Health Care Under Capitalism, Health Care Under Socialism

In the following excerpt from Raymond Lotta’s September 29, 2009 webcast talk (“Behind the World Economic Crisis: System Failure and the Need for Revolution”) he discusses what is behind the system’s failure to provide people with health care and how socialism will be able to address this important question in the context of building a truly emancipatory society. This has been slightly edited for publication.

I want to [talk about] a major public event right now which is the health care debate in the United States. I want to say something about this, because it too concentrates so much of the essence of this system. Here you have a situation, and think about it, where you have to be working (and close to 10 percent of the work force is unemployed), where you have to be working or you have to have a health insurance policy to get health care. This is antediluvian, this is like the age of dinosaurs. Think about that. Health care should be a basic responsibility of society. There are these qualifications, these strictures, and all of them are bound up with private ownership, control over the means of production, the organization of this economy. And what calls the shots? Profit.

You have a situation right now where according to one Harvard medical study, this was in the New York Times, there are some 45,000 needless deaths each year in the U.S. because people do not have health insurance. And there are now some 45 million people without health insurance. And under the most likely of outcomes of this health care debate, of this Obama health plan, these people will likely be herded into pools of profitable private insurance investors.

You have this absurd and obscene spectacle of a so-called debate around health care pivoting in part around whether undocumented workers will get health care. Again, the expendability of a section of humanity. Where whether abortions required by women will be financed—when any sense of care and compassion and justice would dictate that these things would be guaranteed, in any rational, sane society. But they are not, in a society shot through with male supremacy and great nation chauvinism and run according to that profit-rules-all logic.

And listen to this, in terms of the wonderful democratic political structures of this society. There are now—a record has been set—for every member of Congress there are now eight professional lobbyists from the pharmaceutical and “health care industries.” Aha, health care industries, that’s the nomenclature, it’s a sector for investment. It’s not health care, it’s not social need. It’s not social responsibility. It’s a business. It’s the health care industry. Well, there are now eight professional lobbyists from the health care industry per every single legislator in Congress. This is a new record. And then you have this right-wing madness [sarcastically]: “Oh, I’m just fine. I’m feeling very healthy. I don’t give a shit about anyone else, and anyway, they’re just a bunch of freeloaders.” That is an important voice in the town hall meetings in this democracy of ours.

You know, there was something very revealing that I heard on a special CNN forum about health care. I was listening to this guy Sanjay Gupta, some of you may know of him. He’s the CNN health expert. And he was asked at one point, “Wouldn’t it make sense to focus on preventive care, on the actual health of people as the first priority?” This was a question that was put before those who were sitting on this roundtable discussion. You know, they had all their talking heads. Someone raised that. And his answer was, and I had to get my notebook out and take this down; he said, “From a medical and ethical standpoint, yes it would make sense to put more emphasis on preventive health care. But from the bottom line, it doesn’t.” And then later someone raised that it seems as if we should be training more primary care doctors, and Gupta gave the same response: “Well, medically and ethically, it makes sense, but not on the bottom line.”

And you know, Gupta is on to something. He’s not to my knowledge a Marxist. [speaking in an ironic tone:] At least I haven’t found his writings on any of the Marxist websites I go to. But there is in fact a fundamental clash between social need and social health and the imperatives of profit. And this, I think, really concentrates so much of what is before us, this clash between basic needs and the bottom line. The bottom line.

And this is what socialism changes. Profit is no longer in command. There is no such bottom line. Under socialism you will have an economy that is geared to serving the people and that channels resources and expertise to where they are needed. And serving the people and serving the needs of world humanity. This will, going back to Sanjay Gupta, this will be the ethics of socialist society.

Now I want to talk a little more about how we would organize health care under socialist society. I really encourage people to listen to the DVD by Bob Avakian where he talks about this in a section titled, “Imagine.” Imagine how we can do things differently in a society based on the principles that I’ve been talking about. This DVD is now available online—Revolution: Why It’s Necessary, Why It’s Possible, What It’s All About. Under socialism, how it is possible.

Under socialism, you have a new political system that empowers people to solve problems in multi-dimensional ways, drawing on and mobilizing the skills and knowledge and determination of all to remake society. You will have a society which is consciously seeking to break down the divisions between experts and non-experts, in which doctors will be learning from, and actually listening to, patients. You will have medical training that puts doctors in touch with the great needs of society and the world. You will be spreading medical knowledge among basic people and creating new combinations of the highly trained and the less trained.

You will be treating health issues in an integrated way: in relation to how and where people work and where they live; you’d be dealing with health issues of the environment and carrying on appropriate social investigation; you’d be paying attention to the special needs of women and minority nationalities. You will combine advanced research with basic ground-level research that directly draws people into these processes of discovery and experiment.

And the management and decision-making within medical institutions—whether hospitals and clinics or medical schools—will no longer be the province of a privileged and controlling few. It will involve combinations of administrators, doctors and nurses and other medical personnel and medical students, and representatives of the masses. At all levels of society, the basic people will be participating and taking responsibility.

And one thing that socialist society will ban forever is the criminal bottom line of patents and property rights over medications and treatments, like AIDS vaccines or new ways of treating malaria. This knowledge, these breakthroughs, these medications will be made available to the people of the world. Or to put it differently: there will be no such thing as Big Pharma, of pharmaceutical companies profiting off disease and treatment under socialism.

Now, again, this is not some utopia. It’s quite viable. But it can only happen when you have a different kind of economy and a different state power. And it has happened—in Maoist China, especially during the Cultural Revolution.

Now, Maoist China was not a rich country. But it was able to create what the U.S. hasn’t come close to having: a universal health care system. Health services were provided free or at low cost, and the health care system was guided by principles of cooperation and egalitarianism

The emphasis in China when it was genuinely socialist was on prevention, hygiene, and other mass, public measures. China was able in 15 years to overcome epidemic diseases like smallpox and cholera. Mass campaigns were launched to tackle the problem of opium addiction. One of the important and defining features of health care in socialist China was to maximize community participation and people taking responsibility at the grass roots over health concerns and issues. There was both centralized allocation of resources and a tremendous amount of decentralization and reliance on people in neighborhoods and communities. And along with mass mobilization, there was mass education.

The Chinese health system also combined modern with traditional and indigenous treatments, like acupuncture and herbs. The slogan popularized in revolutionary China was “serve the people” as opposed to maximizing self-interest and personal gain. This was the spirit in which doctors were trained. The success of this system was not measured by profits or cost-containment—but by social health and social well-being as a means of building a new and liberating society. And social well-being—people’s health and the overall quality of life—as an important goal of that society.

During the Cultural Revolution, the focus of health care expenditure and allocation of resources shifted to the countryside, even as overall health improved in the cities. At any given time, some one-third of urban medical personnel were on the move, going into the rural and remote areas where they were needed. And one of the most exciting developments of the Cultural Revolution was what was called the “barefoot doctor” movement. These were young peasants and urban youth sent to the countryside who were quickly trained in basic health care and medicine geared to meet local needs and who were capable of treating the most common illnesses.

The results were astounding. You hear these ridiculous and unsubstantiated charges about how many deaths Mao caused. But life expectancy under Mao doubled from 32 years in 1949 to 65 years in 1976. And in the early 1970s, Shanghai had a lower infant mortality rate than did New York City at the time.

This is part of the legacy of the first wave of socialist revolution that we can learn from and build on, and as I said, in the next wave, we can go further and do better.

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