Saturday, March 6, 2010

Disease Care Insurance In A Sick Society

by Michael K. Smith

An extreme illness cannot be cured by a moderate medicine.

-----Malcolm X

Thirty years ago, Dr. Hugh Drummond, then medical editor of Mother Jones magazine, published a wonderfully insightful essay on the significance of the emerging national health insurance debate in the United States ("Your Health at Too High a Premium: National Health Insurance"). Drummond pointed out that the eagerness to enact a national health insurance bill stemmed from the intersection of two forces: the greed of insurance companies, horrified that millions of Americans were escaping paying the monthly ransom for receiving medical care, and the anxiety of an increasingly diseased general population, eager to "save its ass" from the inevitable consequences of living sedentary lives in an environment contaminated with thousands of untested chemicals.

Drummond made the often overlooked points that, (1) health insurance is not really that at all, but rather, "sickness insurance," and, (2) social and environmental conditions have a lot to do with patterns of disease. But since the social roots of disease are a source of considerable private profit, they typically remain unexplored. Therefore, it is not too surprising that discussion of national health insurance does not raise the crucial question of whether a healthy society would be compatible with maximizing profit for the medical insurance-pharmaceutical complex, that is, whether the limitless pursuit of profit might itself be sick.

The answer would appear to be yes. Since illness cannot be avoided, demanding profit as a condition of extending medical coverage amounts to a cynically opportunistic racket in which the poorest and sickest individuals are left to fend for themselves on the dubious assumption that they either don't want or don't deserve to have insurance (suffering much higher than normal death rates as a result). In fact, the only reason the issue of national health insurance ever emerged at all is because having government guarantee payment on behalf of the uninsured (now 48 million) and the underinsured (now 168 million) aroused the insurance companies' usual lust for limitless gain. In other words, there was a lot more money to be made off illness, irrespective of the prospects for prevention and cure, which are merely incidental outcomes of profit-seeking when they do occur.

Naturally, the central premise of the national health insurance advocates had little to do with health. The main idea was, and is, that everyone is terrified of cancer and heart disease, which therefore could and should be treated by enormously costly technological interventions like transplants, bypass procedures, and radiotherapy. Since the price tag for such treatments vastly exceeded patients' ability to pay, the solution seemed to be a classic case of government moving in to do for individuals what they could not do for themselves, that is, underwriting the expenses of medical procedures allegedly designed to cure, or at least temporarily subdue, fatal disease.

Overlooked in this "debate" about universal coverage was the more basic issue of how social and environmental conditions contributed to the pattern of diseases killing off Americans before their time. The pervasive illnesses of the poor and young - like malnutrition and lead poisoning - didn't even rate a mention. Likewise, the fact that highly invasive treatments initiated long after an unhealthy environment had predictably caused epidemics of cancer and heart disease was a far less promising approach than refraining from contaminating the environment in the first place, did not get the fair hearing it deserved. The reign of crackpot realism guaranteed that unexamined social causes of disease would continue generating massive suffering no matter how the debate about insuring treatment costs turned out.

Dreamy utopianist that he was, Dr. Drummond focused laser-like on logic. "To really stop cancer," he observed, "we would need to control all industrial pollutants, such as asbestos, vinyl chloride and sulphur dioxide." The enormous quantities of synthetic additives in food and drink would also "have to be eliminated." As for heart disease, Drummond argued that a general cure should at least entertain the idea of eliminating unemployment, "which has been documented to increase norepinephrine and cholesterol production to murderous levels." He also suggested that Americans eat, drink, smoke, and drive less, but he recognized that if healthy living were ever seriously pursued in the U.S. "the economy would collapse." Hence the need for a system of insurance that would add to corporate profits by underwriting the treatment of symptoms, while the proliferation of deadly chemicals and their attendant diseases went merrily on its way.

Given the unfortunate conflation of disease management with health care, even Medicaid and Medicare, though important social democratic advances, fell far short of their liberatory potential. What exactly happened in the aftermath of implementation of these programs, the precursors of today's debate about national health insurance for all? Most notably, a predictable gorging at the public trough. "In the first year," wrote Drummond, "doctors' fees rose two and a half times as fast as the cost of living." Hospital costs also soared, registering a four-and-a-half fold increase in the programs' initial years, with hospital administrators eagerly increasing their salaries at public expense.

The influx of federal money also went for fantastically expensive drugs and medical supplies, and the control of labor: hundreds of thousands of dollars were allocated to prevent union organizing in the medical industry. Most administrators and doctors welcomed the treasure-trove of government money, not at all persuaded that "socialized medicine" meant they would inevitably earn less than they had before.

Did salary increases for medical professionals constitute proper reward for an array of helpful new treatments? Apparently not. Drummond observed that the most obvious results of the new programs were that "a lot of doctors got richer," and "expensive and 'interesting' medical technology" was introduced, such as a hyperbaric chamber at Mt. Sinai in New York City, which was employed only sporadically and with "unconvincing necessity" in his view. For the money involved in offering this single high-tech treatment option, Drummond complained, the hospital could have funded 20,000 outpatient visits a year, or had a large-scale lead poisoning program for the residents of East Harlem. But that is not the way to expand profit and market share for pharmaceutical and medical insurance companies.

How about the patients these programs were intended to serve? It is true that fewer people were denied access to bad health care, but of those below the federal poverty level, one third remained unaffected by the existence of Medicaid and Medicare, and their illnesses continued to go undiagnosed and untreated.

The problem, of course, is that universal coverage, even if achieved, only fully subsidizes the current medical system; it does not require a change in its dismal health outcomes (the U.S. spends roughly double per capita on health care compared to other industrial countries but has among the worst health outcomes). Doctor-patient relationships do not inevitably improve; community controlled health clinics do not automatically emerge; better hospitals with more responsive staffs don't suddenly spring to life; the chemical industry doesn't stop polluting the air, land, and water.

On the other hand, if President Obama were backing single-payer insurance, a form of which exists in every other industrial country, at least we could look forward to the demise of the medical insurance industry, now fattening its already enormous bottom line at the expense of an American people suffering epidemics of obesity, cancer, and heart disease. But Obama does not favor this. On the contrary, he is pushing for an outcome where everyone has to be covered by the current HMO-dominated system, the most inefficient care delivery there is, with administrative costs many times greater than Medicare. And he wants to pay for those excessive costs at least in part by cutting Medicare benefits, which ought to be increased. This is not universal insurance at all, but the same "rob Peter to underpay Paul" system that continues the American people's subordination to the very medical-insurance-pharmaceutical complex that needs to be eliminated. It is by now virtually certain that we will get some version of the Obama plan, since the HMOs have invested a lot of money in it, which means we will be forced to pay too much for crappy care, with high deductibles and co-payments pushing ever more people into bankruptcy, an accelerated version of what we have already.

And rest assured that no attention will be given to making radical changes in our war-obsessed, consumption-mad culture, so as to achieve a genuinely healthy way of life. Quite the contrary. Obama will instead move ahead with plans to privatize Medicare and Social Security, widening the scale of our current disaster by converting entitlements into speculative schemes like the ones that collapsed the economy in 2008.

For him, that's "change you can believe in."


Hugh Drummond, M.D.,"Doctor Drummond's Spirited Guide To Health Care in a Dying Empire," (Grove Press, 1980)

David Himmelstein, Steffie Woolhandler, Ida Hellander, "Bleeding the Patient - The Consequences of Corporate Health Care," (Common Courage, 2001)

Vicente Navarro, "Obama's Mistakes in Health Care Reform," Counterpunch, September 7, 2009

Eduardo Orbea, "Corporate Power is 'Crushing' - The Health System According to Noam Chomsky," Univision On Line, September 18, 2009

-------Michael K. Smith is the author of "Portraits of Empire" and "The Madness of King George" (illustrations by Matt Wuerker), from Common Courage Press. He can be reached at


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