Morbid Symptoms: Health Under Capitalism

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Socialist Register 2010 – Morbid Symptoms: Health Under Capitalism (Merlin Press) Ed: Leo Panitch & Colin Leys.

There’s been some excellent work published on the many faults of the Irish health service by campaigning journalists like Sara Burke and Maev-Ann Wren. For those who want to put the debates about Irish healthcare in an international context, this volume of essays should prove invaluable. The editors of the long-running Socialist Register (first published in 1964) have lately been giving each edition of the journal an overarching theme. For this year’s offering, that theme is “health under capitalism”, and it gathers contributions from scholars who combine expertise in their field with a commitment to progressive politics.

The Register moves from wealthy nations like Britain and the USA to the global South, taking in such topics as the capitalist food industry and TV medical dramas along the way. Of particular interest to many will be the chapter on Barack Obama’s health insurance reform. There is already a narrative taking shape which holds that Obama and his advisers were too ambitious in their plans for change and had to retreat in the face of a popular backlash. Marie Gottschalk argues, on the contrary, that Team Obama were hamstrung by their reluctance to challenge the powerful health insurance industry:

“To the consternation of some Congressional Democrats and healthcare reformers, they appeared willing to accept a grossly watered down public plan or maybe even to abandon the public plan altogether as a concession to conservatives. They did not proclaim universal coverage as a fundamental goal and were noncommittal on a mandate requiring employers to pay for a portion of their employees’ health benefits. The administration quickly retreated from proposals to fund health reform by levying higher taxes on upper-income earners … the Obama administration and leading Democrats have sought a minimalist solution rather than seizing the exceptional political moment to strike out in a bold new direction in health policy. If they calculated that the political conditions were not fortuitous to secure a single-payer plan, at least they might have pushed for a seriously regulated insurance system. Failure to attempt even that is perilous for the cause of universal health care and for their political futures.”

Gottschalk notes that persistent talk about the unpopularity of universal public healthcare with the American public doesn’t have much purchase on reality:

“Asked whether they support national health insurance and a government guarantee of health care, overwhelming numbers of Americans routinely tell pollsters yes. One of the most surprising poll results came from a 2008 Harvard School of Public Health survey that directly asked whether a ‘socialised medicine system’ would be better than the current one. Among those who said they had some understanding of this historically inflammatory phrase (82%), a stunning plurality (45%) said socialised medicine was preferable (39% said it wasn’t).”

That should have been a solid base for Obama to build on. The real problem was the amount of money sloshing around in campaign contributions from the health insurance industry (much of it finding its way into the coffers of senior Democrats on Capitol Hill), and the broader hostility of economic elites to the introduction of public, non-profit health insurance, which would undermine the free-market ideology that holds sway in US politics. To overcome that opposition, Obama would have needed to come forward with a  clear, unambiguous reform programme and urged his supporters to light a fire under any Congressman or woman who tried to water it down. Instead, it was the opponents of health reform who mobilised their support base with crude appeals to prejudice while Obama tried to reach “across the aisle” to his sworn opponents.

It’s not just the private insurance companies making money out of ill health, as the rest of this collection shows. Health has become a major centre of capital accumulation, with corporate interests pushing to expand the boundaries of private provision. In Europe, the Swedish company Capio has carved out a leading position in the private health care market, becoming the largest operator of private hospitals in Spain and the second-largest in France. A British private equity fund, Apax, took a majority shareholding in Capio in 2006. Apax also has shares in a South African healthcare company, Netcare, which owns Britain’s largest private hospital operator.

Private hospital care is only one segment of the immensely profitable health industry. Estimated global revenues in the pharmaceutical sector for 2008 were $775 billion. Companies producing bio-medical technology earned $180 billion the previous year. With that kind of money at stake, there is constant pressure from the big pharmacorps to secure markets for their drugs by broadening the definition of ill health. As Kalman Applbaum writes:

“The continued expansion of their use depends on the ability of pharmaceutical companies to set the threshold for what is considered to be the risk of disease. Should a blood pressure reading of 140/90 be diagnosed as hypertension, or 130/80? The difference may appear negligible as regards a given individual, but for the pharmaceutical industry the difference is worth many billions of dollars.”

With trillions of dollars at stake, the private health lobby will be on hand to resist any attempt to shift the balance in favour of public, not-for-profit medical care. But in the introductory essay of this fine volume, co-editor Colin Leys suggests that the current economic crisis will create new opportunities for an egalitarian approach to health care:

“Millions of people will remain unemployed for years (many older workers will never work again), while governments cut social services in order to repay the enormous debts they have incurred to rescue the banking system and reflate their economies. In this context, the anti-egalitarian character of neo-liberal health policy seems likely to become more and more apparent. The rhetoric of consumer ‘choice’ will have a much narrower appeal … this could in due course lead to the emergence of a new common sense in which the link between health and equality is once again seen to be fundamental.”