So, in the UK the Coalition Government (Conservatives and Liberals, two sides of the three-sided party system of neoliberal politics and economics that dominates here) has just passed a piece of legislation called the Health and Social Care Act (previously the Health and Social Care Bill - it becomes an Act when it passes).
This legislation is widely seen as an attack on the socialised system of health (and social) care in the Country by those on the Left (and others!). Furthermore, it is seen as an attack on the principle of access to Healthcare for All.
Can we think of health(and social)care as a commons? How can we stop the value created by health and social care workers being sucked away into the pockets of the shareholders in multinational (frequently tax-dodging) companies?
Furthermore, at another level, what will healthcare look like in the midst of the environmental crises of climate change and declining supplies of resources our society is dependent on (specifically oil, but there are others)?
This research project is not just about abstract theoretical questions, but about looking at the social movements and alternative forms of health and social care delivery that exist across Europe, the world, and indeed across time - what can we learn from others and from the past?
A commons? Yes.
speaking as an economist (and relatively fresh from reading The Book on commons, i.e. Ostrom’s Governing the Commons), I would like to try to address your first question. Health care is probably not a commons. A public heanth care system like the NHS, on the other hand, probably is.
Here is the reasoning. For a resource to be a commons, you need two conditions to hold. Both are properties of its consumption.
- consumption must be rivalrous: if I consume one unit of the resource, you cannot consume the same unit.
- consumption must be non-excludable: it must be impossible or very expensive to prevent someone from unduly consuming units of the resource.
Wikipedia has a useful matrix that classifies goods into private, public, common and club according to the properties of their consumption: http://en.wikipedia.org/wiki/Public_good
Now to health care. In a private system, health care is rivalrous and excludable (you can only access doctors and hospitals if you have the money to pay for their services. However, a system like the NHS is designed to be non-excludable, so it becomes a commons. We all pay into it, it can come under strain if too many people use it at the same time, but we can’t easily stop others from accessing it, even incorrectly. an often cited case is that of elderly and lonely people with a lot of time on their hands and hypocondriac tendencies, who go to see their doctor almost every day - and this increases the number of doctors needed to serve everybody.
Health care and social care
Hi James, I wasn´t sure what you meant by, or why you distinguished between health care and social care so I looked them up on wikipedia:
“Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health.”
"Social care in the United Kingdom is defined as the provision of social work, personal care, protection or social support services to children or adults in need or at risk, or adults with needs arising from illness, disability, old age or poverty and their families and carers. That provision may have one or more of the following aims: to protect people who use care services, to preserve or advance physical or mental health, to promote independence and social inclusion, to improve opportunities and life chances, to strengthen families and to protect human rights in relation to people's social needs.[1"
I wonder how much of what healthcare costs is preventible and how much is unavoidable. And how much, as well as which parts in particular, of the diagnosis, treatment and prevention work needs to be done by professionals and why?