Patients at Risk
by Joe Auciello
In March of this year the Boston Globe ran a lengthy, four-part, front-page series on the national crisis of faulty medical care. The series was entitled, “Patients at Risk.” (The series is available on line at http://www.boston-com. Use the keyword: “Patients.”)
The news, to put it mildly, was disturbing. “Nearly 20 million Americans checked in to a hospital last year assuming they’d check out healthier, or at least no sicker.
“One out of 20 of them was wrong. They got the wrong diagnosis or wrong drug, the wrong limb was operated on or something else went wrong for more than one million patients.
“And for 100,000 of them, the mistake was deadly.”
The vice-president of an organization of 1,600 community-owned health care systems was quoted as follows: “I don’t know why the public hasn’t rebelled before now. Maybe it’s because these errors happen one patient at a time — it’s not like a 747 falling out of the sky…But the aggregate effect of all this is like a bunch of 747s falling out of the sky.”
Actually, this crisis became front-page news precisely because certain powerful people and institutions were speaking up. Studies revealed that fatal medical errors were occurring not only in rural or inner-city hospitals, the inadequate refuge of the working class and the poor, but also in the “top-notch” facilities frequented by the affluent and the rich. These people were “holding doctors and hospitals more accountable for their mistakes.” In other words, they were suing and winning. For the hospitals, and more to the point, for the insurance companies, the medical errors were terribly expensive. “The annual cost of those preventable adverse events was estimated to be in excess of $10 billion, while the annual death toll was more than 100,000 — twice the number who die each year on the highway.”
When senior partners in prestigious law firms send their children to the best hospitals, they expect top quality medical care. If they don’t get it, if, instead, accidents occur, they make their complaints into front-page headlines. Rank has its privileges.
But what about the rest of America — the working class, or, as the newspapers like to say, “the public”?
Money Does Buy Happiness
According to an unsigned Associated Press story in March that you did not see, “At least 20 million Americans at risk of heart attacks aren’t getting cholesterol-lowering drugs that could save their lives.” From a survey of 250,000 patient visits to doctors between 1990–1996, it was discovered that necessary medicine for patients diagnosed with cardiovascular disease is “prescribed to only one in five of those who could benefit.”
The numbers, at first, seem to make no sense. Why are so few people getting the help they need, especially since the benefits of the medicine are indisputable? Maybe some patients just don’t like pills or forget to take them. But “specialists cited other reasons the drugs aren’t taken: doctors are better paid for treating disease than for preventing it; and the drugs are expensive, up to $100 a month.”
Leave aside, for the moment, greedy doctors. Isn’t your own life worth the cost of $25 a week? Obviously, yes. But if you’re one of the more than forty-three million Americans without health insurance, one of the millions stuck in a low-paying, dead-end job, then the question is pointless. When you barely make ends meet, you do the best you can and hope to get by. You pray for good health and comfort yourself with the thought that money can’t buy happiness.
Poor and working people, especially people of color, are suffering from easily preventable heart attacks and are dying unnecessary, early deaths. That information is buried in a small article on page thirteen of a daily newspaper. If you didn’t notice it and if you didn’t hear it on the network news, that’s okay. You weren’t meant to. The poor and not-so-well-off die quietly in America, unheard and unseen. It’s not front page news for a fairly simple reason: the social catastrophe of economic inequality is just business as usual.
Let’s at least tell each other the truth. Money can, in fact, buy happiness, because money can buy a longer life. And no matter what the priests and ministers want you to believe, you won’t be happier when you are dead.
Two Parties?
We argue that the Democrats and Republicans do not represent working people because they are the twin parties of the ruling rich. But if you’re not already a Labor Party member or a socialist — if, in other words, you’re like the huge majority of Americans — then the impeachment of President Clinton would seem to disprove that assertion. The trial of a United States president, a historic event unlikely to be witnessed again in our lifetime, was split clearly along party lines at every step of the impeachment process. (Only on the final vote did a handful of Republican senators cave in to common sense and acquit the president.)
In the country’s most significant political trial of this century, the Democrats and Republicans were on opposite sides, fighting against each other. Doesn’t that simple fact prove conclusively that these two parties are fundamentally different? Most workers, if asked, would probably answer “yes.”
After the impeachment, then, how can socialists and Labor Party supporters continue to argue that the Democrats and Republicans both represent the interests of big business? In what way were those interests furthered by a spectacle that could only alienate people from the “democratic process”? After all, the two-party shell game won’t work if the voters no longer care to play.
Those who claim that President Clinton is largely carrying out a right-wing agenda have a further question to answer. Why would the Republican Party have attacked Clinton so viciously, in a way that threatened to shake the stability of the political system, if, in fact, he had all along been dancing to their tune?
These are complex questions, but they are entirely reasonable ones. They are the kind of questions that workers ask when they hear a radical indictment of the bosses‚ parties. For that reason socialists and leaders of the Labor Party should be trying to provide some answers. It’s just not enough to repeat the old formulas and assert the old arguments, even though they are true. We also have the responsibility to argue for the truth in a way that is timely, clear, and convincing to the workers we hope to influence.
How well have we met that responsibility? What articles and editorials from the Labor Party Press actually answer these questions — the kind of questions that their readers in the unions would ask? Where, in the many socialist newspapers and journals, can you find the kind of analysis that creatively applies general principles (no support to the parties) to the specific situation of the impeachment hearings and trial?
One priority for us at this time is to explain that the Democrats and Republicans, despite their varying differences, agree on so many fundamental issues and ideas that in reality they do constitute one party. They support corporations at the expense of workers here and abroad. Their differences center on how best to achieve their common goal of defending private profit and the rule of the wealthy.
The most thorough and convincing left-wing analysis can be found in Tom Barrett’s article, “The Impeachment of Bill Clinton,” published in the first issue of Labor Standard. Barrett points out how different factions in the ruling class pursue different short- and medium-term objectives, sometimes at the expense of their long-term interests. He also explains, “The far right of the Republican Party hated and feared Clinton not because he could defeat them in a political confrontation, but because he could take their issues away from them.” Finally, the article defines a strategy that workers should follow to defend their own organizations and interests.
Along with Marvin Mandell’s articles in the Summer 1998 and Winter 1999 issues of New Politics (Nos. 25 & 26) Barrett’s contribution is the most necessary to read.
The scarcity of first-rate writing on the impeachment question is not the sole example of the left’s weakness in popularizing its programs. For that matter, where is there a readable pamphlet, well-researched and clearly written, explaining the class nature of the two ruling parties in the U.S.? What material do we have to give to a worker who begins to ask questions about those parties and the political system in America?
Superb essays by Robert Brenner and Stephanie Coontz analyzing the Democrats were published in The Year Left —1985, but those articles are by now dated and out of print. Brenner convincingly demonstrated that the “electoralist perspective” of liberal Democrats was “in the end, like other reformist strategies, futile and self-defeating.” Instead, he argued convincingly that “militant mass movements…provide the indispensable basis for actually winning reforms and imposing policies on the government.” Coontz’s conclusion was equally unambiguous: “The Democratic party is not the place for the left in the 1980s.” That analysis is no less true now.
Couldn’t one or two of the many Marxist intellectuals in this country, no doubt engaged in important projects, find the time to write a pamphlet explaining to young workers and students why support for the Democrats (and Republicans —remember the anti-NAFTA working-class support Pat Buchanan received in 1996?) is a waste of their money, effort, and votes? This kind of pamphlet would not be a new or ground-breaking work - just a necessary one if we hope to influence this generation of American workers.
A Man In Full
Actually, it’s a big dud.
The writing in this novel displays Wolfe’s ability as a journalist. He has a sharp eye and can define characters by the telling detail, but they do not come to life. He has an ear for the spoken word and can fix his characters’ social standing by the particularities of their language, but he can’t create believable dialogue. When Wolfe explores the emotional depths of these characters, he only reveals his skill in reporting their surface appearance. Wolfe can recall people and combine them into some composite, but he can’t create a credible character.
With a dash of the hyperbole that attends this 742 page blockbuster, it could be ventured that the social criticism of A Man in Full can be found — and read with more enjoyment — in one chapter of Charles Dickens’ novel of the 1860s, Our Mutual Friend.
Here, in the opening of chapter 11, Dickens anticipates one of Wolfe’s themes and ridicules bourgeois vanity:
“Mr. Podsnap was well to do, and stood very high in Mr. Podsnap’s opinion. Beginning with a good inheritance, he had married a good inheritance, and had thriven exceedingly in the Marine Insurance way, and was quite satisfied. He never could make out why everybody was not quite satisfied, and he felt conscious that he set a brilliant social example in being particularly well satisfied with most things, and, above all other things, with himself.”
So, when you next find yourself at Barnes and Noble or Borders Bookstore, relax in the coffee bar and savor the pleasure of Dickens skewering the world of Podsnappery. Satire goes down well with a croissant and a cup of designer latté.
(Of course, it may seem unsporting to put a middleweight like Wolfe against a heavyweight like Dickens. Still, the match is fair. Wolfe’s ambition, if not his achieve ment, invites the comparison.)