FacebookTwitterRedditEmail

How Capitalist Globalization Forecloses on Health Systems

The groundbreaking 1970 book American Health Empire reported that health care conglomerates had jelled into a profit-making system notable for inflicting chaos on sick people. Someday, the authors wrote, health-care reformers would be facing off against “the empire at its core institutions.” For authors contributing to the recent Monthly Review Press book Health Care Under the Knife, that someday is now.

Former academician and public health physician Howard Waitzkin, more recently a medical practitioner, edited the multi-author volume and contributed several essays of his own. The book includes essays from Steffie Woolhandler and David Himmelstein, co-founders and leaders of Physicians for a National Health Program, a prominent advocacy group on behalf of universal health care in the United States. They survey the political context of health care reform efforts in the United States and comment on the Affordable Care Act, enacted in 2010.

The title evokes an image of a patient undergoing surgery for the sake of a decisive cure, except that the patient in question is our diseased health care system. The subtitle is “Moving beyond Capitalism for Our Health, which implies that the offending pathology, capitalism, was somehow removed or eradicated. Radical political change is surely on the agenda, if not actual surgery.

This book is about antagonism between the neoliberal form of capitalism and decent health care. On display are capitalist-induced perversions that impinge on the delivery of care, interactions among the various health-care players, and the ideals and presumed mission of health workers. Corporations, institutions, and the state do the dirty work, mainly in the United States, but elsewhere too. A record emerges demonstrating that health care for all won’t happen under advanced capitalism.

Many of the problems catalogued in the book have to do with providers and their dealings with patients, employers, companies, and government agencies. The reader learns that primary care is shortchanged, providers must compete for employer approval, quantitative data replace judgment in determining quality of care, and the electronic record supersedes providers themselves as a medical home for patients.

According to authors Gordon Schiff and Sarah Winch, physicians comply with cost-cutting, document trivialities for the sake of reimbursement, “game the system,” and suffer “burn-out.” Atomized and alienated, they face “prolitarianization.”

Their bosses generally regard health care as a commodity. Insurance companies pursuing “vertical integration” absorb heath-care provider groups. Giant hospitals do likewise. The book refers to an omnipresent “medical-industrial complex.” It’s the creature of monopoly capital funded by debt-funded speculation. The pharmaceutical industry, for example, derives most of its huge profits from financial manipulations rather than from drug production, according to contributor Joel Lexchin.

Academic medical departments collaborate with corporations in carrying out research projects. High-level physicians and researchers, having bonded with corporations, end up hawking their products, pharmaceuticals most prominently. What with collaboration of state entities with corporations, business notions of cost-cutting and outsourcing inform governmental decisions on health care. Pharmaceutical companies have corrupted governmental regulatory processes in the United States and Europe. Drug companies exert control over the dissemination of scientific information, Lexchin reports.

These failings plus others described in the book lend support to the book’s main point: real health-care reform is impossible as long as rules, standards, and priorities of neoliberalism are in charge. The Affordable Care Act is shown to have hugely benefited the private insurance industry; it left 27 million Americans uninsured. Having adopted concepts of managed care, the legislation limits access by allowing pre-authorization, cost sharing, utilization review, high deductible plans, tiered benefit packages, and exclusion of out-of-plan providers. Administrative costs remain high.

Throughout the Global South, multi-national insurance companies have built associations with the social security and health care systems of various nations. In the Eurozone, neoliberal remedies like austerity, deregulation, privatization, and retreat from universal coverage have eviscerated some national health plans. Nations honoring international trade agreements don’t easily recover sovereign control. A chapter in the book cites the painful experiences of Greece, Spain, and England.

Another section says a lot about health care philanthropy in the hands of the very wealthy. The Rockefeller and Gates Foundations (GF) are shown to have emphasized technical, short term solutions for public health problems at the expense of preventative strategies. Concentrating on disease eradication, the foundations deal very little with social causes of ill health. The philanthropies are engaged in what authors Anne–Emanuelle Birn and Judith Richter call “philanthro-capitalism.”

They hold that a “global health plutocracy [has] enabled business interests to obtain an unprecedented role in global health policy-making with inadequate public scrutiny.” They claim that the World Health Organization has lost its once prominent role in studying health strategies and organizing primary and preventative care for the world. It functions less well now, mainly because United Nations member states, especially the United States, have been slow with dues payments. Private donations now account for almost 80 percent of that UN agency’s budget.

A section of the book explains how market- oriented mega-projects with a large ecological footprint have aggravated environmental and social threats to human health. These range from diminishing access to fresh drinking water, to deforestation and consequent proliferation of the Ebola and Zika viruses, to industrial-scale concentrations of food-producing animals that harbor disease-producing microbes.

The various contributing authors attend mainly to problems weighing on health care due to capitalism. But solutions they offer look to be scattershot and more in the category of good intentions than workable methods. They find promise in social movements by means of which community-based initiatives and resistance campaigns might be organized. In their concluding section of the book, authors Waitzkin and Adam Gaffney look to progressive elements within the Democratic Party for reform possibilities. And change may “require creating a new working class party (or parties).” In any case, they say, a “powerful, multicentric coalition” is “urgent.”

Praiseworthy examples appear of resistance to capitalist abuse of power. Among them are: water privatization in Bolivia, privatization of health services and social security in El Salvador, and public health failings in Mexico City. Far-reaching health-care reforms in Kerala, India; Bolivia; and Venezuela are mentioned. Authors Woolhandler, Himmelstein, and Gaffney present a “new vision” of single payer health care.

There’s no discussion in the book of a socialist alternative to capitalism. Dr. Waitzkin, the book’s editor, observes that, “We have chosen not to address the Cuban case here, which is in many ways exceptional, and on which a great deal of previous work exists.”

The imperfections of health care under neoliberalism catalogued in the book are legion, but the listing there is hardly exhaustive. Others include: frequently impaired interaction of U.S. physicians with working class patients due to biases relating to social class, heavy U.S. reliance on foreign trained physicians to fill the ranks of medical practitioners, and skewed implementation of affirmative action favoring middle and upper class entrants into medical schools.(1)

And for a long time U.S. medical educators have failed woefully in preparing adequate numbers of primary care physicians. Without them, transformation of U.S. health care is impossible. Also, the motivations of would-be health workers evidently are of no great concern to U.S. medical educators. Their Cuban counterparts, by contrast, foster ideals of service and solidarity.

Dr. Waitzkin and colleagues, it seems here, would have strengthened their critique of capitalist health care had they introduced data on health outcome. In fact, U.S. mortality data are scandalous. Infants die needlessly in epidemic fashion. African-American infants die at twice the rate of white infants. So many mothers die in association with childbirth as to suggest an underdeveloped nation. Minority citizens living in poor communities have diminished live expectancy. Life expectancy of middle-aged white Americans is falling.

Health Care under the Knife is valuable mainly because it provides reams of information on health care realities under capitalism. Moreover, the authors display contagious enthusiasm for a kind of health care that favors people over profits. They earn extra credit for their evident sympathy for a society heading in a revolutionary direction for the sake of just and effective health care. Regrettably, they did not pursue that lead.

Monthly Review magazine recently published two compelling articles that cover ground similar to that of the book. In an essay titled “Absolute Capitalism” John Bellamy Foster (MR, May 2019) traces the evolution of capitalism from Karl Marx’s version to the neoliberal form, the setting, he thinks, for “social-system failure.” Ian Angus (MR, June 2019) describes an out-of-control proliferation of microorganisms resistant to antibiotics – a “profit-driven plague” – which portends a “social and economic crisis.”

Note.

1. W.T. Whitney Jr., “Becoming a Physician: Class Counts,” Nature, Society, and Thought, vol. 15, no. 3 (2002), p. 261.

 

 

More articles by:

W.T. Whitney Jr. is a retired pediatrician and political journalist living in Maine.

bernie-the-sandernistas-cover-344x550
Weekend Edition
March 27, 2020
Friday - Sunday
Rob Urie
Bailouts for the Rich, the Virus for the Rest of Us
Louis Proyect
Life and Death in the Epicenter
Paul Street
“I Will Not Kill My Mother for Your Stock Portfolio”
Jeffrey St. Clair
Roaming Charges: The Scum Also Rises
Pam Martens - Russ Martens
Stimulus Bill Allows Federal Reserve to Conduct Meetings in Secret; Gives Fed $454 Billion Slush Fund for Wall Street Bailouts
Jefferson Morley
Could the Death of the National Security State be a Silver Lining of COVID-19?
Ruth Hopkins
A Message For America from Brazil’s First Indigenous Congresswoman
Kathleen Wallace
The End of the Parasite Paradigm
Anthony DiMaggio
Misinformation and the Coronavirus: On the Dangers of Depoliticization and Social Media
Andrew Levine
Neither Biden Nor Trump: Imagine Cuomo
David Rosen
God’s Vengeance: the Christian Right and the Coronavirus
David Schultz
The Covid-19 Bailout: Another Failed Opportunity at Structural Change
Evaggelos Vallianatos
In the Grip of Disease
Edward Leer
Somebody Else’s World: An Interview with Kelly Reichardt
Robert Fisk
What Trump is Doing in the Middle East While You are Distracted by COVID-19
Daniel Warner
COVID-19: Health or Wealth?
Thomas Klikauer – Norman Simms
Corona in Germany: Hording and Authoritarianism
Ramzy Baroud
BJP and Israel: Hindu Nationalism is Ravaging India’s Democracy
Richard Moser
Russia-gate: the Dead But Undead
Ron Jacobs
Politics, Pandemics and Trumpism
Chris Gilbert
Letter From Catalonia: Alarming Measures
Richard Eskow
Seven Rules for the Boeing Bailout
Jonathan Carp
Coronavirus and the Collapse of Our Imaginations
Andrew Bacevich
The Coronavirus and the Real Threats to American Safety and Freedom
Peter Cohen
COVID-19, the Exponential Function and Human the Survival
César Chelala - Alberto Luis Zuppi
The Pope is Wrong on Argentina
James Preston Allen
Alexander Cockburn Meets Charles Bukowski at a Sushi Bar in San Pedro
Jérôme Duval
The Only Oxygen Cylinder Factory in Europe is Shut down and Macron Refuses to Nationalize It
Neve Gordon
Gaza Has Been Under Siege for Years. Covid-19 Could Be Catastrophic
Alvaro Huerta
To Survive the Coronavirus, Americans Should Learn From Mexicans
Prabir Purkayastha
Why the Coronavirus Pandemic Poses Fundamental Challenges to All Societies
Raouf Halaby
Fireside Chatterer Andrew Cuomo for President
Thomas Drake
The Sobering Realities of the American Dystopia
Negin Owliaei
Wash Your Hands…If You Have Water
Felice Pace
A New Threat to California’s Rivers:  Will the Rush to Develop Our Newest Water Source Destroy More Streams?
Ray Brescia
What 9/11 Can Teach Us About Responding to COVID-19
ADRIAN KUZMINSKI
The Covid-19 Opportunity
John Kendall Hawkins
An Age of Intoxication: Pick Your Poison
Kollibri terre Sonnenblume
The Propaganda Virus: Is Anyone Immune?
Nicky Reid
Fear and Loathing in Coronaville Volume 1: Dispatches From a Terrified Heartland
Nolan Higdon – Mickey Huff
Don’t Just Blame Trump for the COVID-19 Crisis: the U.S. Has Been Becoming a Failed State for Some Time
Susan Block
Coronavirus Spring
David Yearsley
Lutz Alone
CounterPunch News Service
Letter from Truthdig’s Editor-in-Chief Robert Scheer to the Publisher Zuade Kaufman
CounterPunch News Service
Statement From Striking Truthdig Workers
FacebookTwitterRedditEmail