Health Plans and Death Plans
"Medicine is nothing but a social science. Politics is nothing but medicine on a large scale."
–Rudolf Virchow, reflecting on the revolutions of 1848 in Europe.
The first illusion to chase off the stage is that the great debate here has much to do with health. So far, as public health is concerned, many of the biggest battles were fought and won a hundred years ago, at the end of the nineteenth century, with better nutrition, birth control, the change from wool to cotton clothing, the introduction of modern sanitation in the urban environment and – most important – clean water.
Between 1900 and 1973, American life expectancy went from 47 to 71, but most of this rise had taken place by 1949, when the average life span reached 68. Much of the upward curve could be attributed to improved survival rates for infants and young people. Prohibition helped, since people drank less alcohol, ate more, and hence TB rates dropped sharply, well before the introduction of sulfa drugs.
Health in America is class-based, naturally. The poor die sooner, starting with black men who tend to drop dead in their middle 60s, usually from stress and diseases consequent on diet. The better-off folk drink less than they did in the 1950s, take a bit more exercise, and sometimes live longer. The poor get fatter and fatter. A real health plan would start with public executions of the top thousand CEOs and owners of the major food companies and fast food franchises. It would continue with serious penalties for health workers not washing their hands or merely holding them under the tap without using soap.
The plagues of America today are beyond the reach of the modern medical system, and that system is itself a peculiarly outrageous example of antisocial imperatives: high technology health care which serves fewer and fewer people. Part and parcel of this system are the drug companies, working in concert with the hospitals and insurance industry. Doctors have long since been shoved to the side as major players.
Mostly shunned in all this are the major causes of modern disease, which are environmental. Between 70 and 90 per cent of all cancer is environmental in origin. Heart disease and stroke – the largest killers today – are largely caused by hypertension and stress, which are derived from social conditions.
America is very efficient in promulgating Death Plans –- tobacco, sugar additives, excessive salt, nitrous oxides out of power plant chimneys, nuclear testing in the 1950s, industrial accidents, speed-up at work and lengthening of the working day, rush-hour traffic – launched in the hope of making a buck and protected fiercely until, very occasionally, the mountain of corpses gets too high to be occluded by even the most refined techniques of the PR industry and the most lavish contributions to politicians. Thus it was with tobacco.
Health reform in the 1930s, in the Roosevelt era, came mostly in the guise of the Wagner Act – a better deal for unions and workers – and Social Security. Old people got something to live on in their later years. Health reform in the 1950s and 1960s came with better wages, a shorter working week, more leisure, plus Medicare – the federal health plan for older people – driven through Congress by the most consummately cunning and accomplished politician of the postwar era and maybe of the twentieth century (unless you make the case for FDR), Lyndon Johnson, who really did care about poverty, having seen a lot of it up close in Texas.
Since then, we’ve gone nowhere. Nixon declared war on cancer and founded the Environmental Protection Agency – but corporate pollution continued virtually unabated, courtesy of the energy industry and modern, chemical-based agriculture. In 1977, the Senate Select Committee on Nutrition, chaired by George McGovern, issued a splendid special report on recommended dietary goals for the United States. It swiftly provoked the virulent hostility of the medical establishment and the food industry. The former contested the idea that diet might have any particular bearing on health and hotly denounced this particular application of the notion of preventive medicine. The latter, for obvious reasons, saw no reason to welcome the Committee’s recommendation that Americans eat less meat. The injunction was axed from the Report a year later.
The neoliberal attack on regulations has been a health catastrophe. Take accidents — injuries and deaths – at the work place. As JoAnn Wypijewski wrote in this site earlier this year, “Because of under-reporting, the number of injured workers every year is likely closer to 12 million than the official 4 million. The 50,000 to 60,000 who die from occupational diseases each year cannot be a hard estimate; cancer, for instance, doesn’t usually come with a pedigree. Even the precision of deaths on the job (40,019 workers between 2001 and 2007, the latest year for which there are figures and not counting the 9/11 dead) has to be qualified; the number does not account for the fates of 8.8 million public sector workers not covered by OSHA. It does not include deaths in the underground economy. Not the street dealers killed by rivals or police, and not the hookers and massage artists murdered in the line of duty by the likes of the Craigslist killer.”
Typically, Democratic presidents like Clinton and now Obama commit during their campaigns for some kind of “reform,” usually meaning some pledge that the “disgrace” of 45 million or so uninsured Americans will end. In 1993 the Clintons tried “health reform”– a monstrosity that I described at the time as looking like a collaboration between Mondrian and Jackson Pollock – and the insurance industry and lobbyists ate it for breakfast. The radical reformers argue for a national insurance scheme, like Canada’s or the NHS, where the state can use its purchasing weight to drive down drug prices, set rates, clean up the system. This plan go back to the Health Service Act introduced by Ron Dellums in Congress on May 4, 1977, providing for comprehensive , community-based health services with progressive national financing. The Dellums bill had been under discussion since the early 1970s when the Medical Committee for Human Rights proposed a set of principles for a national health plan.
It’s not going to happen, any more than Obama will nationalize the banks and tell householders to repudiate their mortgages. The insurance industry, the drug industry, the real estate and finance sector are the most powerful forces in the country. They’ve just got Obama to commit $23 trillion to their enduring welfare. They’re not going to surrender the treasure trove known as healthcare without serious blood-letting on the barricades. They own the Congress. Men like former Democratic senate leader Tom Daschle spring to do their bidding. So, Obama finally produced a timid compromise, whereby uninsured people would be herded under various health insurance umbrellas with “a public component.” Even if the health industry’s hired man, Senator Max Baucus, had not deep-sixed the public component, the insurance industry could swallow it like a python swallowing a field mouse. Though Obama sometimes confides that the public component of his plan is the springboard to full-bore single payer national health, this is transparent fantasy. In present political conditions, the publicly insured component would soon become a ghetto, offering minimal care to the indigent, and gradually shriveled into some sort of punitive maintenance scheme.
It’s sometimes argued that a decent single payer system would be functional to U.S. capitalism, since industries like the auto sector would be liberated from the burden of health costs. There are scores of decent policies that would be functional to US capitalism. But the soul of US capitalism is wedded to indecency. Consider torture and the death penalty. Critics of these procedures sometimes argue that they don’t work, or are inefficient. People spout out lies amid their torments. Innocent people die in the gas chamber and the justice system is injured in reputation thereby.. But the real allure of torture and capital punishment for the owners of the system is to instill fear and compliance precisely by the demonstration of vindictive irrationality.
Fear never fails. Americans, burdened with the worst and most exploitative health system of any advanced country, are now being expertly stampeded by the right’s campaign that Obama’s health plan means that state-licensed executioners will make the unilateral decision to give granny her final morphine shot whenever they think fit. The present system means that granny gets her final morphine shot once her money runs out.
The liberals are howling bout the unfairness of these attacks, led by Sarah Palin, revived by her “Death Panel” talk and equipped with a dexterous new speech writer who is even adding footnotes to her press releases.
But what is a conservative meant to think? Since the major preoccupation of liberals for 30 years has been the right to kill embryos, why should they not be suspect in their intentions toward those gasping in the thin air of senility? There is a strong eugenic thread to American progressivism, most horribly expressed in its very successful campaign across much of the twentieth century to sterilize “imbeciles.” Abortion is now widening in its function as a eugenic device. Women in their 40s take fertility drugs, then abort the inconvenient twins, triplets or quadruplets when they show up on the scan.
In 1972, a year before the Supreme Court’s Roe v. Wade decision legalized abortion on demand nationwide, virtually all children with trisomy 21, or Down syndrome, were born. Less than a decade later, with the widespread availability of pre-natal genetic testing, as many as 90 percent of women whose babies were pre-natally diagnosed with the genetic condition chose to abort the child.
One survey of 499 primary care physicians treating women carrying these babies, however, indicated that only 4 percent actively encourage women to bring Down syndrome babies to term. A story on the CNS News Service last year quoted Dr. Will Johnston, president of Canadian Physicians for Life, reacted to the American College of Obstetricians and Gynecologists (ACOG) pre-natal testing endorsement as another step toward eugenics.“The progress of eugenic abortion into the heart of our society is a classic example of “mission creep,’ ” Johnson said. “In the 1960s, we were told that legal abortion would be a rare tragic act in cases of exceptional hardship. In the ’70s abortion began to be both decried and accepted as birth control. In the ’80s respected geneticists pointed out that it was cheaper to hunt for and abort Down’s babies than to raise them. By the ’90s that observation had been widely put into action. Now we are refining and extending our eugenic vision, with new tests and abortion as our central tools.”
So if we have mission creep in the opening round, what’s to persuade people that there won’t be mission creep at the other and the kindly official discussing living wills won’t tiptoe out of the ward and tell the hospital that the old fellow he’s just conferred with is ripe to meet his maker. The author of the provision – now dropped – in the health bill before Congress – for “end of life” counseling was Democratic Rep Earl Blumenauer of Oregon. Blumenauer has denounced the “death panel” description as a “terrible falsehood.” Maybe so. But Blumenauer is hot for “death with dignity”, as a speech he made in Congress in 2000 makes clear: “A major concern [in an attempted revision of the Balanced Budget Act]is a provision that would criminalize decisions doctors make on pain management for the most seriously ill and overturn Oregon’s Death with Dignity Act. Oregonians have twice voted to support the assisted suicide law. H.R. 2614 not only is an attack on the Democratic process, but also threatens to pain management. There is evidence that doctors are increasingly hesitant to prescribe pain medications to terminally ill patients for fear of being accused of unlawfully assisting a suicide. The on-going attempts by Congress to criminalize the doctor-patient relationship are a threat to pain management in all fifty states.”
For forty years, every American president has deprecated the powers of government to improve the public weal. Why now should Americans believe that any government-backed “health reform” will do them any good, as opposed to assigning them the appropriate lifespan, relative to their income and contributions to the corporate bottom line, which is what the present system amounts to?
New York Times Director Probed for “Breach of Trust”
To the Sulzberger family that controls the New York Times he has been the ultimate Good German. High-flying Thomas Middelhoff took New York by storm, buying Random House for Bertelsmann, invited onto the NYT board, a member of its compensation committee. Read Eamonn Fingleton’s exclusive on how Middelhof has crashed to earth and how the NYT has buried the story. Amid New York’s savage fiscal crisis, guess what? The city ponies up $50 million for a nice new park for rich people in Manhattan. Read Carl Ginsburg on the High Line. PLUS Elyssa Pachico on how rural revolution in Colombia has gone digital. PLUS co-editor Cockburn on how, in Obama Time, the Israel lobby is carrying all before it. What a surprise. Subscribe today!
A shorter version of the first item appears in The First Post.
ALEXANDER COCKBURN can be reached at firstname.lastname@example.org