Demonstrators carry a coffin over Brooklyn Bridge during a march against gun violence, 06.02.18, in NY. | Mary Altaffer – AP
Under U.S. capitalism, industrial production and consumerism expand. Greenhouse gases increase, the climate changes, and people die. U.S. imperialism leads to wars and potentially nuclear war.
U.S. life expectancy has fallen. According to government statistics released in December, 2022, life expectancy at birth (LEB) for 2021 was 76.4 years. LEB was 77.0 years in 2020 and 78.8 years in 2019. Public health officials claimed this “was the biggest two-year decline in life expectancy since 1921-1923.”
Mothers fare badly. In 2020,19.1 mothers in general and 55.3 Black mothers died per 100,000 live births. They died from illnesses related to childbearing, most of them preventable. In the Netherlands that year, the maternal mortality rate was 1.2 mothers per 100,000 live births. In 2018, 55 nations showed a rate more favorable than that of the United States.
Americans, mostly working-age adults, die from “diseases of despair” – substance abuse, accidental drug overdose, alcoholism, and suicide. They also died of Covid 19 infection, the U.S. rate of 332.81 Covid deaths per 100,000 population being the 16th highest in the world.
During most of the pandemic, Black people died at two or more times the rate of infected white people. Now the cumulative death rates of each group are similar, with 355 deaths of whites and 369 deaths of Blacks per 100,000 population. Cumulative Covid deaths for American indigenous peoples register at 478 deaths per 100,000 population. Vaccine skepticism may account for increased vulnerability of whites.
The pandemic aside, Blacks and American Indians live far shorter lives than white people do. As of October 2022, LEB for Hispanics was 77.7 years; white people, 76.6 years; Blacks, 70.8 years; and American Indians, 65.2 years. In 2020, 65 nations showed longer LEB than did the United States.
Healthcare failings may have contributed to the high U.S death rates. Proposals for reform, especially for universal healthcare, center on its financing. The United States is the top healthcare spender among all nations.
Paying $12,914 per capita for healthcare in 2021, the United States outspent second-place spender Germany whose outlay was $7383 per capita. Total spending on health that year amounted to $4.3 trillion –18.3% of the U.S. GDP. The United States accounted for 42% of healthcare spending in the world in 2018.
Healthcare in the United States is a profit center. The pricing of drugs, medical equipment, medical insurance, and services provided by hospitals and outpatient facilities in general is exorbitant. Executives of medical supply and pharmaceutical companies, specialty physicians, and administrators of hospitals and healthcare networks receive enormous salaries.
Profitmaking hospital chains, health insurance companies, and pharmaceutical companies generate enough revenue to allow for stock buybacks and dividend payments. Over nine recent years 14 pharmaceutical companies spent $747 billion on stock buybacks. Payments to private insurance companies and private hospital networks are large enough to cover astronomically high administrative costs and profit-taking.
Some healthcare and health-promotion activities produce no revenue, or very little. They tend to receive relatively little support and skimpy funding.
- The U.S. public health sector, charged with health education and illness prevention, is a low-priority item. Inadequate preparation and preventative measures largely accounted for the U.S. Covid-19 debacle.
- Insurance companies dedicate effort to denying coverage for particular diagnostic and therapeutic interventions.
- Multi-hospital, multi-service conglomerates are cutting back on health services in rural and economical depressed areas because of decreased “productivity.”
- Many hospitals have recently dropped children’s hospital services as being less remunerative than care for hospitalized adults.
- Small rural hospitals unable to pay bills have been closing down in droves throughout the nation, depriving area residents of care.
- Specialty practitioners and hospitals often prioritize expensive medical procedures and high-technology diagnostic modes over care centering on provider – patient interaction and communication.
- Many physicians during training opt for a specialty rather than a primary-care career, often because of income considerations. Primary care physicians now comprise only 20% of all U.S. physicians.
- Diminished emphasis on a “medical home,” that hallmark of primary care, opens the door to inefficient, low-quality care.
Other capitalist countries have achieved long life expectancies. The average life expectancy for 2021 in eight European countries plus Australia and Japan was 82.4 years. Their average per- capita health spending was $6,003. Japan spent $4,666 per capita on healthcare; LEB was 84.5 years.
Those countries protect healthcare as a public good, mainly because labor unions and social democratic or labor political parties apply pressure. Universal access to care is the norm.
Universal care in the United States is but a dream. U.S. unions are weak and there is no working people’s political party. Some 25 million working age adults had no health insurance in 2021; insurance for 23% of them was inadequate. Too many have no care or fragmented care.
Reform efforts will continue in the United States, propelled perhaps by worsening life expectancy. But healthcare has its limitations. Steven Woolf, retired director of Virginia Commonwealth University’s Center on Society and Health, told an interviewer recently that better healthcare is “only a partial answer” to extending life expectancy, accounting “for about 10 to 20 percent of health outcomes.”
He explained: “Our health is really shaped by our living conditions, jobs, the wages we earn, our wealth accumulation, the education that enables us to get those jobs … The country that we live in is the richest in the world, but we have the highest level of income inequality. So, much of the resources that we need for a healthy population are not available to most of the population.”
Woolf is saying, in effect, that people die early because of inequalities, oppression, and organized greed. The United States appears as different from other rich capitalist counties. Social guarantees are fragile. The wealthy have few restraints on satisfying their wants. A besieged working class lacks voice and agency.
The prospect that reforms, alone, will restore justice and decent lives for working people is nil. They confront a voracious, extreme kind of capitalism. Its rulers tolerate, promote, and seek out collaborators for actions and policies leading to die-offs. Think climate catastrophe, wars, and nuclear war.
In response to impending disaster, Americans desiring better and more secure lives for everyone would adjust their forward vision. Working for reforms, they would aim at something new, which is top-to-bottom social and political change. New motivation, determination and hope would be a shot in the arm.
Revolutionary change is a worldwide project, and not to be left to one people – except in special circumstances. One such was pre-1917 Czarist Russia and another would be that anomaly among capitalist nations which is the death-dealing U.S. nation.
W.T. Whitney Jr. is a political journalist whose focus is on Latin America, health care, and anti-racism. A Cuba solidarity activist, he formerly worked as a pediatrician, lives in rural Maine. W.T. Whitney Jr. es un periodista político cuyo enfoque está en América Latina, la atención médica y el antirracismo. Activista solidario con Cuba, anteriormente trabajó como pediatra, vive en la zona rural de Maine.