Monthly Archives: December 2013

‘What you have isn’t covered by the policy, but we can treat you for something more economical.’

Here’s a variant of an old joke.  Two nuns are in deep discussion of a spiritual question when suddenly a hideous vampire-like creature with the pallour of death and bloodcurdling moans starts banging on the window.

“Quick!”, says one to the other, “Show him your cross!”

And the other says “Get the fuck out of here you bloodsucking filth! This is a private hospital!”

A report in yesterday’s Sunday Independent detailed how the St. Vincent’s Hospital group, owned by the Sisters of Charity, had mortgaged its publicly-funded hospital so as to expand its private hospital enterprise.

Let me quote myself from an earlier post:

“The Sisters of Charity refused to contribute to a compensation fund for the victims of the Magdalene Laundries, two of which it ran. It operated various industrial schools. The Commission to Inquire into Child Abuse report concluded that there was a ‘high level of severe corporal punishment’ in Goldenbridge, an institution run by the Sisters of Mercy. There was a ‘pervasive climate of fear’ in the Institution as a result.

• ‘Children were beaten and humiliated for bed-wetting by both nuns and lay staff’.
• ‘Bead making became an industrial activity that was pursued obsessively; the work was difficult and uncomfortable and it was painful for children’.
• ‘Scraps were thrown out of a receptacle into the yard, and children scrambled for them.’
• ‘Children drank out of the toilet… some children were deprived of water in an effort to cure bed-wetting, and they found water where they could.

The idea that religious orders should own hospitals paid for by the public, but with an important private and exclusive component, is treated as something normal in Ireland.

The Sunday Independent report on the Public Accounts Committee also details how the Health Services Executive had committed to paying full market value to the St. Vincent’s Hospital Group in the event it should ever be required to buy the site.

Conventional economics has it that market value is established through the interaction of supply and demand toward an equilibrium. The point at which the buyer’s willingness to purchase, on the one hand, and the seller’s willingess to sell, on the other converge. This is the ‘natural’ course of things. Conventional wisdom has it that this ‘natural’ course of things in market economies redounds to the benefit of society as a whole.

This is what Adam Smith was talking about with his famed image of the ‘Invisible Hand’. The invisible hand of the market leads the rich to distribute resources equally, without their intention and without their knowing. Smith tells us that it is not from the benevolence of the butcher or the baker that we get fed, but from their pursuit of self-interest.

In Ireland’s health system the benevolence of the doctor is as irrelevant as the benevolence of the butcher or the baker. The organising principle has it that it is through the pursuit of self-interest that the best medical treatment can be obtained for society as a whole (which is not to say that the average doctor is pursuing mere self-interest).

Hence the Irish State splits health care into public and private components. Private firms and organisations are contracted to provide health services to the public. General practitioners run their surgeries as private businesses. Looking out for number one is conducive to the health of the nation. Hence so-called ‘top ups’ for administrators: why shouldn’t they pursue the highest possible salary? Isn’t that how society moves forward?

Although St. Vincent’s Hospital Group is owned by the Sisters of Charity, charity doesn’t really come into it, except as an ideological gloss to pacify those uncomfortable with the idea you should make money out of the suffering of others.

When St. Vincent’s Hospital Group mortgaged its public-funded hospital to set up a private operation, it was simply operating in keeping with the Irish State’s dominant conception of what health is: a commodity, one which, it is fervently believed, will be more equitably distributed through the guidance of the Invisible Hand.

Jimmy Sheehan is ‘founder of the Blackrock, Galway Clinics and Hermitage Clinics, private medical facilities which operate according to a Catholic ethos’, according to the Iona Institute, the right-wing Catholic organisation of which Sheehan is also a patron. Shareholders in the Blackrock Clinic include beef baron Larry Goodman. Back in July, Health Minister James Reilly attended the launch of Sheehan’s book,  ‘Life Close to the Bone:  Musings of an Orthopaedic Surgeon’. Sheehan spoke about the ‘synergies between public and independent hospitals’ (for ‘independent’, read ‘private’). For his part, according to the Blackrock Clinic, James Reilly called ‘the contribution’ of private hospitals ‘tremendous’ and ‘stated his intention to keep the valuable Independent sector integral to Irish Healthcare.’

Notably, the founder of the Blackrock Clinic claimed ‘the division of services into public and private was an illusion created by the media and politicians’. Unfortunately the report of the book launch does not elaborate on the nature of this illusion. But you could forgive a member of the public for believing that public and private health services are -or ought to be- two different things.

For instance, last week, according to the Irish Times, the National Maternity Hospital met with the HSE to explain that the unauthorised €45,000 in private allowances paid to the hospital Master Rhona O’Mahony on top of her publicly funded salary came out of ‘a group practice at the hospital for semi-private patients’.

What does ‘semi-private’ mean, exactly? Is it not like being half-pregnant? Doesn’t private mean -like the sign says: keep out? Doesn’t it mean there are some people who will be unable to access the service because they haven’t got the economic resources? Health rationed on the basis of wealth? Where did they get the semi- from?

Well, in the particular case of Holles Street, it means -or at least it meant from what I could see- a portakabin in the midst of the hospital complex, where a queue of women get weighed, give a urine sample taken, and then four or five minutes with a consultant, who tells you with a benevolent smile to buy a copy of his book if you have any further questions.

There is, of course, another meaning of ‘private’ that might have particular appeal in the case of maternity services. ‘Private’ as in ‘respecting one’s personal intimacy’. When gynaecologist Michael Neary -another committed Catholic- was on the wards of Our Lady of Lourdes Hospital in Drogheda, he would make women stand to attention in front of their beds and in full view of everyone as he made his rounds. So there is a way in which the distinction between what is public and what is private is the distinction between what is undignified and what is not. ‘Public’ thus is rendered equivalent to ‘state property’ and ‘inferior’ and ‘humiliating’; ‘private’ is rendered equivalent to ‘dignified’ and ‘respectful of personal intimacy’.

What is public, in the context of the Irish health system, isn’t a matter of common dignity and respect for all in a site that belongs to all, but a matter of what is inferior and deprived in a site owned by people who have the know-how and money to administer. And it has been the special role of religious orders and the Catholic Church more generally to guarantee this distinction -and the rule of the Invisible Hand- in the health system. Or, to paraphrase Joyce, the hand of a Free Market Christ in the Glove of the State.

“The water is the people’s, damn it!”

If it’s good enough for the residents of Castlerea or Manorhamilton or Longford it ought to be good enough for a Minister of State. This is an elementary democratic principle.

Ming Flanagan TD presented the Minister of State, Fergus O’Dowd, with a glass of the polluted water that his constituents are expected to drink –and pay for.

The Ceann Comhairle, Séan Barrett, described Ming Flanagan’s actions as

“an act of vandalism…never before in the history of this chamber have I seen such behaviour. Of a member walking down and handing a glass of dirty water to a minister. That is just outrageous and unacceptable behaviour and I’ve asked for an immediate meeting of the Committee for Procedure and Privileges to deal with this matter.”

The scandalised stance of the Ceann Comhairle illustrates the hatred of democracy that characterises Ireland’s political establishment. One might imagine similar scenes in which priests and nuns take umbrage at the suggestion a bishop should wash the feet of the poor rather than get his ring kissed by them.

What is the task of a political representative if not to represent the concerns of his or her constituents? And why should such representation stick to mere oratory –which in the Dáil is bound by strict time limitations and all kinds of arcane rules of decorum- when visual images convey constituent concerns more effectively?

Barrett subsequently sought to establish order in the chamber by declaring “we live in a democracy”.

Never mind that the commodification and privatisation of common goods such as water flies in the face of basic democratic principles. Never mind that the government’s efforts to pass its Water Services Bill, without even a superficial debate, demonstrates utter contempt, not only for the views of the official political opposition, but for those people whom political representatives are supposed to represent.

For Barrett, and for the rest of Fine Gael, and for the rest of Ireland’s political establishment, democracy equates to electoral absolutism, to translating the urgings of big business into legislation.

See these? These are votes. And that means we –not you, not really- can do what we want. Yes, we know you didn’t vote for it. Yes, we know we lied our asses off to get elected. But hey – that’s democracy! So shut your fat mouth and drink up your cryptosporidium. Don’t like your A&E department getting shut down? That’s democracy, shithead! Don’t like your water supply getting polluted by fracking chemicals -what are you, some sort of subversive? Why do you hate working for free so much – don’t you know that your legitimately elected government introduced JobBridge on your behalf?

The pale fact is that Ireland’s political institutions as they stand have little to do with democracy and a great deal to do with Committees for Procedure and Privileges. In reality, the Dáil exists to establish Procedures for destroying any prospect of democratic equality or participation, and to maintain Privileges on tap for billionaires, corporations, middlemen, speculators and their political cronies.

I was thinking about Enda Kenny’s ‘state of the nation’ address last night. I didn’t watch it but I did quickly scan the text this morning. What it reminded me of most was the mass mails sent out by CEOs of major corporations to their workforce. Such communiques might speak of some shared bond among employees, but never too much lest the contradiction between shared bonds and rigid hierarchy ever come to the fore.

They might speak of the bright future ahead, but the need for sacrifice in the immediate future. They might recognise past sacrifices while demanding more. Of course they are not intended as a communication to employees as human beings, but as human resources, or human capital, which need to be kept in proper order through words, in the same way as plant equipment requires maintenance and replacement of components. The recipients of these communiques are not supposed to pore over every word as if the Word of God. In fact, it’s well known that a lot of people won’t bother to read them. But they manage to convey, simply by the fact of their sending, that all is in its right place, that the firm is still there, that it is bigger than you and that those at the top know what they’re doing, as always.

Kenny’s address was of that order. The content was not as important as the interpellation of the ‘Irish people’ – that momentary aggregation of isolated monads once every four or so years- by the fossilised ‘Irish Government’, so as to preserve the normal order and run of things. We -I- the sovereign taking care of business; You -yes you- the people, contractually bound to let us take care of business.

That there was a total absence of any kind of social vision beyond renewed subjection to Capital-unsurprising, given the government’s deep commitment to predatory neoliberalism and debt slavery – does not matter to those who put the broadcast together.

They don’t want one. They want submission, atomisation and apathy. They want people to think of themselves as inexorably tethered to State time, as having no voice other than that of an elected political representative, as being bound by the demands of the markets, as having no rights but merely what the caprices of international investors might allow. They want it understood that the prized confidence of the markets demands people’s resignation and silence. This form of address -and all the media attention surrounding it, the poring over the choice of words, the speculation over its success- is geared towards defusing the possibility of collective action -democratic action- in pursuit of a different course, by making it seem as if no other course can or will ever be allowed to materialise.

But it can.

Above is a video of Álvaro García Linera, Vice-President of Bolivia and political theorist, speaking at the 4th European Left Congress last week. It’s in Spanish. I haven’t been able to find any translation online, and don’t have the time to do it right now, but here are some notes I made after watching it.

I don’t think I’d ever heard García Linera speak before. He is a clear and compelling speaker and gave a succinct and illuminating overview of the predatory character of modern capitalism, its processes of primitive accumulation, perpetual accumulation by dispossession, the real subsumption of the production of knowledge and science under capitalism, new kinds of proletarianisation and the drive toward planetary destruction.

He then laid out five tasks for the left.

He had introduced his talk by describing how Europe is seen from the outside: languishing, defeated, self-obsessed, having long abandoned the major universalisms that had inspired peoples around the globe. The description was quite similar to his remarks when Evo Morales’s plane was held in Europe at the behest of the US. But he stressed that this image of Europe was the Europe of big business, of multinational consortia..and that the Europe of its peoples, the Europe of labour, had been hidden from sight.

The first task García Linera outlined for the forces of the left was that they cannot be content with mere diagnosis and denunciation, but that they had to develop new proposals, in the construction of a new -progressive, universalist and revolutionary- common sense.

Then he stressed the need to recover the concept of democracy, which had always been the rallying banner of the left. He talked about the need to get away from the notion of democracy as a mere institutional fact, since such a notion ends up locking people in to a fossilised liberal vision of democracy as simply the boredom of the process of elections every three or five years.

He said that democracy was not only a set of values – tolerance, pluralism, freedom of expression, freedom of association- but practices: collective action, increasing participation in the management and administration of a society’s commons. Democracy exists, he said, if we take part in what we hold in common. He was quite clear in identifying the ‘social war’ for control over water, hydrocarbons, minerals and telecoms, as fought in Bolivia, was democracy in action. He was scathing about the phenomenon whereby common resources are devoted to saving a private banking system, citing this as a sign of a fundamentally anti-democratic dynamic in societies where this took place.

The third task was for the left to recover demands grounded in the universal, in the right to work, to retirement, free education and environmental protection. These were common goods that demanded mobilisation and concrete measures and objectives.

Fourthly there was a need for a new metabolic relation between human beings and nature in light of the present destruction of the natural possibilities for human beings to survive. But he warned of the hypocrisy of the “green economy”, where certain firms and entities under the cover of environmentalism presented themselves as custodians of the environment in one part of the world whilst polluting and laying waste to another.

The fifth task concerned what he described, after Gramsci, as the heroic dimension to politics. A new horizon for life could only exist as a faith held by a society, not as a religious faith, but one that inspired people to lend their efforts, space and commitment. This meant that the left had to be both sufficiently flexible in terms of organisation, and sufficiently united, in order to revitalise people’s hope, in the generation of a new common sense.

This also entailed, he said, fighting to occupy State power, but he stressed that the State should be understood more as an idea than a material fact, as a social relation. He said that the various left forces were too weak, too isolated, to have any prospect of success without unity around points in common.

He rounded off a speech of brilliant eloquence and lucidity by framing things in European terms once again: struggles in other parts of the world- Bolivia, Venezuela, countries in Africa- also needed the struggles of the European left: for a Europe that was a beacon for the destiny of the continent and that of the world.

I want to demand from you, he said: struggle, struggle, struggle. Do not abandon other peoples who are struggling in isolation in certain places.”

For all I know grilled pigeon may be delicious but having seen far too many pigeons picking through the vomited takeaway of last night’s Temple Bar drunks the thought of them is not so appealing.

However I see no great difference between eating pigeon and eating chicken. The former in its shot and grilled form may be a great deal more tasty and even healthy than the latter in its processed form after a life of enslavement and utter misery.

What is wrong with reporting on a man who shoots pigeons to feed himself? The outrage from Ireland’s media booboisie at the New York Times’s report is all the more galling because such enterprising individual use of personal resources is precisely the response they themselves -with their self-help guides and psychologists and mindfulness experts- have been pushing in response to human setbacks in Ireland’s economic crisis.

John Donovan also did Master’s degrees in Law and Business, according to the article, and works as an ‘intern’ for €22k, aged 55. If only he’d laid off the pigeon shooting, Ryan Tubridy -who is paid well over ten times what Donovan gets- would be giving him a pat on the head and presenting him with a Total Entrepreneur Ledgebag award at the National Convention Centre.

Read Maureen Gaffney’s latest brainshit in the Irish Times: “we” are wonderful because “we” are resilient and put the head down and pony up the money for speculator debt and never ask questions and stay clear of political trouble.

But how fucking dare you suggest that “we” eat pigeons! Who do you think “we” are, New York Times, some sort of prole savages? We’re JFK!

The other mention of food in the article -that some people are eating cornflakes for dinner because they have no money- has not caused such a stir. Eating cornflakes for dinner? A tasty improvised repast. Pigeon? Ah now, you’re making us all look like uncultured beasts.

The scandal of the day in Ireland is the matter of so-called ‘top-up’ payments to senior executives at the Central Remedial Clinic. The Central Remedial Clinic describes itself as ‘a non-residential national centre for the care, treatment and development of children and adults with physical disabilities.’

If you read the word ‘national’ in that description the way I normally do, you might be inclined to conclude that the Central Remedial Clinic belongs to the nation, that is, it is a public institution, owned by everyone. But it isn’t. In fact, the Central Remedial Clinic is…. well, I’m not that sure what it is. Is it a business? Is it a charity?

According to its website, the Central Remedial Clinic was ‘set up in April 1951 by Lady Valerie Goulding and Kathleen O’Rourke’.

This is a bit strange, because I thought Ireland did away with aristocratic honorifics when it declared itself a republic. Article 40 of the Irish Constitution says that ‘Titles of nobility shall not be conferred by the State.’ You can’t miss it, it’s there a few lines up from the bit where the State ‘acknowledges the right to life of the unborn’.

So you’d think a self-declared national centre would conform to national norms on fundamental rights, by keeping its website free of feudal vestiges. Wouldn’t you? I don’t know, maybe you wouldn’t. Maybe you think there’s nothing wrong with the use of aristocratic titles in public service provision, in the same way as you think there’s nothing wrong with a health service run by a Minister for Health who lives in a stately home.

Anyway. The Central Remedial Clinic is a Section 38 body. This means the Health Services Executive contracts it to provide services that the HSE itself is statutorily bound to provide. So one solid description of the Central Remedial Clinic is… ‘outsourcing firm’.

How does that work, then? People who use the Central Remedial Clinic have a statutory right to the services it provides. But if you go to the Central Remedial Clinic website, there’s nothing about rights, or -given that it calls itself a national centre- citizens. It does say that the Clinic works ‘in a spirit of partnership’ ‘with the people we seek to serve’. Personally I don’t understand how public services can be delivered in a spirit of partnership. I get on the bus, the bus takes me from A to B. I do not work in a spirit of partnership with the bus. I go to hospital, I get an appendix out. My appendix is not removed in a spirit of partnership.

Now obviously people receiving treatment from therapists need to receive that treatment through a personal relationship that recognises them as equals to the therapist, not subordinates. Fine. What I don’t get is how me or you getting occupational therapy from a Clinic on the one hand, and, on the other, a board member getting a ‘top-up’ allowance of tens of thousands of euro every year, amounts to a ‘spirit of partnership’. I’m bullshitting here, of course I can: ‘spirit of partnership’ is one of those superficially attractive and egalitarian expressions intended to mask unequal relations and the icy cold material concerns of hard cash.

Just what is the scandal here, exactly? From what I can glean from the papers, senior board members were using the proceeds from charity fundraising to feather their own nests. People were getting involved in all kinds of charitable fundraising, thinking their efforts were going to provide people with essential services, when in fact they were lining the pockets of the Clinic chiefs. Just what made the Clinic chiefs worth such amounts of money isn’t all that clear. But then again, employment law contains few references to use value.

You could argue that the scandal here is the fact that people went out and worked their assess off thinking they were funding basic services for people who needed them when in fact they were comforting the really rather comfortable. And you could argue that the trickery involved here will hit the revenues of a whole range of institutions that need charitable funding in order to deliver vital services, with the effect felt most by those who need the services the most. That is how Fianna Fáil finance spokesperson Michael McGrath criticised the scandal.

Well, that all is true, but it isn’t the scandal. The consensus across Ireland’s political and media establishment is: public bad, private good. Rights bad, charity good. Public servants: conniving, self-seeking lazy bureaucrats. Private sector bosses: dynamic innovative go-getters who deserve your cash and admiration. It’s hardly a surprise if the Clinic chiefs expressed this consensus in their own remuneration arrangements.

What is scandalous is the way this event has come to light without even the slightest questioning of whether it’s appropriate for public health services to be outsourced to private firms or charities. Nor has there been any questioning of the role played, by private firms and charitable institutions, in helping to bury the notion that vital services including health ought to be provided on the basis of equality and social solidarity, and not on the basis of access to economic resources and the discretion of moneyed benefactors.

And this scandalous silence should come as no surprise, because the burial of social rights and access to public resources and their replacement with charitable discretion is both longstanding government policy, as is the outsourcing of public service functions.

Ireland’s ruling elites -economic, religious, political- have always hated the idea of universal public services because it smacks of socialism. Charity, on the other hand, bestows a saintly glow on the filthy rich, and consigns all that talk about rights to the domain of what Fine Gael strategist and Forum on Philanthropy Chairman Frank Flannery calls ‘ideological bullshit’.

Safely insulated from ideological bullshit, it doesn’t matter if the person providing you with the service is an aristocratic Lady, or, in the case of Crumlin Hospital for Sick Children’s parental accommodation unit, a clown called Ronald McDonald who makes his money from selling junk food to working class people: sure aren’t you lucky you’re getting it at all? Don’t be complaining, now.

Let me return to the Fintan O’Toole piece I commented on yesterday. In it, O’Toole puts grotesque viscerality in the place of reasoned argument. He ascribes a primal netherworldliness to the howl in order to situate the killing of RUC officers Buchanan and Breen beyond any general consideration of the social and political landscape of Northern Ireland at the time.

Where he situates the killing instead, is on the plane of racist atavism: ‘a dead Jew, a dead Black, a dead Serb, a dead Muslim, a dead Tutsi, a dead Papist’.  So the killing of RUC officers is on a moral par with Nazis killing Jews (‘a dead Jew’) and Loyalists killing Catholics (‘a dead Papist’).

This dehistoricises and depoliticises the Northern Ireland conflict, and on very particular terms. The moral panorama O’Toole elaborates, from the sound of the howl, places the security forces of the British State on the same side as the victims of eliminationist anti-Semitism, and characterises the IRA and loyalist paramilitaries as bad as each other.

The structure of this panorama is not at all different from the way the conflict appears in liberal unionist circles: our forces held the line against the Nazis and are therefore good; the majority of people on both sides are decent and law-abiding people who simply want peace; unfortunately, there are violent extremists on both sides driven by dark timeless urges.

It isn’t hard to see variations of this at work more generally in British society, in terms of how the armed forces of that country operate in other countries, as civilised mediators grappling with age-old hatreds. This is also, of course, the structure of a fairy tale. The RUC and the British Army were major actors in the Northern conflict, and frequently operated with extreme brutality. Their relation to loyalist death squads is, to say the least, close and murky. Their actions were in many cases what drove young people to join the IRA, which had plenty of support in the nationalist population.

When O’Toole takes an incident in isolation and treats it as a manifestation of mere bloodthirsty animalistic euphoria, not only is he downplaying the importance of the structural, political factors that generated the incident and the role of the dominant military power, but he is upholding a politics of the civilised versus the brutes.

To be on the side of the civilised, that is, the ‘Irish society’ whom Sinn Féin, O’Toole says, owes ‘an immense moral debt’, no particular concern is needed for justice for victims of the Northern conflict. Indifference to the role of the British State in murdering Irish citizens is no barrier. All you need, it seems, is a proven track record in keeping your bestial passions in check.