By Jess Stanton

After his health worsened last Christmas, my Grandad Jack had to leave his bungalow in Ellesmere Port – a town he had lived in for 87 years, to move closer to my parents’ home in Oxfordshire. He could no longer cope on his own and he had lost much of his independence when his health deteriorated. I am not trained or employed as a carer in any official capacity, but I am now my Grandad Jack’s carer and I have the upmost respect for this very special profession.

I have learned first-hand that caring is not just a case of doing a few chores for somebody; it is so much more than that. It requires a great deal of expertise, empathy and patience to maintain and be responsible for the dignity of someone else. It can be rewarding, heart-warming and enjoyable on a good day, but it can also be challenging, stressful and very upsetting at other times. I have worked with young people with behavioural problems and various disabilities, so in some ways caring comes quite naturally to me. In other ways it has been unfamiliar and extremely difficult, not for the fault of my Grandad Jack, but because that is just how caring is.

This is why I am deeply concerned about the government’s plans to open up public services, to private firms, including care. I am a strong believer that the state should provide and manage all needs-based services. Many people across the UK need care and carers, who put them first and treat them with the upmost respect. If private firms take over a care home or hospital, they do it to make a profit first and foremost. This means that profit and people are competing priorities in privately-run care institutions and this is, in my opinion, totally unacceptable.

After seeing the horrific treatment of patients at the private Winterbourne View hospital from the BBC Panorama documentary, I was utterly appalled by the shocking and disturbing undercover footage. Although this is an extreme case, it shows that abuse can and does happen even in a privately-owned hospital that is taxpayer funded. What concerns me is how the Care Quality Commission will monitor all the private firms operating care services to ensure an acceptable standard of care is maintained.

I speak as both a carer and family member of a relative who needs care when I say this: Care is not and should not be a profitable commodity – it is someone’s life and dignity at stake, not a ‘product’ up for sale to the highest bidder. I strongly oppose public care services being opened up to privatisation and anybody who cares about care would also oppose this white paper.

I am therefore joining the ‘Week of Auctions’ from the 20^th of October to the 5^th of November. If you want to find out more on how you can get involved too watch this short video or email in your interest.

The Health and Social Care Bill will pass into law and the process of dismantling our public health system will advance again. It would be easy at this point to retreat into despair and defeatism. To think of all the effort we have put into our campaigns over the last few weeks and months and to conclude that we tried our best but we lost. To decide to give up or move onto the next fight. We won on forests, failed on higher education and the NHS, what’s next?

It would be easy to damn the Liberal Democrats but gloat over how they will at least get kicked out in three years. But to be replaced with whom? With Labour? Who support cuts, just a little slower. Who gave us foundation hospitals, supported the internal market in the NHS (not to mention academies and fees, if we want to broaden our scope a little) and believe in the mantra of ‘choice’ and ‘modernisation’ just as much as the Tories and Lib Dems.

With the Greens? or the Socialist Party? (or whichever other far-left electoralist outfit you prefer.) Well that might be nice to imagine. And if it happened they might restore the NHS, they might bring our public services back under public ownership and under some sort of public control. But does anyone really think that’s going to happen? Two or three MPs? maybe. Throw in the LRC and we might get a dozen MPs we could consider to be socialists (if we’re lucky). That’s hardly the mass representation that could legislate to nationalise the towering heights of the economy, though. And even then, we still have to sit through three more years of Tory-Lib Dem government before we even get that far. Who knows what of our public economy will even be left at that point for our parliamentary leaders to speechify upon?

It would be easy to be despondent. But we should not be. We don’t have to wait three years to fight back, we don’t have to accept that we lost and we don’t have to delegate our struggle to someone else to take action on our behalf. But we have to learn the lessons of how we reached this point. We have to build and rebuild our community and grassroots organisation. We need action which is more than symbolic and which cannot be easily co-opted or dismissed.

People are upset, and they are angry, and they are actively looking for new ways to engage with politics to build a genuinely democratic economy, where we don’t only get to vote once every few years, and where we don’t have to pin our hopes on a room full of unelected aristocrats, bishops, business people an ex-politicians to deign to save the institutions we all want to protect.

I may have some reservations about the Occupy X actions happening across the US (and now coming here), but the fact that they are enduring, and spreading does tell us that people are willing to do something more than traditional party politics, that people are fed up of waiting for others to take action and that there is a desire to change the whole system, not just the people at the top. But as Sophie pointed out on this blog, and several people explained on libcom, it needs to go much further than occupying parks.

Mubarak didn’t lose power in Egypt because people sat around in Tahrir Square, much as that seems to have become the dominant narrative amongst some, he fell because of a sustained and coordinated campaign of direct action. Yes, of occupations and public protest, but also of thousands of workers striking and shutting down transport and production across the country.

The general assemblies in Greece prior to the vote on the last bailout package may have garnered all the media attention, but Greek workers didn’t give up once that vote passed. Two weeks ago workers occupied seven government ministries as representative of the troika (the ECB, the EC and the IMF) were due to conduct an inspection of how the austerity measures were being implemented. Today, workers occupied the finance ministry as the start of a nine day strike and “hung a banner reading ‘Occupation’ from the roof of the eight-story building and hoisted black flags around the roof”.

On the 9th of November we will see a national demonstration against fees and privatisation in higher education. On November 30th we will see the largest coordinated strike action in this country in decades. These events give us scope to build a real resistance. They will not be enough on their own, but they are a start.

We must avoid any retreat into defeatism, or a return to tactics that have failed, and instead escalate our response if we are to have any hope of protecting our public services and building the sustainable, democratic society we desire. The power to do so lies in our hands, if we can learn the lessons of today’s set back.

The thing is, pharmacy used to be pretty miraculous. Type I diabetes was a death sentence before the discovery of insulin (1922). Trivial infections killed millions before penicillin (1929) and asthma regularly killed children before salbutamol (1968). Each of these discoveries has saved many millions of young and healthy lives, however this golden age of discovery could not continue indefinitely. The low-hanging fruit was gone by the nineties, and time was running out on the most profitable patents – but a private company must run fast just to stay still. Shareholders demanded further ‘miracles’ in an age of largely prosaic science, which is basically why the American pharmaceutical industry now spends more on marketing than it does on research. This is as good an example as there is of why private sector competition does not automatically lead to net efficiency.

(At this point I had a look at the list of winners of the Nobel prize for medicine, hoping to show that the discoveries I use every day at work date mostly from the middle of the century, and that more recent advances are of more theoretical benefit. This prediction more or less stands up, but to be honest the more striking findings are as follows; 1.The committee gave the prize to the inventor of the lobotomy in 1949 (!), 2. 1970′s winner would appear to be a pirate; a first for this proud race.)

The problem is that most researchers are paid not to ask themselves, ‘how can I improve human health? Instead they must ask themselves, ‘How can I maximise profit for my company?’ As George Monbiot puts it, talking about why capitalist solutions to climate change are intrinsically flawed, ‘the only thing they can’t sell you is less.’

This lead to various phenomena, none of them good, such as the wave of ‘me too’ drugs, which were generally small tweaks to successful old medications whose patent had expired, marketed heavily on what was often pretty thin evidence of any improvement. Basically, the manufacturers would adjust the structure of a chosen drug to produce something that was very similar in efficacy, they would then test it with reference to every side-effect they could think of, and inevitably it will be marginally better in some area or other.

They would then choose that one fairly fuzzy end point and market it agressively at a high price without mentioning any areas in which they’d discovered that it is in fact, worse. As with all scientific critique, the point is best illustrated by reference to XKCD.

At the same time much has been made of the theoretical potential for ultra high-tech therapies based upon genes or stem cells, though both remain some distance from producing many practical applications at this stage. I am a scientist, and I’m all for the work upon these frontiers continuing – however I’m also a leftist, and the knowledge that this research is happening in a world that has so profoundly failed to stop children dying from diarrhoea is deeply unsettling. I have the same mixed feelings about widely reported idea that theoretically, stem cells might one day allow the creation of new organs for those who have been afflicted by cancer. Wonderful as that prospect is, it seems gratuitously technological when we haven’t yet done the simple things as regards prevention.

Around a hundred years ago an Irish doctor called Robert McCarrison was working in the Hunza valley in northern Pakistan. In ten years, in a population of 8000 people, he did not see a single case of a gastro-intestinal cancer, and in writing about this he makes a strong case that their pre-industrial diet and lifestyle is the reason why they are so free of these problems, nor are his broad findings considered controversial. That is about as close as humankind is ever going to get to a single unified ‘cure for cancer’. Implementing radical public health policies based on that knowledge would be inexpensive, green and egalitarian, however as it involves no readily saleable product it is not something that the free market will ever do spontaneously, and thus it has not yet been done.

Obviously I’m not arguing that pharmaceutical research should stop altogether - merely that the current model in which research is dominated by Pfizer et al has probably taken us almost as far as it’s going to. If, on the other hand, we could successfully decouple the need for private profit from the research process, non-pharmaceutical research priorities would spring into life, and such research into medicines as continued would be free to focus on the diseases of the Global South – for having been of little commercial significance previously, there is a better chance of miracle-drugs still waiting to be found in these areas.

This would not be universally popular; people like taking pills, and doctors like handing them out. Whilst doing GP work, I often felt great pressure to prescribe medicine at the end of a consultation in order for both myself and the patient to feel like I had done something tangible, even when I didn’t feel that a medicine was indicated. Similarly in A+E I must have seen hundereds of kids with viral infections who’d been given antibiotics by their GP, which unsurprisingly hadn’t done any good. The idea of a simple, instant, magic chemical solution to cure any human ailment it very appealing – as it requires no difficult change on the part of the patient, nor any consideration of the wider factors behind human illness. This is regrettable as it is in this consideration that many of the breakthroughs of the future lie.

Imagine if the same thinking informed the provision of, say education, or transport – how much closer we would be to the kind of country we would want to live in?

Faced with the current proposed upheavals to the service, the response of the Left, the general public and the healthcare professions has been near unanimously conservative – essentially we have demanded that things stay more or less as they are, and that more money should continue to be invested in the service as the population ages. Indeed the latest Scottish Green Party manifesto falls within this consensus, and whilst it says nothing that I would particularly disagree with, I wonder if we couldn’t articulate a more radical vision for how to improve the nation’s health?

The role of pharmacy strikes me as the orthodoxy in greatest need of upset. The public have a good understanding of the problems that privatised healthcare would cause, and yet the damaging effects of the privatised pharmacy are largely overlooked. The drug companies receive 20 billion pounds per year from the NHS, and behave as ethically as you would expect from any other vast corporation – which is to say they reinvest some of that money in skewing research, distorting clinical judgements and applying marketing to a process which is meant to be scientific – all to the detriment of patient care.

The visible part of this effect is drug reps, a tier of highly-paid professionals whose job it is to travel between hospitals and surgeries making the case for certain drugs. The drugs promoted will always be recent patents, and they will always be expensive. No negative findings that may have arisen from trials will be discussed, and the talk will be tailored to exploit the audience‘s ignorance; as they know fine well that junior doctors are not going to be familiar with all of the literature in a specific area, they can get away with much fuzzier science than they could with an audience of specialists. The freebies that accompany these talks have been reigned in in recent years, but the wards remain awash with branded pens and mugs, whilst in the developing world doctors are still offered formalised rewards for set numbers of prescriptions. Kickbacks, essentially. And this is only the visible part of the spectrum – far more pernicious is the way in which these companies distort research priorities and interfere with the peer review process. Because all research they fund must end in a patented pill, this means that;

* complexity is valued over simplicity (evidence suggests that vitamin D deficiency may have a role in causing various common Scottish diseases, however as Vitamin D is a generic product the research would not be profitable, and has therefore not yet been done)
* pharmaceutical solutions are promoted to the near-exclusion of other means (vast amounts of money goes into the development of psychiatric drugs, very little into research around talking therapies)
* a drug which cures is far inferior to one that merely controls symptoms and must be taken lifelong
* the affluence of a patient population is more significant than their need (male pattern baldness is a bigger research priority than malaria)

None of this should come as a surprise. No corporation is ever going to behave any better than it makes commercial sense to, which is why it is so disastrous to leave anything that really matters in their care.

So how did we get here and what do we do about it?

‘The war on drugs has failed’. This is the recurring theme throughout the Global Commission on Drug Policy’s recent report. Indeed, the sentence was used as the introduction to several sections in the report. It calls for governments across the globe to, among other things, “end the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others”; “offer health and treatment services to those in need”; “abolish abusive practices carried out in the name of treatment”; and to “apply much the same principles and policies stated above to people involved in the lower ends of illegal drug markets, such as farmers, couriers and petty sellers.”

Our own government’s reaction to this was swift and unsurprising. On Wednesday night a spokesman from the Home Office said “We have no intention of liberalising our drugs laws. Drugs are illegal because they are harmful – they destroy lives.”

The reason for the commission making their rather bold claim is clear. In the 50 years since the United Nations began what would eventually become the War On Drugs the measures taken by governments across the world has seemed to have little or no effect on the drug market. In fact, drug consumption has increased in this time, quite dramatically in the cases of some drugs. Heroin consumption, for example, has risen some 34.5%. In addition to this, the effects that a hard line approach to policing drugs has had are almost all negative. A vast black market has grown from the risk-escalated profits associated with the drug trade. Poor countries spend vast amounts of money on ineffectual attempts at law enforcement. Drug users, often with severe health problems, are treated as criminals. Obviously the current approach is not working.

The reason for our government’s reaction to the report, however unsurprising, is less clear. Why in the face of overwhelming evidence against it are they continuing with an outdated programme that causes more problems than it solves? The Commission’s report is based on clear and sensible principles: that drug policies must be based on “solid empirical and scientific evidence,” and “on human rights and public health principles,” and that “the primary measure of success should be the reduction of harm to the health, security and welfare of individuals and society.” The recommendations made in the report all come with a huge amount of data, research or case studies that demonstrate that these policies are in line with their initial principles. What do governments, not just our own, hope to achieve by ignoring that and blindly trudging down a path proven to lead to increased drug dependency and related crime?

I can not claim to be privy to the inner thoughts of the world’s leaders, but in this case I think I can hazard a guess at them. The current War on Drugs does not, as it initially claimed to, focus on ‘health and welfare of mankind’ at all. Rather, it is an ideological stance. Drug use is illegal for the same reason homosexuality was and is: governments believe that it is seen by many as amoral. They outlaw it because they believe that the majority of their electorate find it offensive.

The report would seem to back me up on this. It specifically calls on politicians to “have the courage to articulate publicly what many of them acknowledge privately: that the evidence overwhelmingly demonstrates that repressive strategies will not solve the drug problem, and that the war on drugs has not, and cannot, be won,” as well as stating that “Currently, too many policymakers reinforce the idea that all people who use drugs are ‘amoral addicts’, and all those involved in drug markets are ruthless criminal masterminds.”

If this explanation is indeed the case then in my mind the most important part of the report is its fifth recommendation: “challenge, rather than reinforce, common misconceptions about drug markets, drug use and drug dependence.” Here the commission calls on governments to try and bring about an end to some of the common myths about drug dealers and users by making people aware of some well established facts, such as ‘the majority of people who use drugs do not fit the stereotype of the ‘amoral and pitiful addict’”; “most people involved in the illicit cultivation of coca, opium poppy, or cannabis are small farmers struggling to make a living for their families”; “the factors that contribute to the development of problematic or dependent patterns of use have more to do with childhood trauma or neglect, harsh living conditions, social marginalization, and emotional problems, rather than moral weakness or hedonism”; and that “Most people involved in drug trafficking are petty dealers and not the stereotyped gangsters from the movies – the vast majority of people imprisoned for drug dealing or trafficking are ‘small fish’ in the operation (often coerced into carrying or selling drugs), who can easily be replaced without disruption to the supply.”

I feel that there is another reason to spotlight this particular recommendation. While only those actually in government are able to directly effect the way that drugs are policed or the types of sentences handed out to drug users and dealers, this spreading of awareness can be done by anyone. Every single one of us can help dispel myths and raise awareness of facts.

In all, this report simply reiterates what we on the left have been saying for some time: that a law enforcement approach to tackling the drug trade is counter productive and that what is required are policies based on public health and well-being, which will almost always lead to a reduction in crime. Perhaps if our Home Office understood all this they would see that drugs do not usually do much harm, nor do they destroy lives. Their policies on them, however, do both these things. In the words of the Global Commission on Drug Policy, “Break the taboo on debate and reform. The time for action is now.”

Reviewing the Department of Health’s White Paper, on which the bill is based, last year the Conservative Bow Group said:

“A quick retrospective review of government policy since 1948 suggests there has not been a White Paper as reformist and radical as the current Government’s opening offering. For those who feared a meek and mild Government that would do nothing more than tinker and blinker with a discredited status quo, all fears have been allayed by this aspirational document.”

The Lancet in their latest editorial were even more blunt. Comapring the proposed changes to those of the fundholding experiment in the 1990s they said:

“The principle then was that GPs controlled the budgets to buy the specialist care their patients needed. Fundholding took years to implement, but evidence on short-term or long-term benefits for patients is lacking….there is sufficient  uncertainty and concern about the changes outlined in the Health and Social Care Bill to pause, to learn from the past, and to consider what the changes mean for patients’ outcomes. As it stands, the UK Government’s new Bill spells the end of the NHS.” (emphasis added)

They described the Conservatives claim to be “the Party of the NHS” as “a commitment that seems particularly hollow now.”

The BMA, whilst welcoming some of the changes such as a greater focus on public health, are also highly sceptical of many of the proposed alterations to our health service:

“Enforcing competition and adding price into the competitive mix within the NHS will always be damaging – doing so at a time of huge pressure on public finances and while staff are dealing with major structural change could be disastrous. The NHS needs to find efficiency savings of £20 billion by 2014-15. This is already resulting in cuts to services and staff, which have a direct impact on patient care.”

“The BMA is opposed to the idea that all NHS trusts should be forced to become foundation trusts by 1 April 2014, given the poor outcomes that have resulted in a small number of cases. Intensifying the pressure to achieve foundation trust status within the next three years could distort priorities and drive trusts to place the achievement of this target above all others, including safe patient care.”

The Health and Social care bill will radically alter the structure of the NHS and set us on course for a privately provided service. Management will be first to go, but the changes to Foundation Trusts and the desire to increase the number of social enterprises will mean that Hospitals and other services won’t be far behind. Check out this excellent video from Richard Blogger to see how:

What’s more, these changes will be forced through whilst overselling the need for reform at all. We’re told by the government that the biggest risk is to do nothing, that the NHS is inefficient and our health outcomes are worse than elsewhere. John Appleby, chief economist at the King’s Fund, writing in the BMJ last week, however, analysed mortality rates in the UK to discover that whilst our death rate from heart disease is indeed higher than that of France right now, on current trends we will be lower by next year. We’ll achieve that whilst spending just 8.7% of GDP on health compared with 11.2% in France. Other data paint a similar picture.

Our NHS can always be made better but it’s one of the most efficient in the world as it is, don’t let the coalition destroy it through their ideological attacks. Keep Our NHS public

Fortunately, in Caroline Lucas we have an intelligent, articulate, and passionate representative who has already impressed people outwith the party with her statements on Trafigura and the Ian Tomlinson case.

So why, oh why, did she have to wander into the area of science policy and back the wrong side?

As described in a previous post, homeopathy is nothing more than a marketing strategy from a multi-billion pound pill industry. Clinical trials repeatedly affirm that it performs no better than placebo and yet it gets NHS funding above, for example, prescribing ice-cream when you’ve split from a relationship, or chocolate cake when you’ve got period pains.

So what did Lucas actually do?

The British Medical Association debated the following motion at their Annual Representative Meeting (ARM):

That this Meeting believes that, in the absence of valid scientific evidence of benefit:
(i) there should be no further commissioning of, nor funding for, homeopathic remedies or homeopathic hospitals in the NHS;
(ii) no UK training post should include a placement in homeopathy;
(iii) pharmacists and chemists should remove homeopathic remedies from shelves indicating they are ‘medicines’ of any description, and place them on shelves clearly labelled ‘placebos’.

David Tredinnick MP put down an Early Day Motion in Westminster saying that the BMA had “has overstepped its remit by making such statements without proper consultation with its own membership”. Lucas signed this EDM.

Lucas then seemed to ‘justify’ this signing with the tweet:

EDM is about lack of BMA’s consultation & argues that local NHS better placed to know patient needs, based on objective clinical assessment

The BMA ARM subsequently voted and passed the motion prompting another EDM from Tredinnick condemning the move. Lucas has not signed this one.

So what’s the big deal?

Firstly, it is disingenuous to say the BMA lacked consultation. They set their policy like most other membership organisations – motions are submitted, debated at the ARM and voted on. This is how Green Party policy is made, and a variation on this for all the other parties. Neither political parties nor membership organisations consult their entire membership on each of their policies – that would be far too cumbersome and unworkable.

Secondly, Tredinnick is a famous supporter of frankly bizarre medical faiths including ‘medical astrology’ as well as homeopathy. Again, his accusation of ‘lack of consultation’ is tactical not genuine. He seems to believe that if health policy is set at a local level, homeopathy will get a look in thanks to local campaigns far from the critical eye of regulation. This is a foolish assumption as the grass-roots campaign 10:23 against homeopathy demonstrates; nerds campaign locally too!

But what is most worrying is that signing an EDM like this is a sop to the complementary and alternative medicine (CAM) wing of the Green Party. EDMs are pretty pointless in themselves, but they are helpful for gauging the opinions of back-benchers, identifying who your friends are as a campaigner and a quick an easy way for MPs to be seen to be doing something while they concentrate actual time and energy elsewhere.

I sincerely hope that Lucas values the principle of evidence-based clinical decisions in the delivery of health services and licensing of drugs. If signing this EDM is a way of appeasing the CAM followers in the Party then, although I understand that decision politically, I don’t really respect it.

The Green Party has to appeal to more than its base to progress and one of the things that puts off non-Green voters is seeing the Party as full of woolly thinking. The ‘skeptics’ and science nerds who are the most vociferous in criticising the Green Party’s science policies are so vociferous, I believe, because they WANT to vote Green, they are more aware than most about the science of climate change and are generally left-leaning (OK, I might get shot down on that assertion!).

Lucas is only one MP and I don’t think she should take on NHS drug licensing as an issue. However she should also stay away from those issues that will alienate potential supporters and win her no new friends. Here’s my tip Caroline: Do not touch anything involving Tredinnick with a 50 metre bargepole.

But of course that explanation from Labour HQ was superfluous – of course it is owned the company that built it. It will continue to be even after it opens, thanks to the mortgaging of the NHS that is the Private Finance Initiative.

Specifically, the hospital is the Queen Elizabeth Hospital in Edgbaston, Birmingham, which is being built by Balfour Beatty and will be owned and run by a consortium that includes Balfour as well as HSBC and the Royal Bank of Scotland – except by the happy accident that we are currently RBS’ bail bondsmen, the public will not own any part of this public service.

Instead, we will be in debt to the companies that have done us the favour of profiting from our need for healthcare.

How appropriate, then, that the film unveiled at the Queen Elizabeth by the Labour campaign should be one so indebted to BUPA:

Separated at birth – Labour and Bupa

And how appropriate that the content of this manifesto should also be a grateful tribute to the work of the healthcare profiteers in shaping New Labour:

• Every hospital in the UK to be a Foundation Trust, undermining strategic planning but encouraging competition for most profitable patients.
• NHS services that fail to meet standards will be ditched in favour of private alternatives.
• NHS services required to battle private competitors for patients.
• More money for hospitals with better outcomes – encouraging cherry-picking of patients

For all the criticisms of US healthcare reform, President Obama fought the healthcare profiteers. Gordon Brown might as well wear their logos on his suit like a racing driver (p42).

Let’s start with what Democrats actually managed to get through congress and onto the statutes. There’s no public option, no medicare buy-in, definitely nothing like single payer let alone a proper national health service. There’s no drug re-importation, no national exchanges, no federal commissioner to hold insurance companies to account. There will be expanded coverage, maybe another 31 million Americans, that’s not nothing, but it’ll be provided, mainly, by the same private insurance companies that we’ve been told have been doing such a bad job up till now. There’ll be little in the way of cost control but millions of working and middle class people will be fined up to 2% of their income if they don’t buy coverage. There are other, less ambiguously, good parts to the bill; there are important provisions to stop people with pre-existing conditions being denied coverage, some expansion of medicaid and SCHIP. But, fundamentally, as Michael Moore said on Democracy Now! this is a victory for capitalism, it changes nothing in the way health care is delivered in the US.
And the individual mandate isn’t the only problem with what’s been passed. The bill also included restrictions on funding for abortion services, and the executive order Obama signed to ensure the Stupak block in the house backed the bill goes even further. NOW president Terry O’Neill:

The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. Through this order, the president has announced he will lend the weight of his office and the entire executive branch to the anti-abortion measures included in the Senate bill, which the House is now prepared to pass.
President Obama campaigned as a pro-choice president, but his actions today suggest that his commitment to reproductive health care is shaky at best. Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law — it is an illegitimate tack-on to an annual must – pass appropriations bill. NOW has a longstanding objection to Hyde and, in fact, was looking forward to working with this president and Congress to bring an end to these restrictions. We see now that we have our work cut out for us far beyond what we ever anticipated. The message we have received today is that it is acceptable to negotiate health care on the backs of women, and we couldn’t disagree more.

And undocumented immigrants wouldn’t be allowed to buy insurance on the exchanges. As the good people over at FireDogLake (who seem to be the only ones not to have jumped into the pro hcr group recently) say in their six flaws that need fixing for meaningful reform “[t]his policy is not only cruel and immoral, but fiscally irresponsible.”
So, not really a policy that I’d say is terribly inspiring. But what of the argument that some reform is better than none? That compromise is different than triangulation and while there are problems the bill is a good first step, an advancement after decades of inaction that will set the stage for more extensive reforms to come whilst increasing coverage at the moment. Well, as FDL again point out, 23 senators had signed a letter urging a public option through reconciliation, and perhaps two dozen more had indicated they’d vote in favour of such an option since. The version passed by the house last year also contained a public option, which over 60 members of the house pledged to defend, so why didn’t the white house even attempt to pass one?
Perhaps, it has something to do with Rahm Emmanuel’s strategy, reported in Politico, that the democratic leadership should ignore the progressive opposition to the bill and focus on securing the centre, safe in the knowledge that the left of the party, the unions and the netroots would fall into line eventually. And so they did, almost without exception. Glenn Greenwald over at Salon:

For almost a full year, scores of progressive House members vowed — publicly and unequivocally — that they would never support a health care bill without a robust public option. They collectively accepted hundreds of thousands of dollars based on this pledge. Up until a few weeks ago, many progressive opinion leaders — such as Moulitsas, Howard Dean, Keith Olbermann and many others — were insisting that the Senate bill was worse than the status quo and should be defeated. But now? All of those progressives House members are doing exactly what they swore they would never do — vote for a health care bill with no public option — and virtually every progressive opinion leader is not only now supportive of the bill, but vehemently so. In other words, exactly what Rahm said would happen — ignore the progressives, we don’t need to give them anything because they’ll get into line — is exactly what happened.

A principled stand against triangulation and for a new version of the American Dream? Or a missed opportunity to really alter the structure of American politics?

When I wrote a blog post about how I dislike the political strategy at the heart of the West Wing I knew I’d get a bit of a response. Now seems like the right time to restate my argument. At heart my problem has never been with the televisual spectacle of the West Wing, it’s with what a superficial understanding of the frequently excellent melodrama has to say about politics. I’ll try to keep the spoilers to a minimum in what follows.

At the heart of the West Wing is a political strategy called triangulation. Triangulation is the process of moving your party into the middle ground in the hope of attracting larger numbers of voters. It’s been effective in getting parties of the centre-left, like the Democrats in the US and New Labour in the UK. It was what allowed Bill Clinton to get elected twice. But it fails dismally to change the political culture of those countries. I think it’s at the root of the disaffection with politics that is so damaging to our country, and to America.

Obama’s approach on healthcare has been to take a principled stand, work out how best he can secure a positive outcome and use that position to provide healthcare for all. While it’s not the ideal approach, and is too favourable to the insurance companies, it’s an awful lot better than the current approach. It sets the groundwork for a fully public option in future. The political strategy that delivered this is as far from triangulation as anyone can get. This is a policy change that liberals in the US have been trying to achieve for over 100 years. And now it’s been successful.

To use another example, when New Labour came to power in the late 1990s, it failed to follow through on many of the promises made in opposition. This is why, after 13 years, the UK has made little progress on key issues like child poverty. But there was one area where Labour followed its convictions. It pursued rights for Lesbian, Gay, Bisexual and Trans people to the point where Peter Tatchell can say there’s little left to achieve in legislation. The result has been a dramatic transformation in public attitudes to LGBT issues. While the public is now less convinced that poverty is a problem, it is broadly supportive of LGBT rights. This shows what Labour could have achieved without triangulation.

The most thorough critique of my blog post was from James at Two Doctors. He points to what I think is at the heart of my objection to triangulation. He says that Bartlett was on the right side on gays in the military. Unfortunately the Bartlett administration fails to do anything about it. West Wing politics is too often about thinking the right things, but not doing anything about them. For many of the worst Labour Students I’ve encountered (they’re the most committed West Wing enthusiasts), politics is essentially an ego trip. The only point is to get them into office. Once they’re there they convince themselves the decisions they make must be the best ones. If they ever had principles they get jettisoned in the quest for power.

Many of the worst examples of triangulation result from people who think the right things but do the wrong things. Too often we are asked to support politicians because they agree with us but are too cowardly to do anything about it. The point of politics is to make the world a better place. It’s to stop injustice. It’s to end poverty. It’s to stop climate change and support human rights. It’s not to get yourself into an office and, if you’re really lucky, a ministerial limo. Because so many people involved in politics think it’s all about getting into office politics is held in contempt.

Part of the problem is that people seem to genuinely think that they can learn how to do politics from the West Wing. I’ve watched all seven series of Six Feet Under. I don’t feel equipped to be an undertaker. James describes the West Wing as inspiring. It’s only inspiring if the point of politics is to get yourself into power. For me politics is about something much bigger. Ending apartheid is inspiring. Getting votes for women is inspiring. Ending the hundred year wait for universal health care is inspiring. It’s inspiring to be able to change the world. Merely being elected or selected into some office is not inspiring

The big difference between Bartlett’s fictional administration and the Obama Presidency is that throughout the West Wing, President Bartlett fails to change almost anything. In fact, he only gets one serious policy change through, and then, only because both Democrats and Republicans agree it is needed. Towards the end of his term in office, when his staff are asked to defend his record, they list “8 years of peace and economic growth.” For me, the point of the West Wing is that it is a lesson in how progressives can fail. But worryingly so many seem to think it is to be emulated.

By contrast Obama has shown that it’s possible to make real change, by avoiding triangulation. He has changed America – hopefully permanently – for the good by being true to his politics. He has succeeded where Clinton’s triangulation so spectacularly failed.

Being an MP, a Chief of Staff or even President isn’t inspiring. They might be good ways to change the world. But triangulation is never about changing the world. It’s about power, not change. It’s about the individual, not about the ideas. It’s about putting those ideas into legislation and changing spending. And while the West Wing is great TV, poorly understood, it is terrible for politics.