NPI's Cascadia Advocate

Offering commentary and analysis from Washington, Oregon, and Idaho, The Cascadia Advocate is the Northwest Progressive Institute's unconventional perspective on world, national, and local politics.

Sunday, October 17th, 2021

Book Review: Not-so-hidden racism and profit define the sickness of “American Healthcare”

The oth­er day Face­book remind­ed me that a lit­tle more than a year ago I wrote, “Why are we still hav­ing tele­vi­sion debates when the U.S. pres­i­dent won’t even agree to a peace­ful trans­fer of power?”

Thom Hart­mann, author of The Hid­den His­to­ry of Amer­i­can Health­care, was in a sim­i­lar mood when he wrote the pref­ace to his book, estab­lish­ing that his pub­lish­er had said no changes could be made to it after Novem­ber 3rd, 2020, despite being set to be released in Spring 2021.

“If Don­ald Trump was reelect­ed or some­how man­aged to remain pres­i­dent after Jan­u­ary 20, 2021, then we must take to the streets. This is most like­ly democ­ra­cy’s last stand,” Hart­mann wrote, trapped as he was behind the shroud of the past await­ing an election.

Any­way, we know what hap­pened instead. After four years of repeat­ed­ly sig­nal­ing that he would try to dis­re­gard the result of the pres­i­den­tial elec­tion if he lost, in the fall of 2020 Trump did exact­ly as he had said.

Now with the pow­ers of pres­i­dent, he pres­sured state offi­cials to get him the votes he need­ed to call him­self win­ner of the Elec­toral Col­lege, includ­ing chang­ing the totals, hav­ing Repub­li­can state leg­is­la­tors just dis­re­gard the pop­u­lar vote, and suing every­thing every­where to fundraise and sow distrust.

When all that failed to effect the out­come he want­ed, Trump called upon a pop­u­lar mob to come to the U.S. Capi­tol where he encour­aged them to lynch the vice pres­i­dent (then Mike Pence) and mem­bers of Con­gress that were in the process of affirm­ing Joe Biden’s pres­i­den­tial victory.

The flaws in asym­met­ric media polar­iza­tion have nev­er been stark­er than watch­ing how “the lib­er­al media” has failed to treat a vio­lent, attempt­ed coup with the same lev­el of inter­est it did a Demo­c­ra­t­ic pres­i­den­tial can­di­date’s pri­vate email serv­er or the fruits of a Russ­ian email hack of a nation­al polit­i­cal organization.

Now, that is a lot of intro­duc­tion for a book that is short­er than two hun­dred pages, and short­er even than that giv­en that it’s a 5“x7” paperback.

Hart­mann moves quick­ly. He spends the first sec­tion of the book describ­ing how bad the U.S. health­care sys­tem is, zero­ing in on the deci­sion by Joe Lieber­man to join with Sen­ate Repub­li­cans in killing the Patient Pro­tec­tion Act’s pub­lic option and what that result­ed in: a Rube Gold­berg machine that still kills and bank­rupts peo­ple so insur­ance com­pa­nies can make prof­its and pay­out bonuses.

The Hidden History of American Healthcare by Thom Hartmann

The Hid­den His­to­ry of Amer­i­can Health­care: Why Sick­ness Bank­rupts You and Makes Oth­ers Insane­ly Rich, by Thom Hart­mann (Paper­back, Berrett-Koehler Publishers)

After about forty pages, Hart­mann piv­ots to go back to the ori­gins of Amer­i­ca’s sick­ness-for-prof­it sys­tem, con­trast­ing the path of the Unit­ed States with that of Impe­r­i­al Germany.

And it’s here that the author’s warn­ing, giv­en the ben­e­fit of hind­sight, real­ly echoes loud­ly because Hart­mann describes the way Otto Von Bis­mar­ck, the “Iron Chan­cel­lor”, was the pri­ma­ry fig­ure in gov­ern­ment respon­si­ble for push­ing through Ger­many’s uni­ver­sal health­care sys­tem in the 1880s, along with work­ers com­pen­sa­tion and old-age pensions.

This became the mod­el for the rest of Europe and lat­er East Asian lib­er­al democ­ra­cies. But the rea­son Bis­mar­ck, arch-con­ser­v­a­tive Junker that he was, pushed such mea­sures was because the prag­ma­tist had no oth­er choice.

Bis­mar­ck “did­n’t devel­op the pro­gram out of some enlight­ened sense of human dig­ni­ty or work­ers’ rights,” Hart­mann writes.

“Work­ers in the streets pushed him to it.”

The Social Demo­c­ra­t­ic Par­ty of Ger­many was banned, but they, anar­chists, and oth­er social­ists were still active and so threat­en­ing in their appeal to the peo­ple of Ger­many that a Pruss­ian min­is­ter in an auto­crat­ic regime felt com­pelled to mol­li­fy them and pre­vent revolution.

Although their explic­it rea­son­ing is much dif­fer­ent (e.g. “real Amer­i­ca”), reac­tionar­ies in the U.S. seem to have rec­og­nized this same dynam­ic much more than U.S. lib­er­als and the left. Decades of orga­niz­ing, of week­ly polit­i­cal meet­ings (though they’d call it “church”), and yes, also gobs of mon­ey have led to a moment where all sorts of unpop­u­lar ideas are able to dom­i­nate fed­er­al pol­i­tics. That was true even before politi­cians and mobs start­ed col­lud­ing to take over capi­tols, and actu­al­ly this time I’m talk­ing about Ore­gon.

Because there is no “return to nor­mal” ever com­ing to us.

Of course, unlike Ger­many, the Unit­ed States had and has anti-Black­ness built in as a fun­da­men­tal struc­ture of soci­ety and government.

Hart­mann writes of how sci­en­tif­ic racists, and one in par­tic­u­lar — Fred­er­ick Hoff­man — jus­ti­fied the con­di­tions of depri­va­tion and mis­treat­ment of Black Amer­i­cans at the end of the 19th cen­tu­ry by say­ing that with­out the “pro­tec­tion” of slav­ery, Black Amer­i­cans would nat­u­ral­ly die out unless propped up by unnat­ur­al and ulti­mate­ly fruit­less health­care services.

When seg­re­ga­tion-in-the-law came to an end in the Unit­ed States in the 1960s and 1970s, pub­lic ser­vices like swim­ming pools were sim­ply shut down or pri­va­tized rather than inte­grate. This spite­ful, self-injur­ing hatred did and con­tin­ues to moti­vate many poor whites to work against their eco­nom­ic and bod­i­ly inter­ests. Because, to them, their “real inter­ests” are to main­tain their place in a racist hier­ar­chy and con­tin­ue receiv­ing the psy­cho­log­i­cal wages that pays out.

But for the rich, who are also dis­pro­por­tion­ate­ly white, there’s a lot of very real wages paid out to them, too. And stock options. And bonuses.

You can make a lot of mon­ey off of ser­vices peo­ple need to stay alive and keep their fam­i­ly alive, and you can use that mon­ey to “exer­cise your free speech rights” in influ­enc­ing politi­cians to think that the best thing for every­one is main­tain­ing a sys­tem where you keep mak­ing that mon­ey and they keep get­ting elect­ed. It is very hard to believe a sys­tem isn’t work­ing well when you see it work­ing well for you and those around you.

This is not an espe­cial­ly ambi­tious book, I don’t think. Its pur­pose seems to be that it can be read in a sin­gle com­fort­able sit­ting and be under­stood while pro­vid­ing you with min­i­mal scaf­fold­ing nec­es­sary to make sense of health­care as an indus­try in the U.S., what’s wrong with it, and how that could be fixed, as oth­er nations have fixed some basic prob­lems. Hart­mann makes a com­pelling case for one sim­ple but counter-intu­itive solu­tion to U.S. health­care prob­lems: just have the gov­ern­ment buy the insur­ance companies.

At around $1 tril­lion, it might sound prof­li­gate but is still just what the U.S. wastes in over­pay­ing for health­care every sin­gle year.

But this won’t come about by vot­ing, and it won’t come about by sign­ing peti­tions, or by per­mit­ted march­ing from here to there.

The days when those sig­ni­fied impres­sive orga­ni­za­tion­al acu­men, imply­ing the abil­i­ty to accom­plish oth­er things, has long since passed.

Instead, we’ll have to start treat­ing our lives and health as valu­able as they actu­al­ly are, and, for whites, start choos­ing that as a more impor­tant inter­est than racial sol­i­dar­i­ty that allows rel­a­tive priv­i­lege.

You want to believe we can man­age this after see­ing how dis­pos­ably our boss­es, land­lords, and gov­ern­ments have been will­ing to treat us and our health dur­ing COVID-19, but unfor­tu­nate­ly, reac­tionar­ies in the Unit­ed States seem to be the ones with all the urgency, and they’re cer­tain­ly under no mis­con­cep­tions that the tran­si­tions of pow­er in the future will be peaceful.

Like con­duct­ing a debate amid lin­ger­ing threats of polit­i­cal vio­lence or pub­lish­ing a book about health­care as you see signs of a coup hap­pen­ing out in the open, it’s dif­fi­cult to talk about uni­ver­sal health­care as you’re watch­ing a fas­cist move­ment gain steam and be treat­ed as unse­ri­ous­ly as if no one learned any lessons since 2015.

But if we aren’t orga­niz­ing and mobi­liz­ing with suf­fi­cient seri­ous­ness to counter a vio­lent white nation­al­ist move­ment intent on seiz­ing con­trol of gov­ern­ment by force, not only will we lose out on a chance to be bribed with uni­ver­sal health­care to mol­li­fy us, we’re like­ly to lose a lot of oth­er things, too.

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