Up@dawn 2.0

Tuesday, May 3, 2016

Publicly Funded Healthcare

Pied Piper's product is its stock. Whatever makes the value of the stock goes up is what we are going to make. Maybe sometime in the future, we can change the world and perform miracles and all of that stuff. I hope we do. But like I told you before, I am not going to mortgage the present for that. 

This little gem was dropped in the episode of "Silicon Valley" that aired a few nights back. This was told to Richard Hendricks, the protagonist of the show, a programming phenom who has developed a compression algorithm with his friends in a living room that even the top tech companies couldn't beat. When investors in his company push him out as CEO, he and the new CEO struggle over the direction of the company. Richard wants to continue developing his revolutionary program, and the CEO wants to use his resources to develop whatever products will sell. Not just to generate profit, but to raise the stock price of the company.

This is what Marx referred to as the abstractions of capitalism. What is important is not the thing that is produced, but a return on investment. The fundamental goal of capitalist is the accumulation of value, and given this obvious fact it is no surprise that our healthcare system has ended up the way that it has. (See my last post) The purpose of pharmaceutical companies is not to make drugs that treat disease and disorder effectively, their purpose is to make money for their investors. The purpose of a hospital is not to treat its patients, it is to make money (even if they are non-profit; again, see my last post). The purpose of the biotech companies is not to develop technology and machinery that revolutionizes healthcare, it is to develop technology and machinery that makes a lot of money. The structure of our healthcare system is not designed to benefit the well being of the community, it is to create wealth and value.

The exception to this seems to be public funding of research and development, which is explicitly not for making money but for fostering innovation in the hopes of bettering public health. But we don't fund nearly enough, and the grant writing process has become an increasingly arduous and time consuming process Most scientists finance their laboratories (and often even their own salaries) by applying to government agencies and private foundations for grants.  In 2007 a U.S. government study found that university faculty members spend about 40 percent of their research time navigating the bureaucratic labyrinth, and the situation is no better in Europe.

 On the other hand, our Communist neighbor Cuba has developed one of the most efficient healthcare systems in the Americas. When Fidel Castro came to power in 1959, most of Cuba's resources were put into education and healthcare, and within the decade, the literacy rate and infant mortality rates were among the lowest in the world, and certainly the lowest in the Americas. At the moment, the infant mortality rate in Cuba is 4.2 per 1000, compared to 5.2 per 1000 among American whites and a staggering 11.1 among American blacks.

Cuba has also sent 124,000 healthcare professionals to 154 countries, and currently nearly 30,000 Cuban medical staff are working in over 60 countries around the world.  Similarly, Cuba trains young physicians worldwide in its Latin American School of Medicine (ELAM). Since its inception in 1998, ELAM has graduated more than 20,000 doctors from over 123 countries. Currently, 11,000 young people from over 120 nations follow a career in medicine at the Cuban institution. According to Ban Ki-moon, Secretary General of the UN, ELAM is “the world’s most advanced medical school.” He also praised the Cuban doctors working around the world, including those in Haiti: “They are always the first to arrive and the last to leave. They remain in place after the crises. Cuba can be proud of its health care system, a model for many countries."

But one of the most impressive aspects of Cuba's healthcare system is its research infrastructure. Cuba pulled off its first scientific coup with the discovery of a new vaccine for meningitis B in the late 1980s. The vaccine controlled epidemics at home, and obtained good results abroad especially in Argentina and Brazil. Although it is a small country with only 11 million people, it now boasts 52 scientific research institutes in the capital and more than 12,000 scientists on the whole island. We usually trumpet research and innovation in the United States as being the result of economic competition and profit rewards, as if it were some inherent fact of human nature that we need a profit motive to to good in the world. But we can see with the Cuban model that the more efficient model is a state run system that heavily funds medical research, community healthcare, and education. If the end goal of healthcare should be the health and wellbeing of the community, then our healthcare system should reflect that goal.



  1. Sounds like you're proposing one of the major planks of Bernie's revolution. We'll see if the "movement" grows enough in the next four or eight years to bring the healthcare change we need.

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