2-15-05, 8:05 am

My Capitalism Gone Mad moment for today starts with an op-ed Washington Post story (from February 8) by Elizabeth Warren, a Harvard Law professor. Warren cites a study that shows that a million people declared bankruptcy last year because of medical costs and that 75 percent of these people had medical 'coverage.'

For many years now, people who go into doctors’ offices after presenting what insurance coverage they have are given papers to sign making them liable for all costs not covered, which is stressful enough to heighten whatever illness you do have.

Warren notes that many seriously ill people lose their jobs, which then means that they lose what coverage they have and have to declare bankruptcy in order to keep from losing everything, a contemporary version of what Joseph Heller called catch-22.

When I read that I thought of an old feudal custom in pre-revolutionary China where peasants crushed by debt would commit suicide on the landlord’s doorstep to absolve their family of the debt. But we live under freedom, democracy, and in the 21st century. The Bush administration has an answer to this problem: make it harder for families to declare bankruptcy. I don’t think they would want to revive the old Chinese feudal custom though, since they say they believe in the 'sanctity of life' – at least the life of the unborn and the terminally ill.

Warren, representing here what the Bush administration and its hangers-on would call the 'intellectual elite' (not the poor AMA doctors threatened by greedy malpractice lawyers), compares this policy to Congress closing hospitals in response to a flu epidemic (which I wouldn’t put past the administration, since they might see the epidemic as a plot to establish socialized medicine).

Warren, who can never expect a judicial appointment from this administration, then goes on to catalogue the craziness of the health care system, the tens of millions who are 'covered' by health care plans which aren’t around when they really need them, the administration’s schemes to 'reform' Medicaid along the lines of the Utah plan developed by Michael Leavitt, the new HEW secretary – namely, a clinic system like many third world countries where hospital care and specialists are not covered, meaning a system that works for the poor as long as they are healthy to begin with.

Warren comes out for 'comprehensive health insurance' and warns that the 'middle class,' not only the poor are on the brink of disaster in a society where every thirty seconds someone declares bankruptcy because of medical costs. She could have been a little more specific, and a little more candid about what 'middle class' means in the U.S., which is what 'working class' means in the rest of the developed world, namely the great majority of wage workers and employees who are not wealthy owners, executives and managers on the one hand and the very poor largely outside of the labor force on the other hand.

As I read the article I thought of an old story that a friend of mine told me many years ago about when he was living with a woman whom he later married. He worried that a neighbor, an old women living in his building in Brooklyn might be upset. The old women smiled and said it was OK for unmarried people to live together because 'that’s how the modern people do it.' The 'modern people' in the developed world have had socialized medicine for more than half a century. Who says that the American people wouldn’t be happy to get rid of an insurance system that tries to make them pay the most in premiums and get the least in benefits. Who really thinks that they, unlike everybody else in the develop world, would never accept a full-fledged system of socialized medicine. Mostly the people who profit from the present system, and/or ideologically despise the idea of socialized medicine, and project (a good old Freudian term) their hostility onto the general population.

Actually, it would be relatively easy, I think, to establish a comprehensive system of socialized medicine here, as it was in the UK after World War II. The doctors, however, they might huff and puff, would not have anywhere else on earth to go were a system of socialized medicine established in the US, since socialized medicine has been established in all rich countries and there are only so many jobs open in Saudi Arabia and the few other rich countries that don’t have socialized medicine. (Those jobs also are severely restricted by religion, ethnicity and gender.)

The big pharmaceutical firms would also be very upset, but they would have to cut the prices they currently charge to Americans in half to make them competitive with the prices that they get from socialized medicine systems in England, Canada, France and other countries with socialized medicine. The insurance companies would just have to get out of the business, since medical care would be organized on the basis of use and need, not on insurance principles and their present HMO structures might be nationalized .

Then Americans might begin to reach the life expectancies of people in other developed countries, use much less prescription drugs, since the pharmaceuticals wouldn’t have any major interest any more in using doctors as drug pushers. Americans both use twice as much prescription drugs, which are now advertised regularly on commercial television, and pay twice as much for their drugs than other people in developed countries with socialized medicine. There would also be fewer bureaucrats needed to either push certain treatments on people or deny others.

But the Bush administration, which is both trying to make bankruptcy harder and trying to keep Canadian drugs out of the US, would never see it that way. (Canadian distributors can give Americans big discounts and still make large profits, because they sell to a publicly controlled Canadian market at half the U.S. price.) What does a few more years of life mean, Bush and Cheney would probably ask, if it is spent under socialized medicine. Who would trust the quality of over-regulated Canadian drugs as against the products of our 'free' pharmaceutical firms.

What was it that Anatole France, the French man of letters, said about a century ago: the law and 'freedom' under the existing system gives to the rich man and the poor man the same right to either sleep under the bridge or dine at the Ritz. While millions of bankrupt people face a future of sleeping under bridges, Bush and Cheney will create a commotion as they try to order 'freedom fries' at the Ritz in Paris.



--Norman Markowitz is a contributing editor of Political Affairs.

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