6 votes

Mask off: Crisis and struggle in the pandemic

4 comments

  1. [4]
    no_exit
    Link
    This is an extremely long analysis of the coronavirus with a focus on the US, I read it awhile ago but was reminded about it on here by this New Yorker article. Around the middle section, this...

    This is an extremely long analysis of the coronavirus with a focus on the US, I read it awhile ago but was reminded about it on here by this New Yorker article. Around the middle section, this article discusses the historical evolution of healthcare in the country, and why our current model has dealt so poorly with the pandemic.

    There are a number of components that make up the blanket healthcare system in the US, each subsumed by capital in their own way, contributing to an infrastructure defined by extremely patchy coverage, absurd costs and declining, uneven quality. The dilemma for capital, starkly revealed now by the willful sacrifice of thousands of lives a day, is between, one the one side, allowing for the expansion of the social wage fund that robust public health measures would require, and thus cut into the already suffering rate of profit, and, on the other, letting the general health of the populace decline to the point where it cuts into productivity. Historically, the US capitalist class has opted to thread this needle very close to the bare minimum, foisting more miseries and indignities onto the working class as increasing portions come to contribute to the economy not primarily as labor-power, but as “medical consumers.” The private healthcare industry has a unique position within the wider historical process of declining profitability and the suppression of the social wage fund.

    That entire healthcare section is enlightening, but the whole article is worth a read too if you have any interest in a Marxist perspective.

    2 votes
    1. [3]
      skybrian
      Link Parent
      I don't know, it seems like abstract, empty theorizing to me, unlike the writing about medicine in the New Yorker, which is usually excellent.

      I don't know, it seems like abstract, empty theorizing to me, unlike the writing about medicine in the New Yorker, which is usually excellent.

      1. [2]
        no_exit
        (edited )
        Link Parent
        If you have specific criticisms you're welcome to elaborate. For example, I had never considered the role of union-sponsored clinics in the early 1900s labor movements, and their effects on the...

        If you have specific criticisms you're welcome to elaborate. For example, I had never considered the role of union-sponsored clinics in the early 1900s labor movements, and their effects on the creation of things like MEDICAID.

        As the network of independent worker clinics was displaced by the hospital system, the battle lines moved and workers began to fight for insurance plans and other forms of payment support rather than for direct control over the care itself. In other words, they increasingly had to accept the terms of commodification. But the inadequacy of union insurance plans and the conditional nature of employer plans, based on the principle of “cost-sharing,” lead to agitation for publicly funded coverage. The American Federation of Labor of Samuel Gompers, its latent conservatism coming to the fore as the wave of interwar class struggles began to crest in the early 1930s, opposed universal coverage on the grounds that it would counteract the unions’ appeal, as it would cover union members and nonmembers alike.

        The New Yorker article begins by quoting Beverly Jordan, a partner at an independent clinic. I found it interesting that she was independent, because I recalled a citation in this article about that:

        many of these smaller facilities [out-patient clinics, at-home services, nursing homes, urgent care centers] aree owned by growing hospital conglomerates that are increasingly absorbing these smaller practices, to the point where more physicians are employed by a provider network than operate their own practices.

        emphasis mine. The New Yorker article does not explore this angle in much or any detail. The sentences following are also directly relevant.

        The composition of physicians has decisively shifted, following the incentive structures of private healthcare which emphasizes expensive post hoc diagnoses and procedures rather than preemptive and lifestyle care: primary care physicians, the frontline of any public health system, make up just 12% of medical doctors, 85% some kind of specialist or subspecialist. This has been accompanied by a decline in people who receive primary care, especially in rural areas and urban centers, and lowered life expectancies. Such consolidation offers more opportunities to transition to contract labor and temporary staffing. The division of labor in clinical settings has shifted as well, with nurses taking on more tasks in direct patient care, leading to higher workloads, higher burnout and turnover, and more fatal malpractice.

        There are several citations linked in that quote which I'm not going to redo here. Seems pretty concrete to me? The New Yorker mentions the same, in less detail:

        Experts have long warned of a shortage of doctors providing foundational forms of outpatient care, especially in rural areas.

        2 votes
        1. skybrian
          Link Parent
          Although a large number of things are mentioned, I still find the result to be kind of incoherent. For example, "fee for service" is explained this way: It might be more accurate to say that this...

          Although a large number of things are mentioned, I still find the result to be kind of incoherent. For example, "fee for service" is explained this way:

          Of all the types of billing structure in healthcare systems around the world, FFS squeezes the most out of patients, shunting the risk of business onto them, as providers can recuperate costs through increasing the variety of unbundled billable services.

          It might be more accurate to say that this system creates risks for everyone. As we've seen, fee for service is also a risk for health care providers. The sudden cancelling of elective procedures means that many rural hospitals may be forced to close, if they aren't bailed out. I guess they can't easily recuperate costs after all?

          But that's just one point of all the things mentioned. It seems like biggest problem with the article is that it's not about any one thing. Even health care, with all its complexity, is just one subject it passes through in an attempt to mention everything going on this year. You get glimpses of complexity, but not enough to really understand anything. Writing multiple articles with a smaller scope would be a better way to do this.