[PEN-L:6727] RE: Conceptualizing Proletarianization -Reply

[Patrick Bond <PATRICK@xxxxxxxxxxx>]

Maybe this is stuff you've already covered... but anyhow,

The most vigorous debate on this, I recall, was Vicente Navarro versus
Barbara and John Ehrenreich (who argued your position), during the
1970s, and I know that Vicente continues to use the conceptual
problems involved to reflect upon the nature of labor-power under
extremely hierarchical conditions in the health sector. I think he remains
firmly against the concept though.

But with managed care now entailing widespread purchase by
insurance capital of physician groups, hospitals and various other modes
of health care provision, and with the incentive structure now switched
180 degrees from a kind of petty commodity production (the
fee-for-service system through which the physician encouraged health
care consumption) to a system in which insurers pocket your premium
and then put up all sorts of barriers to prevent you getting access to their
workers (the physicians), the proletarianization thesis may make a
strong comeback. Massive lay-offs of specialists and a growing reserve
army of providers -- amidst general overcapacity, overaccumulation of
health sector capital, and now a period of intense devalorization ahead --
add to the story.

Vicente's _International Journal of Health Services_ carries lots of
material related to corporatization and profitability that you may already
have found useful. In the June 1996 issue of Multinational Monitor, Rob
Weissman and I trace the intensification of corporate concentration in
health services as well.

The other issues of deskilling, speed-up, relative and absolute surplus
value extraction and all the rest of it still seem to apply much more to
nurses (the American Nurses Association has lots of good material on
this), but perhaps soon to physicians as well. One of the key political
reflections of these structural dynamics has been the confusion in the
American Medical Association about which sort of reform serves their
members' interests best.

But you'd still see these chaps out on the golf course at 3PM on
weekdays (I imagine), and then wonder whether we can ever talk about
a physician fraction of the proletariat.

Ciao!