April 12, 2020

Capitalism, Socialism and the Pandemic

IT has taken a tiny but lethal virus, in the twenty-first century, to show up once again, the difference between the two social systems – capitalism and socialism. The way certain countries have dealt with the global coronavirus pandemic has only served to highlight this difference.

At one end is the United States, the most powerful imperialist-capitalist country in the world. It also has the most extreme form of privatised health care system – a health sector run by corporates and profit driven. Such a set-up has been shown to be woefully inadequate in dealing with a public health emergency – it has too few hospital beds, ICUs, ventilators and personal protective equipment for health workers. In normal times too, health care is enormously expensive and the private health insurance system makes it unaffordable for millions. This is a reflection of the highly unequal society that America is, where even in times of the corona crisis, the rich can get better treatment and avail of fast- track facilities by paying fat fees to medical consultancy agencies.

This is in stark contrast to tiny Cuba which in its endeavors to develop a socialist society has built up an enviable socialised health system. Faced with US sanctions and an economic embargo, Cuba has relied on its own resources and efforts to build a model health care system to serve the people. Medical treatment is free in Cuba except for a nominal fee for registration. Cuba has also developed an advanced drug industry based on biotechnology. Cuba has been sending medical missions and its doctors to serve the poorer sections of people in various countries of Latin America, the Caribbean and Africa. In the Covid-19 pandemic, Cuba has sent doctors and para-medical staff to Italy, Venezuela and four other Caribbean countries. Such a medical system and health indicators in Cuba became possible only because there is a socialist system which provides free public education, public provisioning of food and housing and significant changes wrought in the status of women.

In other advanced capitalist countries, where unlike the US, there were relatively better public health systems, neoliberal policies and years of austerity have weakened and eroded the public health facilities. The National Health Service (NHS) in UK suffered due to underfunding and privatsation of the health sector; the Italian public health system was also affected. In the present crisis, the folly of undermining public health care has been brought home to people in these countries in a stark fashion. Spain has even nationalised private hospitals.

China, which was the first to be afflicted by the Covid-19 virus, mounted a tremendous effort to contain the spread from Wuhan and Hubei province and marshaled all its resources in the medical sector to stop the spread of the virus. The WHO-China Joint Mission report has called this the most “ambitious, agile and aggressive disease containment effort in history...” China could do so because it has a robust public health system. In 2009, the Chinese government published an official document, “Opinion on Deepening Health System Reform” – a political commitment to establishing an accessible, equitable, affordable and efficient health system to cover all people by 2020. The progress made in this direction is evident. Total health expenditure grew from 5 per cent of GDP to 6.4 per cent in 2017. Out of pocket expenditure dropped to 29 per cent of total health expenditure and 82 per cent of in-patients care was provided by public hospitals in 2017. China has a giant pharmaceutical industry which also provides the chemical reagents and materials for pharmaceutical companies around the world.  All this was possible because of planning and a social sector development free from the profit motive.

India fares poorly in comparison. It has one of the most privatised health systems in the world. The National Health Policy adopted by the Modi government incentivizes privatisation.  The public expenditure on health is only around 1 per cent of GDP. The out of pocket expenditure of households comprise nearly 70 per cent of total expenditure on health. Only 44 per cent of in-patient care is in public hospitals. Leave alone a public health emergency, the public health system is incapable of meeting the normal health requirements of the people.

The exception to the national picture, is of course, Kerala. Already Kerala has won appreciation for the prompt and efficient manner in which it has gone about tackling the coronavirus epidemic.  This is because of a public health care system which has been developed over the decades. This system has got upgraded and reformed under the current LDF government which launched a health mission called Aardram in 2017. The primary health centres are being converted into family health centres with strengthened personnel and facilities. The taluk and district hospitals have also been upgraded and the training of health workers enhanced. The better health indicators in Kerala are also an outcome of social determinants such as food security, education, housing, sanitation and gender relations. This ‘Kerala model’ is in turn influenced by the Left role in policy making and public action that is motivated by socialistic goals.

The harmful effects of the capitalist system to people’s health and well-being have been brought out starkly by the pandemic. Conversely, the case for socialism has got strengthened. It is upto us to use this experience in our armoury to take the struggle for social transformation forward in the post-Covid phase.

(April 8, 2020)