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Crisis of America's "free market" health care system:
"But tell me, this physician of whom you were just speaking, is he a moneymaker, an earner of fees, or a healer of the sick?"
Plato, The Republic
In his State of the Union address on January 20, 2004, George Bush said his goal is to ensure that Americans can choose and afford private health care coverage. But, in three years he did nothing to ensure health care for all Americans. Rather, he pushed an exploitative Medicare Bill through Congress that bans Americans from getting cheaper prescription drugs from Canada, and that allows even greater exploitation of the elderly by pharmaceutical companies. He is concerned with wasteful medical lawsuits because he works for the wealthy, profit-making doctors whose goals for even greater wealth dare not be hindered by the poor seeking justice from their medical mistakes. While countless Americans are without health care, CEOs of health management organizations (HMOs) and insurance companies earn annual salaries of more than $350,000 with stock options of more than $15 million. Bush said that he wants to preserve the system of private medicine that makes America’s health care the best in the world. But is it the best? Presidential candidate Howard Dean has been rattling off the names of more than ten industrialized countries that all have better health care systems, defined as having lower mortality rates for all categories of diseases and greater longevity. In this 21st century, for the American government to deny health care to 20 percent of its population can be considered as crimes against humanity, and George Bush should be tried for these crimes in the International Criminal Court.
The United States is the only country in the world which has a health care system based entirely on the free market economy. What are the consequences of health care that places a market value on its services? At the onset of 2004, nearly 50 million Americans are without health insurance, and that number is shooting up right alongside unemployment figures. Millions more have only partial, inadequate health care coverage. Eighteen thousand people die in America every year as a direct result of not having access to health care. Beyond that millions are paying more than $100,000 for the hospital stays of their elderly parents in the final one or two months before they die. People with disabilities or who are homebound/chronically ill do not get the care they need. In this so-called richest country in the world, millions have diseases that go untreated. Despite this, the cost of health care has risen from 4.4 percent of GDP in 1950 to more than 14 percent in 2004. This translates to more than $1.3 trillion on health care. The cost is expected to be more than 16 percent by 2008. The U.S. has higher health care costs expressed as percentage of GDP than any other industrialized nation. It is to be noted, however, that America has a two-track health-care system: one track for the well-to-do and the second track for the ‘medically poor.’ The greatest victims are women, minority groups, immigrants, the poor, and the elderly. In the words of Howard Waitzkin,
"Many people with insurance coverage still experience major barriers to access, due to copayments or other deductible provisions. Most strikingly, every proposal for a national health program in U.S., intended to address the problems of inadequate access and high costs, failed. As the U.S. enters the new millennium, it remains the only economically developed country without a national health program that ensures universal access to care … The structures of oppression and the social origins of illness … have emerged as even greater problems as corporate penetration of health care has increased."
Article 25 of the Universal Declaration of Human Rights states:
"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."
George Bush, with his declared support of free-market based health care, is in direct violation of international law, and is directly responsible for the extreme suffering and premature death of millions of Americans who have no access to health care. For this reason, he should be tried at the International Criminal Court for crimes against humanity.
Arnold S. Relmn, editor of the New England Journal of Medicine, wrote in 1980 referring to modern American health care as "the medical-industrial complex [due to] a large and growing network of private corporations engaged in the business of supplying health-care services to patients for a profit." He wrote:
"Health insurance and third-party payment, coupled with increased specialism and the technology explosion, have been largely responsible for the rapid rise in health care expenditures, and have created a new climate for medical practice in which there are virtually irresistible incentives for doctors to become entrepreneurial and profit-seeking in their behavior."
His words were certainly prophetic, as we see today that all players in the health field – including doctors, hospitals, pharmaceutical companies, rehabilitation services and MCOs (managed care organizations) – are involved in health care as big business. In fact, the health care business is today a major force in the U.S. economy. Relman further warned us twenty years ago of the potential conflict between the profit motive inherent in capitalism and the fundamental right of all people to health care. Due to this profit motive, we have doctors in the U.S. taking bribes and kickbacks from pharmaceutical companies in the form of free samples to free consulting services to expensive trips to golf and ski resorts – all to ensure that those doctors prescribe the medications of that company, regardless of its cost. John Le Carre, in his novel, The Constant Gardener, writes about the horrifying behavior of the multinational drug companies dominated by hypocrisy, corruption and greed. Their corruption, in collusion with the U.S. government, includes blocking the manufacture of generic drugs by countries that cannot afford Western prices. It is frightening to consider that the opinions of our doctors are not at all their opinions but rather the opinions of their corporate/pharmaceutical sponsors. The greatest victims of the free-market health care system are the poor. In the words of Gustavo Gutierrez,
"The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited, proletariat, robbed of the fruit of their labor and despoiled by humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."
The Crimes of Unbridled Capitalism
"Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm."
The definition of ‘crimes against humanity’ includes crimes against a group of people. If we study the history of the American Medical Association (AMA), it becomes clear that the AMA is guilty of crimes against millions of American citizens by its hard efforts to block any revision of the American health care system that would provide health care for all. While several presidents have tried to pass a universal health care plan through Congress, the biggest obstacle has been the AMA and the pharmaceutical companies. These two entities virtually control health care and its availability in the U.S.
One hundred years ago this was not the case. Alternative treatments for illness were widespread, and included midwives, lay healers, herbalists, and homeopathic doctors. The Public Health Reform Bill, passed in 1848, proved a milestone in elevating public health, and included changes in drinking water, sewage disposal, housing and working conditions. In 1867 Edward Lister discovered the antiseptic technique which laid the groundwork (along with the work of Louis Pasteur) for the germ theory of disease and the concept of "scientific medicine." Up until the late 1800s physicians in America were relatively powerless and had to compete with lay doctors, midwives, homeopaths and herbalists. With the advent of "scientific medicine," this changed, and by the early 1900s medical physicians gained dominance over all other alternative medicine groups. Physicians established state licensing and passed laws excluding lay practitioners from medical practice. They also pushed women out of the medical field and in particular out of midwifery. Obstetrics was practiced and controlled by men alone.
But the real crimes began with the creation of the American Medical Association (AMA) in 1846. While initially they were powerless, today they rank as the second largest lobby group (after the American Association of Retired Persons - AARP, with the National Rifle Association – NRA - ranking third) in Washington, D.C. In 1910 they commissioned a study of existing medical schools, and then passed tight licensing laws and created new standards, which caused the widespread closure of medical schools, including nearly all black medical schools in the south. The AMA came to comprise of white, middle and upper-class men. Those men limited admissions of women to medical schools to five percent. They also practiced discrimination towards African-Americans and Jews. With the increasing sophistication and technology of treatments, and with the advent of experts and specialists, the common people began to look upon doctors with unquestioning awe. The nursing profession grew but was under the tight control of the doctors. By the 1920s the AMA had become a powerful political force and lobbied against any measure that would undercut either their power or their profits. In the 1930s when President Franklin Roosevelt tried to incorporate a national health care program into his Social Security package, the AMA put up vehement opposition until he dropped the plan. Hospitals also gained power alongside the doctors, and while the federal government was spending substantially to fund new hospitals, the Hill-Burton program forbade the government to interfere with hospital policies. By funding hospitals, the government essentially steered the country away from national health insurance or outpatient medical services.
Again after World War II, President Harry Truman pushed for federal health insurance for all, and again the AMA responded with cries of "socialized medicine." By the 1960s and 1970s the relationship between disease and poverty was clear. However, the AMA was not interested in these issues. It supported private insurance provided by companies who became exempt from state taxes. This system, still in vogue today, provides partial coverage to the employed. But, the unemployed, the elderly, and those whose jobs did not offer insurance, are for the most part unable to pay the high monthly premiums for individual subscribers. In 1965 Medicare and Medicaid were introduced, giving poor people who had never visited the doctor before a chance to get medical care. This period also saw the growth of the hospice movement and holistic health programs. Many people began to question the unbounded authority of the AMA, the insurance companies, and private hospitals. The women’s liberation movement in particular protested at the medical concept of birthing as something traumatic rather than natural. Such complaints led to more changes. (Only due to the unrelenting activism of good women, by 1998 more than 40 percent of medical students were women.)
By 1978 the federal government made drastic reductions in its support for medical centers. In response the health maintenance organizations (or HMOs) developed full-swing, and became the dominant player in the American health-care system. Kaiser Foundation in California pioneered the HMO concept, which involved prepaid monthly fees and minimum out-of-pocket expenditures by patients. However, HMOs reduced the autonomy of physicians and hence the AMA once again stepped in to lobby Congress to pass various restrictions on HMOs that made it hard for them to compete with traditional insurance companies. Ronald Reagan introduced cost-saving government programs which set fixed fees for Medicare reimbursement to hospitals and physicians and raised the deductible paid by patients. During his reign the U.S. saw a steep rise in the for-profit sector in medicine, in particular the for-profit hospital chains. One evolving trend was doctors sending patients to nursing homes, thereby shifting the financial burden to the patient and his family, since nursing home care is not covered by Medicare or Medicaid.
President George Bush the First followed the same policy of reducing federal spending and encouraging the for-profit, free-market approach to health care. Of course, it did not concern him that in the free market system there is no room for the non-players, the people who can’t "buy in" – the poor, the uninsured, the uninsurable.
"The special needs of the chronically ill, the disabled, infirm, aged, and the emotionally distressed are no longer valid claims to special attention. Rather, they are the occasion for higher premiums, more deductibles, or exclusion from enrollment. There is no economic justification for the extra time required to explain, counsel, comfort, and educate these patients and their families since these cost more than they return in revenue."
By 1990 polls showed that two-thirds of Americans were unhappy with health care and wanted creation of a government-funded national health program that would guarantee comprehensive health coverage to every individual. The 1990s saw the costs of health care for Americans going into the double-digits. Employers passed much of this cost onto employees by raising their monthly premiums and increasing their deductibles. The question needs to be raised, into whose pockets are these huge costs and expenditures going?
Consumer and advocacy groups began focusing on the huge profits of the various players in the health care industry, including hospitals, pharmaceutical companies, physicians, insurance companies, big businesses and large corporations. It was and certainly continues to be in the interest of these five groups to maintain the status quo, or capitalist free-market system, in American health care. If a government funded health plan evolved, all these players would lose, particularly the insurance companies. However, as greater numbers of people were suffering under this free-market system, which always seems to leave poor people stranded on the roadside, several reforms were suggested: (1) a Canadian style "single-payer" system to be financed through taxes and monitored by the government. This plan would offer universal health care. No one would be left without needed medical treatment. (2) the Clinton plan, which offered universal health coverage administered through large purchasing alliances under state control. In this plan also all Americans would be guaranteed a minimum standard of basic health benefits. (3) Several "market-based" plans that called for insurance reforms and government subsidies to help poor people pay for health coverage. With the daily lobbying of the AMA along with pharmaceutical and insurance companies, none of these plans was brought to fruition. Rather, health care has become increasingly privatized and market-based.
For-profit hospitals chains such as the giants HCA Healthcare and Tenet Healthcare had profit increases in 2000 of 19 percent. Generally, for-profit hospitals have an operating profit margin of nine percent as compared to nonprofit hospitals which average less than four percent. Secondly, while for-profit hospitals distribute their profits to investors, nonprofit hospitals plow those surpluses back into meeting hospital needs.
But the worst criminals in the health care business are the pharmaceutical companies. Spending on prescription drugs in the year 2000 was $132 billion, an increase of nearly 19 percent from 1999. Contributing factors were (i) more prescriptions being written, (ii) a shift to higher-cost drugs, and (iii) overall price increases. The best-selling prescription drug was antidepressants, while the fastest-growing categories of prescription drugs were antihistamines and cholesterol-lowering drugs. As a result, large companies like General Motors are staggering under the cost of covering these bills for their employees. But, it is the common man or woman who suffers the most from the obscene profits of a few. Women aged 70 and over have watched their prescription drugs rise within the past year alone by more than 20 percent. The costlier prices of drugs for their long-term problems like arthritis, estrogen replacement and diabetes are exacerbating the problem. It is the people over 65 who are consuming more than one-third of the prescription drugs in America. The first crime of the pharmaceutical companies is their obscene profits at the cost of simple people who cannot understand how the greed of those pharmaceuticals affects their own lives. The second crime is the fact that the pharmaceutical companies spend more than $75 million annually lobbying members of Congress and federal regulatory agencies to protect the status quo and to make sure Congress votes against any helpful Medicare benefit. Pharmaceutical companies have given millions to presidential candidates, particularly to Republicans, in the 2000 elections.
Between 2000 and 2003 the total spending of senior citizens on prescription drugs rose an estimated 44 percent. As of January, 2003, for just one prescription drug an elderly person’s annual expenditure was more than $500.00. For two drugs, the annual cost exceeded $1,500 per year. The annual cost of Celebrex was $2,102.00. (In contrast, no generic drugs exceeded $500.00 per year.) Already in 2001, nearly one in four senior citizens reported that they did not fill their medications due to the cost. On November 25, 2003 the U.S. Senate passed a new Medicare bill, which is a sorry sham to hoodwink the common people and collect their votes in the next presidential election. The new bill allows old people to purchase medical coverage for prescription drugs by paying $35 a month with a $250 deductible. The coverage pays 75 percent of costs until a person’s drug costs reach $2,250. After that, drug coverage stops until a person’s out-of-pocket expenses reach $3,600, at which point the insurance would kick back in again to cover 95 percent of costs. The bill also calls for increased privatization of Medicare and increases direct competition between Medicare and private plans beginning in 2010. Essentially, the bill is going to decompose and completely privatize the Medicare program, and hand the pieces over to the same for-profit corporations that have made the U.S. health care system the costliest and most inefficient in the world. The legislation is so corrupt that it even bans any initiatives to lower drug prices. The bill also bans Americans from receiving cheaper prescription drugs from Canada. This will leave elderly persons with huge premiums they cannot afford, or with no medicines at all. Everybody knows that in the capitalist system there is no free lunch. With the passing of this new bill, we will see still huger profits channeled to insurance and pharmaceutical companies and consequent increased suffering of elderly people unable to purchase essential medicines to lengthen their lives. As Doug Bandow of National Review said, "It is the largest expansion of the welfare state in 40 years."
In the capitalist free-market system, it is said that privatization moves functions and assets from the government to the private sector and thereby improves efficiency. Efficiency for whom? And what kind of efficiency? It is efficiency only for those privatized corporations. It is efficient in allocating to them more and more wealth. However, what about the economic equity or fairness of this scenario? Or what about the human fairness of organizing something as critical as health care to be based solely on financial profit for those private sectors, i.e., the doctors, hospitals, insurance companies and pharmaceutical companies?
"Anyone who wishes to be considered humane has ample cause to consider what it means to be sick and poor in the era of globalization and scientific advancement."
The health care industry costs include service in hospitals, nursing home care, long-term-care facilities, laboratory tests, physician and dental visits, prescription and nonprescription drugs, artificial limbs, optometrist visits and eyeglasses, hearing aids, wheelchairs and other equipment for the disabled, and breathing (Bi-pap and C-pap) machines. Beyond these are administrative costs for each of the above ‘suppliers.’ Health care in America employs about 9 million people, including about 700,000 physicians. Costs of health care have risen extraordinarily. As an example, for a back problem, a doctor will send the patient for an MRI costing $2000.00 compared to just 20 years ago when, for the same back problem, the patient would be sent for a simple x-ray costing $100.00. Insistence on using only an MRI instead of a simple x-ray is an example of completely needless, exaggerated health care costs, which also end up precluding millions of Americans who cannot afford that MRI, from obtaining health care. Along with the 50 million unemployed who have no health insurance, there are millions more who are retired and have limited to zero health coverage. States are cutting back on critical Medicare and Medicaid funding, thus penalizing the poorest and most helpless members of society in an effort to bring state coffers out of the red. Presently health care is paid for by (i) private health insurance – 33%, (ii) Medicaid – 15%, (iii) Medicare – 19%, (iv) military or other public insurance – 12%, (v) private expenditures – 4%, and by (vi) copayments and deductibles.
For each kind of health care coverage, there are restrictions on the amount to be covered. Insurance companies demand co-payments and deductibles and do not cover many essential health care treatments, including alternative medical treatments. Their first goal is not the well-being of the consumer but profit for their corporation. Medicare is available to people who have been employed a certain number of years. Still, there is a deductible (as of 2000) of $776 which covers all "reasonable" costs for the first 60 days of inpatient care and lesser amounts for additional days. Medicare does not cover all medical expenses of the elderly. It does not cover the cost of prescription drugs for the elderly. Yet, it is the elderly more than any other age group that require prescription drugs. It is also the elderly that suffer the greatest economic hardship. Today it costs more than $1000 to spend one day in the hospital. The cost of prescription drugs is rising 17 to 20 percent every year, which means they are out of control. Senator Edward Kennedy on January 27th on the floor of the U.S. Senate used that very term, "out of control," to describe the costs of prescription drugs. Experts predict that millions more Americans will be without healthcare in the months to come.
Medicaid is another government program that provides medical care for the handicapped, the elderly, children, and people living below a certain annual income. However, presently Medicaid covers less than half of those living in poverty. Many may be qualified but the paperwork and bureaucracy involved present enough hurdles so as to discourage poor people from even trying to get partial coverage. In many cases, Medicaid patients are required to use one particular doctor only. They have no choice in selection of doctor.
Another consequence of spiraling health care costs is that fewer employers offer health insurance to their employees. If companies do offer health insurance, they will reduce wage increases in order to offset the spiraling insurance costs. Hence it is the employees who are punished maximally. In the case of large companies, it is to maximize their profits, and providing health care insurance coverage for employees certainly cuts into their profits. In the case of small companies, they simply cannot afford to provide health insurance to their employees and still stay afloat economically. A second strategy by companies is to reduce or cut many full-time positions and replace them with part-time and temporary positions which do not include health insurance. FedEx, for example, will contract drivers for their deliveries instead of hiring those drivers as FedEx employees, because it saves them the big cost of providing health care insurance premiums.
The complex American health care system is covered by private health plans, federal and other governmental expenditures, and out-of-pocket payments by citizens. While previously many poor people were covered by Medicaid and Medicare, in the last three years funds have been slashed drastically. More than 30 percent of poor people have no health care coverage of any kind, with minorities such as African-Americans and Hispanics forming a large part. About 14 percent of all children in America have no health care coverage.
Standard of Care
For all these costs, does the U.S. offer the best treatment? While some diseases like polio have vanished, ulcers can be treated without surgery, heart disease patients have the options of pacemakers, angioplasty and bypass surgery to extend their lives, and while overall life expectancy in America has increased by 5 years since 1970, yet the breast cancer mortality rate remains unchanged, tuberculosis has reappeared in more virulent forms, and AIDS is epidemic. Furthermore, many other countries have higher rates of life expectancy, maternal mortality and infant mortality. Canadians, for example, live on average two years longer than Americans. Hence, in spite of having the highest expenditures and costs, the U.S. ranks low internationally as a health care provider. Over the past three decades there has also been a 40 percent reduction in time spent with patients, which minimizes the chance for thorough and accurate diagnosis, treatment and follow-up.
Still another issue is the fact that, according to J.W. Smith, 40 percent of patients admitted to hospitals in the U.S. do not need to be admitted. For example, thousands of troubled teenagers are admitted to psychiatric wards to be analyzed. They usually leave without improvement or change. They were admitted to increase the profits of the hospital owner. Doctors who do not admit a certain percentage of their patients are frowned upon by hospital management.
The growth of huge multi-hospital systems and huge pharmaceutical companies has led to concentration of ownership and control of all health services. Decisions about medical treatment for the diseased come not from local doctors but from corporate boardrooms, with CEOs focusing on the bottom line rather than on quality care of human beings. In this present milieu, public charity hospitals as well as university teaching hospitals are struggling to survive.
Purely competitive markets achieve both allocative and productive efficiency, i.e., markets produce goods and services in the most efficient or least costly manner. Normally in business scenarios the equity or fairness factor plays a very minor role and efficiency, i.e., maximum production and maximum profit, play the dominant or only role. However, in health care, the ethical aspect cannot be ignored. Health care is considered by most rational persons as a fundamental human right. For nearly 20 percent of Americans to be without access to any kind of health care is hence a human rights violation of severe magnitude.
Another problem is asymmetric information, or informational imbalance. Health care buyers / patients know little or nothing about medical problems. In contrast, the sellers / doctors know a great deal about medical diagnosis and treatment. This creates an imbalanced and unhealthy situation between buyer and seller. As profit is primary and the Hippocratic Oath secondary, this leaves the doctor in the position of recommending the maximum treatment for the patient, including surgeries, hospital stays, and repeated visits to the doctor. Tests that can be performed in one visit are spread over four to five visits. It means more profit for the supplier/doctor. With the doctor making all the decisions, a ‘supplier-induced demand’ is created. This is reflected by the exorbitantly high number of surgeries and hospital stays in the U.S. Doctors are paid a fee for each surgery performed, hence it is in the financial interest of doctors to suggest surgery to their patients. One hundred years ago people became doctors in order to fulfill the Hippocratic Oath – to alleviate the sufferings of human beings. Today it is a different story. Today large incomes and profits are a prime incentive to go into the field of medicine. This is in contrast to other industrialized countries where doctors are paid a flat annual salary and hence have no incentive to suggest needless and potentially harmful surgeries.
McConnell and Brue state that because health care is 80 percent financed by insurance, people go to the doctor more often than is really necessary, as compared to if they had to pay the full price for those doctor visits and diagnostic tests, and accordingly that this is what drives up the cost of health care. However, this reasoning is not borne out in other countries like Canada and Sweden, where the government covers the cost of health insurance. In fact, in those countries the percentage of budget going for health care costs is a lower percentage of the annual GDP. The real factor driving up costs in the United States is the profit motive – the fact that hospitals are owned by private corporations who are looking for "customers" who, by staying more days in intensive care, will bring them income and profit. Also driving up the cost are doctor fees, which are far more exorbitant than that of doctors in comparable industrialized countries. Again due to privatization, it is in the economic interest of doctors to call patients again and again for check-ups and follow-ups. Every visit will bring them between $150 to $200, excluding blood and other diagnostic tests.
Cross-elasticity of demand is the ratio between proportional change in quantity demanded to proportional change in price. If there is a big change in price and no change in demand, then there is inelasticity. If there is a small change in price and a big change in demand, there is elasticity. Hence a small price change upwards could curtail demand and this would indicate elasticity. However, regarding health care, even if doctors and hospitals all bump up their prices, there would supposedly continue to be inelasticity of demand because health care is considered as a necessity and not a luxury. In America today, the cost for healthcare is already so high that 50 million people avoid going to the doctor in spite of having clear disease or distress symptoms. The price of elasticity or inelasticity of demand regarding health care becomes irrelevant to people living below the poverty line and without any kind of medical insurance. The poor people are so brainwashed by Fox News and other corporate-owned television channels that they became mentally paralyzed, and their originality and ability to think independently has been destroyed. They cannot understand that they should fight for their right to healthcare!
A third factor is the price elasticity of demand for health care. Estimates put the coefficient at .2, which indicates a very inelastic situation. It means the quantity of health care consumed does not decline when prices go up, and that demand would be reduced by only two percent if prices go up by ten percent. There are four reasons for this: (1) most people consider health care as a necessity, not a luxury; (2) most people consider there are few if any substitutes for traditional allopathic medical services. Medical treatment is often given in an emergency situation, where price becomes irrelevant or a secondary issue; (4) most people prefer a long-term relationship with one doctor they trust, as opposed to shopping around for the cheapest doctor in town; (5) people who have medical insurance are less affected by the prices involved because they do not have to pay the entire amount of the bill.
The for-profit scenario today has only reinforced a dual-track health care system: one in which the employed people and the more well-off receive good medical treatment while the unemployed and poor people receive inferior medical care, if any. Constant cuts in Medicaid during the past three years have removed increasing numbers of children, the poor and the elderly from receiving any health care at all. For this very reason, we can rightfully say that the AMA, the pharmaceuticals and multi-hospital corporations are committing crimes against humanity.
Another economic factor is the aging American population. In 1960 people 65 years and older constituted nine percent of the population. In 1999 the percentage of people over 65 was nearly 15 percent. This further drives up the cost of health care because older people have more frequent and more prolonged health issues. These health problems increase with age. If it is known that a person has a terminal illness, it becomes immoral for the profit-seeking doctor and hospital to instruct the patient or his relatives to place him in the hospital during the final two-three months of his life, to die – and to rack up a bill of $100,000.00 for his nearest of kin to pay. It is pure profit for the supplier and hardship or destitution for the consumer. It is a reflection of the general societal sickness caused by unbridled capitalism in this 21st century.
Conservatives in American society say that health care is an economic resource, and not a right of all people. In contrast, liberals stress the right of all people to adequate health care. They feel that government has a major role to play in this task and also see consumers as participants in decision-making. However, liberals thus far have been unable to break the stranglehold of the medical-industrial complex. What is really needed is a radical restructuring of health care in America. Control of medical treatment needs to be taken away from the few and handed over to the many. Health care must be provided to all people by the government. At the same time, every person in every community must have a voice in local health care planning and services.
Health care should be guaranteed by the government in any country, but should not be controlled by the government, simply because government will also put utility value ahead of human value, just as much as any capitalist corporation would. A crying example of government-controlled health care is Sweden. In November 2003 the Swedish local health boards (Landsting) declared that in future they would issue lists of ailments that would NOT be taken care of by the hospitals and would hence not be paid for by government health insurance. As in other countries, more and more old people need and demand care, and the response by government is frightening. In 1975 in Sweden there were 136,000 hospital beds, many in small local hospitals. In 2001 the number of beds was 29,000, because most of the small hospitals had closed, leaving open only the larger, supposedly better-equipped hospitals. Swedish doctors and nurses spend 50-80% of their time in filling out bureaucratic paper forms. The attitude of nurses overall towards the elderly patients is alarming, evidenced by elderly patients being administered so many tranquilizers as to cause them to lose the will to live. Others are simply killed by disconnecting the IV. This is done with the mindset that hospital beds are for the young who can be cured and hence returned to the production line, while it is better for old people to die earlier so their pension money can be saved by the government and so they don’t cause hospital nurses unnecessary work.
Studies of health and disease show a clear relationship between disease and social class, race, ethnicity, gender and age. There is a strong correlation between disease and poverty. People with small incomes report far more health problems. The death-rate of low-income people is three times higher than those who are economically well-off. Obesity, tuberculosis and asthma are rampant among low-income families. High blood-pressure is also far more frequent in low-income groups and minorities. Diabetes is exploding among the Oglala Sioux Indians in South Dakota, giving them the shortest life expectancy of any group in the U.S. Their federally provided diet comprises of canned goods, white flour, white sugar, high sodium and high fat foods, and near zero fresh fruits and vegetables.
Novelist Harriet Arnow provides a clear picture of problems faced by the poor with regard to health care. In her novel, The Dollmaker, she describes poor Appalachian families who move to Detroit to better their lives. When their children receive tonsillectomies, they are sent home within hours, and the doctors split the insurance money collected with the local hospital. Health care in America is all about greed and profit for a few, and unnecessary pain, suffering and premature death for millions. It is a crime against humanity. This state of affairs is because the government as well as the civic society have allowed legal monopolies and oligopolies to flourish and to greedily acquire and possess cash and assets without any limits to their accumulations.
If we glance south of our borders, every year 14,500 people in Chiapas, Mexico die from curable diseases: respiratory infections, gastroenteritis, parasites, malaria, scabies, breakbone fever, tuberculosis, conjunctivits, typhus, cholera, and measles - as pointed out by the Zapatistas. All this misery takes place under the noses of wealthy tourists. It takes place because of dire affliction – poverty. The people of Chiapas have no social or economic rights. Economic rights in the form of health care is the crying need of the day in every region of the world. It is a mockery to award a handful of political rights to the people in the U.S. or anywhere else, when there are no economic rights and no rights to health care!
Modern public health advocates favor efficiency, cost-effectiveness, sustainability and replicability over equity. Yet, we know that unequal systems can never be considered efficacious unless the needless sickness and premature deaths of the poor don’t matter. Who is most likely to be imprisoned, who is most likely to then become sick, and who is most likely to receive delayed or inappropriate medical treatment? In every country, it is the poorest of the poor who meet these criteria. As Harvard University medical anthropologist Paul Farmer points out, in the coming year (2004) six million people will die of tuberculosis, malaria and AIDS – diseases that are all treatable – as a result of the structural violence meted out by the rich and powerful. In the words of Eduardo Galeano,
"Where do people earn the Per Capita Income? More than one poor starving soul would like to know. In our countries, numbers live better than people. How many people prosper in times of prosperity? How many people find their lives developed by development?"
In a just society, neither monopolies nor oligopolies can be tolerated. Furthermore, a moral foundation in political leadership as well as the people at large is required in order to halt any development of unbounded capitalist greed. What is required therefore is not a free market – free to exploit the masses – but a closely regulated market that is locally controlled while giving local benefits. If the AMA and the pharmaceutical companies are so powerful that they can block any constructive attempts to provide universal health care to the American people, it translates to saying that Americans are experiencing economic colonization. It means, the U.S. government is being colonized by huge corporate powers that are far more powerful than any government in the world.
Alternative Health Care
In the U.S. the medical model of diseases focuses on disease and its treatment, with the standard treatments being drugs and surgery. However, there are other options besides the allopathic medicine practiced in the U.S. It may not be necessary for doctors to select costly methods of treatment in every instance. Alternative health care is very much available but hardly publicized. The National Institutes of Health refer to these alternative health treatments as "complementary/ alternative medicine" or CAM. Of course, thinking on it, this title implies that we are all hopelessly dependent upon the drugs and surgeries of allopathic medicine while other options are only ‘complementary.’ These alternative systems may lack biomedical, scientific explanations for their success; however, the documented success of treatments such as physical therapy, diet, acupuncture, herbal medicines, yogic exercises and natural remedies cause these systems to gain clear validity among thousands of adherents. In the U.S., however, their identity and success are carefully suppressed so that the monopoly of the politically dominant allopathic medicine remains supreme. Most Americans never get the chance to live abroad where alternative medicines such as homeopathy, ayurveda, yogic treatments, chiropractic medicine, Tibetan medicine, tai chi, massage, and Chinese herbal medicine are offered as part of mainstream health care and not as a ‘weird’ alternative. Rather, in the U.S. there is a mere smattering of academic centers for Complementary and Alternative Medicine (CAM), such as at Beth Israel Medical Center in New York, Boca Raton Community Hospital in Florida, the Center for Complementary and Alternative Medicine at Columbia University, the Zakim Center for Integrated Therapies at Boston, the Duke Center for Integrative Medicine in Durham, North Carolina, and the Stanford Center for Integrative Medicine at Stanford Hospital. Alternative medicines have been kept alternative or non-existent because if they were to flourish, it would cut deeply into the profits of the current medical-industrial complex of allopathic surgeons, corporate hospitals, insurance companies and of course pharmaceutical companies. This has to change. Health care is not about money. It is about people’s lives, about quality of life, about longevity of human lives to enable people to evolve to new heights physically, intellectually and spiritually.
Colleges and universities all over India offer four-year baccalaureates in ayurvedic medicine, and some, including the renowned Pune University, offer Ph.D.s. Ayurvedic medicine, which evolved among the sages of India 6,000 years ago, is a comprehensive system of medicine using a holistic approach to health. It focuses on establishing and maintaining balance of the life energies within us instead of focusing on individual symptoms. Ayurveda realizes the need for preserving the alliance of the mind and body and offers tools for nurturing the subtler aspects of our humanity. Ayurveda provides guidance regarding food and lifestyle. Its practices are validated by centuries of observation, enquiry, and direct examination. ‘Ayur’ means life, and ‘veda’ means knowledge. Ayurveda is not just a medical system but rather a science of life, as it uses the inherent principles of nature to bring the individual back into equilibrium with the real self. Yoga postures and stretching are an integral part of ayurvedic medicine, as they improve circulation, accelerate the heart rate, enhance combustion of calories, stimulate the metabolism and regulate body temperature. How many Americans have heard of ayurvedic medicine? This despite the dramatic globalization of information in the world. The herbs and plants used in ayurvedic treatments can be grown in our back yards. Yoga exercises can be learned freely. Certainly, the ayurvedic health care system would cut into the profits of the AMA, the pharmaceuticals, and the insurance companies.
Similarly there are schools and institutes in most countries which offer training in homeopathic medicine. Homeopathic medicine is based on the premise that medicine produces symptoms in healthy people that are similar to those it relieves in sick people. It treats disease based on the administration of minute doses of a drug that in massive amounts produces symptoms. In the words of Sarkar,
"From the standpoint of principle, application and philosophy, homeopathic treatment is completely different from [other] medical systems. Homeopathy aims at treating the symptoms of the patient, not the diseases or its symptoms. So there is hardly any possibility of harm, even if the diagnosis is not quite correct. A doctor with subtle judgment and a keen eye can easily prescribe remedies guided by the patient’s symptoms."
Is homeopathic treatment covered by our insurance companies? Is the development of homeopathic practice in the U.S. encouraged by the AMA? The knowledge and success of homeopathic treatment has been tested over centuries. Why is it not offered to every American?
Traditional Chinese Medicine
In Singapore about half the population chooses to visit traditional Chinese doctors for their health problems instead of allopathic doctors, simply because they have more faith that Chinese medicines can provide cures where allopathic medicines cannot. Traditional Chinese Medicine (TCM) is a large pool of medical knowledge dating back to the New Stone Age over 10,000 years ago, which has evolved as an empirical science with its theories and treatments being used and refined repeatedly. The first and most important classic text of TCM was written in 200 BC, and discussed the theory and philosophy of TCM as well as the therapeutic benefits of acupuncture, herbs, diet and exercise. Acupuncture is the insertion of various needles into specific points on the body. Those points join together in ‘channels’ or ‘meridians’ along which vital energy flows. The purpose of needles being inserted at specific points is to break any blockages along those meridians so as to restore the balance of energy in the body. Chinese herbs are made from roots, stems, bark, leaves, seeds and flowers of hundreds of plants. Each mixture of herbs has a specific function. Tuina, or Chinese therapeutic massage is also an essential part of TCM and usually focuses along energy channels or meridians or an entire area of the body. Traditional Chinese medicine is a completely untapped healthcare resource that can be used for the myriad problems facing people in western countries and particularly in the U.S. Finally, its cost is minimal.
Yoga and Yogic Treatments
Still another alternative medicine is yoga and yogic treatments. It involves yogic exercises, which serve to revitalize and regenerate the internal body organs. It also includes a yogic diet which comprises natural, organic, vegetarian food. In addition there are mudras or postures recommended for specific illnesses, as well as remedies produced from natural ingredients that can cure most diseases. Yoga is a superb holistic approach to health, including exercise, diet, postures, meditation, breath control, and natural remedies. Prabhat Sarkar says,
"The object of the art of healing is to cure a patient, both physically and mentally. So the main question is not to uphold any particular school of medical science; rather, the key task is the welfare of the patient. Just as diseased body organs can be restored to normal by administering medicines internally or externally, they can also be healed, more safely and more perfectly, with the help of yogic exercises and ‘mudras.’
Grassroots Healthcare Systems
Change of diet and change in lifestyle are key ingredients to gaining good health. The citizens must demand access to all forms of medical treatment and not be limited to costly drugs and surgery which lead to profit for a few and possible harm to millions. It is well documented that allopathic medicine often leads to multiple iatrogenic illnesses. According to David Crow, most health problems are caused by poor nutrition, environmental pollution, socio-economic stress, spiritual emptiness, and in particular by allopathic medical treatments and drug toxicity. He suggests the alternative to be community-supported, plant-based healthcare via community and urban gardens, school gardens, eco-villages, nurseries and small herb farms, botanical gardens, seed banks, and the creation of practitioners and educators of herbal medicine. Community gardens and urban gardening are viable alternatives to the modern corporate agriculture embedded in poisonous pesticides. Community gardens are being developed in inner city neighborhoods, tended by homeless people, and are sprouting on the roofs of skyscrapers. They are the foundation of grassroots health care simply because they provide organic, local, fresh, natural food, along with medicinal plants. By transforming our communities into live pharmacies, David Crow says that all five causes of modern-day illnesses can be alleviated.
Public health involves (i) primary prevention in the social environment, (ii) early detection and treatment of disease, and (iii) responding to acute and chronic health problems through rehabilitation. Public health includes maternal and child care measures, immunization against infectious diseases, health education, diet and weight control programs, improvements in hygiene and sanitation. Yet, for whom have public health measures been developed? For the wealthy or for the poor? In how many countries do tuberculosis and AIDS remain the most common cause of death? Why are deaths from AIDS rising fast in the U.S. and who are the victims? Fourteen million people die every year around the world from curable infectious diseases which are linked to poverty and poor sanitation. Since manufacturing medicines for these impoverished people will not bring profits to pharmaceuticals like GlaxoSmithjKline, Inc., they do negligible research into medicines that would help these people.
"Knowledge of suffering cannot be conveyed in pure facts and figures, reportings that objectify the suffering of countless persons. The horror of suffering is not only its immensity but the faces of the anonymous victims who have little voice, let alone rights, in history."
In every country we see how in the final analysis suffering, in particular physical suffering of disease is caused purely by economic forces, in fact by the free market system which creates the structural violence which by default creates "a situation where the rich get richer at the expense of the poor, who get even poorer." Put another way, extreme suffering – especially when on a grand scale like genocide – or as in 50 million Americans dying premature deaths due to no access to health care – is seldom divorced from the actions of the rich and the powerful. Put simply, our government in Washington does not care because our government comprises the richest and most powerful men in the world. Those people who bear the most extreme suffering in the world, including here in the U.S. are those who are poorest. Even the World Health Organization (WHO) acknowledges now that poverty is the world’s greatest killer. It is what Arundhati Roy refers to as the New Genocide, defined as the powerful elite creating the economic conditions "that lead to mass death without actually going out and killing people." They are saved the trouble.
Health care cooperatives date back to the early 1900s with the establishment of the first association of cooperative sanatoria in Denmark. In 1919 health-oriented cooperatives were introduced in India and in 1921 in Yugoslavia. In Japan a National League of Health Cooperatives was formed in 1933. Similar developments occurred in Poland in 1936 with the establishment of independent health cooperatives in what is now the Ukraine. Cooperatives further developed in Madras, India (1938) and in Bengal (1939). Cooperative hospitals developed first in 1929 in Oklahoma, U.S. Sri Lanka began a network of cooperative facilities that finally evolved into the Union of Cooperative Hospitals in 1970. Health cooperatives developed in China in 1958, in France in 1962 and in Spain where by 1989 they had more than one million members. In its 1998 report to the European Commission, the International Cooperative Alliance (ICA) reported the existence of health cooperatives in Armenia, Belgium, Cyprus, Greece, Poland, the Slovak Republic and Spain. In 1997 the United Nations published a report called Cooperative Enterprise in the Health and Social Care Sectors – A Global Survey, which examined the experience and potential of health care cooperatives. In 1996 a new committee was formed of the world cooperative movement called the ICA International Health Cooperative Association. Pharmacy cooperatives have also expanded over the course of the 20th century, with the first known one to be in Belgium in 1882 and in Switzerland in 1906. In 1926 the first cooperative pharmacy opened in Argentina, and in 1928 the Pharmacy Federation of Barcelona evolved into a national association of cooperative pharmacies in 1971. The ILO International Directory of Cooperative Organizations (1988) makes mention of the European Union of Social, Mutual and Cooperative Pharmacies, which includes 1,384 cooperatives and 25.5 million people in the European Community.
In Kerala, India, the people took it upon themselves to launch an integrated health care program with participation from the Health Department and various political and cultural organizations. A group of 200 "barefoot doctor" volunteers were trained to tackle basic healthcare problems. The program began with free camps to identify cancer and other skin diseases. The "barefoot" volunteers prepared a handbook for neighborhood discussions on local health problems. School children received medical checkups, and each school formed a health club. Vaccination programs were started. Surveys were undertaken to identify the main health problems caused by lack of drinking water, sanitation, and poor nutrition. To solve the drinking water problem, the village people began digging wells in the most ideal locations on slopes or in valleys and pumped the water into small overhead tanks from where groups of families could draw water through small-scale networks of pipes. Each network of pipes was financed and managed by the people who could afford to contribute. The villages subsidized the households that were too poor to pay their share. This innovative local healthcare program is an example for the entire world of what can be done to care for those who have no care. Even here in the U.S., "barefoot doctor" volunteers can be trained to go door-to-door to enquire about the health of the residents and determine whether further examinations or medical tests are required. This much care would be far more than what 50 million Americans have presently!
On January 1st, 1947, the Group Health Cooperative of Puget Sound was formed, and began delivering a new kind of health care. Consumers paid flat monthly dues in exchange for comprehensive health care. Doctors and nurses spent equal time in promoting wellness and prevention as they did in curing disease. Group Health Cooperative’s founders believed that health was everybody’s business and everybody’s right. They prescribed democracy to cure a costly, cold and inefficient healthcare system and pledged that the Group Health Cooperative would "serve the greatest possible number." The nearby medical establishment forthwith began plotting their destruction. (For those who don’t believe, in 1943 the U.S. Supreme Court ordered the American Medical Association to stop "harassing" the Group Health Association of Washington, D.C., a cooperative formed by federal workers.) But, despite the swirl of political turmoil surrounding its birth, Group Health Cooperative survived and grew. Its physicians and nurses made family practice a respected specialty. Administrators continually sought new ways to make healthcare more affordable to all. Today this medical cooperative serves more than 560,000 members and is America’s largest consumer-controlled healthcare system and one of the nation’s leading health maintenance organizations. It was universally praised as the model for comprehensive healthcare reform. However, while Group Health Care made medical treatment affordable to many, for economic reasons they denied membership to people over 65 years and to people with pre-existing medical conditions. It was improvement but by no means perfection. In the perfect health care system, every single person must have access to health care.
Cooperatives which provide health and social care are already a large part of the economic system in European countries due to the vision of the people. They have formed chains of pharmacies, funeral services, catering and cleaning services. They have co-operative nursing homes, care co-operatives for the mentally ill, residential cooperatives for the elderly, home care service cooperatives. These cooperatives are a healthy mixture of user/consumer and worker control and they adopt co-operative constitutions as their business charter. While in Britain attempts to establish community-based health care were partially blocked by the medical profession – due to fear of less profits – nevertheless the movement is still alive with concrete experiments which show that a user-owned and controlled community health care organization is beneficial to all - both doctors and consumers. Co-operative health care is finally back on the policy agenda in Britain. In Sweden, where the health care system is rapidly changing to the free-market system, the people have responded by creating their own co-operatives in the areas of home care, residential services for the disabled and the elderly, and housing and insurance. Swedish governmental authorities give full support to these co-operatives and readily transfer charge. France, Portugal and Romania have also adopted the co-operative health care model as a viable economic alternative to what was unaffordable health care. In Barcelona, Spain is a large hospital fully owned by providers and users, with secondary coops forming a national network. However, it is Italy which leads all European countries with more than 2,000 health and social care cooperatives. The majority are worker coops, employing in total more than 40,000 people.
Health care should be decentralized, and be set up primarily as health care cooperatives. Capitalists and corporations have no place in the field of health care. Rather the civic society should form medical cooperatives, which means, the civic society will have full control over their own health. Health care can be offered as a combination of specialized government run hospitals, private and government medical research institutes, and small-sized local private businesses for manufacturing of medical devices such as pacemakers, kidney dialysis machines and artificial prostheses. Diseases such as cancer, Alzheimer’s, arthritis, longevity and strong heart function can all be more effectively treated using alternative medical treatments instead of allopathic medicines. However, the key solution to the economics of health care is medical cooperatives. In cooperatives, membership is open and voluntary. The cooperative is owned and controlled by the members/people. There is democratic control at all levels of the business. It is one member, one vote. Members will mutually agree to put some of the surplus funds back into the business and also towards more education of the worker members. In the words of Steve Hargraves,
"…running a [cooperative] is a political statement to the rest of the country. If you want to go to the heart of the beast, the heart of the beast is economics. This is an economic entity that we’re dealing with, this culture, this society. We’re trying to develop a new way of looking at how to run a business. Employee ownership is dependent on the fact that this company must survive in this capitalist, profit-oriented system. If you can find a different way of approaching those economics, in some ways you’re making a political move."
Health care needs to be locally controlled and directed. It also needs to be at an affordable cost, e.g., within the purchasing power of consumers. Even those who suffer from poverty must have the right to see the doctor and get treatment. A young man in Highland Heights, Kentucky got a deep gash in his finger at work and went to the nearby clinic for treatment and possible stitches. The clinic refused to treat him because he had not brought along his health insurance card, in spite of the fact that he offered to pay cash for services rendered. They provided him gauze to wrap around the wound but refused all further service. This cold, capitalist conduct needs to be removed from the American landscape. No one can be refused health care. Those who refuse to treat a person in distress should be fined and/or imprisoned.
Despite enormous medical advances, millions of Americans die alone in a hospital intensive care ward, or in agonizing pain. Millions endure costly but completely ineffective treatments for illnesses presently considered terminal. Millions of such patients are never told about or referred to their local hospice. Hospices were created in the 1970s because a group of ministers, health care workers and other concerned people began wondering whether all these medical advances had perhaps robbed Americans of the dignity of a natural dying process in their own homes. Today hospices exist in many industrialized countries but need to be established in every single town, and set up as local cooperatives, simply because they are doing the critical work of caring for terminal cancer patients, heart patients, and people with AIDS.
Many doctors are unable to accept death as a natural part of life. In contrast, natural death and dying are the main functions of hospices, who take care of terminally ill patients, mostly in their own homes. Hospices incorporate quality and compassionate care rarely found in hospitals. At present hospices are allowed to take clients only by doctor referral. Due to the profit motive, many doctors will not refer but will instead keep their patient in the hospital and intensive care unit to die. In contrast, hospices will arrange for terminal patients to die in relative peace in their own homes surrounded by loved ones. They do this with the help of nurses, doctors, social workers and home care aids as well as volunteers who serve as companions to the dying. Hospices have on their staff experts in palliative care who provide guidance in pain management of the terminally ill. This kind of care is generally not available in hospitals. Requisite medicines and medical equipment are delivered to the patient’s home free of charge. Referrals from doctors are processed in one day, and a social worker attends all admissions. Hospices further offer bereavement services to the community, including emotional and spiritual support.
More than 50 million Americans are taking care of elderly, dying parents with great difficulty, without knowing the great benefit that hospice services could provide. Many of their parents are in nursing homes and are in continual agonizing pain – which is unnecessary. It is a sad commentary on our society that most doctors and even nurses flunk the ‘humane’ test in their care of patients. Last Acts, an organization devoted to end-of-life issues, found the following results from a national study they conducted: (1) between 35 and 45 percent of nursing home residents are in constant pain; (2) most states in the U.S. have little knowledge of pain management; (3) only 33 percent of doctors and .04 percent of nurses are certified in palliative care; (4) while 80 percent of Americans want to die at home, less than 25 percent actually do so; and (5) less than 25 percent of the elderly in America receive hospice care. There may be several barriers to accessing hospice care, such as (1) physicians having their own mental difficulties accepting death and hence discussing end-of-life issues; (2) physicians being educated to always aim to cure, rather than to ‘let go’ of terminal cases; (3) physicians feeling their failure to cure is their own failure, that their referring a patient to the hospice is a clear indication of their own inability as a doctor; (4) physicians not agreeing to the strong pain management medications that hospices use; (5) but the over-riding reason is simply that the physicians will make far more money for themselves if they keep the patients under their care until the end. They will profit by many thousands of dollars. Hence, it is finally in their absolute financial self-interest not to refer their patients to a hospice.
"The absolute most overriding variable in all this is finances… If anyone is making … more money by treating someone … than they’re going to make if they refer to hospice, they’re not going to refer to hospice."
Yet, the key point here is that the hospice system provides comprehensive, compassionate, high-quality, end-of-life care AT LITTLE OR NO COST to the dying! The Academy of Hospice and Palliative Medicine (AAHPM), dedicated to the advancement of hospice and palliative (pain-relieving) medicine, needs to replace the AMA as a household word in America. Hospice and palliative care should cease to be specialized areas of terminal illness treatment and become a routine part of American life.
The next natural step after giving hospices their due recognition and place in society is to restructure the final aspect of health care. It is to put the ownership of funeral parlors in the hands of the people and set those up also as cooperatives. The result will be reducing the cost of a burial from $6,000.00 to $200.00, and reducing the cost of a cremation from $2,000.00 to $25.00. Funeral co-operatives already flourish in European countries due to the vision, foresight, and simple common sense of the people. The obscenely rich funeral owners perpetrate one more huge economic exploitation of Americans that needs drastic and immediate reversal for impoverished people already in the throes of a severe economic downturn. The simple act of establishing local hospices to care for the dying, and grassroots local funeral cooperatives, will begin the process of regaining the subtler and sweeter aspects of human life, also referred to as "culture."
Crimes Against Humanity
Cherif Bassiouni says that the term ‘crimes against humanity’ today means anything atrocious committed on a large scale. While the original Nuremburg definition of 1945 states that ‘crimes against humanity’ concerns the murder, extermination, enslavement, deportation and other inhumane acts committed against civilian populations, before or during war, today there are eleven international texts defining crimes against humanity. All eleven definitions, however, have some commonalities: (1) "they refer to specific acts of violence against persons irrespective of whether the person is a national or non-national and irrespective of whether these acts are committed in time of war or time of peace, and (2) these acts must be the product of persecution against an identifiable group of persons irrespective of the makeup of that group or the purpose of the persecution." It hence includes the structural violence carried out by the obscenely rich that kills far more people than killed in any local genocide. Furthermore, the United States Code reads as follows:
"Title 18 – Crimes and Criminal Procedure, Part I – Crimes, Chapter 50A, Section 1091 - Genocide, states: (a) Basic Offense – Whoever, whether in time of peace or in time of war, in a circumstance described in subsection (d) and with the specific intent to destroy, in whole or in substantial part, a national, ethnic, racial, or religious group as such – (1) kills members of that group; (2) causes serious bodily injury to members of that group; (b) Punishment for (a) Basic Offense – the punishment for an offense under subsection (a) is – (1) in the case of an offense under subsection (a) (1), ((Footnote 1) where death results, by death or imprisonment for life and a fine of not more than $1,000,000, or both; and (Footnote 1) So in original. (2) a fine of not more than $1,000,000 or imprisonment for not more than twenty years, or both, in any other case. Furthermore, (d) Required Circumstances for Offenses. The circumstance referred to in subsection (a) is that (1) the offense is committed within the United States; or (2) the alleged offender is a national of the United States (as defined in section 101 of the Immigration and Nationality Act."
The American Civil Liberties Union (ACLU) daily fights a brave battle on behalf of the rights of the poor and disinherited in America, including their right to health care. Presently poor people with HIV are denied access to homeless shelters. AIDS today is no longer the focus of the mass media. However, the numbers are rising. It is the worst health calamity since the Middle Ages. According to UNAIDS estimates, 34.3 million people in the world have AIDS and 19 million have died, with 3.8 million of them children. The bubonic plague killed about 30 million people. The U.S. Census Bureau predicts that by 2010, 71 million people in sub-Saharan Africa will have died of AIDS. However, the numbers in America, Europe, Russia, India and elsewhere are rising.
Fifty million Americans - never mind the additional 2.9 million new uninsured people who lost their jobs since George Bush took office - are ‘an identifiable group of persons irrespective of the makeup of that group or the purpose of the persecution.’ George Bush, by refusing to stand up to corporate powers like the AMA, pharmaceuticals, HMOs and insurance companies – rather he courts these groups – is committing crimes against humanity by his persecution of more than 50 million Americans – the group too poor to afford purchasing individual health insurance in a system that is purely for-profit and market-based. Concrete action must be taken. Every one of those 50 million Americans without access to health care, either individually or collectively in the form of class action suits, needs to begin filing lawsuits against George Bush charging him with crimes against humanity.
His callous persecution of the American poor, the elderly, single women, the disabled, and children in denying them health care needs to be exposed to the international community and cases should be filed both in the International Court of Justice at the Hague as well as the International Criminal Court in Rome. George Bush is perpetrating the extreme mental and physical suffering and premature death of up to 50 million Americans! Further, as the most powerful man in the world, Bush presides over the corporate genocide taking place in Haiti, India and the whole of Africa by denying millions of AIDS victims the right to medicine. To deny medicine to dying people who could get back their life with that medicine is nothing short of genocide. Let him be sentenced by the international courts! This conviction will not be carried out by political leaders. It will be achieved by a global social justice movement that demands the health care rights of all of humanity and demands punishment of those who deny this fundamental right. Similarly, let cases be filed today against the AMA and their 1000 lobbyists in Washington, D.C., against the pharmaceutical companies and their lobbyists, against the insurance companies and the HMOs. All who perpetrate the free-market, for-profit health care system in the U.S. and around the world are guilty of crimes against humanity. Let this fact be recorded in the annals of history!
As that great visionary Martin Luther King said, an injustice anywhere is a threat to justice everywhere. Reverend King also said that of all the forms of inequality, injustice in health care is the most shocking and the most inhumane. Health care is the God-given right of every human being. Any person, any institution, any company and any politician that denies this fundamental right must be charged in his own country with the murder of millions. Those same persons/companies must also be reported to the International Criminal Court, so that the entire world body knows that they have been charged with crimes against humanity – for the premature deaths of millions who are denied health care
The Fight for a New Dawn in Health Care
According to esteemed economist and social critic, Prabhat Ranjan Sarkar, the mindset of every human being must be:
"Whatever others may say, I sincerely believe that all human beings have the right to food, clothes, accommodation, education and medical treatment. It is not enough for me to accept their rights in principle; as an honest person I should make the utmost effort to see that they have attained their rights."
Sarkar, defines this fundamental thought-wave as the principle of social equality. Hence in the ideal world, governments must guarantee that every citizen has access to health care. Several countries already have such arrangements. There is no reason why the U.S. cannot follow in their footsteps. The options are expansive, innovative and implementable if people can unitedly demolish the present capitalist framework which metes out health care to medically illiterate consumers for the wrong reason, i.e., monetary profit. And alongside the demolition of the free-market (totalitarian) economic system, people need to be appraised regarding the viable health care alternatives. Alternatives mean, focusing on preventive care, on health maintenance, and particularly on getting educated regarding alternative medical systems such as homeopathic medicine, naturopathic medicine, traditional Chinese medicine and acupuncture, and Ayurvedic medicine. Availing of these (presently referred to as alternative) medical systems will mean drastic reduction in health care costs, and will result in using allopathic medicine almost solely for the purpose of emergency surgery.
The mass media, controlled by the Washington administration and elite corporate mega-powers will never talk about these options, and will never tell us it is our fundamental human right to have access to all available kinds of health care. They will never say that the right to health care should be guaranteed in the constitution of every country, or that it should be a part of international law. Hence, we need to work from the bottom up, from the grassroots level. It will not be enough to learn about alternative medicines, because if those methods continue to be practiced within a capitalist framework, they will likewise be unaffordable to millions of poor people. The approach must be two-pronged: health care education and grassroots transformation must take place hand in hand with the total demolition of the capitalist economic system which deletes human value and accepts only monetary value as the summum bonum of life. If accomplished, this would restore real meaning to the Hippocratic Oath taken by doctors upon graduation from medical school.
To deny healthcare to 20 percent of the population is unparalleled injustice, a crime, and we need to raise our voices in protest. We need to expose that the exploitative, capitalist mindset is causing doctors along with insurance, hospital and pharmaceutical corporations to thrive on the lifeblood of patients and their families.
To brainwash the public into believing that allopathic medicine is the only cure for disease is equivalent to spreading superstition in the society. It is direct and indirect exploitation by the American Medical Association, and should be exposed. We need to encourage people to study, to learn about healthcare and health issues, about preventive measures, and about alternative health care systems which can be far more effective than the often iatrogenic allopathic medicines. We also need to educate people regarding how to set up cooperatives, so that medical and healthcare cooperatives can start to cover the entire earth’s surface. Establishing medical cooperatives will signal the glorious beginning of global universal health care.
I believe that today there is a new Weltgeist – a zephyr gently tapping on the cheeks of the people, stirring them to life. People around the world are clamoring for democracy. People are also endeavoring to redefine democracy. Men and women want democracy in every sphere of their lives – ecological, social, cultural, economic and political. They also want democracy in their health care system, and a clear say in how that health care system should function. People want control. After all, healthcare is our birthright. We need to move away from oligopoly games and cartels and the current collusion of prices in health care which convert oligopolies into monopolies at our expense, and start demanding healthcare as our birthright.
A professor once told me, it is the people who are responsible for their own plight, for not demanding their rights. But, most people are simple, naïve, and completely brainwashed by the mass media monopolies. People only demand their rights when their torture, oppression and suffering become unbearable. And who is responsible for this state of oppression? The political leaders. Paul Farmer talks about structural violence as being the economically driven conditions which guarantee that poor people will die early from diseases easily treatable. Of those people who talk about human rights, how many of those same people are ready to talk about economic rights? As Farmer says, the inequalities of access constitute the chief drama of modern medicine. We need to fight for our own health care but also for the health care of people around the world. People need to get themselves engaged in fighting for justice on behalf of all direly afflicted communities. It should not matter that we have no personal experience of those communities, or that we have not personally been deprived, or have not physically seen bodies wasting away with the scourge of TB, cancer and AIDS. We must get involved in fighting for these people even from positions of physical security and wealth. We need to get ourselves engaged in the issue of health care inequality. In this 21st century, most people in the world do not have access to good health care. We need to make a deep personal commitment to fight for all those human beings who have the right not to be hungry, who have the right not to be wet when it rains, and who have the right to be healthy when treatment is available. The fight for health care for all needs to become a powerful political/social justice movement that allows the wealthy corporate owners no sleep at night until they change their ways. Health care is not a charity or an industry. It is a right. Government has no business to set rules as to who qualifies for health and hospice care and who does not. This is to be decided by the patients themselves – by the people.
If our government in Washington is shameless, then the rest of us cannot afford to be spineless. The American Declaration of Independence states that:
"… all men are created equal, [and] are endowed …with certain unalienable rights, that among these are life, liberty and the pursuit of happiness -… - that whenever any … government becomes destructive of these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness."
The Declaration further states that
"… mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations… evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such a government, and to provide new guards for their future security."
Our government has refused for decades to provide health care for all the people. Under the bullying and bribing of pharmaceutical companies and physicians, as represented by the American Medical Association, our government has completely failed to provide the fundamental right of every citizen to health care. Therefore, it becomes the inalienable right of the people of America to throw off such a government and to institute a new government which will guarantee the five fundamental necessities to all people, including the right to health care. In the words of Prabhat Sarkar:
"We must make arrangements for the food, clothes, education, shelter and medical treatment of each and every individual, so that all can live in this world as long as possible and become assets to the earth. We must provide them with the inexhaustible resources for their forward movement towards their spiritual goal. This very mentality is known as the principle of social equality. All the expressions of human life will have to be based on this principle of social equality."
And in the words of Abraham Lincoln, we need to announce to the powers-that-be in Washington that "this nation, under God, shall have a new birth of freedom – and that government of the people, by the people, for the people, shall not perish from the earth." It is now the urgent duty for all of us, in the words of Howard Dean, to take back America and in that process take back our ailing health care system and create local networks of caring based on a neo-humanistic culture of universal love for all created beings - a health care system that is set up for all the people and controlled by all the people at the local level. This is now imperative for our society in which over-worked health care workers are ground down mentally by the rapacity of HMOs and hospital administrators. We must not merely fight to end the corporate stranglehold in the U.S. and resulting AIDS genocide in Haiti, India and Africa. Communities must empower themselves and establish the health care rights of their members in the form of a constitutional right. Health care rights are in fact just the first step – the essential beginning in the fight for pervasive economic freedom for all people.
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