James Petras: Socialism, Capitalism and Health Care


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

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

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.


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

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.