The Inhuman State of U.S. Health Care ... (Class Power is the reason)

....even though this was presented at John Hopkins in 2003, it is as true today as it was then...maybe even more so.........

The Inhuman State of U.S. Health Care
by Vicente Navarro


This essay was the opening address at a seminar sponsored by the medical and public health students of the Johns Hopkins University, held there in 2003.

The health sector of the United States is in profound disarray. Even though the United States spends more on health care (14 percent of its GNP) than any other country, we still have problems that no other developed capitalist country faces. Let me list some of them. The first and most overwhelming problem is that no less than forty-four million of our people have no form of health benefits coverage whatsoever. The majority of them are working people, and their children, who cannot afford to pay the health insurance premium that would enable them to get care in time of need. Many of them work for small companies that cannot or will not pay their part of the health insurance premium. Because these individuals cannot pay for insurance, they do not get needed care, and many die as a consequence. The most credible estimate of the number of people in the United States who have died because of lack of medical care was provided by a study carried out by Professors David Himmelstein and Steffie Woolhandler (New England Journal of Medicine 336, no. 11 <1997>). They concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDs. It is important to note here that while the media express concern about AIDs, they remain almost silent on the topic of deaths due to lack of medical care. Any decent person should be outraged by this situation. How can we call the United States a civilized nation when it denies the basic human right of access to medical care in time of need? No other major capitalist country faces such a horrendous situation.

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You may well ask why this situation continues and is reproduced. The answer is, again, because of class power, that is, because the corporate class, such as insurance bosses and large employers, has enormous power in our political system. This class power manifests itself in many different forms. One of them is the class composition of the top decision-making bodies of our government: 84 percent of cabinet members, 78 percent of the Senate, and 62 percent of the House over the last forty-two years have been members of the corporate class. The remainder have been members of the upper-middle class. There are very few from the lower-middle class or from the working class. One of these is a senator for Maryland, Barbara Mikulski, who was a social worker before being elected to the U.S. Senate. Politicians of working class backgrounds tend to be the most progressive. But there are remarkably few of them in the U.S. Congress.

Let me stress that the same class composition we see in these decision-making bodies of our government also occurs in our health care institutions. For one example, look at who sits on the Board of Trustees of the Johns Hopkins University and of the Johns Hopkins Hospital. You will see that they are the CEOs of some of the most powerful insurance, banking, and manufacturing corporations in Maryland. Actually, there is not one hospital in the entire Baltimore region that has on its board a member of the working class—which happens to be the majority of the Baltimore population.

These points need to be made, because in our country you may have been encouraged to check for the presence of minorities and women in positions of power, and to denounce institutions as discriminatory when you see very few minorities and women in them. I encourage you to continue doing this. But I have to stress that if your concern is—as it should be—to improve the representativeness of our institutions, then class plays a key role. You should ask not only about the race and gender of the members of boards, but also about what class they belong to, pressing for changes in the class composition of those boards. If you press for that, you will soon encounter an enormous resistance—much, much larger than when you ask for an end to race or gender discrimination.

Another way that class power is reproduced in our political system is through the privatization of the electoral process. Here again, we in the United States are quite unique. In no other country does money play such a key role in the electoral process. As Senator Mikulski said recently, “money is the milk of politics.” And most of that money comes from the corporate class: in 2000, 92 percent of the soft money that went to the key members of Congress who make decisions about health care and financial matters came from large insurance, banking, and employers associations, hospital corporations, pharmaceutical firms, and professional associations, such as the AMA. Indeed, it is an alliance of corporate and upper-middle-class interests that pays for those politicians, paying with the aim—successfully achieved—of defending their corporate and professional interests. The profits of the medically related industries, such as the health insurance industries, have reached an all-time high during the administration of George W. Bush, the most class-conscious U.S. president since Hoover.

Let me stress here that this situation is often reproduced in the way progressive forces choose to operate. Indeed, we have the most divided progressive community in the developed capitalist world. We tend to focus on gender or on race or on age, or on specific groups or issues. The United States is indeed the country of social movements. I of course applaud this diversity, but it is dramatically insufficient. For example, the United States has a very powerful association of the elderly—the AARP—but our elderly are less taken care of than those in any other developed capitalist country. They don’t even have their medications included in their health benefits. We see the same with women. We have a very strong women’s association, NOW. But American women have very limited maternity leave: just four weeks without pay. Sweden, which does not have a very strong women’s organization, provides a year’s maternity leave with pay.

Why this difference? Class power is the explanation. If you establish a spectrum of capitalist countries, listing them from very “corporate friendly” (like the United States) to very “worker friendly” (like Sweden), you will find, where the capitalist class is very strong, very poor health benefits coverage (in the public as well as in the private sectors), highly unequal coverage, and very poor health indicators. This is, indeed, the U.S. case. But in countries where the working class is very strong, with a strong labor movement (as in Sweden, which has been governed by a labor party for forty-eight years since the end of the Second World War), you will find very comprehensive health benefits coverage, a more equal distribution of resources, and better health indicators. The lesson here is clear: it is important that we help to strengthen the labor movement in the United States, and in doing so we should also capitalize on the diversity of the social movements, helping those movements to see the basic commonality of their struggles to unite rather than divide working people. This is, indeed, the best thing you can do to improve the health of our people.

http://www.monthlyreview.org/0903navarro.htm

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