Howard Waitzkin and his colleagues explain capitalism's barriers to health care reform

Health Care Under the Knife: Moving Beyond Capitalism for Our Health

By Howard Waitzkin and the Working Group on Health beyond Capitalism
Monthly Review Press, March 2018


Introduction: What We're Trying to Do Here and Why by Howard Waitzkin

PART ONE: Social Class and Medical Work

1. Disobedience: Doctor Workers, Unite! by Howard Waitzkin

2. Becoming Employees: The Deprofessionalization and Emerging Social Class Position of Health Professionals by Matthew Anderson

3. The Degradation of Medical Labor and the Meaning of Quality in Health Care by Gordon Schiff and Sarah Winch

4. The Political Economy of Health Reform by David Himmelstein and Steffie Woolhandler

PART TWO: The Medical-Industrial Complex in the Age of Financialization

5. The Transformation of the Medical-Industrial Complex: Financialization, the Corporate Sector, and Monopoly Capital by Robb Burlage and Matthew Anderson

6. The Pharmaceutical Industry in the Context of Contemporary Capitalism by Joel Lexchin

PART THREE: Neoliberalism and Health Reform

7. Obamacare: The Neoliberal Model Comes Home to Roost in the United States - If We Let It by Howard Waitzkin and Ida Hellander

8. Austerity and Healthcare by Adam Gaffney and Carles Muntaner

PART FOUR: The Trajectory of Imperialism's Health Component

9. Imperialism's Health Component by Howard Waitzkin and Rebeca Jasso-Aguilar

10. U.S. Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present by Anne-Emanuelle Birn and Judith Richter

PART FIVE: The Road Ahead

11. Resisting the Imperial Order and Building an Alternative Future in Medicine and Public Health by Rebeca Jasso-Aguilar and Howard Waitzkin

12. The Failure of Obamacare and a Revision of the Single-Payer Proposal after a Quarter-Century of Struggle by Adam Gaffney, David Himmelstein, and Steffie Woolhandler

13. Overcoming Pathological Normalcy: Mental Health Challenges in the Coming Transformation by Carl Ratner

14. Confronting the Social and Environmental Determinants of Health by Carles Muntaner and Rob Wallace

15. Conclusion: Moving beyond Capitalism for Our Health by Adam Gaffney and Howard Waitzkin

From the Conclusion

As Obamacare is increasingly recognized as insufficient and inadequate, the demand for such fundamental change in capitalist health care, as well as the economic system that shapes both health care and health itself, will continue to grow. We have highlighted several facets of the struggle ahead: organizing among health workers including physicians; building communal, democratic structures and processes within health care organizations; and transforming political parties and social movements so they become forces that can achieve fundamental change in health care and in capitalist society. Such struggles also must target the social and environmental pathologies that capitalist society constructs as normal and impact health in ways even more important than health care.

The forces that resist these changes command wealth and power that emanate from a tiny part of the U.S. population (less than the 1 percent made famous by the Occupy movement) and an even tinier part of the world's population. Those in this minority will no doubt continue to fight ferociously to preserve the profound advantages they gain from the status quo, of which capitalist health care figures as only one part. Though the power of this small number should not be underestimated, neither should ours. The road ahead is a steep one, but given the fragility of our harsh capitalist system together with the discontent and suffering it breeds, it is one that we can and must surmount.



By Don McCanne, M.D.

Those of us who have been working for such a long time on trying to bring all of us together into a high quality health care system that is equitable and affordable have certainly been frustrated by the barriers that have locked us out of an obviously superior system. "Health Care Under the Knife" by Howard Waitzkin and his colleagues is invaluable because it enlightens us as to just what those barriers are (hint: it has to do with some of the dysfunctions of our capitalist system). Understanding those barriers is an essential prerequisite to organizing our strategy to move forward in achieving health care justice for all.

Highly recommended.

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