The Reformist Doctor Who Treats the Symptom, Not the Cause

Through this scheme, specialists in public hospitals are allowed to take on private patients — a more lucrative side hustle. This would supposedly increase the income of public doctors and thereby incentivize them to stay in the public service. It would supposedly be a win-win situation for those who can afford to pay, as well as those who cannot. At the very least, the absurdity laid bare in these confident assertions is something Jeyakumar and we can both agree on.

Where we agree

Over the years the FPP scheme has been counterproductive, to say the least. The apparent problems are manifold. To begin with, by and large only senior doctors — often specialists or consultants with substantial experience — are eligible to provide services under the scheme, whereas junior doctors are largely excluded. This is not to mention that, seeing as FPP fees go only to the specialists and the government, other healthcare workers are not remunerated at all. Add these to the unsurprising result that those eligible for the scheme naturally tend to prioritize paying patients over subsidized ones, so that the side hustle becomes the main hustle, and both healthcare receivers and givers are split still further along the public-private line.

Put bluntly, we have a public healthcare system where young doctors are conditioned to grind through poor patients in order to work their way up to more affluent patients, understandably for the sake of better pay — all this while private hospitals continue to leech off our national healthcare budget under the guise of “public-private partnership”. On the other side of the equation, surely full-paying patients would still enjoy cheaper private healthcare than actual private healthcare. But whatever else, then, could this scheme be other than a means to squeeze middle class families, who find themselves increasingly torn between an increasingly broken public healthcare system and its increasingly expensive private counterpart?

Such a contradictory scheme is necessarily suicidal. The pandemic simply sped up the inevitable. Since then, three out of ten participating hospitals have practically ceased offering FPP services, a regulatory disaster celebrated by free market healthcare correspondents such as CodeBlue: “Five years later post-Covid, the service today is severely limited and not uniformly available across the remaining seven hospitals… This raises questions about the MOH’s ability to ‘expand’ an already declining FPP service — described by Health Minister Dzulkefly Ahmad as creating ‘private wings’ in government hospitals — in a new program called Rakan KKM with investments from GLICs in a special purpose vehicle.”

If the FPP scheme has fallen short of setting up private wings in public hospitals for fear of being overtly “classist”, then its successor in the form of Rakan KKM is here to annihilate that barrier once and for all. Launched as part of Budget 2025 and granted RM25 million to be piloted in five MOH hospitals, this program is simply more in line with the capitalist profit motive in such neoliberal times, during which capital develops a ferocious appetite for public goods and services — the more essential the better. After all, there can be no half-measures when it comes to privatization. 

But while we may agree on the futility of this expanded scheme, this is also where our perspective diverges from that of Jeyakumar, who maintains that this is merely a case of “too much of capitalism”. Because capitalism has run amok, he surmises, the solution to this is to have less capitalism. That means more regulation over the private healthcare industry, and of course higher taxes. To his credit he does not also forget to remind us of the international scope of this problem with respect to capital flight and offshoring, as well as the nature of the world market. Yet not unlike the very FPP scheme he sets out to criticize, he falls short himself of taking up an overtly class-based perspective, for fear of alienating his “progressive” liberal allies.

Where we disagree

More broadly, PSM would like us to think of neoliberalism — characteristically expressed in market deregulation and privatization of public goods — as a moral problem. The capitalist class has simply gone too far. “You want to have capitalism, fine, you have capitalism,” Jeyakumar concedes, “but you can’t allow the capitalists to take away so much of the wealth” because, well, “you’re going to have civil unrest.” He thus sees neoliberalism as some sort of departure from capitalism, as some kind of disease that can be cured. He then invites us to take a good hard look at the good side of Europe (never mind its crumbling economies) and learn a thing or two from Western European welfarism, the good old NHS for example.

We on the other hand view neoliberalism as a necessary advancement of capitalism. It began as global capitalism’s response to the energy crisis in the 1970s. It was the result of the conscious efforts on the part of the global bourgeoisie to shift the burden of crisis onto the working class, by commodifying all aspects of life and pushing ordinary people still further into poverty, particularly in the neocolonial world.

Since then, one crisis after another have broken out, uprooting billions of lives in the process, but each time as the capitalist class becomes more reactionary, the reformist in turn becomes even more apologetic. We would like to believe that this is not for the lack of principle, but of awareness. In all likelihood, the obsession of “socialists” like Jeyakumar with the potential moral awakening of some among the capitalist class, if not at least that of a state capable of whipping into their heads its independent morals, all stems from two basic assumptions for which they have no explanation.

First they believe it is the individual capitalist’s choice to exploit more or less. Thus they take concessions literally for granted. We certainly do not deny the particular existence of particularly good-natured, benevolent capitalists out there, be they philanthropists, tax-paying tycoons, or law-abiding elites, who under particular circumstances can in fact make particular differences in particular communities. But to deduce from this that it should therefore be feasible in general for the capitalist class to reform capitalism — as a class — is to ignore the forces of competition, the material necessity of exploitation, and therefore, the centrality of the class struggle.

Secondly they believe without question in the possibility of such a thing as a neutral state. In their eyes, even the wildest capitalists can be tamed — with unbiased laws enforced by a state devoid of class character. This will perhaps also shed light on why PSM devotes practically all its political energy into parliamentarism, rather than into the building of an independent working class party. We are not here to say that PSM does not want to do the latter, just that it is unable to do so due to its reformist nature. Because it does not recognize, as we do, the material fact that the state is nothing more than an instrument of the ruling class — that is, a tool for domination of one class over another — thus it is at best reluctant, and at worst unwilling, to challenge the capitalist state at its core. Instead, its strategy revolves around operating within the constraints of the existing system, lobbying for reforms and seeking the support of progressive liberal allies along the way, promising to curb the excesses of capitalism.

Here’s a concrete example. In the podcast, Jeyakumar stresses that the RM42 billion allocated to healthcare as per Budget 2025 represents only about 2.2% of our national GDP, as compared to about 10% in, say, the UK and Japan, underscoring Malaysia’s lower relative allocation as absolute spending rises. In response, “what a lot of NGOs and PSM […] have been asking for is to increase the government allocation for healthcare to at least 4 or 5%—almost double it from what it is now” — by means of increasing corporate taxes, for instance. At the same time, however, he laments that doing so tends to trigger capital flight, as we are all “living in fear of investors”.

PSM would agree with us that low public spending on essential services — austerity more broadly — is much more common and severe in the neocolonial world. It only becomes a point of contention when Jeyakumar calls for regional cooperation between neocolonial states, rather than competition, as a form of solidarity against imperialism. He imagines a somewhat OECD-like ASEAN where member states could agree on, say, a common taxation framework (so-called “two-pillar solution” to the MNC tax fraud problem worldwide) to keep one another from courting foreign investors “irresponsibly”, for example by dramatically lowering corporate taxes to cut off the others.

Forget the fact that even the once-enviable living conditions and democratic rights in what used to be called “welfare states” in those better parts of Europe have eroded over the years and are now threatening to fall apart altogether. So long as capital continues to dictate the world economy, and so long as the world market remains alive, competition is the default economic relation between all nation-states.

Clearly this is much more so the case among neocolonial economies, where the capitalist mode of production is much less advanced and develops much more unevenly. It is naturally the task of these underdeveloped national bourgeoisies scattered across the neocolonial world to play catch-up with their imperial overlords and wrestle their way into better positions in the global economy. To facilitate this untimely ascension is the duty of all neocolonial states; thus they have no choice but to engage in what Jeyakumar himself describes as a “rat race to the bottom”, where exploitation of the working class by such means as wage suppression and austerity measures becomes markedly more brutal, especially in times of crisis when cheap credit is hard to come by.

But at the same time we can and must take advantage of this fact that there can be no solidarity within the capitalist class, and therefore also among capitalist states. In stark contrast, the shared exploitation of the working class necessitates its unity not only within but also beyond national borders. Workers in neocolonial countries as well as those in the imperial core, while unequally exploited, are exploited nonetheless. Thus the struggle against capitalism, which must be fought out on the international scale, is a historic battle waged by the exploited against the exploiting class — not, as PSM so fervently imagines, one fought between neocolonial and imperial states.

The revolutionary socialist perspective

That it is the state’s duty to uphold the rule of capital means capitalism cannot be challenged from within. Reformist strategies like those championed by Jeyakumar and PSM fail to recognize this fundamental, material truth. The state, as an instrument of class rule, is not a neutral arbiter capable of prioritizing the needs of the propertyless laboring class over the imperatives of capital. Even the most progressive reforms will ultimately be undermined or reversed so long as the capitalist system remains intact, as it continuously reproduces the conditions of inequality, exploitation, and crisis.

The expansion of public healthcare, increased social spending, or even stricter regulation of private capital — while necessary for immediate relief — will always be constrained by the capitalist framework. The real solution lies not in tinkering with the system but in fundamentally transforming it. This is why the revolutionary socialist perspective must center on the complete overthrow of capitalism and its replacement with a democratically planned economy under workers’ control.

Such a transformation can never be achieved through parliamentary lobbying or alliances with liberal “progressives”. History has shown that these reformist approaches, while every now and then capable of winning temporary concessions, ultimately serve on the one hand to demobilize and pacify the working class, and on the other to mobilize and embolden the ruling capitalist class.

This much is clear from the experience of the British Labour Party’s betrayal of the miners’ strike in 1984–85^[1], as well as that of the Syriza government’s betrayal of its voters during the 2015 debt crisis in Greece^[2]. Or, if the reformists should again make the stubborn case that these examples are not comparable with the neocolonial experience, then might we point them no further than to those of the African National Congress in South Africa^[3] and the Workers’ Party in Brazil^[4].

At this point does it bear repeating that not only do reformist “socialists” such as Jeyakumar — or modern-day social democrats to be exact — fail to recognize the root of and address systemic crises, but their politics also actively undermines revolutionary momentum. It therefore has to be said that they are reactionary in character. Whether or not they genuinely desire progress does not alter this fact one bit.

If we all agree that capitalism wreaks terror on the rest of us, then surely we do not negotiate with terrorists, do we? For what earthly gains could possibly arise out of compromising with our enemy who is ever more ready to exploit the very same compromises to neutralize our opposition and consolidate their power?

Instead, as revolutionary socialists we must focus our political energy on organizing the working class independently of bourgeois institutions and bourgeois parties. Only through the diligent building of a mass workers’ party that completely and unapologetically divorces bourgeois politics, does the proletariat stand a chance of taking power.

There would not be a party, it goes without saying, without a program. After all, every political party is a class representation, such that the program of a party is necessarily a program for the class it represents and, at the same time, a program against the class it battles. A capitalist party like PKR adopts a capitalist program, while a workers’ party like SA adopts a workers’ program. What perhaps confuses the general public is not the fact that all mainstream parties are in fact capitalist parties, but that an apparently pro-workers party like PSM claims to have a workers’ program, all while it constantly seeks electoral collaboration (yet so far to no avail) with other more overtly pro-capitalist parties — this time around with the self-identified social democrats of MUDA, if not also with potential progressive outcasts within PH.

Consider PSM’s stance on the question of minimum wage, for example. The party recognizes that half of Malaysian workers get paid lower than RM2,800 a month — a little more than what used to be the standard cost of living for an individual in urban areas as per Bank Negara’s assessment — back in 2017. It is further noted that 35% of all formally employed workers earn less than RM2,000 a month (as of 2023).

We of course share the fury of everyone in PSM upon the government’s increasing the minimum wage from RM1,500 to a mere RM1,700. But it is also our responsibility to point out the contradiction of PSM’s call instead for RM2,000, what must be called here as the absolute bare minimum. It is absurd for a party that calls itself “socialist” to demand still lower than what is actually needed by the workers, whom it claims to represent — let alone lower than what BNM recommended almost a decade ago!

But now that we understand the reformist character of PSM, what seemed absurd becomes sensible. Because it views socialist revolution as “undoable” (for an indefinite time being), much like any reformist party, PSM necessarily takes “minimum” to mean literally “doable”. That is to say, they are “minimum” as far as the capitalist class can be pressured to concede. A ringgit more? Immediately shelved in the “unpragmatic” folder.

We, on the flip side, take “minimum” to mean literally “undoable”. As far as the “minimum” wage is concerned, SA calls for RM20 per hour, which translates to roughly RM3,600 a month (assuming a monthly average of 180 working hours). This rate accounts for inflation (since Bank Negara’s estimate seven years ago) and takes into consideration more than just the workers’ basic means of subsistence, which in our view best reflects what they need in reality to live a dignified life. But obviously the capitalist class will never agree to what is reasonable, such that they will have no choice but to fight us on our ground.

Put bluntly, we do not want to make it easy for the capitalist class to give concessions just so that it can drag out its dying order. In fact, we want just the opposite. We want to organize the working masses around demands that are reasonable for them but precisely and ultimately undoable from the capitalist point of view. In so doing we reveal the futility of reformism on the one hand, and on the other excite the working class to its ability to achieve what even the most “progressive” capitalists cannot.

All this is to say that we support “minimum” demands only insofar as they are transitional; that is, only if they serve to address the immediate needs of the working class and, at the same time, expose the inability of the capitalist system to meet those very needs. Such is the essence of a transitional program, whose goal in the positive is to bridge the gap between the workers’ current consciousness and the necessity of socialist revolution, by posing transitional demands which not only resonate with the lived experience of the masses, but also expose the contradiction between their needs and the capitalist profit motive.

Back on the specific subject of Malaysian healthcare, a specific transitional program can indeed be used to mobilize healthcare workers against healthcare-specific neoliberal measures such as the FPP and Rakan KKM schemes — though not as isolated policies, but as part of the broader capitalist agenda to commodify healthcare. In this light we also take inspiration from Hartal Doktor Kontrak, who recently published a press release in opposition to the government’s new austerity directive mandating additional working hours for public nurses (for which we also wrote a solidarity statement). With revolutionary socialist intervention, such a demand, among many others, can take on a transitional character and, with time, grow in scale as well as in essence, into broader and more critical demands such as nationalizing healthcare.

At the end of the day, between PSM and us there is no question at all as to whether healthcare should be a commodity to be bought and sold in the free market. It is without a doubt a fundamental human right that must be guaranteed to all. And we should likely find ourselves in agreement that in a socialist economy democratically planned by workers, the immense public resources currently wasted on profit-driven healthcare models would be redirected toward establishing a universal, high-quality healthcare system that includes not only curative care but above all investments in preventive measures, public health infrastructure, and advances in various social determinants of health. However, while we commend PSM’s willingness to critique capitalism (however partially), its failure to draw revolutionary conclusions ultimately leaves it trapped within the narrow confines of reformism, which is bound to be counterproductive.

Still, should it be insisted in the last analysis that the objective conditions are not ripe for revolution, as its leaders have so often conceded, then it must be said in passing that there may very well be as many stars in the sky as there are factors contributing to this objective ripeness. Barring those with a savior complex, never is it up to any one of us meager individuals to decide. That decision belongs to the laboring masses, whose lived experiences of exploitation and struggle collectively determine the course of history.

As their vanguard we do not sit idly on the fence, belittle the workers for being oblivious, and flirt with the foe to score a handful of parliamentary seats — all while casually waiting for the arrival of some mythical “perfect moment”. As opposed to these fatalists, it is our daily task to actively intervene in the class struggle no matter its maturity, honing our skills and perspective along the way. It is only through persistent revolutionary education, agitation, and organization — however small and constrained by the present moment — that we create the conditions for future victories.