The fiscal crisis of the state and state financing of health care

Abstract

After recognizing the absence of Marxist conflict perspectives in classic surveys of public finance and explanations of public support for medical care. a conflict perspective is suggested. O'Connor's work is drawn upon for the framework suggested here. In addition, the suggested framework places emphasis upon class struggle within neo-imperialist monopoly capitalism functioning in a world political economic system. Key components in this struggle are seen as national states, their component and ruling class structures, multinational corporations, and a supporting cultural hegemony. The nation state is seen as collecting and disbursing taxes and other financing to attempt to (1) provide favorable conditions for capital accumulation by the bourgeoisie and (2) integrate the potentially rebellious working class through a variety of cultural as well as welfare and service programs and. when necessary, repression. State financing of medical care is then considered within this perspective. As monopoly capital comes to require ever larger amounts of state financing, ruling class pressures develop to cut back on public support for services to the ‘non-productive’ portions of the population—the unemployed. those on welfare, the elderly, etc. The paper concludes with some action strategies and suggestions.