That being said, let’s look at something that capitalism does not do well—the delivery of health care.
The American health care system, as it stands today, is market driven.
(It’s actually a mix of private and public entities, and was formed in many ways by the tax policies of the 1950s and ‘60s. But compared to other systems, it’s fair to call it market driven.)
Since it’s a market, let’s look at the bottom line. The bottom line is that we spend double what other national health care systems do, without giving us better health.
In fact, the World Health Organization ranks the US 37th out of 191 countries in the delivery of health care.
A lot of our health care money goes to advertising, profit, overhead, and multiple layers of providers, managers, and administrators. I recently heard a representative from the Heritage Foundation on the radio, attacking (of course) the idea of a national health system, on the basis that markets are always more efficient. A national health care system, he announced, would be so bureaucratic that doctors’ offices would spend hundreds of hours filling out forms. But that’s what they do already. Indeed, they have to fill out forms and figure out billing for hundreds of health plans. All of them different. With different deductibles, allowances, and procedures. The nightmare is not awaiting us, it’s with us.
But the issue—and it’s an issue about capitalism, not just how to deliver health services—goes much deeper than that.
Even a cursory review of the history of our advances in medicine and health demonstrate something very dramatic.
They have come from individuals—usually, but not always, in universities, hospitals, medical schools, and genuine research institutes. These include the discovery of germs, vaccines, vitamins and the results of vitamin deficiencies, antibiotics, the pacemaker, oral contraceptives, sulfa drugs, and a host of your other favorites.
This is significant because our giant pharmaceutical companies claim to be the engines of innovation, and therefore any assault on their profits, or the way they do business, would slow the march forward into our brave new world. History does not bear this out.
Even more important—in terms of our general health and well being—has been our vast public works systems. Water works, sewer systems, garbage collection and disposal, universal vaccinations, and health education in our public schools.
The third major source of better health comes from fighting business.
This usually comes from a single individual who stirs up public revulsion against the way business is practiced to such a degree that it results in government regulations. In 1906, Upton Sinclair wrote The Jungle, a docunovel describing how insects, rats, and the human body parts of mutilated workers ended up in packaged meat products. That led to government food inspections and the creation of the FDA. Richard Doll (a Socialist) discovered the link between smoking and lung cancer in 1950. The tobacco industry has been fighting his findings ever since, often by funding fake science, a tactic that’s been used by all the other industries that poison us, either directly or by polluting the planet. In 1962, Rachel Carson wrote Silent Spring, which led to the control of the use of pesticides and from there to the Clean Air and Water Act and the rest of our environmental regulations. In 1965, Ralph Nader wrote Unsafe at Any Speed. Today we have seat belts, air bags, crash tests, safety ratings, and safety regulations. Now we have Al Gore, with his film An Inconvenient Truth. And it is going to create significant change. (By the way, if you have any way to tell Al to run for president in 2008, please do, and do so quickly.)
Once we see where improved health actually comes from, the implications for how we look at capitalism and how we might go about organizing our society are very significant.
First of all, people don’t just work for money. They work because work is interesting. Because they’re idealists. Because they see things that are wrong and they would like to make them better. They work for the pleasure of working. Sometimes they like helping people. Or God tells them to.
Second of all, individuals working for their own economic self interests may produce positive results that they’re not even thinking of. But they won’t produce all the possible good results that we want and need. A lot of them come because of other reasons.
Third, markets may work against the common good.
Fourth, market forces may make it impossible for businesses to do better business, even if they want to. This was the case in the meat packing industry. Cheap products—produced in an unsanitary way by exploited workers—routinely drove out good products because it cost more to handle meat in a clean, healthy way. Only regulations—which leveled the field—allowed meat companies to sell you food that they could be reasonably sure wouldn’t make you sick.
Fifth, the way markets work, inherently, and the way businesses operate, whenever they can, keeps certain costs off their books. For example, the chemical industry does not want to pay for the health care costs of polluted ground water. Nor can the market-driven health care system force the cost back on them. Recently, the pharmaceutical companies got Bill Frist to put an item in the Homeland Security bill to protect them from being sued when the additives they use cause autism.
Sixth, a market-driven system produces distortions.
One of our number one health issues is obesity. Obesity, in its current epidemic proportions, is a result of market forces. As are bad food, delivered by the fast food, agribusiness, and soft drink industries; and lack of exercise, created as a result of our automobile culture and the television industry. All supported by vast merchandising and advertising industries who exploit our push-button responses. And finally, by the capitalist campaign against taxes and public expenditure that has taken exercise and sports out of our schools.
A good diet requires the availability of healthy food, knowledge about it, and cooking skills. Who will profit enough by providing that to counter Archer Daniels Midland—who wants high-fructose corn syrup in every food product on the planet?
Obviously, the place to do it is in the schools. This requires public expenditure. And an active resistance to market forces when the major food corporations eagerly volunteer to provide “educational materials” and shape the science.
So the next time a guy from the Heritage Foundation or some other shill from the insurance companies and pharmaceutical industry talks about free markets as the best way to provide health care, you can be confident when you say that’s not true. It’s not historically true, it’s not currently true, and it won’t be true tomorrow. Because there are things in life other than money.