[Marxism] The-Opportunity-Costs-of-Socialism.pdf [not sent]

Ralph Johansen mdriscollrj at charter.net
Wed Oct 24 20:23:50 MDT 2018

MM wrote

"“The Trump chart doesn’t say what the White House seems to think 
it says,” Kliff concludes. “It isn’t telling us that 
single-payer healthcare has long wait times. If anything, it says that 
it is possible to build a single-payer system with short wait times—and 
our Medicare program has already done it.””


Thoughts on single payer which, no less than Medicare, is at best a way 
station to what everyone deserves as birthright: adequate preventive and 
curative health assistance, at commensurate costs which do not obscenely 
enrich a few. In other words, it's an arrangement which if implemented 
still masks serious shortcomings. Present single payer schemes from what 
I see would not at all disturb the over all regime of the 
pharmaceutical/medical complex in this country. We might come to the 
point where we are universally protecting each others' health, as best 
we think we can, through an insurance scheme into which everyone pays 
who is able, similar to any practical solution to a common problem like 
auto and accident or unemployment insurance. But at what hidden taxed 
costs, increased social rot and ill-health, profit-taking and related 
gross inefficiencies?

What do about systematic inflated charges, over billing, the many 
overpaid (possibly many overburdened) doctors in a system of guild 
restrictions on entry (now mitigated to the limited extent that 
substantial returns on investment allow by a less-trained phalanx of 
physicians' assistants and nurse practitioners)?

What about over-reliance on allopathic, chemical-based medicine to the 
virtual exclusion of serious peer-reviewed research on and evaluation of 
naturopathic, herb-based and other possibly more effective types of 
medicine, and the need for much greater emphasis on nutrition, 
preventive care, and on the ways in which the toxics in our food and 
environment combine to undermine health - - not to mention the 
undermining effects of social inequality?

What do about the bloated and rapidly increasing profits of clinics, 
hospitals, pharmaceutical companies, government-funded or subsidized 
institutional and university research labs, all the others who benefit 
from the profit-making subsidized, proprietary and other rights built 
into medical, biological, and other health-related research and 
marketing? All of which are hidden beneath any current health scheme. 
This may be one reason that the medical-industrial complex might 
ultimately accede inasmuch as profit-taking will still be there, on 
stilts, protected with all necessary caution in back-filling increments 
which protect their flanks, as they have to an extent elsewhere. How has 
that worked for the Scandinavian countries, or UK, France, Canada?

Another factor that is important where I live: care supply. What of the 
fact that, in small rural communities such as mine, hundreds and 
thousands of people cannot find a doctor to care for them? Doctors 
typically seek out remunerative regions in which to plant their 
practice, those large urban complexes with attractive returns on their 
investment in education, more comfortable amenities and better prospects 
for their children. Among patchwork remedies might be that medical 
schools require as a condition of scholarships or lightening the debt 
load for an education in medicine, or the federal government requires as 
a condition of license to practice, that on some equitable basis doctors 
do a far more extended period of service than mandated so far, or 
mandate total career commitment, to under-served communities. That 
includes most especially under-served, more populous communities in 
urban areas. Without some better equalizing arrangement we in poorer, 
less well-educated, isolated communities have neither the local means 
nor infrastructure to bring in competent medical staff and facilities in 
sufficient quantity and quality to maintain our health. (And by the way, 
is it possible that any adequate solution to our social and polluting 
environmental problems will mean extensive dispersal to underpopulated 
areas, exacerbating this problem as well?) The result of course is that 
rural health and that of poor urban regions lags far behind.

Looking for solutions brings up Cuba. Although I have little information 
from what I see they are gradually being forced into the capitalist, 
profit-oriented medical system, particularly as it applies to r&d and 
pharma trade and and resource access, vulnerability to profit-seeking 
capital entering to drive down costs and capture market, participation 
on competitive terms in the global, dog-eat-dog, cost-cutting 
pharmaceutical industry. Doesn't the same apply to any national plan, 
short of universal socialism, to redistribute health care costs, 
including single payer and attrition in other countries' health systems? 
Other nostalgia: remember the barefoot doctors of Maoist China?

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