I. Opiate of the Masses "So, wherever the doctrine of predestination was held, the question could not be suppressed whether there were any infallible criteria by which membership in the electi could be known.”
Max Weber The Protestant Ethic and the Spirit of Capitalism
Our Puritan ancestors believed that wealth and good health are the signs of God’s blessing. Society is not to blame for the sick and poor. The sick and poor are to blame for their own misfortune. Some essential defect in their character keeps them from God’s grace, and so their life on earth is a misery and their life in Hell will be much the same. When illness and poverty are treated as divine justice, little effort is made to correct these problems, since who wants to go against the will of the Almighty? Instead, the sick and poor are held up as a lesson---work hard or you will end up in the garbage heap with these folks.
Our ancestor were not 100% Calvinist Protestants. Plenty of Catholics came to this shore, too. However, the Catholic notion that God creates the poor so that the rest of us can show off our virtue by taking care of them is not much of an improvement. While lepers may be told “God loves you!”, that provides little solace for the day to day misery they suffer here on earth.
Spiritual opium can not take the place of the real thing----opiate pain relievers---when you are in pain.
II. Science is Money Poverty and illness go hand in hand. All the studies prove that. In industrialized nations, in developing countries, in the most poverty stricken areas of the Third World, you are more likely to be healthy if you are also wealthy.
Since association is not causality, we can not say “Poverty leads to illness” or “Illness leads to poverty.” However, if you read through the literature of poverty and health, you will find an emphasis on the detrimental effects of poverty on the health. Researchers keep trying to prove that if you are poor, your health will suffer. This makes a certain amount of sense. Poor folks live in homes near refineries and other polluting industry, which increase the risk of asthma, heart disease and certain cancers. They lack access to basic preventive health care. If they are lucky enough to get health insurance, it is often the type that they can not afford to use---high deductible and co-payments and many necessary treatments excluded. They lack internet access, which would allow them to learn about disease treatment and prevention. And certain types of disorders----psychiatric, substance abuse, family violence---have been clearly linked to income inequality if not to absolute poverty. Being poor and shit upon in a wealthy society causes low self esteem and hopelessness, which leads to more stress which leads to depression and alcohol abuse in a never ending cycle of despair.
What about the reverse scenerio? Disease as a cause of poverty? Scientific researchers are supposed to be unbiased. They are judged on how objective their studies are. Science is held up as the great leveler, which sweeps aside prejudice and looks for the facts---just the facts---even if they run counter to common notions.
In fact, science is just another commodity under capitalism. It is used to increase profits and cut the bottom line. If factory owners need to keep an underpaid work force----like Blacks---uneducated and disenfranchised so that their businesses will prosper, scientists will come up with theories to explain why African-Americans are
genetically inferior. If Monsanto wants to keep farmers from harvesting seeds for their next crop, they will find a scientist somewhere who is willing to design terminator seed. And every year, thousands of new engineering graduates go to work for the War Industry (aka Defense), designing weapons that will be used to kill civilians. The atomic bombs that leveled Hiroshima and Nagasaki were designed by scientists. So were DIME bombs.
In order to fund a research study, you have to appeal to someone with money. And money likes money. So, if you want to show that Plavix is better than aspirin at preventing heart attack and stroke, you will find donors lining up at your door. Good luck getting funding for a study that shows that red yeast extract is as good as patented Lipitor. If you want to study the health effects of the pollution spewing from the local big employer’s smoke stacks, you might as well give up.
Back to poverty and illness. What difference does it make which comes first? Consider public policy. If your dogma is “poverty breeds ill health”, what does that mean? Since the United States is still a puritan nation, you will find few people in favor of handing out money to the poor. They will tell you that “you can not solve the problem by throwing money at it.” They will insist that poverty is a lifestyle choice. Poor people do not take care of themselves, because they are lazy, self indulgent. If they would just get off their butts and exercise and diet, they would be perfectly healthy. This last is especially popular among health care providers.
On the other hand, if you point to illness as a cause of poverty, folks feel uncomfortable with the status quo. Disease---especially inherited disease like diabetes, heart disease, asthma, arthritis--- is not a lifestyle choice. It is bad luck. Our notions of fairness require that we do something to help a neighbor who is suffering a misfortune beyond his control. We start talking about universal access to health care and improving air and water quality----
And then we run up against a great big brick wall. For capitalism demands a permanent poor, undereducated work force in order to keep costs down. And so, rich folks, like the ones at Koch industries
http://journals.democraticunderground.com/McCamy%20Taylor/421Will spend a lot of money to persuade us that we do not really want good health---for our neighbors. And the divided and conquered work force, which has been convinced that the economic suffering of other working class groups is
good for their own group, will nod like a bunch of bobble heads and repeat "We do not want good health---for our (insert racial or ethnic slur of your choice) neighbors." Because they do not understand that when wages are suppressed for Blacks, for women, for immigrants,
everyone's wages are lower.
Yes, I know that this is Marxist talk, of a kind that is not considered politically correct in our new, improved, corporate friendly Democratic Party. To anyone who is offended---too bad. The working class in this country is under attack. Education leads to better salaries---and so our system of public education is being dismantled. Middle class wealth and financial security is in the family home----and therefore, our homes are being taken from us. Public coffers could be used for social programs---and so, all our money has been given to the War Industry and to Banksters. The recession was engineered so that Morgan-Chase and Exxon could prosper.
The attack on the public health is more of the same. Because the corporate CEOs know (though they will not admit) that illness leads to poverty. And poverty is good for business.
III. I am Sick and Therefore I am Poor Rep. Jim Moran wrote about the economic effects of chronic illness last year. Rheumatoid arthritis is a devastating disease which causes crippling and death if not treated. Even with health insurance, the costs of treatment can be high.
But keeping Elizabeth insured has also come at a price. Her family pays $2,000 a month for just one of her medications; add to that the high deductibles and co-pays for blood tests and procedures, and the price tag is overwhelming. Elizabeth’s illness is threatening to drive her parents into bankruptcy.
http://thehill.com/special-reports/healthcare-october-2009/61935-the-price-of-chronic-diseaseHow many of you have $2000 dollars lying around each month in case one of your kids develops RA? What would happen to your family budget?
Now, consider the fact that autoimmune diseases, like RA, run in families. If you have a relative with RA, you are also likely to have relatives with Lupus or Grave’s Disease or other potentially crippling, fatal conditions. If one of your parents suffers from one of these disorders, you probably grew up in poverty. Since marriages can flounder when one partner is sick, you may have grown up in a single parent household, in which case you were
really poor. You probably missed school as you tried to take care of siblings at home. Even if you get to college and find a good job, there is a high likelihood that you or one of your children will develop a severe, expensive illness, too, which will plunge you back into poverty----
Medical debt, hospital bills and other unaffordable healthcare costs contributed to 62.1% of personal bankruptcy filings in 2007, according to a study published in The American Journal of Medicine in 2009.
Most people believe that poor, uneducated and uninsured or under-insured people file medical bankruptcy. They assume that having health insurance coverage can protect them from financial ruin if they end up having a chronic or catastrophic illness. The shocking truth is that they're absolutely wrong!
The surprising finding from the study showed that most Americans who filed for personal bankruptcy due to medical debt and other health care costs were middle-class, homeowners who had gone to college -- 75% reported having health insurance.
http://hubpages.com/hub/unpaid-medical-debt-leads-to-most-personal-bankruptcy-filingsOver half the people who go bankrupt do so because a family member got sick. And almost three quarters of them had health insurance. Disease can plunge a “hard working American” family into poverty. A breadwinner may have to quit work to care for the invalid. High co-payments and deductibles may eat up the family savings. Economic hardship can strain the family, leading to divorce, violence, depression which affect the other children.
I found lots of studies about the way that poor people get sick. Many of them had conflicting results. Depression seems to be the only illness definitely associated with being poor. Here are a few studies about the way that sick people become poor.
In 2003, lost productivity due to chronic disease cost the country over a trillion dollars.
http://www.chronicdiseaseimpact.com/A whole lot of people have to be out of work in order to account for a trillion dollars in productivity. In the U.S.
Nearly 48 million Americans have a disability, an increase of three million from 1999, and arthritis tops the list of most common causes of disability, according to an article published today in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR).
Snip
The disability caused by arthritis often robs people of the ability to live independently. People with arthritis commonly report needing help getting around inside their home, getting out of bed or a chair, bathing, dressing, eating and other important activities of daily living.
http://www.disabled-world.com/disability/disability-numbers.phpWith that much disability, working may be out of the question.
A study done in Europe showed that chronic illness was associated with unemployment. Keep in mind that the people in this study probably had access to health care.
Among employed workers 18% reported a poor health, whereas this proportion was 37% in retirees, 39% in unemployed persons, and 35% in homemakers. A perceived poor health was strongly associated with non-participating in labor force in most European countries. A lower education, being single, physical inactivity and a high body mass index were associated with withdrawal from the labor force. Long-term illnesses such as depression, stroke, diabetes, chronic lung disease, and musculoskeletal disease were significantly more common among those persons not having paid employment.
http://www.springerlink.com/content/d11721m01641p42u/In the U.S., lack of universal health care complicates the picture. This study commissioned by the Robert Woods Johnson foundation found that many uninsured Americans with chronic illness do not have a source of income.
http://www.urban.org/publications/411161.htmlEven if you qualify for Social Security disability---a process that can take years and require the assistance of an attorney---your problems are not over. Having Medicare helps. You are now in a situation closer to that of disabled folks in Europe, since you can see a doctor. However, your medications will probably not be covered. And, in order to qualify for Medicare, you must be unable to work---in other words, you must become poor and be willing to live in poverty. Social Security payments are likely to be a small fraction of what you made when you were working, so there will be a lot of things that you have to forgo----like recommended foods to control your condition, exercise since you probably live in a heavily polluted crime infested area where rents are dirt cheap, and, of course, the medication which your doctor swears will help you feel better if only you could afford it.
Going from employed to unemployed can be a tremendous psychological burden. People start to feel worthless, hopeless. They have nothing to do but think about their pain and misery. Since they know that any improvement in their medical condition may result in loss of their Medicare benefits, they develop a fear of getting better.
IV. Walk a Mile in My Orthopedic Shoes Meet Jim. He is a 50 something year old social studies teacher. His school increased class sizes so that they could lay off teachers. Right now, with all the standardized testing, public schools are only hiring science, math and reading teachers. Since he has diabetes, heart disease and high blood pressure and since he is only ten years away from retirement, no one wants to hire him for a new career—the kind of job that provides health insurance benefits. If he gets a minimum wage service sector job, he will not have health insurance, and therefore he will likely die before reaching the age of 65. He is not sick enough (yet) to qualify for Social Security, but just give him time. In a few more years, he will have a massive heart attack and develop congestive heart failure. Or, uncontrolled sugars will put him into renal failure---dialysis is one of the quick ways of getting your Social Security.
Meet Charlene. Her mother had lupus. The family scraped by on SSI. Charlene was the oldest, so she missed a lot of school taking care of her mother and siblings. Not that she missed much at school. Being poor, her family lived in a school district plagued by overcrowding. Charlene was passed through even though she could not read. She holds down two jobs, neither or which has health care benefits. She will never get promoted at either job, since her reading skills are poor. When her daughter, Tanya begins to develop stiff, swollen joints, she thinks about her mother. Eventually, she scrapes together the money to take her child to a doctor, who diagnoses her with Juvenile Rheumatoid Arthritis. The condition can be treated, but right now, Charlene makes too much to qualify for SCHIP. So, she quits one of her jobs. Now, Tanya can get her medication. But the family often goes to bed hungry at night.
Meet Juan. He was his family’s breadwinner, making good money in a construction job, until a drunk driver forced him off the road and damaged his spine. The driver was uninsured, so he will not be getting a fat settlement check. Instead, he will lose his job, his house. His kids will quit school and go to work to help pay the bills. His wife would look for work, but then who would look after Juan and take him to all his medical appointments? Juan qualifies for Medicare, but when his wife starts having diabetes symptoms from all the starchy, cheap food the family has to eat, there is no place for her to turn.
Patty has sleep apnea (though she does not know it). She overslept one time too many, and she was fired for cause. Therefore, she will not get unemployment. The public clinic where she now goes for health care can not afford sleep apnea testing or treatment, though they have her on round the clock narcotics for her (sleep disorder induced) fibromyaligia. Since there is no public bus system in her town, she is still driving a beat up old Honda. One day, she will fall asleep behind the wheel and die in a car crash, leaving her two teenaged kids orphaned. They will be passed from foster home to foster home, a practice which severely limits kids’ ability to get an education. This means their future financial prospects are not good. At least one of those two kids will also develop a sleep disorder. And so it goes.
V. “To each according to his needs” The solution to our country’s problems seems clear enough. The motto “to each according to his needs” (Karl Marx) needs to be applied to healthcare. High deductibles and other out of pocket expenses may be necessary to keep healthy people from overusing their medical benefits for frivolous reasons----say cosmetic treatments---but they have no place in the care of people with severe chronic medical problems. The sicker you are, the less you should have to pay out of pocket for your care.
Everyone should have access to health care, but those most in need should have improved access. If your city does not want to pay for a bus system, then it should provide transportation to and from doctors’ offices. Social Security payments should reflect the increased needs of people with certain types of diseases. If you have to stay home to take care of an ailing family member, you need more than just the job security of the Family Medical Leave Act. You need a guaranteed income of your own.
Folks with chronic diseases who rely upon Medicare for their treatment should not be forced into the poverty of unemployment in order to qualify for their insurance. What kind of choice is death from disease versus death from starvation?
Children of people suffering from chronic disease require special education services. They need scholarships and affirmative action the same way that members of certain minority groups do. Families need to be provided with internet access and computers. Healthy food and exercise facilities are also a must. Our public schools have cut out PE and increased their offering of sugary, fat foods. While we are at it, can we just plain ban cigarettes? And offer birth control where it is needed---in our schools.
None of this will break the budget. If more people with chronic disease can work, there will be more tax revenue. If fewer people get sick, because of public health disease promotion, then our (staggering) national health care costs will drop, the way that they have dropped in most of western Europe.
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