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Getting to the Root of a Sick System August 24, 2010

Posted by rogerhollander in About Health, Health, Socialism.
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by Roger Hollander

Review of Sick and Sicker: Essays on Class, Health and Health Care by Susan Rosenthal (2010) 


for the Amazon kindle edition: http://www.amazon.com/SICK-SICKER-Essays-Health-ebook/dp/B003PPDHSE/

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.

Supporting Obama’s Health Bill: Lesser of Evils or Pact with the Devil? March 23, 2010

Posted by rogerhollander in About Health, Health.
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No one tears a patch from a new garment and sews it on an old one. If he does, he will have torn the new garment, and the patch from the new will not match the old. [37] And no one pours new wine into old wineskins. If he does, the new wine will burst the skins, the wine will run out and the wineskins will be ruined. [38] No, new wine must be poured into new wineskins.

Luke 5: 37-39

Roger Hollander, March 23, 2010


The health industry stocks shot up once the bill passed.  More than anything else that tells us who stands to benefit.

What I find so frustrating is the notion, prevalent amongst Obama’s supporters, that by adding a few new benefits (some of which may or may not happen) to a totally corrupt system, somehow you have moved forward.  The Obamites badly needed a political victory, and they were willing to sell out not only their “progressive base,” as many have mentioned, but the vast majority of Americans who want, need and deserve a single-payer national plan.  Not to mention the roll back on a woman’s right to choose and such things as cruel, costly and stupid restrictions on undocumented immigrants buying health insurance.  

Perhaps the biggest irony is that the Republicans are attacking the bill as “socialistic” when in fact it is just the opposite.  The Republicans are making the right criticism (the government forcing people to buy private insurance, something that actually is right up their alley) for the wrong reason (trash the Democrats regardless of the issue).  Inwardly they are rejoicing at the bill’s entrenchment of private insurance with no public option while outwardly they are indignant at the “socialist” imposition of health insurance.  A win-win situation for them.

The Democrats might as well have put in a single-payer plan, which of course they didn’t not because they chose the wrong strategy, but because they just as much as the Republicans are owned by the corporate insurance and pharmaceutical industries. 

But it is the facile notion that a few crumbs are better than nothing that is staggering in its naïveté and its failure to realize that you do not pour new wine into old wineskins, that in so doing you may (may!) make some small gains at the cost of the ultimate objective.

To those who acknowledge that a single-payer, medicare-for-all plan is the only genuine solution, but that sometimes you have to settle for the lesser of evils, I suggest that there is a difference between the lesser of evils and a Faustian bargain with the Devil.

Healthy Opinions About Health Care June 21, 2009

Posted by rogerhollander in A: Roger's Original Essays, About Health, Canada, Health.
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Roger Hollander, www.rogerhollander.com, June 21, 2009

We Canadians know a good thing when we see, and live it and enjoy it and depend on it.  I’m not talking about maple syrup, although that might come in a distant second.  It’s our national health plan.  In the forty one years I have lived in Canada I have never once heard any politician from any political party suggest its abolition (not that the Tories do not do their best to defund and attempt to erode it).  It would be political suicide.  A few years ago a CBC poll asked Canadians who in their estimation was the greatest Canadian of all times.  The hands down winner was Tommy Douglas, the man who, as Premier of the prairie Province of Saskatchewan, introduced universal health care to Canada (he also happened to be Donald Sutherland’s father-in-law).


What Canada has is NOT government health care.  It is rather universal health insurance with a single insurer, the government (organized province by province).  Contrary to myth, and unlike HMOs and other private health insurance in the States, Canadians have an absolute right to choose their own physicians.  Furthermore, in all my years living in Canada not once have I walked into a doctor’s office, clinic, laboratory or hospital and had to open my wallet (other than to produce my plastic health card).  When my father was visiting from the States and needed to see my primary care physician, the office staff had to fumble around trying to figure out how to take a cash payment from him.  It had never happened before.


The Canadian health care provider, be it a physician, laboratory, etc., simply fills out a form and sends it to the government for payment according to a scale that is negotiated between the government a provider organizations such as the Canadian Medical Association.  There are no blood-sucking private health insurers to send costs through the ceiling and squeeze out bigger profits with co-payments and by denying treatment.  The Canadian plan is funded by employer and employee contributions. 


Despite massive disinformation campaigns about the Canadian health care system that are funded and promoted by the health insurance industry, the pharmaceutical industry and the Republican Party, a majority of Americans favor what is referred to as a single-payer system over the existing Rube Goldberg system in the States that passes for health care, a system that costs more, yields poorer results, and leaves tens of millions without coverage.

A CBS News/New York Times poll that was published in today’s New York Times (http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=1&hpw) showed that 72% of respondents supported government health insurance with only 20% opposed (the poll did not refer to a “single-payer” plan, but rather a public plan that would compete with private plans; other polls have shown a majority in favor of single-payer).

Surprisingly, the poll showed 50% of Republicans in favor with 30% opposed.  87% of registered Democrats approved and 73% of Independents.

50% of all respondents thought government would do a better job than private insurance companies in providing medical coverage against 34% who thought it would do a worse job.  59% thought government would do a better job of holding down health costs while 26% thought they would do worse.

But here is what for me is the most interesting and telling statistic that arises out of the poll.  Respondents were asked if they were willing to pay higher taxes so that all Americans have health insurance that they can’t loose no matter what.  57% said yes and 27 % said no.  That’s better than a two to one ratio.  And here’s the kicker: of those who earn less than $50.000 annually, 64% are willing to pay more so fellow Americans are not denied health care and 27% are not.  For those earning more than $50,000, 52% are willing and 44% are not.  

Look at those numbers carefully.  While only 27% of poorer Americans are not willing to help their fellow citizens, a whopping 44% of those with greater means don’t give a damn.

This is what I call compassionate conservatism.