Critical Education Articles Placed in the Teacher Staff Lounge While I Was a Teacher, Part Seven: Critique of the School Curriculum

This is a continuation of earlier posts.

When I was a French teacher at Ashern Central School, in Ashern, Manitoba, Canada, I started to place critiques, mainly (although not entirely) of the current school system. At first, I merely printed off the articles, but then I started to provide a summary of the article along with the article. I placed the summaries along with the articles in a binder (and, eventually, binders), and I placed the binder in the staff lounge.

As chair of the Equity and Justice Committee for Lakeshore Teachers’ Association of the Manitoba Teachers’ Society (MTS), I also sent the articles and summary to the Ning of the MTS (a ning is “an online platform for people and organizations to create custom social networks”).

As I pointed out in a previous post, it is necessary for the radical left to use every opportunity to question the legitimacy of existing institutions.

The context of summaries related to the brain was that the principal of Ashern Central School, where I worked, started talking about “brain research’ and how teachers needed to implement such research in their daily teaching practice. He even placed an article on brain research in our school mailboxes. As a consequence, I researched the issue and provided critical summaries that critiqued his reductionist view of human intelligence as “brain work.”

Good morning, everyone,

I sent the attached article to the ESJ Ning yesterday. I prefaced it with the following:

After attending the ESJ workshop, it is evident that many consider the school system is equivalent to education and that education is equivalent to schooling. John Dewey, throughout his long life, criticized such a view since most schools become formal organizations isolated from life and organized in such a way as to prevent children from becoming educated.

The author of the following article, “John Dewey’s The Child and the Curriculum,” (D.C. Phillips) provides a summary of Dewey’s 1902 work The Child and Curriculum. Dewey opposed throughout his long career many dualisms, such as mind/body, thought/action, the individual and the social—and the child and the curriculum.

Typically, schooling has focused on the curriculum at the expense of children (subject matter organized logically in the form of the disciplines and attendant skills of reading, writing and arithmetic) but has, at times, focused on children at the expense of the curriculum.

Dewey argued that children’s experience is merely the beginning of education and the curriculum is the end of the education. The child experiences the world in a certain way and the logical curriculum in the form of the disciplines is the culmination of that experience when it is organized to maximize control of that experience. Formal education is to be designed in such a way that childhood experiences become increasingly differentiated until they assume the form of the disciplines. Formal education must provide a mediating process by which childhood experience can be both differentiated into the disciplines and integrated, with each logical form (the disciplines) reinforcing the other logical forms so that the child can engage in the world in as artistic manner as possible (since art integrates the diverse into a coherent whole, with each aspect modified by the other distinct aspect but at the same time supported by the other aspects).

The curriculum developed in the twentieth century and still prevailing in the twenty-first century in most schools has not solved the problem pointed out by Dewey. Given this curriculum, the child’s interests and the objective nature of the content of the disciplines often clash. It has, alternately, emphasized the child (whole language, to a certain extent) and the content of the curriculum. Nowadays, of course, the content of the curriculum is emphasized at the expense of the child. Dualism prevails in schools.

Rather than seeing the curriculum as defined by the disciplines as the end point that requires a mediating structure that transforms childhood interests into more logical forms (forms designed to increase our control over our lives), and the end point thus serving as a basis for interpreting and guiding childhood behaviour, the modern curriculum defines childhood experience as merely a simplified form of the logical form of the disciplines. Such a view has no theoretical basis.

One aspect that was not mentioned in the article was the eventual departmental structure of the Dewey School (the University Laboratory School), with teachers being specialists so that they could interpret adequately the potentialities of childhood behaviour. Initially, a generalist teacher was hired, but it was found impossible for a generalist to provide the precision necessary for learning to occur.
Integration of the specialized departments and teaching occurred, in terms of the curriculum, through the mediating structure of the use of social occupations linked to the basic needs stemming from the human life process: food, clothing and shelter. These needs and the activities required to satisfy them have been subject to evolution as social life has become more complicated. The disciplines emerged from the pursuit of such basic needs (chemistry in the case of cooking and wool dyeing) and mechanics (and physics) in the case of the shelter. Pedagogically, integration occurred through weekly meetings of teachers. Experientially, the children did not experience “studies,” but rather the studies were functions of the life process—means to the end of that process and not ends in themselves. Socially, the school was a community.

Childhood experience requires many transformations before it can be organized into a logical form. Furthermore, for most people, learning is a means towards the end of life and not an end in itself; human beings are not academics (how many reading this dedicate themselves to inquiry for inquiry’s sake?). Although children and adolescents should learn to appreciate the pursuit of knowledge as an end in itself (making inquiry into inquiry an end in itself so that the consequences of inquiry must conform to the conditions for further inquiry), most will not engage in the active pursuit of inquiry for inquiry’s sake in their own vocation; being an academic or scientist is not the calling of most people. To assume otherwise is both unrealistic and authoritarian.

The analogy of the relationship between a journey and a map illustrates Dewey’s concerns. A journey forms the presupposition for the creation of a map; it constitutes the psychological aspect of map making. The actual temporal process of the journey may lead to unexpected and unwanted experiences.

But a map, once it is created, enriches the journey by providing a summary and a form which can guide future activities and make the journey more efficient; it constitutes the sociological aspect of map making. The map is intermediary between the original experience and the enriched experience.

The making of the map must, at some point, become the end in order for an enriched experience is to emerge. However, a map is still intermediary between the original journey and the enriched journey. It is not an end in itself except temporarily; when viewed from the totality of experience, it is intermediary. Learning is, likewise, intermediary and not an end in itself when the totality of experience is considered.

The child and the curriculum are thus not opposed. The curriculum must be organized to enable the child to organize her/his own experience into an increasingly organized, controlled and meaningful manner.

The author also points out a weakness in Dewey’s theory: some dualisms cannot be resolved but rather one side must win out against the other side. Dewey recognized this situation in the case of the natural sciences but in the case of the social sciences he often failed to recognize the irreconcilable nature of social conflicts between classes, for instance, where one class controls, oppresses and exploits another class. The Deweyan curriculum must, therefore, be modified to incorporate the dualism of social relations.

How can equity and social justice be achieved when the dualism characteristic of the modern curriculum prevails (with the content of the curriculum being opposed to children’s own experiences)? Can living beings be treated as central when the environment constitutes necessarily part of the life process? Can the environment be considered central when an environment is an environment only in relation to living beings? Can equity and social justice be achieved when the life process is simply set aside or considered from only one side of the relation?

How can equity and social justice be achieved when human beings lack so much control over their own environments in school and at work? Is not real education to increase control over the environment? How are teachers real teachers if what they do leads to a lack of control by students over their own environments? Given the modern economic structure, how can students gain control over their own environments?

When teachers begin to face these issues (rather than avoiding them through silence), then perhaps inquiry can begin and education can be released from its shackles. Until that time, students will be shackled to the chains of the modern curriculum—despite the pedagogical efforts of teachers and the illusions that such pedagogical efforts engender by being restricted to that level.

Fred

Socialism and Central Planning: Mr. Gindin’s Analysis of The Political Situation of Workers in General, Part Two

The following is the second of a two-part series on Bill Resnick’s interview with Sam Gindin, in accordance with the two-part presentation of the interview. I put my summary of Mr. Gindin’s talk in italics; my comments are in regular print. I also use italics when quoting others.

According to Bill Resnick, part two is an exploration of the potentialities for stimulating the working class from its lethargic state of passivity, cynicism and individual self-defense in order to inspire people to recognize their powers and capacities and thereby a socialist society.

Mr. Resnick then claims that climate change will oblige us to think how the economy is working.

Moving on to Mr. Gindin’s views, Mr. Gindin claims that it will be the environment that will be the key issue in relation to inequality. The rich are satisfied with the status quo of environmental conditions since they do not have to suffer the consequences from its deterioration.

Mr. Gindin then refers to the situation in Oshawa. He points out that, despite workers losing their jobs anyway, any suggestion of a serious alternative still meets with resistance since they have experienced thirty or forty years of lowering their expectations of what is possible. Their response to a left alternative is that it is a great idea, but it will never happen because they do not see their unions fighting for it nor do they see that larger social force fighting for it.

We should pause here. When have most unions, even during the 1950s, 1960s and the 1970s, generally fought for a larger vision of socialism? Most unions accepted the justice of collective bargaining and of collective agreements. Mr. Gindin implies that before the onset of neoliberalism 30 or 40 years ago, unions did have a larger social vision. That is a myth.

Indeed, red-baiting and the expulsion of communists from the Canadian labour movement forms part of the history of unions in Canada–a fact which Mr. Gindin conveniently ignores (see Irving Abella, The Canadian Labour Movement, 1902-1960). Social democracy won out within unions over any radical vision of society.

Why does Mr. Gindin ignore such facts? It is likely that Mr. Gindin indulges his supporters rather than taking the necessary step to criticize them. He probably panders after union support rather than criticizing the limitations of unions–including the limitations of collective bargaining and collective agreements.

He fails to criticize the responsibility of unions for, historically, partially contributing to the suppression of an alternative vision.

By the way, Mr. Gindin’s reference to the environment as being the key to inequality lacks any historical and factual basis. Where is there evidence that it is the environment that forms the center around which people are willing to fight against those in power and attempt to defeat them? It is the daily grind of working and living in a society dominated by a class of employers that will form the key issue–a social relation, and not the “environment” in the abstract sense of “nature” or environmental conditions in a general sense.  Mr. Gindin, as I indicated in my earlier post, wants to jump on the bandwagon of environmentalism in general and the climate crisis in particular in order to prop up his appeal. I doubt that he will be successful.

Mr. Gindin then argues that we need to develop structures through which people can fight so that they can gain a clear vision of the forces that support them and the forces that oppose them as well as understanding the importance of collective action for realizing workers’ aims. That is why political parties are important because they form a space for strategizing about what needs to be done. We must take organizing seriously.

Mr. Gindin then reiterates how impressed he is about what the environmental movement has done. However, he points out the limitations of that movement, that criticizes corporate power or the 1% but does not seriously propose taking power away from them. It is insufficient to merely lobby against them. If we are going to have [democratic] planning, we cannot have corporations making the investment decisions.

Mr. Gindin is certainly correct to point out the limitations of the environmental movement–but he should be consistent and point out the limitations of unions as unions in relation to collective bargaining and collective agreements. He does not. He avoids alienating his social-democratic supporters. Is that what is needed at present?

Furthermore, he refers to the importance of organization–but is organization by itself going to lead to the questioning of corporate power? Ms. McAlevey does not question such power. Social democrats do not question such power. Both engage in organizing of one sort or another. It is not, then, organizing in general that is the issue but what kind of organizing–on what basis? Organizing from the start needs to question corporate power–and that includes questioning the legitimacy of their power to manage workers as such. We may need to make compromises along the way, as embodied in a collective agreement, but let us not bullshit the workers by calling such agreements or contracts “fair,” “just” and other such euphemisms.

To be consistent, Mr. Gindin should question the limitations of unions and union organizers in relation to collective bargaining and collective agreements. Why does he not do so?

Mr. Gindin claims that struggles are fundamental and that they develop the capacity to recognize the limits of being militant. They develop democratic capacities that prevent them from accepting authority.

Workers certainly do learn the limitations of being militant (they get fired, for example), but such a lesson hardly need translate into learning the limitations of unions, collective bargaining and collective agreements.  Workers may blame unions for the limitations of militancy–unless the limitations of unions, collective bargaining and collective agreements are pointed out, on the one hand, and an alternative vision of what may be is outlined, on the other.

Although struggles are certainly necessary, are they sufficient to enable workers to come to the conclusion that the authority of the class of employers should be questioned? What is more likely is that such struggles will lead to criticisms of particular aspects of such power but not that power as such. Mr. Gindin vastly underestimates the ideological hold this kind of society has on workers and how it is vital to engage in constant ideological struggle if we are to develop democratically to the point where we can consciously and organizationally take corporate power away.

We need to take state power, but not just that. We need to take state power and transform that power so that we can develop our democratic capacity so that there is, on the one hand, a check on what the state does and, on the other, that people are actually participating in state power. This requires developing the technical capacity of ordinary workers to make appropriate decisions that affect their lives and not just having scientists come into government to make decisions for us.

We certainly do need to take state power–and transform it. However, if we are to do this consciously from the start, then we need to question the present state structures in their various dimensions. For example, we need to question the current educational structures, with their emphasis on assigning marks or grades to students, their separation of curriculum into academic (intellectual) and non-academic (vocational, which allegedly has more to do with the body), and so forth. When I belonged to the Greater Toronto Workers’ Assembly GTWA (which morphed into the Toronto Labour Committee), of which Mr. Gindin was practically the head, Mr. Jackson Potter was invited to discuss how the Chicago Teachers’ Union (CTU) organized and led a successful strike. I eventually wrote up a critique of one of the CTU’s documents (see my article “A Deweyan Review of the Chicago Teachers‘ Union Publication The Schools Chicago Students Deserve: Research-Based Proposals to Strengthen Elementary and Secondary Education in the Chicago Public Schools” in the Publications and Writings section of this blog). The response of the GTWA to my critique was–silence.

Education, of course, is just one area that needs to be restructured through the abolition of its repressive features. The courts, police and the legal system need to be radically transformed as well (as I argued in another post and about which Mr Gindin was silent (see   Socialism, Police and the Government or State, Part Two). Health is of course another area which needs to be radically restructured and its repressive features abolished (see various posts on the health and safety of workers on this blog).

Mr. Resnick then mentions Lucas Aerospace, which closed; in response,  and workers came up with a plan to change things by focusing on products needed by the community. Workers built a powerful movement both inside and outside the union.

Mr. Gindin points out that Lucas ended in defeat. Nevertheless, what is inspiring in the case of Lucas and in Oshawa is the focus on producing not for profit but for social need, which stimulates the imagination and leads to diverse creative ideas. The problem is that you need the power to implement them.

You do indeed need the power to implement them. The illusion that workers have much power through collective bargaining and collective agreements needs to be constantly criticized so that they can begin to organize to challenge the power of employers as a class and not just particular employers. In other words, it requires ideological struggle and not just “organizational” struggle. How workers are to build power when they have faith in the collective-bargaining system and collective agreements is not something Mr. Gindin addresses. Why is that? Why does he ignore such a central issue when it comes to talking about unionized workplaces?

Mr. Gindin then points out that people do rebel, but the problem is how to sustain that rebellion.

That is indeed a problem, but failing to criticize one of the keystones of modern unions–collective bargaining and collective agreements–surely impedes a sustained effort at rebellion. Faith in the collective-bargaining process is bound to lead to cynicism since the cards are stacked against workers from the beginning because of the implicit or explicit management rights clause that exists in the collective agreement–and yet workers are fed the ideology that collective agreements are “fair,” “just” and so forth.

Mr. Gindin next claims that people can see that capitalism is not the ultimate end of history since it does not address their needs nor the needs of the environment.

This gives way too much trust in people’s rhetorical criticism of capitalism but their real acceptance of it–as he himself earlier implied. People lack a vision of a better world and accept, reluctantly at times, the so-called inevitability of capitalism in practice. Social democrats may refer to capitalism this and capitalism that, but they do not really seek to overthrow the power of employers.

Mr. Resnick then refers to racial, gender and sexual orientation as divisions that will be overcome in the social movement. Mr. Gindin does not specifically address these issues but claims that when people work together, they begin to form common dreams as they realize they have common problems.

Is there evidence that workers in the closed GM plant at Oshawa now are opposed to the power of employers as a class? After all, surely some of the workers for GM at Oshawa have come together and discussed some of their common problems. Yet earlier Mr. Gindin pointed out that there is much cynicism among such workers. It is not only insufficient for workers to get together and to discuss common problems–since there is such a thing as their immediate common problem–which centers around a particular employer, and the common problem of having to work for an employer as such (any employer)–a problem that is rarely if ever discussed.

Furthermore, Mr. Gindin’s view is not only naive, but there is evidence that contradicts it. As a member of the Toronto Labour Committee, and in good faith, I tried to bring up the issue, in the context of striking brewery workers, of whether their work constituted “decent work” and whether the wages that they sought should be called “fair wages.” I was met with insults by one trade unionist. Mr. Gindin, in addition, claimed that the reference to “decent work” was a purely defensive move. That is nonsense; it is ideology, and should have been criticized. People did not work together over the issue of the legitimacy of collective bargaining and collective agreements; the issue was simply buried through insults and the rhetoric of “defense.”

There is a continuation of the theme that organization is the key–it is insufficient to become aware or that capitalism is bad.

Mr. Gindin fails to see the need to combine a specific kind of organization with ideological struggle. To be sure, without organization workers cannot gain power, but workers will unlikely gain power without engaging in organization and ideological struggle simultaneously. Mr. Gindin minimizes the importance of ideological struggle and exaggerates the importance of mere changes in organizational struggles (such as Ms. McAlevey’s innovations in organizing). Both are required simultaneously, and that means engaging in an ideological battle with the traditional left. Mr. Gindin, however, indulges the social-democratic left and panders to them by avoiding an ideological struggle. Any organization that emerges as a consequence will unlikely be more than an organization that accepts the power of employers as a class.

For Mr. Gindin, what has been defeated is the socialist idea.

That idea was long ago defeated–few workers in Canada adhered to it even in the 1960s and 1970s. Furthermore, Mr. Gindin now implies that ideological struggle is indeed vital–but he implied just above that it was not that important–that organization was vital. Or is he now arguing that both organizational and ideological struggle are vital? If so, why does he not explicitly engage in ideological struggle with his social-democratic supporters?

The following does indeed imply that it is vital to unify organizational and ideological struggle:

We have to organize to end capitalism.

Good. To do so, however, requires meeting objective conditions–and one of those conditions is criticizing those within the labour movement who idealize organizing efforts that merely lead to collective bargaining and collective agreements (such as Tracy McMaster, union steward, organizer, former vice president, Ontario Public Service Employees Union (OPSEU), “our Tracy,” as Mr. Gindin once called her). Mr. Gindin, by not criticizing Ms. McMaster’s reference to “decent work” and “fair wages” fails to meet such objective conditions for the ending of capitalism.

However, Mr. Gindin then makes the following claim:

People see through the system.

Do they really? I doubt it. This view vastly underestimates the ideological hold that the power of employers in its various facets has on workers and the repressive character of various institutions–from work institutions to state institutions People do not see through the system. If they did, they would not pair the struggle for a minimum wage of $15 (and needed reforms in employment law) with the concept of “fairness” so nonchalantly. They would not call collective agreements fair, nor would they imply that there is a relatively equal power between organized (unionized) workers and employers.

Mr. Gindin once again minimizes the ideological struggle.

The issue of a worsening environment through global warming then comes up. Mr. Gindin argues once again that access to the environment will be one of the great inequalities of our times–access to the environment.

As I argued in the previous post, Mr. Gindin’s concept of the environment is faulty. The environment of human beings has included the use of land and tools for millenia. That access has been denied with the emergence of classes and some form of private property (and communal property can be private property relative to another communal property). Access to the environment has always been a class issue–even before capitalism.

An environmental crisis may lead to authoritarian structures arising rather than democratic ones. One of the problems is that people do not see structures through which they can work, commit and have confidence that such issues will be addressed–and this includes unions and political parties. People know that something is wrong, but they lack the confidence of getting at it. That is why fighting through unions is so important; you learn on a daily basis that collectively you can effect things: you can affect your workplace, you can affect your foremen, you can have different kinds of relationships to your workmates.

It keeps coming down to whether people do not know enough or whether people do not see the structures through which they can fight through and win. Mr. Gindin believes it is the lack of structures which forms the problem, not whether people do not know enough,

Mr. Gindin’s criticisms of unions is welcome–but too general and vague to be much help. He should elaborate on why unions are not the structures through which people can “work, commit and have confidence” that their problems will be addressed adequately. Why such a vague characterization of the inadequacy of unions and union structures? What is it about union structures that prevents workers from having the confidence and the commitment to work though them to achieve their goals?

Again, Mr. Gindin underestimates the importance of ideological struggle within the labour movement in general and the union movement in particular.

The labour movement, despite having been kicked around for the last 30 or 40 years, has not concluded that we need to unite in class terms. Certainly, engaging in resistance is vital, but what have we learned from such resistance? To push harder for our own particular agenda, or have we learned that we need a class perspective to address our problems? That we need to recognize that gender, race and wage inequalities must be overcome so that we can function as a class? That does not happen automatically and has not happened automatically. That class perspective has to be built. Otherwise, workers are only individual, fragmented workers with particular identities separate from each other. We need to make ourselves a collective force–a class; it does not happen spontaneously. The potential for workers to make themselves a class has increased, but the potential will not be actualized automatically.

There are various openings or potentialities for politicization, but we should not exaggerate this by arguing that we are well on the way to winning. People are willing to fight, but then the question is: How do we actually organize ourselves to win. We are not very far along in that road.

That road is socialism, which allows the best aspects of humanity to develop.

Certainly, divisions within the working class need to be recognized and overcome in order to form a class. A class perspective needs to be fought for in various fronts. Unfortunately, Mr. Gindin does not see that such a class perspective requires a confrontation with the ideology of the legitimacy of collective bargaining and collective agreements. There will be no spontaneous overcoming of the organizational limitations of unions (including the ones proposed by Ms. McAlevey in her various books) unless the legitimacy of collective bargaining and collective agreements is called into question. This does not mean that unions would not engage in collective bargaining or not have collective agreements voted on; rather, the limitations of collective bargaining and the corresponding limitations of collective agreements would be explicitly recognized via a class perspective, which permits recognition of the need for temporary truces because of a relative lack of power.

My prediction is that Mr. Gindin’s efforts in Oshawa will be in vain since he underestimates greatly the need for ideological struggle in general and the struggle in particular for union members to recognize the limitations of collective bargaining and collective agreements not just rhetorically or by way of lip service but rather practically by ceasing every opportunity to demonstrate their limitations and the need for an organization that addresses such limitations–a socialist organization.

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.