Deaths of despair: Health crisis - capitalism in the dock
Peter Taaffe, Socialist Party political secretary
Under the colossal weight of the worldwide pandemic, health services on every continent and in practically every country have struggled to stem the rising numbers of Covid victims. However, it is not just the poorer countries which have been found wanting. The richest, strongest capitalist society and economy on the planet, the USA, has utilised the crisis to line the pockets of big business, but has utterly failed the American people.
In an article in the Financial Times, the organ of big business, a piece by a practising surgeon in San Francisco highlights spiralling hospital costs "as the real US healthcare scandal". As is well known, the US under Trump had at one stage the highest death rate from Covid. He writes: "The parallels between banks' skyscrapers in downtown Manhattan and today's hospital behemoths are striking: sparkling glass windows, vast marble lobbies and expensively maintained greenery, with skyrocketing executive bonuses and global brand recognition to boot.
"Similarly, they have both been large-scale recipients of federal support. As hospitals struggled with Covid-19 last summer, the country's largest and richest health networks absorbed billions of dollars of stimulus. The picture is reminiscent of Wall Street in 2008: much of America's healthcare sector has become too big to heal."
Over the past 20 years, the price of US hospital services increased by more than 200% compared with average inflation of 60%! Yet large hospital networks, which contribute three times more than drug prices to the total US health spending, have largely remained outside of public scrutiny.
One consequence has been that unpaid medical bills totalled an estimated $140 billion last year. The writer comments: "The unabated rise of healthcare prices threatens to plunge more patients into financial despair". Indeed, books, pamphlets, and articles like this serve to warn us of what can happen in Britain if the rotten Tory government pushes for even more privatisation of the health service.
A recent book, 'Deaths of Despair' by two economists, Angus Deaton and Anne Case, exposes the full horror of the failed US health system and what awaits British working people if they allow mass privatisation of the NHS at an increased pace.
It is not an accident that some spokespeople from the private sector refer to themselves as 'health providers' - mostly they represent sections of the private health sector, much of which is funded with public money, and leech off the NHS. Nye Bevan confronted a similar conflict as health secretary when the Labour government of 1945 established the NHS. He was only able to do this by, in his words, mollifying the private sector, including doctors, by "stuffing their mouths with gold".
Various governments - Tory and Labour - have sought to extend this principle by providing ever more opportunities for privatisation. Where this could lead is spelt out in 'Deaths of Despair': "Given the great costs, we might hope that Americans have superior health outcomes. Not so... American healthcare is the most expensive in the world, and yet American health is the worst among rich countries, something that has been true for a long time, well before the recent epidemic of deaths and the decrease in life expectancy".
This led the authors to conclude how the American healthcare system is "a good example of reverse Robin Hood redistribution, what we have called Sheriff of Nottingham redistribution". And why is this happening? They answer: "Hospitals that used to be run by doctors are now run by corporate executives - some are doctors who have turned in their white coats for business suits - who are paid CEO salaries to build empires and raise prices."
Yet despite the mountain of facts, figures and real examples of capitalist failure, the authors still staunchly defend capitalism: "The economy does not need to be run this way. Capitalism does not need to be abolished, but it should be controlled and regulated in the public interest, not solely in the interests of stockholders or profitable businesses". They completely fail to understand that capitalism is a system whose sole aim is producing a surplus, i.e. profit, flowing from the exploitation of the labour of the working class.
What the authors of 'Deaths of Despair' object to is not the capitalists themselves garnering the surplus, but what they - and before them Adam Smith, the great bourgeois economist - call 'rent seeking'. This represents the parasitic layer stealing from the poor on behalf of the rich and playing no role in developing industry and society, but seeking merely to amass wealth. They are 'illegitimate' as far as these capitalist theoreticians are concerned.
Marx was right
They ignore and discount the laws of capitalism itself, as analysed by Karl Marx, which remain highly relevant to explaining the current crisis, including the global health catastrophe. There could be no greater demonstration of the correctness of Marx's analysis than the devastating economic recessions, and the major and mini-slumps of the recent period. We have fully analysed these ideas in our recent publication 'The Struggle for World Socialism', which underlines the need for socialist planning on a world scale.
The authors show that life expectancy in the US in 2018 has fallen for three years in a row. "In 2018, moreover, 158,000 Americans died from avoidable 'deaths of despair' - equivalent to three 737 Max jets falling out of the sky every day with no survivors!"
These damning figures, and many more, are a terrible indictment of US capitalism, although the authors themselves amazingly defend this system, with their enduring faith in private enterprise which is criminally failing the US population.
Yet they willingly concede that the areas of highest addiction leading to early death, are linked to economic and social conditions. The risk of dying in midlife from suicide, accidental drug overdose or alcoholic liver disease was in 2017 a third higher in poor states like Kentucky than the national average. Other 'left behind' states also experienced the greatest economic decline because of deindustrialisation - itself a failure of US capitalism.
Moreover, it is the poor and less educated who have borne the brunt of the catastrophic loss of high-paying jobs, as the authors demonstrate. The extent to which addiction has taken hold in the US is shown by the fact that "a third of all adults, 98 million people, were prescribed opioids in 2015". Moreover, "huge sums from legal opioids are generated by the US healthcare system, by far the most expensive in the world... [which] is failing to prevent the decline in life expectancy but is actually contributing to its fall".
The authors make an astonishing admission: "The US is different to other rich countries in having several million extremely poor people, who arguably have living conditions as bad as poor people in Africa and Asia"! This leads the authors to pose the question: "Why is capitalism failing so many?"
Yet their conclusions are as astonishing as they are contradictory. They conclude: "We are not against capitalism. We believe in the power of competition and free markets." However, the description of the collapsing healthcare system in the US powerfully refutes their arguments.
The only realistic conclusion to be drawn from this exposé is that the system of capitalism has had its day. Patchwork solutions are no longer capable of restoring either capitalism itself or the peoples of the world to health, including economic health.
This would only be possible through the socialist reorganisation of society on a national and international scale. This in turn will inevitably pose the question of the coming together of the workers of the world in a democratic socialist confederation. Then the idea of profit being made out of suffering and ill-health will be a bad dream of the past!
In The Socialist 15 September 2021:
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