Journal of Public Health Research 2012; volume 1:e37
Perspectives and Debates
The crisis of capitalism and the marketisation of health care: the implications for public health professionals Martin McKee,1 David Stuckler2 1London School of Hygiene and Tropical Medicine; 2University of Cambridge and London School
of Hygiene and Tropical Medicine, UK
Significance for public health In circumstances such as those described in this paper, public health professionals have a duty to speak out. They can look for inspiration to the Prussian physician Rudolph Virchow who, while fully aware of the key role played by lice, drew attention to the social and economic circumstances in Silesia in the nineteenth century that allowed typhus epidemics to occur.* Yet, in recent years, too many public health professionals have left the big decisions to politicians and economists, assuming they must know what they are doing. But now we know that they do not. A different solution is needed that prioritises health and social wellbeing. Public health professionals are as well equipped as anyone to propose it. They might start by looking at how they can change what is happening in health care and then apply the lessons more broadly. At least it will be a start. *Reilly RG, McKee M. 'Decipio': examining Virchow in the context of modern 'democracy'. Public Health 2012;126:303-7.
Abstract The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, there is a hidden consequence of this system: an unfolding crisis in health care, driven by the greed of corporations whose profit-seeking model is also failing. Proponents of commodifying healthcare simultaneously argue that the cost of providing care for ageing populations is unaffordable while working to create demand for their health care products among those who are essentially healthy. Will healthcare be the next profitfuelled investor bubble? In this paper, we call on health professionals to heed the warnings from the economic crisis and, rather than stand by while a crisis unfolds, act now to redirect increasingly market-oriented health systems to serve the common good.
Two crises On 26th December 1991, the Soviet flag flying over the Kremlin was lowered for the last time, to be replaced by that of the newly independent Russia. This symbolised the death of communism as an organising principle of society in Europe, the end of an experiment that had begun in St. Petersburg in October 1917.1 No longer would there be any serious argument about what was the best way to organise socie[page 236]
ty, communism or capitalism. Communism was broken and capitalism was triumphant.2 Yet, twenty years later, it is the capitalist system that seems broken.3 Mass demonstrations on a scale seen two decades ago in Prague, Warsaw and Budapest are being replayed on the streets of Athens, Lisbon, Madrid and Rome. The situation in Western Europe displays many parallels with the dying days of the communist system. Just as, in the 1980s, the communist economies stagnated, real incomes for average families in employment in western Europe have barely changed since the early 1990s, although now the reality has been disguised by the availability of cheap credit. Yet neither system was sustainable. Just as in central Europe in the late 1980s, once the system began to unravel, it did so very quickly, with politicians rapidly losing control of events.4,5 In both cases, the policies they pursued failed, often spectacularly. Then, it was the attempt to reform the system from within. Now, it is the policies of austerity, promoted as a means of tackling the economic crisis, but making things much worse.6 Suicides are a key indicator of the confidence that the population has in its rulers. Yet, suicides are now rising in western Europe too, reversing the long downward trend that had lasted for several decades.7 As in the communist period, not everyone is equally affected. Then the beneficiaries were the nomenklatura, the communist party elite. Now, it is the 0.001% of the population who head major corporations, earning over 350 times the wages of the average worker. Just as the nomenklatura had their own Zil lanes in the Soviet Union, now they use the separate Olympic lanes in London as they speed to the events they have sponsored using money they have taken from the general public. There was not always such dominance by a super-rich aristocracy. For much of the post-war period, the capitalist system benefitted most people, just as in the days following the Russian revolution, the communist system brought enormous benefits to its people, introducing universal health care and expanding education to achieve universal literacy. But both went very badly wrong. In the case of communism, it was the murderous policies pursued by Stalin from the late 1920s.8 In the case of capitalism, it was the laissez faire policies pursued by Thatcher and Reagan in the 1980s.9 What do these systemic changes mean for the future of health systems in Europe? First, we trace the rise and fall of market capitalism in Europe and North America, showing how the major corporations in the financial sector redefined their roles, abandoning their traditional role of providing income for savers and supporting small businesses, and taking up what amounts to reckless gambling with the money of their shareholders and depositors, all for their own benefit. Then, we will reflect on how changes in the financial system will affect health care. The pressure to expand markets has moved into basic human needs, creating bubbles in food and housing. Inevitably when they crash, investors seek to expand more markets for profiteering. Healthcare is set to become the next commodity bubble as an increasing number of corporations enter this sector, moving into the delivery of health care. Like
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