We need the complete nationalisation of health care, taking the whole system back into public hands. This might seem radical, but the pandemic has shown both how irrational for-profit health care is, and how easy it would be to change it.
In Spain – one of the worst affected countries – the government took all private hospitals and health care providers under state control to help deal with the COVID-19 crisis. In the US, private hospitals haven’t been nationalised, but they have received hundreds of billions of dollars in government funding simply to keep their doors open because rates of elective surgery have plummeted, cutting off their main source of income. In Australia, the Victorian government temporarily brought private hospitals under government control to enable a coordinated response to the pandemic across the health care system.
No more public money should be spent propping up the for-profit system of private health care. But arguing for a better, publicly run health system is just the start. In the era of neoliberalism and privatisation, demands for better health care have almost always centred on calls for no cutbacks or for more hospital beds. We have limited our vision of a better health care system to one in which we talk primarily about hospital funding.
Funding is important, but there is much more to good health than simply having access to a hospital bed. Outside of pandemics, very few people at any given time need hospitalisation. And ultimately, hospitals alone cannot fix the myriad ways in which the capitalist system makes us sick.
If we’re serious not just about treating ill health, but in preventing it, we need to look beyond the health care system to the nature of the society it exists within. Take air pollution as an example. Many studies, including one by Harvard University published in April, have linked high levels of air pollution to higher rates of death from COVID-19. And even without the pandemic, our cities are poisoning us. The World Health Organization estimates that air pollution causes 7 million “premature deaths” every year, a number that in any reasonable society would be cause for emergency action. We’ve known about the dangers of air pollution for generations, but little has been done about it.
The pandemic has also put a spotlight on inequalities in access to health care based on race and class. In the UK, the Office for National Statistics released data on 7 May showing that Black people are four times more likely to die from COVID-19 than the rest of the population. “These results show that the difference between ethnic groups in COVID-19 mortality is partly a result of socio-economic disadvantage”, the department concluded. Blacks in the UK are more likely to be poor. Poor people in turn are more likely to die from the disease.
Similar statistics are coming out of the US, where poor and marginalised communities are overwhelmingly bearing the brunt of the death toll. In New York, the highest death toll per capita has been in the working-class Bronx, the poorest borough in the city.
Part of the problem is that many people getting COVID-19 already have other conditions and diseases of poverty. For example, the link between type 2 diabetes and poverty has long been established, as has the link between low income and smoking. Even the link between low income and cancer is becoming clearer as more and more evidence emerges of a correlation between poor diet, stress and cancer mortality. In fact, when it comes to most chronic diseases, being non-white and having a low income are leading risk factors.
The appalling state of aged care systems is another major problem. We know how badly the pandemic has ravaged the elderly, but many people may not realise that the public hospital system has more and more come to be used as crisis care for those failing to be properly looked after by the aged care system. Even before the pandemic, nursing home residents were neglected by a grossly understaffed system and dumped into public hospitals as soon as they required more than just a basic level of care.
A 2019 report from the New South Wales Aged Care Roundtable found that hospital admissions from aged care homes were increasing rapidly. The report concluded that there is a direct correlation between inadequate levels of staffing and lower skill levels in nursing homes, and rates of hospitalisation of their residents. That just might be the most obvious thing ever to have been observed by a research group, and it’s another example of a problem that more hospital funding alone cannot fix.
So yes, our public hospitals need to be better, and we should nationalise all sections of the private system without question. But creating a better health care system is about so much more than just hospital funding. It’s about creating a new and better society. That’s not an easy task, but it’s one that’s never been more urgent and necessary.