Public Health for Profits: Malaysian healthcare at the crossroads

To be piloted by the MOH in seven public hospitals starting from February 1, the Waktu Bekerja Berlainan (WBB) shift system, as described by the Malaysian Medical Association (MMA) in its open letter, will have our already overburdened, underpaid doctors working “fewer hours on-call” (from 24–33 to 18 maximum consecutive hours per shift), but on the condition that they “stand to lose income” in reality. This is all while the persistent issue of overcrowded, chronically understaffed public hospitals unceremoniously flies out the ministry’s windows.

Unlike the current, considerably less grotesque shift system, the new WBB shift system basically views weekday evening shifts as normal working hours; that is, graveyard shifts are to be taken as part of the regular 45-hour work week. With this little trick, on-call allowance (ETAP) will no longer be given to doctors who work past 5PM on weekdays.

In practice, this means no more than the nasty prospect that doctors who rightfully want to earn extra bucks on top of their meager pay will soon have to compete with their peers for on-call duties exclusively during weekends and public holidays. Even “progressive” liberal, “stakeholder-capitalist” healthcare mouthpieces like the Galen Centre know this to be the recipe for disaster it very much is.

Life and death for profits

Meanwhile, real wages remain at an all-time low for doctors and, for that matter, every other public health worker. In this case, Health Minister Dzulkefly Ahmad recently boasted that on-call allowance would finally go up from, effectively, RM9.16 per hour to — wait for it — a stunning RM10 per hour! The insulting nature of this pathetic increment — not to speak of a long-overdue one — needs as much explanation as was offered in the immediate backfire from health workers all over the country, as well as resistance organizations such as Hartal Doktor Kontrak.

The new WBB shift system, however, is no mere regulatory disaster — as free market advocates would have us believe. It is not a mere reflection of “systemic inefficiencies […] which prioritize bureaucracy over meaningful reform”. Neither, as regards the chronic “exodus” of public health workers into the private sector, is this “a direct result of the government’s refusal to offer competitive salaries and adequate support…” In short, the failure of our public healthcare system is not because of “bad governance” and “bad politicians”. It is not a bug, but a feature, of the capitalist economic system — one based on profits for the few, rather than the needs of the many.

So long as the incessant capitalist drive toward ever more profits remains intact, there will never be quality healthcare for all. This is particularly evident in this day and age, when capitalism falls under such immense pressure of perpetual crisis of its own making. In order to survive at all, the capitalist class is driven to commodify all things public, subjected under the absolute rule of its profit motive. Such is the fate of the literal health of our nation, where public healthcare is the only lifeline for more than 70% of the masses, who simply cannot afford the far more “superior” and “efficient” private healthcare. Whatever could possibly go wrong by letting private corporations and billionaires dictate the lives and deaths of the rest of us?

And so long as the capitalist class keeps eating away at what little remains of our public health system, this system will never do our public health workers justice. Far from it, wages will never be fair, working conditions will only deteriorate, and workloads will keep piling up. Worse still is the prospect of even more regressive, anti-labor policies down the line, as neoliberal attacks on the global working class are expected to intensify amid one of the worst capitalist crises to date.

A global capitalist offensive

Such brutal austerity measures are far from being a uniquely neocolonial experience. There is much we can learn, case in point, from the systemic privatization of the once-lauded National Health Service (NHS) in Britain. Since the 2008 global financial crisis, austerity has become the go-to policy of successive British governments, be it Tory or Labour. In both cases public spending has been slashed bare, and the NHS has been starved of resources, opening the floodgate for private contractors to step in under the guise of “efficiency” and “cost-saving reforms”, not to mention rampant outsourcing in all sorts of areas such as cleaning services, catering, and even patient transport, leading to further decline in service quality while at the same time putting still more workers on precarious contracts.

By 2012, the Health and Social Care Act, championed by former PM David Cameron’s Conservative government, fundamentally altered the NHS structure, giving private companies unprecedented access to provide NHS services. In practical terms, this meant profits for private providers came at the expense of patients and frontline workers, with resources diverted to serve shareholders instead of the public. Today, Britain’s public healthcare system lies in tatters — waiting lists have skyrocketed, staff burnout has reached crisis levels, and patients face increasing out-of-pocket costs.

Taking inspiration from this impressive feat of Thatcherism, then, is the so-called Madani state whose reform agenda has since its momentous rise to power in 2022 turned out to include not only intensifying the exploitation of public health workers via its brutal imposition of one austerity policy after another, but also its continued push for privatization, even though this is often carried out under the guise of “public-private partnership”. One such example is the Rakan KKM program, the contradictions underlying whose stated goal we have dissected elsewhere.

The lesson could not be any clearer: once the profit motive enters the equation, healthcare ceases to prioritize human need. For us in Malaysia, such examples serve as a stark warning of even worse things to come. If the mantle is not taken up by the working class to organize collectively and resist these neoliberal policies, the complete collapse of our public healthcare system becomes not a question of if, but when.

An independent HSC?

The idea of establishing a Health Service Commission (HSC) independent from the Public Service Department (JPA), and from the state apparatus more broadly, though not new, has become rather popular in recent years. While the wording varies widely, the idea at its core is to grant healthcare workers the power to steer national health policies, more autonomy over their own working conditions, and to break free from JPA’s red tape as well as the oppressive state machinery.

Among the many organizations calling for the establishment of such a commission is none other than Hartal Doktor Kontrak, according to whom “this commission would eliminate lobbying and half-baked solutions, provided its members are carefully selected capable leaders.”

At the same time, however, especially considering the fact that this “independent HSC” is also supported by no less than PAS Youth chief himself, perhaps a little skepticism of its pitfalls, and certainly a more complete characterization of this commission, is in order. 

The term “commission” is itself rather troublesome from the perspective of the working class’s struggle for true independence. In the conventional sense, commissions are generally established, funded, overseen — hence commissioned — by the bourgeois state to carry out specific administrative, regulatory, or “advisory” roles. Under the patronage of the capitalist state, commissions as such are therefore “independent” only insofar as the state allows — that is, insofar as the ruling capitalist class is willing to tolerate. Hopefully, the exemplary “independence” of the Election Commission will quash this myth in a concrete, relatable enough fashion.

A public health service that is truly commissioned by the masses — never by the ruling elite — can only be one that is unapologetically socialist in character. This means complete, democratic workers’ control of the national healthcare system, as well as the complete rejection of all forms of privatization and neoliberal theft.

But even with this big picture in mind, clearly the challenges right before us cannot be ignored. Clearly this draconian WBB shift system must go! And clearly there are many more immediate, no less urgent demands, that require attending to — namely higher wages, more humane working conditions, fewer working hours, boosting the workforce, upgrading our public health infrastructure, constructing more hospitals and clinics, improving public access especially among the poorest and disadvantaged — the list goes on.

Yet we have also established that these reforms can never be achieved within the framework of capitalism, not to mention the constant threat of rollback. Ultimately, concessionary politics is as fragile as the words of those among contemporary union leaderships who are markedly fond of a more “professional” approach to collective bargaining, such as the markedly calm-headed president of CUEPACS who, on this specific matter of the WBB shift system, advised “full cooperation with the ministry by not making any provocative statements that can disrupt the working relationship between the superior and subordinates […] so that a win-win situation can be achieved.”

“Win-win”! Datuk Dr. Adnan imagines a purely moralistic class struggle where both classes should have no issue emerging victorious… together — hugs, smiles, and all. Such a rich statement can only emerge out of the mouth of a traitor who is either corrupt, complacent, or straight up clueless — but a traitor nevertheless. As against this and many more acts of betrayal, and while the rule of capital continues to run amok and deep in every nook and cranny of the state healthcare bureaucracy and its allies in big union offices, the working class must resolutely reject reformist politics at its core — if we are to go beyond compromises and lies — if we are to win! 

This is not to say that we oppose the formation of an independent HSC. However, lest we fall as we so often do for the trap of state-endorsed, manufactured consent, some serious lines must be drawn. Surely it feels great to be independent — but independent from whom? To the aforementioned PAS Youth chief, this “independence” necessarily means only that from the liberals over at Team Madani (the reverse is just as true). To the reformist “left”, as we have so often argued in the case of PSM, they ask for “independence” only from the relatively more regressive elements yet still holding sway within the capitalist state.

But to the working class and masses, genuine independence can only be that from the capitalist state machinery in its entirety — independence from capitalism itself. After all, the working class has at its disposal all that it ever needs to plan and run the economy. Collectively, as a class, workers stand to lead society in the complete absence of a capitalist class — this bygone minority of parasitic pretenders whose main social function now as capitalism writhes in its death agony is to siphon off public wealth (and health) into tax-free offshore havens.

Capitalism in and of itself, by systematically exploiting the working class, in turn equips this exploited class with unmatched knowledge of industry and civil life, forces upon it the material need for solidarity, and finally, furnishes it with the historic role to transform society to the benefit of the masses — that is, with a revolutionary character.

Crisis simply makes this character more tangible. It is no wonder that more progressive demands such as nationalizing healthcare have become increasingly conceivable by the masses. The growing call for an independent HSC, for example, illustrates this leap in consciousness. In this light, now is not the time to cower behind negotiation tables and bargain for piecemeal reforms. Instead, now is the time to channel the collective anger and frustration of public health workers and the masses into a bold, united movement that demands nothing less than the complete overhaul of the healthcare system.

Build independent mass workers’ party!

This labor movement has certainly found its spark among health workers, for instance with the more radical Hartal Doktor Kontrak. As when both sides of the parliament are now seen scrambling about — the one finding its way out of this mess and the other finding its way into this mess — the only question that remains is this: how should this battle be fought such that the capitalist elite and its political agents should have no choice but to fight us on our ground?

Firstly, solidarity is our strongest asset, in which spirit this struggle for a truly public healthcare system must not take place in isolation. Instead, it must be part of a broader program to take key industries and services into public ownership under democratic workers’ control. This includes education, housing, energy, transportation, agriculture, the media, telecommunications, among other vital sectors — all of which are interconnected with the health and well-being of society at large. Should healthcare workers — both public and private — call for a sector-wide strike, this movement stands to gain a whole lot more momentum if other budding workers’ movements, as was seen in the recent e-hailing workers’ picketing in Putrajaya, also go on strike in solidarity.

Secondly, this program must be transitional in character. It must link the immediate demands of workers — a sliding scale of wages (adjusted to inflation), a sliding scale of hours (working toward full employment), better working conditions, the establishment of said independent HSC, etc. — followed by more systemic demands such as the outright rejection of all austerity measures, nationalizing healthcare, abolishing private healthcare and insurance, and so on — to the end goal of overthrowing capitalism and replacing it with a society based on human needs, not profits.

This historic task requires in the first place that we build not only independent unions. Economic demands alone — the standard unionist program — will never be enough to free the working class from the shackles of capital. The bourgeoisie imposes and reproduces its hegemony through its state machinery in the most politicized fashion. Entire fields of “science” and “art”, in fact, have been dedicated to rationalizing their political shenanigans, justifying their unjust rule. 

Political problems require political solutions. As the bourgeois crumble on their feet, we must hit them where it hurts! Thus it is time for us to build a mass workers’ party that is uncompromising in its fight against the capitalist order.

For this party to succeed, it must be firmly rooted in the principle of democratic centralism — best summarized as “freedom to criticize and unity of action”. This ensures that the party remains both flexible in responding to challenges while always unified in every action it takes, while preventing internal fragmentation and co-optation by bourgeois forces. In addition, it must actively champion the demands of all oppressed communities, rejecting all forms of chauvinism, racism, and sexism that the ruling class actively uses to divide us. Above all — and this point always bears repeating — it must aim not merely at reforming capitalism but at dismantling it altogether, replacing it with a socialist order based on solidarity, equality, and democratic control by the working class.

We owe it to our public health workers who, in spite of their severe conditions of exploitation, toil through days and nights to give the best care they can to our sick and elderly. No society can be healthy if the healthcare providers themselves are not healthy in the first place. It is therefore in the material interest of workers from all sectors and backgrounds, and the masses in general, to show our fullest solidarity both in words and in action.

Bourgeois apologists will keep dismissing us for “thinking too big”. Yet as history shows, every snide retort and snarky remark they shall throw at us of being “impractical”, “unpragmatic”, even “crazy”, will only go to vindicate every point we have made —  and shall not cease to make — about the historic task of the working class and its revolutionary role.

As against the hypocrisy of the capitalist Madani state, the opportunism of right-wing forces, and against the misguided politics of reformist social democrats — as against all of these reactionary cliques — we stand firmly with all healthcare workers and the working masses in fighting for a public healthcare system that does justice to all. Unite!

• For the immediate retraction of the WBB shift system, the SSPA 45-hour work week ruling, and all other regressive, anti-labor policies of the MOH and Madani state!

• No to austerity! For an immediate nationwide training and hiring drive to boost the public healthcare workforce, and to further reduce workload and hours!

• For an immediate raise in wages for all healthcare workers — as with all other workers (including migrant workers) — adjusted to inflation and national cost of living (as of 2024); for a federal minimum wage of RM20/hour, RM3,600/month!

• No to healthcare privatization! Abolish so-called “public-private partnership” projects such as the FPP Scheme and Rakan KKM Program!

• No to outsourcing auxiliary services in public hospitals, clinics, and all healthcare facilities to private businesses! Treat all contract workers as full-time employees, with full benefits!

• For the establishment of a fully public-owned Health Service Commission (HSC) that operates 100% independently from the government, collectively and democratically controlled by all healthcare workers!

• For the universal, unconditional right for all workers to unionize! No to union busting! No to careerism among union leaders! For the establishment of 100% independent, democratic unions!

• For the establishment of a 100% independent mass working class party in Malaysia! 
• Healthcare not as a commodity but a fundamental human right — for universal free healthcare!