AUSTRIA - Corona-pandemic and class struggle on the question of health care

April 4, 2020

We have received the following article from the Marxist theoretical journal “Vorbote” (“Pioneer”) from Austria in English translation. It takes a stand on the question of health care and class struggle in the midst of the "corona-crisis" and develops important perspectives for communists. The German Original you can find here.

Corona-pandemic and class struggle on the question of health care.

The global happenings in the course of the Corona-Virus reveal the deep political crisis of the ruling class and massively aggravate the crisis-ridden contradictions that already exist in the economy. Thereby the current global political situation is characterized by an extremely rapid and extensive aggravation of the general crisis of capitalism. The fact that the ruling class in the wake of the crisis, is also increasing the tendency towards fascism and increasingly uses surveillance and repression as a means of "fighting the crisis", that it is carrying out an unprecedented attack on fundamental democratic rights in recent years, clearly shows that the current aggravation of the general crisis also aggravated the contradiction between the proletariat, which is allied to the masses, and the bourgeoisie. In light of the severe political "corona-crisis", the worker’s movement raises demands and formulates its interests against the crisis program of the ruling class, and also independently led strikes and other great struggling measures had taken place. In this situation many organizations and initiatives formulate demands that more or less correspond to the immediate interests of the working class and the people, but do not go beyond this, do not direct a path and thus no direction in the class struggle, aimed at overthrowing the bourgeoisie. Thereby they ultimately subordinate the political struggle of the working class to the bourgeoisie. So it is not only the immediate daily demands that are needed, but also the direction on which the class struggle can be continued. On the one hand, the current situation exposes the forces of opportunism and subordination to bourgeois politics, on the other hand it shows that some revolutionary forces must deepen their understanding of the situation and sharpen their clear and long-term orientation.

Ultimately, in addition to the struggle against fascization and the shifting of the costs of the crisis on the masses, the corona-crisis also requires the vanguard forces of the proletariat to deal with the question of health and medicine within capitalism and imperialism, because in this sector the current aggravation of the political crisis arose. In addition to this article, we recommend the article "The coronavirus pandemic shows the weaknesses of the old semi-feudal and semi-colonial state of Ecuador" by comrades from Ecuador, which deals primarily with questions of the "corona-crisis" and its effects in semi-colonial countries. We want to take a fundamental approach to this question in the present article, which is why we first turn to some questions of epistemology, then comment on the emergence of capitalist society, modern medicine and public health care, in order to shed light on the question of people's health in the class struggle and develop an orientation in this question. We do not present an analysis of the pharmaceutical industry here, also the privatization of public health care in capitalism or people's health care in socialism - all of which are certainly very important issues – will only be commented marginally. We will comment on these questions in the future, but in the current situation we consider it more important, to address to the topic more fundamentally. We believe that this will serve the vanguard forces of the proletariat the best and will allow them to show a path, even in the midst of their struggles during the Corona-crisis, that goes beyond necessary, justified immediate demands and thereby not just strikes back the current attacks of the bourgeoisie on the working class, but also drives forward the struggle for the final overthrow of capital in the proletarian revolution. Only in this way the struggle for a health care system in the service of the people can be led successfully.

Knowledge and sources of truth.

In its first step the human knowledge takes place as a movement from the lower to the higher, from the concrete to the general, from the simple to the complex. In a second step, the general knowledge is then applied again to the analysis of concrete phenomena, whereby a deeper understanding of the matter can be obtained. The "movement of knowledge" thus goes from the concrete to the general and back to the concrete. The "process" of knowledge can be summarized as follows:

“As regards the sequence in the movement of man’s knowledge, there is always a gradual growth from the knowledge of individual and particular things to the knowledge of things in general. Only after man knows the particular essence of many different things can be proceed to generalization and know the common essence of things. When man attains the knowledge of this common essence, he uses it as a guide and proceeds to study various concrete things which have not yet been studied, or studied thoroughly, and to discover the particular essence of each; only thus is he able to supplement, enrich and develop his knowledge of their common essence and prevent such knowledge from withering or petrifying. These are the two processes of cognition: one, from the particular to the general, and the other, from the general to the particular. Thus cognition always moves in cycles and (so long as scientific method is strictly adhered to) each cycle advances human knowledge a step higher and so makes it more and more profound.” (Mao Zedong: “On Contradiction”)

These "laws of motion" of knowledge are generally valid, but they do not usually take place quickly and within a few months, but last for entire epochs, the knowledge of which then compresses into leaps and leads to the next higher level. Friedrich Engels describes this in one of his main works, the "Anti-Dühring", using the example of biology and physiology. Even if the examples given here by Engels may seem a bit outdated from today's perspective, the (expanded and enhanced) third edition of the work, which is normally used until today, was already published in 1894, the co-founder of Marxism shows very well and understandably how the knowledge process develops, in its course repeatedly overturns “old certainties”, hence how the “spiral movement” mentioned above takes place:

“The second department of science is the one which covers the investigation of living organisms. In this field there is such a multiplicity of interrelationships and causalities that not only does the solution of each question give rise to a host of other questions, but each separate problem can in most cases only be solved piecemeal, through a series of investigations which often require centuries; and besides, the need for a systematic presentation of interconnections makes it necessary again and again to surround the final and ultimate truths with a luxuriant growth of hypotheses. What a long series of intermediaries from Galen to Malpighi was necessary for correctly establishing such a simple matter as the circulation of the blood in mammals, how slight is our knowledge of the origin of blood corpuscles, and how numerous are the missing links even today, for example, to be able to bring the symptoms of a disease into some rational relationship with its cause! And often enough discoveries, such as that of the cell, are made which compel us to revise completely all formerly established final and ultimate truths in the realm of biology, and to put whole piles of them on the scrap-heap once and for all.” (Friedrich Engels: Herr Eugen Dühring’s Revolution in Science)

As Marx's closest companion of struggle, Friedrich Engels was one of the five classics of Marxism (alongside Marx, Lenin, Stalin and Mao) and certainly not a "postmodern". Postmodernism denies the existence of an objective truth and therefore of course the possibility of recognizing it. In contrast, Marxism says that in a historical process of human activity, human knowledge gets closer to the objective truth, and in this process the knowledge of objective truth develops higher and deeper. But what are the criteria according to which this spiral movement of the historical process takes place? Marxism teaches that there are three such criteria, namely: production struggle, scientific experiment and class struggle. According to the objective conditions, people draw their knowledge of objective truth from these three sources. Because these three sources develop in ascending order, become more complex (thus higher and more comprehensive) in the course of human history, the knowledge gained from them develops the same. The knowledge thus corresponds to the three social sources from which they emerge. At the same time, because new general knowledge is applied again in the particular, the sources develop by applying their own results to themselves. This is also the case with medical science.

Medical conceptions have existed since humans began to seperate from the animal kingdom. In order to give a short, very general overview, it should be briefly mentioned here that such views are expressed in the primitive society (gentile constitution) in primitive and less complex terms in “totemism”, in the slaveholding society (“antiquity”) in the “doctrine of the humors” and in feudalism (already in its transition to late feudalism) in the various mechanistic conceptions of “human as machine” or “human mechanics” [1]. However, the forms of society and conceptions should not be viewed as templates, because the new always develops within the old, before it is overcome by struggle. Just as the relations of production hinder the development of the productive forces, within the ideological field accordingly the old conceptions hinder the new conceptions (which express the potency of new productive forces, although in their beginnings mostly quite immature, such as the early socialists, for example, were the expression of the early proletariat) [2]. All previous forms of society (apart from the primitive society) were divided into different classes and stratums of society, there were ruling classes and ruled people. And so it is also in the modern society, at the highest stage we live today: Capitalism (today imperialism), where the proletariat (the working class) and the bourgeoisie (the capitalist class) emerge as the main classes. With the proletariat also Marxism emerged, which means scientific socialism, whose point of view on questions of medicine is interesting for us here, which is why we first turn to the development of modern society, capitalism, today imperialism.

The emergence of bourgeois society and the development of sciences.

In its earliest form, capitalism develops above all through trade-capitalism. However, it is still very limited in terms of the subsumtion of producers to its needs, which is why it persists within the late feudalism ("early modern times") for a very long time. This only changes with the emergence of industrial capitalism. Industrial capitalism radically transforms all existing production conditions. It deepens and extends the division of labour, turns millions of small owners and peasants into workers, which means proletarians, and draws them into the production process. The emerging industrial capitalism, with this expansion of its mode of production, through the fact that it subsumtion even larger parts of nature and society, can no longer exist alongside feudalism. It therefore blows up feudalism in the process of bourgeois revolutions, such as the French Revolution and the revolutions of 1848. The new, capitalist mode of production subordinates nature and society completely. This leads to the necessity and the interest to better understand the productive forces and the means of production in order to organize, use and exploit them more efficiently. This is the prerequisite for the incredibly dynamic and explosive development of sciences in the 19th century, from around 1780 to around 1900. The sciences, liberated from the chains of feudalism and the narrow limitations of trade-capitalism, are experiencing an unprecedented, stormy development. In accordance with the production struggle in industrial capitalism, the scientific experiment develops: modern chemistry develops from the interest to make agriculture more productive and calculable, as well as from the needs of the early textile industry; within the industrial preservation of food, bacteriology arises, as well as enzyme research; tropical medicine develops under the impression of the exploitation of the colonies, etc. The development of the sciences is that dynamic, in view of the rapid development of the productive forces, that not only a lot of new knowledge emerges, but some sciences are completely redefined, such as biology by Darwin, or newly created as independent disciplines, such as psychology. The development of the sciences in this epoch shows us very well that knowledge is not primarily a question of “geniuses”, but above all a question of the interests existing in society. The interests arising from the contradictions in a society, which are expressed in the “three sources of truth”, put forth the “leading personalities” (Mr. Darwin, for example, could not have done much 300 years earlier. A specific form of society and specific interests were necessary to put forth a personality like him and put him in the place, from which he could unfold his leading role).

Historically, in the progression of the forms of human class society, it is like this: if a society does not have the specifically necessary prerequisites of the productive forces, it can not advance to a certain complexity of knowledge. According to the three sources of truth, the following part of the knowledge process takes place according to what has been ascertained so far: through the class struggle (bourgeois revolution and smashing of feudalism) the production struggle has reached a level (capitalist mode of production) that makes new scientific experiments necessary and possible. The knowledge gained from these new scientific experiments then again enrich the class struggle and the production struggle, that develops with that and expands its mode of production.

Of course, the emergence of the bourgeois social order and the accompanying explosive development of the sciences corresponds to the emergence of new conceptions in philosophy, ideas that correspond to the productive forces and express the capitalist relations of production. Thus the bourgeoisie put forth the modern methods and conceptions of dialectics (G. W. F. Hegel) and materialism (L. Feuerbach). We want to refrain from showing the gigantic and stunning effects that this had for philosophy as a whole and ultimately stick to the topic: medicine. Modern dialectics and materialism in the sciences have now, for the first time, made it possible to a certain extent, to reveal the contradictoriness between their internal and external factors, also in questions of illness and health, to become conscious about that to some degree and to push back the previously predominant dualistic conceptions about it. This came along with the general need of capital to develop new conceptions and thereby to focus on the demystified human to a certain extent, because controlling its mental and physical abilities became with capitalism the core question of appropriation of surplus value, the capitalist form of exploitation. Only the expenditure of human labour creates surplus value. This is created by the proletariat, but the capitalists appropriate it privately. If they want to increase the accumulated surplus value, they have to deepen the exploitation and make it more "productive", which requires a certain knowledge about the human being as the holder of the labour force. But this was also already the limit of capitalist medicine, because capitalism does not use scientific knowledge for the benefit of the people and the all-round development of the productive forces, but only subordinates them to the profit interests and needs of capital. For this reason, it creates, for example, ever greater conditions and possibilities for the eradication of diseases, but at the same time endangers the health of the people's masses to an ever greater extent and, through its policies, makes the emergence and spread of new diseases and entire diseases possible.

The current political crisis, which was aggravated by the spread of the Corona-Virus, is an excellent example of that. The epidemic was downplayed and trivialized at the beginning, because it only hit “the bad Chinese". That even continued when the first cases appeared in Europe, for example the state broadcaster ORF [3] still reported on its homepage: "Real flu more dangerous than coronavirus" (article from 28.1.2020). It was only when the virus endangered parts of production and thus capitalist profits, that one was forced to take measures and at the same time started with scaremongering and alarmism.

Medicine and public health care as battlefields in class struggle.

The proletariat stood together with the bourgeoisie in a certain struggle-unity against feudalism. There was the common interest to smash this old society of principalities and aristocrats, putting off its narrow chains. But after feudalism was smashed and capitalism prevailed, the contradiction between the working class and the capitalist class, that is the contradiction between the proletariat and the bourgeoisie, emerged openly. Marx and Engels describe this very well in the "Manifesto of the Communist Party". In any case, with the seizure of power of the bourgeoisie, the two main classes of modern society, the proletariat and the bourgeoisie, are in open struggle against each other. The bourgeoisie established its democracy, the bourgeois democracy, and thus smashed democracy for the people’s masses and the proletariat in order to secure its own power. The fact that the bourgeoisie tends to negate democracy for the people has not been resolved with imperialism, but, as Lenin determines, has even increased. The bourgeoisie strives „towards violations of democracy, towards reaction.“, and: „In this sense imperialism is indisputably the ‘negation’ of democracy in general, of all democracy...“ (Lenin: „A Caricature of Marxism and ‚Imperialist Economism‘“) Therefore, even in the most developed bourgeois democracy, the proletariat always has also to solve democratic tasks in the struggle for the socialist revolution.

The basis for the struggle between the proletariat and the bourgeoisie is the production process of capital, because there the proletariat is exploited: it sells its labour force to the capitalist for a certain wage, but produces more value by the expenditure of the labour force than it needs for recovering its labour force. The wage that the worker receives for his work is intended to ensure the recovery of his labour force, called reproduction. The values that he produces additionally, is going to the pocket of the capitalist. The working class is therefore expropriated of surplus value, the bourgeoisie lives from it. The health of the labour forces is becoming a question for capital, because only physically and mentally moderate healthy workers can produce the surplus value that capital needs. Safeguarding and maintaining the health of the commodity labour force at a minimal level thus becomes, to a certain extent, a necessary part of the reproduction of the labour force for the capital, it becomes a certain "economic necessity".

Now it is the case, that the single capitalists are primarily interested in exploitation, that they make as much profit as possible, because they are in competition with other capitalists (or entire capital groups such as cartels and monopolies) and must remain competitive. Capital therefore wants to keep pushing the price of the commodity labour-power, which of course means that the bourgeoisie is developing the tendency to continue to damage the health of the working class, until it is barely able to work. This tendency led to more and more social phenomena, especially in the cities, which Karl Marx describes in great detail in the second volume of the "Capital": grievances in the sewerage system of the working class neighborhoods and therefore upcoming epidemics, emergence of "workers diseases" which were typical for that time, such as TBC and rickets, etc. This completely uncovered the class character of bourgeois medicine, which forces them continually to tear theory away from practice and only bring it together where capital benefits from it. The bourgeoisie does not practice medicine in the service of mankind, but in order to exploit and suppress the exploited and oppressed more rationally and efficiently. The best representatives of medicine in the 19th century, who idealistically still put the “human being” at the center of their conceptions, faced, due to the social conditions and the gap between theory and practice of medicine, the contradiction with the social order, which puts the proletariat into massive impoverishment. Analyzing and overcoming this situation from a medical point of view was not in the interests of the individual capitalists, who wanted to continue exploiting the proletariat, even if it was endangered by diseases and new epidemics. The old idealistic conception of medicine of rising capitalism ("the human being" in the center) came into contradiction with the bourgeois class rule, which disturbed and hindered the further development and application of medical knowledge, since it had no interest to explain new phenomena that "only affect the people”. In a class society, of course, medicine always has class character. With the development of capitalism, this is also becoming more and more apparent. Thus, with increasing specialization, also methodically the subject matter is becoming less and less "the people" per se, but rather concrete groups and individuals of people with specific clinical pictures (which were caused by something) in a concrete society. Both the problems it is dealing with, the reason why it is dealing with it and the ways how it proposes to solve a problem, etc., all of this has class character and has brought some medical doctors into harsh contradiction to the bourgeois class interest. Friedrich Engels gives an excellent example in a letter to Kautsky:

“In ‘Nature’ you will find a speech made by John Simon, before the international Medical Congress here in which the bourgeoisie is virtually put on the mat by medical science. J. Simon is medical officer to the Privy Council, virtual head of Britain’s entire public health inspectorate, and the same who is so frequently and approvingly quoted by Marx in ‘Capital’, a man – perhaps the last of the old really professional and conscientious officials of the 1840-60 period who, in the performance of his duty, everywhere found that bourgeois interests were the first obstacle he was obliged to combat. Hence, his instinctive hatred of the bourgeoisie is as violent as it is explicable. Now he, a doctor, finding his own special field invaded by the (…) bourgeoisie and their anti-vivisection movement, has turned the tables on them. Instead of preaching dull and colourless sermons like Virchow, he goes into the attack comparing the few scientific experiments made by doctors on animals with the vast commercial experiments made by the bourgeoisie upon the popular masses, thereby placing the question for the first time in its true perspective.” (Friedrich Engels: “Engels to Kautsky in Zurich”, 27th of August 1881)

The more the nature and society get subordinated to the bourgeoisie, the more it deepens the division of labour and thus the objective socialization of production. No product is produced from the start to the finish by one labour force alone, but each product requires thousands of steps and hundreds of labour forces. This was valid in modern capitalism in the 19th century, and it is even more today in imperialism, where monopolies extend their production chains around the world and, in addition to the workers in the imperialist countries, suppress and exploit millions as (semi)colonial working slaves. With the progressing objective socialization of parts of production and the accompanying industrialization, a certain extent of the massive impoverishment of the proletariat became more and more an obstacle to production, which required more and more skills and knowledge. At the same time, the modern workers' movement developed, which struggled for their interests with increasing determination and better organized.

In order to keep the proletariat and the people's masses able to work and to make their work more productive, also the reproduction of the labour force had to be socialized to a certain extent, education and health care were more and more often not left in responsibility to the single capitalists or even proletarian families, but handed over to the countries or the state. This process was highly competitive, and it became an important question in the class struggle, who would be able to assert his interests in the area of the partial socialization of reproduction, including the beginning of public health care. The modern worker’s movement represented its own interests in the face of this objective development, and through great and protracted struggles and demands, it achieved that public education- and health services were granted more than was considered necessary by the capitalists. So the worker’s movement successfully struggled for certain reforms in the education system, or a certain public health care. In the class struggle, questions in this regard became more and more key questions of the mass movements. Since the proletariat was repeatedly confronted with the danger of epidemics due to its miserable living conditions, but the bourgeoisie only showed interest in it when its profits were at risk, modern epidemic legislation was of course an important battlefield between the ruling class and the proletarian movement. The questions concerned the class character of the public health care and generally are still valid today. The struggle against the emerging cholera epidemic, which was led in 1908 by Viktor Adler, then leader of the Austrian Social Democracy, may remind us at some points of how the ruling class deals with the Corona-virus in 2020: “...the epidemic law, a law that may very soon have an doleful relevance, because, gentlemen, cholera is on the march; it is not known whether we will get it this year or next year, but we are threatened by it, it is on the march and the medical services department is facing this danger with outdated regulations. Now there is an epidemic law that cannot satisfy of inspire me; it is insufficient in many directions, especially because it does nothing for the sanitation, for the prophylaxis, but only for the defense and isolation, if there is already a plague.” (Viktor Adler: “The procrastination of the epidemic law”).

The centralization of public health care was highly competitive between the proletariat and the bourgeoisie, and just as the proletariat was interested in the best possible general reproduction of its labour force, the bourgeoisie was interested in ensuring that public health care only covered what was needed immediately to “repair” the commodity labour forces, so that it can continue to work. Before the development of public health care, reproduction was left to the proletariat privately, sometimes also to single capitalists, parishes or "benefactors". Health care conditions were therefore very bad, causing rebellion and resistance from the proletariat, and they were very uneven developed, which in turn meant that the bourgeoisie could not enforce towards the labour forces a level of reproduction that was on average necessary for capitalist exploitation interests. In 1844, Karl Marx pointed out this state of non-uniformity and absentmindedness: “The ‘Prussian’ heaps further obloquy on the unpolitical nature of Germany because the King of Prussia has located the cause of pauperism in ‘failures of the administration or of charitable institutions’ and has therefore looked to administrative or charitable measures to provide a cure for pauperism. Is this analysis peculiar to the King of Prussia? Let us again look briefly at England, the only country where these has been any large-scale action against pauperism worth mentioning. The present English Poor Laws date from Act 43 of the reign of Elizabeth. How does this legislation propose to deal with pauperism? By obliging the parishes to support their own poor workers, by the Poor Rate, by legal charity. Charity dispensed by the administration: this has been the method in force for two centuries. After long and painful experiences what view is adopted by Parliament in its Bill of Amendment in 1834? It begins by explaining the frightening increase in pauperism as the result of a ‘defect in the administration.’ It therefore provides for a reform of the administration of the Poor Rate by officials of the different parishes. Unions of about 20 parishes are to be set up under a central administration.” (Karl Marx: “Critical Notes on the Article: ‘The King of Prussia and Social Reform.’”)  

The state, to which the socialized areas of reproduction are left, is not a “neutral authority” that would exist above the classes, but it is the state of the bourgeoisie, a bourgeois state that also serves the interests of the capitalists. It became its function in the reproductive sector, that the health care system ensures a certain reproduction of the commodity labour forces, but only to that extent, as it corresponds to the "general interest" of the capitalists. The proletariat, on the other hand, is interested in going beyond this minimum and increasing the value of its labour forces. By controlling public health care and thus also the social insurance system, the bourgeoisie consolidated its control and administration over the people and especially over the proletariat. The "problem" for the bourgeois state is, however, that there is no surplus value from reproduction [4], but it is merely the prerequisite for producing surplus value in production. Therefore, the bourgeoisie must accept a certain development and centralization of the public health care system, but at the same time must always develop new ambitions to pass the costs of the reproduction of the commodity labour-power on the workers and the people. The costs that the worker incurs with health care, are comparable to the rent or the simple surcharge from a small grocer. Marx writes: “But the exploitation of the worker begins anew as soon as he exchanges the price for his labour back into other commodities. - Epicier [retailer], pawnbroker, landlord [houseowner], everybody exploits him over again.” (Karl Marx, “Wages”)

The bourgeoisie is developing a contradictory double-interest here: On the one hand, it needs a certain public health care system that ensures a minimum level of general reproduction, in order to have labour forces which are appropriately able to work, which also produce a decent amount of surplus value. And it also has to control the social reproduction of these labour forces through its state apparatus (offices, authorities, etc.), which becomes an extremely important question when the health care system is handed over to the public sector. On the other hand, the bourgeoisie must constantly strive to reduce and decrease the costs of reproduction as far as possible, because the reproduction of the labour forces is only an economically necessary evil for them. From its point of view, it must be as cheap as possible and, as far as possible, remain limited to the basic needs.

The proletariat and the people's masses are also developing an interest in partially socialized reproduction in the form of the public health care system. For them, maintaining and increasing their health also means that they can full-fledged sell their labour forces, which means to get the highest possible price for it. In addition, in the class struggle, general people's health is also a question of the immediate fighting ability of the masses. The proletariat can also address to other things, such as political education and activity, if it can hand over parts of private reproduction to the public. What can be derived from that is that the proletariat and the masses, contrary to the bourgeoisie, have an interest in expanding the public health care system as comprehensively as possible. Now it is the case that the bourgeoisie does not manage the socialized parts of reproduction through its state because it wants to, but because it has to. Since the bourgeoisie is constantly striving to pass on the costs of public health care to the people and the proletariat, the second interest of the proletariat and the people is on the one hand to finance the public health care system in such a way that it does not lead to any additional burden. If the general maintenance of the public health system or its expansion is financed at the expense of the working class and the people, this means that the exploited must additionally bear the recovery of their labour force, which is exploited by the capitalist. So that would deepen the exploitation! Neither the people nor the proletariat are interested in this. On the other hand, in addition to the interest in a public health system that is as well-organized and as closely meshed as possible, the proletariat is also interested in not being further controlled by the bourgeois state and administrated for the capitalists. Because the administration and organization of the reproduction of the labour force must be in the hands of the owners of the labour force, of the the working class, only then it will be reproduced according to their needs. Therefore, the people with the proletariat at the forefront must lead the struggle for the maintenance and expansion of public health care, but at the same time they must struggle that they do not bear the costs themselves and that they do not get controlled  and administrated further by the bourgeois state in the service of the capitalists. This is the only way to ensure, that these parts of the costs of reproduction are borne by the bourgeoisie.

Within the international worker’s movement of the 19th century, this complicated relation caused some confusion and therefore also deviations from the proletarian line, especially in Germany this question caused a lot of struggle within the worker’s movement, which is why we want to take up this example here. Despite it was clear and absolutely implemented that it is necessary to struggle for a public insurance- and health care system, there was no doubt about it. But the "state socialists" around Ferdinand Lassalle, who simply begged the bourgeois state and asked for help, also did not go beyond that. They did not understand that the struggle for a public insurance- and health care system in this situation could only be the first step, which the workers' movement could not be content with, since otherwise they would have delegated the whole administration and control over the reproduction of their labour force to the bourgeois state, which means that the health care- and insurance system is not orientated to the reproductive needs of the people and the working class, but to the capital interests regarding the reproduction of the commodity labour force. We still see this line today when, in the midst of the “Corona-Crisis”, many alleged “worker parties” and “worker organizations” do not want to go beyond justified immediate demands for the protection of people's health, stop at this point and only delegate everything else to the bourgeois state. The exact opposite deviation from the Lassalleans were the liberal forces in the worker’s movement. They were so afraid of the bourgeois state and had so little understanding of the class struggle, that they advised the workers and the people against the struggle for a public health care- and insurance system and instead preached "self-help and self-sufficiency". This went hand in hand with calls to the working class that they should be as frugal and willing to deprivation as possible, so that it could master the financial burdens and administration in health care- and insurance matters without the intervention of the bourgeois state! Of course, this was extremely reactionary, hindered the national unification of the working class, as well as the progress in the struggle for a solution to the health and insurance question in the sense of the proletariat, which, with the proposals of the liberals, bore all reproductive costs in the health question itself and thus even increased its own exploitation. Since many workers in Germany at that time justifiably hated Lassalle's belief in the bourgeois (Prussian) state, the liberals were successful for a certain time with their harmful and class-hostile agitation. A similar line can still be found today, for example among anarchists and similar state-phobics, who thus turn out to be inheritors from the liberal bourgeoisie and, even in the face of the Corona-Virus, agitate against the alleged "strengthening of the state" when it comes to immediate measures to protect the people's health. Karl Marx and Friedrich Engels were already struggling for a correct solution to the confused question of a public health care- and insurance system. For today's situation, however, the solution by Lenin and the Bolsheviks, which we will deal with below, gives especially important teachings.

The proletarian line in the struggle for health care.

Is the class struggle for health care essentially an economical struggle for the conditions of the sale of the commodity labour force, which is primarily a matter of the unions? Of course not, even if it often seems like this in daily politics. Of course, the workers' movement also raises immediate demands for people's health issues, such as those currently being broadly taken up in the political crisis (“Corona-Crisis”), which in many aspects have the character of the economic struggle and, above all, are oriented immediately, which is why it they are "immediate demands".

However, the overall character of the question of a public health care- and insurance system is not only the economical question of how to finance the reproduction of the commodity labour force and the important conditions for its sale, but also the question of who distributes the funds, approves certain therapies, approves the funds, handling of patient data, etc. How important this question is for the people and especially the working class can be clearly illustrated by the insurance question for occupational diseases: The insurance is in the hands of the bourgeois state apparatus and partly private capitalists. Their interest is, that as much as possible is paid in, but as little as possible is paid out, which means the number of insurance claims is continuously reduced. Of course, some of the occupational diseases change and others disappear completely over time, because working materials and entire job profiles change. At the same time, new occupational diseases arise, because of new professions, new work materials, etc. Nevertheless, the number of recognized occupational diseases in Austria decreased from 2,603 in 1975 to 1,569 in 2013, which means there are 1,000 less recognized occupational diseases! With this reduction, the number of insurance claims has of course drastically decreased during this period, from 208,417 to 123,827. It is the working class and the people who are suffering, because their occupational diseases are less and less recognized as such, which means nothing more than that the insurance coverage is getting worse! It is not different regarding the question of who decides, for example, about the annual increase if deductibles for everyday therapeutic items, such as visual aids. Especially for children, where such forms of therapy still have the best effect and most likely to be used, the deductibles for visual aids are currently the highest, at least 104,40 euros per piece! The working class suffers from such measures, gets exploited and fleeced. Those who just want to see the public health system getting more supply, but do not raise the question of control and administration, continue to surrender  the working class to these conditions! Because the insurance system is getting worse, the masses have to pay more and more parts of treatments and therapies from their own pockets. The costs of private health expenditure in Austria rose from 6.6 billion to 11.3 billion in the period between 2005 and 2017!

The struggle for public health is both an economic struggle and obviously a struggle that must set explicit political goals of control and organization (competences of power), because otherwise it will remain completely toothless in the long run and the proletariat and the masses will remain under control of the bourgeoisie. Too often this is overlooked by opportunistic forces in the workers' and people's movement. One of the basic questions of health care is the insurance question, especially for the proletariat, but also for the peoples. As long as the capitalist order persists, the worker is exploited. He has to sell his labour force like a commodity, since he has nothing else that he could carry to “the market” and from which he can live in the long run. This labour force is exploited and worn out by the capitalist, because the working conditions dictated by the capitalist lead to accidents and premature physical and psychological deterioration of the labour force. Especially with the current aggravation of the general crisis of capitalism. Only with the development of socialism, in the dictatorship of the proletariat, as result of the class struggle, the labour force will end to be a commodity, because under the leadership of the working class not only a new society but also a new mode of production will be implemented. In socialism, not only the production struggle will be carried out for the good of society, but the knowledge of the scientific experiment is placed in the hands of the working class. But until then, the working class must keep its workforce as capable of work as possible, otherwise it "falls out of the market", because the capitalist no longer benefit from it. The proletariat therefore needs insurance. But, of course, the ruling class tries to arrange things in such a way that the insurance serves its own purposes, and is not in the hands of the proletariat and the people, but is used by the bourgeoisie and its authorities to blackmail and exploit the working class. The struggle must be directed against that, for the self-administration of insurance by the working class and the people!

It is not just about reversing the turquoise/blue health insurance reform [5], but in medium and long term also about eliminating the interference of the ruling class in public insurance at all! As part of the revolutionary-democratic struggle in Russia, Lenin called for state insurance for the working class and the people, with the insurance being administered by the insured themselves and the contributions paid by the capitalists and the bourgeois state. These demands were recognized as a programmatic orientation at the sixth All-Russian conference of the Social Democratic Workers' Party (later: the Communist Party), and were therefore calculated as a guideline in the class struggle for a longer period. This orientation enables the working class to take an independent line on the health care issue without falling for the limitations and the conservatism of a Lassalle or the reactionary views of the liberals on this issue. Lenin's red line drew lessons from the class struggle on the issue of health care. Today, the public insurance officials are minions of the bourgeois parties, officials of the capitalist state apparatus. In contrast, those responsible in insurance must be made employees of the masses. They must be able to be elected and deselected and are accountable for their activities to the working class and the people, the insured.

The entire public health system is to be subordinated to these insurance institutions in the hands of the masses, under the leadership of the proletariat. The popular masses themselves know what is good for them and will carry out the reproduction of their work force accordingly to themselves, according to the best possible conditions. The entire insurance costs have to be paid by the capitalists. All insurance costs must be eleminated for the working class!

Anyone who claims that such reforms are “not possible” should deal with the history of self-administration of social insurance. We do not imagine these things, but they have already become reality in different countries, fought by the proletariat, especially in the years 1918/19 (Also in Austria this achievements reached an relatively high level). However, these achievements were snatched from the proletariat under the leadership of social democracy and placed in the hands of the bourgeois state. Similar questions about the revolutionary-democratic achievements of the masses and the proletariat have accompanied all revolutions and heralded the victories of the proletariat and its allies. There are examples of this from factories, from insurance, from agriculture, from the army, from education, etc. Because wherever the proletariat and the masses get moving, depending on the specific conditions, they realize their interests, where also revolutionary-democratic demands are an important part. So there is no reason why demands for such reforms should be “impossible” unless you are faint-hearted and suspicious towards the masses. It is true that such demands will not be achieved if the proletariat and the people are not organized as a powerful revolutionary force, it is true that such reforms can only be achieved through the class struggle, which is why many petty-bourgeois and reformist-oriented forces reject them.

The orientation towards a revolutionary-democratic goal not only prepares the proletariat and the masses for even greater victories, but is also important in order to achieve sub-goals in the revolutionary initiative and to establish “fortifications” around which the masses can gather and consolidate, to then further move on. The proletariat will learn a lot in the course of its struggle, in which it orientates as a by-product also towards such reforms, and will thus prepare for the decisive battles for the victory of socialism. It is therefore unavoidable that a Communist Party also has a revolutionary-democratic program that provides answers to various questions of the daily struggle and shows the proletariat and the masses the way beyond their great and justified daily demands in the direction of the proletarian revolution, in direction of socialism!

Social insurance under the self-administration of the working class and the people!

Eligibility and ability to deselection of social insurance employees by the insured!

Transfer of the entire public healthcare system to the self-administered social insurance system!

Settlement of all costs of insurance and public health care by the capitalists and the bourgeois state!



Vorbote [Pioneer], March 2020


[1] At the same time, this does not mean that everything that was gained as knowledge in previous forms of society is bad or inferior just because we have higher knowledge today. Some insights are ahead of their time because they provide correct insights and conclusions from the material found, but the entire conditions of society are not yet ripe to integrate these insights firmly into themselves. So it happened e.g. with the primitiv form of the microscope, which was already used in the form of crystals by Islamic medicine but was later forgotten, or the theses on atoms in ancient Greece, which were of course still very idealistic, but also pointed in the right direction and were subsequently buried for thousands of years. However, these are always individual findings and insights, not entire conceptions of scientific disciplines, such as biology using the example of Darwin, which certainly require a certain complexity of social exchange relationships as a precondition.

[2] Socialism is an excellent example of the increasing unleashing of science with an increasing social form. It was only with the dictatorship of the proletariat that conditions prevailed in the Soviet Union until 1956 and in China until 1976, which made people advance to higher levels in class struggle, scientific experiment and production struggle: it is not for nothing that contemporary neurology finds its foundations in the Soviet Union Medicine, just as the physiological knowledge of brain activity by Iwan P. Pawlow made breakthroughs in the Soviet Union, which meant a leap in the history of science: “One can say that the inexorable advance of science since Galileo's times showed the first clear sign of a halt when it faced the problem of the brain.” (I. P. Pavlov from: Dr. K. Keltschejew: ‘Pavlov's legacy’). On the other hand T. D. Lyssenko's achievements in biology have been ignored and laughed at in imperialism for decades. Today, some of his most important theses are confirmed in the form of the young science of epigenetics… It should therefore be noted, that socialism as a historically higher form of society than capitalism, also produces the higher and more complex form of scientific knowledge.

[3] „Austria Radio and Television“

[4] There is no surplus value from reproduction, that is correct. Nevertheless, there are more and more private capitalist companies in the healthcare sector that are exacerbating the lasting crisis of the capitalist public healthcare system (for example, by removing intensive care beds, as the 50 privatized hospitals in the greater area of Madrid did, which no longer had the capacity to carry out difficult Corona courses - to treat illnesses and thus not little to contribute to the fact that Madrid and with it Spain are in a disastrous situation during the "Corona-crisis"). However, the surplus value that state and private capital appropriates in the healthcare sector arises in processes “next to” (or before and after) treatment, not through it. The scientifically at least appropriate and correct treatment of the cases is becoming less and less important, since the treatments, i.e. the reproduction in the narrowest sense, are increasingly becoming a side issue in the business-run health system. Bourgeois social science mostly describes this development of the reproductive sector as "economization".

[5] This insurance reform was an anti-peoples reform in the health care system, what was implemented threw the last government of the Austrian Peoples Party (conservative Party) and the Freedom Party of Austria („right wing“ Party) in 2019.

 

 

 

 

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