LOOKING THE GIFT HORSE IN THE MOUTH: WHY PROPOSED HEALTH CARE REFORMS ARE NO ANSWER TO THE HEALTH CARE CRISIS
It is no secret that one of the cornerstones of Bill Clinton's election campaign was his promised reform of the health care system. Leaving aside the fact that his work on the reform is well behind the unrealistic schedule he promised, the fact is that many people view these reforms as a positive step that will be of greater benefit to society. Yet, if the reform is carried out, people will immediately realise that the new system is little better than the old. Yes, the fact that many Americans who need health care cannot afford to see a doctor is disturbing, but what is even more disturbing is how patients are treated at public clinics and through low-cost care providers, and how the medical industry, in general operates.
Anybody reading this article who has had a chance to be around a low-cost medical center run by an insurer (or HMO - health maintenance organization) or a city hospital, particularly in a depressed urban area has probably seen how bad the so-called health "care" system can be like. Similarly, many who have lived in a country with mass public health care can tell you that you are often better off paying to go to see a private doctor, or not bothering to go to the doctor at all. I myself, family and friends have seen enough of the system to know that even if it were free, we wouldn't want it.
I grew up in one of those zip codes in New York which automatically qualify you for a Mayor's Scholarship. A block away from my home was the borough's general hospital, and behind that another hospital, famous for it drug rehab center. My mom, a city worker (of the Akaky Akakievich sort) had us insured with Health Insurance Plan (HIP) and if we had to see a doctor, we went off to the Jamaica HIP Center. Although we had this center to go to, we rarely went, for various reasons. The first reason obviously was that a trip to the doctor took up the whole day or evening. I remember that if you went to see the doctor, you often had to wait 3, 4, or 5 hours and then you were afforded the most minimal of care. It was routine that they would skip the checkups (to this day I have never had a complete physical) ask you a few questions, if necessary look in your throat and check your blood pressure, and prescribe a drug or sign your form as quickly as possible. Misdiagnoses were common and I remember our spice rack being overrun by at least 12 different types of pills that my mother was prescribed for her high blood pressure. (What she really needed was to eat more fresh foods, quit smoking, exercise and, most importantly, she needed to quit her job. But, she was tied to the mortgage and worked until she died young of a heart attack on the job.) The medical center was always the last place anybody wanted to go, especially if they were ill, so we went mostly to fulfill the needs of the school system to know that we were healthy. Then we'd wait for 5 or six hours with all the other families trying to get their kids papers signed, and when we saw the doctor she would ask how we felt, check our weight and height, maybe our blood pressure, declare us healthy and send us on our way. If we were sick, it was always more convenient to go to the drug store than to wait at the doctor. It was this disgust and distrust of the doctors that kept me, my family and friends away from them more than anything. The fact that we could consult them for free was practically worthless to us because their care was worthless; it was rare that their help was useful to us, and with all the medications they prescribed, we knew that it was actually often harmful. On Friday nights the women of the neighbourhood would come over the house, and there you could here what people thought of doctors: my new medicine gives my headaches, I'm retaining water, I stopped taking my medicine and I feel much better, etc.etc.. So unlike today, when I simply cannot afford any medical care, I didn't go to the doctor even then, under the insurance plan, and even came down with pneumonia because I didn't treat myself. Dad probably hasn't seen a doctor voluntarily for forty years; last time he saw one was when he came home after being hit by a car and the next day couldn't move. Broken ribs; x-rays showed his lungs are black. A lot of people say I should make my dad go to the doctor, cause he's old and dying and that he's being stupid not to go. But after hearing stories such as I've heard about the doctors at the center, and after having very bad experiences with them myself, including misdiagnoses that recommended this or that surgery, I have no faith that doctors will help him. Yes, there may be some medicines or medical procedures that help people, or there may be better doctors than others, but the fact that someone went through medical school does not guarantee that he or she is willing or able to help you, particularly when they are working under the conditions that the clinics often force them to work under.
I've had some pretty scary experiences in my life, but without a doubt the most traumatic I've had to face was my stay in a New York City hospital some years ago. I was riding my bike home one day when I got hit by a truck in front of the hospital. An ambulance driver saw the accident and I was taken to the hospital. I was taken into the emergency room where I waited for 7 hours with my leg shattered before I could see a doctor, gets x-rays taken etc.. Not that my injuries were any greater than those of the screaming people around me with gunshot wounds, broken bones, respiratory and heart problems, etc.. But it is easily to understand why 30% or more of the emergency cases taken to that hospital don't make it out alive. Of course none of us had to wait for so many hours to see the doctor; in that time I could have been taken to another hospital where such waits don't exist, but of course once you answer the first question, "What kind of insurance do you have" the wrong way, that's it.
After I saw the doctor I was told I needed surgery, but I'd have to wait eight hours until the morning shift came. A month in that hospital followed, until I was able to get into a wheelchair by myself and literally escape. Unfortunately what I witnessed was not health "care" at its worst, but was bad enough.
In the mornings we would be woken up and forced out of beds, most of us being strapped into wheelchairs. As I was unable to get into bed myself, I was totally dependent on the nurses to do this for me, and even for them to help me take a piss. We were often left 6 or 7 hours this way, our buzzers being placed out of reach, or our calls for help not being answered. I, as well as others with heavy casts on our legs, sometimes tipped out of the wheelchair, and there were times when people in our ward would have an accident and scream and holler for the nurses, being helpless to help the others. I faced numerous horrors there: falling out of my wheelchair, having my IV put in incorrectly after surgery and having to rip it out after my arm swelled up like a balloon and after screaming in pain for more than an hour, getting no help. Then there was the old woman across from me who screamed all night and who the nurses were tired of. The wanted her to die quickly because they were tired of cleaning the shit out of her bed. They let her die one night and all though none of us were happy about the constant screaming and smell, and some knew she was better off dead, we cursed the way in which she was left to die. The woman was alone, and I only remember two people ever coming to visit her- women from her church. One time she was asleep when one of the visitors came, and I asked about the woman. I heard sketchy details about how she grew up in Constantinople, about being a refugee, about the woman's tough life. I was initially irritated by her, by the fact that she kept me up all night with this awful screaming, and although I never had a chance to talk to her, after I heard about her I was deeply concerned that she should be treated well, and was horrified at how badly she was treated in her final days.
One night the woman next to me, who somehow was able to get into her wheelchair herself, despite the fact that the nurses would put it on the wrong side of the bed so that she couldn't easily slip into it, feel out the wheelchair and began to scream in pain. Everyone in the room (and I think there were 8 or 10 that day as the ceiling was leaking in the next room) began ringing their buzzers and the nurse came at last. The woman was worried that she hurt her knee and demanded that the doctor see her. But it was Saturday night, and as a rule we didn't have doctors come to see us on the weekends. The nurse admonished her saying that the doctors could only be summoned in case of emergency. Soon after being back in bed the woman pissed and a large clot of blood came out and she called the nurse who admonished her again. She bled the whole next day and when the doctor finally showed up, it turned out she had been pregnant (which she didn't know) and had a miscarriage. The woman and her family summoned the person in charge whereupon some bureaucrat woman showed up and everyone complained. My neighbor vowed to sue the hospital and I promised to back her up, but I guess that she got as far as all the other people I've known who have tried to complain about something.
Of course these stories are just the tip of the iceberg, and, as far as I know, they aren't uncommon. The numerous surgeries I had went O.K:, but the doctors summarily refused to explain what they were going to do to me and in one case, after an operation when my ankle really began to hurt, nobody told me my ankle had undergone surgery and only when I was having a cast change and could see the scar did somebody tell me, "Of course they operated there - didn't you know that?" Of course the doctors technically did nothing illegal cause the surgery was necessary, but I would seriously question the professional ethics of a surgeon who refuses to explain the surgery he will perform to the patient and upon being questioned refers to me as "a pest". A year and a half after the accident I had my last operation. I was told it would take six weks to heal. I was naturally concerned because I was making a semi-legal living and wanted to know when I'd be able to work. I was told the operation was "minor" and it was to be ambulatory. The fact that it had to be ambulatory, I later learned, was because I wasn't going to have some insurance company pay for a room, and that under other conditions, I would have to had remained in the hospital a few days. This fact however was obvious when I woke up after surgery and could only cry and ask them what they had done. I was totally dizzy, in complete pain and with a cast so high that sitting was completely impossible. I asked how I was supposed to sit in this cast, which was set so my knee was locked, (an uncomfortable position to be in for over 5 minutes, especially after surgery) and found out that I was supposed to lay in bed for six weeks and not sit up. Then I was sent home and couldn't even sit during the car ride, never mind how I was supposed to get into bed and stay there for six weeks. I couldn't make it for more than one night in the thing and wound up breaking it upon and resetting it myself. I must add that I healed up much better than anybody expected, through the help of medicinal herbs and exercise.
Of course maybe some of you are thinking that I just had bad luck and just bad doctors, and that the majority of doctors are really good, caring people. Maybe, but the fact is that I received very bad care due to the fact that I'm not rich and that I don't have insurance. Throughout the whole affair it was clear that I was only going to be treated in accordance to how much I could pay. I saw also how the hospital lied about the treatment I got to get more money reimbursed, and how they would bring me $18 pain killers every morning that I would refuse and that they would claim I would take, how they put daily physical therapy on my tap when I received it to or three times for 15 minutes. This is what I see in the future of "free and universal health care".
There are of course very many problems concerning health care, ranging from how it is administered to what methods of healing are to be used. Without getting into the question of whether instutionalized medicine should even exist (which is a valid one which I don't want to dismiss, but which would be better treated by someone more knowledgable on the subject), I can say that health care will not be seriously improved under the proposed Clinton plan. The main problem of course is that health care is primarily an industry in which people try to make huge profits. In the public health industry as well, most of the problems are based in the capitalist/profitist system.
Let's take for example those nurses at the hospital. Any number of people could agree that these people simply do not belong in that job. The fact is that they probably don't want to do that job anymore themselves. I cannot guess what their motives were for choosing the nursing profession - whether they were once people who thought they would dedicate their lives to helping people or whether they were simply drawn to the profession by the relatively good salary and stable employment opportunities they would have. But these people are not capable of doing their jobs; they view the patients as nuisances and are tremendously overworked. Their jobs make them tired and irritable, and although this is no excuse for neglecting the patients, it is understandable.
I know a few people in the health care profession. I remember one friend who upon graduating school and becoming a physicians assistant, was expected to be on call on round- the-clock shifts. I remember how exhausted she was and how she eventually had to take another job and is now waiting to be able to get out of the health care profession altogether. I asked, what is the sense of exhausting these people who after all have a difficult job at which they should be able to concentrate so as not to make any mistakes in the operating room. It's not fair to them, and not fair to the patients. But think about it - the hospitals fork over a lot of money because its the only thing that attracts and keeps some people in the profession. They don't want to hire more high-priced workers. The profession becomes exclusive and elitist. The medical schools become more and more elitist and expensive, promising graduates big returns, which they feel like they deserve after all the money they fork over in med school and all the hours they have to needlessly put in their first years on the job. One of the first steps in reforming health care would have to be making health education accessible to everybody who wants access to it, allowing more people to be qualified health practitioners, putting less pressure on doctors, nurses and other workers to work long hours, etc.
Of course in a country where workers slave a good part of their lives just to have a roof over their heads, and wealth has a certain status, people have a certain motive to make money. If investors, insurers, med schools and the like, who don't give a shit about anything more than profit, see little profit in health care, they will turn their investments elsewhere. The same can be said of workers who would choose more profitable professions. For the situation to really improve, the profit motive must disappear not only from health care, but from society at large. To follow this train of thought, we should look at how the profit motive negatively effects American health care, how, even when there is supposedly public, non-profit health care, there can be big money involved, and how the way capitalist societies adversely effect health.
The way that the health care system is structured, a lot of money is wasted, particularly by bureaucrats, paper pushers and the system of insurance companies. An eighth of the cost of health care is administrative. In addition, drug companies, insurance companies and hospitals, driven by the profit motive, drive up the cost of health care for everyone. Since health care is so expensive, many people go without, which is a fact so obvious that nobody can deny it. Any system which can fail to provide basic medical services to so many people is obviously a failure. Now the Clintons think its time to change the health care system, but not because people go without medical attention so much as (as one AFL-CIA operative said) the cost to companies of providing insurance for the workers drive up the cost of production.
Apparently, to keep the corporate greedy sated enough with the meagre millions they take in every year (as opposed to the money they could make shipping this business to another part of the world with a more desperate work force), the state has thought up a plan.This plan should be more cost efficient; they tell the workers who begrudge state spending that it will be more cost effective to provide preventative medicine than to treat the effects of going without it. The fact is that whatever changes they make (and it is questionable if they can manage even part of what they themselves envision) will profit mostly everybody but the people. Coverage will be minimal and will involve copayments which will keep the poorest from seeking help. The quality of medical care may not improve, and may even worsen as more and more people find themselves insured by HMOs where the care leaves something to be desired. Medicaid and Medicare would be slashed. Many of the very poor and unemployed would remained uncovered, with money for existing public medicine being cut. The poor working class would be serviced by the corporate HMOs and would receive substantially different care than the wealthy and professional classes, even though in general they run greater health risks. New bureaucrats would take over this system, adding new costs; if costs need to be managed, it will be at the expense of care and not these new bureaucrats. Part-time workers, an ever- growing group of people as businesses try to avoid paying health care and other premiums, will find that they might have mandatory coverage, for which their employers will pay a pro-rated amount while they have to fork over the rest.
It is obvious that the new system, while trying to be more cost effective than the old, will also be more bureaucratic. Medicaid reciprients will be transferred to private carriers, who, with more overhead, are much less cost efficient. If the new policies save any money, it will most likely do so by cutting on care.
The idea that people have about free health care (not unlike that which many people have about inner city schools) is that it is far from perfect, but at least it exists. This is a very poor attitude to have when people's lives are in question. There is no reason that decent health care cannot be given everybody, except that the people who are in control have their priorities fucked up, and that health care is too regulated and the system run stupidly. What we don't need is a more bureaucratic and universal system, but more alternative systems of health care which are run by people and not corporations or their legal arm - the government.
L.C.
THE MISSING PERSON; HEALTH AND ECOLOGY IN POST-PERESTROIKA RUSSIA
The rapid industrialization which communism brought to the former Soviet Union proved to be an ecological disaster. Some of the worst ecological disasters in history have occurred here, including Chernobyl and the depletion of the Aral Sea to supply water for cotton crops. But these are only the most wide known cases in the world - in addition, there are numerous cities which have been contaminated by industry, where the people suffer from many of the typical diseases associated with industrial pollution. This is why the emergence of an ecological movement is of such importance. Yet after visiting with some actvists and having gotten the feel for the politics of the ecologists, I get the feeling that something is missing, something which is usually of concern to environmentally aware people in the West. This is a connection between the environment and the person and between the way that we treat our bodies and the way we treat the earth. The environmental movement seems to have developed without the traditional health consciousness and sense of personal responsibilty for the environment that is supposed to accompany it.
by Kati Laapaikan
The state of health consciousness in the former Soviet Union seems to be nil. Though I had visions of a nation of well-trained athletes, in good form and rosy-cheeked, eating youghurt and living to the age of 105, the reality is quite different. Tired looking, malnourished bodies with translucent faces that betray bad health. I found that the average diet in Russia is way too high in fats and cholestoral, too much salt and too much sugar. Although it seems that most food is without preservatives, much of it is of questionable quality, and is sold in filthy conditions, just right for the transmission of disease. The idea of writing the ingredients on anything seems to be useless to the Russians, who apparently have little concern for the nutritive value of what their consuming. The basics of diet are not taught, and so most people that I spoke to were totally unaware of the condition between food and health. Many people also feel that their health is somehow too frivolous a thing to worry about. "I don't know if I'll have enough money to last me through the month. I'm supposed to worry about my health?", an aquaintance asked me, as if I had approached a question to ridiculous to even answer.
Some Finnish tourists that I met told me of a diptheria epidemic in Russia and referred me to the embassy medical staff. I took the occasion as an opportunity to find out what a foreign doctor thought about Russian health care. The opinion was very low. With the exception of a few reknowed specialists and a few hospitables which serve the elite, Russian hospitals were best to be avoided. Unsanitary conditions. Wrong dignoses. Over medication. I told my Russian friends about my innoculation. They thought I was a crazy person, willing to waste good money on an innoculation. I thought, maybe they know something I don't. Maybe there is something natural which protects Russians from disease. None of them had heard of the epidemic. They refused to believe it existed. "Nothing about it in the Russian news." I thought, this is incredible. Is there an epidemic, or is this something that some doctors thought up to squeeze some money out of tourists? "About 600 something people died. I don't know if you can call that an epidemic", said an American friend living in Moscow. "The papers didn't say a word about it, at least not the Russian language ones. Back home if you had 60 people who died of a disease, it would be on the news and the media would make a big to do about it. Experts would give advice and the medical community would create a health alert. Of course I am a great critic of the medical industry and I dislike the way that the media functions in general, but when I see what happens here, I really begin to wonder if there is any value in human life at all."
What I found was no preventative medicine, practically no health consciousness at all. I did however find that traditional herbal medicines were in use, but , as one person pointed out, that was only to compensate for the low supplies of pharmeceuticals that reach the people. People are unaware of the side effects of many of the medicines that they take. Analgin, for example, seems to be the most popular pain killer. I thought that this would be an area which environmental activists might be interested in - in helping people heal themselves and live a healthier, more balanced lifestyle, in coexistence with environmental concerns.
I brought my idea to various activists, but it seemed to fall on deaf ears. I mentioned that I thought it was odd to be in a room of people who had protested against the emission of pollutants into the air by factories yet had no problems about emitting cigarette fumes into the air, despite my request not to smoke. (They did open the window in the 0+ weather however.) "You yourselves probably do as much damage as the factory, if not more," I finally blurted out, vexed by so much seeming indifference to the role that personal behaviour plays in creating our circumstances, both physical and mental. A long tirade followed about how people cause pollution and waste energy, how bicycles were perferrable to cars, and how cities were environmental hazard zones. Finally somebody said, "Yes, it would be better if we all lived in the country, but then there wouldn't be work for some of us. We all can't be farmers."
I felt that, although the activists could easily understand that city life was unnatural, they were not ready to dismantle the idea of the city, and had very little, if any critique of technology and industry. "Your Western activists are elitist intellectuals," I was told. "They always demand the closing of factories without thinking of the workers. When there was a camp at Cherepovetz, where there is a huge but dangerous metallurgical factory which employs the whole city, we demanded that the factory use ecologically clean equipment, but we didn't demand that it be shut down. If we had demanded that, we would have alienated the workers from our cause. The main problem of the Russian worker is to feed himself, and problems of health and safety come later."
I wanted to protest that it wasn't just the emission of toxins into the air that should be of concern with Cherpovetz. The factory is just the end stop in a cycle of environmental production, and the people are chained to it only because their area was industrialized. However they lived before the huge metal works must have been a lot more pleasant than spending 8 hours a day in a noisy, polluted metal shop, spending 4 hours just to recover from the experience, and spending the rest of your life feeling the ill effects, both physical and psychic, of their employment. I wanted to say all this, but it didn't come to my head quick enough. I was busy digesting the dose of guilt I had just been fed by my Russian friend, who honestly felt he was protecting the working class. Poor environmentalists, I thought. Afraid to let people know of their own complicity in the ailing environment, too self- abasing to say to themselves that their bodies are as important as the trees in the taiga.
Upon my arrival home, I sent a care package of literature back to Russia with a friend. I felt that maybe, if they saw the case for health consciousness in print enough, they would come to believe it was important. If I learned one thing during my trip, nothing seems to impress people there as much as glossy printed publications. (I often wondered curiously what was so interesting about my magazines that people would page through them endlessly, despite the fact that they didn't read a word of Finnish.) I have yet to see the results, but I am waiting.
NOTICES
Radical pamphlets and books need to be printed in the Russian language now more than ever. There are several ready for publication now but we are having great logistical problems with getting them printed. We would like to ask people who have access to printing presses to help out in this difficult time. We are mostly interested in making small print runs of several pamphlets and are more than willing to reimburse all or part of the material costs. Please contact the publishers of this magazine if you are able to help out.
The Moscow Institute for the Study of Racism, Fascism and Nationalism is looking for people who are doing scholarly work on any of the three subjects. Please contact the Institute c/o this magazine or on e-mail at
cube@glas.apc.org Anarchists and other interested people are busy cleaning out their new squat on Petrovsky Blvd. in Moscow. The squat, known popularly as "Gulyai Polye" (due to the fact that there is an authoritarian neighbour by the name of Petliura), hopes to open up early in the spring and have discussions, performances and other events, as well as serve as a meeting place.
Russian President Boris Yeltsin has posthumously rehabilitated the Kronstadt rebels. Anarchists around the world still consider themselves the enemies of the state.
[See Spunk000 for "You Can't Rehabilitate An Anarchist, which appeared here in the original edition.]
LETTERS
Dear editors,
I'd like to thank you for taking the time to think of me as I find myself in this difficult position. I read the two issues of Mother Anarchy that you sent me with great pleasure, especially as they differ so radically from the rest of the red-brown crap I am sent. Having read the material published in your magazine, as well as Alexander Tarasov's excellent pamphlet entitled Provocation, I have changed my views on the events that have taken place.
I'd like to say first of all that I have always considered anarchist ideas to be very admirable but too idealistic to work. I have always maintained that one must take an active part in the political system in order to change it. In my own role as Speaker of the Russian Parliament, I tried to create an atmosphere in which the best direction for the country could be examined openly and honestly in order that the best decisions be made. As you already know, many people have entered politics for entirely different reasons, and know I have begun to realize that all the politicians in Russia are bastards.
I am glad to know that there are some people who are ready to see that Yeltsin provoked the events of last October. As the legally elected legislature, we felt that Yeltsin had no right to usurp our authority. But upon seeing that the public did not support us, and furthermore that myself and my colleagues were being villanized by the media, I realized that the stance of Rutskoi and his friends was stupid. In fact, Rutskoi is one of the last people on the earth I would want as president, the macho shithead. During my unfortunate time in the White House during the seige, I had to listen to the most disgusting crap I have ever had the misfortune to hear in my life, including constant racial epiteths being hurled my way, anti-semtitic nonsense, and calls for agression against Russia's neighbours in order to bring Russia back to superpower status.
Now that Russians have elected Zhirinovsky, I am tempted to think that the people have gone out of their minds. But thinking it over now, I see that such people have always been in power here, albeit that they expressed their programs in different forms. I try to have faith, like you, that the Russian people have not gone insane. I realize that you are right, that many people didn't support us because we were just as bad for them as was Yeltsin. (Especially Rutskoi, that son of a bitch.) I swear that if I ever get out of here, I am turning my back on politics. All politicians are scum and I don't want to be part of it anymore.
I hope that you will forgive my language, but I am very upset , understandably. Please continue to write. It is a great relief to know that somebody is willing to send me mail besides the Stalinists and a few fans who want me to be the president of an independent Chechnya. I wish that those idiots would just leave me alone. A special hello to Comrade Akai whose constant condemnation of Russian nationalism, and particularly of the deportations which took place after the coup d'etat is greatly needed and to Alexander Tarasov, whose Provocation is an admirable work of scholarship.
For your freedom and mine, (especially mine),
Ruslan Imranovich
MOTHER ANARCHY is one of the few remaining independently produced, self-financed samizdat publications left in the world's newest liberal democracy. The culture of samizdat has all but died away completely as people aspire to make high cost, widespread publications that are almost completely subsidized, and without these subsidies could not exist. We on the other hand would like some of our readers to get involved with the actual publishing and distribution of the zine. Rather than collect money and then bankrupt ourselves publishing this zine only to then have to hawk it, we ask readers who might find it interesting to pass any or all of it on to a friend or to make xerox copies of it and spread it around. Nothing is coppyrighted, and anything is free to reprinted as well.
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