The editor-in-chief of The Lancet said she is
‘Britain’s Prime Minister, Theresa May, has said that capitalism is ‘the greatest agent of collective human progress ever created’. But more and more people, especially younger generations, believe that economies based only on free markets are not necessarily the best means to deliver fairer or healthier societies. New Zealand’s new Prime Minister, Jacinda Ardern, noted last month that, “When you allow markets to decide the fate of your people … that does not serve a country or people well.” Marxist ideas have re-entered the political debate.’
There was a local stir when Richard Horton, the respected editor-in-chief of the greatly respected British medical journal The Lancet, pronounced Jacinda Ardern a Marxist, in an opinion piece last November But a good doctor is not necessarily a good political thinker.
Horton seems to be saying if one is not a Marxist, one is opposed to the British National Health Service and its commitment to medical care without payment; that a system run entirely by private payments, perhaps supplemented by medical insurance, would run better. Apparently non-Marxists support an even purer form of the clumsy American health system, the most expensive in the rich world and yet with poor health outcomes. There would be no need to socially regulate safety in the medical system. And there would be no publicly driven population-based preventive measures such as immunisation programs. He seems to define everyone who is not a neoliberal as a Marxist. Huh?
The issue of the degree to which markets need to be socially regulated has perplexed economists since at least the time of Adam Smith who wrote, probably as an aside, about the merits of the ‘invisible hand’. One of the major strands in economic analysis has been under what circumstances the invisible hand leads to good social outcomes. I do not think any of the major contributors to this analysis could be called ‘Marxist’. Many would have studied Karl Marx as a major nineteenth-century economist, but they will have done that for many other comparably important intellectuals.
They have identified a host of circumstances in which the socially unregulated market gives poor outcomes. Yet there is always a caution. Fixing it can be difficult; as a result many minor failures are left unattended since interventions to correct them would make things worse. But even so, there are some failures so large that properly designed measures can be introduced to reduce them. So the health system is an example par excellence of the failure of the ‘free’ market to deliver. That is the easy conclusion for a health economist – the difficult one is how to run the system better.
A complication is that new circumstances, often as the result of technological innovation, need new responses. I do not recall network industries (the telephone system is a simple example) ever being mentioned in my (very orthodox) economic training because they were not so difficult to deal with then. Given the impact of the ICT revolution, I imagine that today’s well-trained students give them a very thorough going over.
The view that the market needs to be moderated to make it contribute better to society comes from quite different ideological threads rather than Marxism. The one I know best is the British liberal-socialist one, which was evolving before Marx and which continues to evolve to this day. To what extent Ardern knows this literature I cannot tell; it will take time for us to learn whether she is a social democrat or a democratic socialist, to learn whether her government will continue the evolution of these traditions or whether it is stuck in a time warp.
I am sure that running the system better is what Jacinda Ardern is concerned with, but so is Theresa May (who is certainly not a Marxist and is hardly the great political philosopher to give credibility to the sentiment Horton attributes to her). When she talks of capitalism as the greatest agent of collective human progress ever created, she does not mean unbridled free markets but socially regulated ones. However the extent to which she would intervene probably differs from Ardern’s (even if they faced the same political pressures).
The genius of capitalist development has been the willingness to adapt to deal with its failures. Marx thought that capitalists were too short-sighted. Maybe they are, but pressures from the population have led to a kinder gentler capitalism than the raw in tooth and claw that Marx expected.
These are proper matters for discussion and debate. Reasonable men and women will disagree on what should be done but they would surely agree on the proposition that focusing only on socially unregulated markets does not serve a country or its people well. They are not Marxists, unless all reasonable people are.
So it is unfortunate that Horton lumps all those who believe that it is necessary to socially regulate the market for good social (and health) outcomes as Marxists; presumably he includes Theresa May and himself. I do not think it helps to do this though, especially when some neoliberals went berserk over this categorisation of Ardern. (One said she was a communist because at socialist gatherings she called her colleagues ‘comrades’.)
I have the greatest respect for Marx’s thought especially when he combines economics, political studies and sociology into an integrated whole, a very nineteenth-century approach which, alas, has been abandoned by far too many of today’s economists. (For the cognoscenti I mention that when I studied at university I was particularly moved by his Economic and Philosophic Manuscripts of 1844 which present a lyrical and humanist account of the agonies of the human condition during early industrialisation. Others of his works I found heavy or tiresomely impenetrable.)
But in many ways Marxism has not got past its nineteenth-century heritage. We have learned much since, which far too many Marxist avoid. Like capitalism, followers of British liberal-socialism have better adapted (although I often get impatient at their slowness of response).
Horton is right that we need to design our health and other social systems with more attention to the human condition as encapsulated in the 1844 Manuscripts and, even better, in the great British traditions arising out of Christianity. The neoliberal tradition has a nastier vision of humanity, although, thank God(dess), not all the neoliberals I know follow its precepts.
Horton’s grasp of political theory is well illustrated by the opinion piece’s conclusion: ‘as the centenary of his birth approaches, we might agree that medicine has a great deal to learn from Marx.’ Karl Marx died 134 years ago; even the cleverest doctor cannot enable a person to be born after they have died.