Views & Reviews

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: 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.

David A Johnson

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