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The Drowned and the Saved

In Books, Politics, Theory on December 15, 2014 at 9:53 pm

From Primo Levi’s If This is a Man, an account of his time in Auschwitz. This is an excerpt from Chapter 9: The Drowned and the Saved.

 

What we have so far said and will say concerns the ambiguous life of the Lager. In our days many men have lived in this cruel manner, crushed against the bottom, but each for a relatively short period; so that we can perhaps ask ourselves if it is necessary or good to retain any memory of this exceptional human state.

To this question we feel that we have to reply in the affirmative. We are in fact convinced that no human experience is without meaning or unworthy of analysis, and that fundamental values, even if they are not positive, can be deduced from this particular world which we are describing. We would also like to consider that the Lager was pre-eminently a gigantic biological and social experiment.

Thousands of individuals, differing in age, condition, origin, language, culture and customs are enclosed within barbed wire: there they live a regular, controlled life which is identical for all and inadequate to all needs, and which is much more rigorous than any experimenter could have set up to establish what is essential and what adventitious to the conduct of the human animal in the struggle for life.

We do not believe in the most obvious and facile deduction: that man is fundamentally brutal, egoistic and stupid in his conduct once every civilized institution is taken away, and that the Haftling is consequently nothing but a man without inhibitions. We believe, rather, that the only conclusion to be drawn is that in the face of driving necessity and physical disabilities many social habits and instincts are reduced to silence.

But another fact seems to us worthy of attention: there comes to light the existence of two particularly well differentiated categories among men – the saved and the drowned. Other pairs of opposites (the good and the bad, the wise and the foolish, the cowards and the courageous, the unlucky and the fortunate) are considerably less distinct, they seem less essential, and above all they allow for more numerous and complex intermediary gradations.

This division is much less evident in ordinary life; for there it rarely happens that a man loses himself. A man is normally not alone, and in his rise or fall is tied to the destinies of his neighbours; so that it is exceptional for anyone to acquire unlimited power, or to fall by a succession of defeats into utter ruin. Moreover, everyone is normally in possession of such spiritual, physical and even financial resources that the probabilities of a shipwreck, of total inadequacy in the face of life, are relatively small. And one must take into account a definite cushioning effect exercised both by the law, and by the moral sense which constitutes a self-imposed law; for a country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.

But in the Lager things are different: here the struggle to survive is without respite, because everyone is desperately and ferociously alone. If some Null Achtzehn vacillates, he will find no one to extend a helping hand; on the contrary, someone will knock him aside, because it is in no one’s interest that there be one more “mussulman” * dragging himself to work every day; and if someone, by a miracle of savage patience and cunning, finds a new method of avoiding the hardest work, a new art which yields him an ounce of bread, he will try to keep his method secret, and he will be esteemed and respected for this, and will derive from it an exclusive, personal benefit; he will become stronger and so will be feared, and who is feared is, ipso facto, a candidate for survival. [Levi’s footnote explains: ‘This word “Muselmann” I do not know why, was used by the old ones of the camp to describe the weak, the inept, those doomed to selection.’ By selection, he means transfer from the concentration camp to a death camp, i.e. extermination.]

In history and in life one sometimes seems to glimpse a ferocious law which states: “to he that has, will be given; to he that has not, will be taken away.” In the Lager, where man is alone and where the struggle for life is reduced to its primordial mechanism, this unjust law is openly in force, is recognized by all. With the adaptable, the strong and astute individuals, even the leaders willingly keep contact, sometimes even friendly contact, because they hope later to perhaps derive some benefit. But with the mussulmans, the men in decay, it is not even worth speaking, because one knows already that they will complain and will speak about what they used to eat at home. Even less worthwhile is it to make friends with them, because they have no distinguished acquaintances in camp, they do not gain any extra rations, they do not work in profitable Kommandos and they know no secret method of organizing. And in any case, one knows that they are only here on a visit, that in a few weeks nothing will remain of them but a handful of ashes in some near-by field and a crossed-out number on a register. Although engulfed and swept along without rest by the innumerable crowd of those similar to them, they suffer and drag themselves along in an opaque intimate solitude, and in solitude they die or disappear, without leaving a trace in anyone’s memory.

The result of this pitiless process of natural selection could be read in the statistics of Lager population movements. At Auschwitz, in 1944, of the old Jewish prisoners (we will not speak of the others here, as their condition was different), “kleine Nummer” low numbers less than 150,000, only a few hundred had survived; not one was an ordinary Haftling, vegetating in the ordinary Kommandos, and subsisting on the normal ration. There remained only the doctors, tailors, shoemakers, musicians, cooks, young attractive homosexuals, friends or compatriots of some authority in the camp; or they were particularly pitiless, vigorous and inhuman individuals, installed (following an investiture by the SS command, which showed itself in such choices to possess satanic knowledge of human beings) in the posts of Kapos, Blockaltester, etc.; or finally, those who, without fulfilling particular functions, had always succeeded through their astuteness and energy in successfully organizing, gaining in this way, besides material advantages and reputation, the indulgence and esteem of the powerful people in the camp. Whosoever does not know how to become an “Organisator,” “Kombinator,” “Prominent” (the savage eloquence of these words!) soon becomes a “musselman.” In life, a third way exists, and is in fact the rule; it does not exist in the concentration camp.

To sink is the easiest of matters; it is enough to carry out all the orders one receives, to eat only the ration, to observe the discipline of the work and the camp. Experience showed that only exceptionally could one survive more than three months in this way. All the mussulmans who finished in the gas chambers have the same story, or more exactly, have no story; they followed the slope down to the bottom, like streams that run down to the sea. On their entry into the camp, through basic incapacity, or by misfortune, or through some banal incident, they are overcome before they can adapt themselves; they are beaten by time, they do not begin to learn German, to disentangle the infernal knot of laws and prohibitions until their body is already in decay, and nothing can save them from selections or from death by exhaustion. Their life is short, but their number is endless; they, the Muselmanner, the drowned, form the backbone of the camp, an anonymous mass, continually renewed and always identical, of non-men who march and labour in silence, the divine spark dead within them, already too empty to really suffer. One hesitates to call them living: one hesitates to call their death death, in the face of which they have no fear, as they are too tired to understand.

They crowd my memory with their faceless presences, and if I could enclose all the evil of our time in one image, I would choose this image which is familiar to me : an emaciated man, with head dropped and shoulders curved, on whose face and in whose eyes not a trace of a thought is to be seen.

If the drowned have no story, and single and broad is the path to perdition, the paths to salvation are many, difficult and improbable.

The most travelled road, as we have stated, is the “Prominenz.” “Prominenten” is the name for the camp officials, from the Haftling-director (Lageraltester) to the Kapos, the cooks, the nurses, the night-guards, even to the hut-sweepers and to the Scheissminister and Bademeister (superintendents of the latrines and showers). We are more particularly interested in the Jewish prominents, because while the others are automatically invested with offices as they enter the camp in virtue of their natural supremacy, the Jews have to plot and struggle hard to gain them.

The Jewish prominents form a sad and notable human phenomenon. In them converge present, past and atavistic sufferings, and the tradition of hostility towards the stranger makes of them monsters of asociality and insensitivity.

They are the typical product of the structure of the German Lager: if one offers a position of privilege to a few individuals in a state of slavery, exacting in exchange the betrayal of a natural solidarity with their comrades, there will certainly be someone who will accept. He will be withdrawn from the common law and will become untouchable; the more power that he is given, the more he will be consequently hateful and hated. When he is given the command of a group of unfortunates, with the right of life or death over them, he will be cruel and tyrannical, because he will understand that if he is not sufficiently so, someone else, judged more suitable, will take over his post. Moreover, his capacity for hatred, unfulfilled in the direction of the oppressors, will double back, beyond all reason, on the oppressed; and he will only be satisfied when he has unloaded onto his underlings the injury received from above.

We are aware that this is very distant from the picture that is usually given of the oppressed who unite, if not in resistance, at least in suffering. We do not deny that this may be possible when oppression does not pass a certain limit, or perhaps when the oppressor, through inexperience or magnanimity, tolerates or favours it. But we state that in our days, in all countries in which a foreign people have set foot as invaders, an analogous position of rivalry and hatred among the subjected has been brought about; and this, like many other human characteristics, could be experienced in the Lager in the light of particularly cruel evidence.

About the non-Jewish prominents there is less to say, although they were far and away the most numerous (no “Aryan” Haftling was without a post, however modest). That they were stolid and bestial is natural when one thinks that the majority were ordinary criminals, chosen from the German prisons for the very purpose of their employment as superintendents of the camps for Jews; and we maintain that it was a very apt choice, because we refuse to believe that the squalid human specimens whom we saw at work were an average example, not of Germans in general, but even of German prisoners in particular. It is difficult to explain how in Auschwitz the political German, Polish and Russian prominents rivalled the ordinary convicts in brutality. But it is known that in Germany the qualification of political crime also applied to such acts as clandestine trade, illicit relations with Jewish women, theft from Party officials. The “real” politicals lived and died in other camps, with names now sadly famous, in notoriously hard conditions, which, however, in many aspects differed from those described here.

But besides the officials in the strict sense of the word, there is a vast category of prisoners, not initially favoured by fate, who fight merely with their own strength to survive. One has to fight against the current; to battle every day and every hour against exhaustion, hunger, cold and the resulting inertia; to resist enemies and have no pity for rivals; to sharpen one’s wits, build up one’s patience, strengthen one’s will-power. Or else, to throttle all dignity and kill all conscience, to climb down into the arena as a beast against other beasts, to let oneself be guided by those unsuspected subterranean forces which sustain families and individuals in cruel times. Many were the ways devised and put into effect by us in order not to die: as many as there are different human characters. All implied a weakening struggle of one against all, and a by no means small sum of aberrations and compromises. Survival without renunciation of any part of one’s own moral world apart from powerful and direct interventions by fortune was conceded only to very few superior individuals, made of the stuff of martyrs and saints.

We will try to show in how many ways it was possible to reach salvation with the stories of Schepschel, Alfred L., Elias and Henri…

Levi P. If This Is A Man. New York: The Orion Press; 1959, p.99-106

I have stopped there, but everyone would benefit from reading the whole book. In fact, I should be more forceful than that. Everyone should read this book. I think Adorno said something about writing poetry after the Holocaust being “barbaric”. Doing anything after reading about Levi’s experiences is certainly difficult. How does one think, how does one moralise, how does one act after the fact of the Holocaust? We are challenged to try to make sense of this. We must never forget that this happened.

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Gramsci on Government as a Political Party

In Politics, Theory on April 7, 2014 at 2:34 pm

“Classes produce parties, and parties form the personnel of State and government, the leaders of civil and political society. There must be a useful and fruitful relation in these manifestations and functions. There cannot b any formation of leaders without the theoretical, doctrinal activity of parties, without a systematic attempt to discover and study the causes which govern the nature of the class represented and the way in which it has developed. Hence, scarcity of State and government personnel; squalor of parliamentary life; ease with which the parties can be disintegrated, by corruption and absorption of the few individuals who are indispensable. Hence, squalor of cultural life and inadequacy of high culture. Instead of political culture, bloodless erudition; instead of religion, superstition; instead of books and great reviews, daily papers and broadsheets; instead of serious politics, ephemeral quarrels and pers0nal clashes. The universities, and all the institutions which develop intellectual and technical abilities, since they were not permeated by the life of the parties, by the living realities of national life, produced apolitical national cadres, with a purely rhetorical and non-national mental formation. Thus the bureaucracy became estranged from the country, and via its administrative positions became a true political party, the worst of all, because the bureaucratic hierarchy replaced the intellectual and political hierarchy. The bureaucracy became the State/Bonapartist party.”

 

Gramsci A (1971 [1948]) Selections from the Prison Notebooks of Antonio Gramsci. London: Lawrence and Wishart, p227-228

The NHS: A Symbol in Peril

In NHS, Politics on March 22, 2014 at 8:52 pm

This article was first published by New Left Project on 14 February 2014

The NHS is now locked into a transformative process since the enactment of Andrew Lansley’s Health and Social Care Bill last year. My friends in the world of public health tell me there is a fair amount of confusion as to what is actually going on, with the dissolution of primary care trusts in favour of clinical commissioning groups. What is for certain is that a period of difficulty during and after a top-down reorganisation was entirely predictable and, moreover, predicted.

Meanwhile, we are supposedly anticipating a demographic crisis. With all of the doom-laden rhetoric around the burden that these oldies will place on working-age people over the next few years and decades, it’s a wonder we’re still trying our damnedest to shut our borders to economic migrants, who boost the birth rate, work more, consult healthcare less and generally ‘cost’ the state less. The basic argument seems to be that old people aren’t dying fast enough. I’m surprised nobody has drawn up a neoliberal economic argument for legalising euthanasia.

This is an apposite time to wonder about the public’s interpretation of what the NHS is. What is it? What is healthcare for? Is it simply there to improve our health? But then what is health? The WHO defines it as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. This isn’t really what most of our resources are aimed at. We spend most money on treating illness, not improving health. For many years, there’s been a running joke in the world of public health that it shouldn’t be called the National Health Service at all; it should be the National Illness Service. (Chortle chortle.)

But I would argue that it is neither a health service nor an illness service. Or rather, it is both, and more. The NHS is a symbol of the kind of society we are. Which is why people are so passionate about it, why it is the site of so much contestation. And as with many symbols, it works at a number of levels: at a national level, of course, although this is difficult to keep track of given the complexities of the beast it has become. But also at a local level. The local hospital is a symbol that the state cares, that if the shit hits the fan, the state can and will look after you.

For those who already visit these hospitals, they may well already be a literal lifeline. And what about healthcare workers? The symbol of state-provided care, equal for all, regardless of wealth or background, is massive for those who participate in its provision. Cheesy as it may sound, for many of us it is exactly this that gives us our sense of vocation. Doing this locally engages us in communities in ways that faraway super centres simply cannot.

So what happens when this symbol is forcibly taken away despite public protest? We interpret it as another sign that government doesn’t give a shit about normal people. More importantly, it really doesn’t give a shit about disadvantaged people. You’ll hear experts talking about how centralisation of specialist services improves quality and reduces morbidity. There’s a great deal of truth in this. If you have a car accident, the difference between being taken to the nearest district hospital or to a major trauma centre has been shown to be pretty significant. Put simply, you are more likely to live if the ambulance takes you straight to the trauma centre.

But the centralisation of resources in this way means investing more in those sites, which may mean investing less in peripheral sites. And what if is this evidence-based argument is used to justify closure of peripheral sites without increasing central capacity, as we have had in Manchester? The closure of Trafford A&E is a recent case in point, which led to Wythenshawe hospital being way over capacity at the end of 2013. It is quite clear that the expert-led argument which had aimed to improve services has simply been used to obscure a cost-cutting measure, thus reducing the quality of care. In other words, the justification for the change was saving lives. But the change implemented was not quite what was presented. And the final result may well be the opposite: increased morbidity and mortality.

In the field in which I work, mental health, all inpatient beds were recently closed in central Manchester with the North and South Manchester sites expected to pick up the slack. This has led to an acute shortage of beds, with inpatients having to be transferred hundreds of miles to find a bed. I admitted a patient from a Manchester A&E department three weeks ago who had to wait several hours for her ambulance to arrive. When it did, it took her to the closest available NHS bed: in Sunderland. The reduction in mental health beds has followed a slightly different argument to the centralisation of specialist services discourse described above. In mental health there was a move to providing care in the community, rather than in huge institutions cut off from society. Again, this was based on societal change, on improving attitudes to the mentally unwell, on reducing stigma and helping the unwell to re-integrate back into society rather than suffer in isolation, separated from others. The arguments were all sensible, ethically sound and often evidence-based. But instead of seeing adequate resources devoted to provision of community care, we have just seen the closure of inpatient beds, with not enough done to replace the care they used to provide. Like the local A&E as a symbol that the state will look after you when you have a heart attack or break your leg, the mental health hospital serves as a symbol that the state will look after you when your psychological suffering becomes so great that you need respite. When you can’t get into that hospital because it’s full, the meaning of that symbol changes.

The point here is that one argument has been used to persuade the populace that a change in the system is for the best. And that argument has obscured the fact that the change has not served the people whose health the NHS is supposed to protect. The only people who have gained from these changes are private providers of care who have been able to gain access to taxpayers’ money: a fail-safe, government-backed investment.

We have seen the Tory party, in particular Andrew Lansley and Jeremy Hunt, attempting to persuade us that we needed a huge top-down organisation of the NHS (months after David Cameron had promised us none of the sort) in order to improve ‘patient-choice’. Rather than improving actual care, this has simply opened the market to private providers. The common sense being appealed to here is that competition improves care. The evidence suggests otherwise, and there are very good reasons for this, as explained here.

More recently, Jeremy Hunt has attempted to persuade us that he needs to shut hospitals and A&E departments, using the arguments described above. His arguments though have not worked. He has forgotten the power of the local hospital as a symbol, and therefore not anticipated the mobilisation against hospital closures. So what happens when persuasion fails? The ruling class gets spooked and has to reassert its authority. It resorts to coercion. And this is what we see with clause 118. Jeremy Hunt is trying to put through a bill that will give him ultimate power to shut hospitals at will. The rhetoric of patient choice and public involvement is exposed as vapid bullshit as he tries to bulldoze public opinion into giving him the ‘power to turn around failing hospitals quickly’. He is simply doing ‘tough but necessary things’, which ‘should be supported by everyone who cares about the NHS’ or else ‘lives can be put at risk’. The curiously transparent emotional blackmail (where does he find his speech-writers?) is desperate schwarmerei, one last attempt at persuasion while he fiddles in parliament to enact the coercive clause 118.

In a way this move is encouraging. It is a sign that people aren’t being persuaded. People aren’t buying into the bullshit. They, we, are not allowing the oppressive new order to be born, are not consenting to our own subordination, are forging our own common sense. It is under these circumstances that old Jeremy feels the need for extraordinary measures.

Don’t let him get away with it.

What you can do:

1.Sign a petition with 38 degrees

2. Get involved with Keep Our NHS Public. They have a number of local branches who meet regularly to plan campaigning and activism.

3. Write to your MP. You can find his/her details here.

4. If your local hospital is facing closure, it probably has a group of people campaigning for it to remain open. Examples are Lewisham, Trafford, Bolton.

5. Join the NHA Party, a newly formed political party formed by two doctors who are passionate about keeping the NHS as a publicly funded service free to all.

6. Educate yourself – read NHS SOS by Raymond Tallis and Jackie Davis.

7. Tell people, have a conversation with someone, start an argument/discussion!

Letter to MP Regarding Pay Freeze

In NHS, Politics on March 15, 2014 at 3:11 pm

I have just sent a letter to my MP regarding the NHS pay freeze. You can read it below. Please feel free to copy and paste from it as you please.

You can find you own MP’s details, as well as UNITE’s template letter and opinion poll here.

Dear _______,

I’ve written to you several times in the past, always about issues related to the NHS. You may remember that I am a doctor. Previously I was an anaesthetic trainee. I have now changed career paths and am a psychiatric trainee.

On this occasion I am writing about the plan not to go ahead with the 1% pay increase for all NHS workers, going against the advice of the NHS pay review body. As I’m sure you are aware, this will equate to a cut in pay in real terms. This will not make a huge difference for myself or my wife (a ______ trainee), but will make a rather large difference for the 40,000 NHS workers paid below the living wage.

The following paragraph is copied and pasted from a letter template created by the UNITE website, but I fully support it and I hope you will too.

“Please show your support for workers like me; sign Unite’s NHS pay pledge guarantee:
• I pledge to support my constituents who work in the NHS in their call for a substantial, above inflation pay rise for 2014/15,that is the same for everyone
• I pledge to campaign for the living wage and support the call for the NHS to become an accredited living wage employer in line with the principle that ‘work should be the surest way out of poverty’: (Living Wage foundation)
• I pledge to support my constituents in their call for an end to the practice of downbanding and performance related pay.”

Yours,

__________

Fneremy Fnunt

In NHS, Politics on February 12, 2014 at 9:46 pm

I managed to get inside the Rt Hon Fneremy Fnunt’s head recently. This is what I found.

I say, that Polly Toynbee has a nerve, doesn't she? [What's that? She writes for the Guardian? I bloody well should've known.] Those leftie loonies, don't they have anything better to do? Didn't they get the memo? COMMUNISM FAILED, LOSERS! Oh, they'll never learn, those ruddy Guardianistas. Do you know what I call that journalistic blight on our beloved British soil? They call it the Guardian. I call it the Guardian. I mean the Grauniad. The Grauniad. Yes? Get it?

Fnar fnar.

Anyway, how dare she call me nefarious when she's the one named after a parrot? (And we all know how evil parrots are.) I mean I'm the one trying my damnedest to make something of this country and my first stop is the NHS. Well, second stop actually. First stop was the Olympics. Yes, that was me. Me me me. I did the Olympics. Me. The Olympics were me. And you saw how good they were. [Didn’t you? Where the fuck were you?] So when the nurses said they didn’t like old Andy, Dave gave me the NHS. It’s mine now. That’s the problem with success you see, when you’re super successful (like me), you just earn yourself a bigger, harder job.

 

Like the NHS. Now there's a bloated beast. She employs over 1.4 million people. That's more than the Red Army. Booooooooo, hisssssssss, down with the reds. [What do you mean, “Stop it”? Oh I'm only joking old sport, I love those commies really, lolz. They may be terribly misguided but their hearts were in the right place, weren’t they? Weren’t they? Oh. Who said that? Govey?! But state control of the public imagination is exactly what he… never mind, I shan’t ever understand that old fruit.] Anyway, that many people employed by the state, that's a recipe for disaster, isn't it? Look at what happened to the USSR! What we need is competition between different providers of care. That'll push costs down and standards up as we've seen happen in all walks of life since the dawn of capitalism.

Why Polly and her minions fail to understand this, I do not know. They just refuse to accept that the cold hard world of providing healthcare to the masses can only be bettered by the introduction of the profit motive. Much as I would like to change this, it's money that makes the world go round, and the faster doctors and nurses accept this, the faster they will be able to adapt to...

[Eh?]

Oh yes, sorry. No I don't mean the profit motive. I got confused, I'm sorry. They're not caring enough. Caring. Yes. We need culture change. We need to incentivise them to care more. [What? That's wrong too? Are you sure? Train them to care? You expect me to say that? It's bloody nonsense.]

Fine.

Yes, what we need in the NHS is a new culture. The culture is the problem. The problem with the NHS is the culture in it. So we need to change the culture. It is the culture that we must change. We need to indoctrin...[STOP INTERRUPTING ME! If you want to do the talking then go ahead, bozo… Chocolate? And poppers? For me?... I do like poppers… Oh ok, I’ll do it your way, since you asked nicely.] We need to re-educate nurses to be nurses again, you know, to really care about their patients. Too often now we see nurses not caring enough, and it reminds me of that time at the Olympics when that black man won that race and then ran around with the big eyes. Now he really cared. And do you know why he cared? Because he was sponsored by Virgin. And because he was at the greatest Olympics of all time. And guess who was responsible for them? Yep, you guessed it. Moi. But anyway, unlike nurses, he cared. (Just to clarify for any of you that are a bit slow, what I am saying is that nurses do not care about their patients. I mean do not care enough. They might care, but I want them to care more.)

Just like I care about you. And your health. Especially your granny's. I really care about your granny. With her little leathery hands and her purple pantyhose, clinging to her oedematous legs. Her lovely, lovely legs. Look at those lovely legs, see how they swell. Is that pitting oedema up to her umbilicus or is it a stairway to heaven? [Stop there? Is that enough you think? I was just trying to add a bit of the personal touch, you know, like when Haguey said he used to drink 14 pints a day. You think it’s creepy? Do you who I am? I did the bloody Olympics! That was me, you know! ME! Fuck Sebastia… Did you say poppers? WHERE?!]

On Cameron’s BS

In Politics, Society on March 7, 2012 at 3:28 pm

This article was first published by New Left Project on 15 Feb 2012

‘Our challenge to be a young country is not just economic, it is social and moral. Look at ‘the wreckage of our broken society.’ Tony Blair, 1995

‘What is it I am really passionate about? It is actually social recovery as well as economic recovery. I think we need a social recovery, because as I have said lots of times in the past, there are too many parts of our society that are broken.’ David Cameron, 2011

One theory of comedy suggests that punchlines are lent greater potency by the presence of the letter k.  While the now commonly heard epithet, ‘the broken society’ is no punchline, the hard syllable does give it an evocative quality.  And the man who popularised the term was certainly someone who had a talent for coining a catchy phrase – Tony Blair.  The term has become a modern cliché in the UK, used as justification for a variety of political changes and policies, and deserves some background and some analysis. How did Blair use the term, and how has it developed since then?

In 2012, the person we most commonly hear talking about the ‘broken society’ is David Cameron. While it appears he is discussing the same thing, actually he is arguing something quite different from Tony Blair. So do these words carry any meaning as a descriptor, and if they do, is it that which was intended by the speaker? And if society is broken, then how do we fix it?

Blair

In 1993, two year old James Patrick Bulger was tortured and brutally murdered by two ten year old boys on a railtrack in Liverpool.  The story was and is horrific. The subsequent public outcry was understandably hysterical.  How could such a thing happen in a supposedly civil society?

The country had been under Conservative rule for thirteen years, but a new light was emerging in the Labour Party. That year, Tony Blair, then shadow home secretary, had written a pamphlet for the Fabian Society criticising Clause IV of the Labour Manifesto. This was the beginning of the Third Way, New Labour was being born. After the murder, he gave a speech in Wellingborough in which he said, ‘We hear of crimes so horrific they provoke anger and disbelief in equal proportions… These are the ugly manifestations of a society that is becoming unworthy of that name.’

One year later, Blair became leader of the Labour Party and one year after that took up the refrain again at his leader’s speech in Brighton.  He captured the popular mood in describing the country as ‘dying, broken, demoralised Britain.’  He described something that middle class Britain perceived, and in so doing consolidated that picture in its collective imagination, ‘the family weakened, society divided, we see elderly people in fear of crime, children abused, youngsters hanging around street corners with nothing to do…’

How had Britain reached this perceived state of moral decrepitude? Blair had one explanation – ‘I love my country and I hate what the Tories have done to it.  Every promise ever made has been broken – taxes, unemployment, crime, the health service, education…. Imagine for one moment a Tory fifth term Britain.  Would there be a National Health Service? [Audience – NO!] Would there be a free state education system for all? [NO!] Would Mr Redwood be in charge of deciding which single parents get to keep their children? [NO!]’

Near the climax of the speech, he let rip his direct accusation, ‘I know what the people want to say to those Tories: it is no good waving the fabric of our flag when you have spent sixteen years tearing apart the fabric of the nation; tearing apart the bonds that tie communities together and make us a United Kingdom; tearing apart the security of those people.’

In 1987, Margaret Thatcher had said in an interview with Woman’s Own magazine, ‘There is no such thing as society. There are individual men and women, and there are families.’ Seemingly in direct response to this, Blair now said, ‘We are not simply people set in isolation from one another, face to face with eternity, but members of the same family, same community, same human race. This is my socialism and the irony of all our long years in opposition is that those values are shared by the vast majority of the British people.’  This quotation is particularly interesting; the first part shows how he disagreed with neo-classical economics. He did not conceive the basic unit of society to be an individual whose behaviour was dictated entirely by self-interest. But the second part also shows that nor did he believe in all that economic guff in socialist theory and practice – socialism was about society. ‘Socialism for me was never about nationalisation or the power of the state, not just about economics or even politics. It is a moral purpose to life, a set of values, a belief in society.’

Part of that morality involved a Kennedy-esque appeal to the electorate.  He spoke of responsibility, ‘Our challenge to be a young country is not just economic, it is social and moral. Look at the wreckage of our broken society… A young country gives rights but it demands responsibilities… Justice for all, responsibility from all.’  Part of his rhetoric involved a nostalgia for the traditional family unit, ‘A young country that wants to be a strong country can not be morally neutral about the family. It is the foundation of any decent society… In every area of policy, we should examine its effect on the family.’

The speech painted a vision of a broken society, but it was not morose or backward-looking.  As the Guardian‘s leader article described it, ‘He told the hall that he loved the party, and the hall told him that the party now feels the same way about him. Mr Blair has learned how to make his party feel good.’ He used the idea of the broken society to create a vacuum into which a new party with a new vision must enter – New Labour. As well as the descriptions of a country ostensibly ravaged by Tory rule, there was also repeated use of the words, ‘young nation,’ ‘a nation reborn,’ ‘a new Britain.’  He said Labour had ‘100,000 new members’ and ‘a huge increase in Young Labour – five times as many in Young Labour than in the Young Conservatives’. It was a party revitalised, so what better party to be the midwife for this rebirth of the nation. ‘New Labour, new Britain, the party renewed, the country reborn.’

And what better person to lead the way than Tony Blair. Supremely confident in his own ability to solve any problem by ‘drilling down’ to the heart of the matter. Supremely confident in his ability to convince others of his solutions. And, as it would prove, supremely confident that his solutions to problems were correct – no matter how many millions of the electorate marched in the street to protest otherwise.

So what did he propose? An increase in health and education budgets, and new ways of thinking about and deploying this funding. Public private partnerships would no longer be taboo for the Labour Party. Of the NHS, he said, ‘Let the internal market that pits hospital against hospital cease.’ In education there would be ‘no return to selection, academic or social’.  We would see more police on the beat. Regarding central government, he planned to ‘sweep away the quango state’. He promised to discard a Tory demand for compulsory identity cards. Finally, he gave his word, ‘The party will carry out in government the programme we provide in our manifesto – nothing more, nothing less.’

Under Labour rule, the electorate saw the NHS being opened up to independent sector treatment centres to create an internal market, faith schools selecting pupils on the basis of religion, a general flourishing of quangos and focus groups and a government push for identity cards.  And of course, the travesty of Iraq despite two million marching in protest against the war. He accused the Tory government of breaking its promises and then went on to do the same himself.

A society that had been told it was broken had also been told by the man it would elect as leader that he had the answers. He delivered a booming economy, a re-energised NHS and unemployment levels just above 5%. (Northern Rock collapsed a few months after he announced his resignation.) But the electorate felt betrayed by the man who had broken his promises.  It felt he had displayed not supreme competence, but supreme arrogance.

By the end of Blair’s reign, I recall it became common at UK hip-hop concerts for acts to start a chant of ‘Fuck Tony Blair! Fuck Tony Blair!’ The audience, largely young men aged fourteen to thirty, would join in enthusiastically and this would go on for several minutes before seamlessly segueing into the next track. I heard no further debate on who or what should replace him. Just a unified desire to ‘fuck’ him.

Cameron

In February 2011, David Cameron set out his vision for the ‘Big Society’. He described ‘economic recovery’ as his ‘duty,’ and ‘social recovery’ as his ‘mission,’ about which he felt passionate because ‘there are too many parts of our society that are broken.’ He cited evidence of a moral nature similar to Blair’s, ‘Whether it is broken families or whether it is some communities breaking down, whether it is the level of crime, the level of gang membership, whether it’s problems of people stuck on welfare, unable to work, whether it’s the sense that some of our public services don’t work for us – we do need a social recovery to mend the broken society.’

The word, ‘responsibility,’ is of even greater importance to Cameron than it was to Blair. In one passage of the February speech, he uses the word three times in three sentences, ‘There’s one word at the heart of all this, and that is responsibility. We need people to take more responsibility. We need people to act more responsibly.’ The lack of responsibility of which he speaks is targeted at a specific socioeconomic group. The speech does not mention the irresponsibility inherent in the causes of the global financial crisis, nor that displayed by those who would gain from the consequences of it.

Tony Blair’s sentinel event was the death of Jamie Bulger. For Cameron, it was the August riots. Once again, the country reached a level of hysteria conducive to the use of the event as a political football. The left blamed the riots on the government’s austerity drive. The right spoke of a culture of irresponsibility and entitlement, a generation bred on welfare, the Human Rights Act and X-Factor.

In Witney, David Cameron spoke of the nation’s ‘slow motion moral collapse that has taken place in parts of our country these past few generations. Irresponsibility. Selfishness. Behaving as if your choices have no consequences. Children without fathers. Schools without discipline. Reward without effort. Crime without punishment. Rights without responsibilities. Communities without control.’ Rather than wait for the evidence on the motivations of the rioters being collected by sociologists at the LSE, he rushed in with his own analysis, ‘I don’t doubt that many of the rioters out last week have no father at home. Perhaps they have come from one of the neighbourhoods where it is standard for children to have a mum and not a dad.’ He goes on, ‘From here on, I want a family test applied to all domestic policy.’ Sound familiar? Sixteen years earlier, Blair had said, ‘In every area of policy, we should examine its effect on the family.’

That Cameron’s rhetoric was insincere demagoguery was belied by his inconsistency. He starts by saying to the House of Commons, ‘The perpetrators of the violence we have seen in our streets are not in any way representative of our country – nor of our young people.’  But in the same speech he uses the riots as representative evidence of a culture without decency, ‘This is not about poverty, it’s about culture. A culture that glorifies violence, shows disrespect to authority and says everything about rights but nothing about responsibilities.’  In the Witney speech, he says, ‘Those thugs do not represent us, nor do they represent our young people.’  He then concludes by contradicting himself, ‘Whatever the arguments, we all belong to the same society and we all have a stake in making it better. There is no them and us, there is us. We are all in this together, and we will mend our broken society together.’ So does that ‘we’ include the rioters or not? What about their supposedly absent parents?

So what is Cameron pushing when he speaks of the broken society? What is the conclusion of the argument for which he is invoking the broken society as ballast?

To the House of Commons, he summarised his response to the riots, ‘There is no one step that can be taken. But we need a benefit system that rewards work and that is on the side of families. We need more discipline in our schools. We need more action to deal with the most disruptive families. And we need a criminal justice system that scores a clear, heavy line between right and wrong. In short, all the action necessary to help mend our broken society.’

Welfare has been at the heart of objections to Tory policy under Cameron. A basic summary of the Welfare Reform Bill is that certain specific benefits will be cut, such as child and housing, as well as a benefits ‘cap’ introduced, while Iain Duncan Smith pushes towards the holy grail of a single benefit, Universal Credit. The Tory argument is that the current system is profitable enough for people to live on welfare without any motivation to find work. It is ‘a system that encourages the worst in people – that incites laziness, that excuses bad behaviour, that erodes self-discipline, that discourages hard work, above all that drains responsibility away from people.’ Therefore, an overall cut in what is offered will create or improve the incentive to work. The attachment of the broken society rhetoric to this argument adds an emotionally charged social and moral counterweight to what is essentially an economic change which will disproportionately affect the worst off in society.

In the Witney speech, Cameron compares the actions of the workless with the actions of those other great demons of our time – the bankers, ‘We talk about moral hazards in our financial system, where banks think they can act recklessly because the state will always bail them out. Well this is moral hazard in our welfare system; people think they can be as irresponsible as they like because the state will always bail them out.’ But the vapidity of the comparison is demonstrated by the lack of any other references to the causes or consequences of the global financial crisis in this speech until the final few words, ‘Moral decline and bad behaviour is not limited to a few of the poorest parts of our society. In the banking crisis, with MPs’ expenses, in the phone hacking scandal, we have seen some of the worst cases of greed, irresponsibility and entitlement. The restoration of responsibility has to cut right across our society.’ This is not followed by spelling out what his actions will be to combat what he sees as immorality is these other areas. Instead it is followed by the aforementioned warm, fuzzy, ‘There is no them and us, there is us.’ We are all in this together, but only some of us need fixing.

Cameron’s concentration on removing the ‘incentives’ that he believes keep people on benefits, focuses the debate on the poor while ignoring the much greater incentives on offer in the financial industry for those who would act without thought for the consequences of their actions.  The idea of blunting this incentive, or allowing the taxpayer to gain from it via a financial transaction tax, seemed so unpalatable to him that he saw fit to withdraw himself and the country from the recent EU treaty over the issue, putting at risk the country’s continued authority in Europe. The idea that such a tax might pay for another incentive to work – a higher minimum wage – is not even entertained.

Is society broken?

Blair described the broken society, and blamed its creation on the previous fifteen years of Tory Rule. Cameron used similar anecdotal evidence to support his description of a society devoid of morality or responsibility, but instead blamed its existence on a culture of entitlement in which the ‘worst aspects of human nature [were] tolerated, indulged – sometimes even incentivised – by a state and its agencies that in parts have become literally de-moralised’.

But is society really broken? To refer to the descriptors which Blair and Cameron cited themselves, Home Office figures from 2010 show that divorces have been on a downward trajectory since 2001, teenage pregnancy rates have remained flat and crime has been falling since 2002. However, the same document also shows that popular perceptions of the level of crime have risen in the same time.

Neither Cameron nor Blair cited the increasing disparity between rich and poor, the homogenisation of wealthy communities and their separation from the less well-off, the stagnation of real wages since the 1970s, even while the economy was booming. While these may not be evidence of a broken society, they could certainly support an image of a divided society.  However, the conclusions to which this evidence would lead would likely differ from the two leaders’.

It is also undeniable that the riots did happen. Children and young adults, largely young men aged fourteen to thirty, did think that it was okay to smash shops and steal things. They threatened people and in some cases actually caused physical harm to them. Why? The studies done by the LSE show that opportunism was a key factor; i.e. Cameron’s description of ‘criminals who’ve taken what they can get’ was not incorrect.  However, in saying, ‘The young people stealing flat screen televisions and burning shops was not about politics or protest, it was about theft,’ he is refusing to countenance any further motivating impulses, allowing him to characterise them as two-dimensional thugs who must be disciplined, rather than humans who must be understood.  If there is a break in society, it appears that he would seek to consolidate it rather than mend it.

The LSE studies showed that the rioters had diverse motivations, but it seems that one key aspect was a generalised cry of rage against a pervasive sense of injustice – increases in student tuition fees, removal of education maintenance allowances, police stop and search procedures and of course, the spark that set it off, the death at the hands of the Metropolitan Police of Mark Duggan. Why did these young people feel that an appropriate way of expressing this rage was through property destruction, theft and in some cases, violence?

Could it be that ‘appropriate’ has nothing to do with it, and ‘opportunity’ has everything to do with it? The words of Martin Luther King have become hackneyed over the past few months, but I must indulge them again ‘The riot is the language of the unheard.’ Is this not an amplification of the chant, ‘Fuck Tony Blair! Fuck Tony Blair!’

This is a generation (of which I am part) which feels let down by politicians, uninspired by politics. But not in the slightest apathetic to the state of society, the country or the world. It protested in its millions against war in Iraq, but the government it had elected did not listen. It protested in its thousands against the increase of tuition fees, but the government it had elected did not listen. The Liberal Democrat Party, which owed a large share of its votes to students and young people, broke its own manifesto promise to support the increase. It protested in its hundreds of thousands against the government’s cuts to public services and against top-down NHS reforms that had been explicitly ruled out in the Tory manifesto. The government it had elected did not listen.

This is a generation that has witnessed the entire Parliamentary establishment become engulfed in an expenses scandal, seen a major newspaper collapse after its criminal practices were exposed, watched helplessly as the economy floundered after a crisis caused by irresponsible practices which David Cameron still baulks at  de-incentivising. We’ve listened to him tell us ‘we’re all in this together’ while he hobnobs with a coterie of Chipping Norton neighbours with a seemingly stentorian influence over him of which we can only dream. In our most recent efforts to be heard outside St Paul’s Cathedral, as part of the international Occupy movement, to create a new model of direct democracy, he told us our efforts were ‘not particularly constructive’.

The basis of representative democracy was and is accountability at election time, an accountability that assumes and depends on reliable, accurate information regarding what the government has done, what it is doing and what it aims to do. All of this has become suspect.

Voter turnout in 1992 was 78%. By 2001, it had fallen to 59%. While there has been a slight increase since then, the 2010 turnout was still languishing at 65%. Labour party membership has fallen from a peak of 405,000 in 1992 to 166,000 in 2008. Conservative Party membership has fallen in the same time period from 500,000 to 250,000, Liberal Democrats from 101,000 to 60,000. The numbers of people who perceived a great difference between the parties fell from 56% in 1992 to 23% in 2010. The numbers who saw not much difference rose from 12% to 34%. The numbers of people who thought it was not really worth voting rose from 8% in 1991 to 18% in 2010. This is a generation that feels representative democracy, dominated by an elite of professional politicians, is not working. And the less we engage with it, the less representative it becomes.

So what will this generation do to be heard? What must it do?

The hard syllable poetry of those who govern us is a sophistic nonsense. The ‘broken society’ has been an argument for ‘muscular liberalism’ of various kinds, but the electorate has submitted to neither what it expected, nor what it wanted. The broken society may be a misrepresentation, a malleable tool used in myriad ways by a congeries of elite players of the political game. It may be BS. But at heart it is not a myth. Society is divided and our version of democracy is embodying its most important division – between the powerful and the powerless. The ‘broken society’ is an incitement to renew our democracy, to obliterate the distance between us and them, rich and poor, workers and workless, governing and governed. We must speak, shout and scream if necessary. And we must listen to ourselves speak, shout and scream. We must hear. And we must be heard.

This article was first published by New Left Project on 15 Feb 2012 at http://www.newleftproject.org/index.php/site/article_comments/david_camerons_bs

Competition in the NHS

In NHS, Politics on January 3, 2012 at 7:43 am

This is a slightly edited version of an article that was first published by Now Then Magazine in December 2011.

Andrew Lansley’s Health and Social Care Bill has been attacked on many grounds. I’ll summarise these objections before adding my own.

  • Neither the Conservative Party nor the Liberal Democrat Party mentioned wholesale reforms of the NHS in their manifestos. David Cameron expressly promised there would be no top-down reorganisations.

  • Questions regarding the influence of donations to Andrew Lansley’s political office by private healthcare providers remain unanswered. In January 2010, The Daily Telegraph revealed John Nash, chairman of Care UK, had donated £21,000 to Lansley’s private office.

  • General practitioners currently receive no training in the commissioning of services and have no expertise in the management of large budgets.

  • The administration of these large sums of money by the same people who provide care will create conflicts of interest and affect the trust that patients place in their doctors.

  • The provision of services by ‘any willing provider’ will lead to fragmentation of services, which will make the co-ordination of care more difficult. Currently, the management of patients with complex medical conditions, e.g. children with multiple related but separate diagnoses (cerebral palsy, epilepsy, learning disability, psychiatric illness) require the GPs and specialists to collaborate to provide a delicate, customised, evolving package of care. If the service providers are seeking to compete with and therefore antagonise one another, the smooth provision of such a package will become more challenging.

  • Similarly, junior doctors require exposure to many environments and specialties during their training. This will become increasingly haphazard.

  • It will lead to duplication of services, rather than the streamlining that one would associate with economic efficiency. The evidence that competition within healthcare improves efficiency is sparse and mixed.

  • The duty of care of the secretary of state to provide or secure health services will be removed.

I wish to add one more reason to oppose the bill. It will make the NHS less beautiful.

Yesterday, I stood at a urinal in an airport in another country. In front of me, there was an advertisement for earplugs. Below the name of the brand and a picture of what one was being led to assume was a satisfied user, it read, ‘Ask for them by name and beware of imitators.’ In other words, buy our earplugs, not our competitors’. We won’t deign to explicitly say that ours are better, but we will imply as much by describing our rivals as ‘imitators’.

Of course, that’s all they can do, because they are just earplugs. How much better can one brand be than any other? But in order to ‘compete,’ they must cast aspersions. They must secure the custom and loyalty of the public. In order to do this, they do not need to provide a better product. They just need to convince the public that they are providing a better product. They need to devote time and money to doing so.

Is this what we want in healthcare? Apart from the vulgarity of describing health services as products, is the way to deliver the best, safest and most efficient care by opening it up to a system in which each provider will have to budget for advertising as much as they do for the actual care they provide? I not only contest the evidence that this will lead to greater efficiency or better health, but I also object on aesthetic grounds.

The tone of the earplugs advertisement was bullying. It was mean-spirited. It aimed to hector me and to denigrate its competitors. It was ugly. But it was a necessary component of the market. And the principles of the earplug market will apply to the healthcare market as well. Providers will vie to convince those who commission services that their product is better. But the cheapest way to do this will not always be to actually provide a better, safer service. Mr Lansley’s hopes that forcing competition on the NHS will also force increased efficiency are misguided. They may lead to increased efficiency in some cases. In others, they will lead to cost-shaving corner-cutting, and the expert concealment of this by companies whose key purpose is to turn over a profit.

I would like to think that I am wrong. I would like to think that in ten years time, I will look back at these opinions and see them as quaint, as a conservative appeal to keep things as they are. Simple resistance to change. But to force myself to think that now would be disingenuous. I believe we are throwing away something great.

If you would like to review the evidence upon which I have based my views, please follow the hyperlinks.

Letter to Baroness Cumberlege Regarding NHS Reforms

In NHS, Politics on October 11, 2011 at 12:21 pm

On Wednesday 12 October, the House of Lords will vote on Andrew Lansley‘s Health and Social Care Bill. They will either wave it through, hold it up or stop it completely.

Lords and baronesses are not used to being written to as they do not represent a particular constituency. Therefore, 38 Degrees and the TUC drew up separate campaigning sites to ‘adopt a lord’. Both sites make it very easy to find a lord or baroness and write them an email explaining why you feel they should vote against the bill. They even give you instructions on how to back up your argument, should you need them.

Here is my letter to Baroness Cumberlege, a Tory baroness whom I met last year at a leadership course that she runs for people working within the NHS. She was elegant and dry. I rather liked her.

Dear Baroness Cumberlege,

I am a doctor, currently working in Australia until February, when I will return to the UK to resume training in anaesthesia. I met you last year at your excellent ‘Politics, Power and Persuasion’ one day course in Bolton.

I am writing to you to express my concerns regarding the Health and Social Care Bill. I would like to start by saying that neither the Conservative Party, nor the Liberal Democrat Party mentioned wholesale reforms of the NHS in their manifestos. Indeed, as I’m sure you are well aware, in 2008 Mr Cameron promised ‘We will stop the top-down reorganisations and pointless structural upheavals that have done so much damage in the NHS.’ (http://www.yorkshirepost.co.uk/news/debate/columnists/david_cameron_there_is_such_a_thing_as_society_and_we_must_start_to_value_it_1_2500825) In 2009, he repeated the same thought, ‘There will be no more of those pointless re-organisations that aim for change but instead bring chaos.’ (http://www.conservatives.com/News/Speeches/2009/05/David_Cameron_Speech_to_the_Royal_College_of_Nursing.aspx) The coalition parties’ votes were gained under this banner of no reorganisations to the health service. There is no popular mandate for the Health and Social Care Bill.

The evidence that increased competition will improve patient care is sparse, and the studies that have been done have had mixed results. ( http://www.badscience.net/2011/02/andrew-lansley-and-his-imaginary-evidence/ and http://www.badscience.net/2011/02/why-is-evidence-so-hard-for-politicians/ ) Pushing through these expensive, complicated and disorienting reforms without the requisite evidence that they will improve care is risky at best (I’m talking about risks to people’s lives and livelihoods, not political risk).

The impact of competition law on health services remains uncertain as well. ( http://www.38degrees.org.uk/page/content/NHS-legal-advice ) The increased cost of EU procurement procedures has not been factored into the price of the already hugely expensive reforms.

The effect on training remains a huge issue – if services are provided by a host of differing and probably overlapping (a neccessary function of ‘competition’) services, who will hold the responsibility to train? In particular, who will oversee training so that doctors rotate through all of the neccessary fields in a timely manner so that by the end of their training period, they will be competent consultants? This is currently done by deaneries, which will be abolished by the bill.

Competition was discussed in part 3 of the bill, which received very little scrutiny after the post-‘listening exercise’ amendments. Lords Owen and Hennessy are to propose a referral to a special Select Committee to review this section of the bill. I am sure you will agree that an issue and service of such great importance to the health, function and pride of the country deserves at least the level of scrutiny they are propose.

I urge you to support Lords Owen and Hennesy’s amendment. And I urge you to vote against the bill.

Mr Cameron has already broken his promise. The actions of all of the Conservative Party need not reflect this.

Yours sincerely,

_______

38 degrees has also organised a petition which you can sign online.  This will be used as an argument to demonstrate that there is no popular mandate for these reforms.

Finally, I apologise for the uniform, poor formatting on this post. The reason is that I am posting from my smart phone rather than my computer.

Formatting updated 12.10.11

NHS Listening Exercise

In NHS on April 17, 2011 at 1:07 pm

The Department of Health has launched its ‘listening exercise’ (accessible through this link).  We should all be contributing to it.  I have sent in this response.  Please feel free to use it yourself, but try to change the odd word here or there if you are going to use it, because otherwise it will look like spam.

How can we best ensure that competition and patient choice drives NHS improvement?

We are interested in your views on this area, including:

  • Which are the types of services where choice of provider is most likely to improve quality?
  • What is the best way to ensure a level playing field between the different kinds of provider who could be involved?
  • What else can be done to make patient choice a reality?

This is clearly a leading question.  The question that must come before this is what is the value of competition, and should it play any role in the NHS?

By the introduction of competition, what is meant is the opening up of the market, i.e. consortia to commission from ‘any willing provider’.  Market dogma is that competition drives quality up and prices down in all industries.  This has not happened with the privatisation of public transport or utilities.  The evidence for the benefit of competition within healthcare is scant. (http://www.badscience.net/2011/02/andrew-lansley-and-his-imaginary-evidence/ ) We have already heard that price-based competition will be ruled out, and therefore we should only have quality based competition, but even the evidence for this is very meagre.  It appears that we are being forced down the expensive and irreversible road to market-based healthcare not on the basis of evidence, but on the basis of ideology.  A market-based ideology not explicitly related to the NHS in the Tory or Lib Dem manifestos.

The ‘cherrypicking’ of services argument has already been well made by other people on the message board, so I will not repeat it.

‘Patient choice’ has become a buzz-phrase over the past few years, with little debate as to its actual benefit.  Of course, given the option, people would like to have a choice as to where they receive their care.  However, the prioritising of patient choice over patient care is irrational, and there is no evidence that the public actually wants more choice than it already has.  ( http://www.badscience.net/2011/04/id-expect-this-from-ukip-or-the-daily-mail-not-from-a-government-leaflet/ )

The phrasing of the question above suggests that the government has not fully understood exactly what it is to which the public objects.  It is not the way in which the bill hopes to open up the market, not the way it hopes to introduce competition.  What we object to is actually the introduction of competition at all.  We do not want fragmented services offered by a variety of private companies with an over-riding commitment to profit rather than care.

I am not arguing for the NHS to remain stagnant.  I am arguing that market-based reforms are unproven, expensive, a dangerous way to spend billions of pounds of taxpayers’ money, and a topdown reform of the NHS which David Cameron explicitly promised he would not give us.  (http://www.yorkshirepost.co.uk/news/debate/columnists/david_cameron_there_is_such_a_thing_as_society_and_we_must_start_to_value_it_1_2500825 )

Chantal Mouffe

In Politics, Theory on April 9, 2011 at 10:19 pm

Friday 12 November, 2010

Liverpool Biennial Visitor Centre, Liverpool

Heavy rain and cultural theory go hand in hand.  Especially on a Friday night.  In Liverpool.  With free wine.

We had gathered in the Biennial Centre on Renshaw St to hear Chantal Mouffe and Mark Sealy speak.

Chantal Mouffe is a luminary of the left, a political theorist who was involved in the May ’68 protests and is most famous for formulating a theory of democratic ‘agonism’ with Ernesto Laclau.  Mark Sealy is the director of a charity that educates the public in photography and curator of many different exhibitions throughout his career, with a particular interest in identity and identity politics.

After a short introduction from Alfredo Jaar, Chantal Mouffe came on stage.  From the warmth of her reception, it seemed that most people were here primarily to hear her.  This good will was further amplified by the fact that she could not see over the lectern, and so had to ask for it to be replaced a step lower than her.  Diminutive, yes.  But unfazed.

She broke her talk down into the three parts; starting with a précis of the current state of the left in Europe, followed by her thoughts on how it could make steps to move forward, before finishing with how art could contribute to this.

The picture she painted of today’s left was appropriately disheartening, and yet not quite something I recognised.  She described a movement which had given up on working through conventional channels, such as parties, unions, etc, and was now advocating self-organisation.   To me, this sounded like mutualism or even anarchism, i.e. a branch of the left.  Has this become the dominant force on the left?  I don’t believe it has.

However, she did make some more accurate, and more interesting observations.  One of these was that the left was no longer appealing to what she called the ‘passion,’ or the ‘affect’ of the general public.  Nor was the centre, and nor was the right.  In fact, in her estimation, it was only the far right that was doing so.  Only they were able to mobilise this mysterious passion of which she spoke, and the left must think of ways to do so too.  She did not go into the specifics of how this might be done, and this lack of flesh on the elegant bones of her theorising became a frustrating theme.

The far right appeals to people through oversimplification and demagoguery, as well as having the advantage of only wanting to appeal to a small and homogenous group.  The left and the centre parties are somewhat hindered by their desire to appeal to a larger and more heterogeneous group.  The message therefore becomes either atomised or vague.  Or both.  So how does one appeal to the ‘passion’ of the people?  Mouffe did not offer anything more concrete.

In discussing how the left might move forward, she outlined her theory of ‘agonism,’ as compared to ‘antagonism’ and ‘competition.’  She described the antagonist model as that of revolution, i.e. wanting to destroy the current order to rebuild a new one.  She offered Lenin and the Jacobins as examples of this approach.  Her example for the competitive model was New Labour, and the ‘third way’ of the 90s.  Frankly, her description of how the left had been subsumed and therefore ultimately defeated by neo-liberalism, and in particular how the architects of New Labour had contributed to this, was right on the money (pun intended).

In the agonist model, the aim was neither to accept the prevailing system, nor to destroy it.  The aim was to disarticulate the structures through which the authorities effected their hegemony, and re-articulate them with a new alignment, new priorities, new goals.  Again, elegant theory without the ugliness of practical suggestions or specifics.  A what, but no how.

Finally she discussed how art might contribute to this.  Here her theorising was more palatable and less frustrating.  And her ability to offer sharp analysis remained; in particular her observation that art need not be ugly to be subversive.  Beauty need not be the betrayal of truth, and nor should it be understood as such.

So eloquent analysis, and elegant theory.  While I felt somewhat more edified for having listened to Mouffe, I did not feel any more ready or better equipped to tackle inequality.

Perhaps we should not be looking to her for specifics.  Perhaps we should not be looking to her for practical ideas.  Perhaps it is easy to criticise her, and perhaps in so doing we are actually abdicating our own responsibility to take on her ideas, analyse them and use our own imaginations to formulate our own ideas.  But if we do not look to our intellectuals for ideas, the very intellectuals who are able to offer such clear understanding of our times and circumstances, then to whom shall we look?  Of course, we must continue to formulate our own ideas, but I do not feel it is unfair to expect more from Mouffe too.