- Interview by
On the 72nd anniversary of the NHS, there is no scarcity of praise for the greatest social achievement in Britain’s history – but amid the avalanche of articles readers would find precious little mention of its socialist roots.
Aneurin Bevan, the minister responsible for its creation, suffered from no such timidity. He described the National Health Service as “a piece of real socialism,” and spoke of how it stood “opposed to the hedonism of capitalist society.”
For Bevan, the National Health Service was a radical endeavour, an effort to decommodify healthcare and make it not only public but free and universal. So committed was he to this principle that he resigned from the government over the introduction of prescription charges in 1951.
Longtime confidant Michael Foot would write of Bevan’s politics that
“His Socialism was rooted in Marxism; whatever modifications he had made in the doctrine, a belief in the class struggle stayed unshaken. Marxism taught him that society must be changed swiftly, intrepidly, fundamentally, if the transformation was not to be overturned by counter-revolution.”
In this interview, published in Tribune on July 2nd 1948, just a few days before the NHS came into being, Bevan makes those influences clear.
Placing its creation in the context of a broader social transformation aimed at empowering workers – and diminishing what Marx referred to as “the wages system” – Bevan describes the NHS as “the most revolutionary feature of the British Socialist programme.”
What relationship do you see between the social reforms to be introduced on July 5th and the general programme of Socialist advance?
The Socialist movement has advanced on three fronts. Each advance has been based upon a philosophical appreciation of the relationship of the working-class in the modern world towards modern society.
In the first case, the aim has been to increase the share of the available social product by way of higher wages and salaries. In that activity the trade union movement has been the spearhead. During the past century very considerable progress has been made, and the trade union movement has now an established position in society. This part of the front was obviously limited, because the assault was directed not to bring about a transformation in the structure of society, but to winning a more agreeable place for the workers in the existing structure.
On the second front we aimed at the transference of power by the transition from private to public ownership of the forces of production. Here we have made some headway in Great Britain in the last three years but, of course, there is still a long way to go. We have transferred coal, transport, electricity and gas. We are about to transfer steel. This is a fundamental change, because it is a transference of power.
The third front – and the one which has its roots more deeply in the Socialist philosophy than any other – is what we might call the distributivist front, that is, the slow destruction of the inequalities and disadvantages arising from the unequal possession of property and the unequal possession of individual strengths and opportunities.
How much do you think the new schemes satisfy the Socialist ideal of an advance towards equality?
The most important feature of the social services of Great Britain is the advance which they make possible on the distributivist front – what Marx called the “withering away” of wages by the reward according to people’s needs. This is done partly by the development of the environmental services, with which we are so familiar in this country that we do not realise the impact they have on the life of the community – sewage, modern water supplies, sanitation, scavenging, proper road ways and all the other governmental services of that sort which are mainly responsible for the great improvements made in public health.
Another category is provided by the direct social services like old age pensions, housing, widows’ pensions, family allowances, school feeding, national insurance from the 5th July, assistance of various kinds under the National Assistance Bill, the Children’s Bill, and now the Health Act.
The effect of all these measures, taken in totality, is to iron out the differences between one citizen and another which arise as a consequence of the anomalies of the wages system. If the wages system alone was the sole means – as, to a degree, in America – whereby the social product reached the individual citizen, it would reach him as unequally as the wages are unequal. But social services give people a share of the national product in accordance with their need, and thus emphasise the distributivist aspect of the Socialist advance. This advance is, in fact, undermining the wages system. The wages system is maintained as a stimulus to production, a traditional relationship between the worker and his industry; but distributivist activities undermine the worst consequences of the inequality.
The National Health Act does this much more effectively than any other part of the social service system, because it is not based on contributions. It is on the financial side a vast redistribution of national income. On the active and administrative side, it brings to the individual citizen all the battery of modern medicine, irrespective of the individual’s means. Furthermore, it is not only distributivist but it is perfectly democratic, because it democratises the social consumption of the recent advances in medicine, and it destroys the money barrier which inevitably existed in orthodox capitalist society between the doctor and his patient.
The insistence which Socialists lay upon the development of this distributivist service sharply distinguishes the Labour movement from the Tories. The Tories are laying increasing emphasis on what they call “property-owning democracy.” They want the consumption of the individual citizen always to be governed by the amount of property he possesses. The more property he has got, the higher his consumption. The extension of the social services ignores that property qualification, and insists on the equality of the individual citizen as such.
Here, then, is the main line of advance, whereby we are withering away the disabilities of the wages system, and it can be regarded in any respects as the most revolutionary feature of the British Socialist programme.
Where you speak of national insurance, the distributivism is not so marked. The element of equality is still there, of course, because the benefits are equal; but as a very large proportion of the financing of the scheme is provided by the workers themselves, the distributivist element is to some extent modified. In all the other social services, however, which are financed by taxation and by local rates, the central money pool from which they are financed is strictly related to the earnings of the taxed individual. The distributivist element is most marked.
It is not yet possible to express in arithmetical terms the value in weekly wages of the totality of social services in this country, but it must now be very considerable. Moreover, the economies of distributing social services rather than selling them, are enormous. Think what an army of persons would have been required if all these needs that we are now becoming accustomed to see supplied as social services were sold as commodities. You see the economic utility, as well as the social justice, of this expanding programme.
Have you any comment to make on the difficulties which may be encountered in putting the new schemes into practice?
I would like to make one reference to some of the difficulties that I have encountered in launching the National Health Service. It is an attempt at the introduction of egalitarianism through the medium of a society which is certainly not egalitarian, either in its structure or in its inspiration, and further through the medium of a profession, highly conservative, deeply traditional, and in many sections of it, hostile.
Further, it had to be introduced at a time of sharp inflation. This made the professions concerned even more resistant than they would have been in normal times. Were it not for the powerful authority of the Labour government, and its massive support among the people as a whole, it is fairly certain that professional resistance would have been too difficult to overcome.
However, the Act will now be launched on July 5th, and it is to be hoped that the momentum of this vast machine will begin to develop a tradition of its own, and extinguish the evil inheritances which tended to threaten it at its birth. It must be clear, however, to everybody in the Labour movement that we are not going to obtain from the National Health Service the best results possible, except by the utmost vigilance on the part of the whole Socialist, Co-operative and trade union movement.