensional– experiences, actions, and interactions that make life worth fighting for, protecting, and living.

The call for nationalization as a prelude to socialism is typical of social democrats; they idealize and fetishize the modern state–contrary to Professor Noonan’s disclaimer–and thereby short-circuit what needs to be done–expose the anti-democratic and alienated nature of the modern state–a nature that has its parallel in the modern economy dominated by a class of employers or what some call civil society (see Employers as Dictators, Part One).

This issue, however, is somewhat complicated and will be dealt with in the next post. Professor Noonan’s position, ironically, is similar in some ways to the Leninist view of the modern state–a view that Professor Noonan supposedly finds unsatisfactory.

 

 

Class Harmonies in Health Care? The Social-Democratic Way

Researchers in health care, like researchers in education, seem to assume that the current social structures are sacred. They simply research what is there, and assume that any problems must be resolved in terms established by that social structure. There are, of course, possible differences in the way problems are defined or solutions proposed, but there are limits to problem definition or proposed solutions can be forthcoming from the social-democratic point of view. That limit is the class of employers. Social democrats assume–probably without being aware of it–that all problem definitions and proposed solutions must fit into a social structure characterized by a class of employers.

Consider research on what has been called “patient-centred care” (PCC). This idea is similar to the idea of a “child-centred curriculum” that often circulates in school circles.

One researcher, Sara Kreindler  (“The Politics of Patient-Centred Care,”2013, in pages 1139-1150,  Health Expectations, volume 18) argues that there are at least three different groups that argue for PCC, with each one excluding the other two as legitimate representatives of the interests of patients: management, providers (doctors and nurses) and patient advocates outside the health-care system. Each group claims to represent the interests of patients, but they do so by excluding the other interest groups as legitimate representatives of the interests of patients.

Her solution to this problem is to claim that the aspire model (The Actualizing Social and Personal Identity Resources) provides a four-step model that permits the simultaneous recognition of each group’s identity while enabling a synthesis to emerge that incorporates the different views without trampling on each other’s social identity.  The groups are identified through a survey of staff, then each group discusses issues related to its own point of view without the influence of other groups. The third step involves the selection of representatives from each group to come together in order to come to a common vision of what PCC involves. The fourth step is to implement the common vision. Ms. Kreindler argues that it is the process that will lead to change; we should not second-guess the changes required to realize a PCC approach.

Ms. Kreindler, however, argues the following contentious view (page 1147):

While it may be counterproductive to define PCC in terms of taking power or focus away from certain groups, it remains very legitimate to talk about putting patients first.

In the first place, Ms. Kreindler assumes what she needs to prove: that a focus on patient care can exist independently of power relations. She does recognize such power relations when she makes the following assertion (page 1147):

Second, each subgroup discusses the issue separately, defining it in their own terms and using their own language (which may or may not include the term ‘patient-centred care’5). This is very important if staff groups are to have real ownership of the process and make a meaningful contribution; it is even more important for
patients, who have the least power and perceived expertise within the health-care system. Patient/family groups should have a neutral facilitator and not be led (or even frequented) by managers, to avoid the risk of co-optation either by ‘the system’ in general or by whatever subset of managers happens to run the involvement activity.

Ms. Kreindler never questions whether it is really possible to have equality between different “interest groups” in the context of the employer-employee relation and in the  context of the power of a class of employers. We see this problem when Trump argued that workers should go back to work on April 12–despite the biological possibility of many workers being exposed to the coronavirus as a consequence. Workers and many community members in a society dominated by a class of employers are, ultimately, things to be used, and this priority conflicts with any real concept of the patient coming first.

Ms. Kreindler’s belief that somehow managers, as representatives of employers, can somehow be treated at the same level of power as professional groups and patient advocates has little warrant. Since employers have control, in one way or another, over budgeting, finance, health facilities and wages, they ultimately call the shots concerning patient care. This situation does not mean that some of the power of managers cannot be limited. Such a limitation, however, is similar to the limitation of collective bargaining and collective agreements. Employers may be forced to grant some concessions, but this hardly means that they are not the primary power holders in the situation.

One of Ms. Kreindler’s implicit views is that the employers’ interests (represented by management) and the interests of employees can somehow be reconciled. An alternate view argues the contrary:

One highly useful example from the empirical literature that illustrates
the effects of process alienation is that of Whitehall I and Whitehall II studies
of Whitehall civil servants (Marmot et al., 1997, 1999). Forbes and
Wainwright (2001, p. 810) have commented, but do not develop further, that
the evidence and results from the studies appear ‘to be directly related to the
Marxian concepts of alienation and exploitation’. The research has identified
that among civil servants of differing ranks there are decidedly different
experiences of health that appear to relate to how much control a worker has
in their workplace. Looking more squarely at the studies a picture of how
process alienation is at play can be established. In both studies, there is a
clear social gradient in mortality (Marmot et al., 1984) and morbidity
(Marmot et al., 1991). In these studies we see how a worker’s health is
affected by the extent of their control (examples being, choosing what to do at
work, in planning, or in deciding work speed) within their working
environment (Bosma et al., 1997), and how on a variety of measures the health, whether physical (for men and women) or mental (mainly for men),
is influenced by the position or rank that they hold within the organization
(Martikainen et al., 1999). This chimes very much with the alienation that
arises out of the labour process where ‘[i]nstead of developing the potential
inherent in man’s powers, capitalist labour consumes these powers without
replenishing them, burns them up as if they were a fuel, and leaves the
individual worker that much poorer’ (Ollman, 1976, p. 137).

Ms. Kreindler assumes that in a relation characterized by economic dependence, hierarchical authority and detailed division of labour, the interests of management and health employees can somehow converge by putting the patient first. Her assumption reminds me of Professor Noonan’s assumption of class harmony at universities (see The Poverty of Academic Leftism, Part Five: Middle-Class Delusions). Both magically wand away the antagonistic interests of subordinates and superiors in public institutions.

In relation to the principle that patients come first, it is too much to believe that patients will ever really come first when human beings are evaluated on the same level as things: they are a cost, in money terms, and such costs, when set in the context of a society dominated by employers, must always be considered in relation to “alternative use of resources” for such things as buying medical equipment, medication, and so forth, internally, and in relation to the diverse expenditures in other government departments for the maintenance of a society dominated by a class of employers.

Related to this issue is the reason why a hierarchy of skilled and less skilled workers arises in the first place; such a hierarchy has advantages from the point of view of the class of employers. Charles Babbage (a pioneer in developing some principles of computer construction in the nineteenth century), published a book in 1832 titled On the Economy of Machinery and Manufactures, where he pointed out a major advantage for such a hierarchy. From Harry Braverman, Labor and Monopoly Capital: The Degradation of Work in the Twentieth Century, pages 79-80:

In “On the Division of Labour,” Chapter XIX of his On the Economy of Machinery and Manufactures, the first edition of which was published in 1832, Babbage noted that “the most important and influential cause [of savings from the division of labor] has been altogether unnoticed.” He recapitulates the classic arguments of William Petty, Adam Smith, and the other political economists, quotes from Smith the passage
reproduced above about the “three different circumstances” of the division of labor which add to the productivity of labor, and continues:

Now, although all these are important causes, and each has its influence on the result; yet it appears to me, that any explanation of the cheapness of manufactured articles, as consequent upon the division of labour, would be incomplete if the following principle were omitted to be stated.

That the master manufacturer, by dividing the work to be executed into
different processes, each requiring different degrees ef skill or ef farce, can purchase exactly that precise quantity ef both which is necessary for each
process; whereas, if the whole work were executed by one workman, that
person must possess sufficient skill to perform the most difficult, and
sufficient strength to execute the most laborious, ef the operations into which
the art is divided. 13

To put this all-important principle another way, in a society based upon the purchase and sale of labor power [the commodity the worker sells on the market, different from labour since workers, when they labour, have already sold their commodity], dividing the craft cheapens its individual parts.

Ms. Kreindler does not even consider the issue as relevant; indeed, I doubt that she is even aware of the issue. She blindly assumes the permanent status of a hierarchical division of labour.

Of course, there may be other conditions which involve a hierarchical division of labour than the allocation of diverse skills to different individuals for the purpose of cheapening the total wage bill, but this process undoubtedly forms part of the reason why there exists a hierarchical division of labour.

Some workers in that hierarchical division of labour may, on the other hand, be more autonomous than others. Doctors may, for example, be formally employees at hospitals, but their monopoly of certain skills may give them much more autonomy than other employees. Some or even many may form part of the middle class, but other employees in the hierarchy at work have less autonomy–such as nurses, nurses’ aids, food workers and custodians.

In this situation, the idea of patient-centered care will undoubtedly be focal point for diverging definitions of what constitutes such care. That in the struggle over such definitions patients may not be the real focus is possible. On the other hand, given the power advantage of management to regular employees, it is unlikely that their way of defining PCC will be on the same level as management’s definition. The same could be said of patient-advocate groups. Even if her intent is different, Ms. Kreindler’s assumption papers over differential power relations–to the advantage of management undoubtedly.

Another silence in focusing on PCC is the need to look at the relation between health care and prevention of sickness, injury and disease. In a socialist society, health care would still be important. From  Calum Paton (1997),  (pages 205-216), “Necessary Condtions For A Socialist Health Service,” in Health Care Anal., volume 5, page 209:

A socialist health service in a non-socialist society may be forced to stress care and rescue rather than prevention, health maintenance or the promotion of better health and more equal health status. Nevertheless this may be an important role. Even in a utopian society of perfect health promotion and prevention, people are more likely to die of more complex comorbidities at a later stage in the life cycle. The concept of substitute mortality and morbidity is useful here. 5 As a result simplistic trade-offs which suggest that ‘the more primary care there is, the less secondary care will be necessary’, are unlikely to be true either in the here and now or in the perfect society.

To be cared for with dignity, and to suffer with dignity and to die with dignity–these would all be important aspects of socialist health care.

Ms. Kreindler’s focus on PCC also excludes a major issue dealing with health: its prevention. By focusing exclusively on patients, she ignores entirely the need to consider the prevention of disease, injury and sickness in the first place (at least in the article above). What are the social conditions that increase the likelihood that a person would become a patient in the first place? Undoubtedly, as we become old, we will likely become patients at some stage in our lives–there is no getting around this fact. However, there are social determinants of health as well, and consequently becoming a patient is also often a function of social conditions.

In a socialist society, prevention would be a major focus of social policy and would deal with addressing the social determinants of health problems, ranging from health problems linked to the workplace to health problems linked to environmental conditions, including food processing.

Today, though, many social determinants are largely ignored in favour of focusing on caring for those already sick. Consider breast cancer. It arises in many instances from environmental conditions, and yet most money is allocated to caring for those already inflicted with the disease rather than with preventing it from arising in the first place. From Faye Linda Wachs (2007), (pages 929-931), “Review. Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy. By Samantha King,” in Gender & Society, volume 21, number 6 (December), pages 930-931:

Recent studies reveal that simply removing known carcinogens from products and our environment could prevent thousands of cases annually (Brody et al. 2007). However, funding for such research is limited, while the monies for identifying and curing existing cases is the focus of most efforts. Indeed, many of the companies that fund survivorship continue to use known car cinogens in their products. King points to the fact that despite increased awareness, rates of breast cancer have increased from 1 in 22 in the 1940s to 1 in 7 in 2004. Even if one considers women’s increasing longevity, this still indicates an increase in the prevalence of breast cancer. Moreover, structural factors that affect risk and survivorship, such as socioeconomic status, remain woefully understudied.

Personally, the issue of cancer research funding versus caring for cancer patients hits home. In March 2009, I was diagnosed with invasive bladder cancer, and in June 2010 I was informed that I had a 60 percent chance of dying in the next five years (it never happened, of course). The extent of “inquiry” into why I had cancer was a sheet of paper when I was admitted into the hospital for surgery. Two questions related to the causes of the cancer were: Did I smoke? And did I or had I worked in areas that might contribute to cancer. Nothing more. Of course, scientific research is much more extensive and hardly limited to inquiry into specific personal cases. I did find, however, that no qualitative inquiry into possible causes of cancer indicated a lack of a certain kind of cancer research in the area.

Even worse, in December 2015, I was diagnosed with rectal cancer. In 2016, I asked the doctor why I had cancer again. His answer was: Bad luck.

Of course, I would have preferred never to have been a cancer patient at all–patient-centered or otherwise.

Social democrats in various spheres of society (such as the economy, education, health and unions) generally assume the legitimacy of the hierarchical division of labour in society. They seek reforms within such hierarchy–rather than challenging such a hierarchy in the first place. Ms. Kreindler does the same. She, like her fellow social democrats, assumes that such a hierarchy can, ultimately overcome its divisions and serve the public (such as in the idea of patient-centered care).

The focus of social democrats often result in neglect of the wider picture. In the context of health, Ms. Kreindler neglects not only the importance of the employer-employee relation and its power differentials, but she also neglects the importance of preventing disease in the first place. Being a patient is to be avoided, if possible–and that means balancing health prevention and the inevitable need for health care as we age (or are accidentally injured even in a socialist society).

Rather than assuming class harmony between different sectors of health care, we should seek to analyse the class discord in that field and how such discord can lead, ultimately, to a society without classes. Social democrats, however, by assuming the possibility of class harmony within existing economic, political and social conditions, oppose, practically (and often theoretically) such a move.