Sunday, February 24, 2008

A Horror Story About "Health Insurance" in America

by Norman Markowitz

It is difficult for me to write this, because my anger is so great. The story, from today's New York Times, concerns working class people who essentially risked their life, because they feared that genetic tests showing that they were virtually certain to get diseases that would require expensive treatments might result in both their losing access to any "health insurance." In the U.S. such care is controlled by insurance companies who make their money by maximizing premium payments and restricting benefits, and these working people quite possibly might lose their jobs when and if employers found this out.

I immediately thought of my father, a second hand peddler who walked with a hernia for twenty-seven years, along with suffering other illnesses, including emphysema, the condition that a woman in the article had, until an emergency led him into a public hospital in the Bronx and where he received both an operation and other treatments which he should have had many years earlier. By then I was teaching at Northern Illinois University and could provide him and my mother with substantial financial assistance and move them out of the slums, but the ravages of a lifetime of ill health took its toll. Both died within the next six years. As a final insult, they had initially removed from Medicaid during the early Nixon administration when I began to provide aid to them(although with the help of a Congressman, they got back on the program).

I also thought of a Latina women in Brooklyn whose story I had read about a decade ago--a woman whom I often cite in my classes when I get to the Clinton-Bush years and contemporary America. She was a victim of the Gingrich-Clinton elimination of Aid to Families with Dependant Children (AFDC) and found herself working a subsistence job in order to sustain her family benefits. When she experienced a lot of pain, she delayed as a long as she could seeking medical assistance, because she feared that she and especially her children would lose their health benefits entirely. When she sought aid, it turned out to be too late, the doctors saying that had she come earlier, an operation might have caught her cancer in time and saved her life. All of this happened at a time that both the Republican Right and Bill Clinton personally were taking credit for their "welfare reform." the only major piece of New Deal social legislation (AFDC) which was completely repealed.

But the people in the Times story, like most of the others mentioned, are "middle class" the term used in the U.S. since the 1950s to separate the overwhelming majority of wage and salary workers from the marginalized poor like my late father and the late Latina woman from Brooklyn.

These are people with "health insurance" whom doctors report are increasingly afraid to deal with genetic research that suggests they may be prone to major illnesses like colon cancer and breast cancer because of the "dire economic consequences."

The "health insurance industry," of course has issued denials that it would discriminate against anyone based on genetic testing (which most Americans, given their experiences with that "industry" would take with a pitcher of salt) Business associations are rushing to oppose legislation that would bar such discrimination as unnecessary, but the evidence the article presents is substantial that women, for example, often pay in cash for genetic tests for breast cancer because they don't want their health insurers to get the information.

The article then goes on to mention that Americans are far less likely to use the new diagnostic genetic testing services than citizens of other countries "where people are guaranteed health care." Doctors are quoted as saying that they warn patients of the possible financial risks, because, as one notes, "especially if they are self-employed, I don't want it to be a surprise if their health insurance premium goes up." One woman says simply " I don't want have to work for a big business just to get health insurance. This could be determining what I do with my whole life."

Karl Marx, commenting an an American economist of the mid nineteenth, praised the Americans, in comparison to Europeans in their ability to collect important statistical data, and then noted that they then don't do much with that data, seeing the collection as the end of scholarship and science. In its analysis or lack of one, the article reminded me of that comment.

Capitalism, even our very rich capitalism, transforms everything into commodities to be produced and distributed to accumulate wealth for the capitalist class. The modern bureaucratic corporation is the most important institution of the capitalist class today. The insurance companies are agencies essentially of "bank capital," financing the health care industry for their profit, allied to the pharmaceuticals, who along with companies that produce diagnostic and treatment technologies, function as "industrial capital" within the system.

Together, and they are together, they can be seen as "finance capital," working to sell more and more drugs and other commodities at one end, inventing in some cases new diseases and using television commercials to advertise their treatments, and, of course, restricting services and benefits at the other end. The system is classic "state monopoly capital," since the state plays a leading regulatory role, in the interests of the both groups of companies primarily. who also use doctors at both ends, the pharmaceuticals to push their drugs, the insurers to restrict services and of course to get high premiums from the doctors for malpractice insurance.

As capitalism develops, even our rich capitalism, it deskills and deprives more and more people in order to cheapen their labor, making the "middle class" people in the Times article have the same fears and take the same risks that my father and the woman from Brooklyn did.

You don't need genetic testing to realize that the "health care industry" in the U.S. is and has been for at least half a century a grotesque anachronism that not only deprives nearly fifty million people of any "coverage" but seriously mistreats the majority who have coverage, creating a situation where Americans both take twice as many prescription drugs which in turn cost twice as much as people in other developed countries, have slightly lower life expectancies than people in other developed countries, and have far greater institutionalized inequality in health care than people in other developed countries.

The only real answer is "abolitionism," that is, abolish the present system by eliminating entirely the insurance companies and replacing them with a social security based public administration system of funding. HRH 676, the legislation introduced by Representative John Conyers under the title "Medicare For All , is the most important step in that direction, potentially the most important heath care legislation since the creation of Medicare and Medicaid in 1965.

A national public health program would compel the pharmaceuticals to sharply reduce their prices by having them sell their drugs to and through the public sector (which is what is done in the rest of the developed world). It would both create "universal coverage" and also effective and less unequal coverage, stressing preventive health programs, including diet, exercise, and holistic therapies which connect patients to their families and communities. For those who say that can't be done, the answer is that it already has been done, in an incomplete but significant way, through the developed world, in some countries, better than others, but in no country except the United States has it been so buried. Once more, to use this quote Franklin Roosevelt's rallying American workers to win the battle of production, (a quote that has great resonance on a great many issues) "it can be done because it must be done."


Ann Catherine Keirns said...

ABSOLUTELY! My son will have to divorce his wife so that she can get the care she needs for her rheumatoid arthritis, which she has had since she was 12 years old.

Harold said...

Excellent analysis, Norman. Thanks very much. I especially appreciated that you wrote that "the modern bureaucratic corporation is the most important institution of the capitalist class today."

In a paper I that just completed which I'll be presenting at the New York State Political Science Association's 2008 Conference in April, I argue that contrary to what many prominent Marxists, such as Ralph Miliband (whose work is tremendously important) have argued, in today's advanced capitalist society, corporations serve as an integral part of the state apparatus; even though we're supposed to believe that the state and big business are entirely separate entities, the interests are essentially the same, and there is an inextricable link that cannot be denied no matter how we twist the words.

This is especially evident in the health care/insurance industries (which should not be industries in the first place), where we see countless more examples of how profits, not people, have become the be-all end-all of social maintenance.