USA: The Health Care Epidemic

With the recent outbreak of SARS, and flu season once again upon us, much attention has been given to the state of America’s public health system. It’s been 30 years since the last big influenza outbreak, and health officials say the odds are another deadly wave could be just around the corner. In an average year influenza kills 36,000 Americans, mostly the elderly, very young children and people with other diseases. It puts 115,000 into the hospital. But that’s nothing compared to the influenza pandemic of 1918 - 1919. That outbreak killed more people than World War I – somewhere between 20 and 40 million people worldwide. More people died from influenza in a single year than in four years of the Bubonic Plague Black Death of 1347 – 1351.

So how prepared is the US for an outbreak on this scale? Not at all. Despite pouring over $2 billion into the system since September 11, the US public health system is only marginally better prepared to handle a bio-terrorism or other major health emergency. How is it possible that $2 billion of our tax money was spent and we got next to nothing in return? In a for-profit health care system, that’s just par for the course. The examples of Enron in the energy sector and of Halliburton in the reconstruction of Iraq clearly show the relationship between big business and the government, and it’s the same in the billion dollar health care industry. Corruption, mismanagement, and massive profit for private companies are what it’s all about when a capitalist government has control over public dollars. 

However, the crisis in health care in this country goes much further than being unprepared for an epidemic. There are an astonishing 44 million Americans without healthcare. Those who do have healthcare have to pay ridiculous amounts of money for it, and even then, they have to worry about co-payments, deductibles, etc. A recent Census Bureau report states: “the ranks of those without health insurance grew from 41.2 million in 2001 to 43.6 million in 2002. The percentage who lack insurance rose from 14.6 percent in 2001 to 15.2 percent in 2002. The percentage of non-elderly adults (those aged 18 to 64) with private health insurance slipped from 70.9 percent in 2001 to 69.6 percent in 2001.”

And yet, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health, Americans spend considerably more money on health care services than any other industrialized nation - but the increased expenditure does not buy more care. According to the study, U.S. per capita health spending rose to $4,631 in 2000, which was an increase of 6.3 percent over the previous year. The U.S. level was 83 percent higher than Canada and 134 percent higher than the median of $1,983 in the other OECD member nations. They found that in 2000, the United States spent 44 percent more on health care than Switzerland, the nation with the next highest per capita health care costs.

The study also found that the United States spent 13 percent of its gross national product on health care in 2000, which was considerably higher than other nations. In contrast, Switzerland spent 10.7 percent of its GNP on health care, while Canada spent 9.1 percent. The median spending level for the OECD nations was 8 percent. American private spending per capita on health care was $2,580, which was more than five times the OECD median of $451. In addition, the United States financed 56 percent of its health care from private sources, which was the greatest amount of the OECD countries.

According to the study, public financing of health care from sources like Medicare and Medicaid accounted for 5.8 percent of U.S. GDP in 2000, which is similar to the OECD median of 5.9 percent. However, the United States spent $2,051 of public funds per person, which was much more than the OECD median of $1,502. In most of the other OECD countries the public health care expenditures cover everyone, unlike the United States. At the same time, Americans had fewer physician visits, and hospital stays were shorter compared with most other industrialized nations. The study suggests that the difference in spending is caused mostly by higher prices for health care goods and services in the United States. The results are published in the May / June 2003 edition of Health Affairs.

According to the New England Journal of Medicine, in 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada (which does have a form of socialized medicine, albeit imperfect). After exclusions, administration accounted for 31 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.

So where does all the extra money spent on healthcare go? Why isn’t it being put to use to provide universal coverage for all Americans? The US Chamber of Commerce explains: “despite the recession, the HMO industry posted $503 million in profits during the first half of 2001, a 16 percent increase over its profits for the first six months of 2000.” In other words, much of that money disappears in the form of profits and does nothing to improve our physical health, with 44 million not covered at all. These super-profits are gained at the expense of the health of all working class Americans. In a rational society, one that values the health and well being of its citizens, that money could be put to use improving everyone’s quality of life. Americans spend more on health care than any other country in the world, and yet we do not have coverage for all. In the wealthiest nation on earth, this is simply absurd. In its epoch of decline, the capitalist system is not able to provide even the most basic social services to the millions of working people it leeches its profits off of.

And yet, even the capitalist government is forced to acknowledge this in some ways. Due to severe shortages of flu vaccines, the U.S. Health and Human Services Department has contracted to buy 375,000 doses of influenza vaccine from Chiron Corp. on top of 250,000 doses it purchased earlier this year. They have also negotiated for 3 million doses of a second vaccine, FluMist, for any states that want to buy it. In other words, when it comes down to a vitally important aspect of public health, the state is forced to intervene where private health cannot do so at a profit (and just imagine all the lost work hours and hence profits if there was another severe influenza outbreak!). The example of the flu vaccines also highlights the “efficiency” of the capitalist market system. Last year the vaccine makers had to throw away 12 million doses of flu vaccine that were never used, so this year they made less. 12 million doses literally down the drain. And now that there is increased need this year, they don’t have enough to go around. Very efficient indeed. 

As always, it all comes down to profitability. But as socialists, we think that all health is important – not just avoiding the flu. The media and most politicians say that universal healthcare is simply not possible. But they’re wrong – the above figures show that the money is there, and that Americans already pay more than enough to cover it. It is a matter of how the money is being spent – billions of those dollars go to line the pockets of the rich, not to mention the countless millions spent on marketing, advertising, etc., which do nothing to improve our health. Universal healthcare is impossible only under capitalism.

Americans like the idea of “progress” – the idea that things continually get better over time. It used to be that way, but not any more. Nowadays, the gains that were fought for in the past by the working class are being taken away. Real wages are falling, unions are under attack, and in most cases health care is at the center of it all. The UFCW grocery workers’ strike in California is largely about health care. Even though operating profits for Kroger, Safeway, and Albertson's over the past decade have risen ten times faster than their contributions to worker health care in Southern California, the companies insist on what amounts to a 50 percent cut in medical benefits that would shift almost a billion dollars in health care costs onto employees over the term of the proposed contract. For those already living from paycheck to paycheck, this is simply not tenable. In the coming years, health care will be a central issue in the fight back of the working class against the attacks of the capitalist class. 

The only way to get society back on the track of progress is to end the capitalist system and all the waste and inefficiency it brings with it in the name of profit. Cosmetic measures such as Bush’s Medicare prescription drug plan do nothing to solve the fundamental problems that result from a lack of quality health care for all. This bill is in effect a massive subsidy for the billionaire drug corporations, and does not even cover the elderly adequately. What is needed is nothing less than the complete socialization of all aspects of health care from the cradle to the grave.

The benefits of universal healthcare to the whole of society would be tremendous. Preventative health care alone including regular checkups would improve the overall health of millions and rapidly reduce the need for more expensive procedures. But this is not going to happen under the capitalist system. Certain politicians may make this a part of their platform, and we would support the implementation of a universal health care system, but the fact is that this is pure demagogy and will not come about so long as the billionaire corporations run the show.

Only a rationally planned socialist society can put the wealth of the world to use in the interests of everyone, not just the profits of a handful of people. All the needless waste and lack of foresight and planning can be swept away only when the working class has democratic control over the wealth we produce. We will be able to eliminate unemployment and scarcity in goods and services only when we have a real say in what is produced, how it is produced, when it is produced, etc. 

The fight for universal healthcare involves a lot more than just more frequent doctor’s visits and cheaper prescription drugs. When we get right down to it, the fight for universal healthcare is a fundamental part of the fight for an end to the diseased capitalist system. Join us in the fight for a better world!

• Free, quality health care for all.
• For a nationally funded single-payer socialized health care system.
• Abolish private health care and HMOs.
• Full access to the latest medical technology, treatments, and discoveries.
• Free science from the dead hand of corporate greed.
• Massively fund research and treatment for AIDS, cancer and other curable and preventable diseases.
• Nationalize the pharmaceuticals giants that squeeze their profits out of the health of working people.