There
has been a lot of talk about “health care reform” in the u.$. this year.
Like other government-led reforms, there is no progressive side to this
debate. It is between the wealthy libertarian individualists who want to
retain the power to pay lots of money for highly specialized care on
demand, and wealthy labor aristocracy activists who want to make sure
the wealth of health care is shared out among Amerikan citizens. Neither
side represents the interests of the world’s oppressed. When they talk
about “Universal Coverage” they are never talking about more than 15% of
the world’s population.
As we approach the end, the anti-climatic outcome of all the hyped media
and political hoopla supports the theory that it was nothing but a
distraction. This is a much safer debate than what would come out of
discussions of Obama’s expanding war on the Middle East and Central
Asia. But we will indulge this topic for an issue of Under Lock
& Key because we think our comrades have some interesting
things to say about health care that is being left out of the amerikan
dialogue, particularly in relation to the disproportionately
incarcerated nations.
The connection between wealth and health
Under imperialism, the wealthier a country is the better health care the
population can expect to receive, which results in a healthier
population (measured by things like life expectancy and lower rates of
key mortality indicators for children and for some common diseases).
This is not just based on individual wealth, or ability to pay, but on
national wealth that is accumulated by those that exploit other nations.
Infrastructure such as water sanitation, hospitals and medical schools
are all concentrated in the First World. This is a material benefit of
imperialism that is not directly about income.
Wealth also brings its own health problems in imperialist countries.
Where people are “free” to eat at McDonalds and KFC whenever they want,
and where it is actually cheaper to eat this food than to buy fresh
vegetables, obesity and related diseases are a growing health problem, a
problem poor countries can only dream about. Wealthy countries have the
money to solve these and other health problems, but capitalism
perpetuates illogical systems like subsidies for the Amerikan corn
industry which let Amerikans buy unhealthy foods for less than they cost
to produce. For this reason, overall health is something that all people
can expect to improve under socialism, including the labor aristocracy
and imperialist oppressor classes. Capitalism is inherently inefficient
at meeting humyn need, even in the rich countries.
Amerikan individualism bad for Amerikan health
Despite spending the most on health care of all countries in the world
(both overall and directly out of pocket), compared with other First
World countries, the u.$. has one of the lowest percentages of its
population covered by health care and has some of the worst health
indicators when compared to those same wealthy countries.(1) The u.$.
doesn’t even make it in the top 40 countries for life expectancy. In the
u.$. the health gap between rich and poor is far wider than most other
First World countries.(2,3) And overall Amerikans live shorter lives
than people in every western European and Nordic country except
Denmark.(4) These numbers are all skewed by oppressed nation populations
in prisons, ghettos, barrios and reservations where health care
statistics are often comparable to the Third World. An example of this
is the 50 year life-expectancy gap between Asian males and Black males
in the u.$.(4) Other examples are in the reports from behind bars
accompanying this issue of Under Lock & Key
(ULK12 - January
2009).
Countries that provide health care have higher taxes than the u.$., but
they also have no persynal medical bills, and generally have overall
better health than the u.$. That Amerikans believe that the proposed
“universal” medical coverage in this country would be a bad thing for
Amerikan citizens is a wonder of political pundits and advertising.
Individualism in Amerika is a disease that leads people to value
extending the life of an 80-year-old man with terminal cancer for an
extra month over preventing the deaths of 100 people from diabetes and
cardiac conditions.
The way countries generally fund health care for all their citizens is
through taxes. The same way most countries, including the united $tates,
provide education, fire, road, sanitation, and other basic
infrastructure services. This is most certainly not socialism. It is
just capitalism taking care of its own citizens to the extent necessary
to perpetuate capitalism. In First World countries this is a pretty high
standard of living; in Third World countries this is often barely enough
to sustain a workforce.
In the health care debate within Amerika there has been some confusing
rhetoric about what will cost the government and the people of this
country more money. In terms of keeping its well-off citizens happy for
a price the imperialists can afford, ignoring Amerikan single-minded
individualism and forcing through some sort of “universal” health care
plan is probably in the best interests of this country. However,
universal coverage for Amerikan citizens is basically off the table as
an option, thanks in no small part to very heavy lobbying and financial
contributions from the Amerikan health care industry. By the end of
September almost $300 million was spent by health care industry
lobbyists.(5)
The failures of the health care system in imperialist Amerika serve as a
good example of why capitalist individualism is an impediment to the
health and welfare of even its own citizens. But we communists are not
interested in reforming health care in imperialist countries to better
serve imperialist citizens, because there is no significant net
improvement in humyn health to be had in that struggle.
Saving millions of lives through changes in health care is easy; it is
only those who benefit from those deaths that stand in the way. Just
like every other debate over taxes, Amerikans are fighting over how to
spend the superprofits stolen from the death and suffering of the Third
World. Real health care improvements cannot occur in the exploited
nations until they have liberated themselves from the imperialist
economy that enforces this relationship.
The myth of universal health care
For the oppressed people of the world there is no such thing as
universal health care. The life expectancy of the oppressed is
alarmingly lower than wealthy First World citizens. In early 2009, the
World Bank estimated that 11 million children die each year from lack of
health care, sanitation, food and clean water.(6) These are the most
basic of health care needs.
Relatively cheap solutions to common problems could prevent far more
deaths and suffering than any of the proposals for reshuffling
superprofits in the united $tates. By dealing with these simple but
massive problems first we would vastly increase our healthy population,
which could better address the more complicated health care problems
others face. But such an approach would require a system that serves
humyn need. Not even a system that serves the need of every persyn in
the elite 15% (i.e. all Amerikans) can unleash such powerful forces.
The premature deaths and chronic illnesses of Third World people are a
direct result of imperialist occupation and exploitation, serving as a
tool of population control, both in numbers and in ability to take
effective anti-imperialist action. Amerika sends billions of dollars in
“aid” to foreign countries, and just a small fraction of this could
provide clean water and sanitation and prevent rampant and debilitating
diseases that exist only in Third World countries. The 1.5 million
children who die each year from diarrhea could be saved with clean water
and sanitation and cheap medical supplies, and 2 million who die from
pneumonia need only existing vaccines and inexpensive antibiotics.(7)
The Amerikan government rushes to send military aid and troops to ensure
access to oil and stable pro-imperialist regimes, but can’t be
interested in spending a small fraction of that money to save the lives
of these children.
Imperialist exploitation of the labor of people in the Third World is
made possible by direct military intervention and funding for military
regimes that are puppets to imperialism. And this has dire consequences
for the health of the exploited around the world. For instance,
Amerika’s 20-year battle for control of Iraq has included sanctions and
then military action that destroyed the infrastructure and health care
in that country. From just the sanctions alone deaths among Iraqi
infants and children under 5 doubled in 1991.(8)
Amerikan imperialist companies that provide health insurance for their
Amerikan citizen workers don’t even consider offering any kind of health
care for their Third World workers, and those are the people most in
need of health care. Workers in Haiti can expect to live only 62 years
and in India only 64, and they have a high chance of dying of easily
preventable diseases, but the Amerikan corporations many of them work
for offer no help.(9) And while the Amerikan corporations, government
and people are benefiting from the imperialist profits (often in the
form of inexpensive goods & services) made off of the Mexican
workers, they’re not even discussing extending “Universal Coverage”
health care to them.
Health Care for the people
The best example of health care truly serving the interests of the
people existed in China between 1949 and 1976 when the communist
government dramatically improved the health of the people. They did this
by focusing on preventive care, sanitation, and education, combined with
a massive campaign to get health care out to people in the countryside
previously unable to access doctors.
Four basic guidelines for the organization of health care were developed
at The People’s Republic of China’s first National Health Congress in
August 1950:
-
Medicine should serve the workers, peasants and soldiers
-
Preventive medicine should take precedence over therapeutic medicine
-
Chinese traditional medicine should be integrated with Western
scientific medicine
-
Health work should be combined with mass movements
Before 1949, life expectancy in China was just 35 years and the
illiteracy rate was 80%. In 1979 life expectancy rose to 68 years and
illiteracy had declined to less than 7%. As a part of the dramatic
improvements in health, the Chinese infant mortality rate was reduced to
a lower level than in New York City. Looked at another way, China
achieved a drop in death rate per 1000 from 28 in 1949 to 6.3 in
1978.(10)
Essentially China achieved health for its population comparable with
much wealthier countries by the end of the 1970s by focusing on serving
the people rather than serving the profits of the wealthy. Building such
a system of health care came only after the forceful removal of
imperialist powers from China and the destruction of the former
institutions of rule.
Notes:
(1) From the World Health Organization’s World Health
Statistics 2009 report: Globally in 2006, expenditure on health was
about 8.7% of gross domestic product, with the highest level in the
Americas at 12.8% and the lowest in the South-East Asia Region at 3.4%.
This translates to about US$ 716 per capita on the average but there is
tremendous variation ranging from a very low US$ 31 per capita in the
South-East Asia Region to a high of US$ 2636 per capita in the Americas.
(2) Harvard Magazine, July/August 2008
(3) 2009 World Health
Survey from the World Health Organization
(4) The Independent, July
17, 2008 report on American Human Development Index study
(5)
CNNMoney.com, September 13, 2009, Health Care Lobbying: The Political
Power Machine
(6) World Bank Press Release, Feb 12, 2009
(7)
UNICEF, World Children’s Report, November 19, 2009
(8) British
Medical Journal, 1992 Feb 22;304(6825):455-6
(9) World Health
Statistics 2009, from World Health Organization. Compare to the u$ at 78
years and France at 81.
(10) The Health of China, Ruth and Victor
Sidel, 1982