Class struggle in NZ Health services

The NZ state under capitalist pressures (tendency for fall rate of profit and periodic crises) tries various restructuring of healthcare to shift health costs onto working people; thus reducing the proportion that the state pays. This serves the capitalist class by reducing their taxes and propping up their otherwise falling profits (which the working class produced anyway). NZ capitalism has cut health care costs in 2 main ways – cutting wages, and cutting funded services.

In mental health services ‘trusts’ were created for the purpose of providing services to ‘clients’ who were no longer provided for by public services. This occurred at the same time as institutions - hospitals were closed. Community care has always been on a tension with community dumping (neglect) and the state driving down wage bills by contracting services into private has been the underlying dynamic to this. Fortunately for the state this occurred at the same time as rising education and skill levels (% passes in education have steadily increased). So this change may have been able to be done without a noticeable loss in quality of care. However, occasional media exposure of extreme cases of rest home neglect shakes confidence in these services.

In the starting positions care giving roles “health aide” or “community support worker”, the wages are near the state’s minimum wage level; competitiveness for jobs, and lack of union organisation maintains this situation. The capitalist state runs with an unemployed “reserve army of labour”, and the Employment Contracts Act and scattered / smallness of sites allowed employers to keep unions out of many new trusts.

The access to fully funded free services has been made more difficult. Health services were not funded to meet the needs of the population and so waiting lists became a typical experience of trying to access public funded services. Increasingly emergency departments turn away patients – sending them to private 24hr GP clinics instead. A new definition of an emergency is a barrier to free health care. Currently the District Health Board covering Queenstown is proposing a deal with local doctors (GP) whereby “emergency” patients will have to see a primary health practitioner (Dr / Nurse, etc) before being passed onto the emergency service. A private health service is allowed to charge a fee to the patient, so the state’s proportion of health services decreases.

The policy of primary healthcare, was Labour government policy from 2000 – 2009. “Primary” is the frontline doctor the “General Practitioner” (GP) who most people first see for a (non emergency) health need. Government had tried to shift services from fully funded public hospital based services to GP and non-government organisation (NGO) providers. This cut costs for the state since generally NGO’s were paying frontline workers less than the equivalent public services had.

While the Labour government shifted some money (funding) to GPs they also tied GPs to contracts for their enrolled ‘patient’ population. Contracts forced GPs to provide after-hours “medical” services. GPs were grouped into larger organisations “PHOs = Primary Healthcare Organisations”. This centralised and concentrated their resources into larger organisations. PHO’s had brought forward proposals to take over some functions from the Public Health system, for example, district nursing. Maori health was also organised into Maori PHO’s and so a layer of Maori managers has been created while frontline workers remained low paid. Many Maori organisations were able to super-exploit their workforce – extolling workers into longer hours and more, while re-defining cultural values to ‘do it for the whanau’.

The working class approach to healthcare is that this is a basic human necessity and fair access for all is essential. The capitalist class has no interest in providing this. Organised workers were able to force a Labour government into providing public health services in 1935. This has steadily been undermined by the capitalist class complaining about their falling profits and the costs of providing healthcare and using the state to dismantle the welfare state. Capitalists push user pays reforms through their governments.

The fact of private healthcare still existing in NZ, points back to a failure of the first Labour government to bring all Health services under public funding. Doctors or GPs were never fully in the public system, specialists always wanted to charge their own rates. GPs in the poorer areas of the country raise less money in fees from their enrolled patients, instead relying on government for the most part of their funding. Whereas GPs in the richer areas can charge higher fees and so rely less on government funding to provide service and take profits. The danger with this de-facto introduction of “user pays” health care is the access to services is unfair and quality of service uneven (eg. more GPs per person in Remuera than in Manurewa). Primary healthcare has always been mainly user-pays because of privatisation of service providers. It is an individualistic model of healthcare where the user is forced to pay.

Under crisis capitalism, the government is rewriting the rules for entry into health services and so keeps more services out of public health sending patients out to their GPs – to pay. Each winter the District Health Boards have urged people to stay away from Hospitals’ emergency departments as they struggle with staffing shortages and winter illnesses.

It is clear that capitalism will not consistently provide usable and accessible health services. Health workers (Doctors, nurses and the rest) cannot defend public health alone. We need to unite with the working class to fight effectively for full public health services. The capitalist system must be buried before it buries us. The principle for organising the new economy is, from each according to their ability to each according to their need: Socialism.

Class struggle in NZ Health services

The NZ state under capitalist pressures (tendency for fall rate of profit and periodic crises) tries various restructuring of healthcare to shift health costs onto working people; thus reducing the proportion that the state pays. This serves the capitalist class by reducing their taxes and propping up their otherwise falling profits (which the working class produced anyway). NZ capitalism has cut health care costs in 2 main ways – cutting wages, and cutting funded services.

In mental health services ‘trusts’ were created for the purpose of providing services to ‘clients’ who were no longer provided for by public services. This occurred at the same time as institutions - hospitals were closed. Community care has always been on a tension with community dumping (neglect) and the state driving down wage bills by contracting services into private has been the underlying dynamic to this. Fortunately for the state this occurred at the same time as rising education and skill levels (% passes in education have steadily increased). So this change may have been able to be done without a noticeable loss in quality of care. However, occasional media exposure of extreme cases of rest home neglect shakes confidence in these services.

In the starting positions care giving roles “health aide” or “community support worker”, the wages are near the state’s minimum wage level; competitiveness for jobs, and lack of union organisation maintains this situation. The capitalist state runs with an unemployed “reserve army of labour”, and the Employment Contracts Act and scattered / smallness of sites allowed employers to keep unions out of many new trusts.

The access to fully funded free services has been made more difficult. Health services were not funded to meet the needs of the population and so waiting lists became a typical experience of trying to access public funded services. Increasingly emergency departments turn away patients – sending them to private 24hr GP clinics instead. A new definition of an emergency is a barrier to free health care. Currently the District Health Board covering Queenstown is proposing a deal with local doctors (GP) whereby “emergency” patients will have to see a primary health practitioner (Dr / Nurse, etc) before being passed onto the emergency service. A private health service is allowed to charge a fee to the patient, so the state’s proportion of health services decreases.

The policy of primary healthcare, was Labour government policy from 2000 – 2009. “Primary” is the frontline doctor the “General Practitioner” (GP) who most people first see for a (non emergency) health need. Government had tried to shift services from fully funded public hospital based services to GP and non-government organisation (NGO) providers. This cut costs for the state since generally NGO’s were paying frontline workers less than the equivalent public services had.

While the Labour government shifted some money (funding) to GPs they also tied GPs to contracts for their enrolled ‘patient’ population. Contracts forced GPs to provide after-hours “medical” services. GPs were grouped into larger organisations “PHOs = Primary Healthcare Organisations”. This centralised and concentrated their resources into larger organisations. PHO’s had brought forward proposals to take over some functions from the Public Health system, for example, district nursing. Maori health was also organised into Maori PHO’s and so a layer of Maori managers has been created while frontline workers remained low paid. Many Maori organisations were able to super-exploit their workforce – extolling workers into longer hours and more, while re-defining cultural values to ‘do it for the whanau’.

The working class approach to healthcare is that this is a basic human necessity and fair access for all is essential. The capitalist class has no interest in providing this. Organised workers were able to force a Labour government into providing public health services in 1935. This has steadily been undermined by the capitalist class complaining about their falling profits and the costs of providing healthcare and using the state to dismantle the welfare state. Capitalists push user pays reforms through their governments.

The fact of private healthcare still existing in NZ, points back to a failure of the first Labour government to bring all Health services under public funding. Doctors or GPs were never fully in the public system, specialists always wanted to charge their own rates. GPs in the poorer areas of the country raise less money in fees from their enrolled patients, instead relying on government for the most part of their funding. Whereas GPs in the richer areas can charge higher fees and so rely less on government funding to provide service and take profits. The danger with this de-facto introduction of “user pays” health care is the access to services is unfair and quality of service uneven (eg. more GPs per person in Remuera than in Manurewa). Primary healthcare has always been mainly user-pays because of privatisation of service providers. It is an individualistic model of healthcare where the user is forced to pay.

Under crisis capitalism, the government is rewriting the rules for entry into health services and so keeps more services out of public health sending patients out to their GPs – to pay. Each winter the District Health Boards have urged people to stay away from Hospitals’ emergency departments as they struggle with staffing shortages and winter illnesses.

It is clear that capitalism will not consistently provide usable and accessible health services. Health workers (Doctors, nurses and the rest) cannot defend public health alone. We need to unite with the working class to fight effectively for full public health services. The capitalist system must be buried before it buries us. The principle for organising the new economy is, from each according to their ability to each according to their need: Socialism.

Zionism: A road map to Hell

 A Zionist Youth

Having been raised in a Zionist household, going to Hebrew school, buying memorial trees in Israel as a youth for my grandparents as they passed away, being taught that the whole world hates us and that Israel is our only safe refuge, being hated as a Jew-boy by my Catholic home town co-youth for "killing their lord", being finally accepted in 1967 when Israel showed it "had some balls" (meaning mine must also be hanging to the floor) . I have experience with anti-Semitism in the concrete form of boots in the ribs and a metal lunch box smashed against this "faggot-Jew-boy's" face, so the Zionist claim that Israel was our last refuge and that the world hates us was my experience as a youth growing up in 1960's American suburbia. Since then I have seen and fought with American flag waving swastika wearing jackbooted Nazi thugs in the streets of San Francisco, Walnut Creek, Boston and Berkeley so I know in a way only bruised knuckles and the taste of blood can teach one of what I speak.

A seminal part of my training as a Zionist youth was that Israel was "a land without people-for a people without land" we could point to Mark Twain (Samuel Clemens) who visited the area and claimed it empty barren, unclean and uninhabited. So why shouldn't it be ours?

And just this last weekend, as we listened to and discussed the Prime Minister's tongue lashing of Obama for stepping out of line on the 1967 borders issue, my father reminded me of Mark Twain's observations in Innocents Abroad. But what is rarely mentioned about Mark Twains trip is: “ Palestine’s arable land is only 17% of its total area”, that “Mark Twain visited in the middle of the hot Mediterranean summer”, and that “Mark Twain’s visit was brief by all accounts, and only encompassed the areas that were cited in the Bible.” Indeed Twain’s comments about Greece were quite similar to those about the Holy Land; one could get an impression that Greece also was abandoned to the ghosts of Zeus and Hera.

The Israeli hero in 1967 was General Moshe Dayan a man of impeccable Zionist credentials. Lets hear what he has to say about how Israel was settled. “Jewish villages were built in the place of Arab villages. You do not even know the names of these Arab villages, and I do not blame you because geography books no longer exist, not only do the books not exist, the Arab villages are not there either.”

Well that contradicts the rhetoric (and the Zionist youth training received at Hebrew school and Hebrew summer camp where we sang the Hatikva); so there were people there? Who the hell were they and what were they doing there? How did we get rid of them? Could this be true? Not possible, we are the dispossessed coming home not them. So I found the book Righteous Victims by Benny Morris a highly regarded Zionist historian.

Morris draws his own subjective pro-Israel conclusions but his book is full of powerful historic observations:

"Most of the settlers who came in the First and Second Aliyot lived, at least for a time, as illegal residents. They entered as tourists or pilgrims and overstayed their permits, or they entered illegally." p.41

"A land without people for a people without a land" was the Zionist slogan-originating, curiously, not with Herzl or one of the forebears, but in Lord Shaftebury's memoirs, in 1854, and recycled by the Zionist writer Israel Zangwill in an article in 1901. Ahad Ha'Am, a leading Eastern European essayist, opened many Jewish eyes when he wrote in 1891, after a three month visit to Palestine: "We abroad are used to believing that Eretz Yisrael is now almost totally desolate, a desert that is not sowed....But in truth that is not the case. Throughout the country it is difficult to find fields that are not sowed. Only sand dunes and stony mountains...are not cultivated." p.42

But the arriving Jews had multiple problems as the Zionist project commenced. Yitzhak Epstein a Palestinian Jew came to Basel to address a Zionist gathering in 1905: "He had been troubled by the eviction of the Druze tenant farmers at Medulla in 1896. For the time, he said, there was no "Arab movement in the national or political sense in Palestine," but, he implied, one might develop in the not-so-distant future: "Among the difficult questions connected to the idea of the renaissance of our people on its soil there is one which is equal to all others: the question of our relations with the Arabs... We have forgotten one small matter: There is in our beloved land an entire nation, which has occupied it for hundreds of years and has never thought to leave it"" (p. 57 Morris)

How did the newly arriving Jews (the olim) see the local population? "...as primitive, dishonest, fatalistic, lazy, savage-much as European colonists viewed the natives elsewhere in Asia or Africa." (pg43 Morris)

Not to belabor the point but even today's historians of Zionism cannot deny the primary source documentation. The founding of Israel was based on a lie sold to Jews across Europe who were being persecuted and the land of milk and honey sounded like heaven in the face of pogroms of the East and the Nazi onslaught and genocide that would follow; even if the concept of a land of “milk and honey” contradicts the concept of a barren, desolate untended expanse.

Were there people there? Yes. The McCarthy (Columbia U. press 1990 The Population of Palestine) showed the Non Jewish population in 1877 to have been 426,908 or 97% of the population at the time 13,942 or 3% were Jewish by 1946, 60 some odd years after the Zionist project began there were 1,339,763 Non-Jewish Palestinians or 69% of the population and 602,586 or 31% were Jews. In the post 1949 era the Jewish population in the area swelled immediately outnumbering the Palestinian.

Who owned the land?

At first the Jewish National fund bought up land from the Ottoman land lords from whom the local Palestinians rented eking out a serf like existence. Of course some land was wholly owned by the locals. But we know that land ownership is really just a question of power relations over property distribution. The Ottoman empire had no more right to the land of the local people whom they controlled than say the Tsar had to the land on which the serfs worked or the Southern Slave Plantation owners had to "their" land. Those working the land and dispossessed are the fountain from which the democratic revolution for land redistribution springs, just as it upset the ancien regime across Europe the land question is the national question and it had yet to be resolved in the land which the Zionists were buying from the landlord empire which (if it were to remain) would have faced the wrath of the rising Arab national revolution. Instead the Jewish National Fund bought the problem of the unresolved tasks of the democratic revolution in Palestine which would ultimately be directed at who ever got left holding the bag, the Ottoman were defeated, the English knew when it was time to release the hot potato and the Zionist project outpaced the advance of the nationalist consciousness and organization of the Arabs. Thus the juggernaut!

Remember Epstein at the Basel meeting in 1905, he "...took the Zionists severely to task for purchasing land from effendis and then pushing out the poor tenants, and he asserted, provocatively , that Palestine in fact belonged to both peoples: "We are making a great psychological error with regard to a great, assertive and jealous people. While we feel a deep love for the land and our forefathers, we forget that the nation who lives in it today has a sensitive heart and a loving soul. The Arab, like every man, is tied to his native land with strong bonds." (Morris, p. 57)

Either this was a "land without people - for a people without land" or as the numbers and the land transfer records show, the land was colonized by many illegal immigrants who then found a way to bring in their families and friends buying up land from the landlord class of a dying and soon to be vanquished empire, you can't have it both ways.

The record will show that in the early years the Jewish immigrants were not fit or capable of doing the strenuous work in the land they came to own. Even on the early socialist kibbutz much of the manual work would be done by hiring the very Arab workers who had lost their land. Has it occurred to the Zionist that the modern conflict between the Jew and the Arab in historic Palestine/Erez Yisrael has a material basis in the dispossession of the land, first by purchase then by driving a people off their land? Of course not, it is impossible for one who derives the benefit of an oppressive act of annexation and subjugation to see it as anything other than justified.

What the Zionists did not want to see is the universal truth that when an entire people progressively loose their land, are changed from a self sustaining farming people into a class of workers for hire with nothing to sell but their labor power, when their families are driven apart and half are forced into refugee status for generations, human beings will resist, fight back and will continue to do so until they are treated justly or you can terrorize them into total submission. These are the objective facts, one can go into subjective apoplexy reading this but all rational people agree on what the historic record is. Over sixty years ago some 600-700,000 Palestinians, by no fault of their own, became refugees when they lost their land, and as General Dayan reminded us, their villages were bulldozed right off the map. Historic maps with demarcated Jewish and Palestinian Territories are exactly what Dayan wanted to erase from history. I guarantee if you went to Hebrew school like I did you were never shown maps like these.

The question of the occupied territory

For Zionists like my father there are no Palestinians, the land was empty when "we" arrived; there is already a Palestinian State which is Jordan; the early Jewish fighters were not illegal immigrants and terrorists illegally attacking the British mandate, they were freedom fighters; if there are refugees it is the fault of the other Arab nations for goading the refugees into voluntarily fleeing; we bought the land fair and square and when they attacked us we created defensive boarders (it just happens that we control the water, and have cut up the Palestinian contiguous areas into Bantustans); the wall is necessary and when they stop sending over bombers there will be no need for it and all the defensive border checks, road blocks and such. That these population control mechanisms take place all over the West Bank can not be denied yet the true Zionist denies that this is an occupation.

So the question is who is actually terrorizing whom, what are the real consequences of the armed conflict between the occupied and the occupier.

Looking at statistics on the death of civilians the numbers from B'Tselem, an Israeli human rights group and and Remember These Children, examining fatal violence between the Palestinians and the Israelis has shown it has been disproportionate. Since Sept 29, 2000 until Oct 2010 at least 6,430 Palestinians and 1,084 Israelis have been killed. Among children 124 killed were Israeli while 1,452 were Palestinian. Of the civilians killed 731 are Israeli while 3,535+ are the cited as Palestinian dead. Where did the people die? 54.1% of the Israelis killed were killed on their own territory while 98.9% of the Palestinians killed were killed in their own area, the occupied territories. Conversely 45.9% of the Israelis who were killed were killed on others' land while 1.1% of the Palestinians killed were killed on others' land. These numbers are revealing of the nature of the conflict and the brutality under which the Palestinian people suffer and other innocents suffer. Until the rights of the Palestinian people are attained there can be no peace. You can not dispossess a people and keep them in refugee camps on your borders, oppressed, exploited, and expect there to be peace.

After saying all this to close without pointing to a solution would be disrespectful to the reader. So although that is a major discussion in and of it self what follows is the short version.

What is to be Done?

There can be no peace while historic Palestine is occupied and the refugees are denied the right of return. Democracy can not exist for the Jews in the area and be denied the Arabs. The Zionist state is a dependent state and sub imperialist acting as a foot hold in the middle east for Western/US/UK imperialism. It is not the much touted “Democracy” that we (US Imperialism) love; it is the real estate as it applies to military security in particular of oil routes. The entire power of imperialism is thus arrayed at keeping the Palestinian subjugated hence the annual billions of tax funding going to the Zionist military.

Behind the Palestinian conundrum is what is facing imperialism today across the Near and Middle East, the unresolved tasks of the national revolution of the Arab people issues of national independence from imperialist (IMF/World Bank, JP Morgan) control, land distribution, democracy, freedom, the right to a job, and other economic rights are today inspiring the Arab people more than Al-Qaeda ever could. But the national capitalist class of these countries and in Palestine are too weak and too dependent on imperialism’s finance and market to carry out the tasks which in Europe and North America were carried out by an emerging and growing capitalist class between 1680’s and 1880’s. Therefore the tasks of the Democratic-Bourgeois revolution will fall to the working class to resolve.

It is the workers’ revolution which can secure freedom for Palestine and ensure the Jewish workers and the Jewish people safety within and integrated and multi-ethnic secular democratic workers’ state. Jews who accept the Palestinians’ right to return and who join in making the workers’ revolution will build a democratic workers’ state which recognizes the cultural and religious rights of all while providing economic planning by the working classes to assure economic justice which is the only way to end the blood between the sons and daughters of Abraham, Isaac and Ishmael; a family broken asunder by first slave relations then the Roman imperium and ultimately by today’s super power US imperialism. If the Jewish workers in historic Palestine cannot break from their capitalist overlords and ally themselves with the Palestinian right to Self Determination and fight for a democratic workers state they allow the continuation of the siege mentality of Zionist colonialism, and peace will not be possible.


Charles Rachlis

Humanist Workers for Revolutionary Socialism

Japan: What's 'Natural' about Disaster?

 A ‘natural’ disaster is a ratio of one 1 part nature and up to 10 parts ‘social’ on the Karl Marx scale. Nothing could prevent the earthquake in Japan of 9 on the Richter scale, nor the massive Tsunami that followed. But a lot could be done to prevent its effects on the human population. Most of the death toll can be put down to the ‘social’ contribution of living in a capitalist society. Towns built on the coast, in many cases near or even below normal water level. So while many of the high rise buildings in the cities are built to withstand earthquakes, in the regions, inadequate sea walls, poor location and design of dwellings contributed to most deaths. As a result 10s of thousands have perished. Many more may yet perish if the Fukushima nuclear power station built to withstand big earthquakes but not a 10 meter Tsunami suffers a meltdown and contaminates Japan and much of the Northern Hemisphere with nuclear fallout. 

Thus on the Karl Marx scale, Christchurch, NZ had a 7.1 quake in September 2010 that caused no deaths. This would be rated as 1/2 since most of the destruction was to buildings and infrastructure and was not serious. However, this was followed by a 6.3 quake in February this year which killed around 200 when two multi-story buildings, and a number of shop frontages crashed into the streets. There was also much more damage to the physical infrastructure and buildings. This quake might rate at 1/4. Much worse and possibly a 1/8 was the Haiti Earthquake of 2009 also a 7.1 but where 230,000 perished due to a history of colonisation that left poorly built dwellings incapable of withstanding even a moderate earthquake even without Tsunamis or meltdowns of nuclear power stations. We have yet to see what total death and destruction has been wrought by the Japanese quake on Japanese society and the wider world. 

As comrade Tyashi of the new wave in India puts it: “natural calamities are essentially rooted in man-made factors....destruction of environment for blind profits at the hands of capitalists and the states under them, is the chief contributory factor to these calamities....but the working and toiling masses are the worst sufferer under their axe...natural calamities hit hard at the heads of ruling classes, as they expose the class contradictions in the given society to the core....we hope that Tsunami in Japan would give an opportunity to the workers and poor there to see that capitalist Japan does not care about them at all.....and thus they must overthrow the power of capitalists, and establish their own rule to deal effectively with such calamities...we call upon the Japanese working class to turn the tsunami over to the ruling class of capitalists...let their regime be shaken by powerful jolts of a proletarian revolution...”