Ebola, Capitalism and the Idea of Society
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Sid Shniad
2014-10-21 21:14:42 UTC
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* CounterPunch October 17-19, 2014*

*The Plague of For-Profit Health Care*

*Ebola, Capitalism and the Idea of Society*
*by **Rob Urie*

Thomas Duncan didn’t have health insurance
when he entered Texas Health Presbyterian Hospital with Ebola. The hospital
claims that he was initially turned away because important information
about his condition didn’t find its way to the admitting physician. Without
specific knowledge that he had Ebola a temperature of 103C didn’t require
the hospital to admit him. With the two days it took the hospital to
confirm Ebola on his return visit, Mr. Duncan risked hospital bills in the
tens of thousands of dollars that he reportedly didn’t have. The hospital
‘risked’ providing expensive treatment to a man who likely couldn’t have
paid for it.

Missing from this ‘process’ that now finds Mr. Duncan dead, two nurses who
attended him with Ebola themselves, the American health care system
revealed as wholly unprepared to deal with what at present seems a
moderately communicable disease, is any notion of a public interest. This
can be seen internationally as well with the U.S. sending soldiers to West
Africa while Cuba has sent a large contingent of emergency health care
The difference is fundamental: Cuba sees both public purpose and moral
imperative to help those stricken with Ebola and the U.S. sees a threat to
profits at ‘home’ and a military exercise to ‘contain’ the spread of Ebola

[image: urieebola1]

*Chart (1) above: what could have and should have been a quickly contained
outbreak of Ebola through response by health care workers from rich
countries was instead militarized and ignored. From the CIA using fake
tuberculosis screening as a premise to gain intelligence to the history of
‘humanitarian’ interventions that slaughtered thousands to illicit
pharmaceutical testing and dumping by Western drug manufacturers the
nations of Africa have every reason to mistrust Western intentions there.
This written, the only response that the U.S. apparently could muster was
to send troops to ‘contain’ the crisis. Anyone with knowledge of Western
imperial history in Africa should cringe at what the word ‘contain’ might
be a euphemism for. Source: WHO*

At the more fundamental level the far ‘poorer’ Cuba sees health care and
education as human rights for its citizens and for those of other
countries. Despite claims of capitalist ‘efficiency,’ the U.S. has the
worst health care outcomes among ‘developed’ countries at a price of twice
or more per person. Illustrated in the Texas case is the radical
inefficiency of a health care system whose public purpose is subverted by
the profit motive. With a fever of 103C Mr. Duncan was turned away but
shitting and vomiting himself he was admitted. And lest this remain
unclear, it isn’t until a clear emergency can be claimed that hospitals in
the U.S. are mandated to provide treatment.

Even in capitalist economics the distinction was long ago made between
‘public’ goods that have social value, but that businesses are unwilling to
provide, and ‘private’ goods whose production is best left to capitalists.
This public / private frame had political leaders in the U.S. supporting
public health programs paid for by the federal government, publicly funded
schools and the building of the infrastructure that ultimately supported
the ‘private’ economy and private profits. Whereas many of the ‘contracts’
for public programs went to private contractors, their historic purpose was
public service and this was the measure of their success.

[image: urieebola2]

*Graph (2) above: in the U.S. ‘private’ railroads were built with land
grants (‘free’ land) from the federal government. Setting aside for the
moment the goal of genocide against the indigenous population that was part
of their motivation, by the end of the nineteenth century the accumulated
fortunes of the railroad ‘barons’ were put forward as the bounty produced
by capitalism. Today many of the drugs being sold by ‘private’ health care
companies were developed in government labs at public expense. And much of
the health care infrastructure being increasingly privatized was developed
either wholly or partially at public expense. Source:

Beginning in the 1970s under Democrat Jimmy Carter what had formerly been
considered quasi-public goods like transportation infrastructure was
privatized under the theory that the capitalist profit motive produced more
‘efficient’ outcomes. With airlines and railroads heavily unionized at the
time the major component of this ‘efficiency’ came through breaking
organized labor and driving wages down. However, even in capitalist
economics shifting wages to capitalists as profits is only ‘efficient’ if
the increase in profits is greater than the wages lost.

What was lost in this shift was the sense of a public interest. The idea
had always depended on dubious circumscription— class; race and imperial
interests had left most of the world and much of the U.S. on the outside.
What happened was that the private interest consumed the public interest.
The railroads had been built through federal land grants and airlines flew
mandatory routes to serve both public and private interests. By the 1970s
the private fortunes built on this ‘partnership’ decided they wanted it all
for themselves. That a Democrat President (Jimmy Carter) was behind the
shift to the private takeover of the public realm ties Mr. Carter to Bill
Clinton and Barack Obama as effective proponents of the neo-liberal program.

To tie this back to Cuba and the human rights view of health care and
education, there was and remains no capitalist class in Cuba to subvert the
public interest. The U.S. had public and private interests and the private
interest consumed the public interest. Public health care and educational
infrastructure were ‘public’ and served public purposes. Through
privatization this public purpose has been subverted. As with the railroads
and airlines, their public-private conception and the public-private
resources that built them were simply taken by capitalists through

The idea that the profit motive produces ‘efficient’ outcomes in the public
realm depends on redefining it. ‘Private’ drug companies didn’t develop an
Ebola vaccine because doing so wasn’t estimated to be profitable. What
state of the world must exist for such a vaccine to be profitable? An Ebola
pandemic would provide the needed ‘customers’ to make it profitable.
Stopping an epidemic and preventing it from becoming a pandemic is costly
for ‘private’ interests with few profit opportunities from the direct
‘customers.’ But as was understood and inconveniently forgotten decades
ago, what is ‘inefficient’ as capitalist enterprise is often astonishingly
efficient as public policy.

Ebola has the public imagination because it is deadly and a horrific way to
die. However, left out of press reports are the preventable and curable
medical conditions that poor people face every day that go untreated. And
what ‘Obamacare’ reinforced is the private takeover of the public interest
for private gain.

Obamacare proceeds from the premise that health care exists to serve
private interests by subsidizing ‘customers’ of private health care
providers. Persons with health insurance who contract a communicable
disease are forced into the ‘personal’ (‘private’) calculus of whether they
can afford the insurance co-pays and deductibles of getting health care.
And as ‘businesses’ health care providers calculate how to provide the most
profitable health care, not the best. With stopping the spread of
communicable diseases in the public interest, the profit ‘motive’ that in
theory supports capitalist efficiency is the antithesis of social
efficiency in the public realm.

The shift from public to private interests in the West isn’t an accident of
history. It comes through bi-partisan support for the crudely ideological
capitalism that re-emerged through the conflation of public and private
interests. And in fact, this conflation has it perfectly backwards— private
interests never served the public interest but private interests owe
everything to this public interest from land grants to government research
given / sold to ‘private’ corporations to bank bailouts. As Albert Camus
had it in his book ‘The Plague,’ perhaps a modern plague will be the road
back from the Western nation-states of the ‘self.’ But why should it come
to that?

The poor and beleaguered nation of Cuba has maintained the social and moral
bearing that places the public interest above private interests. Outside of
the implausibility of Western ‘profits’ capitalism is the antithesis of the
public interest and must be gotten rid of. Health care profiteers have
taken the public interest and put it into their own pockets. And for-profit
health care is a plague every day for the people who don’t get health care
because they can’t afford it.

*Rob Urie* *is an artist and political economist. His book Zen Economics is
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