Nov 292017
 

By James Petras, 99GetSmart

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Introduction

The US political and economic elites have always bragged that capitalism is far superior to socialism in terms of providing people’s personal welfare. They claim that citizens live longer, healthier and happier lives under capitalism.

The debate between the supporters of the US Affordable Care Act or ‘Obamacare’ and its most vehement opponents under President Trump is not part of any larger system debate since both ‘sides’ base their vision and plans for medical care on private, for-profit corporate insurance schemes. This source of funding would ‘harness market forces’ to deliver quality medical care … in a marketplace of ‘free competition’, in which every American, even the most fragile, cancer-ridden patient, would be an engaged stakeholder, weighing a huge menu of free choices …

The real comparison of how these economic systems provide basic health care should be based on showing which provides the best population outcomes, personal satisfaction and community security across national boundaries. National health systems top the chaotic private system in these parameters.

On the other hand, the US tops all European countries in terms of the percentage of workers and family members who avoid necessary trips to the doctor because they fear financial ruin from the inflated costs of their private health care. In other words, majorities of people, dependent on private for-profit insurance schemes to provide health care, cannot afford to visit a medical facility, doctor or clinic even to treat a significant illness. The type of economic system funding health services determines the likelihood of a patient actually going to seek and receive important medical care that will preserve life, one’s ability to work and enjoy some level of satisfaction.

This essay will include a brief discussion of the social and political conditions, which gave rise to the socialized, and clearly more effective, health care system. And we will touch on the consequences the two health systems in terms of people’s life expectancy and quality of life.

Comparing Costs of Medical Visitation by Economic System

The US is the only developed country relying on a private, for-profit insurance system to fund and deliver medical care for its working age population. In contrast, all countries in the European Union have some form of publicly funded and delivered health plans for its workers.

One of the key quality measures of a health care system is a patient’s access to timely competent medical care.

The Organization for Economic Co-Operation and Development (OCECD) recently conducted a systematic comparison of seven countries, with different levels of GDP, and the percentage of people in each country who are able to afford medical consultations for necessary medical care.

The European countries all have established national public health programs with clear goals and measures in terms of outcomes. The US is the only nation to rely on privately administered and funded health care systems for its working age population.

The Results

Over one-fifth (22%) of the US working age population believe they cannot afford to consult a doctor or medical clinic – in the event of an illness or accident. In contrast, less than eight percent of European workers view themselves as unable to afford necessary medical care. For the largest EU nations, less than 5% of the working population avoids care because of a perceived inability to pay for essential services. US workers are five times more likely to voluntarily forego health care, often with disastrous long-term consequences.

If we compare the US with its ‘free market’ private insurance run system with any EU nation, we find consistent results: Access to competent, essential medical services in the US is far worse!

In Germany and France, the EU’s most developed nations, working age citizens and their family members have three to ten times better access to health care than the US. 8% of workers in France and 2% in Germany postpone necessary visits to the doctor because of a perceived inability to pay. Among middle developed EU nations, 4% in the UK and 4.5% in Italy cite financial reasons for skipping essential medical care – compared to 22% of working age Americans.

Even in the least developed EU nations, Spain and Portugal, with the highest unemployment rates and lowest per capita income, workers have greater access to health care. Only 2.5% of workers in Spain and 7.5% in Portugal view costs as a reason to avoid visiting their doctor.

High Tech Billionaires Speak of ‘Values’ while Maximizing Profits

Protecting our community is more important than maximizing our profits’, the multi-billionaire Mark Zuckerberg opined this month, after his company, Facebook posted its first ever $10 billion quarterly earnings result. (FT 11/16/17 P 8)

Zuckerberg and entourage had apparently ventured into Middle America discovering to their shock that American communities were in the midst of a narcotic addiction crisis, which had caused hundreds of thousands of deaths and disrupted the lives of millions of addicts’ family members. The natives of Middle America were more concerned about access to effective addiction treatment than their access to Facebook! Zuckerberg, with his legions of highly educated foreign workers on the West Coast, conveniently missed the chance to identify the source of the American addiction crisis: The over-prescription of opioid pain medications by tens of thousands of private US medical practitioners, pushed by the giant US pharmaceutical industry in a 2 decades-long medical genocide that the nations of Europe had so ‘miraculously’ avoided because of their centralized, regulated, socialized health systems.

While the US may have the least available and least affordable health care for working people, it can certainly boast about producing the highest number of super-rich in the world. Five of the world’s largest companies are US-owned with a combined market capitalization of $3.3 trillion for the top US tech giants. Europe’s largest tech company, SAP, is sixty notches below.

The US giant mega-billion dollar tech companies and CEO’s are also mega-billion dollar tax-evaders who stash their fortunes overseas and avoid the inconvenience of having to contribute to any national health programs for workers – whether in the US or elsewhere. The monopoly tech corporations’ wealth and power are one important reason why over a fifth of working age Americans cannot afford necessary medical care. As one acute observer noted, ‘The new high tech elite tend to cloak their self interest by talking about values which has the collateral benefit of avoiding talk about wealth.’(FT 11/17/17 P9)

The scarcity of European multi-billion dollar tech CEOs, like the American Zuckerberg and Gates, is linked to the domestic tax systems that provide public financing and management of effective medical service serving hundreds of millions of European workers.

In other words, the US, with its far more extreme concentration of wealth and social inequality, continues to have the greatest level of health care inequality among industrialized nations.

Europe is not without inequalities, monopolies and underfunded health programs but it delivers far better and more accessible care to its citizens than the private capitalist health system promoted in the US.

Historical Roots of the Superior European Health Care System

The power of monopoly capital is one of the key factors resulting in the deteriorating quality of health care for the US working population. Another factor is the lack of consistent working class struggle in the US compared to Europe. After the Second World War, there were huge waves of working class strikes across France, Italy and the UK. Various communist parties in continental Europe played a leading role within the trade unions demanding for publicly funded, national health care. In the UK, Socialists and the Labor Governments were pushed by their trade union members to craft a national health system to meet the needs of workers and their families. While Germany had a basic national health system dating from the time of Bismarck in the late 19th century, the socialist economy and public services developing in the German Democratic Republic (East Germany) after the Second World War provided an alternative for West German workers who then successfully pushed for the implementation of an advanced welfare state, including a socialized medical care system, within the thoroughly capitalist German Federation.

In the 1970’s Spain and Portugal shed their fascist past and post-war dictatorships. The militant trade unions and leftist parties ascended to power on promises to implement social-welfare programs, which, even with their economic limitations, included highly effective national health programs. Life expectancies rose dramatically.

The US has neither welfare nor national medical programs for its working population. Despite a brief interlude of American workers’ strikes shortly after WWII, leftist militants, communists and socialists were purged and corrupt business-linked trade union leaders took over. Rather than struggle for an effective national system of publicly funded medical care, the trade unions, linked to the Democratic Party, pushed their membership to struggle for ‘nickel and dime’ wage increases – accepting a system of the most expensive, and unaccountable private health care in the world.

The capitalist US has been the only country to deprive its working age citizens and their family members of an effective national health system. After over 60 years, the results are damning. Providing essential medical care for American workers, through the various forms of private, for-profit insurance schemes, has resulted in an uncontrolled health care cost inflation making manufacturing in the US far more expensive than its European, Japanese or Canadian competitors.

From 2001 up to 2018, under Presidents Bush, Obama and Trump, the US taxpayers have spent $5.6 trillion dollars on privately delivered, for-profit medical care with unimpressive results in terms of population health and life expectancy. On a per-capita basis, this is twice the amount spent on citizens of the EU who have consistently enjoyed rising life expectancy and improving health parameters. Despite this enormous investment of money in a chaotic, ineffective private system, the US Treasury has steadfastly maintained it could not finance a National Health Program for the population.

Present and Future Consequence of a Capitalist ‘Health System’

Today millions of US wage earners can expect to suffer shorter and less healthy lives than their counterparts in other industrialized countries in Europe and Japan. The opioid addiction epidemic among US workers, caused entirely by uncontrolled prescription of highly addictive narcotics by private practitioners and pushed by the profit-hungry US pharmaceutical industry, has led to over 600,000 deaths by overdose and millions of lives shortened by the brutal realities of addiction and degradation. This legally prescribed epidemic is unique to the United States where an estimated 15% of construction workers need treatment for addiction, millions have dropped out of the labor market due to addiction and the medical plans of numerous US building trade unions are facing bankruptcy because of the cost of addition-treatment for its members. The anti-addiction drug, Suboxone, is the most expensive and heavily prescribed medication for some union health plans. The reasons for this atrocity are clear: Injured American workers were being prescribed long courses of cheap, but highly addictive opioids to address their pain during cursory visits to ‘medical clinics’, rather than providing them with the more expensive but appropriate post-trauma care involving physical therapy and rest. The bosses and supervisors, who just wanted ‘warm bodies’ back on the job, were oblivious to the impending disaster.

Mega billion dollar private drug companies manufactured and promoted highly addictive prescription narcotics and paid ‘lobbyists’ to persuade US politicians and regulators to ‘look the other way’ as the addiction epidemic unfolded. Corporate hospitals and for-profit physicians, nurses, dentists and others participated in a historic catastrophe of medical irresponsibility that ended up addicting millions of American workers and their family members and killing hundreds of thousands. A huge proportion of prescription narcotic addicts are white workers in poorly protected manual jobs (construction, factories, farms, mines etc.). They lack access to effective, responsible medical care. In new millennium America, their jobs would not provide for ‘time off’ or physical therapy following injury and they unwittingly resorted to the ‘miracle’ of prescription opioids to get back to work. In many cases, their private medical insurance plans blatantly refused to pay for more expensive non-addictive alternatives and would insist the workers receive the cheap opioids instead. The rare worker, who demanded to take time off to seek effective medical and physical therapy for an injury, would be fired. US capitalists could easily ignore the growing shortage of healthy American construction and other workers by importing cheap, skilled labor from abroad and sanctimoniously blame American workers for their disabilities.

Conclusion

Workers in even the poorest European Union countries have greater access to better, more effective medical care then their US counterparts. They continue to enjoy rising life expectancies and longer lives without disability. Their injuries are treated appropriately with rest and physical therapy. Injured European or Japanese workers are never prescribed ridiculously long courses of highly addictive narcotics given to Americans. Certainly any increase in overdose deaths from prescribed opioids in the European Union or Japan would have generated rapid public health investigations and corrective action – a marked contrast to the two decades of callous indifference within the US medical community that bordered on Social Darwinism considering the working class identity of most victims. In Europe and Japan, long-term narcotic therapy is reserved for terminal cancer patients suffering from intractable pain. It would never have been offered to rural or working class teenagers for sports injuries – a common practice in the US!

The European public medical care systems are the product of class struggle and socially conscious mass movements and political parties that produced welfare states where improving population health was a central goal of its social compact. In contrast, the private-for-profit health system in the US is the shining example of the triumph of capitalism – the consolidation and further enrichment of capitalist control and the subordination of labor in each of its phase – from low to high tech business. In this ultimate triumph of capitalism, the old class struggle slogans were revised – becoming – Long live the bosses! Early death to the workers!

Private health care and the drive for higher profits provided enormous benefits for the pharmaceutical industry, making billionaires out of the owners and CEOs. This spawned the ‘ultra-philanthropic’ billionaire Sackler family whose Purdue Pharmaceuticals peddled the deadly Oxycontin to tens of millions of Americans. For profit-hospitals, private medical practices and rapacious insurance companies all reaped the bounty of mismanaging a bloated, unaccountable system that has provided the American worker with an early death by overdose or a shortened life of despair and disability.

Private capitalist employers and insurance companies continue to benefit from the epidemic of pre-mature deaths of their former employees: Pension costs and health care liabilities are slashed because of the decreasing life expectancy – Wall Street is jubilant. There will be fewer communities to educate and protect and this will lower taxes. Cheap imported replacement workers (educated or trained on their own societies’ dime) can conventiently be deported or replaced.

It is undeniable: increasing life expectancy and a decent life free of disability has disappeared for the American worker. With poor health and inadequate care, maternal and infant mortality are on the rise especially in rural and de-industrialized areas.

By every health and living standard indicator, the history of successful class struggle led to the implementation of effective national welfare and health programs. Their societies have reaped benefits for their citizens that were clearly superior to corrupt boss-worker class collaboration under private capitalism in the US.

Oct 052017
 

By James Petras, 99GetSmart

where-billionaires-come-from-cartoon

America has the greatest inequalities, highest mortality rate, most regressive taxes, and largest public subsidies for bankers and billionaires of any developed capitalist country.

In this essay we will discuss the socio-economic roots of inequalities and the relation between the concentration of wealth and the downward mobility of the working and salaried classes.

How the Billionaires become Billionaires

One of the most likely sources of billionaire wealth is through tax evasion in all of its guises and forms.

Contrary to the propaganda pushed by the business press, between 67% and 72% percent of corporations had zero tax liabilities after credits and exemptions … while their workers and employees paid between 25 – 30% in taxes. The rate for the minority of corporations, which paid any tax, was 14%.

According to the US Internal Revenue Service, billionaire tax evasion amounts to $458 billion dollars in lost public revenues every year – almost a trillion dollars every two years by this conservative estimate.

The largest US corporations sheltered over $2.5 trillion dollars in overseas tax havens where they paid no taxes or single digit tax rates.

Meanwhile US corporations in crisis received over $14.4 trillion dollars (Bloomberg claimed 12.8 trillion) in public bailout money, split between the US Treasury and the Federal Reserve, mostly from US tax payers, who are overwhelmingly workers, employees and pensioners.

The recipient bankers invested their interest-free or low interest US bailout funds and earned billions in profits, most resulting from mortgage foreclosures of working class households.

Through favorable legal rulings and illegal foreclosures, the bankers evicted 9.3 million families. Over 20 million individuals lost their properties, often due to illegal or fraudulent debts.

A small number of the financial swindlers, including executives from Wall Street’s leading banks (Goldman Sachs, J. P. Morgan etc), paid fines – but no one went to prison for the gargantuan fraud that drove millions of Americans into misery.

There are other swindler bankers, like the current Secretary of Treasury Steve Mnuchin, who enriched themselves by illegally foreclosing on thousands of homeowners in California. Some were tried; all were exonerated, thanks to the influence of Democratic political leaders during the Obama years.

Silicon Valley and its innovative billionaires have found novel way to avoid taxes using overseas tax havens and domestic tax write-offs. They increase their wealth and corporate profits by paying their local manual and service workers poverty level wages. Silicon Valley executives ‘earn’ a thousand times more than their production workers..

Class inequalities are further reinforced by ethnic divisions. White, Chinese and Indian multi-millionaires exploit Afro-American, Latin American, Vietnamese and Filipino workers.

Billionaires in the commercial conglomerates, like Walmart, exploit workers by paying poverty wages and providing few, if any, benefits. Walmart earns $16 billion dollar a year in profits by paying its workers between $10 and $13 an hour and relying on state and federal assistance to provide services to the families of its impoverished workers through Medicaid and food stamps. Amazon plutocrat Jeff Bezos exploits workers by paying $12.50 an hour while he has accumulated over $80 billion dollars in profits. UPS CEO David Albany takes $11 million a year by exploiting workers at $11 an hour. Federal Express CEO, Fred Smith gets $16 million and pays workers $11 an hour.

Inequality is not a result of ‘technology’ and ‘education’-  contemporary euphemisms for the ruling class cult of superiority – as liberals and conservative economists and journalists like to claim. Inequalities are a result of low wages, based on big profits, financial swindles, multi-trillion dollar public handouts and multi-billion-dollar tax evasion. The ruling class has mastered the ‘technology’ of exploiting the state, through its pillage of the treasury, and the working class. Capitalist exploitation of low paid production workers provides additional billions for the ‘philanthropic’ billionaire family foundations to polish their public image – using another tax avoidance gimmick – self-glorifying ‘donations’.

Workers pay disproportional taxes for education, health, social and public services and subsidies for billionaires.

Billionaires in the arms industry and security/mercenary conglomerates receive over $700 billion dollars from the federal budget, while over 100 million US workers lack adequate health care and their children are warehoused in deteriorating schools.

Workers and Bosses: Mortality Rates

Billionaires and multi-millionaires and their families enjoy longer and healthier lives than their workers. They have no need for health insurance policies or public hospitals. CEO’s live on average ten years longer than a worker and enjoy twenty years more of healthy and pain-free lives.

Private, exclusive clinics and top medical care include the most advanced treatment and safe and proven medication which allow billionaires and their family members to live longer and healthier lives. The quality of their medical care and the qualifications of their medical providers present a stark contrast to the health care apartheid that characterizes the rest of the United States.

Workers are treated and mistreated by the health system: They have inadequate and often incompetent medical treatment, cursory examinations by inexperienced medical assistants and end up victims of the widespread over-prescription of highly addictive narcotics and other medications. Over-prescription of narcotics by incompetent ‘providers’ has significantly contributed to the rise in premature deaths among workers, spiraling cases of opiate overdose, disability due to addiction and descent into poverty and homelessness. These irresponsible practices have made additional billions of dollars in profits for the insurance corporate elite, who can cut their pensions and health care liabilities as injured, disabled and addicted workers drop out of the system or die.

The shortened life expectancy for workers and their family members is celebrated on Wall Street and in the financial press. Over 560,000 workers were killed by opioids between 1999-2015 contributing to the decline in life expectancy for working age wage and salary earners and reduced pension liabilities for Wall Street and the Social Security Administration.

Inequalities are cumulative, inter-generational and multi-sectorial.

Billionaire families, their children and grandchildren, inherit and invest billions. They have privileged access to the most prestigious schools and medical facilities, and conveniently fall in love with equally privileged, well-connected mates to join their fortunes and form even greater financial empires. Their wealth buys favorable, even fawning, mass media coverage and the services of the most influential lawyers and accountants to cover their swindles and tax evasion.

Billionaires hire innovators and sweat shop MBA managers to devise more ways to slash wages, increase productivity and ensure that inequalities widen even further. Billionaires do not have to be the brightest or most innovative people: Such individuals can simply be bought or imported on the ‘free market’ and discarded at will.

Billionaires have bought out or formed joint ventures with each other, creating interlocking directorates. Banks, IT, factories, warehouses, food and appliance, pharmaceuticals and hospitals are linked directly to political elites who slither through doors of rotating appointments within the IMF, the World Bank, Treasury, Wall Street banks and prestigious law firms.

Consequences of Inequalities

First and foremost, billionaires and their political, legal and corporate associates dominate the political parties. They designate the leaders and key appointees, thus ensuring that budgets and policies will increase their profits, erode social benefits for the masses and weaken the political power of popular organizations.

Secondly, the burden of the economic crisis is shifted on to the workers who are fired and later re-hired as part-time, contingent labor. Public bailouts, provided by the taxpayer, are channeled to the billionaires under the doctrine that Wall Street banks are too big to fail and workers are too weak to defend their wages, jobs and living standards.

Billionaires buy political elites, who appoint the World Bank and IMF officials tasked with instituting policies to freeze or reduce wages, slash corporate and public health care obligations and increase profits by privatizing public enterprises and facilitating corporate relocation to low wage, low tax countries.

As a result, wage and salary workers are less organized and less influential; they work longer and for less pay, suffer greater workplace insecurity and injuries – physical and mental – fall into decline and disability, drop out of the system, die earlier and poorer, and, in the process, provide unimaginable profits for the billionaire class. Even their addiction and deaths provide opportunities for huge profit – as the Sackler Family, manufacturers of Oxycontin, can attest.

The billionaires and their political acolytes argue that deeper regressive taxation would increase investments and jobs. The data speaks otherwise. The bulk of repatriated profits are directed to buy back stock to increase dividends for investors; they are not invested in the productive economy. Lower taxes and greater profits for conglomerates means more buy-outs and greater outflows to low wage countries. In real terms taxes are already less than half the headline rate and are a major factor heightening the concentration of income and power – both cause and effect.

Corporate elites, the billionaires in the Silicon Valley-Wall Street global complex are relatively satisfied that their cherished inequalities are guaranteed and expanding under the Demo-Republican Presidents- as the ‘good times’ roll on.

Away from the ‘billionaire elite’, the ‘outsiders’ – domestic capitalists – clamor for greater public investment in infrastructure to expand the domestic economy, lower taxes to increase profits, and state subsidies to increase the training of the labor force while reducing funds for health care and public education. They are oblivious to the contradiction.

In other words, the capitalist class as a whole, globalist and domestic alike, pursues the same regressive policies, promoting inequalities while struggling over shares of the profits.

One hundred and fifty million wage and salaried taxpayers are excluded from the political and social decisions that directly affect their income, employment, rates of taxation, and political representation.

They understand, or at least experience, how the class system works. Most workers know about the injustice of the fake ‘free trade’ agreements and regressive tax regime, which weighs heavy on the majority of wage and salary earners.

However, worker hostility and despair is directed against ‘immigrants’ and against the ‘liberals’ who have backed the import of cheap skilled and semi-skilled labor under the guise of ‘freedom’. This ‘politically correct’ image of imported labor covers up a policy, which has served to lower wages, benefits and living standards for American workers, whether they are in technology, construction or production. Rich conservatives, on the other hand, oppose immigration under the guise of ‘law and order’ and to lower social expenditures – despite that fact that they all use imported nannies, tutors, nurses, doctors and gardeners to service their families. Their servants can always be deported when convenient.

The pro and anti-immigrant issue avoids the root cause for the economic exploitation and social degradation of the working class – the billionaire owners operating in alliance with the political elite.

In order to reverse the regressive tax practices and tax evasion, the low wage cycle and the spiraling death rates resulting from narcotics and other preventable causes, which profit insurance companies and pharmaceutical billionaires, class alliances need to be forged linking workers, consumers, pensioners, students, the disabled, the foreclosed homeowners, evicted tenants, debtors, the under-employed and immigrants as a unified political force.

Sooner said than done, but never tried!  Everything and everyone is at stake: life, health and happiness.