Or rather why do metropolitan elites not trust the Working Classes?
Before you doubt my sanity, let me clarify a couple of buzzwords in the title. By regressive left I mean a widespread political current that positions itself on the progressive left, but always sides, when push comes to shove, with remote institutions who want to control rather than empower ordinary people. If progress means redressing the balance of power from elites to humble commoners, we should call many policies favoured by today's trendy left regressive as they undo much of the real emancipatory progress we have made since we cast aside the tyranny of our feudal overlords and the slave labour masters of early capitalism.
The second misconception is that anyone who questions the sanctity of the UK's National Health Service must be motivated by the vilest hatred towards the sick and disabled. Most of us aspire to good health and greater personal independence, which usually entails ideally being able-bodied. Medical advances have in many ways worked wonders enabling more otherwise incapacitated people to survive than ever before. Moreover, assistive technology can overcome the limitations of many physical and sensory disabilities, which most of us would agree is a good thing. I wouldn't wish paraplegia on anyone, but I welcome the availability of electric wheelchairs, adapted cars, hoists and robots to help the victims of spinal injuries lead more independent lives. However, the real debate is not whether we need health services, but how do we best provide healthcare to let more people lead meaningful lives? In other words, should our healthcare system empower us to lead the lives we want or should it empower professional elites to control our lives for the greater good?
I recently sprained my ankle on black ice, struggled to stand up afterwards and needed help to travel home. As the pain did not subside and my ankle swelled, my wife took me to the local A&E for an X-Ray. Predictably I was asked about all the medical conditions I may have, what medication I was on, whether I smoked, how much exercise I got, whether I had had a flu jab or suffered from any mental health issues. Ever since a misdiagnosis for a neurological condition 15 years ago, I've been a low-maintenance NHS patient. I hardly ever use the service unless I really need to. Admittedly the NHS did help me following two road accidents as a child, but back in the 1970s total healthcare spending amounted to just 4% of GDP. It now stands at 8% and rising without taking into account the country's huge social welfare budget and the growing private healthcare sector.
Like it or not, lifestyle changes and better medical technology have transformed the healthcare sector as we live longer and are more likely to be diagnosed with lifelong conditions requiring some form of treatment. Being on life support is a mixed blessing. You may enjoy more fruitful years of your life, but at the expense of less personal independence. If you're a subsistence farmer eking out a frugal living on a remote farmstead, you can maintain a high degree of personal independence as long as you are able-bodied. Sooner or later we all die, but the experiences we cherish most are our personal achievements in building a livelihood for ourselves and our loved ones. If other organisations assume these roles, then these feats are no longer personal achievements, but merely rewards for our participation in wider society.
I'd like to think that control over your body is one of the most fundamental human rights, but apparently not if you subscribe to the concept of socialised medicine in which healthcare professionals implement solutions that minimise the incidence of disease and problematic medical conditions in the general population. A classic example of this mentality is fluoridation of the water supply. Small doses of fluoride can help combat tooth decay when applied topically in the form of toothpaste. I won't debate whether alternatives are more effective or how we managed before the advent of toothpaste. Nonetheless, many people are lazy and do not brush their teeth as regularly and effectively as they should. In the 1940s some social planners heeded advice from phosphate industry lobbyists to add fluoride to the municipal water supply. Many surveys published since have shown marginal decreases in the incidence of caries in working class children, the category most at risk. However, dental health has improved in leaps and bounds almost everywhere over the last 50 years, mainly due to better personal hygiene and a growing obsession of perfectly aligned white teeth, in regions that have never introduced fluoridation, which is most of continental Europe. Indeed many independent biochemists have argued that risks of foetal brain damage and dental fluorosis caused by a fluoride overdose outweigh the marginal benefits of reducing tooth decay in vulnerable individuals who eat lots of sweets and fail to clean their teeth often enough. While public policy wonks may debate its effectiveness, fluoridation transfers responsibility away from families and individuals to remote organisations. Support for such policies always comes from elitist think tanks, and seldom comes from grassroots movements. People like to have emergency health services available locally in case of unexpected injuries or illnesses, hence widespread public opposition to the closure of smaller local hospitals, but almost total indifference to the provision of flu jabs. Sure nobody likes to get the flu, but many of us remain unconvinced of the efficacy of a vaccine against a common family of viruses that keep mutating. As it happens, many of us have friends and family who have succumbed to flu despite agreeing to their annual injections. Alas we often have little choice than to go along with professional medical advice. Vaccines against common diseases are now practically mandatory for school children, teachers and care workers due to the concept of herd immunity. It doesn't matter what you think as a mere layperson about the effectiveness of medication, only what health professionals advise you to do.
The relative pros and cons of vaccination and fluoridation may be the least of our worries. Moves are underway to merge healthcare, social care and psychological monitoring, also known as mental healthcare. Inevitably over time combined social, physical and mental healthcare will amalgamate with education and policing too. Currently politicians from all parties here fall over each other to support the equality of mental and physical health. Sadly few have seen where this is leading us as we begin to equate unwelcome feelings, awkward personalities and politically incorrect beliefs with real illnesses and injuries that have verifiable physiological causes. If I disagree with the orthodox view on climate change (and by the way I don't), I'm not diseased. I may be wrong, but that's my right. Likewise if I'm generally a bit grumpy and too argumentative for the likes of some colleagues and family members, that's my business. As a rule if you want to keep your friends, it's not good to be grumpy all the time, but we would not be human without feelings and a strong sense of self. If I visit my GP with a sprained ankle, I don't expect him or her to evaluate my state of mind, enquire about my erotic preferences or try to have me assessed for a flurry of unrelated medical issues such as diabetes or prostate cancer. We may call this modern approach mission creep or disease-mongering.
Most practical people accept the need for public services in any complex society reliant on infrastructure like roads, railways, clean water supply, electric power and telecommunications. I know some libertarian anarchists imagine all services could eventually be privatised or run by small cooperatives, but let's be honest human nature would soon lead to some very exploitative practices as some entrepreneurs try to outsmart the masses and create new oligopolies. The point is do these public services serve us or do we serve them ?
One of the main dilemmas of modern medicine is the sensitive topic of personal responsibility. If I choose to engage in dangerous sports such as free climbing, off-piste skiing or motocross, should I expect my socialised health service to foot the bill in the event of an accident? Likewise if I prefer not to wear a seatbelt or crash helmet, should I expect other taxpayers to subsidise the additional costs of post-trauma care if I suffer severe brain damage that these safety devices may have prevented? Today in most Western countries one has little choice but to comply with strict regulations on these matters. So what happens if I choose to eat lots of junk food and partake in regular in binge drinking sessions, both perfectly legal activities in Western Europe? Should my indulgences be taxed to subsidise my statistically greater chance of succumbing to a broad gamut of diseases and, come to think of it, mental illnesses?
We really have to ask how a small subset of the population can cost the NHS a disproportionate amount of resources due to illnesses related to lifestyle choices. Yet now social justice activists play politics with good science by downplaying the importance of personal agency and social values while emphasising inherited behavioural traits or neurological diversity. Thus a dysfunctional behaviour like gambling addiction may be viewed as a neurological defect rather than a problem either with somebody's lack of wisdom or with the cultural pressures that may have led to such ill-judgment.
Solidarity requires trust and mutual respect, which in turn rely on strong cultural compatibility. We can either win the trust and respect of our neighbours through our own good conduct or we can rely on external agencies to engineer solidarity through education, awareness raising, social monitoring and law enforcement. By medicalising a condition that we would have until recently considered just part of someone's personality, the authorities can expand the range of people who require some form of treatment and thus depend on their guardianship. The system, for want of a better word, treats us increasingly like children incapable of making rational choices without some official advice. It wants us not just to seek their guidance, but to be fully integrated into an invasive human inspection network. The more often we require some form of interaction with social and medical services, the more they can monitor every aspect of our private lives and delve into our innermost thoughts. Just imagine visiting your GP for a regular checkup, only to be asked not just about your sexuality, but your state of mind via a series of questions that tap into your attitudes about key cultural and philosophical issues. What if your GP is required to ascertain not just if you're gay or straight, but if you have opinions that some may consider homophobic or Islamophic? I doubt medical professionals would ask such questions directly, but these subjects may crop up in a discussion about your mental health e.g. Suppose a patient reported feeling depressed because she's the only non-Muslim person left in her street since her old neighbours moved away. Should her GP note her patient's cultural alienation as a contributing factor to her depressed state of mind or should she consider her patient's perceived xenophobia as a medical condition in and of itself? With the rapid proliferation of recognised personality disorders, it is easy to see how concerns about someone's mental health can blur into an intrusive investigation of their philosophical outlook on life in a drive to mould people's behavioural patterns for the greater good of wider society. But who gets to decide what is good for society or not? Inevitably this task will fall to a bureaucratic elite of social planners and their army of enforcers in the guise of health visitors, primary school teachers, special needs assistants and social workers.
Hierarchical Collectivism vs Widespread Empowerment
The anti-plutocratic left, with which I still identify, has long had two main currents that aim:
- to engineer a collectivist social conscience via an enlightened vanguard or
- to empower millions of ordinary workers to lead more fulfilling lives with greater personal independence.
Most ordinary people focused on their immediate circumstances and the wellbeing of their family and friends favour the latter approach. Campaigns for better pay and working conditions appeal to millions of common folk. In a battle between greedy bosses and poorly paid shop floor workers, the empowerment left sides with the wage-earners rather the parasitical managerial classes. That's broadly why left-leaning parties like Labour in Britain still attract more support from the notional proletarian demographic. Despite all its betrayals, many of us just can't bring ourselves to vote tactically for the Tories and hesitate before placing our cross next to demonised parties associated with the nationalist right.
In most of Europe and North America the working classes have long given up on ideological socialism as a route to self-empowerment. Meanwhile, the vanguard left have co-opted other victim groups to further their cause and have counter-intuitively forged new alliances with the emerging technocratic elite, who no longer need a large skilled working class.
The ongoing cybernetic revolution with the rapid evolution of artificial intelligence and versatile robotics will soon dispense with rank and file workers and thereby consign the labour movement to the dustbin of history. What matters is not so much the percentage of people who are in some way employed, but the proportion of mission-critical workers whose expertise cannot be easily replaced. The latter number has declined significantly. If project managers, recruiters, marketing executives, health and safety inspectors, social media supervisors and psychiatric nurses all go on strike, the system will not grind to a halt overnight, just its smooth operation will not be monitored as meticulously. Rest assured that many aspects of these jobs will eventually be computerised too.
Working class idealists of yore dreamed of a bottom-up revolution in which the workers would overthrow their bosses. By contrast today's social justice activists infiltrate NGOs, public sector organisations and increasingly big business itself to campaign for greater social regulation and surveillance. The healthcare sector is at the very epicentre of the new social-corporate complex that is gradually emerging from closer integration of tech giants, leading retailers, public services, charities and government. Facebook, Twitter and Google are deeply integrated not only with Amazon, but increasingly with supermarket chains like Tesco, Asda and Sainsbury's, your local hospital and myriad third sector organisations involved in various aspects of our lives. It's hard to tell where one ends and another begins.
Most policies that media pundits like to call progressive on topics as diverse as immigration to transgender rights and mental healthcare, tend to appeal much more to professional elites than to ordinary people on the ground, unless they can be persuaded that they belong to a favoured victim group. Back in the day leftwing activists would stand up for factory workers, miners and lorry drivers because they were exploited by their greedy bosses. These days upper middle class leftists champion the disabled, mentally ill, single parents, LGBTQ+ community and, of course, new itinerant communities defined by their ethno-religious affiliation as potential beneficiaries of what we can only logically call corporate welfare and potential clients of the mushrooming social surveillance sector.
Who Funds the Welfare Panacea ?
Over the last two decades Western European healthcare policies have ironically taken their lead from North America with a growing emphasis on the proactive diagnosis of medical conditions and precautionary mass medication, despite mean life expectancy being higher in most of the Western European than in the US. Healthcare spending per capita is significantly higher in the US with often exorbitant medical insurance bills. However, this lavishness has led to greater innovation and a much higher propensity to treat a wider range of medical conditions, bodily imperfections and psychological challenges. Traditionally Britain's NHS had a reputation for frugal cost-effectiveness and was, until recently, much less inclined to treat ailments that did not significantly impair someone's livelihood, such as cosmetic surgery to treat depression resulting from a poor body image. As a result the health spending gap between the world's top economies has closed.
The biomedical lobby has appealed both to growing public demand and to the instincts of politicians keen to improve healthcare to persuade either government or insurers to fund a massive expansion of their industry. This is not necessarily bad news as advances in medical technology have undoubtedly saved the lives of millions who until recently would have suffered early deaths. However, it has also greatly increased the number of people who depend on regular medical treatment, turned many into hypochondriacs and medicalised emotional unease. In his 2010 book Anatomy of Epidemic Robert Whitaker chronicled the proliferation of psychiatric diagnoses in the United States , which has now spread to Europe. Prescription rates for depression, social anxiety and psychosis are also soaring in the UK, as highlighted only yesterday in the left's bête noire, the Daily Mail. This predictably led twitter activists and virtue-signalling bloggers to condemn the popular newspaper for sensationalism and hatred against millions of ordinary people on such medication. Only a decade ago, most criticism of pharmaceutical lobbies would have come from the left. Alas drugs play a major role not only in mental health treatment, but in promoting alternative sexual lifestyles and gender expressions. The biomedical lobby is totally on board with the new fad for transgenderism, yet another excuse for medical intervention on spurious neurological grounds. Yet few ask just how are we going to fund this huge expansion in the age of smart automation and a growing wealth gap? In the end big business will foot the bill as practically the only generators of real wealth, but only by turning patients into loyal customers and experimental products.
The elitist left plan to secure their key role in the new social management sector by actively championing any causes or cultural trends that boost the number of people who need some form of monitoring. This is not social progress as I imagined it as a young socialist over 30 years ago. Social justice warriors, as many critics call this new breed of arrogant bandwagon jumpers, do not want to overthrow the establishment, they want to cheerlead the new technocratic establishment's attempts to reimagine humanity.