Not the most eye catching title, but bear with!
I’ve been thinking quite a bit about what on earth has happened and is happening to healthcare, particularly in the UK, but globally, also. My musings are being particularly influenced at the moment by the writings of William T Cavanaugh, Georgio Agamben and Michael Foucault. More from WTC and GA another time (when thinking more about healthcare and the nation state)….
Foucault, speaks of biopower, i.e. the commodification of life itself, so that even what would have been considered within the private sphere of our lives, is now the fodder of the economic machine. Truthfully, healthcare has become utterly commodified and in such a complex way that we find ourselves entangled in a sick web and it takes some major diagnostic work to make sense of what is happening.
Firstly, the system of healthcare has become commodified and is itself driven by economic greed. I have yet to find any clinician who thinks that the top down reorganisation of the NHS in the UK at the hands of Andrew Lansley, (but started by the government of Thatcher and most certainly compounded by Tony Blair’s team) has been in any way a good thing. It has cost literally billions of pounds, and has led to and will lead to more private companies, limited by shares, owning and running the health care services. This is driven by the EU-US trade agreement and is based on an utterly flawed philosophy that competition will improve patient care. Except, it won’t. The problem is that share holders don’t give a toss about the needs of the chronically sick or the marginalised poor. Rather they want to protect and guarantee their ‘income’. So health care will worsen. The WHO recently stated that the NHS is the best health system in the world and yet our government has thought it best to dismantle it! The claim is that the system is costing too much money! The thing is that the NHS is and has been ‘in profit’ for a long time. It isn’t run badly. All the cuts that are being made (which the Tories won the last election by promising they wouldn’t make) are in part due to the fact that many corporations are paying such little tax, and also because we have such an utterly corrupt banking system. The reason that successive governments have not stood up to the banking sector or these corporate giants (and are now cutting public services instead of challenging them) is because they are not really the government! The banks and the corporations are (well they are not either, but they act as though they are)! That is why the healthcare system itself is becoming more commodified! At a corporate level it is simply fodder.
Secondly the patients have become commodities. Do not be deceived. We have a healthcare system based on a Pasteurian philosophy of healthcare. Kill the disease. You are a commodity. Your children are a commodity to the advertising companies, cheap supermarket trash and fast food chains, which are driving up childhood obesity and diabetes, whilst we take exercise out of schools. You are a commodity to the pharmaceutical industry and when you reach 40, if you’re not there already, you will be offered a free NHS health check, which will tell you that your BP, Blood Sugar and Cholesterol are too high, so you will shortly be needing some medication to control it all. But here’s the thing…..it’s mainly too little, too late. What happens in our early life far more affects our health in older age. We need to be majorly cheerleading the promotion of healthy living to our kids, especially our young women, as the health of your mum whilst she is pregnant has a huge impact on your future health, far more so than drugs you take after your mid-life crisis. You are also commodified by the breakdown of the welfare system. We don’t have time or money, apparently, for you to be off sick. We need you back in work to get the economy going. You will notice that most therapies are being extremely cut back – we don’t have time for you to get really healed, we just want you functional……
Thirdly, there is the commodification of the health-workers. Burn out, low morale, tired and flagging. The pressures are mounting and we are not taking care of our staff, and the sad truth is, it will get worse and not better. One reason is that we are becoming increasingly self-centred and demanding as people, due to a multiplied sovereignty in our history, which leaves us feeling like we have the right to behave like mini-emperors. Another is a kind of learnt helplessness due to the breakdown of community. A third is the anxiety driven nonsense we find daily in our media, a kind of chicken-licken hysteria about every mild ailment. And fourthly, there has been little foresight or planning to think about where on earth our workforce is going to come from if we don’t train them. We have a 50% trainee doctor shortage in the Emergency Departments. We will shortly have a national shortage of over 30000 GPs (and yet the government is promising 7 days a week cover, 8-8, just incase you want to discuss your piles on a sunday afternoon), but little thought is given to exactly where we will magic the workers up from. And if we take them from the EU? What then of healthcare in those countries? Ah yes…..multiplied sovereignty, we don’t really care. That’s why we continue to complain bitterly about the health services in this country, and yet we have the same population as South Africa, and ten times as many doctors. How do like them apples? Try being grateful!
So we and our health are commodified. So what? How does knowing do anything except add to our already felt sense of powerlessness?
Well, we have some choices and some options.
We can choose to subvert the system wherever possible.
We can create some exciting alternatives.
We can protest.
We can radically love Andrew Lansley
We can vote out this government at the next election, though we must press for a new way of doing government, and allow our selves to completely reimagine how we do life.
We could have a revolution.
We can treat patients as sacred beings and refuse to treat them as commodities.
We can treat workers as gifts and not use them or abuse them.
We can be thankful that we have the best health system in the world and change our attitude somewhat.
A big thanks for the insightful survey. Seems healthcare is right at that point when it could be lost as healthcare and subsumed under the giant of biopower… or it could be reborn. Probably both? And if so where might be interesting. Any thoughts on the where the green shoots might be appearing?
Thanks Martin! As ever, you push for the new! I’ve been mulling your question in my dreams! I have many thoughts on this, although they are mainly in the form of soup in my brain….I think this is a time for creative alternatives, but here are some further mindsets to challenge (especially in myself!).
Some ideas/musings I’ve been having are:
1) Kenarchy is an antidote to biopower. For those of us in healthcare, the choice to function from a place of love, especially towards those whom you feel abused by is vital. To subvert the system and to refuse to treat people like fodder or numbers, but really choose holistic care is again key. Also to deliberately prioritise those who are ordinarily sidelined, or who cost more….
2) I have historically found myself anti business, and pro state…. I guess that is based on the idea that the state is somehow more caring, and less out to make profit….especially in a free market…. I have been really challenging my own view of this…. The state is currently acting in a very uncreative way, and the one-size-fits-all approach is stifling genuine care. The state is a figment of our imaginations, and many of us do not realise how much faith we put in it (more on this another time…). Unpicking some of my own faith in the nation state project has left me wide eyed to the vastly negative impacts of it at many levels. I’m not for one minute saying that I don’t believe in nations, but I have no faith in the nation sate…. It will take some brave thoughts to reimagine something else!
I heard that Landa Cope recently said that she sees the whole purpose of business being that no one in the world should be hungry. There’s a huge amount in there. But if (kenarchic) business (with a radical gift based economics) and healthcare could mix to be not about lining the pockets of share holders, but about genuine creativity and loving provision of care, then that could be a potent mix for good….
3) Green shoots are not in plenty, especially in the UK, as in my opinion, things are currently quite homogenised, and alternatives are often privatised and widely unaffordable to the vast majority of people….(and please, the health care on the nhs is generally excellent, so why seek for something new?)… Why seek something new? First because healthcare as we have known it will soon be privatised, and we will see more clearly how government is truly functioning as this occurs. This is a time to create some alternatives that speak a new hope. And secondly, healthcare has become (mainly) about getting people ‘fit enough to keep going’ but not really healed, or whole….
4) There may not be many green shoots, but there are plenty of seeds germinating, and there are loads and loads of people consciously and subconsciously subverting the dominant system on a daily basis, to try and provide excellent care.
5) Internationally there is great hope, I think. For example, with so much taken off Obamacare, there could be a sense of dismay, or maybe it reveals the rotten core of the nation state and it’s failure to care (protect) or provide. I’ve often wondered why much of the ‘church’ (as an example, albeit a poor one, due to often imperial and colonising ways of operating) spends so much money on more buildings when it could have provided genuine and loving healthcare (with no strings attached and no enforced practices) instead. This would have been and could be a far more loving thing for the local communities (especially for the 50million who can’t afford healthcare)…. The same could equally be said for creative entrepreneurs…. In the developing world, especially, I hold little hope of healthcare changes happening via current government initiatives, but for those who can see alternative ways of doing things….
Oops – sorry for such a long reply!!! Ha!!!
Reply is another great article in its own right. Awesome stuff you are posting. Love to see this out in the public arena… Now is the opportune time.