By Dr Peadar O’Grady
This conference was organised jointly by the NPA in France and the ‘August 1980’ trade union from Poland.
It was mainly an attempt to discuss the ways the union could respond to a new Polish law which demands the privatisation of all public hospitals. Saturday morning started with introductions and a brief report from each country’s delegation (Irish report is Appendix 2 below). Then there was a discussion of the variety of healthcare systems with a presentation by Dr Klaus Engert, a German surgeon. He emphasised the ‘social determinants’ of health and the importance of prevention and public health but that health systems differed in how effective they were. He showed that while there was no clear correlation between the cost of a health system and the quality of outcomes (US has high costs but relatively poor population health outcomes) there was a clear correlation between the type of system and the quality of outcomes. Tax-funded and social insurance/tax-funded systems are better than market systems. Netherlands was listed as one of the social insurance based systems moving towards a market system and therefore ‘driving the wrong way’ from the point of view of health policy that would improve the health of the population. It was noted that for all the claims made for market systems the opposite is true:
Less bureaucracy: Market systems add a layer of pricing, billing and collecting money which was not necessary previously. They also need a host of market regulators.
Less cost: More bureaucracy, advertising, profit itself, executive salaries and duplication means more costs not less.
Less waste: Competition rather than cooperation between clinics and hospitals means duplication and developing services to raise profits rather than meet health needs.
More choice: Restrictions and rationing of care mean poorer choice of decent care for most people; co-pays and additional insurance to pay for services outside the ‘basic package’ is the norm in a market system.
Patient-centred: Payment incentives like ‘MFP’ (popularised by Margaret Thatcher) means in practice that there is an incentive for service providers to carry out as many profitable services as possible and to avoid unprofitable ones; regardless of patient needs. Money needs to go ahead of the patient to provide the facilities we need. This means actual democracy and planning.
Saturday afternoon involved a discussion of the privatisation drive in Poland. In many countries privatisation happens piecemeal and by stealth, so-called ‘marketisation, introducing fees, splitting up purchasers and providers (ie buying and selling) in advance of a for-profit company getting involved. In Poland however the ‘reforms’ are more sweeping and hospitals are being privatised en masse. The trade union is proposing that the workers support the formation of a cooperative in order to keep the for-profit providers out of health care.
The following were the main points of the
discussion:
Ownership is not the key issue, public control and funding are. In a situation where there is a forced choice between privatisation and a cooperative it is important to maintain a demand for public funding (a better, more efficient service) and a return to public ownership asap. Otherwise you may appear to be advocating cooperatives as best. Tories in Britain are calling for cooperatives to run public services as they know it is a step in the direction of privatisation.
Privatisation with cooperative ownership still means operating in a market system. In this situation competition for profits means cost and pricing pressures even on the more efficient not-for profit cooperative. This means a pressure on wages and the amount of qualified staff. For this reason cooperatives tend to break up into a layer of exploiting managers and exploited workers in the medium term. Longer term outcomes can be a gradual privatisation as workers or others sell their shares; bankruptcy and closure or the complete takeover by a for-profit organisation.
It was agreed that a call for cooperatives would not be a general demand in the fight against privatisation but that it would be useful to encourage debate on a variety of forms including cooperatives in order to further the experience and sophistication of activists in understanding the process of privatisation. Compromises are often forced on us but if we assist it is collaboration. Even the best welfare states are a compromise with profiteering: agreeing to withdraw the profit dynamic from a particular service or public good instead of from every area of goods and service. In the end the problem with any compromise is it allows the capitalist system to survive and take back the progressive reform at a later date. In the case of European Health systems these were mostly rapidly developed in the post-war 40s and 50s but started to be taken back in the 80s with the neoliberalism of the ‘Thatcher-Reagan’ years and continuing to the present.
On Sunday morning the statement of common demands (see attachment below) was agreed.
To read the FULLReport or to print the report, click on attachment below
To submit queries to Dr Peadar O’Grady on the report: [email protected]