Healthcare – P2P Foundation

Book of the Day: Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor

P2P Foundation — Wed, 16 Jan 2019 10:00:00 +0000

A powerful investigative look at data-based discrimination—and how technology affects civil and human rights and economic equity

The State of Indiana denies one million applications for healthcare, foodstamps and cash benefits in three years—because a new computer system interprets any mistake as “failure to cooperate.” In Los Angeles, an algorithm calculates the comparative vulnerability of tens of thousands of homeless people in order to prioritize them for an inadequate pool of housing resources. In Pittsburgh, a child welfare agency uses a statistical model to try to predict which children might be future victims of abuse or neglect.

Since the dawn of the digital age, decision-making in finance, employment, politics, health and human services has undergone revolutionary change. Today, automated systems—rather than humans—control which neighborhoods get policed, which families attain needed resources, and who is investigated for fraud. While we all live under this new regime of data, the most invasive and punitive systems are aimed at the poor.

In Automating Inequality, Virginia Eubanks systematically investigates the impacts of data mining, policy algorithms, and predictive risk models on poor and working-class people in America. The book is full of heart-wrenching and eye-opening stories, from a woman in Indiana whose benefits are literally cut off as she lays dying to a family in Pennsylvania in daily fear of losing their daughter because they fit a certain statistical profile.

The U.S. has always used its most cutting-edge science and technology to contain, investigate, discipline and punish the destitute. Like the county poorhouse and scientific charity before them, digital tracking and automated decision-making hide poverty from the middle-class public and give the nation the ethical distance it needs to make inhumane choices: which families get food and which starve, who has housing and who remains homeless, and which families are broken up by the state. In the process, they weaken democracy and betray our most cherished national values.

This deeply researched and passionate book could not be more timely.

WINNER: The 2018 McGannon Center Book Prize and shortlisted for the Goddar Riverside Stephan Russo Book Prize for Social Justice

The New York Times Book Review: “Riveting.”

Naomi Klein: “This book is downright scary.”

Ethan Zuckerman, MIT: “Should be required reading.”

Dorothy Roberts, author of Killing the Black Body: “A must-read.”

Astra Taylor, author of The People’s Platform: “The single most important book about technology you will read this year.”

Cory Doctorow: “Indispensable.”

Reposted from MacMillan publishers. Click on the link for more reviews and an excerpt.

The post Book of the Day: Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor appeared first on P2P Foundation.

Art, Debt, Health, and Care: an Interview with Cassie Thornton

Marc Garrett — Mon, 20 Aug 2018 08:00:00 +0000

Since the financial crash 10 years ago, we’ve learned that it tends to be everyday people, on the ground, who pick up the pieces and not governments. Millions have been dragged into poverty while those who caused the “crisis”, after creating dangerously high levels of private debt, remain unscathed. ¹ The UK Conservative government’s response was an Austerity policy, driven by a political desire to reduce the size of the welfare state. Amadeo Kimberly says, “austerity measures tend to worsen debt […] because they reduce economic growth.”² The effect has been devastating, creating all together, more homelessness, precarious working conditions and thus pushing working communities, deeper into debt. In the UK, the NHS is being privatized as we speak. According to a CNBC report, medical bills were the biggest cause of bankruptcies in the U.S in 2013, with 2 million people adversely affected. ³

The work of artist and activist, Cassie Thornton is included in the upcoming Playbour– Work, Pleasure, Survival exhibition at Furtherfield, curated by Dani Admiss. In this interview I wanted to explore the following questions as revealed in her current Hologram project:

What do current conditions say about trust and care, and can we trust the current, governing systems to have our best interests at heart?
How do we produce non-hierarchical trust and care that thrives outside of the doctor/patient relationship, which is especially important in the U.S., where it is a profit making industry?
How do we reverse engineer all this tragedy, and put power back where it needs to be?
How do we begin to build solidarity?

Cassie Thornton is an artist and activist from the U.S., currently living in Canada. Thornton is currently the co-director of the Reimagining Value Action Lab in Thunder Bay, an art and social center at Lakehead University in Ontario, Canada.

Thornton describes herself as feminist economist. Drawing on social science research methods develops alternative social technologies and infrastructures that might produce health and life in a future society without reproducing oppression — like those of our current money, police, or prison systems.

Interview

Marc Garrett: Since before the 2008 financial collapse, you have focused on researching and revealing the complex nature of debt through socially engaged art. Your recent work examines health in the age of financialization and works to reveal the connection between the body and capitalism. It turns towards institutions once again to ask how they produce or take away from the health of the artists and workers they “support”. This important turn towards health in your work has birthed a series of experiments that actively counter the effects of indebtedness through somatic work, including the Hologram project.

The social consequences of indebtedness, include the formatting of one’s relationship to society as a series of strategies to (competitively) survive economically, alone, to pay the obligations that you has been forced into. It takes so much work to survive and pay that we don’t have time to see that no one is thriving. Those whom most feel the harsh realities of the continual onslaught of extreme capitalism, tend to feel guilty, and/or like a failure. One of your current art ventures is the Hologram, a feminist social health-care project, in which you ask individuals to join and provide accountability, attention, and solidarity as a source of long term care.

Could you elaborate on the context of the project is, as well as the practices, and techniques, you’ve developed?

CT: Many studies show that the experience of debt contributes to higher levels of anxiety, depression, and suicide. Debt disables us from getting the care we need and leads us away from recognizing ourselves as part of a cooperative species: it is clear that debt makes us sick. In my work for the past decade, I have been developing practices that attempt to collectively discover what debt is and how it affects the imagination of all of us: the wealthy, the poor, the indebted, financial workers, babies, and anyone in-between. Under the banner of “art” I have developed rogue anthropological techniques like debt visualization or auxiliary credit reportingto see how others ‘see’ debt as an object or a space, and how they have been forced to feel like failures in an economy that makes it hard for anyone (especially racialized, indigenous, disabled, gender non-binary, or ‘immigrant’) to secure the basic needs (housing, healthcare, food and education) they need to survive, because it is made to enrich the already wealthy and privileged.

“The rise of mental health problems such as depression cannot be understood in narrowly medical terms, but needs to be understood in its political economic context. An economy driven by debt (and prone to problem debt at the level of households) will have a predisposition towards rising rates of depression.”⁴

After years of watching the pain and denial around debt grow for individuals and entire societies, I was so excited to fall into a ‘social practice project’ that has the capacity to discuss and heal some of this capital-induced sickness through mending broken trust and finding lost solidarity. This project is called the hologram.

MG: What kind of people were involved?

CT: The entire time I lived in the Bay Area I was precarious and indebted. I only survived, and thrived, because of the networks of solidarity and mutual aid I participated in. As the city gentrified beyond the imagination, I was forced to leave. I didn’t want to let those networks die. So, at first, the people who were involved were like me– people really trying to have a stake in a place that didn’t know how to value people over real estate and capital

The hologram project developed when, as I was leaving the city, I had invited a group of precariously employed, transient activists and artists to get together in the Bay Area for a week of working together. We aimed to figure out ways to share responsibility for our mutual economic and social needs. This project was called the “Intentional Community in Exile (ICE)” [the ICE pun was always there, now an ever more intense reference in the public eye] and it grew out of an opportunity offered by Heavy Breathing to choreograph an event at The Berkeley Art Museum. They allowed me to go above and beyond my budget to invite a group of 8 women together from across the US to choreograph methods of mutual aid: sharing resources, discussing common problems and developing methods for cooperating to co-develop an economic and social infrastructure that would allow us to thrive together, interdependently. What would it mean for our work as activists and artists to feel that we had roots within an intentional community, even if we didn’t have the experience of property that makes most people feel at home?

Miki Foster closing the ICE ritual called “dying in the eyes of the state”.

Members of ICE: Tara Spalty, Yasmin Golan, Miki Foster, Tori Abernathy, & Cassie Thornton.

Facebook event: “In departing from the idea of a long term home, family, property, or ownership, ICE models a mutual aid society to sustain creative and political practices within a hostile economic system. This project is about finding ways to exit economic precarity by building human relationships instead of accumulating capital– or to make exile warm. After a one week convergence of a small group of collaborators, ICE presents a discussion and performance of life practices as well as frameworks for material and immaterial mutual support.”

The Hologram was one of many ideas that developed as part of this project. One of the group members, Tara Spalty, founder of Slowpoke Acupuncture, (and one of the two acupuncturists you will see at SF protests or homeless encampments) and I fell into this idea when combining our knowledge about the solidarity clinics in Greece, our growing indebtedness and lack of medical records, and the community acupuncture movement. Then the group brainstormed about what the process would be like to produce a viral network of peer support.

MG: What inspired you to do this project? (particularly interested in the Greek influences here and what this means to you)

CT: My practice of looking at debt became boring to me by 2015 as it became more and more clear that individual financial debt was a signal of a larger problem that was not being addressed. The hyper individualism produced by indebtedness allows us to look away from a much bigger deeper story of our collective debts, financial and otherwise. We don’t know what to do with these much bigger debts, which include sovereign debts, municipal debts, debts to our ancestors and grandchildren, debts to the planet, debts to those wronged by colonialism and racism and more. We find it so much easier to ignore them.

When visiting austerity-wracked Greece after living in Oakland, I noticed that Oakland appeared to have far more homeless people on the street. It made me realize that, while we label some places “in crisis,” the same crisis exists elsewhere, ultimately created and manipulated by the same financial oligarchs. The hedge funds that profit off of the bankruptcy in Puerto Rico are flipping houses in Oakland and profiting off of the debt of Greece. We’re all a part of the same global economic systems. The “crisis” in Greece is also the crisis Oakland and the crisis in London. For this reason, I have been interested in what we can all learn from activists, organizers and others in crisis zones, who see the conditions without illusions.

This led me to an interest in the the Greek Solidarity Clinic movement, which since “the crisis” there has mobilized nurses, doctors, dentists, other health professionals and the public at large to offer autonomous access to basic health care. I went to go visit some of these clinics with Tori Abernathy, radical health researcher. Another project using this social technology is called the Accountability Model, by the anonymous collective Power Makes Us Sick. These solidarity clinics are run by participant assembly and are very much tied in to radical struggles against austerity. But they have also been a platform for rethinking what health and care might mean, and how they fit together. The most inspiring example for me was in at a solidarity clinic in Thessaloniki, the second largest city in Greece. The “Group for a Different Medicine” emerged with the idea that they didn’t want to just give away free medicine, but to rethink the way that medicine happens beyond conventional models, including specifically things like gender dynamics, unfair treatment based on race and nationality and patient-doctor hierarchies. This group opened a workers’ clinic inside of an occupied factory called vio.me as place offer an experimental “healed” version of free medicine.

When new patients came to the clinic for their initial visit they would meet for 90 minutes with a team: a medical doctor, a psychotherapist and a social worker. They’d ask questions like: Who is your mother? What do you eat? Where do you work? Can you afford your rent? Where are the financial hardships in your family?

The team would get a very broad and complex picture of this person, and building on the initial interview they’d work with that person to make a one-year plan for how they could be supported to access and take care of the things they need to be healthy. I imagine a conversation: “Your job is making you really anxious. What can we do to help you with that? You need surgery. We’ll sneak you in. You are lonely. Would you like to be in a social movement?” It was about making a plan that was truly holistic and based around the relationship between health, community and struggles to transform society and the economy from the bottom-up . And when I heard about it, I was like: obviously!

So the Hologram project is an attempt by me and my collaborators in the US and abroad to take inspiration from this model and create a kind of viral network of non-experts who organize into these trio/triage teams to help care for one another in a complex way. The name comes from a conversation I had with Frosso, one of the members of the Group for a Different Medicine, who explained that they wanted to move away from seeing a person as just a “patient”, a body or a number and instead see them as a complex, three dimensional social being, to create a kind of hologram of them.

MG: Could you explain how the viral holographic care system works?

CT: Based on the shape above, we can see that we have three people attending to one person, and each person represents a different quality of concern. In this new model, these three people are not experts or authorities, but people willing to lend attention and to do co-research, to be a scribe, or a living record for the person in the center, the Hologram. We call these three attendees ‘patience’. Our aim is to translate the Workers’ Clinic project to a peer to peer project where the Hologram receives attention, curiosity and long term commitment from the patience looking after her, who are not professionals. Another project using this social technology is called the Accountability Model, by the anonymous collective Power Makes Us Sick.

So the beginning of the process, like that of the Workers’ Clinic, is to perform an initial intake where the three patience ask the Hologram questions which are provided in an online form, about the basic things that help or hurt her social, physical and emotional/mental health. When this (rather extended) process is complete, the Hologram will meet as a group every season to do a general check in. The goal of this process is to build a social and a physical holistic health record, as well as to continue to grow the patience understanding of the Hologram’s integrated patterns.

Ultimately, over time we hope to build trust and a sense of interdependence, so that if the Hologram meets a situation where she has to make a big health decision (health always in an expansive sense) about a medical procedure, a job, a move, she will have three people who can support her to see her lived patterns, to help her ask the right questions, and to support peer research so that the Hologram is not making big decisions unsupported.

But, in order for the Hologram to receive this care without charge and guilt free, she needs to know that her patience are taken care of as she is. I think this is one part of the project that acknowledges and makes a practice built from the work of feminists and social reproductive theorists – you can’t build something new using the labor of people without acknowledging the work of keeping those people alive; reproducing the energy and care we need to overturn capitalism needs a lot of support. Getting support from someone feels so different if you know they are being, well taken care of. This is also how we begin to unbuild the hierarchical and authoritarian structures we have become accustomed to – with empty hands and empty pockets.

And then, the last important structural aspect of the Hologram project is the real kicker, and touches on the mystery of what it means to be human outside of Clientelist Capitalism – that the real ‘healing’ (if we even want to say it!) comes when the person who is at the center of care, turns outward to care for someone else. This, the secret sauce, the goal and the desired byproduct of every holographic meeting– to allow people to feel that they are not broken, and that their healing is bound up in the health and liberation of others.

The viral structure, is built into this system and there is a reversal of the standard way of seeing the doctor and patient relationship. In this structure it is essential that we see the work of the Hologram as the work of a teacher or explicator, delivering a case that will ultimately allow the patience to learn things they didn’t previously know. This is the most important, (though totally devalued by money) potent and immediately applicable, form of learning we can do, and it is what the medical system has made into a commodity, at the same time as it is seen as ‘women’s work’ or completely useless.

MG: Could you take us through the processes of engagement. For instance, you say a group of four people meet and select one person who will become a Hologram, and that this means they and their health will become ‘dimensional’ to the group. Could you elaborate how this happens and why it’s important for those involved?

CT: We are about to experiment, this fall, with what it means for these groups to form in different ways. We will start with four test cases, where an invited, self-selected person will become a Hologram. She will be supported to select three Patience in a way that suits her, based on an interview and survey. The selection of Patience is a part of the process that we have not had a chance to refine. It is not simple for any individual to understand what support looks like for them, or who they want support from, if they’ve never really had it.

The experiments we will work through this fall will attempt to understand what changes in the experience of the whole Hologram when the Hologram is supported by Patience who are trusted friends and family, acquaintances or highly recommended strangers. An ‘objective’ perspective from an outside participant also adds a layer of formality to the project, because, instead of a casual gathering of friends, an unfamiliar person signals to the other members of the hologram to be on time, and make the meetings more structured than a regular friend to friend chat.

The onboarding process for the Hologram and the Patience includes a set of conversations and a training ritual, which are still quite bumpy. The two roles every participant is involved in, requires a different set of skills, and so they both involve a special kind of “training” that one can do in a group or independently. This “training” is a structured personal ritual that allows participants to witness and adapt their own communication habits so that they feel prepared to participate and set up trust, curiosity and solidarity for the group in the opening intake conversations.

At the completion of the intake process, the Hologram (1) transitions to become a Patience. At this time, the Hologram (1) begins a short training to transition to the other role, and she is supported by her Patience to do this work. At the conclusion of the Hologram’s (1) transition to Patience, and the completion of the new Hologram’s (2) intake process, the original Hologram’s (1) Patience become Holograms (3,4,5).

MG: The Hologram project was first trialed as part of an exhibition called Sick Time, Sleepy Time, Crip Time at the Elizabeth Foundation Project Space in New York City, March 31-May 13, 2017. What have you learnt in more recent undertakings of The Hologram project?

CT: Since the original trial one year ago, which lasted for 3 months, the research has shifted to looking at building skills and answering acute questions that will accumulate to support and build the larger project. Starting in the Spring of 2017, I began to offer the Hologram project as a workshop, where participants could test the communication model that is implicit in the Hologram format. The method for offering it is, as a performance artist and rogue architect, creating a situation in a space where people go through a difficult psycho social physical experience together. In the reflective conversations that follow, I ask the groups to use the personal pronoun ‘we’ for the entire duration of the conversation. The idea is that one person’s experience can be shared by the group, and even as temporary Patience we can take a leap and share their experience with them for a duration of time, allowing a Hologram to feel as if their experience is “our” experience. And this feeling that one is not alone in an experience, if carried into other parts of life, has the potential to break a lot of the assumptions and habits that we have inherited from living and adapting to a debt driven hellscape.

Graeber, David. The Newstatesman. We’re racing towards another private debt crisis –so why did no one see it coming? 18 August 2017. bit.ly/2we2Bv5
Kimberly, Amadeo. Austerity Measures, Do They Work, with Examples. The Balance. 2018. thebalance.com/austerity-measures-definition-examples-do-they-work-3306285
Amadeo, Kimberly. Medical Bankruptcy and the Economy: Do Medical Bills Really Devastate America’s Families? The Balance. Updated May 16, 2018. thebalance.com/medical-bankruptcy-statistics-4154729
Davies, Will. Wallin, Sara. Montgomerie, Johnna. Financial Melancholia –Mental Health and Indebtedness. PDF Edition. 2015. perc.org.uk/project_posts/financial-melancholia-mental-health-and-indebtedness/

Reposted from Furtherfield.

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Enabling Data Philanthropy for Health and Care

Annemarie Naylor — Fri, 23 Mar 2018 08:00:00 +0000

In our report Intelligent Sharing: unleashing the potential of health and care data in the UK to transform outcomes, we recommended a number of measures to promote and facilitate what we termed ‘data philanthropy’, and the passage of the Data Protection Bill through Parliament affords us a timely opportunity to explore how Government might implement some of them in practice.

What is data philanthropy?

There are a number of competing definitions, but we take ‘data philanthropy’ to mean:

an informed contribution of data to a trusted vehicle by an individual data subject for mutual benefit; or
an informed contribution of data to a trusted vehicle by an individual data subject for public benefit; or
a data/data insight donation to a trusted vehicle on the part of a corporate entity – allowing it to “give back in a way that produces meaningful impact and reflecting the businesses’ core competencies, while preserving or expanding value for shareholders” (Stempeck, 2014).

It reads across, then, to distinct forms of ‘trusted vehicle’ that are designed to harness ‘data for good’ – which, for our purposes, means facilitating research and innovation to transform health and care outcomes.

In our report, we explored member-controlled ‘data cooperatives’ and ‘data communities’ operated by trusted intermediaries to facilitate data philanthropy on the part of individuals – in recognition of MiData Coop initiative in Switzerland and the success of the UK Biobank. We also looked at what are commonly referred to as ‘data collaboratives’, which involve private sector organisations donating and/or analysing the data they control, to explore data philanthropy on the part of corporate entities. Here, notable examples include private enterprises supporting the UN Global Pulse initiative and Strava Metro. Ultimately, we believe a range of ‘trusted vehicles’ that reflect the values of different individuals and corporate entities could usefully be established to further research and create the conditions for innovation with the aim of transforming health and care outcomes.

Why promote data philanthropy for health and care?

We welcome the introduction of provisions to the Data Protection Bill that are designed to facilitate peer-to-peer support amongst groups characterised by particular conditions and/or disabilities. However, there is otherwise a manifest lack of provision to underpin collective action for mutual and/or public benefit in the Bill, and we have recommended the Government considers introducing measures to promote and/or facilitate ‘data philanthropy’ for the following reasons:

Trust: there is already considerable support for ‘data philanthropy’ on the part of the general public where the aim is to further research in relation to health and care, but we believe the Data Protection Bill could function to proactively build trust by affording data subjects concrete opportunities to take a digital stake in society – in accordance with their values and irrespective of their socio-economic status. The Bill could also do more to recognise the role that businesses can play in stewarding well-being, by championing bespoke permissions and ‘trusted vehicles’ in relation to the re-use of privately controlled data for public benefit. It would then better reflect the UK Digital Strategy, which states that Government will ‘encourage innovative uses of data by making it easier, where possible, to access and use data held by both government and businesses’ (DCMS, 2017).
Size: whilst the UK benefits from unique health data sets which are of interest to researchers right around the world, most real-time data capable of indicating a person’s wellbeing (or otherwise) is currently vested in privately controlled and siloed data repositories. Moreover, the larger a dataset is, the more valuable it becomes – in particular, where machine learning and the development of Artificial Intelligence is concerned. Measures to promote and/or facilitate ‘data philanthropy’, both on the part of individuals and corporate entities, could serve to grow the overall quantum of data made available for research and innovation in relation to wellbeing and, with that, enhance the UK’s competitive edge in relation to comparable endeavours being pursued by countries that benefit from comparatively larger populations.
Quality and Scope: increasing the size of a dataset generally allows for extracting greater value from it, but this might not happen if ‘trusted vehicles’ are left to deal with low quality data [Carballa Smichowski, 2018]. Moreover, the capacity to link several datasets and the capacity to use a single dataset for several purposes render it more valuable still, because they increase the possibility of making good ‘descriptions, explanations, predictions and prescriptions’ [Chignard & Benyayer, 2015]. Therefore, whilst the Data Protection Bill and GDPR provide for individual Subject Access Requests and enhancements to ‘data portability’, the quality and scope of data that a ‘trusted vehicle’ might attract in promoting a standalone opportunity for ‘data philanthropy’ to individuals – on the basis of ‘explicit consent’ and in the absence of legal assurances and/or open standards and APIs – is questionable. A Government-backed data donor bank or data donation scheme could help to overcome these critically important issues.

Ultimately, our rationale for championing ‘data philanthropy’ and ‘trusted vehicles’ flows from our aspiration to effect a step-change in health and care outcomes in the UK. If we are able to harness Voice Assistant data from Alexa and kindred devices for the purposes of conducting research, might we be in a position to identify and better support people struggling with early onset dementia or mental ill-health at an earlier stage? If we increase access to the loyalty card scheme data currently collected by retailers for marketing purposes, might we be better placed to devise new interventions with which to help tackle obesity?

The possibilities are seemingly endless but are less likely to be realised – unless we empower individuals and businesses to play an active role in stewarding well-being in our digital age.

Practical Steps to Enable Data Philanthropy

In our report, we made a number of recommendations about promoting and enabling ‘data philanthropy’, and the Government could take practical steps to introduce them in the course of the Data Protection Bill’s passage through Parliament:

It may be appropriate, for example, to introduce a ‘duty to review provisions for data philanthropy’upon the Secretary of State for DCMS. Alternatively, the Government could simply expand the opportunities for data subjects to contribute data to electronic health and care records and other data sharing initiatives by introducing a ‘right to donate data to a third party to further research and innovation in health and care’ in the section of the Data Protection Bill concerning ‘rights of the data subject’.
The Government could commit to explore the development of a ‘gift-aid’ style scheme for data so as to encourage and facilitate data donations to further research and innovation in health and care. The National Data Guardian could, for example, be required to investigate the circumstances in which it may be appropriate to invite the giving of explicit consent to the processing and pooling of personal data for the purposes of research and innovation in health or social care. Alternatively, the Government could add to provisions concerning Subject Access Requests and ‘data portability’ so as to mandate that businesses invite people to give their explicit consent to donate their data to a recognised third party in order to further research and innovation in health and care integral to soliciting consent in relation to their standard terms and conditions of service.
The Government has welcomed our call to explore the development of ‘trusted data exchanges’ – most recently, in its endorsement of ‘Data and the Future of Health and Social Care’ [March, 2018]. It has also taken note of the issues raised by Baroness Neville-Jones during the Data Protection Bill’s Second Reading in the House of Lords – when she asked the Government to “think about the possibility that they should allow for the creation of governance and accountability regimes that will fit special circumstances” – adding that “the existence of the Information Commissioner should not result just in enforcing the law effectively and well; it should provide an opportunity for creativity under her auspices and the ability to create variations on governance regimes where they are needed”.

We support this sentiment and provisions that would further support the creation of ‘trusted data exchanges’ for health and care, underpinned by ‘data philanthropy’ and creative approaches to lawful consent. The Government could, however, go further and introduce provisions for ‘trusted data exchanges’ to be recognised in law as not-for-private-profit vehicles designed to safeguard data donated for the purposes of research and innovation in health and care. This would constitute a bold move and attest to the Government’s ambition to support the evolution of public, private and third sector organisations alike in the digital age. In particular, it would recognise that we currently lack a legal vehicle which benefits from the digital equivalent of the tangible ‘asset locks’ that are applicable to established charities.

There is, then, considerable scope for the Government to take action to better enable data philanthropy in the interests of transforming health and care outcomes – and there is, perhaps, no better time than at present.

REFERENCES

Carballa Smichowski, B. (2018) The value of data: an analysis of closed-urban-data-based and open-data-based business models. Available from: https://www.sciencespo.fr/ecole-urbaine/sites/sciencespo.fr.ecole-urbaine/files/2018_01%20-%20Carballa.pdf

Chignard, S., & Benyayer, L.-D. (2015) Datanomics. Les nouveaux business models des données. FYP editions.

Department for Digital, Media, Culture and Sport (DCMS) (2017) UK Digital Strategy 2017, [online]. Available from: https://www.gov.uk/government/publications/uk-digital-strategy/uk-digital-strategy

Stempeck, M. (2014) Sharing data is a form of corporate philanthropy. Harvard Business Review, 24 July 2014, [online]. Available from https://hbr.org/2014/07/sharing-data-is-a-form-of-corporatephilanthropy

Woods, T., & Kihlstrom, E. (2018) Data and the Future of Health and Social Care. Future Health Collective, March 2018 [online]. Available from: https://www.colliderhealth.com/future-health-collective/

Reposted from Future Care Capital

Photo by mag3737

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John Restakis on the emergence of social care coops

Stacco Troncoso — Mon, 18 Sep 2017 07:00:00 +0000

Guerrilla Translation’s transcript of the 2013 C-Realm Podcast Bauwens/Kleiner/Trialogue prefigures many of the directions the P2P Foundation has taken in later years. To honor its relevance we’re curating special excerpts from each of the three authors. First up, John Restakis describes the transformation of the traditional cooperative model into today’s growing Social Coop movement.

John Restakis

John Restakis: Historically, cooperatives have been primarily focused around providing support and service to the members. Cooperatives, which are basically a democratic and collective form of enterprise where members have control rights and democratically direct the operations of the co-op, have been the primary stakeholders in any given co-op – whether it’s a consumer co-op, or a credit union, or a worker co-op. That has been the traditional form of cooperatives for a long time now. Primarily, the co-op is in the service of its immediate members. That has changed over the last 15 years or so, particularly in the field of the provision of social care.

Social co-ops emerged in the late 70s in Italy as a response to a market failure within public services in Italy. Groups of families or users of social services, primarily originally from within a community of people with disabilities, decided to organize cooperatives as a better way of designing and providing services to themselves. This is a very different model from the state-delivered services to these people. What was really fascinating about the social co-ops was that, although they had members, their mission was not only to serve the members but also to provide service to the broader community. And so, they were communitarian, community service organizations that had a membership base of primary users of that service, whether it was healthcare, or help for people with drug addictions, or whatever.

These social co-ops have now exploded in Italy. I think they have taken over, in a sense, the provision of social care services in many communities under contracts to local municipalities. In the city of Bologna, for example, over 87% of the social services provided in that city are provided through contract with social co-ops. These are democratically run organizations, which is a very different model, much more participatory, and a much more engaged model of designing social care than the traditional state delivered services. The idea of co-ops as being primarily of interest in serving their own immediate membership has been expanded to include a mandate for the provision of service to the community as a whole.

This is an expansion of this notion of cooperatives into a more commons-based kind of mission, which overlaps with the philosophy and values of commons movement. The difference, however, is that the structure of social co-ops is still very much around control rights, in other words, members have rights of control and decision-making within how that organization operates. And it is an incorporated legal structure that has formal recognition by the legislation of government of the state, and it has the power, through this incorporated power, to negotiate with and contract with government for the provision of these public services. One of the real strengths of the cooperative form is that it not only provides a democratic structure for the enterprise – be it a commercial or social enterprise – but it also has a legal form that allows it to enter into contract and negotiate legal agreements with the state for the provision of public services. This model of co-op for social care has been growing in Europe. In Québec they’re called Solidarity co-ops, and they are generating an increasing portion of market share for the provision of services like home care and healthcare, and it’s also growing in Europe.

So, the social economy, meaning organizations that have a mutual aim in their purpose, based on the principles of reciprocity, collective benefit, social benefit, is emerging as an important player for the design and delivery of public services. This, too, is in reaction to the failure of the public market for provision of services like affordable housing or health care or education services. This is a crisis in the role of the state as a provider of public services. So the question has emerged: what happens when the state fails to provide or fulfill its mandate as a provider or steward of public goods and services, and what’s the role of civil society and the social economy in response? Social co-ops have been part of this tide of reaction and reinvention, in terms of civic solutions to what were previously state-designed and delivered public goods and services. So I’ll leave it at that for the moment, but it’s just an indicator of the very interesting ways in which the co-op form is being reimagined and reinvented to respond to this crisis of public services and the changing role of the state.

Read the full trialogue here

Photo by OiMax

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Unleashing the potential of data to transform health and care

Annemarie Naylor — Mon, 31 Jul 2017 08:00:00 +0000

Future Care Capital seeks a step-change in health and care and believes that a concerted effort to unleash the potential of health and care data could significantly improve outcomes for everyone in our society.

This report explores how the United Kingdom (UK) might support data-driven research and innovation to transform health and care. It also makes plain that, to achieve this, the UK needs to blaze a trail in the development of ‘data ethics’ to proactively build trust whilst safeguarding individuals.

Full Report – Unleashing the potential of health and care data

Executive Summary – Unleashing the potential of health and care data

In brief – our key recommendations

National context: enabling responsible data sharing and building public trust

Empower the Information Commissioner’s Office to tackle data-driven exploitation and discrimination to build public trust.
Introduce new sanctions to tackle the re-identification of data subjects from anonymous data sets, where consent, legitimate interest or contract is lacking.
Invest in technologies to positively impact social care services and task the Care Quality Commission with championing the digitisation agenda, including planning for a data-driven inspection regime to improve standards.
Streamline information governance modelling for Integrated Digital Care Records to expedite data sharing at the local level across health and care organisations.
Increase investment and support for data controllers to unleash health and care data in a standard and anonymised form, where there is a value in secondary analysis by third parties.
Expand the opportunity for data subjects to contribute health and care data to integrated records and other data sharing initiatives.

Pushing the boundaries: creating a culture of data philanthropy in a digital Britain

Establish a new National Health and Care Data Donor Bank, to coordinate data from the public and help improve the alignment of research to clinical need.
The Ministers for Digital Economy and the Third Sector, working in conjunction with the Open Data Institute and NHS Digital, business and the third sector, should develop a suite of tools to stimulate ‘data philanthropy’ in the UK.
Introduce a national Government programme to pilot the development of new health and care Data Cooperatives, Data Communities and Data Collaboratives to promote a culture of data philanthropy through the demonstration of tangible health and care outcomes delivered by a range of ‘trusted vehicles’.
The Government should explore the development of a ‘gift aid’ style scheme for health and care data, encouraging individuals to make health and care data donations to better enable research and innovation.

Establishing a health and care data advantage: investing in skills, business and infrastructure

Establish data-driven business clusters for new health and care enterprises backed by Government. These clusters should also offer skills training to help prepare the future workforce for the increase in demand for data-related job opportunities.
The Government should explore the scope to introduce tax and other incentives for businesses prepared to enter into Joint Ventures with a National Health and Care Data Donor Bank to help place future services on an affordable footing.
The new Chief Data Officer and National Data Guardian should be tasked by Government with contributing to the development of a strengthened and/or dedicated ‘data privacy shield’ for health and care data, applicable to any future trade negotiations outside Europe, to safeguard the public whilst improving the UK’s competitiveness.
The Government should support the establishment of ‘Living Labs’ to encourage innovators and entrepreneurs to develop new technologies to transform health and care outcomes. A ‘Living Lab’ could comprise of private dwellings, a residential care home and/or connected streets, and would involve the deployment of technologies associated with the Internet-of-Things.

About the Authors

Annemarie Naylor MBE is the Director of Policy and Consulting at Future Care Capital. She studied Government and Sociology at the University of Essex. For a large part of her career, Annemarie has work in public policy and economic development working with local, regional and central government.

Emily Jones is a Policy and Research Officer at Future Care Capital. She studied at the London School of Economics and Political Science where she achieved a degree in Social Policy. Emily was previously a Research Assistant at the Centre for Analysis of Social Exclusion.

Acknowledgements

We are very grateful to Dr Alison Powell for her insight and comments provided on a draft of this paper as well as for writing the Foreword. The team at Anthony Collins Solicitors LLP provided valuable legal input to inform our research. The contribution of individuals on behalf of the Leeds Care Record, Dorset Care Record, Hampshire Health Record and Connected Yorkshire has also been invaluable in the production of this report.

Photo by Community Eye Health

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Are You Ready To Accept That Capitalism Is the Real Problem?

The Rules — Fri, 21 Jul 2017 08:00:00 +0000

Before you say no, take a moment to really ask yourself whether it’s the system that’s best suited to build our future society.

Jason Hickel and Martin Kirk: In February, college sophomore Trevor Hill stood up during a televised town hall meeting in New York and posed a simple question to Nancy Pelosi, the leader of the Democrats in the House of Representatives. He cited a study by Harvard University showing that 51% of Americans between the ages of 18 and 29 no longer support the system of capitalism, and asked whether the Democrats could embrace this fast-changing reality and stake out a clearer contrast to right-wing economics.

Pelosi was visibly taken aback. “I thank you for your question,” she said, “but I’m sorry to say we’re capitalists, and that’s just the way it is.”

The footage went viral. It was powerful because of the clear contrast it set up. Trevor Hill is no hardened left-winger. He’s just your average o—bright, informed, curious about the world, and eager to imagine a better one. But Pelosi, a figurehead of establishment politics, refused to–or was just unable to–entertain his challenge to the status quo.

Fifty-one percent of Americans between the ages of 18 and 29 no longer support the system of capitalism. Illustration: Ignotus the Mage/Flickr

It’s not only young voters who feel this way.

A YouGov poll in 2015 found that 64% of Britons believe that capitalism is unfair, that it makes inequality worse. Even in the U.S., it’s as high as 55%. In Germany, a solid 77% are skeptical of capitalism. Meanwhile, a full three-quarters of people in major capitalist economies believe that big businesses are basically corrupt.Why do people feel this way? Probably not because they deny the abundant material benefits of modern life that many are able to enjoy. Or because they want to travel back in time and live in the U.S.S.R. It’s because they realize—either consciously or at some gut level—that there’s something fundamentally flawed about a system that has a prime directive to churn nature and humans into capital, and do it more and more each year, regardless of the costs to human well-being and to the environment we depend on.

Because let’s be clear: That’s what capitalism is, at its root. That is the sum total of the plan. We can see this embodied in the imperative to grow GDP, everywhere, year on year, at a compound rate, even though we know that GDP growth, on its own, does nothing to reduce poverty or to make people happier or healthier. Global GDP has grown 630% since 1980, and in that same time, by some measures, inequality, poverty, and hunger have all risen.

Gains are seen as the natural property of the investor class. Illustration: Ignotus the Mage/Flickr

We also see this plan in the idea that corporations have a fiduciary duty to grow their stock value for the sake of shareholder returns, which prevents even well-meaning CEO’s from voluntarily doing anything good—like increasing wages or reducing pollution—that might compromise their bottom line. Just look at the recent case involving American Airlines. Earlier this year, CEO Doug Parker tried to raise his employees salaries to correct for “years of incredibly difficult times” suffered by his employees, only to be slapped down by Wall Street. The day he announced the raise, the company’s shares fell 5.8%. This is not a case of an industry on the brink, fighting for survival, and needing to make hard decisions. On the contrary, airlines have been raking in profits. But the gains are seen as the natural property of the investor class. This is why JP Morgan criticized the wage increase as a “wealth transfer of nearly $1 billion” to workers. How dare they?What becomes clear here is that ours is a system that is programmed to subordinate life to the imperative of profit.

There’s something fundamentally flawed about a system that has a prime directive to churn nature and humans into capital. Illustration: Ignotus the Mage/Flickr

For a startling example of this, consider the horrifying idea to breed brainless chickens and grow them in huge vertical farms, Matrix-style, attached to tubes and electrodes and stacked one on top of the other, all for the sake of extracting profit out of their bodies as efficiently as possible. Or take the Grenfell Tower disaster in London, where dozens of people were incinerated because the building company chose to use flammable panels in order to save a paltry £5,000 (around $6,500). Over and over again, profit trumps life.It all proceeds from the same deep logic. It’s the same logic that sold lives for profit in the Atlantic slave trade, it’s the logic that gives us sweatshops and oil spills, and it’s the logic that is right now pushing us headlong toward ecological collapse and climate change.

Millennials can see that capitalism isn’t working for the majority of humanity, and they’re ready to invent something better. Illustration: Ignotus the Mage/Flickr

Once we realize this, we can start connecting the dots between our different struggles. There are people in the U.S. fighting against the Keystone pipeline. There are people in Britain fighting against the privatization of the National Health Service. There are people in India fighting against corporate land grabs. There are people in Brazil fighting against the destruction of the Amazon rainforest. There are people in China fighting against poverty wages. These are all noble and important movements in their own right. But by focusing on all these symptoms we risk missing the underlying cause. And the cause is capitalism. It’s time to name the thing.What’s so exciting about our present moment is that people are starting to do exactly that. And they are hungry for something different. For some, this means socialism. That YouGov poll showed that Americans under the age of 30 tend to have a more favorable view of socialism than they do of capitalism, which is surprising given the sheer scale of the propaganda out there designed to convince people that socialism is evil. But millennials aren’t bogged down by these dusty old binaries. For them the matter is simple: They can see that capitalism isn’t working for the majority of humanity, and they’re ready to invent something better.

What might a better world look like? There are a million ideas out there. We can start by changing how we understand and measure progress. As Robert Kennedy famously said, GDP “does not allow for the health of our children, the quality of their education, or the joy of their play . . . it measures everything, in short, except that which makes life worthwhile.”

We can change that. People want health care and education to be social goods, not market commodities, so we can choose to put public goods back in public hands. People want the fruits of production and the yields of our generous planet to benefit everyone, rather than being siphoned up by the super-rich, so we can change tax laws and introduce potentially transformative measures like a universal basic income. People want to live in balance with the environment on which we all depend for our survival; so we can adopt regenerative agricultural solutions and even choose, as Ecuador did in 2008, to recognize in law, at the level of the nation’s constitution, that nature has “the right to exist, persist, maintain, and regenerate its vital cycles.”

Measures like these could dethrone capitalism’s prime directive and replace it with a more balanced logic, that recognizes the many factors required for a healthy and thriving civilization. If done systematically enough, they could consign one-dimensional capitalism to the dustbin of history.

None of this is actually radical. Our leaders will tell us that these ideas are not feasible, but what is not feasible is the assumption that we can carry on with the status quo. If we keep pounding on the wedge of inequality and chewing through our living planet, the whole thing is going to implode. The choice is stark, and it seems people are waking up to it in large numbers: Either we evolve into a future beyond capitalism, or we won’t have a future at all.

Dr. Jason Hickel is an anthropologist at the London School of Economics who works on international development and global political economy, with an ethnographic focus on southern Africa. He writes for the Guardian and Al Jazeera English. His most recent book, The Divide: A Brief History of Global Inequality and Its Solutions, is available now.

Martin Kirk is cofounder and director of strategy for The Rules, a global collective of writers, thinkers, and activists dedicated to challenging the root causes of global poverty and inequality. His work focuses on bringing insights from the cognitive and complexity sciences to bear on issues of public understanding of complex global challenges.

Originally published at Fast Company

Lead Photo by Ignotus the Mage

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Working to Death: Leftist Critiques of Basic Income Fail to Offer Meaningful Alternatives

Ann Marie Utratel — Mon, 12 Jun 2017 07:00:00 +0000

Click here to read all our curated stories on Basic Income

This post by Miles Krauter in collaboration with Carter Vance was originally published on Medium.com, here and here.

From Finland to Kenya to Ontario, it seems that everyone interested in social policy is talking up basic income. It’s not a new idea, having been theorized since at least Thomas Paine’s musings on a “citizen’s dividend” in the late 1700s, and with variations actually having been piloted in several US cities and in Manitoba during the 1970s. Though many variations of the concept exist, with terms such as “negative income tax,” “basic income grant,” and “universal social payment” all signaling slightly different policy approaches, the basic idea is the same: the government would ensure, either by a direct payment or a top-up in the tax system, that all citizens (in some plans, certainly those proposed on the left, this would be extended to include refugees and permanent residents) not fall below a certain level of income per year. The exact level of cut-off varies between plans, but is usually located somewhere just above the Low-Income Cut-Off (LICO) in Canada, which is roughly $24,000 per year for a single adult, or a similar poverty measure in other jurisdictions. You wouldn’t have to work, or, indeed, do anything else other than breathe and sign up for the benefit in order to receive it. Sounds simple, right? The idea is quite tantalizing in its simplicity, being touted by its boosters as having the power to, at once, end absolute forms of poverty as well as provide social support to workers buffeted by automation and outsourcing, while giving more bargaining power to people trapped in the modern piecework of the so-called “gig economy.”

At the same time, for reasons that are understandable, there has recently been a set of voices on the left calling this idea out as too good to be true. To this side of the argument, basic income is being advanced as a Trojan Horse by governments attempting to maintain and deepen a neoliberal policy project while putting a new coat of paint on it to placate an increasingly restive public. They warn that a basic income will be used as cover for continuing cuts in health and educational services, along with privatization of other social programs, and state that leftists who advance even cautious cases for basic income are being played for suckers. While such arguments are not without merit in certain respects, they nevertheless fail to recognize both the traditions of social citizenship on the left that a basic income, at least in its leftist variation, speaks to, and the necessity for positive, emancipatory policy visions. Furthermore, these critiques also have the unwitting effect of continuing to unduly valourize “work” performed under capitalist conditions in a way that testifies to the deep penetration of certain harmful ideas about the sources of human dignity and worth into our collective social psyche. Basic income, properly formulated and applied with a critical eye, offers at least the potential of thinking about social organization in a different way. Given the upsurge of interest in the idea currently, those on the left would be foolish to not at least engage with it in order to shape the policy outcome.

The Dangers Are Real

Critics of basic income are right that BI programs should not be viewed as a panacea and that, absent a political struggle to make them the kind of basic income that is actually redistributive, they are not inherently a good thing. We can easily imagine a situation where a “basic income” program is instituted by a right-wing government in such a way that it is both inadequate to purchase basic needs and has its existence used as an excuse to slash other social expenditures (that are not adequately replaced by the BI) and to privatize public goods. To this end, there is a rightful caution to not simply take something called a “basic income” as doing what it says on the label, particularly when it is being advanced by governments with questionable records on social service. The “basic income” program currently being pushed by the right-wing government of Finland, for example, is nothing of the sort, and in reality has had more to do with an attempt to cut down expenditure on unemployment benefits. However, this is more of a basic point about not being bamboozled by flashy promises and to always be skeptical of the intentions of those in positions of political power than it is about basic income as a proposal in and of itself.

Any “basic income” proposal deserves intense scrutiny, as does any government policy proposal. In particular, aside from the actual levels of the benefits, we ought to be critical about who can receive the benefits (will it be conditional on citizenship?), the ease of receiving them (are we still going to have to make humiliating trips to the social services office?), and what other benefit programs are going to be phased out as a result. This level of scrutiny, in fact, could actually temper some of the left criticisms of left BI, such as the argument that any adequate BI would be so expensive, that left proponents of it are simply dreaming.

Any evaluation of the costs of a left BI must account for the fact that it would need to be gradually implemented (just like hikes to the minimum wage), and that it could eventually adequately replace welfare, disability benefits and tax credits rendered redundant. It must also account for the money that would be saved on less-burdened healthcare and justice systems, as well as the multiplier effects attendant to cash transfers to people with little capital. Finally, left critics of BI should understand that left proponents are generally banking on significant changes to our national revenue streams to sustain a generous BI, such as quantitative easing for the people, increased taxes on the wealthy (financial transaction, corporate, income, luxury, inheritance, etc), but also increased public ownership; is it too fantastical to dream of new automation-exploiting crown corporations directly funding a BI scheme? The left critic response is, presumably, yes, because none of this is ‘on offer.’ Like so many ‘realist’ arguments, this one’s cynical assumptions have a more narrow view of reality — potential and current — than what is warranted.

One of the assumptions underpinning this line of criticism appears to be that a genuinely democratic socialist government, or at least one capable of pushing politics in that direction, is out of reach. This is presumably so, under this line of argument, because change necessarily comes from below, and worker power is not at a point where a transformational government is feasible or sustainable. This view of political change assumes the forces behind (socialist) change to be unidirectional and linear, necessarily building from below and emanating upwards. Of course, this is truer than the reverse assertion, but the reality is more dialectical: forces at the macro scale can also feed into and grow forces for change from below. This has been demonstrated most recently by the campaigns of Jeremy Corbyn and Bernie Sanders. History consistently demonstrates that socialist-inspired programs and policies generally appear to be out of reach — until they aren’t. Advocacy of BI within a broader left policy framework is coming to the fore in France (the programs of both Benoit Hamon and Jean-Luc Melenchon advocated versions of a BI), in the UK (with John McDonnell promising to win the BI argument in the UK’s Labour Party), and even the federal NDP in Canada appears to be moving in a leftward direction generally, with space for a BI as a plank in that broader program. Meanwhile, it seems highly unlikely that the — presumably outgoing — Ontario Liberals will ever convert their problematic pilot project BI into implemented provincial policy.

Further, the idea that BI is merely some kind of bait-and-switch is belied by the fact that previous BI experiments have yielded positive social results. In the Manitoba “Mincome” case, crime, hospitalizations, mental health-related incidents and general social stress all declined, while wages at entry level jobs rose at a level above the provincial average. Though that and other pilots were unfortunately terminated too early to fully analyze their effects, the evidence we do have suggests that such a program would be likely to increase bargaining power at work, rather than decrease it. It is perhaps true that some boosters for BI have oversold it by presenting the idea as a panacea to a wide variety of social ills, but that observation should not lead to the overcorrection of outright dismissal.

A further critique within this vein links basic income to its sometimes supporters amongst the likes of Silicon Valley CEOs, with the idea that the program will merely be a form of noblesse oblige whereby such crumbs stave off absolute destitution amongst the masses, while income inequality grows ever higher. Again, this is not entirely without merit, and it is certainly possible to see how such a scenario would come to pass. But, in saying that this in itself should make BI a dead letter for the left, a couple of basic historical and tactical points are ignored. For instance, even though Bismarck created the foundations of the modern European welfare state as an explicit way of heading off the rise of socialist politics, this does not mean the welfare state itself is inherently a poison chalice. Though sometimes making critiques of its paternalism, its lack of inclusivity and its need to be more democratically organized, defense of the welfare state is one of the causes most near-and-dear to the modern left, including those who critique basic income.

Guilt-by-association will not do in this case, particularly given that it could be just as easily argued that we sully ourselves by association with public healthcare and old age pensions since these programs are currently supported by so-called “welfare nationalist” groups and parties of the right, as well as being historically implemented by a wide variety of political forces for a wide variety of reasons. Indeed, Canadian public healthcare was, in part, achieved thanks to the Conservative Diefenbaker government, which helped T.C. Douglas fund the Saskatchewan Plan, and the later Liberal government who oversaw the introduction of the federal Medicare program. All of this, of course, took place in a context of social and labour mobilization and agitation in favour of such programs.

On a tactical level, dismissing BI off-hand even as there is a growing interest in it risks giving over the conversation entirely to the very neoliberal types that those doing the dismissing are ostensibly concerned about. Refusing to engage in a conversation is rarely a good way of shaping it, and the space for more radical action rarely comes in the absence of preceding reform. Even a modest implementation of basic income, which provided some benefits to a wide social strata, could be a good organization point for further reforms as it would create a more widely-held stake in cash-based assistance, which is currently deeply stigmatized and cordoned-off from the more popular parts of the welfare state. Like the introduction of other universal programs, BI would create a public that could then be mobilized to defend and enhance it.

It is sometimes said by left BI critics that the conditions for a livable basic income are impossible under capitalism, because capitalist states would not allow workers to have access to what amounts to a kind of permanent strike fund. But, again, this ignores a rather obvious point: that a welfare state of any kind should not exist if this were wholly true. Any kind of state-furnished provision, whether in-kind or cash-based, allows workers to exercise some degree more leverage when negotiating with employers (otherwise, would Republicans constantly be trying to remove food stamp eligibility for workers on strike?). To this extent, we already have some degree of “strike funds” within the current makeup of the welfare state.

Basic income can be won on the same terms, which is to say via political struggle, that those other forms of social provision were, and though it may seem impossible at the current moment to see a future with a sufficiently high BI program, it is doubtless true that public healthcare once seemed such an impossible dream as well. Even as it stands, ‘public healthcare’ in Canada, and in many other countries, remains insufficient — an unfinished project. Yet, this universal program, even in its flawed state, is doubtless worth supporting. The analogy to public healthcare is helpful, as it highlights the importance of universal programs vis-a-vis workplace contingent benefits. Certainly, the American model of healthcare, which remains very much contingent on one’s workplace, is not ideal, and would not be ideal even if the state set a floor for health benefits at each workplace. BI, then, could potentially be seen as a kind of nationalization or decommodification of the wage, on the path to increased separation of means of subsistence from capitalists and the workplace. That said, we should not expect the most ideal BI to be the one that is implemented at first, but we can struggle for BI to be enhanced and expanded once implemented.

Work Sucks! Let’s Do Less of It (but Still Get Paid)!

At a more basic level, though, the left case against basic income is fundamentally uninspiring, on both the strategic and the philosophical levels. On the first, it is curious that critics tend not to offer their own prescription for tackling some of the core concerns that BI speaks to. Yes, they will sometimes gesture in the direction of either a full-employment policy (which may be problematic in and of itself on environmental grounds, and is vulnerable to some of the same critiques of BI concerning what state and capitalism can and will permit), or some combination of increased welfare rates and expanded in-kind social service provision, but in most cases they prefer to keep the conversation on increasing wages, expanding collective bargaining and updating labour law protections, particularly for precarious workers. This is not to say that all of these shouldn’t be on the menu of left goals, in particular turning those sectors of the economy which are growing (such as home health care and customer service) into relatively desirable, secure positions. Even with a robust basic income in place, there would still be a need for increased investment in in-kind services such as health care and education and the left should be committed to fighting for those. However, we should also recognize that these programs are not necessarily a response in themselves to the questions that left advocates of basic income are putting forward. It is not exactly clear how the prescription often offered by these critics of higher social assistance rates combined with a less restrictive and punitive benefits system meaningfully differs from a system of direct cash transfers set a sufficiently high level. Further, administering this benefit through the tax system or some other state agency not heavily stigmatized and structurally problematic as the welfare bureaucracy would help to increase social buy-in to the idea of government cash transfers. Socialists usually argue in favour of universal, or at least widely distributed, welfare state interventions precisely for the reason that targeted services or benefits are more vulnerable to attack from the political right, so, it remains curious why they want to retain the structural essence of the social assistance system, even if they do want it to be more genuinely helpful in some general sense.

We are sensitive to the point that many individuals currently employed in the social assistance delivery system are genuinely attempting to help their clients and that they do, on many occasions, provide them with system navigation advice which goes beyond the monetary benefits they administer. We do not, unlike libertarian basic income advocates, see BI as a way to slash good-paying public sector jobs. However, those who oppose BI on grounds of these jobs being lost, particularly those in organized labour, should at least acknowledge that there are contradictions in the roles that workers perform within these environments, that their function has increasingly become to police the behaviour of individuals receiving social assistance, and that acting to protect these jobs without an actual stated plan to change their function appears parochial and impedes the development of solidarity between social strata. People receiving higher, less restricted, levels of monetary support would be less in need of “system navigation” assistance in the first place, and there is nothing to say that public employees currently charged with welfare case management could not be shifted to other, more genuinely helpful, functions in the event that a direct cash transfer came to replace social assistance as we currently know it.

Though it is right to be skeptical of the “automation” explanation for the loss of well-paid, unionized jobs in the manufacturing sector, it is nevertheless true that many rote tasks in factories and elsewhere no longer require nearly the amount of physical labour they once did. With machine learning and commercially-ready ‘AI,’ this effect is only likely to intensify over the coming decades. Doubtless, some new jobs will be generated to make up for those which are lost, but this points to a deeper question about what the purposes of “innovation” and, indeed, work itself are. If the left response to the proliferation of what David Graeber has described as “bullshit jobs” is simply to make them better remunerated, we would seem to simply be buying into the capitalist mindset that what society labels as “work” gives our lives meaning, regardless of how mundane and unfulfilling we find the tasks themselves. The tiresome folkloric tale of a coming ‘knowledge economy’ — told to us by neo-liberals and post-Marxists alike — amounts to little more than a euphemism for a service economy that is already here. Yet neither a job at Google nor a job at McDonalds, with their different approaches to enforced happiness, will lessen our reliance on alienated wage-slavery, even if the former is better paid and more pleasant than the latter.

Instead, why shouldn’t our program be focused on creating the maximum social benefit of technological change through political participation? In other words, in noting that technology has created vast wealth that is privatized, we nationalize it, either through a basic income, or a French-style reduction of working hours without reduction in pay, or any combination of policies in this direction. Recognizing that even those well-paid manufacturing jobs of yore were often unpleasant, alienating and intellectually numbing is not a hard thing to do (even Adam Smith wrote about it in Wealth of Nations), but when presented with at least the potential to overcome this aspect of life in post-industrial capitalist society, there is a demurring to the nostalgia of an older era. Instead of shifting the subject of social justice to a kind of social citizenship, which thinkers such as Eduard Bernstein and T.H. Marshall envisioned with the expansion of the welfare state, the thinking remains stuck on limited definitions of “work,” “worker,” and the “economy.”

The objection to this shift of emphasis, other than its fairly acknowledged political difficulty, seems to be that it betrays the classical Marxist notion of the “worker” as the central political identity and the workplace as the central point of political struggle within capitalist society. Moving away from this conception, therefore, threatens both the recognition of the capitalist economic base as the main determining factor of sociopolitical conditions and the notion of work as being key to the “species-being” of humanity. What this objection ignores, however, is that Marx was not using “work” to mean the now-general notion of remunerated employment, but rather an expenditure of productive effort. The alienation of this “work” occurs when one does not capture the full value of what one produces, but also when the work being done is not freely chosen or self-directed.

Under the utopian conception of a basic income future (in essence, automated machines do most or all of the unpleasant work and BI levels are set at a level at which no one needs to work for money if they do not wish to), people would still “work” in Marx’s sense (they would write, paint, create dank memes, etc), just not in the commonly understood sense. Marx even muses about something that sounds suspiciously like a BI proposal in his economic and philosophic manuscripts — “an equality of wages paid out by the communal capital” — as a ‘crude communist’ first step towards an end to alienated labour.

In all, such a notion of “work” appears to be deeply tied to an uncritical, productivist form of Marxist thinking which may have had relevance in another political context but appears hopelessly dated in the current reality. This is all to say nothing of the fact that there are many people who have disabilities which prevent them from “working” in the conventional sense of the term, either temporarily or permanently, who are entirely written out of this analysis and would likely stand to benefit most from a basic income. Even the removal of the often intrusive, deliberately demeaning and manipulative aspects of the current social assistance regime would be deeply beneficial here, absent higher benefit levels. Similar remarks could be made as to the way in which basic income would act to, at least in part, recognize unpaid care work, usually done by women, which is often not considered as “work” under the status quo.

A Legacy to Build On

Enhancing and expanding any less than ideal BI program will inevitably come up against the limits of state and capitalism, but it is unclear why this is a bad thing. Capitalism’s contradictions, and their attendant crises, are not going to be avoided through BI, or any other redistributive reforms for that matter. As socialists, we should hope to confront these contradictions when state supports are in place and the rungs of the societal ladder are closer together, for this is when those of us on the lower rungs are most healthy and most powerful, and least likely to be swindled by shock doctrine elites. Undoubtedly, one of the best ways to achieve redistribution is through workplace struggles, but we also need socialist governments to implement a framework that makes these more likely (and more likely to be successful). However, we must also recognize the need for socialist governments to implement other redistributive mechanisms that exist separately from the workplace, such as a BI, if we ever hope to achieve a post-work society, and not just a more equal capitalism.

Basic income-type plans have enjoyed purchase on the left for some time, with in particular such luminaries as Francis Fox Piven and Martin Luther King Jr. calling for their adoption in the late 1960s. More recently, books such as Nick Srnicek and Alex Williams’ Inventing the Future and Paul Mason’s Post-Capitalism have put the idea back on the table. At the same time, it is true that Austrian economic figures such as Fredrich Hayek and Monetarist’s like Milton Friedman also supported their own version of basic income, which involved the grant replacing most if not all of the existing in-kind welfare state provisions. It can often be unclear, in the current debate, from which direction particular proposals around “basic income” are coming from, and perhaps it is for this reason that so much confusion and discord around BI exists on the left.

However, there is a crucial difference between the two essential variations of the idea that bears repeating: the latter seeks, fundamentally, to liberate the market from the control of the state, while the former seeks to liberate human beings from the market. Accomplishing the dream of unalienated labour is no easy task, and it is doubtful that any one of us has the exact right cookshop recipe to make it so. That said, the leftist dismissal of basic income, though it emerges from genuine concerns as to the instrumentalization of BI, is at the very least premature. Moreover, it remains unclear why we should believe the public would be more likely to accept continued privatization and austerity with the presence of a BI (elites appear to be proceeding just fine without it). We struggle now for a higher minimum wage and against these forces; why would we not struggle for a higher annual income and against these forces in the future? The left should view BI, as it does most aspects of the welfare state, as a tool whose political character is dependent on a balance of social forces. Rather than dismissing the notion outright based on its also being supported by some neoliberal forces, we ought to be fighting to make it our own and to make the best version of it possible.

Carter Vance is an MA candidate in the Institute of Political Economy at Carleton University and a former legislative researcher with the offices of Erin Weir and Peter Julien. His writing has appeared online at Jacobin, Truth Out and Inquires Journal.

Miles Krauter is a PhD candidate in the Sociology Department, and an alumni of the Institute of Political Economy, at Carleton University. He is the Vice President External at his union, CUPE 4600, and an organizer with the Fight for $15 & Fairness Ottawa. His writing has appeared online at rabble.ca, Ricochet, and Canadian Dimension.

Photo by familymwr

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Can Commons Thinking Drive a New Health System?

Shareable — Sat, 14 Jan 2017 09:00:00 +0000

Cat Johnson: What would it take to move from planetary imbalance into a state of sustained health and healing? In a recent report, Jamie Harvie, Executive Director of the Institute for a Sustainable Future and founder of the Commons Health Network, argues that we need a new health system, one based on a “profound appreciation of the complexity and interconnectedness of life across traditionally silo-ed institutional spheres of influence—healthcare, economics, agriculture, and others.”

Harvie points to the World Economic Forum (WEF) Global Risks report, which states that “global risks remain beyond the domain of just one actor” and that to create a healthy planet and people we must focus on collaborative and multi-stakeholder action. He also calls for a decentralization of our food systems using ecological principles and local knowledge and input.

Recognizing that clinical care determines only about 10% of health outcomes, Harvie explains that it’s essential to shift our health system to one that sees health as an interconnection of emotional, mental, spiritual, and physical well-being driven by social, economic and environmental factors.

As our current healthcare system is profit driven and externalizes social and environmental costs “in a manner that is inconsistent with health,” our next health system needs to “untangle deeply enmeshed financial incentives within the business of healthcare, so as unlock the true health potential within us all” and create a healthcare approach that recognizes the body as a complex, interrelated system.

To address the immense challenge of creating the next health system, Harvie turns to complexity science which provides the following insights into how a systems worldview changes our perception:

From parts to the whole
From objects to relationships
From knowledge to contextual knowledge
From quantity to quality
From structure to process
From contents to patterns

To create new systems of collaboration, empowerment, self-organization, transparency and more, he looks to the principles of the commons, where communities work together to “craft, monitor, enforce, and revise rules to limit their behavior and keep their resources available for the long term.” Harvie explains: “At their core is an acknowledgement of the importance of an approach that has a fair set of rules, a means to represent a voice, transparency, self-determination, localized boundaries or a sense of place, inclusivity and the right to health and well-being.”

Creating the next health system is a big task that will not happen overnight. The importance of rethinking the health of the planet and its inhabitants requires long-term commitment, collaboration and a new perspective. As Harvie writes:

“As we move forward, we must keep in mind that these issues are complex and require ongoing experimentation to test and probe the potential of nascent models and approaches. This uncertainty is challenging for our culture, which is accustomed to long term planning and the belief in predictability, especially in the context of impending climate change impacts. Moreover, we are accustomed to working within silos of expertise and have undeveloped interpersonal tools to work in this new networked, relational space. We must incorporate commons principles and subsidiarity in the context of a strong national and global rights framework.”

Cross-posted from Shareable.

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Open Source Revolution Circumvents Capitalist Monopoly

Kevin Carson — Mon, 05 Dec 2016 09:30:00 +0000

As my C4SS comrade Charles Johnson has pointed out, circumventing state authority and capitalist monopoly is far more cost-effective than lobbying and organizing to reform the law. This is confirmed, once again, by news of open-source hardware projects that offer much cheaper versions of two outrageously expensive medical devices: the EpiPen and the MRI machine.

The Open Source Imaging Initiative aims to “to develop an MR scanner that is affordable to build, operate, maintain and repair by providing full, freely available technical documentation that follows the standards of open-source hardware.”

At Activist Post, Brian Berletic (“EpiPen goes from $300 to $30 to $3 with Opensource and 3D Printing,” Oct. 11) notes that, compared to the superficial political outrage and posturing over the EpiPen, “perhaps more effective was a DIY biohacking group’s demonstration of turning an ordinary store-bought autoinjector into a functioning EpiPen, called an “EpiPencil.” This prototype costs $30-40 to make; but replacing the store-bought plastic parts with 3D-printed ones could lower the cost to $3. The design is not yet shelf-stable for extended and requires further development, but offers exciting possibilities.

Berletic notes that such open hardware projects “represent the surest means of holding corporations and governments accountable, not by begging them to do what they should already be doing, but forcing them change their behavior or face being displaced from markets by cheaper, opensource alternatives and eventually, an entirely alternative paradigm.” While activism may mean participating in projects, people also engage in activism when they “roll up their sleeves and create with their own two hands the change they want to see in the world.”

Johnson (“Counter-Economic Optimism,” Rad Geek People’s Daily, Feb. 7, 2009) stated the same principle back in 2008 in regard to copyright law. While copyright laws written by the proprietary content and software industries might be more draconian than ever, he said, the situation on the ground was more favorable than ever to people who wanted to ignore the laws and copy protected content.

If you direct your hopes and efforts into legal reform, “you will find yourself outmaneuvered at every turn by those who have the deepest pockets and the best media access and the tightest connections.” This is only to be expected “because, after all, the system was made for them and the system was made by them.” Lobbying and legal reform efforts have a huge effort-to-payoff ratio.

The cost-benefit calculus is much better for circumvention. “A law that cannot be enforced is as good as a a law that has been repealed, and that is where we’re headed, faster and faster every day, when it comes to the intellectual monopolists and their jealously guarded legal privileges.”

Imagine federations of neighborhood cooperative clinics sharing open-source MRI machines and other devices, using open-source versions of EpiPen, O2 cannulas, IV tubing, etc., printed in neighborhood cooperative machine shops, and pirated versions of drugs under patent printed in DIY Bio labs — all for a tiny fraction of the present cost of healthcare inside the corporate-state monopoly framework, and funded by the kinds of working class mutuals that flourished in the 19th and early 20th century.

When the state does fund healthcare, as with Medicare Part D and Affordable Health Act subsidies, its approach is to leave all the state-enforced capitalist monopolies (patents, practitioner licensing cartels, entry barriers and restraints on competition among giant bureaucratic hospitals) and simply help the poorest to purchase healthcare at the enormously inflated monopoly price. But it’s the monopoly price of healthcare itself — embedded rents on “intellectual property,” licensing, and bureaucratic overhead — that’s the problem in the first place. And the state will never do anything about this problem because enforcing the artificial property rights the propertied classes extract rents from is the main thing states do. Plus the managerial bureaucracies of state regulatory agencies and giant corporations are basically run by the same people, shuffling from one institution to another and back.

Governments, corporations and other large institutions will never truly represent us or be accountable to us. We need to create horizontal, cooperative institutions of our own that serve us, instead of bleeding us dry.Photo by Niels Heidenreich

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Camille Kerr on Unionized Platform Cooperatives for the Caregiving Industry

Michel Bauwens — Thu, 01 Dec 2016 08:29:00 +0000

This video from the amazing Platform Cooperativism conference that took place recently, brings the good news of the creation of transformative unionized labor platform coops for healthcare:

“Platform cooperativism has the potential to completely transform the caregiving industry – including childcare and homecare – into dignified jobs where people make a livable wage and have control over their work lives. Because of this potential, the ICA Group has been partnering with multiple divisions of the Service Employees International Union to research, build models, and launch unionized platform coops. For example, The ICA Group has been working with SEIU Public Services Division to develop a childcare platform solution that enables family childcare providers to benefit from shared services, centralized administration, as well as joint marketing services. The coop-network, likely to launch this coming spring, will further act as a bridge between industry, unions and policy-makers who share the goal of improving childcare jobs and quality.”

Photo by havens.michael34

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