Care Homes placed a spotlight on private enterprise, greed, and short-termism in ‘Care’ Homes. The data cited on deaths in Canadian Long-Term Care (LTC) facilities look better for public or voluntary provision than for private provision.
The apparent differences between the figures, however, might really mean that public and voluntary are grim with private provision even grimmer rather than one is inherently good and the other bad, particularly if both increasingly operate the same way even if it is for different reasons.
Both academic and lay accounts of what is going on in the care sector, particularly dealing with Covid linked care home deaths in facilities run by mega-companies, invariably mention neo-liberalism, asset stripping, outsourcing, and auditing as though these are all features of private enterprise.
Not so in between the lines, we are being told we need a rethink private enterprise.
For two centuries, however, risk averse governments putting money into things have been more insistent on auditing and evaluating the results they are getting than risk taking entrepreneurs who were more likely to just take a gamble. And the personal touch has generally been thought to be more likely in a private enterprise than a public one.
While the Left see the problem as neoliberalism, entrepreneurs and the Right see the problem as socialism, bureaucracy, or a Deep State getting in the way.
Blaming Neoliberalism and the Deep State are too easy when either no-one can nail down what either of these are, or everyone has their own idea.
This post is part of the Politics of Care Forum. A version of this and the following two posts was posted last week on the website of the Institute of Art and Ideas News under the title How Modern Medicine Became Dangerous, where the Care theme is more obvious
It is an absolute article of faith on the Left that Reagan and Thatcher ushered in neoliberalism – even though few on the Left can define it – other than to vaguely intimate the world is going badly wrong and this started in the 1980s and is an Anglo-American thing. And of course Reagan and Thatcher endorsed Milton Friedman and Chicago School talk about Free Markets, and ultimately Friedrich Hayek and The Road to Sefdom.
This iconic image of Reagan and Thatcher featured right at the start of a Guardian article on Neoliberalism, the ideology at the root of all our problems by George Monbiot, one of Britain’s most prominent Green campaigners. George has done a great deal of good on very many fronts. He was early drawing attention to the dangers of Sense about Science and the Science Media Centre.
The article was written in 2016. By then, it had become almost impossible to suggest this view might not be entirely correct.
Just as it is difficult to distinguish Neoliberalism from the Deep State, so also it is difficult to distinguish either or both from Technocracy.
In this sense, the first mention of a new problem came from Dwight Eisenhower on January 17 1961, when he referred to a military-industrial and scientific-technological complex. The key excerpts are here but the whole is worth reading.
A vital element in keeping the peace is our military establishment… Our military organization today bears little relation to that known by any of my predecessors in peacetime…
Until the latest of our world conflicts, the United States had no armaments industry. American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. Added to this, three and a half million men and women are directly engaged in the defense establishment. We annually spend on military security more than the net income of all United States corporations.
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence — economic, political, even spiritual — is felt in every city, every State house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications…
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes… Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
Akin to, and largely responsible for the sweeping changes in our industrial-military posture, has been the technological revolution during recent decades.
In this revolution, research has become central; it also becomes more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.
… the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded. Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite…
Equally compelling is a letter Eisenhower sent two years earlier to a dying Veteran, Robert Biggs, where he stresses that what is essential for a successful military operation cannot be the basis for a Free Society – Eisenhower to Biggs.
Eisenhower’s mention of a military being conjured up almost out of thin air just before World War II will surprise many.
As part of this conjuring act, we got military technology like never before culminating in the Atomic Bomb.
Less well known was the military turn to Cybernetics and the support of Cybernetics after the War. Computers would be the future of industry, warfare and much else – with DARPA later laying the basis for the Internet.
Cybernetic thinking brought algorithms and operationalism into the frame, along with flowcharts. Flowchart and provisioning rather than generalship or leadership were critical to mounting operations like D-Day.
They also laid the basis for a new Management Science, Systems Theory, that developed after the War. This management science laid the basis for MBA and related degrees which American Universities opened up to accommodate returning soldiers, particularly the officer class.
The new managers, allied to an increase in automation facilitated by computers, appear to have been supported by the military in automating a lot of US heavy industry – in part because the workers on the factory floor, particularly skilled workers, were viewed by the military as a possible fifth column, communists supposedly, who could handicap a military response in the case of a crisis.
So, when Kennedy and the Democrats took hold of the reins of power a few days after Eisenhower’s speech, what happened?
This was the party of the Left, the representatives of skilled and unskilled workers. Well Kennedy had campaigned on closing the missile gap with the Soviet Union, a gap that Eisenhower wasn’t bothered by. He engaged in a Space Race – putting a man on the moon was a test of Democrat virility. As was invading Vietnam, where a few years before Kennedy had been sympathetic to Ho Chi Minh and viewed Vietnamese wish for independence from France as similar to American wishes for independence from Britain.
Neoliberalism is widely viewed as an Anglo-American thing. At the same time as Camelot was flourishing, in Britain Harold Wilson, the new leader of the Labour Party, was sloganizing about how the White Heat of Technology would make Britain great again.
A few years later, Labour Peers were talking about UK plc – years before Thatcher came to power. When Thatcher won, Labour briefly flirted with a return to its socialist roots but then turned to Tony Blair and the Third Way – a code for neoliberalism
Years before Reagan came to power, Jimmy Carter’s Democrats were openly technocratic. They were talking and implementing deregulation long before Reagan. See Democrats and NeoLiberalism.
The Democrats didn’t entertain the idea of returning to socialist roots of any sort. In the early 1980s, before anyone else had heard of neoliberalism, the Democratic National Committee, the body that later propelled Clinton to power with a mission to End Welfare as we know it, had agreed to adopt the tenets of what was later called neoliberalism as the platform for returning to power.
One of the few people on the broader Left who took a different view was J.K. Galbraith. In his 1967 The New Industrial State, Galbraith identified a neo-corporatization. Private companies were no longer run by entrepreneurs – they were run by bureaucrats (managers). These people were trained in business schools, who had not asked what the consequences for business might be if we replaced entrepreneurs with bureaucrats – now one of the key features of Deep State complaints.
There was in effect no such thing as a Free Market anymore. Corporations were at one with the government – at least in being process driven and averse to risk-taking. Grappling with them was increasingly Kafkaesque.
In contrast, another icon of the Left, Michel Foucault, was by the 1980s clearly making the transition to neoliberalism – again before anyone had heard the words. Foucault branded Sartre, the previous leading figure on the French Left as a nineteenth century liberal – what came to be called an ordo- as opposed to neo-liberal. Sartre hadn’t realized according to Foucault that governance was now how we governed ourselves.
Many on the Left point to a moment in 1971, when the US Chamber of Commerce approached Lewis Powell, one of the Supreme Court Justices, to draft a plan to save US corporations from a growing democratic threat. After 1968, democracy did seem to be tottering – the people seemed more powerful than ever before.
Powell’s 1971 prescription fuelled the huge increase in corporate lobbying that is such a feature of politics today. This prescription is spun as the key remedy that restored corporations to good health.
Power and control were restored soon after this – and the people were put back in their place. But it is not clear that anyone on the Right or Left of politics could have had much sense as to how order was about to be conjured out of chaos. It had little to do with corporate lobbying. If Galbraith is right, Powell’s memo was effectively promoting the Deep State.
Less than two decades later, whether we came from the Right or Left, the idea that if we apply the best techniques to problems we will get the best possible results, seemed utterly obvious. Technocracy had arrived. But in 1971, this was not on many people’s radar and certainly not on Powell’s. Corporate lobbying increased but this usefully diverts our attention away from more important drivers of events.
As outlined in Shipwreck of the Singular, looking at what happened in medicine at the same time, faced as it was with an antipsychiatry and Ivan Illich castigating Big Medicine, an establishment being besieged by the people, it is clear that no-one had any idea about how control was about to be restored there either – but it was. How?
Lobbying increased at both the macro and micro-level with every doctor individually lobbied by company reps. Groups like No Free Lunch formed to undo the corrupting influence. This usefully diverted attention away from more important drivers of events – the technocracy that Medicine turned to in an effort to save itself ironically from this pharmaceutical industry lobbying – Evidence Based Technocracy.
Pointing to all these discrepancies in the traditional narrative about the rise of Neoliberalism and Deep States doesn’t tell us what either of these are or indeed whether one of them is both the same.
There are two elements to both. One is an operationalism, incorporated in a new management science, that led to a neo-corporatization, or a bureaucratization of corporations that had not been there before.
This led to the outsourcing or subcontracting, which along with auditing many see as Neoliberalism and others see as part of the Deep State.
But we don’t have the full Neoliberal or Deep State deal, the thing that locks the Iron Cage shut on us, without a turn to metrics, to figures, for which an algorithmic, if X then Y, is the answer. If the temperature goes up, the air-con turns on or furnace turns off.
If an economic metric goes up or down, the politicians do whatever it takes to get the figure back to where it should be regardless of what happens the country or the climate. There is, as Tina said, no alternative.
If physiological figures go up or down, a drug is the answer and it is becoming increasingly close to negligent not to prescribe, regardless of what happens the patient.
We are now heading toward mandating biopharmaceuticals. This is not just the superficial rationality of correcting some figures with something that claims to be an answer but an increasing inability to think of any alternatives.
The patients are waiting for HARPA.
Again and again reviews of the failure of Social Care indicate that the number of complaints point to ‘problems with systems and policies’ rather than ‘one-off mistakes’.
Added to the constraints of rationality that lock our politicians and doctors into a prescribed course of action, the system failures bring a hopelessness that stems from a failure to imagine anything other than what we have and perhaps a lack of the courage to make a difference.
Our dilemmas were caught beautifully by Chuang Tzu in 323 B.C.:
“For security against robbers who snatch purses, rifle luggage, and crack safes, one must fasten all property with ropes, lock it up with locks, bolt it with bolts. This is elementary good sense. But when a strong thief comes along, he picks up the whole lot, puts it on his back, and goes on his way with only one fear – that ropes, locks and bolts may give way.”
There Are Options – TAO.
Chuang Tzu was fishing with his bamboo pole in Piu river.
The Prince of Chu sent two vice-chancellors to say
“We hereby appoint you Prime Minister”.
Chuang Tzu said:
I am told there is a sacred tortoise offered and canonized 3000 years ago,
venerated by the prince, wrapped in silk
in a precious shrine, on an altar in the Temple.
What do you think, is it better to give up one’s life
and leave a sacred shell as a cult object in a cloud of incense for 3000 years,
Or to live as a plain turtle dragging its tail in the mud?
Go home. Leave me here to drag my tail in the mud.
Succeeding posts will cover the operational
and metric components
of Neoliberalism, Deep States and Technocracy, and the impact of these on Care.