FacebookTwitterGoogle+RedditEmail

What’s Missing from the Health Care Debate

by SUSAN ROSENTHAL, MD

The latest report by the Commonwealth Fund confirms what we already know; Americans pay more for health care and have poorer health compared with people living in nations that spend less on health care yet enjoy better health.

It is generally assumed that lack of access to medical care is to blame for America’s abysmal health statistics and that improved access will remedy the situation. This is mistaken. Lack of access is just one indicator of the social inequality that is driving America’s health crisis.

The myth that good health is a product of the health-care system was fueled by the expansion of the welfare state after World War II. The establishment of the British National Health Service (NHS) in 1948 was accompanied by improved population health and a reduction in the difference in death rates between the social classes. Politicians claimed that the NHS had produced these benefits, but later studies revealed that improved health follows a rise in the general standard of living and a reduction in class inequality, as occurred in Britain after the war.

To investigate the link between health and inequality, researchers examined workers in the highly stratified British civil service. Despite all the subjects enjoying decent pay and equal access to health care, the risks of illness and premature death increased as one moved down the social hierarchy. These health differences were significant and could not be accounted for by differences in smoking, diet or exercise.

Over the past 50 years, numerous studies have confirmed that social inequality is not only an independent factor in determining health, it is the most important factor. As social inequality increases, health deteriorates. This holds true for everyone living in an unequal society, not just those on the short end of the stick.

In 1998, the American Journal of Public Health published a study comparing income inequality with death rates in 282 American cities. Greater inequality was associated with higher death rates at all income levels. Areas with the greatest inequality suffered 140 additional deaths for every 100,000 people per year compared to areas with the lowest inequality. The difference in death rates was comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, HIV infection, suicide and homicide. There is no consensus on why inequality is so health-damaging, but there is no longer any question that it is.

Class inequality in the U.S. has risen steadily since the 1970s, when Corporate America pushed to raise productivity by driving down workers’ living standards. The result has been growing inequality, deteriorating health and the emergence of poverty epidemics like HIV/AIDS and tuberculosis in the world’s richest nation.

The U.S. has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world. This inequality is the source of America’s economic success and its continued position as global super-power. Forced to compete with the U.S., other industrialized nations including the U.K., Canada and the European Union are dismantling and privatizing their own national health-care systems.
Breaking the stalemate

In matters of health, Corporate America is caught between a rock and a hard place. Increasing productivity requires a basic level of fitness within the working class; however, paying for this in the form of higher wages, employee benefits or higher taxes decreases productivity. This conflict finds expression in the demand for a more effective health-care system and the failure to provide one. Simply arguing that the current system is unfair, ineffective and overly expensive will not be enough to break this stalemate.

In the past, universal health care was won through mass struggle. Germany established the first European national medical plan in 1883 to avoid a revolutionary upheaval like the one that shook France in 1871. In Britain, the 1911 National Insurance Act was rushed through Parliament during a mass strike wave. In 1943, a Conservative member of the British Parliament warned, “If you don’t give the people reform they are going to give you revolution.” The British NHS was part of a social welfare program to stabilize relations between capital and labor after the war. Canadian unions won a national health plan in 1972, the year of the Quebec General Strike.

In the U.S., the Congress of Industrial Organizations and the American Federation of Labor pushed for a national health program after World War II. The ruling class preferred to build the world’s biggest military machine. America’s Cold War with Russia provided the opportunity to attack the unions and gut them of militants. That defeat explains why there is still no labor party in the U.S. and no national health plan.

The accumulation of profit at the top of society creates an accumulation of sickness at the bottom. No form of health-care system can reverse the health-damaging effects of rising inequality. The current debate on health-care must go beyond discussions of the best way to manage the carnage created by capitalism.

At the Cannes screening of Sicko, Michael Moore states, “The bigger issue in the film is, ‘Who are we as a people?'” Human health is not a commodity that can be churned out by the right kind of health-care system. Human sickness is a product of sick social relationships, and human health is a product of healthy social relationships. The quality of our medical system is a result and a reflection of those relationships.

Dr. Susan Rosenthal has been practicing medicine for more than 30 years and has written many articles on the relationship between health and human relationships. She is also the author of Striking Flint: Genora (Johnson) Dollinger Remembers the 1936-1937 General Motors Sit-Down Strike (1996) and Market Madness and Mental Illness: The Crisis in Mental Health Care (1999) and Power and Powerlessness. She is a member of the National Writers Union, UAW Local 1981. She can be reached through her blog: www.powerandpowerlessness.typepad.com

 

 

 

 

More articles by:

CounterPunch Magazine

minimag-edit

August 25, 2016
Mike Whitney
The Broken Chessboard: Brzezinski Gives Up on Empire
Paul Cox – Stan Cox
The Louisiana Catastrophe Proves the Need for Universal, Single-Payer Disaster Insurance
John W. Whitehead
Another Brick in the Wall: Children of the American Police State
Lewis Evans
Genocide in Plain Sight: Shooting Bushmen From Helicopters in Botswana
Daniel Kovalik
Colombia: Peace in the Shadow of the Death Squads
Sam Husseini
How the Washington Post Sells the Politics of Fear
Ramzy Baroud
Punishing the Messenger: Israel’s War on NGOs Takes a Worrying Turn
Norman Pollack
Troglodyte Vs. Goebbelean Fascism: The 2016 Presidential Race
Simon Wood
Where are the Child Victims of the West?
Roseangela Hartford
The Hidden Homeless Population
Mark Weisbrot
Obama’s Campaign for TPP Could Drag Down the Democrats
Rick Sterling
Clintonites Prepare for War on Syria
Yves Engler
The Anti-Semitism Smear Against Canadian Greens
August 24, 2016
John Pilger
Provoking Nuclear War by Media
Jonathan Cook
The Birth of Agro-Resistance in Palestine
Eric Draitser
Ajamu Baraka, “Uncle Tom,” and the Pathology of White Liberal Racism
Jack Rasmus
Greek Debt and the New Financial Imperialism
Robert Fisk
The Sultan’s Hit List Grows, as Turkey Prepares to Enter Syria
Abubakar N. Kasim
What Did the Olympics Really Do for Humanity?
Renee Parsons
Obamacare Supporters Oppose ColoradoCare
Alycee Lane
The Trump Campaign: a White Revolt Against ‘Neoliberal Multiculturalism’
Edward Hunt
Maintaining U.S. Dominance in the Pacific
George Wuerthner
The Big Fish Kill on the Yellowstone
Jesse Jackson
Democrats Shouldn’t Get a Blank Check From Black Voters
Kent Paterson
Saving Southern New Mexico from the Next Big Flood
Arnold August
RIP Jean-Guy Allard: A Model for Progressive Journalists Working in the Capitalist System
August 23, 2016
Diana Johnstone
Hillary and the Glass Ceilings Illusion
Bill Quigley
Race and Class Gap Widening: Katrina Pain Index 2016 by the Numbers
Ted Rall
Trump vs. Clinton: It’s All About the Debates
Eoin Higgins
Will Progressive Democrats Ever Support a Third Party Candidate?
Kenneth J. Saltman
Wall Street’s Latest Public Sector Rip-Off: Five Myths About Pay for Success
Binoy Kampmark
Labouring Hours: Sweden’s Six-Hour Working Day
John Feffer
The Globalization of Trump
Gwendolyn Mink – Felicia Kornbluh
Time to End “Welfare as We Know It”
Medea Benjamin
Congress Must Take Action to Block Weapon Sales to Saudi Arabia
Halyna Mokrushyna
Political Writer, Daughter of Ukrainian Dissident, Detained and Charged in Ukraine
Manuel E. Yepe
Tourism and Religion Go Hand-in-Hand in the Caribbean
ED ADELMAN
Belted by Trump
Thomas Knapp
War: The Islamic State and Western Politicians Against the Rest of Us
Nauman Sadiq
Shifting Alliances: Turkey, Russia and the Kurds
Rivera Sun
Active Peace: Restoring Relationships While Making Change
August 22, 2016
Eric Draitser
Hillary Clinton: The Anti-Woman ‘Feminist’
Robert Hunziker
Arctic Death Rattle
Norman Solomon
Clinton’s Transition Team: a Corporate Presidency Foretold
Ralph Nader
Hillary’s Hubris: Only Tell the Rich for $5000 a Minute!
FacebookTwitterGoogle+RedditEmail