Medicare—government-run health insurance for the elderly—was fiercely opposed by conservatives and political reactionaries when it was proposed half a century ago: “We are against forcing all citizens . . . into a compulsory government program,” said one; it’s nothing less than “socialized medicine,” and, if implemented would mean that “one of these days, you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
That was the demigod of today’s political right, Ronald Reagan, speaking before he’d entered electoral politics, and his comments echoed right-wing opposition to Social Security in the 1930s (a plan to “Sovietize America”), and the minimum wage and mandated overtime pay (“Communism, Bolshevism, fascism and Nazism”). Here we go again.
Good medicine at its heart requires trust and an assumption of honesty and fairness; the market requires nothing more nor less than profits for shareholders. The near-total corporate capitalist capture of health care incentivizes bad behavior: a primary-care doctor ordering a battery of tests of questionable medical value because fee-for-service makes it profitable, or an obstetrician performing an unneeded Caesarian section because that procedure brings in more money only makes sense if dollars—and dollars alone—are the standard of care. Unnecessary medical tests (and procedures) are to the health industry what alcohol is to the hospitality industry: the Midas touch, everything turning magically to gold.
The health care marketeers lie in public, devise make-believe disorders and promote them through public relations and clever advertising, and then deal meds at the open-air drug bazaar to treat invented afflictions. Erectile dysfunction is now a fact of life, so I’ll leave that one alone—except to note that Viagra is covered by Hobby Lobby’s health care plan and birth control is not. But who knew millions of men are also suffering from a “medical condition known as Low-T?” “Known as” by whom, you might ask; well, known as Low-T by the drug runners who made the condition up. Here is their sales pitch: “If you’re forty-something and just feel blah sometimes, out-of-focus, lacking energy, and not as charming as you thought you were at twenty, maybe it’s not you . . . maybe it’s Low-T. Here, just apply this special underarm deodorant filled with testosterone for a few weeks and you’ll be the life of the party once more. Oh, and we should warn you to keep this out of the reach of women, children, and household pets, wash thoroughly after applying, and (sotto voce) be aware that this product may cause uncontrollable itching, hearing loss, temporary blindness, sneezing, hiccups, rectal bleeding, tumors, athlete’s foot, dry mouth, suicidal thoughts, stroke, heart attack, hair loss, night sweats, crippling gas, adult-onset acne, attention deficit disorder, fever, moodiness, frequent nose hemorrhages, gagging, facial tics, vertigo, burning sensations in your testicles— no worries, we have pills for each of those, too. If you have an erection lasting more than seven days call this toll-free number and we’ll rush you the antidote for that at reduced cost.”
The United States is the only industrialized country in the world in which it’s legal to advertise prescription drugs to the public. It serves no public health interest whatsoever, but it does indeed serve corporate wealth: antidepressants alone represent a $10 billion market; half of all Americans are taking prescription drugs at any given moment, and one in ten is taking more than five; millions of youngsters are taking prescription drugs for ADHD, including fourteen thousand children ages two or three. We are all potential customers; even babies are the potential drug fiends the old dope peddlers hope to hook for the future.
The market in health care has created a deeply unequal system that stretches from the shameful state of mental health care to the tawdry patchwork of nursing home care, from disdain for the poor to the war on women The market—like all markets—creates winners and losers, and not surprisingly the biggest winners are the rich, and the biggest losers are those traditionally oppressed and exploited: descendants of enslaved people, First Nations peoples, recent immigrants from impoverished countries, people of color, women, and poor and working people. Health disparities are everywhere, and universally appalling: 25 percent of Black mothers get no prenatal care during the first trimester of pregnancy (and 6 percent get no care for the entire nine months) compared to 11 percent (and 2 percent) of white mothers; mortality rates during the first year of life are fourteen per one thousand for Black children and six per one thousand for whites; by the age of thirty-five months 25 percent of Black children and 16 percent of white children have not received standard vaccinations; in poor Black urban neighborhoods in California there is one physician for every four thousand residents compared to one in twelve hundred in white neighborhoods.
Martin Luther King, Jr. noted, “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”4 Since 2011 more than 280 laws have been enacted in 31 states restricting women’s access to reproductive health. These laws make access more costly, more difficult (with mandatory wait times and multiple visits), and more humiliating.6 Health disparities focus a hard lens on our avowed values revealing monstrous contradictions in a society that claims to value equality. It is wrong and shameful that one’s zip code, for example, can be the strongest predictor of whether a person will suffer chronic lung disease.
Inequities between men and women are monstrous in the capitalist industrialized health system. Women’s judgments about reproduction and birth are strictly policed by the state and the mobilized mob; this policing now includes a broadly accept- ed sense that a doctor and a hospital provide the best care during childbirth, while a mother is always cast as a potential risk to her baby, or a danger to be managed (“Don’t drink wine during pregnancy” and “Women of a certain age should always assume they are pregnant!”). Since 2011 more than 280 laws have been enacted in 31 states restricting women’s access to reproductive health. These laws make access more costly, more difficult (with mandatory wait-times and multiple visits), and more humiliating.
Health care must be taken back from the grasping hands of the profiteers, and taken to a higher ground appropriate to the project itself: everyone has the right to a standard of living ad- equate to health and well being, including food and clothing, housing and medical care, and security in the event of circumstances (unemployment, sickness, disability, old age) beyond their control. Everyone has the right to lead a healthy life in a healthy community. Everyone has the right to life, liberty, and the pursuit of happiness—in the language of human rights, the highest available standard. It’s time to organize ourselves to transform a system so blatantly destructive to these ends, and to institute a new community of associative living that will guarantee those rights to all.