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John Passant

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August 2009



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My interview Razor Sharp 18 February
Me interviewed by Sharon Firebrace on Razor Sharp on Tuesday 18 February. (0)

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Can we humanise hospitals?

Can we humanise hospitals?  

The fundamentally undemocratic society we live in leads me to conclude not.

The profit system and the commodification of treatment and the rewards that flow to major participants like specialists, big pharmaceutical companies, insurance providers and medical technology companies, but not to nurses and general practitioners, reinforce that conclusion.

Not only that,  they create a powerful group or groups whose interests in health care for the rich present real obstacles to fundamental change like universal free health care, as those who supported Obama are now discovering.

Even the humanity that exists in hospitals is in the main provided by low paid nurses. 

The rest – the delivery programs, the architecture, the treatment of the patient as a consumer of a product, the brusqueness of specialists, the petty and not so petty cost cutting –  is a product of a system that puts profit before people.

This is not to say that the treatments we have today are not advances on the past.

Of course they are.  But they are narrowly focused and  benefit only small parts of humanity. 

A truly democratic and planned society would make health care in Australia a priority along with education, and addressing the 17 year mortality gap between aboriginal men and non aboriginal males one of its highest priorities.

It would divert the $25 billion we currently spend on the unproductive and anti-human defence forces to improving health and education for all.

Removing cost as a factor in determing both the nature of treatment solutions developed and offered and replacing it with a needs based approach turns treatment and the profit priorities that drive it on their head. 

Only a society which puts the human being at the centre of all health care concern can do that. 

In hospitals for example it would be the staff working there who make decisions about what should be done and who can argue in the newly established democratic forums for the appropriate level of funding from the wealth we as workers create to go to health care and the best way for delivery of such care.

Every nurse shall govern.

Until then the struggle for decent health care will continue unabated, with capitalists able only to offer minor changes over time, unless we force them. 

Free health care for all remains our dream



Comment from Benny
Time August 20, 2009 at 9:48 am

I’m confused – are you saying that the big pharmaceutical companies shouldn’t be in healthcare?

Comment from John
Time August 20, 2009 at 1:46 pm

I am not saying that Benny.

I am saying we should run society so that big phama and big medicine no longer exist, and we liberate health care from the narrow focus of profit. This is a fundamental turning of society on its head – we should do things cooperatively to help people, not indvidually or in mass concentrations of capital to make a profit.

While there is some cross over between profit and providing health care, it is, as Australia’s public health system shows, inadequate. It is skewed towards those with money and develops as it has for money.

The US is a good example of putting profit based health care before people based health care – 50 million Americans can’t get health care because their wallets aren’t big enough.

Comment from Benny
Time August 20, 2009 at 2:40 pm

Now I’m really confused by your response. Big pharmaceutical organisations develop new drugs and other things because they want profit. If you take the profit motive out of the equation, then aren’t you removing the primary driver for medical advances?

So are you advocating non-progression in healthcare?

You say “we should do things cooperatively to help people, not indvidually or in mass concentrations of capital to make a profit”, but if this was what people wanted, wouldn’t they be doing it now? I see a few medical developments that come from not-for-profit organisations, but they’re vastly overwhelmed by the output from the big profit seeking organisations. Surely then it’s in humanities best interest to keep the advances coming as quickly as possible, even if we have to pay for it?

Comment from John
Time August 20, 2009 at 4:14 pm


I want that as the future, when workers democratically run society to satisfy human need (and for example address malaria, HIV/AIDS) around the world.

The profit motive limits what we research and develop and its distribution.

Your arguments are I think a defence of the profit system as the highest form of humanity. Mine are that it is a step on the road to a truly democratic society based on cooperation not competition.

Research into medical advances would blossom, not be constrained by the narrowness of profit and its detemination of what is worthwhile to research and what is cost effective to do so.

Comment from Benny
Time August 20, 2009 at 4:26 pm

Sorry John, I don’t understand. You say that profit motives limit research and development, but that’s not demonstrated by what’s happening now. In fact, the big pharmaceutical companies are developing things at a much faster rate than non-profit organisations. Are you disputing that?

I could understand your point if non-profit companies were producing at the same rate as the for-profit companies, but that’s not the case.

So I can only ask the question again: Isn’t it in humanities best interest to keep the medical advances coming? If that’s the case, shouldn’t we keep the profit motive for the big pharmaceutical companies?

Or, to put it another way, if we remove the profit motive, won’t medical procedures and medicines stagnate (or at least stop moving forwards at the rate that they currently do) and so don’t we, as a society, go backwards?

Comment from Benny
Time August 21, 2009 at 2:10 pm

Hi John,

I noticed that you haven’t responded to this yet so perhaps if I ask the question a different way it’ll get a response:

what I’d like to understand is how removing the profit incentive will increase production of new procedures and medicines?

Could you please explain that?


Comment from John
Time August 21, 2009 at 2:47 pm

Because the profit motive both limits what is considered appropriate to research (ie concentrates only on what might lead to a profit rather than what will benefit humanity) and the distribution of any benefits. I am a bit distracted at the moment with my father having had a bypass yesterday, which is what prompted this article in the first place.

Comment from Benny
Time August 24, 2009 at 10:02 am

Hi John,

Sorry to hear about your father. Hope all goes well for him.

I understand how you might view research that way, but isn’t that a purely subjective viewpoint? For example, those who are now in need of the swine-flu vaccine are probably glad that the companies are chasing the profit and coming up with something that will (hopefully) work for them?

I guess on the other hand, my other question is whether it’d be a better overall system if we removed the advances that the big pharmaceutical companies make? If I try to do a cost/benefit equation on that, I come up with more costs (via less progress – even if it’s not always in the direction we (subjectively) want) than benefits, to which I can’t actually see any.

I guess my final question is if the research isn’t/shouldn’t be done by the big pharmaceutical companies, who should do it? And if whoever that is does it, will that be any better than the current system?

Comment from John
Time August 24, 2009 at 10:14 am

A democratic society in which all who produce the wealth make decisions (ie workers) would decide what is needed in general terms to research and provide the funds for that for the wealth they create. This would result in a massive blossoming of health care, including beneficial drugs.

in teh present system there is no apparent alternative, and non-profits are not the answer int eh context of a profit driven system. Only a complete overturning of social relations can change that.

Cost benefit is of what is, not what can be.

For the millions who die daily from preventable diseases, the cost benefit approach is irrelevant.

Comment from Benny
Time August 24, 2009 at 12:53 pm

Hi again John.

I’m sorry John but your last response doesn’t make sense to me. You say “A democratic society in which all who produce the wealth make decisions (ie workers) would decide what is needed in general terms to research and provide the funds for that for the wealth they create. This would result in a massive blossoming of health care, including beneficial drugs.”

How does the average lay-person in the street have the understanding of the importance of a particular medicine/treatment/requirement to make that decision?

I would suggest that the average person on the street neither wants to be involved in that decision nor is the appropriate person to make that decision. Most people, myself included, don’t have even a basic understanding of what it takes to research something, put it through the appropriate trials etc, so how could we really make a meaningful contribution to that decision? And the idea of putting our own cash into it… no thanks.

Plus, reality says that every person can’t understand everything to be in a position to make these decisions. And that’s even on the things that we want to make decisions on, let alone the ones that we don’t care about or don’t want to make decisions on.

And then we run into the risk which is inherent with people who don’t fully understand whatever the issue is: where inter-personal politics comes into it and people could be manipulated into agreeing to something that they don’t really want.

It doesn’t sound feasible to me. How could you overcome these issues?

But to take that further, if we were to apply that same process to all facets of our lives (city planning, working conditions, education curricula, tax concepts, production) then no one would ever get anything done – we’d always be arguing against each other trying to sort what we want to do?

This doesn’t sound realistic to me, John.

How would you suggest that we deal with these issues?

Comment from Benny
Time August 24, 2009 at 1:13 pm

Sorry John – I forgot to mention one other point:

I think we would all agree that people are generally self-interested, and in the case of medicine, I suspect that most people would advocate that ‘society’ researches things that are important to that individual, not necessarily what’s good for society.

Given that, it’s hard to see how the approach you’re advocating would be any different to the current one, with the exception that I suspect that rates of advancement would decrease

Comment from John
Time August 24, 2009 at 9:32 pm


I disagree. Most people aren’t self interested. They want enough to provide for themselves and their families and to live in peace. The society we live in emphasises self-interest at the expense of altruism and co-operation, but our essence is I believe cooperative. Otherwise nothing would get produced in capitalism.

As to decision making, yes I do believe we can all make those democratic decisions through workplace meetings, higher city and regional councils, national councils and international councils. Ordinary people are quite skilled and in any event we would use specialists (eg scientists on climate change) to aid our community decisions.

Removing the profit motive frees us from the present constraints.

As to health care, and research in particular, some research in universities is driven by the need to address a particular human need; the profit if it arises is an adjunct.

Indeed much pure research is not driven by profit but the quest for knowledge.

I just see our unplanned undemocratic society as a fetter on real human development and a democtratic one especially in the field of production as the next step forard for humanity.

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