Getting to the Root of a Sick System August 24, 2010Posted by rogerhollander in About Health, Health, Socialism.
Tags: capitalism, class analysis, health, health care, health insurance, health reform, healthcare, medicine, mental health, roger hollander, socialism, SUSAN ROSENTHAL
by Roger Hollander
Review of Sick and Sicker: Essays on Class, Health and Health Care by Susan Rosenthal (2010)
for the Amazon kindle edition:
It is one of the great tragedies of contemporary human existence that the massive suffering that results from world-wide poverty and sickness is entirely unnecessary. Through past and present collective human productive creativity there exists sufficient wealth that the entire population of the planet should be able to live securely, free of economic deprivation and its derivatives (e.g. hunger, sickness, war, environmental degradation, etc.). But, as we know, the reality is otherwise.
The small but elite community who benefit from the profoundly unequal status quo (the tiny percentage who own and control massive accumulated wealth – i.e. capital) and the sycophantic community that follows in its wake (political pundits, organized religions, the corporate mass media, bought-and-paid-for academics, well-paid professionals, professional cynics, etc.) argue that world suffering is an unfortunate but inevitable product of unchangeable human nature and a scarcity of resources.
In Dr. Susan Rosenthal’s new book, Sick and Sicker: Essays on Class, Health and Health Care, a chapter entitled “The Myth of Scarcity” provides evidence that collectively-working human beings produce more than enough for everyone to live in relative comfort. “If the total wealth produced by American workers in 2003,” she points out, for example, “had been shared [equally], every US … family of four would have received $152,000 in that year alone … [and a] much larger [share] if it included a share of the wealth produced in the past.”
Rosenthal goes on to show the unconscionable disparity in the distribution of our collective wealth: “The top five percent of individuals in the world receive about one-third of total world income. The top 10 percent get one-half of world income, and the bottom 10 percent only 0.7 percent of it. Within 48 hours, the richest people acquire more than the poorest people earn in a year.”
“Capitalism,” she concludes, “is not about sharing.”
Critical thinkers contend that the fundamental cause of social and economic inequality is not found in “human nature,” God’s will, or scarce resources but resides in the concrete reality of historically-determined unequal social relations, that is, the unequal relation between those whose labor creates wealth and that small minority of capitalists who own it. This is a social structure created by human beings, and therefore subject to change by human action. They argue that a new society based upon human values rather than economic profit is not just a Utopian dream but rather the only alternative to the destruction of our species and the biosphere we inhabit.
While Rosenthal is clearly among this tradition of critical thinkers, there is something I find in her approach that sets her apart from many others. Her insight stems from a wealth of personal experience, and she writes with a passion that is palpable. One senses righteous anger in her words. The very first sentence in Sick and Sicker reads, “What does it mean to strive for health in a sick society run by psychopaths?”
Rosenthal explains that she entered the medical profession in order to help people, but after decades of immersing herself in the “details of people’s miseries,” she saw “a pattern emerge – an exploitive and heartless system was making people sick, the medical system was blaming them for being sick, and funding agencies were moaning about the cost of caring for the sick. I had wanted to be an agent of health, but I had become an agent of damage control for an utterly damaging social system.”
At first blush, one might accuse Rosenthal of hyperbole (“a sick society run by psychopaths”!) and dismiss her as someone whose anger has clouded her objectivity. But the reader who takes the trouble to go further will discover a passion that is grounded firmly in reason. Sick and Sicker is a work of carefully structured logical arguments buttressed by extensive and meticulous documentation to support her central thesis, which is that “social inequality affects the health of populations more than any other factor,” and that such inequality is a product of a profit-driven capitalist economic system.
In her first book, POWER and Powerlessness (2006), Rosenthal referred to a class of social critics who produce marvelous studies characterized by biting criticisms of the status quo, studies that document social inequality and its effects, but then go on to offer vague and generalized “solutions” that call for more study, education, the changing of attitudes, etc. – that is, anything but go to the heart of the problem because that is the greatest taboo in the academic world. Rosenthal’s work shatters that taboo. A radical thinker is one whose task is not finished until she gets to the root of the problem.
For in order to understand a reality with the objective of changing it (for the better!), one must go beyond analytic description of that reality to ascertain what is the cause. Having said this however, let me assure you that the reader whose primary interest is understanding our health-care system and how it functions will not be disappointed by this book.
Rosenthal addresses questions of how health care is delivered (assembly-line medicine), how it is financed, the roles of private and state sponsored health insurance, different models of rationing health-care resources, a comparison of health care in the U.S and Canada, and how the notion of mental health “disorders” and psychiatry relate to the pharmaceutical industry. She includes a “dialogue” between the author and Frederick Engels, who “was the first to connect a broad number of medical and social problems to the way capitalism is organized” and ends by recounting democratizing health-care reforms in Chile under the Allende government and how and why they were reversed by the Pinochet dictatorship.
The chapter in Sick and Sicker that compares medical systems in the United States and Canada goes a long way towards putting in perspective the recent farce of Obama’s so-called health care reform in the U.S. At the same time it helps us to understand that Canada’s (deteriorating) system of universal health insurance is another way of rationing health care and why it falls far short of achieving the goal of free and accessible comprehensive health care for all.
Mental-health professionals will find challenges and psychiatric survivors will find resonance in the chapter on mental illness. Rosenthal shows how the mental-health structure serves as a mechanism of social control under the false guise of scientific medicine. She describes psychiatry as “a pseudoscience – ideology disguised as science” where “mental disorders” are defined by whatever behavioral criteria the psychiatric profession chooses, as opposed to the biological markers that form the basis of scientific medicine. She shows how separating the brain from the mind, the body, and – most importantly – the social context, results in casting the blame for mental illness on those who suffer rather than on the stresses of life in a society characterized by ever deepening social and economic crises. “Mental distress becomes the problem to be treated, not the social conditions that create distress … To serve a sick system, psychiatry extracts the individual from society, splits the brain from the body, severs the mind from the brain and drugs the brain.”
Sick and Sicker is nothing less than a scathing indictment of our medical systems and the social and economic structures of the society that they serve. Apologists for the status quo and reformists who dismiss calls for fundamental structural change will always find ways to rationalize, discredit or simply ignore such penetrating analysis. However, for the millions in North America and the billions around the world who face the reality of inadequate health care on a daily basis , Dr. Rosenthal has performed a valiant and worthy service.