The world is in the grip of the COVID-19 crisis. The death toll is rising every day and health care systems across the world face collapse under the pressure of the virus. CWI Ireland member Billy Flynn sets out the broader context to the current crisis and shows how decisions made decades ago which prioritised private health care over public, are undermining efforts now to stop the virus.
‘Nature is the proof of dialectics,’ Friedrich Engels: Socialism, Utopian &Scientific.
Acting Taoiseach Leo Varadkar in his address to the Nation on St Patrick’s Day, told us that the enemy is the virus. This is not true. The real enemy is capitalism, and to be more precise: neo-liberal capitalism.
It comes as no surprise to Marxists that the countries most affected so far by the pandemic – the ones with the increasing infection rates and high death tolls – are the developed countries of the West, where neo-liberalism has been the dominant form of capitalism for over 40 years. In particular, the EU, where member states Spain, Italy and France have been hard hit. In Britain and the United States, where a particularly brutal form of capitalism is in place, both appear to be in the grip of a catastrophe.
COVID-19 has laid bare the brutal reality of decades of neo-liberal cuts to public health systems which have left them struggling to cope. In Ireland we have had a constant health care crisis dating back to the 1980s when Labour Party Minister for Health Barry Desmond enforced major cutbacks on public health, which led to the closing of wards, massive reductions in bed capacity and the loss of jobs – especially for porters and care staff. As a result, many working class people lost trust in the public health care system. In its place the State promoted private healthcare and private hospitals. Tax breaks and sweetheart deals were hatched to ease the rise of private healthcare and hospitals. Working class people were sold the illusion, through relentless advertising by private hospitals, that they would get better care in the private system and avoid the long waiting lists associated with public health.
Workers felt forced to spend tens of thousands over the years on private health insurance in the belief that they were buying ‘peace of mind’. In fact, as this crisis is proving, you receive better treatment in the public health system. In a public hospital you are under the care of a team -including well qualified doctors and nurses as well as a consultant. Whereas in a private hospital you are under the care of the consultant alone who stands to gain financially from your care.
For decades the only option for private care was the Voluntary Health Insurance (VHI), a State-owned not-for-profit insurance company, a product of the Catholic Church’s defeat of the ‘Mother and Child’ public health scheme in 1951. VHI was a scam: instead of paying for a publicly funded health care system through progressive taxation, people paid ‘premiums’ to an insurance company. In recent years due to EU regulations, the health insurance ‘market’ was opened in order – so the argument went – to provide competition and drive premiums down. This did not happen. Instead working-class people have seen premiums rise annually and private hospitals picking off the more lucrative business for themselves: quite often day care cases where there’s a quick turnover of patients, lining the pockets of shareholders and consultants.
Healthcare workers have warned for years that the country’s health system was unsustainable leading to a haemorrhage of medical and nursing personnel emigrating abroad looking for better pay and conditions. Nurses took strike action over poor pay and conditions leading to an inability to retain staff in 1999; but only last year they were forced to take strike action again over the same issues!
The unprecedented economic ‘boom’ of the late 1990s and early 2000s saw almost no improvement in the public health system. Instead there was a proliferation of private hospitals, most notably The Beacon Hospital in Sandyford, Co. Dublin – originally owned by the Beacon Medical Group but since purchased by billionaire and tax exile Denis O’Brien. Under the pressure of the COVID-19 crisis these hospitals have been temporarily taken over by the state for a reported fee of 130 million euro per month.
Winter after winter nurses and hospital doctors have warned about a range of impending dangers:- Seasonal Flu, MRSA and other antibiotic resistant microorganisms, and Norovirus – the so called Winter vomiting bug. Every one of these put a serious strain on the healthcare system but rather than tackle them, consecutive Ministers for Health decided it was the patients and staff who were at fault.
In 2006 the HSE claimed that the main cause of problems in the public health system were nurses not working their contractual hours. It was claimed that late starts, early finishes, unofficial tea breaks, and unapproved time off was a leading factor in the long waiting lists. The then Minister for Health, right-wing neo-liberal Mary Harney, said she was ‘very disturbed’ by these reports; however, an audit of the health system found the claims were false.
On the other hand, patients were blamed for getting sick. The lack of aftercare provision meant older patients could not be discharged from hospitals, and they became known by the insulting term, ‘bed-blockers’. Rather than funding the hospitals, paying the staff a decent salary in order to retain them and therefore open more wards and provide necessary beds, the most vulnerable patients were being denounced merely for having the audacity to need the care and attention the health service is duty bound to provide.
Overcrowding in A&E departments has been a constant issue over the last decades. Images of patients lying on trolleys in corridors, has become the norm despite vacuous promises from various governments. Who can forget the Fine Gael election poster from 2007 with Enda Kenny promising: ‘I’ll end the scandal of patients on trolleys’? The bullet points for that poster shed a light on the neo-liberal thinking of the future Taoiseach and his successor Dr Leo Varadkar, particularly the promise to ‘Get the drunks out of A&E, increase security and charge more to those abusing the system.’
It is true that alcohol abuse – particularly the ‘binge culture’ prevalent in society and encouraged by the politically powerful capitalist drinks industry – can add to the numbers attending emergency departments, but rather than tackle this in a serious way, threatening the profits of capitalist corporations like Diageo and other companies, the response of the neo- liberals was to charge people for accessing A&E.
Anyone with an injury, who did not attend with a GP’s letter or was not considered a genuine emergency, was charged a fee for attending A&E. We were told it would keep down the numbers of unnecessary attendees. However, during the austerity period, a constant charge was applied. Basically a person attending in pain or distress was told they would not see a doctor unless they stumped up 100 euro – whether or not they were a genuine emergency. The ideology of neo-liberalism and the logic of capitalism created chaos in the health system. Dubious methods learned in the ideological factories of the Universities and Business schools were being applied to Hospitals: health care staff became ‘providers’, while patients became ‘clients’. Other essential services, such as cleaning, catering, non-nursing carers such as attendants and porters in some hospitals were tendered out to agencies and outside contractors.
To rub salt into the wound, in recent years we have seen a proliferation of medical vultures – not dissimilar to the vultures feasting on the housing crisis. Companies like Affidea – owned by Waypoint Capital Group and run by the Bertarelli family who according to the Sunday Times Rich List in 2017 are worth £11.5 billion sterling – have swooped in to provide diagnostic services for a price, meaning people on long waiting lists for MRIs or scans can have their test done sooner rather than later. Like all private medical companies; they profit on the fears working class people have of long waiting lists and the need for quick diagnosis to ensure prompt treatment.
The whole health system in Ireland has been subjected to scandal after scandal from Cervical Check to Symphysiotomy; overcrowding, the monthly trolley counts, long waiting lists, all of which add up to the perfect storm, which has arrived in the form of Covid-19.
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This isn’t something that ‘just happened’ or was unexpected. Epidemiologists have been warning for years of the possibility of a serious pandemic. However, we should not be surprised that their warnings were ignored. After all, the same politicians have been ignoring similar warnings about climate change for decades.
Covid-19 isn’t the first pandemic in recent history. In the 1980s we had the AIDs pandemic and an even more reluctance by the conservative neo-liberal establishment to deal with it, perhaps because at first, HIV and AIDs disproportionately affected gay men and the spread of AIDs in poorer neo-colonial countries, like those in sub-Saharan Africa, was of no interest to either Western politicians or the bureaucrats in the Stalinist USSR. The HIV/AIDS pandemic is still ongoing and it is only recently that researchers have developed the necessary therapies to manage this virus.
2009 heralded the emergence of two novel flu viruses. The first was H1NI, which broke out on pig farms in America and earned the nickname ‘Swine Flu’ – even though all flus originate in birds. Then there was H5N1, which originated on chicken farms in Thailand and was given the nickname: ‘Bird Flu’. The intensive farming methods, based on the horrific ill treatment of animals, demanded by capitalism, have provided the perfect conditions for novel viruses to emerge and move into the human population.
There were lessons to be learned, and they were learned by scientists and medical staff but they were not learned by the capitalist ruling class. After all, the capitalists had to deal with something else of much more importance to them: the credit crunch and subsequent economic collapse, which saw austerity inflicted on the working class and funding for health care cut across the world. The austerity implemented then is still ongoing as is evidenced by the continued underfunding of the public health system in Ireland and the NHS in the UK and the utter failure to build stockpiles of Personal Protective Equipment (PPE) for healthcare staff. In the United States President Trump dismantled the Pandemic Response Unit in the Centre for Disease Control which has had disastrous consequences.
In December 2019 we saw the first cases of a new disease break out in Wuhan China. Within a few months it would become a global pandemic, putting the most severe strain on health systems around the world since the second world war. After an initial attempt to cover-up the illness, the Chinese government began a lock down in Wuhan; however, viruses – especially novel viruses – are hard to control. They recognise no borders, they simply follow their genetic imperative to grow and multiply. While ordinary people were unprepared for what was to come, capitalist government should have been prepared, but were not.
Iran and Italy quickly became centres of the disease outside China. Italy and Spain have been hit hard by the pandemic: the neo-liberal ideologies and the austerity inflicted upon them since the economic crash a decade ago, have left them unprepared for this outbreak, with death tolls now far exceeding that in China.
The USA has now become the new centre of the Covid-19 outbreak, with over 750,000 cases and 40,000 dead. The power seat of capitalism and the driving force of neo-liberal ideology, is brutally exposed by a pandemic of this nature. The lack of public healthcare, combined with the avarice of the private healthcare sector alongside a free market attitude and profiteering by medical companies is seeing the rapid spread of Covid-19, especially among the poor and uninsured. African-American and immigrant communities are particularly affected. It remains to be seen if this pandemic will spur working class Americans to fight for a public healthcare system – even a limited one like Bernie Sanders offered during his presidential campaign.
The flag waving empty patriotic rhetoric US citizens are exposed to constantly by the right wing media, not to mention politicians from both the Republican and Democratic parties, is exposed as meaningless by this pandemic. More and more workers in the USA see that it is not the greatest country on Earth. The US capitalist establishment’s empty talk of ‘Freedom’ and the ‘American Dream’ are pointless in a land where people have been dying from lack of even basic health care and poverty long before this pandemic emerged.
In a country where millions have no health insurance and tens of millions more are dependent on employer provided health insurance, the recent jump of almost ten million unemployed will leave even more households without even the barest health cover in the face of this pandemic.
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The vast bulk of the Earth’s biomass is made up of microscopic organisms. They are everywhere. The majority of them are beneficial and indeed we could not survive without them. Viruses are some of the smallest; in fact they are so small, some viruses infect bacteria. While viruses can only replicate within living cells, the majority of them do no harm to humans.
The virus that causes Covid-19 is called SARS-Cov-2. It is one of many coronaviruses a broad term that includes HCoV-229E and HCoV-OC43, both of which are viruses known to cause the common cold.
SARS-COV-2 is extremely infectious and while most of those who catch it will suffer mild symptoms, it does cause moderate to severe illnesses among some people: the elderly, those with chronic medical conditions, and even some younger healthy people with no underlying conditions. While its exact mortality rate has to be determined it has killed over 100,000 people so far, a figure that will sadly rise very significantly in the weeks ahead. There is growing evidence that mortality from the virus is strongly related to poor health infrastructure and preparedness. Where the numbers presenting requiring hospitalisation exceeds capacity, the difference is measured in lives lost.
Because it is so infectious, it means many people are contracting it over a short space of time. Those who become seriously ill need immediate medical care and because of the lack of funding and deliberate mismanagement of public health care systems globally by the capitalist ruling class, there is a shortage of vital equipment such as ventilators. This has led to capitalist states confiscating ventilators intended for other states. For instance, the United States confiscated ventilators bound for the poor Caribbean state of Barbados.
Medical personnel in the countries hardest hit have had to make difficult choices: deciding who gets a ventilator and who doesn’t. This style of battle field triage is having a detrimental effect on the morale and psychology of doctors and nurses: having to decide who lives and who dies.
There is much talk about ‘flattening the curve’. This means slowing down the rate of infection to allow medical staff treat those already infected. Such measures are necessary due to the abject failure of capitalist governments everywhere to invest to prepare for this eventuality. The lockdowns demanded by the public and imposed by authorities albeit with varying degrees of speed and application can help reduce the spread of the virus, so that instead of large numbers of people needing treatment over a short period of time – putting excessive pressure on the hospitals – we can spread the rate of infection over weeks and even months meaning more equipment available for those who require it. The net result of such an approach would be a significantly reduced death toll.
However, the medical imperative for a lockdown to contain the virus and save lives clashes with the capitalist imperative to keep the economy moving, money flowing and workers creating profits for capitalists. This pressure is leading to dangerous calls for the premature easing of lockdowns which will put millions of workers in danger while also running the risk of a resurgence of the virus. Trade unions and workers must demand that any easing of the lockdown is only implemented when it is safe to do so and that workers workplace committees have a direct say in determining the pace of easing at every stage.
Mass testing is another key element in the battle to beat the virus. Except there is a shortage of testing equipment so those who are infected and showing mild or even no symptoms are not being diagnosed. The shortage of ventilators and ICU Units means those who are moderately and severely ill will end up needing more serious interventions. The chances are, even with the lockdown, doctors in Ireland will be forced to make the same difficult decisions as have their colleagues in Italy and Spain.
There is mounting evidence that the virus is spreading rapidly through the care homes system where PPE is scarce and testing has only begun. Similar concerns exist around the provision of domiciliary care. With the failure to adequately test for Covid-19 infections among many dying in this situations, there are real concerns that the hidden death toll is likely to be much higher. The risk to care workers is also hugely concerning but not a priority for neo-liberal governments.
We are still in the early stage of the pandemic yet and we do not know what the weeks and months ahead will bring. However, it is obvious that capitalism cannot cope with this crisis – or indeed any crisis. Once this pandemic ends, there can be no going back to the way things were. Working-class people have seen that they are the true creators of wealth in the economy, those most needed to keep society functioning, are those who have been neglected by the ruling class: doctors and nurses, shop workers, transport drivers, delivery people, postal workers; artists; those working long hours to keep us well, fed, and entertained through this period.
Capitalism has been badly exposed by this pandemic. The lack of PPE for healthcare staff symbolises how this system does not value the lives of working people. Huge numbers of healthcare staff have caught the virus and died from it so far, with the lack of PPE the major contributing factor. Capitalism views workers purely as a source of labour power – a commodity it buys to generate profit – not as human beings with meaningful lives independent of the capitalist economy.
This inhuman system cannot continue. It must go. One other huge lesson we can learn is that private healthcare can never meet the needs of the wider working class. We demand a single tier National Health Service free at the point of use for everyone. In the post COVID-19 world working class people will need a planned economy and the true democracy it affords. This can only be can only be achieved through a socialist transformation of society.