I was asked to write this piece by Brian Fisher as a contribution to the debate on alternative policies for health and the NHS.
To do this I have tried to return to 'first principles' in terms of what socialism means and I have distinguished between a) socialism as the alternative to the rule of capital and b) options for socialist coordination. The failure to distinguish between these two dimensions can lead to confusion - for example simplistic debate about markets.
The piece distinguishes between 4 approaches to socialist coordination and identifies the 'really existing NHS' with statism (albeit with market socialist dimensions). If we are to establish a society (and health and welfare systems) that is based on meeting human need, rather than the needs of capital, then we will need to do better than simply defending the statist model. To get beyond that we need to get off the chosen terrain of neoliberalism - state versus markets and identify more adequate approaches to socialist coordination.
My proposal then is that we establish models of participative democratic socialist coordination - that nevertheless require state and local state coordination, some use of markets and of cooperative forms.
Since writing this I have stumbled on the incredibly inspiring story of the Kerala People's Campaign for Democratic Panning. I was aware of the Kerala (India) social model and its comparative achievements but hadn't realised that from the mid 90s they'd done so much to establish local participative democratic control over state resources. I'm still researching this but it is clear that their approach is more thoroughgoing than say that of participative budgeting in Brasil.
see this book http://www.amazon.co.uk/Local-Democracy-Development-Campaign-Decentralized/dp/0742516075/ref=sr_1_3?ie=UTF8&s=books&qid=1287951169&sr=8-3 and this resource list http://www.chitram.org/mallu/keralamodel.htm
Mark
21st Century Socialism and Health / Discussion
This is the discussion related to the wiki page 21st Century Socialism and Health.