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Wednesday, 3 January 2018

Why Healthcare in NZ Implies Priorities in Advocacy

Earlier today I happened to come across this post.  It's about solidarity, but I initially paid much more attention to healthcare. This post will reflect that. So, first, the healthcare stuff:
Take healthcare. We Kiwis [ed. yuck] take such pride in our public health system. We look at the absolute disaster of American healthcare and feel very smug.
Labour’s policy platform says this about health: “a nation where all New Zealanders, regardless of income or social circumstances, are able to live longer and healthier lives because they have the knowledge to make informed health decisions and the support of a strong and adequately funded public-health system.”
That’s a damn strong set of values.
But let’s take three issues which put that principle on shaky ground. (This may be where I lose some of you.)
And, indeed, that is indeed where Rodgers lost me. But not, I think, for the reason she imagines. There is, you see, a fourth issue (i.e. beyond abortion, assisted dying and trans health care) which is much much bigger and a much much stronger criticism of that statement. It is extremely conspicuous by its absence and it is the sort of thing I interpret as proof of my views on the modern political paradigm. I speak of the very affordability and accessibility of healthcare in this country.

(The bulk of this post was written as a comment at the bottom of Rodgers' repost.)

The reality is that when it comes to healthcare in New Zealand those are relatively small issues (and assisted dying/euthanasia is always in and out of the mainstream). I die a little bit inside whenever someone tries to tell me how much better NZ's health system is than the USA's. Do you know why? It's because ours is pretty rubbish for a pretty similar symptom... there are massive access problems associated with the system. Why the USA's system is terrible for the deprived is different (that's true) and the USA's healthcare system is uncategorically worse but our system is only better in the sense of "at least it's not as bad as theirs". There is nothing to feel smug about in our healthcare system.

Visiting your GP in this country has a varying cost dependent upon where you live. For instance, we used to live across the road from a doctor but we could also have gone to the local Counties Care which was quite a lot further away. If we were enrolled at the latter site (which we shouldn't be because, you know, it's so much further away) visiting the GP would be cheaper. That's a problem.

In New Zealand, the way the subsidisation of the very basic concept of "visiting your doctor" works is not just arcane in the sense that it's hard to understand, but also in that relatively few people actually experience it. Why? Because the subsidisation is a long long way from the point of "so cheap you don't notice the price". Which is why you find emergency rooms chock to over-filling... even late at night. I know this, because I've seen this.

Probably the best bit of our system is ACC. Of course, it creates a lot of stress because you've got to fill in all these forms. The chief worry is probably that (due to not being a doctor) you're always wondering that if you tell the complete truth you're going to end up having to face costs because maybe this thing you weren't worried about last week might have caused whatever you're coming in with. And I guess ACC also creates the perverse case of trying to make things look like accidents... and then it turns out that some stuff has exceptions even though it is an accident (see the not-Botulism poisoned family)... universal no fault my arse. Which is to say, ACC has some big problems too.

Don't even get me started on how screwed up it is that we have a God-damn charity running our ambulances. And charging through the nose, if you've got the nerve to need an ambulance for something ACC won't cover. In America the state actually looks after this. Much better. Ugly ambulances, but provisioned in a rational manner. No idea if they charge through the nose also (thinking about it now, that's an almost certainty) but there you are. But where's the smugness?

Honestly, I'm not sure what it is in our health system that I can have no reservations about. I guess I can just be thankful it's better than how it was in (the post-reform) 1990s, right? But that's almost as bad as saying it's better than America's. Maybe the higher level stuff (serious illnesses and the like) is done better but the way the system should be engaging with the majority of people is screwed up in such a fashion that people just don't see a doctor. That's an enormous problem and it should attract serious attention. It doesn't. And, unfortunately, because the root cause is "not having money" the only ways anyone talks about it is through "the living wage" and where deprivation intersects with other forms of disadvantage.

That last bit is why I think Rodgers' views on solidarity are seriously challenged by the nature of healthcare in New Zealand. But before we get to the title of this blog post, I should probably quote those views, no?
When we talk about values, and say we believe in certain things, and then we turn around to people and say “shush! Wait your turn! We don’t want to talk about your health, or your lives, or the support you need, it’s a distraction!” all we do is undermine ourselves. We show that our values aren’t dearly-held and unyielding – they’re flimsy. No one elects flimsy.
[...]
This is how we improve the political prospects for the left in 2017: being bold. Standing on our principles. Even if people disagree with you, they respect you when you’re consistent and honest. [...]
This sounds good, but it has its problems. Values should be applies to circumstance, which means we need to stop acting like "flip flopping" is a great sin in politics (I'm simplifying a bit, flip flopping is more than just updating). Political values and positions that don't respond to contradictory evidence are not worth respecting. Truth has a bit of a bad name, but it's a value that everyone should have. The trouble is that Truth and Consistency are not good bedfellows.
A mass movement is not built by finding the largest homogeneous group we can and appealing solely to them. A mass movement is not built by nominating one group – like white working-class men – as the most important people to reach, and expecting women or Māori or queer activists to fall in line for the good of the cause.
[...]
That’s how we change the world. By being ourselves. Being the people who believe in solidarity and standing up for the oppressed, even if they don’t look like us or sound like us or need the same things as us.
[...]
In 2017, the challenge for the Left is not to find the magic words which will make a mythical racist white working class vote for us. It’s not to silence women or transgender folk or Indigenous people. It’s to stop buying into this divisive bullshit, and show everyone what our values are, and that a better way of doing things is possible. 
I think that Rodgers misses several key points in here. Firstly, that people who believe they've been silenced and excluded... told to sit by and wait why the real fight happens... isn't just women, Maori or queer activists. Secondly, that this sounds all rather impossible. How on earth can one do all things for all people? And I do think that's what she's saying here. Our values are, by definition, enormous and far reaching. Ultimately, I think Rodgers is working with a standard of solidarity that is not only unreasonable but actively harmful. The reason for that is scarcity.

It turns out that people have only so much time in their lives. That scarcity of time isn't, or shouldn't be, a barrier to solidarity because, hey, solidarity is signing a petition, it's driving past a strike on your way home and honking your horn or spontaneously donating some food to the strikers and it's saying you're on board. What solidarity isn't is advocating for everyone and everything. You can't do that. It's too much.

If you want to get serious about getting stuff done, you've got to have priorities. I feel like that's a non-controversial statement. In advocacy, if you don't prioritise you splinter. And you have to splinter because there just isn't enough time in the world.

I can't dedicate my energies to issues that face me (be myself) and to completely different issues that face someone else without compromise. I could half-arse both jobs, but the truth is that I care deeply about me. (I also view this as an issue of self-respect.) And that's true of most people. Solidarity thus either requires minimal effort (voicing support... i.e. prioritisation of effort) or sidelining of some subsection of groups (prioritisation). Splintering is the consequence of trying to do everything with maximum energy (i.e. no priorities).  What's keeping the movement together? It's actively trying to pull itself in all directions, all at once.

This paradigm (all values, all at once) also creates a situation where you can pull people up for not doing enough about some cause or other, or even a different parts of the same cause. That should be obvious. After all, you're competing for attention with other factions. If your faction doesn't get attention, what it is you're doing your all for is going to fall by the wayside. Other factions don't add nuances to the actual push because from the point of view or you and your fellows, every minute spent on them isn't spent on you. That's particularly clear if you're a healthcare reformer and they're education. (And let us not get started on how to handle disagreement... consider different views on how to handle sex work: illegal market, illegal buyers, legal market?)

The thing is that there's actually a very, very obvious way of prioritising effort. Advocacy for the deprived, neglected and unprivileged could be rationalised. And the way to do that is through socio-economic deprivation (otherwise known as what the left traditionally cared about). Why? Because it is either an alternative cause of the problems of an inter-sectional group (e.g. Maori would have better access to healthcare if it was accessible in general) or an exacerbating issue (e.g. the general lack of access compounds the disconnect between tikanga Maori and Westernised health provision).

In other words... actually it's an entirely sensible (and more sensible thing) to return to the old way and fighting working class fights, because, hey, it's everyone's fight. That's certainly true if the alternative is what strikes me as a naive call to be all things for all people all the time. (Racialising the working class helps no-one, however.) Although, by working-class let's not mince words... I mean the poor and the working poor (people for whom budgeting is not a solution).

Doing things this way doesn't mean neglecting other (subsidiary?) groups. For instance, you just tack on extra components when you have the time... which is something you create when all you're trying to do is a part of the struggle.

Say you're fighting for healthcare reform... you approach it from the position of building it from the ground up. It's no big deal to then chuck in some measures for trans health, for women's health, for men's health, for elderly health, for Maori health etc. etc. because you're only dealing with those things. You're not trying to simultaneously reform healthcare, provide an exhaustive set of rights for trans people, have a comprehensive reform of indigenous policies etc. etc. You pick the war (theatre), fight one war, and then try and win in every battle. Then you move on to the next war. You don't sacrifice the other wars/theatres, you just try and keep them in equilibrium/status quo. (Europe First, then the Pacific.)

If you throw full efforts behind a cause, you dedicate your best arguments and your best work. That stuff is a lot more effective and thus ultimately more efficient. It's how you achieve movement. That's why you can (metaphorically) create more time and that's why you can then add on stuff which the generalised push on wealth lines misses. If you try to do everything at once, you're never going to change the paradigm. You're going to force people to dedicate themselves to what they care about most. You may even create the Oppression Olympics, whereby it's necessary to attack other forms of unprivilege in order to finally get some attention for people like you. Solidarity isn't about doing it all, it's about giving up on the individual and making those concerns front and centre when the time for it arises. That's what I think Rodgers misses. Although, of course, I may have misunderstood her interpretation.

tl;dr -- division is the inevitable consequence of not having priorities, of holding solidarity as a call to advocate for everything rather than support it

(No-one should say Trump won because he cared about the "white" working class... people say he won because the "white" working class felt ignored and rejected by the Democrats. Or, in other words, that they felt excluded from the solidarity. Of course, in NZ Trump would never have won on account of not having most of the votes, which is another really important thing to think about when trying to use Trump as an argument for or against solidarity.)

See also my previous posts:

my criticism of state charity 

the Vimes Boot Theory 

1 comment:

  1. Rodgers' response to original comment...

    You make some good points about the health system, Harry, but you’ve really rather missed mine, which is, (as I said):

    “When we talk about values, and say we believe in certain things, and then we turn around to people and say “shush! Wait your turn! We don’t want to talk about your health, or your lives, or the support you need, it’s a distraction!” all we do is undermine ourselves.”

    “We don’t narrow our focus. We reach out and show that all our struggles are the same struggle. This achieves several things. It means our values of solidarity and universalism and community are demonstrated to an immensely broad group of people. Two, it gives people certainty.”

    It’s all well and good to tubthump about “working class fights” but when those are inevitably defined as “things that matter to white men, not things that matter to women or indigenous people or anyone else” then it is certainly not “everyone’s fight”.

    Reproductive rights, healthcare, equal rights under law, harassment and violence are not “extra components” to be “tacked on”. They are people’s lives. If they’re optional extras to you, guess what: no one is asking YOU to lead those fights. You are only being asked:

    1. to understand how many different fights ARE part of the same struggle, and
    2. not throw people under the bus because they’re choosing to focus on an aspect of the struggle which you don’t care about

    TLDR: try reading the post I wrote.

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