Dispelling myths about for-profit health care / Pat Armstrong and Hugh Armstrong

_{Originally published in Canadian Dimension on February 7, 2023}

An old friend of ours recently confessed to using a private clinic for her cataract surgery. She said that, while she felt guilty, she nonetheless received wonderful care and paid with her health card. When we asked the name of the clinic, she said the Kensington Eye Institute (located on Toronto’s College Street). It is indeed a private clinic that provides vision surgeries for cases considered non-complicated. It has justly received a good reputation. But a critical piece was missing from the ‘private’ label. Kensington is a non-profit, community-based eye surgery centre.

It is this essential distinction that is too often missing from current debates about Canada’s health care crisis, even among those who are usually on top of the issues (including our friend). Indeed, the term ‘private’ is often used to purposely hide distinctions (and consequences), with proponents arguing that our health care system is already mainly private. All those hospitals named after saints are not public in the sense that they are not owned by the government. But they are public because of the fact that they are responsible to the public and, in Ontario, fall under the Public Hospitals Act. Their books and board meetings are public. They report publicly. They do not seek a profit nor are they allowed to earn a profit on care.

When we argue that the primary objective of for-profit care is profit, this is not an ideological argument, as Premier Doug Ford insists. Indeed, it is factual. Businesses that do not make a profit go out of business. Moreover, the primary responsibility of for-profit companies is to their shareholders, not the public. So it is often hard to tell where the profits are coming from and what this means in terms of care and care work.

Take the case of for-profit long-term care homes. We know they make a profit; we know they have a pattern of fewer staff, lower pay, more bed sores and more transfers to hospitals. This reveals some sources of profit, but doesn’t provide a full picture. There is indeed gold in the golden years, but too often not for those needing or working in care.

Ford likes to repeat the line that people will pay for standalone services offered by the for-profit clinics he’s granting a larger role in health delivery with their health card and not their credit card. Not to worry, he says, there will still be access to care without fees. But he fails to tell us what the sources of profits will be. There has been talk about ‘upselling’ services that you may or may not need: special lenses for those cataracts, to take just one example. However, there are some indications that the government will also pay more for services in these clinics than in hospitals, meaning that we may pay for the profits through our tax dollars.

When questions are raised about accountability, the answer has been unspecified regulations. It is a rather ironic answer from a government dedicated to removing ‘red tape.’ Some regulations are obviously necessary but many of these will undoubtedly be required, and at more cost to public funds if they are to be enforced. Effective regulations to prevent the poaching of doctors, nurses, and technologists from public hospitals to new ‘independent’ clinics with shorter hours will be very hard to implement.

Our research on scandals about long-term care homes in various countries shows both that the scandals are more likely to arise in for-profit homes and that in North America especially they are more likely to result in more, but not necessarily more effective, regulation. Unlike in Sweden and Norway where governments cancel their contracts with for-profit owners when scandals are exposed in the media, North American governments choose to regulate. In the US we are repeatedly told that care homes are more regulated than the nuclear industry, but regulation too often mean workers spend scarce care time on filling out forms with little visible improvement in the delivery of care.

A case can be made for specialized clinics. They can make sense in a number of areas such as cataract surgeries. But as doctors’ organizations in Ontario have argued, they make the most sense when they are connected to hospitals so that resources can be shared and complications easily transferred for more advanced care. They also make sense when they are not searching for profit but rather focused on quality care, with oversight from hospitals. And when they are publicly funded, they are publicly accountable, with open board meetings and minutes and enforced regulations about quality care and working conditions. What doesn’t make sense is spending public money on profit. Premier Ford has not even offered a case supporting for-profit care, only for independent clinics.

It is not enough to declare that, given the current crises in health care, the status quo will not do and thus we need to turn to the for-profit sector. Changes that are proposed need to be backed up with evidence-informed arguments. Meanwhile, the evidence indicates that for-profit delivery is less efficient, not more. Experiences ranging from dismal overall health outcomes in the US, to the dismantling and thus fragmenting of the NHS in the UK, to longer wait times for many following the move to for-profit cataract eye surgery in Alberta all make clear.

The crises in health care brought about by years of austerity faced with a pandemic have created the opportunity to build back better. However, it also created the opportunity for those searching for profit in all corners of care, from dental offices to home care, telehealth, colonoscopies, and vaccinations. We are at a critical point in our health care system. Now more than ever we have to make the distinction between private and profit clear. If our friend didn’t see the differences, clearly we have a lot of work to do.

_{Pat Armstrong is a Canadian sociologist and Distinguished Research Professor at York University. She is a Fellow of the Royal Society of Canada.}

_{Hugh Armstrong is a Distinguished Research Professor and Professor Emeritus of Social Work and Political Economy at Carleton University in Ottawa, Ontario. Dr. Armstrong’s major research interests include long-term care, the political economy of health care, unions and public policy, the organization of work and family and household structures.}

When Jamaican Slaves Rebelled on Christmas Day / by Perry Blankson

_{^{The destruction of the Roehampton Estate in January 1832. (Adolphe Duperly / Wikimedia Commons)}}

_{Originally Published in Jacobin on December 25, 2022}

On Christmas Day in 1831, 60,000 enslaved Africans carried out the largest uprising in British West Indies history. Their uprising would prove a milestone on the road to emancipation only a few years later.

In late December 1831, white Jamaican planters slept restlessly in their beds. Rumors had long been circulating of disquiet among the enslaved Africans residing in plantations across the island. Before they knew it, the island would be set ablaze as tens of thousands armed themselves to fight for their freedom.

As it became known, the Christmas Rebellion (or Baptist War, named so after the faith of many of its key conspirators) was the largest uprising of enslaved Africans in the history of the British West Indies, and directly influenced the abolition of slavery in 1833 and full emancipation in 1838.

To understand the dynamics at play during the uprising, it’s vital to understand the social structure of nineteenth-century colonial Jamaica. Jamaica, like much of the West Indies, was what was known as a plantocracy. In this arrangement, a minority of white European settlers, human traffickers, and plantation owners dominated the enslaved African majority on the island.

Conscious of their minority (Africans outnumbered whites twelve to one), planters deployed ferocious violence to discipline their slaves at home, and used their substantial wealth and influence to lobby against abolitionists in Parliament and the press. But despite their efforts, the sun was setting on slavery in the British Empire, and hopes of emancipation around the corner emboldened the enslaved population to take matters into their own hands.

Samuel “Daddy” Sharpe, a black Baptist deacon, organized enslaved Africans to participate in a peaceful general strike on December 25, 1831, demanding wages and increased freedoms. While nonviolence was intended, Sharpe was under no illusions that the infamously violent planter class would respond in kind.

The Plantocracy

Aside from providing an insight into mass resistance against slavery, the Christmas Rebellion also provides a valuable case study into the complexities of governing a plantocracy and the contradictions of slave resistance. Seeking assistance to put down the rebellion, the colonial authorities enlisted the help of the Accompong and Windward Maroons — both disparate, militant guerrilla organizations of escaped former slaves.

The Maroons had gained a degree of independence following their own Maroon Wars in the eighteenth century. As a result of treaties signed with the colonial authorities following the First Maroon War of 1728–1739, signatory Maroon factions were granted small parcels of land that soon became known as Maroon towns.

The caveat to this treaty was that these Maroon towns would be assigned a white superintendent, and that Maroon fighters would be required to assist colonial authorities in putting down future uprisings by their enslaved brethren and catching runaway slaves. This arrangement was resisted by many Maroon factions, but they would later find themselves fighting opposite their fellow oppressed Africans.

The uprising led to the deaths of fourteen planters and two hundred enslaved Africans, with property damage worth an estimated £124 million today. African rebels burned hundreds of buildings across the island, including Roehampton Estate, the blazing scene of which was later recreated by French lithographer Adolphe Duperly. But it was the aftermath of the uprising that saw some of the most sadistic violence take place.

Enlisted to be his military commanders were fellow literate enslaved Africans spanning several different estates, illustrating the effectiveness of the vast communication network known colloquially as the slave “grapevine.” Also crucial was the limited degree of freedom given to Sharpe: as a deacon, he had the ability to move around the island and secretly organize after prayer meetings.

The initially peaceful demonstration soon became a violent uprising, and out of a population of 600,000, an estimated 60,000 took up arms to resist their oppression. Any pretense of a peaceful demonstration was lost when Kensington Estate was set ablaze by enslaved rebels, with the rebellion taking place in earnest soon after.

The Aftermath

The white Jamaican plantocracy responded to the Rebellion in the only language it knew: unspeakable brutality. The reprisals of the Jamaican planter class in response to such an affront to their authority was merciless and indiscriminate. Immediately after the rebellion, approximately 340 Africans were executed using a cruel and gruesome variety of methods. The majority were hanged, their heads displayed in plantations across the island to serve as a warning against future uprisings.

Beyond the pale for Parliament, though, was the tarring and feathering of a white missionary suspected of fanning the flames of rebellion. It’s difficult to find a clearer example of the racialized priorities of the British Empire: rather than the brutal murder of thousands of black Africans (perceived as nothing more than chattel), it was the punishment of a white missionary by white planters that drew significant protest. The missionary’s filthy neckerchief was paraded around Britain to the horror of those who saw it, bolstering the cause of white abolitionists.

Today, it wouldn’t be too far off the mark to call Sharpe an advocate of a form of liberation theology. Sat in jail following his failed uprising, Sharpe proclaimed that he learned from the Bible that “whites had no more right to hold black people in slavery than black people had to make white people slaves. . . . I would rather die on yonder gallows than live in slavery.” Sharpe was executed on those gallows on May 23, 1832. He’s remembered as a national hero in Jamaica, with his likeness printed on the $50 Jamaican banknote.

An Ongoing Struggle

The popular narrative would have us believe that the British Empire chose to fully emancipate the thousands of African slaves in Jamaica in 1838 out of moral duty. But the truth is quite the opposite. Despite its failure, the sheer scale of the Christmas Rebellion, coupled with the constant resistance of enslaved Africans, demonstrated that the centuries-old practice of slavery had become untenable.

The Christmas Rebellion directly precipitated the 1833 Slavery Abolition Act, which on its surface abolished slavery, but also stipulated that formerly enslaved Africans would have to undergo a period of “apprenticeship” under their old masters before they could be freed. It was not until 1838 that full emancipation was granted by Britain.

In addition, slave owners, the Jamaican planter class among them, were awarded a handsome £20 million in compensation — a sum comprising 40 percent of the Treasury’s national budget at the time, and worth more than £17 billion today. This monumental debt was only paid off in 2015, meaning that the tax revenue generated by living British citizens, potentially among them, the descendants of enslaved Africans, has been used to contribute to recompense for human traffickers. The formerly enslaved Africans, subject to untold brutality for generations, got nothing.

This year, the Jamaican government was unsuccessful in its petition for £7 billion in reparations from the British government. The latter dismissed Jamaica’s claims due to questions of practicality. Who would pay for it? And to whom?

No such questions were asked when the British government compensated slaveowners for the loss of their “property.” As we remember the Christmas Rebellion and the bravery of those Africans who struggled against near insurmountable odds, we must also remember that the long fight for justice remains incomplete.

_{Perry Blankson is a Tribune columnist and a project coordinator at the Young Historians Project. He is a member of the Editorial Working Group for the History Matters Journal.}

On Why Capitalists Are Guilty of Social Murder / by Friedrich Engels

_{^{Friedrich Engels directing the construction of a barricade in the streets of Elberfeld during the riots of May 1849 in Prussia. (Universal History Archive / Universal Images Group via Getty Images)}}

_{Originally published in Jacobin on November 28, 2022}

In 1845, Friedrich Engels wrote a scathing condemnation of English capitalism, The Condition of the Working Class in England. In it, he accused the bosses of carrying out “social murder” against workers and the poor.

The following is an edited extract from Friedrich Engels’s The Condition of the Working Class in England, first published in 1845. You can read the full text here.

Atown, such as London, where a man may wander for hours together without reaching the beginning of the end, without meeting the slightest hint which could lead to the inference that there is open country within reach, is a strange thing. This colossal centralization, this heaping together of two and a half millions of human beings at one point, has multiplied the power of this two and a half millions a hundredfold; has raised London to the commercial capital of the world, created the giant docks and assembled the thousand vessels that continually cover the Thames.

I know nothing more imposing than the view which the Thames offers during the ascent from the sea to London Bridge. The masses of buildings, the wharves on both sides, especially from Woolwich upwards, the countless ships along both shores, crowding ever closer and closer together, until, at last, only a narrow passage remains in the middle of the river, a passage through which hundreds of steamers shoot by one another; all this is so vast, so impressive, that a man cannot collect himself, but is lost in the marvel of England’s greatness before he sets foot upon English soil.

But the sacrifices which all this has cost become apparent later. After roaming the streets of the capital a day or two, making headway with difficulty through the human turmoil and the endless lines of vehicles, after visiting the slums of the metropolis, one realizes for the first time that these Londoners have been forced to sacrifice the best qualities of their human nature, to bring to pass all the marvels of civilization which crowd their city; that a hundred powers which slumbered within them have remained inactive, have been suppressed in order that a few might be developed more fully and multiply through union with those of others. The very turmoil of the streets has something repulsive, something against which human nature rebels. The hundreds of thousands of all classes and ranks crowding past each other, are they not all human beings with the same qualities and powers, and with the same interest in being happy? And have they not, in the end, to seek happiness in the same way, by the same means?

And still they crowd by one another as though they had nothing in common, nothing to do with one another, and their only agreement is the tacit one, that each keep to his own side of the pavement, so as not to delay the opposing streams of the crowd, while it occurs to no man to honor another with so much as a glance. The brutal indifference, the unfeeling isolation of each in his private interest, becomes the more repellent and offensive, the more these individuals are crowded together, within a limited space.

And, however much one may be aware that this isolation of the individual, this narrow selfseeking, is the fundamental principle of our society everywhere, it is nowhere so shamelessly barefaced, so self-conscious as just here in the crowding of the great city. The dissolution of mankind into monads, of which each one has a separate principle, the world of atoms, is here carried out to its utmost extreme.

Hence it comes, too, that the social war, the war of each against all, is here openly declared. Just as in Stirner’s recent book [The Ego and Its Own], people regard each other only as useful objects; each exploits the other, and the end of it all is that the stronger treads the weaker under foot; and that the powerful few, the capitalists, seize everything for themselves, while to the weak many, the poor, scarcely a bare existence remains.

What is true of London, is true of Manchester, Birmingham, Leeds, is true of all great towns. Everywhere barbarous indifference, hard egotism on one hand, and nameless misery on the other, everywhere social warfare, every man’s house in a state of siege, everywhere reciprocal plundering under the protection of the law, and all so shameless, so openly avowed that one shrinks before the consequences of our social state as they manifest themselves here undisguised, and can only wonder that the whole crazy fabric still hangs together.

Since capital, the direct or indirect control of the means of subsistence and production, is the weapon with which this social warfare is carried on, it is clear that all the disadvantages of such a state must fall upon the poor. For him no man has the slightest concern. Cast into the whirlpool, he must struggle through as well as he can. If he is so happy as to find work, i.e., if the bourgeoisie does him the favor to enrich itself by means of him, wages await him which scarcely suffice to keep body and soul together; if he can get no work he may steal, if he is not afraid of the police, or starve, in which case the police will take care that he does so in a quiet and inoffensive manner.

During my residence in England, at least twenty or thirty persons have died of simple starvation under the most revolting circumstances, and a jury has rarely been found possessed of the courage to speak the plain truth in the matter. Let the testimony of the witnesses be never so clear and unequivocal, the bourgeoisie, from which the jury is selected, always finds some backdoor through which to escape the frightful verdict, death from starvation. The bourgeoisie dare not speak the truth in these cases, for it would speak its own condemnation. But indirectly, far more than directly, many have died of starvation, where long-continued want of proper nourishment has called forth fatal illness, when it has produced such debility that causes which might otherwise have remained inoperative brought on severe illness and death. The English workingmen call this “social murder,” and accuse our whole society of perpetrating this crime perpetually. Are they wrong?

True, it is only individuals who starve, but what security has the workingman that it may not be his turn tomorrow? Who assures him employment, who vouches for it that, if for any reason or no reason his lord and master discharges him tomorrow, he can struggle along with those dependent upon him, until he may find someone else “to give him bread”? Who guarantees that willingness to work shall suffice to obtain work, that uprightness, industry, thrift, and the rest of the virtues recommended by the bourgeoisie, are really his road to happiness?

No one. He knows that he has something today and that it does not depend upon himself whether he shall have something tomorrow. He knows that every breeze that blows, every whim of his employer, every bad turn of trade may hurl him back into the fierce whirlpool from which he has temporarily saved himself, and in which it is hard and often impossible to keep his head above water. He knows that, though he may have the means of living today, it is very uncertain whether he shall tomorrow . . .

_{Friedrich Engels was a German socialist instrumental to the development of Marxism}