This is Richard Wolff from Democracy At Work responding to another Ask Prof Wolff question
from our Patreon community. And this one comes from Brandon Desidario. Brandon picks up
a question from a book, or an interview, of the author Gabriel Winant, and the book is called,
“The Next Shift.” It's about the transition in the Rust Belt of the United States from industry
in the past, to the health care business in the present. And what Brandon wants to know,
having been stimulated by the interview and the book, is what we have to say (we as advocates
of worker co-ops) about the need for, the possibility of, the benefits from a cooperative
organization of the health care industry. So let me respond briefly, but I hope to the point.
Number one. Worker co-ops have existed in the healthcare industry, both inside the United
States, and outside the United States, for a long time. There is no problem in reorganizing
health care — a doctor's practice, a hospital, a clinic, and so on — with a worker
co-op organization. And the same applies to the production of medicines, devices, and so forth.
No difficulty in conceiving, or understanding, or seeing empirical documentation for the existence
already of that way of organizing health care, but I want to make a claim that's much stronger.
I want to make a claim that the failures of the health care system in the United States,
and by failures I mean that we don’t have a national health insurance as every other advanced
country has, that we didn't do well when our medical care system was tested by COVID over the
last two plus years. Why didn't we do well, or how do I measure that? Simple. The United States has
four and a half percent of the world's population, yet we account for 16 or 17 percent of the world's
deaths from COVID. That is a failure. There's no fancy way to dance out of that situation.
We are a very wealthy country, we have a highly developed medical care system, but it doesn't
work real well for the mass of people. We suffer extraordinarily from an opioid overdose crisis.
We are one of the worst countries in the world for overweight problems, obesity.
I could go on. The last few years our longevity, how long we live, has come down,
not gone up, as it has in most other countries. And our birth rate has been cascading down
to where our population would have shrunk over recent years were it not for the immigrants, who
are having a harder and harder time coming here. Which means that we expect already perhaps, in
this year, to record a declining population, not just one whose growth is shrinking. I could go on,
but our health care system leaves a lot to be desired, and the reason is, it is a profit-driven
system. We have been privatizing our health system at breakneck speed over the last
half century, closing public facilities, and converting them into private, profit-driven
entities, and that profit motive is built in now to health care. It’s built into hospitals.
It's built into the doctor's practices. It already was in the insurance companies, and it already was
in the medical device, drug, and so on, companies. Profit is everywhere and, as you know,
profit means that the people in charge, the tiny number of folks who run capitalist enterprises,
are driven to be “cost effective.” That's a fancy term for cutting costs,
making three people do what they used to do with four people, replacing people with machines,
outsourcing various anything and everything to cut corners.
So no one should be surprised, even though so many seem to be, that we are all suffering.
Why? Has all this cost cutting led to our medical care being cheaper than in other
countries? Absolutely the opposite. We spend more for medical care in the United States than
any other advanced industrial country. So what is it that it produced, all the cost cutting? Really
good profits, extraordinary profits collected in the hands of a tiny minority of our people,
the shareholders of the big corporations, the top executives who make all of this
happen. And at the bottom of the food chain, inside health care activities,
the nurses, the orderlies, the workers on the line, they’ve been squeezed, making it impossible.
That's why we have so many resignations in the health care field. People are driven to work
unspeakably hard, with not enough support, and now in the midst of a very scary disease, with the
companies trying to save money rather than make sure that the workplaces are safe. I could go on.
Bottom line: Yeah, we can make the healthcare industry a worker cooperative based industry.
It’s been done. We can do it again. Americans are just as smart at learning how to do these things
as everybody else has been, and we should do it because our healthcare system produces mediocre
results the way it is now. It produces mediocre results even though it costs us more than other
people pay in other countries, far less wealthy. Who wins this? Well, it’s the perfect Capitalist
story — a tiny number of shareholders at the top. And remember the basic statistic: the richest 10
of our people own 80 of the stocks, and that is particularly true in the medical field. So yeah.
Yeah, we need to make big changes and we should, and we could start right there in the
Rust Belt that needs it so badly, by a massive program of converting Capitalist businesses,
profit-driven, into worker co-ops. It is the better way to go.
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