Tuesday, August 15, 2017

Why protect the poor

Capitalism exists to make profits. This is the underlying mechanism of the system, for a business must be successful at not only making, but maximizing profits, or it will lose out to competitors. 

The cost of labour, that is, wages, depends on the costs of maintaining the worker in working condition, providing training, and replacing workers lost to disability or retirement. Thus a low-skilled worker in a time of high unemployment, when he or she can be easily replaced, is much less valuable and is paid less than a highly trained one with scarce skills.

Within capitalist nations, where industrialized production requires the well-being of a large number of workers and the availability of healthy young workers for the military, the level of health and health care must be ample to maintain this productive force. Services that are necessary to maintain workers in general, such as public schools, sanitation, and health care, are general expenses to the capitalist system.

In the 19th century, as factory production flourished, workers lived in filthy crowded hovels, ate very poor diets, worked 15-hour days, suffered exposure to filthy air and toxins, and had frequent crippling accidents.  The economist CEA Winslow wrote in 1908 that improved factory ventilation would pay for itself by decreasing absences and preventing workers from being stupefied by late afternoon. Another economist, Irving Fisher, wrote a report using a cost-benefit analysis of disease pointing out the loss of work years by early death. Stacy May, a WWII era Rockefeller-linked economist, summed up the capitalist view of health: “Where mass diseases are brought under control, productivity tends to increase – through increasing the percentage of adult workers as a proportion of the total population, and through augmenting their strength and ambition to work….”

It is clear that the health and survival of the poorest people of the world, away from capitalist centers of production, is not of enough concern to the wealthy and powerful to mitigate the plagues of cholera and the many other infectious diseases that plague only the destitute poor of the less developed world or those whose well-being is less important. A century ago, W.E.B. Dubois said “The Negro death rate and sickness are largely matters of [social and economic] condition and not due to racial traits and tendencies”  This year, Harvard sociologist David R. Williams noted that every 7 minutes, a black American dies prematurely, over 200 people each day who would not die if their health were the same as their white counterparts. He presented evidence that these racial differences cannot simply be accounted for by unequal economics and education because even within groups of equal income and education, racial gaps persist. Only racism can be the answer. Even among college graduates, there is a 4.2 year black/white gap in life expectancy, and it rises for each lower rung of achievement.  High blood pressure, obesity, cancer, heart disease and premature death have all been shown to correlate with the experience of everyday racism.  Another factor is different access to medical care, which reflects housing and employment discrimination. In addition to these institutional factors, implicit bias, or unconscious racism, occurs amongst many health care providers, even well-intentioned ones.

 In Israel/Palestine, there is a ten-year gap in life expectancy between Jews and Palestinians, and a five fold difference in infant mortality. In South Africa, based on data from 2012, black men had an 18 year shorter life expectancy than white men, 17 years after the end of apartheid.

In sum, some health services for workers, from the unskilled to the professional, are necessary under capitalism to provide a dependable workforce, in order to maximize profits. Care for the unemployed, unemployable or less skilled and easily replaceable workers is not a priority. To admit this is in no way seen as a dark matter to be couched in euphemisms but is proudly touted with all sorts of cost-benefit analyses. For example, during medical student and resident training, the introduction to every lecture on a condition starts with a statement that cost in loss of time from work is XXX million/year and the expenditure in medical cost is XXX million or billion/year. Thus young doctors are inculcated with the ethic of measuring treatment or prevention benefits on the basis of profitability to capitalism, as opposed to the well-being of patients.  Thus it is unlikely – indeed, economically unfeasible — that any political administration will usher in a health care system that provides excellent preventive, chronic or acute care to all segments of the population. Only a mass movement which includes millions, employed and unemployed, old and young, and of all ethnicities can realistically fight for that.

Taken from