Category Archives: Patient Rights

A Green New Deal for Workers

Workers in 2020 have a unique opportunity to vote to put two fellow workers in the White House. Howie is a recently retired Teamster and Angela is a dump truck driver. We know the economic realities that working people face in the United States. This Labor Day we call for a better class of people in the White House than the corporate crooks and flunkies that have been occupying it.

The COVID pandemic and economic collapse have highlighted the race and class inequalities in our society. With more than 35 million jobs lost, millions have lost their employer-connected health insurance in the middle of a pandemic. COVID-19 deaths are disproportionately afflicting working-class people, particularly Black, Latinx, and Indigenous people. The case for universal healthcare through a publicly-funded Medicare for All has never been stronger.

As income disappears, the rent — already too high — has become impossible for many to pay. The threat of eviction is with many of us every month. Even if eviction has been stopped by a temporary moratorium for some of us, we see our rent piling up each month so that we will be evicted anyway when the moratorium ends. We need a federal emergency housing relief program that helps people make their rent and mortgage payments during the emergency. To fix the fundamentals of the housing crisis requires a major investment in public housing, this time not just as segregated housing for the poor but as high-quality mixed-income developments that include middle-income workers and professionals.

Congress and the president are responding to the economic collapse so poorly that the nation is falling into a depression. A poll this week reported that 50% unemployed workers, 8.3 million people, were unable to cover their basic expenses in August.

Trump and Biden rely on private enterprise alone to pull us out of this economic hole. Their public economic recovery spending proposals feature corporate welfare grants, loans, and tax breaks that will supposedly trickle-down to working people as new jobs. But with working-class consumer demand depressed, it is too risky for corporations to make job-creating productive investments. Instead, they will again invest their stimulus money in stocks, bonds, and derivatives, just rearranging and further concentrating who owns the productive assets we have rather than creating new ones.

Our alternative is large-scale public investment in new public enterprises and services to benefit the working-class majority. Our ecosocialist Green New Deal will create 30 million jobs in manufacturing, construction, transportation, energy, and agriculture to rebuild our production systems for zero-to-negative carbon emissions and 100% clean energy by 2030. It provides for a Just Transition of up to five years wage and benefits maintenance for workers displaced by this economic transition, but few will need it for very long with all the new jobs that will be created.

We create 8 million more jobs with an Economic Bill of Rights to a living-wage job, a guaranteed income above poverty, affordable housing, universal health care, lifelong tuition-free public education, and a secure retirement for every senior by doubling Social Security benefits.

The two corporate parties, who represent their Wall Street and big business donors, continue to undermine the rights of workers and let employers get away with breaking labor, health, and safety laws. It is time to repeal repressive labor laws, starting with the Taft-Hartley law that restricts labor’s ability to organize, act in solidarity, and engage in political activity. We need to enact new laws that enable union organization, including card check union recognition and the repeal of anti-union “right-to-work” laws.

We call for a Workers Bill of Rights, including workers rights to unions, to living wages, to portable defined-benefit pensions, to information about chemicals used at work, to refuse unsafe work, and to participate in enterprise governance. In order to increase economic security and strengthen workers’ power, we must replace employment-at-will laws, which let employers discharge workers for any reason or no reason, with just cause termination laws, where workers can only be fired for nonperformance or economic reasons. We must extend constitutional rights into the workplace, including free speech, association, and assembly, and freedom from warrantless employer surveillance, search, and seizure.

Even before the pandemic health and economic crisis hit, three super-rich Americans owned more wealth than the bottom 50% of the population, who earn a poverty-level median income of $18,000 a year.

Now, mounting COVID-19 deaths, economic depression, accelerating economic inequality, and climate collapse are all reasons to restructure our economy into a socialist economic democracy where the working-class majority is empowered to protect its interests and receive the full value of its labor. The first step is the ecosocialist Green New Deal for economic recovery as well as climate recovery.

The post A Green New Deal for Workers first appeared on Dissident Voice.

Cuba: From the Moncada to the Front Lines of the Pandemic

Santiago de Cuba. Photo: Bill Hackwell

Today Cuba celebrates the 67th anniversary of the assault on the Moncada and Carlos Manuel de Céspedes barracks that mark the beginning of the Cuban Revolution. From this beginning, Cuba’s altruistic view of making the world safer and healthier began.

It has developed into a society that gives everything it has without expecting credit. There are hundreds of examples of this; for instance, what took place in 1986, after the nuclear catastrophe of Chernobyl, when blockaded Cuba took in over 20,000 young cancer victims and their family members from 1989 to 2011 providing medical care, schooling, clothing, food, accommodation, playgrounds – all free of charge.

Another story worth remembering is one of forgiveness in 2007 when Mario Terán, the Bolivian sergeant who murdered Che Guevara on October 9, 1967, was operated on for free by Cuban doctors who restored his vision in a hospital donated by the Cuban government to Bolivia and inaugurated by President Evo Morales in the city of Santa Cruz de la Sierra.

And now Cuba is on the world stage in the midst of this dangerous global Pandemic and Cuba is continuing to save lives, while the US government and its media, instead of being constructive in the battle, have intensified the campaign to discredit Cuba’s collaboration. The misinformation is not surprising from a country whose president’s main vocation is preaching an endless stream of lies.

Even Trump’s faithful followers must be starting to see that there is a contradiction in how the richest country in the world has not been able to put any brake on the virus, is accumulating the highest number of infections and deaths, with no end in sight, while attacking Cuba, a nation that not only has been able to control the pandemic but has extended their full solidarity to other nations.

Why the Trump administration puts priority on discrediting Cuba’s international missions abroad that save lives instead of focusing on the social and human cost in the US is mindboggling and criminal. Trump, his anti-Cuba friends in Florida, and the mainstream media are mixing up a concoction of ignorance with malicious intention, never mentioning that Cuba has flattened the curve of the virus and has had only one death in three weeks.

All the empty words we hear about the Cuban Medical Brigades going to other countries being forced labor is not only without proof but fails to explain why there are many more medical professionals who volunteer to go than openings. Furthermore, the White House, the State Department, and the media fail to mention one word about the 60-year-old US blockade and its impact against the island that causes unnecessary suffering for the Cuban people. As we have become accustomed, the Trump Administration likes to throw things at the wall to see what sticks.

A few days ago, Kenneth Roth, the executive director of Human Rights Watch, an organization with a long history of parroting the official line of the US,  jumped on the bandwagon with a tweet, “Cuban doctors deployed abroad offer valuable service but at the expense of their freedoms”. At least Mr. Roth admitted that Cuban doctors offered valuable services but Roth offered no proof about what he meant. He continues, “They can be disciplined for being friends w/ people who hold hostile or contrary views to the Cuban revolution and face prosecution if they “abandon” their jobs. This is the Executive Director of an international so-called human rights organization talking with no examples.

Cuba, with a little more than 11 million people, has more than 95,000 doctors, 9 for every 1,000 inhabitants, and more than 85,000 nurses that are part of the 492,000 Cuban health professionals according to the latest Statistical Yearbook at the beginning of 2019.

According to the Pan American Health Organization (PAHO), the first brigade of Cuba health professionals to provide services abroad was in Algeria in 1963. Since then, more than 400,000 professionals have served in 164 countries in Latin America and the Caribbean, Africa, the Middle East, Asia, and even Portugal.

These services, popularly known as “medical missions,” include sending health professionals to countries that officially request them from the Cuban government. And those who go do so voluntarily because they are part of a society that puts human lives at the center. They leave their families behind for a just cause but they also know that the Cuban government will take care of them.

Cuba is so respected around the world that recently eight Cuban Scientists were chosen as Advisors for the World Struggle against COVID-19 as part of an Inter-Academy Panel (IAP). In 2000, the IAP founded the Inter-Academy Council (IAC) and the Inter-Academy Medical Panel (IAMP).  Currently, membership includes 140 national and regional Academies of Science, including all branches of science, engineering, and medicine from around the world.

Despite the slander, Cuba continues to extend its solidarity with great pride. Currently, there are three thousand members of the Henry Reeve medical brigades (designed to fight pandemics and natural disasters) who are on the front lines of the pandemic in 37 countries with 43 brigades.

But the attacks never quit.  On May 8, 2020, the U.S. Agency for International Development (USAID) added another $2 million to undermine the work of the brigades and a month later, head Cuba hater Marco Rubio joined other Republican Senators and presented a bill to “punish” countries that sign agreements with the Cuban government to receive this support. Rubio’s credibility has been suspect ever since he was caught in his own lies by claiming his parents ‘came to America following Fidel Castro’s takeover’ of Cuba when, in fact, they came to the US in 1956, three years before the revolution during the repression of the US-backed Bautista regime.

One would think that government officials in Florida like Rubio would be focused on containing COVID-19 in their state that has become an epicenter of infection rates and deaths instead of being fixated on tarnishing the success that Cuba is having in beating back the pandemic.

Some of the medical personnel are now returning to Cuba from their missions and have been telling their experiences in their own words to the people through video conferencing, welcomed by President Miguel Diaz Canel.

Dr. Edelsy Delgado, an Intensive Care specialist from the Gustavo Aldereguía Hospital in Cienfuegos, kept a journal during the three months he spent in Andorra. He said upon his return “Believe me, we represented Cuba at the highest level.”

Leidisbet Lopez Cantero, a nurse from Camaguey, was the flag-bearer who couldn’t hold back her tears when she got off the airplane that brought her to Havana and saw her mother and son speaking of her in the welcoming video.

Dr Michael Cabrera Laza, head of the group of five distinguished consultants in Nicaragua, was deeply moved as he spoke of traveling through all 17 regions of Nicaragua, and finding in absolutely all of them the marks left by some Cuban doctor or teacher or the presence of some community leader trained in Cuba. “And in every action that we carried out, Fidel was there.”

Nurses Francisco Gonzalez Prada of Sancti Spiritus, Liliana Martinez of Holguin, and Aldo Moreira of Camaguey, who were all part of the Antigua and Barbuda brigade testified about their own feelings when they saw the positive changes in how their patients felt when they found out they were being cared for by Cubans. “I didn’t make a mistake; I am right where I should be.”

Cuba is right where it should be without hesitation.

The American Teaching Hospital: School for Psychopaths

Medicine has changed. We used to be a calling that catered to the public welfare, and our prime consideration was the patient. Now we are a business, and some of us practice as impersonal corporations, with the bottom line the profits, not the well-being of the patient.”

— From The Doctor, by Dr. Edward E. Rosenbaum, 1991

The most shocking thing about the neoliberal health care model is not that it bankrupts and murders hundreds of thousands of Americans each year, but that vast numbers of physicians continue to support it. The insatiable depravity of the anti-single-payer virus has metastasized throughout every organ of the American teaching hospital, an institution which has betrayed its sacrosanct purpose, and which increasingly inculcates residents with the pernicious idea that good health care is a privilege and not a right.

The teaching hospital has become a dangerous place, not only for patients, but also for trainees, who are being forged into physicians without having been inculcated with a respect for basic principles of medical ethics. In this way have American physicians largely been reduced to an army of automatons trained to make money for the medical industrial complex. Indeed, it should come as no surprise that many residents lose themselves in a pitiless sea of soulless careerism, as they are immersed for years in an environment where they are beholden to, and at the mercy of, rapacious interests that place profit-making over all other considerations.

The teaching hospital is to health care what the ballet academy is to ballet and the music conservatory is to the symphony orchestra. All who covet this career must pass through its gates, and the values it imparts to its pupils form the basis of the light — or the inexorable darkness — that will assuredly follow.

Knowing that patients are often confined to extremely narrow networks, it is standard practice for teaching hospitals to arm-twist patients with inferior insurance into being medical models during physician office visits. This underscores the sociopathy of the contemporary teaching hospital, and serves as a metaphor for how these institutions have become inhuman machines that harm patients and sully the souls of their trainees. Cornell Dermatology, a department that could win an award for teaching residents how to coerce patients with inferior insurance into being clinical teaching tools, takes great pride in their villainy, writing on their website:

In addition to basic and clinical dermatology training, we strive to instill ethical behavior, compassion, communication and the recognition that we are here to serve our patients.

Residents that are the most amenable to the dictates of unscrupulous attendings position themselves to become chief resident or to be awarded a prestigious fellowship. In the American teaching hospital, this is the only thing on the mind of most trainees.

It is incontrovertible that the multi-tier system, the spawn of privatized health care, is incompatible with the oath to do no harm. Cornell Oncology, which once assigned me to a fellow due to my unglamorous insurance, writes on their website that “We care for the whole person and put the needs of our patients at the center of everything that we do.” Despite a blatant predilection for medical Jim Crow, Weill Cornell claims in their literature to have “a legacy of putting patients first.” In actuality, American teaching hospitals put profit-making first, research second, the attending’s comfort (vis-à-vis their desire to have a medical scribe or chaperone present in the examination room) third, the teaching of the trainee fourth, and the patient last.

In “I am a physician and I am not your enemy,” by Megan Gray, MD, the author laments the fact that her patients are wary of doctors. “I am asking you to trust that every day I put your needs above my own,” she writes entreatingly. It is possible that Dr. Gray does, in fact, put the needs of her patients above her own. Regrettably, this is often not the case, as evidenced by the fact that American physicians wrote over two hundred million prescriptions for opioids each year from 2006 – 2016, millions of our countrymen have been made addicted to psychotropic drugs, while Vioxx took the lives of roughly the same number of Americans as died in the Vietnam War.

It is clear that the physician-patient bond, regarded as inviolable for millennia, cannot coexist within the mores of privatized health care. Yet many doctors would argue otherwise. In “Being a doctor is not what it used to be,” by Raviraj Patel, MD, the author writes that “in my humble opinion, the patient-physician relationship is sacred, and the entire system is designed to facilitate that relationship.” In “To combat COVID-19, we endanger our doctors in training,” Gali Hashmonay, MD, writes of our uniquely dysfunctional for-profit apparatus, that “This system attracts doctors in training who are eager to put a patient’s well-being in front of their own.” Indeed, accepting gifts from pharmaceutical companies, performing practice pelvic exams on anesthetized patients, not disclosing long-term chemotherapy side effects, getting patients addicted to drugs (formerly benzodiazepines and barbiturates), imposing unwanted observers on patients during their physician office visits, pushing unnecessary surgeries, and ignoring do not resuscitate orders are some of the many things that residents have to look forward to when training at our esteemed teaching hospitals. After the corporate lexicon of “humanism,” “patient-centered care,” and “compassion” are stripped away, blind obedience is the attribute most coveted by teaching hospitals when interviewing prospective residents.

By refusing to acknowledge that corporatization has been a catastrophe, anti-single-payer physicians have sacrificed their autonomy to the devilish whims of the private health insurance companies, which have usurped the medical decision-making process. They have also sold their souls to the pharmaceutical companies, which continue to corrupt medical knowledge and foment quackery; and to hospital executives, who treat doctors as if they were employees at an investment bank.

The successful Cuban response to the pandemic underscores the fact that money and technology are useless when profits are placed over human lives. Vietnam, also a poor country with limited resources, has likewise mustered a stronger defense against the virus than the Beacon of Liberty. Cuba’s health care system is so robust that they have continued to send teams of doctors abroad, even in the midst of the pandemic.

Successfully completing a residency is analogous to being awarded a black belt in karate. Without a sense of compassion and virtue, such an individual is destined to become a danger to themselves, and a danger to others. As profiteering and the multi-tier system have become normalized in the American teaching hospital, this can only result in the commodification of the patient in the mind of the debased trainee.

In “5 things that make U.S. health care great,” by Suneel Dhand, MD, the author posits, without satire, that “A homeless American entering the doors of a hospital with an acute medical issue — be it sepsis, a myocardial infarction, or a stroke — will get better care than a rich person almost anywhere else in the world.” Writing for KevinMD, Kent Holtorf, MD, concedes that “The U.S. far exceeds any nation in expenditures for insurance administration, where the essential means of cost control is denial of service and rationing of care via ever increasing complex treatment approval systems, resulting in spiraling costs.” He then concludes:

A free-market system is shown to be the only reasonable method of reform that addresses the true underlying problems of the U.S. health care system and effectively lowers health care costs, allowing for universal insurance coverage for most everyone so any reasonable person — doctor, patient, Republican or Democrat — could support.

Not to be outdone, Kevin Tolliver, MD, asks In “A framework to understand universal health care:”

At its core, universal health care forces healthy people to pay for others’ medical care. Is this fair? Why should an active, healthy-eating, non-smoker pay for health care for an obese, sedentary diabetic who chain smokes all day?

In “Corporate games have ruined the health care system,” Osmund Agbo, MD, acknowledges that “When an insurance executive is making a seven-figure bonus, it’s very clear his loyalty lies somewhere else outside the interest of regular Americans struggling to pay an infinitely rising monthly premium.”  He then informs us that “I am not a fan of socialist medicine. On the contrary, I am a firm believer in the free market enterprise system.”

Where does all of this irrationality and deranged thinking come from? Surely, the media has played a role. And yet we cannot discount the deleterious influence of the teaching hospital, which far more than medical school, profoundly shapes an impressionable trainee’s sense of right and wrong. Polluted and defiled by the pathogen of amorality, the fallen wallow in the plague wards of neoliberalism, banished from the world of compassion and rationality, and forever condemned to live out their days enveloped by a shroud of blindness.

Let us recall Pope’s haunting words in An Essay on Man: Epistle II:

Vice is a monster of so frightful mien,
As, to be hated, needs but to be seen;
Yet seen too oft, familiar with her face,
We first endure, then pity, then embrace.

Only by collectively acknowledging that health care cannot be sold as cars, kitchen appliances, and soap are sold; that it is the doctor’s sacred duty to treat all patients equally, regardless of their ability to pay; and that medical ethics can only flourish in a nonprofit socialized system, can we take this desperately needed step in reclaiming our humanity. For too long have American teaching hospitals been bastions for every form of knavery, perfidy, and skulduggery. These institutions must cast off their shackles of corporate thralldom, and join the fight to restore dignity and honor to American health care.

My Experience with Hospice, Inc.

One nurse told Clay, “I’ve given him the highest dosage I can. It’s enough to kill a horse. Most hospice patients die from morphine, but I can only OD him within an acceptable margin of error.”

— From Christopher Bollen,  A Beautiful Crime, 2020

In this age of coronavirus, it has become abundantly clear that Western culture has little respect or reverence for its elders.  Deaths of the elderly seem of no account and only to be taken in stride. Such an attitude has increased the opportunities for the hospice/medical industry as it profits off the expendable bodies of older, vulnerable human beings. For me, that expendability was brought abruptly into focus when my mother, aided and abetted by my siblings, was quickly dispatched by large doses of morphine:  even at 93-years-old, way ahead of her time to die. My brother and sister-in-law had prominently displayed her “Do Not Resuscitate Form” on the front of her refrigerator for months—and Hospice Inc. efficiently obliged them.

The hospice movement had some thought-provoking beginnings, at least the modern version.  Of course, the good offices of monks and nuns had cared for the dying in medieval times and before. In the modern version, Dame Cicely Saunders is credited with beginning the movement with her London hospice in 1967. She was nurse, social worker and doctor, and dedicated her (much-decorated) life to helping the terminally ill. Saunders brought compassionate (“palliative”) care to patients’ last days, advocating they die in their own time, and “naturally.” She did, however, introduce the use of morphine to ease pain. Her philosophy was somewhat different from America’s hospice pioneer, Florence Wald, dean of Yale nursing. Wald, in 1974, brought “assisted suicide” and “euthanasia” to her Connecticut hospice. What has evolved in the American hospice industry seems to be a very successful melding of the image of Dame Saunders’ “compassionate” care with the use and apparent abuse of assisted suicide and what author and former hospice nurse Roger Gantz calls “stealth euthanasia.”

A 2014 Huffington Post study found that once Medicare introduced a hospice benefit in 1983, the hospice industry burgeoned into (by 2014) a $17 billion industry. In that year, one million died under hospice “care,” and nearly half of all Medicare patients died as home or institutional hospice patients. The study reported hospice “marketers, doctors, [and] rehab centers” trolling for ill (enough) patients for their purposes. The now for-profit business is publicly traded and receives little government oversight, regulation, or inspection. The industry is also rarely punished when lawsuits or investigations claiming wrongdoing are brought. Many patients and their families never complain—but a 2017 Kaiser News study analyzing 3200 complaints filed against hospice companies over five years, found that with 75% of companies who did receive complaints, none suffered punishment.

There is definitely a host of problems that could bring complaints. In 2014, a Washington Post report found that hundreds of hospices did not provide promised care; and in 2012, at least one in six had not. In 2019 the Office of the Inspector General found millions of dollars of hospice Medicare fraud, and a “task force” was formed. Also on the federal level, US Health and Human Services did a study showing that between 2012 and 2016, 80% of hospices had “deficiencies,” with 20% having “serious” deficiencies. And in 2018, statnews.com found that in 2006 Medicare had paid out $9.2 billion for one million hospice beneficiaries, and in 2016, that grew to $16.7 billion for 1.4 million beneficiaries. They cited a Texas nurse in their report who gave “high doses of morphine” whether “a patient needed it or not,” to justify getting “higher hospice payments.”  And they reported the case of a woman with dementia being signed up a year before her scheduled demise. For that, in a rare outcome, the head of the hospice got six and a half years in federal prison—for her treatment, and for his $20 million scheme to sign up people who were not dying.  Most complaints made to or about hospice are ignored. That would certainly be my experience:  my complaint was met with denials, lies, and offers of bereavement counselors.

In looking through the hospice patient cases presented on hospicepatients.org, collected by Roger Krantz, it’s clear that there is a definite pattern to how hospice operates in securing and then “treating” their patients. One case I read involved a woman professional whose 60-year-old boyfriend was basically hijacked by his sister and her husband, apparently so they could have access to his money. It began by the man needing rehab, and then changed to his health care providers declaring him “terminal” and placing him in hospice. A health care provider, under today’s protocols, identifies you as terminal if they decide you have six months or fewer to live (a very iffy determination). He had trusted his sister with his power of attorney after he had experienced a “depressive episode” and was placed back in hospice after having been upgraded to rehab for a time. His sister placed him in hospice, where, to his girlfriend’s dismay, he was given zyprexa—a stroke inducer. His girlfriend was kept away from him as his condition worsened, and she was told he had “dementia” (a typical hospice move). When the girlfriend succeeded in getting him back to rehab, he improved, but his sister was furious.

The sister was able to suddenly move her brother to a hospice house, where the girlfriend was told he had eight days to live. The hospice nurses stopped his IV, and told the girlfriend he would now receive only “comfort [palliative] care.” The nurses also had been “warned” by his sister about the girlfriend, and said she “was in denial” (another hospice bullet point).  When she pressed on and was able to get him to eat and drink, his sister was furious, and said the girlfriend got him “agitated”—causing hospice to re-drug him.  The girlfriend’s questions were met by “blank stares.” He was given meds for pain, although he was not in pain.  The girlfriend told the doctor the man should not be there, and the sister “flew out of the room in rage!” At that point, they upped the morphine he was being given.  The girlfriend was told without holding his POA (power of attorney), there was nothing she could do.  She tried reasoning with his sister, and soon thereafter got a “vicious letter” from the sister’s husband which said she was “venomonous” and “in denial.” The sister sent her an email informing her of his death.

The experience of this woman is not at all unique. Time and time again, hospice agencies exploit vulnerable patients and ignores any protest they might get from concerned family and friends. My experience with hospice was a nightmare. It was not an anomaly. After I discovered that was the case, it was a comfort, (“I’m not crazy!”) but also a horror to find a very widespread pattern and problem. My mother was a very independent and feisty lady—in very good health for most of her life. At 91, she fell in her kitchen, breaking a finger and shattering her pelvis. She was hospitalized and then placed in rehab in a nursing home where she successfully recovered her mobility and went home.  I gradually became aware that my brother and sister-in-law, visibly upset when my mother left the nursing home, had developed a long-range plan not atypical of many children of elderly parents, not for control of her money really, but apparently for the convenience of not having to deal with their elderly mother.  My brother had my mother’s POA and was the sole executor of her will, and thus was able to solidify his control over family decisions.  He and his wife, a 22-year volunteer for hospice, also secured the loyalty of my two sisters, who stopped questioning any of his decisions, particularly about my mother’s health care.

The problem was that I had been her primary caregiver for over a year and a half, there every day, taking care of most of her needs—eye drops, pills, errands, meals usually, and also taking her to doctor appointments, etc.  When I questioned my (younger) brother’s decisions, he began a campaign to separate me from my mother’s care.  This was done by not so subtle assertions to my family, and beyond, that she was not “safe” with me at home, that I was “over my head.” My input into my mother’s care was shut off—my brother and sister-in-law refused to speak to me—and it was easy for them to solve any of my mother’s objections by drugging or ignoring her.  This was especially true once my brother and his wife instituted their new, long-term “palliative” medical regime for my mother.  My hospice veteran sister-in-law told the family that “palliative care” would “mean no change in her care,“ and “assure Mom’s remaining days are comfortable.”   When it was apparent she was developing difficulty bathing and cooking for herself, and had to take two trips to the hospital to treat anemia resulting from the blood disorder myelodysplasia, I began to think of ways to get help to improve her home care.  But I was pre-empted.  My sister-in-law had already arranged a hospital-style bed for my mother, something my mother (who was fully coherent and lucid right up until her death—unless heavily drugged) repeatedly and emphatically said she did not want.  The day it was delivered she was heavily dosed with lorazepam and morphine in case she got “agitated.”

The new regime for my mother included hiring numerous home health aides, done without my prior knowledge much less consent. Her doctor, who had spent little time examining my mother, signed onto the new plan. I questioned the need for what they called her new palliative care regime, which had my mother receiving no showers or baths, sitting in unclean clothes, having an unhealthy diet, being drugged into very long periods of sleep, and receiving no treatment for her urinary infections. All the aides were required to sign a letter promising to speak only to my brother and his wife and not to me, about any aspect of her care.  One of the health aides, a woman with 26 years’ experience, told me my mother’s health was not bad enough to require palliative (hospice) care. She also warned me that if hospice came in, she’d be dead within a week. My mother was almost always alert, and her diagnosis of myelodysplasia was not necessarily dire. My observation was that she was still as active as she could be, cheerful and not in much pain. When that experienced aide who objected to her palliative care would not sign my brother’s letter, he fired her.

According to hospice care reformer and author Roger Krantz, for patients under hospice care, the line between so-called palliative care—“pain relief, symptoms management”—and “imposed death” has blurred as hospice and palliative care groups became “heavily funded.”  Palliative care is supposedly a “niche” in medicine for treatment of pain.  But, as with my mother, when every patient is sedated because they’re defined as “agitated,” that’s not what palliative care is supposed to be.  Krantz asks, “Is it ‘palliative’ to refuse to treat treatable medical problems?”  And then just “anaesthetize and kill—?”  In some cases, families are led to expect palliative care, but get no treatment at all.  A woman in New York City who recounted her experience in a 2018 New York Times article, said their family was promised 24/7 oversight by a doctor and 24-hour service by a nurse by hospice, for their father, but were not told it depended on “staffing levels” whether or not her father got “palliative care.”  He slipped into a coma before they could say goodbye.

According to author/reformer Roger Krantz, there are apparently thousands of patients being cheated of competent and humane treatment.  A father of two daughters died under hospice care because his regular lung medication was refused him against his stated wishes.  He was given no food or water—just morphine—killing him in a few days. Another man had heart problems, but not life-threatening.  After being taken to a hospice facility, he gradually diminished, and died in a few days, after being given morphine every 15 minutes. [!]  And in the account referred to earlier, a 60-year-old man in rehab became deathly ill in a hospice institution after being given dangerous amounts of morphine instead of treating his actual medical condition.

It is an all too common experience for families of hospice-bound patients to be misled and given misinformation at all points of the process. It is also common to be treated with coercion, hostility and intimidation. For my mother’s admissions/information visit by Hospice Inc., my sister-in-law announced that a “palliative care nurse” would be coming to my mother’s house (September 19, 2019) to “check over” my mother, answer our questions about hospice and discuss whether or not my mother should become a hospice patient. The hospice nurse began by explaining the Hospice Inc. program, with heavy emphasis—and a handout—on the drugs they administer via visiting nurses: Tylenol, prochoropenzine (for vomiting and psychosis), lorazepam (for anxiety), and most especially, morphine. I learned that day that my mother had already been taking morphine for some time, presumably part of her “palliative” care.  My questions about how things worked, who made the decision to have Hospice Inc. come in, and so on, were answered politely by the admissions nurse, at first, with her stressing that they would work “hand-in-hand” with her doctor to have treatment “pain-free and with dignity.” But she also said there would be no (more) palliative care.  My mother was “with Hospice, when no treatment is done.”

My sister-in-law punctuated my questions with sighs and groans and throwing up her hands, along with comments like, “Oh, she’s just a distraction.” My mother was there at this meeting, heavily drugged with lorazepam (and maybe morphine), and half-dozing, but awake.  She and I exchanged grimaces a few times, because she had made it clear to me on a number of occasions—when she was fully cognizant and coherent—that she didn’t think hospice coming in was necessary.  When I asked who made the decision for her to become a Hospice Inc. patient, the nurse said “the patient—the family—her health proxy.” My older sister held the health proxy, but my brother said he was her advocate. And when I asked what if some of the family disagrees?  At that point, the nurse turned her back on me, and related only to the people who were busy yelling at me that I knew nothing and “lived in my own world.”

The nurse suggested a “family meeting” to work the whole thing out. My sister seemed dazed and kept saying she just wanted information. I told my brother and his wife that I was opposed to Hospice Inc. coming in at that time.  When I told the two of them they do not control everything, my brother said, “Yes, I do,” and moved as if to strike me, putting a fist up to my face. His wife told him “no.” But then she stood up, went behind my chair, and using both hands, shoved me forcibly into it. Beyond disgusted, I told my mother goodbye and left. I encountered the nurse outside, and told her the situation “was not over.” She said nothing. She did not tell me that the Hospice Inc. admittance papers were already prepared, and that within minutes after I left, my confused sister, my mother’s health proxy, had signed them all. The “admissions” procedure, characterized by lies, misrepresentation and coercion, was accomplished.

Hospice agencies have become notorious for misrepresenting what’s to come, to patients, and to family. As noted earlier, in the case of the woman with a boyfriend in rehab, she was totally misled about what would happen with hospice, and more importantly, she was totally helpless to remove him when she saw what was happening. In another case, a daughter thought her father’s heart problems were treatable, but he “diminished” when placed in a hospice facility, a place one doctor had warned her had a “license to kill.” After morphine doses, he died after a few days there. The 2018 Times article cited earlier, writing of “not the good death we were promised,” makes clear that the woman’s father did not receive anywhere near the care hospice promised with a resulting nightmare for her as he went into a coma. And in 2014, the Huffington Post reported on what happened to Evelyn Maples, whose family was horrified to watch her “overmedicated.” She had not given her consent, although capable of doing so—her family was misled about her treatment, and they were unable to get her out of hospice “care.”

After I found out my mother was officially a patient of Hospice, Inc., I checked the medical notations done by the aides, and found my mother was being given 0.25 ml of morphine three times a day, by Friday the 21st. Shortly after that, Nurse “Naomi” was administering 0.5 ml every two hours, with doses of prochloropenzine. (My brother’s home health aides also gave her morphine.) My mother’s condition very quickly deteriorated from being alert and seeming fine, when she was allowed to be awake, to just weeks later, being a vegetable lying with her mouth open—, and given no food, bathing, and little water. Just the morphine. I was alarmed at her rapid downhill slide. She and I had had no time to talk, to say goodbye. On Monday the 24th, I finally convinced my older sister that we should call Hospice Inc. and see if they would ease up on the morphine. (My younger sister refused to believe me when I appealed to her.) We spoke to a nurse on phone duty there, and she was incredibly rude. When I said I’d like to call my mother’s doctor (her original one, back from leave) about it—she became very angry. “They’d tell you the same!” When I went to see my mother after that call, I said, out loud: “It’s way too late.” She looked barely alive.  She died two days later.

It was too late to save her from the “morphine cocktail.” As in the opening quote, as part of popular culture, it is known that morphine is hospice’s weapon of choice. “Most hospice patients die from morphine, but I can only OD him within an acceptable margin of error.”  An RN told the hospice patients organization that when her mother was given over to hospice, both her own and her mother’s wishes were ignored. The RN told the hospice nurses they should not give her mother morphine, but she was ignored. Her mother quickly began to show signs of “poisoning” as a result of the morphine. The hospice nurses told her—as Hospice Inc. told me, using almost the exact same language—that her mother “didn’t want to eat,” “would be sleeping more,” and would begin to “have trouble breathing.” When the RN objected to the morphine, the nurse turned her back on her and yelled at her, and then security took her away. [!] The RN said hospice gave her mother “a death cocktail,” and echoing my sentiments, said she “looked like a euthanized animal” when she died. Evelyn Maples, mentioned above, was over-medicated, including with morphine, even though she was “full code resuscitate.” They ignored that since hospice patients are assumed to have a DNR form.

Case after case reveals the same deadly prescription: a father died when his lung medicine was replaced by morphine; as noted, another father died in a few days after being given morphine every 15 minutes! A woman with COPD (chronic obstructive pulmonary disease) had a cut left untreated, medicine denied and died, according to her autopsy, of “morphine intoxication.” The study on statnews.com cited earlier found a North Texas nurse giving “high doses of morphine” whether “a patient needed it or not” to get higher payments from Medicare. And Huffington Post reported a former hospice doctor in Atlanta saying hospice nurses gave morphine against a patient’s will and doctor’s orders. The world of hospice continues unabated in the coronavirus pandemic. In a pbs news report, a hospice institutional manager laments that hospice patients were tending to not go to a hospice facility, but to just stay at home. Those patients could go to a hospice facility and “be comfortable with morphine and attentive nurses and sparing community exposure.”  Attentive nurses who will gladly give a death cocktail.

When I sent Hospice & Palliative Care, Inc. my formal complaint in January of this year, the CEO gave me her “deepest condolences” in her reply, and assured me she did a “full investigation.” Of course, that investigation did not include speaking to me, or to the veteran home health aide who voiced grave reservations about their treatment. She also, unsurprisingly, put all the responsibility on my mother’s physician and refused to reveal any medical records.  She also said my brother had my mother’s health care proxy; something easily disproven by the fact it was my older sister who signed the admission forms.  He did not have it, but since according to her he did, she said she therefore considered him the one who was supposedly the “point person” in charge of giving me information.  Unfortunately, he had not been really speaking to me in some time. All the wonderful written information that she told me Hospice provides, I never saw. She also lied about their 24/7 availability for families, although they were available to be hostile to questions.  She was sorry if I “felt the Admissions Nurse did not include me”; she denied that was her intent.  Oh?  Turning her back on me?  Not speaking to me? Lying to me?  And the CEO (so appropriate, a CEO!) insisted “the patient,” my mother, “received a gradual dose change of ‘pain management medication’ based on her physician’s recommendation.” This was a lie—I saw the aides’ notes on the rapid increase of morphine and could also see the results. My response to her response addressed the above, and was, of course, never answered.

She obviously thought I could be fobbed off with her assurance she would use “my concerns” “in staff training … so no one will feel left out.” And the kicker: “I hope you will consider using our bereavement services that are available to family members of all Hospice patients.” Yes, that would do it. “Bereavement” doesn’t begin to touch my feelings towards Hospice Inc. and their part in killing my mother with morphine, with my siblings’ compliance. I knew that my protest would not result in any satisfactory action, but as I said in that complaint, I wanted them to know “that not everyone will simply accept the sort of cruel, callous and incompetent treatment” that my mother received. And, of course, it’s evidence for this article.

Hospice Inc. deals in lies, coercion, manipulation and greed. And they get away with it. As noted, Kaiser News reported in 2017 that a five-year study found 3200 complaints filed against various hospice organizations which were rarely punished. Police, prosecutors, county and state health officials, the DEA—complain all you want, they refuse to go there.  And a wrongful death suit is very difficult to win: you have to show how you suffered a loss of income (!), among other requirements. There are privacy laws. The media is very hospice-positive: “They do much more good than bad.” Most victimized family members just stay silent, and if they do speak up, they get nowhere. In California, in 2019, Steve Lopez’ mother Grace died after neither her medications nor her hospice nurse showed up from the hospice agency.  The California Public Health Department “could not validate his complaints,” nor did they get around to, as promised, investigating further. A Kentucky man who complained about his wife’s death being caused by “suspicious use of a drug [morphine] pump” was told by hospice lawyers that his “trauma had colored his perception.”  In case after case investigated by Roger Krantz, complaining family members are told they are “not able to deal with death.” This is what Hospice Inc. told me in suggesting their bereavement counselors. My younger sister has repeatedly said to me that I obviously have a hard time dealing with death.  Yes, I do.  Especially when, for my mother it was unnecessary, premature and made possible by her own children.

The elderly are not revered in Western society. Oxford economist Jeremy Warner finds the virus beneficial for “culling elderly dependents.” Scotland’s George Galloway writes scathingly of British treatment of old people which, in the midst of the pandemic, is encouraging an increase in “Do Not Resuscitate” orders. “Euthanasia by stealth and contrary to law, has washed up on our shores.” And our own local Hospice Inc. is eagerly seeking new patients. The CEO says her staff “performs like true angels,” providing bedside care, social work and “spiritual care” (bereavement).  She says Hospice Inc. reduces the strain on the healthcare system.  She then tells us it is important people know Hospice is there: “We’re still taking care of people at home so they don’t have to go to the hospital to die.” They can die by morphine overdose in the comfort of their own home. They do not resuscitate.

We are Being Held Hostage to Unfettered Capitalism: not to Trump, Racism, the Chinese or COVID-19

As the US continues to be ravaged by the SARS-CoV-2 pandemic, the country remains in lockdown, a morbid irony of which is that we appear to have traded COVID-19 deaths for suicides. The catastrophe has laid bare the cruelties of neoliberalism, yet this has not stopped the media from unleashing a barrage of misinformation, blaming the disaster on the president, racism, and the Chinese, interspersed with other creative attempts at scapegoating. Indeed, the pandemic appears to have coincided with a peculiar outbreak of epidemiologic hallucinations.

Many have been happy to blame the president for the country’s disastrous coronavirus response. In a Common Dreams article titled “As Nation Mourns 100,000 Dead, Trump Goes Golfing,” the authors write, “President Donald J. Trump, who has faced mounting criticism for his administration’s mishandling of the coronavirus crisis and his lack of empathy throughout, decided to leave the White House on Saturday to play golf.” “Trump going golfing shows a tone-deafness and a lack of empathy,” the authors chide.

A Common Dreams article by Julia Conley blames Trump for Americans that refuse to wear masks, referring to these miscreants as “Trumpian anti-mask jerks.” “This Is Trump’s Fault: The President is Failing, and Americans are Paying for his Failures,” which appeared in The Atlantic, pushes a similar faux-left argument. In an article that appeared in Mother Jones titled “Trump’s 100 Days of Deadly Coronavirus Denial,” the authors write that “The severity of the moment has often escaped the president, who seems intent on solving the crisis with spin and bluster—along with a healthy dose of magical thinking and buck-passing.” Riding this wave of philistinism, Michael D. Shear and Donald G. McNeil Jr. write for The New York Times:

For weeks, President Trump has faced relentless criticism for having overseen a slow and ineffective response to the coronavirus pandemic, failing to quickly embrace public health measures that could have prevented the disease from spreading.

Recent polls show that more Americans disapprove of Mr. Trump’s handling of the virus than approve.

It is true that the president has failed to be transparent regarding the lack of testing, ventilators, and personal protective equipment (PPE). He has also repeatedly, and without scientific evidence, promoted hydroxychloroquine, which he even claims to be taking himself. Yet the president’s lexical inanities cannot alter the fact that the American health care system is not run by the White House at all, but by corporations which have long placed profit-making over all other considerations.

While lampooning the 45th president may fill liberals with a perverse sense of schadenfreude, the fact is that the present health care system is precisely the very system that Trump inherited from his predecessor. In fact, this is the same diabolical system we have had for over thirty years.

When not blaming The Orange One, China has also served as a convenient scapegoat. Writing for SILive.com, Tom Wrobleski posits in “Here’s who to Blame for Coronavirus: Communist China,” that “A leaked report from the so-called ‘Five Eyes’ intelligence alliance – consisting of the U.S., U.K., Canada, Australia and New Zealand – lays out in damning detail how the Chinese downplayed the outbreak from the very beginning, according to multiple media reports.”

The New York Post, a China-bashing aficionado, informs us in “China Admits to Destroying Coronavirus Samples, Insists it was for Safety,” that “Secretary of State Mike Pompeo has charged that Beijing refused to provide virus samples taken from patients when the pandemic began in China in late 2019, and that Chinese authorities had destroyed early samples.” An article on CNN.com titled “US Government Report Assesses China Intentionally Concealed Severity of Coronavirus” further promotes this preposterous narrative. Not one to be outblustered or to shy away from scapegoating, Trump himself has attempted to lay the blame on both Beijing and the World Health Organization (WHO).

There is undoubtedly some truth to the claim that African Americans, Latinos, and Native Americans have been particularly hard-hit by the virus. (The Seattle Indian Health Board requested COVID-19 tests, and were sent body bags instead). And yet identity politics demagoguery is being used as a means to divert attention away from the fact that a health care system which allows people to die because they cannot afford their insulin will inevitably be ill-equipped to contain a pandemic.

Already, there have been efforts made to profit off of the catastrophe, as evidenced by the rash attempt to promote not only hydroxychloroquine, but also remdesivir, another drug which is being hailed as a savior yet which has likewise been inadequately tested.

The financial barriers that go hand in hand with obtaining medical care in a for-profit system can only facilitate the spread of the virus. Writing for The Nation, Augie Lindmark, MD, writes:

Long before SARS-CoV-2 dominated news cycles and hospitals alike, there were already established epidemics in US health care: namely, medical bills and uncertainty. In 2019, a third of US adults reported that their families couldn’t afford health care and 44 percent endorsed skipping a doctor’s visit because of cost. Medication affordability wasn’t much better: 29 percent of adults reported not taking a medication as prescribed because of cost.

Enter Covid-19. You could almost hear the virus salivate.

Indeed, prior to the pandemic there were Americans that were unable to get a divorce, get married, quit their job, or even work, out of a legitimate fear of losing their insurance. Insufficient and inadequate PPE will continue to endanger the lives of frontline health care workers and their families, as well as the lives of non-COVID patients that require emergent care. Furthermore, as Dr. Ashish Jha, Dr. Leana Wen, and others have noted, a lack of testing makes reopening the economy a particularly hazardous endeavor.

Taiwan, Singapore, Hong Kong, and South Korea have largely been able to keep their economies open due to comprehensive testing, widespread temperature checks, contact tracing, and universal coverage; while the Danish government implemented a scheme ensuring that most of its workforce would continue to be paid in the event that they were forced to stop working as a result of the quarantine. Commenting on the draconian lockdown measures implemented in a number of Western countries, Yoram Lass, former Director-General of the Israeli Ministry of Health, said in an interview with spiked: “In developed countries many will die from unemployment. Unemployment is mortality. More people will die from the measures than from the virus.”

It is incontrovertible that the lack of hospitals, ventilators, respirators, testing, and contact tracing, are the spawn of an oligarchy which continues to sabotage the implementation of a nationalized single-payer model. Moreover, this is the same health care system that relentlessly pushes profitable yet ethically dubious treatments, such as staggering amounts of opioids and psychotropic drugs, Vioxx, and unnecessary surgeries. With an official death toll hovering around 100,000, the US has been the country most ravaged by the virus, a testament to a health care system whose avarice is insatiable, and which is indifferent to human life.

The question is, will any lessons be learned from this conflagration of misery and despair?

Capitalism is an Incubator for Pandemics: Socialism is the Solution

A new coronavirus called “SARS-CoV-2” — known colloquially by the name of the disease it causes called “coronavirus disease 2019” or “COVID-19” — is wreaking havoc around the world. In Italy, the death toll has risen to 366 today and the country just extended its quarantine measures nationwide. In China, production has shut down at factories across the country. According to the WHO, over 100,000 cases have been confirmed in over 100 countries and the death toll is now up to 3,809 as of this writing. The stock market in the U.S. fell by 7% today and  we may be headed towards another 2008-like recession.

Reports range from 200-400 (213 per WHO and 434 per NBC News) confirmed cases of COVID-19 in the U.S., but there are likely many many more that have not been detected, as health facilities still do not have a readily available rapid test for diagnosis. The Centers for Disease Control (CDC) botched a first response, sending out faulty testing kits that required a recall. At this point in the U.S. the CDC is refusing to report how many have been tested, but we know the number tested in the US is extremely low largely due to the immense hurdles government officials have put in place. The FDA recently announced over 2 million tests should be shipped to labs by Monday with an additional 4 million by the end of the week. This could lead to a great increase in confirmed cases around the country. We are also seeing reproduction of racist, xenophobic tropes and attacks as fear of the epidemic grows.

The spread of the coronavirus is exposing all of the contradictions of capitalism. It shows why socialism is urgent.

Coronavirus in Capitalism

It is only going to get worse. The spread of the virus is impossible to stop — and this is due to social reasons more than biological ones. While doctors recommend that people stay home when they are feeling sick in order to reduce the possibility of spreading the virus, working-class people just can’t afford to stay home at the first sight of a cough.

Contrary to Donald Trump’s recent suggestions that many with COVID-19 should “even go to work,” the CDC recommends that those who are infected by the virus should be quarantined. This poses a problem under capitalism for members of the working class who cannot afford to simply take off work unannounced. New York City Mayor, Bill de Blasio recently suggested avoiding crowded subway cars or working from home if possible, but many rely on public transit. Suggestions from government leaders show their disconnect from the working class. 58% Americans have less than $1,000 in their savings and around 40% of Americans could not afford an unexpected bill of $400. So for many, staying home or not using public transit is simply not an option.

Even more people avoid the doctor when we get sick. With or without insurance, a trip to the hospital means racking up massive medical bills. The Guardian reports that 25% of Americans say they or a family member have delayed medical treatment due to the costs of care. In May 2019, The American Cancer Society found that 56% of adults report having at least one medical financial hardship. Medical debt remains the number one cause of bankruptcy in the country. One third of all donations on the fundraising site GoFundMe go to covering healthcare costs. That is the healthcare system of the wealthiest country in the world: GoFundMe.

Clearly, this is a very dangerous scenario. Already, people are being saddled with massive bills if they seek tests for the coronavirus. The Miami Herald wrote a story about Osmel Martinez Azcue who went to the hospital for flu-like symptoms after a work trip to China. While luckily it was found that he had the flu, the hospital visit cost $3,270, according to a notice from his insurance company. Business Insider made a chart of the possible costs associated with going to the hospital for COVID-19:

Of course, these costs will be no problem for some. The three richest Americans own more wealth than the bottom 50% of Americans. The concentration of wealth in the hands of fewer and fewer capitalists is part of capitalism’s DNA. But as Kate Pickett and Richard Wilkson highlight extensively in their book The Spirit Level: Why Greater Equality Makes Societies Stronger, people in more equal societies are healthier. They live longer, have lower infant mortality, and have high self-ratings of health. Inequality leads to poorer overall health.

So how does this relate to COVID-19? The main theory for these outcomes is that inequality of wealth and power in a society leads to a state of chronic stress. This wreaks havoc on bodily systems such as the cardiovascular system and the immune system, leaving individuals more susceptible to health problems. This means as societies become more and more unequal, we will see individuals more and more susceptible to infection. Capitalism’s inequality puts us all at greater risk as COVID-19 spreads.

Coronavirus (COVID-19) in Socialism

COVID-19 highlights the need for socialism to face epidemics like these. And by socialism, we don’t mean Medicare for All or New Deal liberalism. Medicare for All is not enough to face pandemics like the coronavirus. We mean a society in which human needs govern production, not the drive for profit. It’s a society without capitalists, where production and reproduction is democratically planned by the working class and oppressed. In this kind of society, we would be able to respond to the COVID-19 infinitely better than in capitalism.

In a socialist society, both prevention and responses to outbreaks of illness would change drastically. Supplies such as hand soap, hand sanitizer, and surface sanitizing wipes or sprays are in extremely high demand at this time. We are already seeing shortages of key supplies around the world. The need for profit maximization under capitalism has led companies to drastically raise their prices in this time of high demand. For example, the Washington Post has reported drastic increases in prices of products such as Purell Hand Sanitizer. Under capitalism, scarcity leads to greater profit.

Capitalism has led to a globalized system of production containing industries at disparate ends of the globe that truly depend on each other to function. This allows for a capitalist’s exploitation of a worker in a factory in China producing iPhones that goes unnoticed by an Apple customer here in the U.S.. It also allows corporations to drive down costs in one area of the world that may have weaker protections for workers. While this is beneficial for capitalists, outbreaks of illnesses such as COVID-19 highlight clear weaknesses in this system. A large portion of the basic materials used to make new medicines come from China. Since industry is so affected by viral spread, production of supplies has been drastically cut. This delays the ability for a rapid response in other countries such as the U.S..

A central aspect of socialism is a democratically run planned economy: an economy in which all resources are allocated according to need, instead of ability to pay. Need is decided democratically by both producers and consumers. With the means of production under workers’ control, we would be able to quickly increase production of these products in an emergency.

Furthermore, with the elimination of the barriers between intellectual and manual labor, increasing numbers of workers would be familiarized with the entire production process and ready to jump in where needed. In worker cooperatives within capitalism like MadyGraf in Argentina and Mondragon in Spain, workers already learn all aspects of production. This allows workers to shift to areas where extra effort is needed.

Socialism cannot exist in only one country, so a global planned economy would be key in these moments. If one country is experiencing a shortage, others would have to make up for it. This is key for reigning in global epidemics like the coronavirus: it will only be stopped if we stop it everywhere. In a global planned economy, this would be a much easier task.

Staying Home

If one does get sick, making a decision to protect oneself and others by taking time off should never lead them to have to worry about losing their job, paying their rent, putting food on the table, or being able to provide for their children. Under capitalism services such as housing and healthcare are reduced to commodities. This often presents people with the ultimatum: work while sick and potentially expose others, or stay home and risk losing your job.

Under socialism, the increased mechanization of production and the elimination of unnecessary jobs — goodbye advertising industry! goodbye health insurance industry! — would already drastically reduce the number of hours that we would need to work. We would be spending vast hours of the day making art or hanging out with friends and family.

During disease outbreaks, we would be able to stay home at the first sign of a cold, in addition to getting tested right away. In a planned economy, we could allocate resources where they are most needed, and take into account a decrease in the workforce due to illness.

Where are the Coronavirus Therapies

Currently, multiple for-profit companies are attempting to test (sometimes new, sometimes previously rejected and now recycled) therapies to see if they can treat or prevent COVID-19. While there are attempts to produce a COVID-19 vaccine, this vaccine would not be ready for testing in human trials for a few months according to Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research. Yet even last week, Health and Human Services Secretary Alex Azar refused to guarantee a newly developed coronavirus vaccine would be affordable to all stating, “we can’t control that price because we need the private sector to invest.” The statement is ironic to say the least coming from the former top lobbyist to Eli Lilly who served at a time when the company’s drug prices went up significantly.

Companies such as Gilead Sciences, Moderna Therapeutics, and GlaxoSmithKline all have various therapies in development. Each company’s interest in maximizing profits around their particular COVID-19 therapy has kept them from being able to pool their resources and data to develop therapies in the most expeditious manner possible. The state of COVID-19 research exposes the lies about capitalism “stimulating innovation.”

It is also important to note that much of the drug development deemed “corporate innovation” could not have been possible without taxpayer-funded government research. Bills such as the Bayh-Dole Act allow for corporations to purchase patents on molecules or substances that have been developed at publicly funded institutions such as the National Institutes of Health (NIH), then jack up the prices to maximize profits. A study conducted by the Center for Integration of Science and Industry (CISI) analyzed the relationship between government funded research and every new drug approved by the FDA between 2010 and 2016. Researchers found “each of the 210 medicines approved for market came out of research supported by the NIH.”

Expropriation of the capitalists would mean the public would no longer have to subsidize private corporate profits. The nationalization of the pharmaceutical industry would allow for both intellectual and financial resources to be pooled to tackle the globe’s challenges, instead of focusing on blockbuster drugs that benefit only a few. In the case of COVID-19, we would see a mass mobilization and coordination of the world’s greatest minds to pool resources and more quickly develop effective therapies. In fact, there would likely be more doctors and scientists as people who want to study these fields are no longer confronted with insurmountable debt.

Health Care in Socialism

Under socialism, the entire healthcare industry would be run democratically by doctors, nurses, employees, and patients. This would be drastically different from the current system in which wealthy capitalists make the major decisions in hospitals, pharmaceutical companies, device manufacturing firms, and insurance companies (the key players that make up the “medical industrial complex”). In the case of the COVID-19, health care would be a human right, and not a means to make money. This would allow for every individual concerned to obtain testing and treatment without fear of economic ruin. If hospitalization or quarantine was needed, a patient and family would be able to focus on what was best for their health instead of worrying whether a hospital bill would destroy them economically.

The purview of what is considered “health care” would also need to expand. An individual’s overall living situation and social environment would be key to addressing their health. This would mean a health system under socialism would address issues such as pending climate collapse. While a connection between COVID-19 and climate change has yet to be established, rising global temperatures — largely driven by 100 largest corporations and the military-industrial complex — will increase the emergence of new disease agents in the future. Shorter winters, changes in water cycles, and migration of wildlife closer to humans all increase the risk of new disease exposure.

Capitalism created the conditions of the epidemic. Capitalist “solutions” are insufficient and exacerbate the crisis, meaning more sickness and more death. Capitalism has been an incubator for the continual spread of the coronavirus. Health care under this system will always be woefully inadequate in addressing epidemics. The coronavirus highlights the fact that we must move to a more social analysis of health and well-being. We are all connected to each other, to nature, and to the environment around us. Socialism will restructure society based on those relationships.

At the same time, socialism is not a utopia. There will likely be epidemics or pandemics in socialism as well. However, a socialist society — one in which all production is organized in a planned economy under workers’ control — would best be able to allocate resources and put the creative and scientific energy of people to the task.

Six Quick Points About Coronavirus and Poverty in the US

In the United States, tens of millions of people are at a much greater risk of getting sick from the coronavirus than others.  The most vulnerable among us do not have the option to comply with suggestions to stay home from work or work remotely.  Most low wage workers do not have any paid sick days and cannot do their work from home.  The over two million people in jails and prisons each night do not have these options nor do the half a million homeless people.

One.  Thirty-four million workers do not have a single day of paid sick leave. Even though most of the developed world gives its workers paid sick leave there is no federal law requiring it for workers.  Thirty seven percent of private industry workers do not have paid sick leave including nearly half of the lowest paid quarter of workers.   That means 34 million working people have no paid sick leave at all.  As with all inequality, this group of people is disproportionately women and people of color. More than half of Latinx workers, approximately 15 million workers, are unable to earn a single sick day.  Nearly 40 percent of African American workers, more than 7 million people, are in jobs where they cannot earn a single paid sick day.

Two.  Low wage workers and people without a paid sick day have to continue to work to survive.  Studies prove people without paid sick days are more likely to go to work sick than workers who have paid sick leave.  And workers without paid sick days are much more likely to seek care from emergency rooms than those with paid sick leave.

Three.  About 30 million people in the US do not have health insurance, according to the Kaiser Family Foundation.  Nearly half say they cannot afford it.   They are unlikely to seek medical treatment for flu like symptoms or seek screening because they cannot afford it.

Four.  Staying home is not an option for the homeless. There are about 550,000 homeless people in the US, according to the National Coalition for the Homeless.  Homeless people have rates of diabetes, heart disease, and HIV/AIDS at rates three to six times that of the general population, according to the National Alliance to End Homelessness.  Shelters often provide close living arrangements and opportunities to clean hands and clothes and utensils are minimal for those on the street. Homeless people have higher rates of infectious, acute and chronic diseases like tuberculosis.

Five.  Nearly 2.2 million people are in jails and prisons every day, the highest rate in the world.  Prisoners are kept in close quarters and receive inadequate medical care.  Iran released 70,000 prisoners because of coronavirus.   Hand sanitizers are generally not allowed in jails because of their alcohol content.  Prisoners are kept in local over 3,000 different federal, state and jails and prisons, each of which has its own procedures and practices for dealing with infectious diseases.

Six.  Solutions?  For sick leave, see The National Partnership for Women & Families  which publishes several fact sheets about the need for paid sick days.  For prisons, see Prison Policy Initiative which has five specific suggestions for jails and prisons, starting with releasing as many people as possible.  New York City has developed a working paper on coronavirus for homeless shelters.  And, of course, the country needs economic justice and universally available health care.

Democrats Team Up With Trump to Maintain Disastrous Healthcare System

On Tuesday, February 4, Donald Trump delivered his third State of the Union (SOTU) address. As expected, it was filled with contradictions, falsehoods, and distortions. Among other things, Trump spoke for close to ten minutes about health care in the U.S., claiming that he “will always protect Medicare.” However, neither Trump and the Republicans, nor the Democrats can be trusted when it comes to health care.

Just last week, for example, at the World Economic Forum in Davos, Switzerland, Trump suggested he would think about cutting Medicare and Social Security to reduce the federal deficit. The Trump administration also recently announced it would take steps to overhaul Medicaid through a program ironically named “Healthy Adult Opportunity,” allowing states to choose to cut federal government funding they receive at a lump sum or block grant instead of paying a fixed percentage of costs. The goal is for states to reduce spending by decreasing health provider reimbursements, limiting drug coverage, or making it difficult for individuals to qualify for care. Trump’s plans for his 2021 budget are lockstep with his previous statements and would increase military spending while cutting Medicare and Medicaid.

This all comes from an administration that ran on a platform of protecting such programs.  As Trump told Fox News in 2015, “People have been paying in for years. They’re gonna cut Social Security. They’re gonna cut Medicare. They’re gonna cut Medicaid […] I’m the one saying that I’m not gonna do that!” Yet the administration’s most recent budget called for a total of $1.9 trillion in “cost savings” from programs such as Medicaid and Medicare.

Who Heads Government Health Programs?

Despite Trump’s SOTU remarks, his recent proposals should be no shock when one looks at who he tapped to oversee the distribution of healthcare in the United States. Seema Verma, who helped announce the “Healthy Adult Opportunity” program, serves as head administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to being appointed to her position, Verma was President, CEO and founder of SVC, Inc., a national health policy consulting company which helped drive Republican state-level Medicaid reforms while also encouraging state outsourcing to private companies converting government funding into private profits. Since taking office, Verma has been instrumental in allowing states to institute work requirements—essentially requiring Medicaid beneficiaries to prove they are working, by logging work hours regardless of computer or internet access, in order to get health care. She has also railed against universal health care, stating National Improved Medicare for All (NIMA) would “strip choice away from millions.”

Trump’s initial Health and Human Services (HHS) Secretary, Tom Price—who resigned in 2017 after it was revealed that he used taxpayer money on personal travel—sponsored congressional budgets to turn Medicaid into a block grant program. Now-current HHS Secretary Alex Azar, sworn into office in 2018, was former head of the pharmaceutical corporation Eli Lilly and played a key role in driving up prices of crucial medicines, such as insulin, to increase profits. Individuals like Azar have proven time and again that they will not work to “lower drug prices” as Trump touted in his SOTU. Instead, Azar will defend the corporate elite; his new government position puts him in a perfect place to do just that. With individuals such as these heading the US healthcare system, it is no wonder such policies are being proposed.

The Democrats Aren’t Innocent Bystanders

While some members of the Democratic Party will want to condemn or distance themselves from these efforts, it is important to note their culpability in helping create the environment for Trump’s current policy proposals. For example, cutting safety net programs that working people rely on is not new for Democrats. As The Intercept recently reported, “As early as 1984 and as recently as 2018, former Vice President Joe Biden called for cuts to Social Security in the name of saving the program and balancing the federal budget.” Biden advocated for freezing spending on “every single solitary thing in the government” including Medicare, Medicaid, and veterans’ benefits.

And Joe Biden is not an outlier. Under the capitalist system, advocating for programs of “austerity” to combat the crises that are built into the system is standard practice. Austerity is often recommended despite evidence suggesting government cuts typically worsen economic downturns. Professor of Economics, Richard Wolff, has analyzed how this system functions, arguing that in times of economic growth, austerity is capitalists’ preferred policy: it means less taxes and thus more profits for them. In times of economic downturn, however, they are the first beneficiaries of state-sponsored bailouts, which require governments to run massive budget deficits.

The cycle Wolff describes only benefits the rich—Democrats and Republicans alike play into it. Despite their rhetoric to the contrary, the Democrats advocate for austerity just as Republicans do, because ultimately they are beholden to the same capitalist interests that run the country.

It should be also noted that the entire distribution of health care under the current for-profit model allows for continued cuts and alterations to programs such as Medicare and Medicaid to occur. Dominated by the interests of the medical-industrial complex, leaders of the Democratic party have never articulated the vision that health care should be a human right and the profit motive should be removed from health care. They have never been able to collectively articulate that National Improved Medicare for All (NIMA) is the only path to a relatively rational health care system.

Obama was not only not able to garner support for NIMA, but gave up even the modest reform of a public option when advocating for the Affordable Care Act (ACA). While the ACA did expand Medicaid coverage, Democrats have attempted to frame its passage as a colossal win and this is simply not the case. The ACA mandates individuals purchase insurance from private, for-profit insurance companies, and still leaves 31 million Americans out of coverage. This has created  a situation in which being underinsured is quickly becoming the new normal. The bill was really anything but a win for the majority of Americans.

Trump also spent part of his SOTU bashing NIMA proposals calling them a “socialist takeover of the healthcare system that would disrupt the care of many “happy Americans.” One would think that today with various polls showing a majority of the public now wants Medicare for All, Democrats would oppose Trump’s rhetoric and advocate for such policy. Unfortunately, Democratic elites still refuse to accept NIMA’s popularity. Instead of getting uniformly behind universal health care, we have seen proposals ranging from strengthening the ACA (Biden) to proposals resembling a public option (Buttigieg).

Warren and Sanders have been the only two candidates who have had the courage to advocate going further to Medicare for All. Faced with conservative backlash, however, Warren has considerably back-pedaled on her Medicare for All rhetoric, now saying she would wait until at least her third year in office to attempt implementation. As for the proposed “leader” of the party, House Speaker, Nancy Pelosi, it was reported as recently as 2019 that her top policy aide was meeting with Blue Cross Blue Shield executives and assuring them they did not have to worry about Medicare for All. It appears Pelosi believes her energies would be better suited feigning progressiveness by ripping up Trump’s speeches, rather than actively opposing his poor health care policies by supporting the movement for NIMA.

Often Democrats and Republicans alike who are opposed to the NIMA claim it would be too costly. Various versions of “how we are going to pay for it?” are brought up over and over. Even if one ignores the fact that 30 years of single payer research shows NIMA would save money compared to the status quo, it is peculiar this same argument is not used when discussing funding for instruments of suffering, death, and destruction. The same conversation is never had when talking about providing tax incentives for large capitalist institutions to continue to oppress workers and destroy the planet. The same conversation was not had after 188 Democrats recently joined with Republicans to approve a $738 billion military budget—a budget which upholds the US military contributing more to pending climate collapse then 140 countries combined. The same conversation was not had after the Pentagon failed its first ever audit in 2018 and mysteriously could not account for $21 trillion dollars from 1998 to 2015.

NIMA: A Step Forward for the Working Class

As we have argued in the past, NIMA would be a large step forward for the working class. Currently close to 50% of the US population obtains their healthcare through their employers. This keeps workers in a vulnerable position when it comes to organizing in the workplace, because if a worker loses their job, they and their  family could lose health care coverage, which can be devastating for those with chronic conditions such as diabetes, heart disease, or various forms of cancer.

Not having NIMA also puts the public at the mercy of large insurance companies, hospital corporations, and pharmaceutical companies whose number one priority is profit maximization. This leads to companies trying to raise prices for the “product” as much as possible, which leaves the public in an economically precarious position. Today some 70 million Americans are struggling to pay off medical debt, and medical debt is the number one cause of bankruptcy in the country. A sudden illness in the US can mean financial ruin. A 2018 study in the American Journal of Medicine (AJM) found almost half of cancer patients studied depleted their entire life savings by the second year of treatment. The financial burden that illness can cause on working-class families under the current for-profit health care—or, put differently, the “exploitation of illness”—is nothing short of outrageous. It shackles working people and keeps them focused on struggling with not only their illness, but also their debt.

The Need to Go Beyond National Improved Medicare for All

The left needs to not only oppose the Trump administration’s current proposals, but advocate for National Improved Medicare for All (NIMA) and for health care for all as a human right. At the same time connections must be made to the dynamics of capitalism and imperialism continually benefitting capitalists at expense of us all. The current revolving door system that operates as a result of wealth and power concentration inside capitalism, allows executives from exploitative institutions to continually guide the policy of both Republicans and Democrats. This only reiterates the need to move beyond a two party system structured to benefit the ruling class. In order to take on the vested interests of the medical industrial complex and provide health care each of us wants and needs, we must overcome an economic system based on exploitation and oppression. This system damages the health and well-being not just of humans, but all life systems on our planet. Only once we can transcend capitalism will we have not only a truly just health care system, but a society that prioritizes life and health over capital accumulation.

Greece:  Suicide or Murder?

Pundits from the left, from the right and from the center cannot stop reporting about Greece’s misery. And rightly so because the vast majority of her people live in deep economic hardship. No hope. Unemployment is officially at 18%, with the real figure closer to 25% or 30%; pensions have been reduced about ten times since Syriza – the Socialist Party – took power in 2015 and loaded the country with debt and austerity. In the domain of public services, everything that has any value has been privatized and sold to foreign corporations, oligarchs, or, naturally, banks. Hospitals, schools, public transportation – even some beaches – have been privatized and made unaffordable for the common people.

While the pundits – always more or less the same – keep lamenting about the Greek conditions in one form or another, none of them dare offer the only solution that could have rescued Greece (and still could) – exiting the euro zone; return to their local currency and start rebuilding Greece with a local economy, built on local currency with local public banking and with a sovereign Greek central bank deciding the monetary policy that best suits Greece, and especially Greece’s recovery program. Why not? Why do they not talk about this obvious solution? Would they be censured in Greece, because the Greek oligarchy controls the media as oligarchs do around the (western part of the) globe?

Instead, foreign imposed (troika: IMF, European Central Bank (ECB) and European Commission (EC) — the latter mainly pushed by German and French banks and the Rothschild clan — austerity programs have literally put a halt on imports of affordable medication, such as like for cancer treatments and other potentially lethal illnesses. So, common people no longer get treatment. They die like flies; a horrible expression to be used for human beings. But that’s what it comes down to for people who simply do not get the treatment they humanely deserve and would have gotten under the rights of the Greek Constitution; however, they simply do not get treated because they can no longer afford medication and services from privatized health services. That is the sad but true story.

As a consequence, the suicide rate is up, due to foreign imposed (but Greek government accepted) debt and austerity, annihilating hope for terminally ill patients, as well as for pensioners whose pensions do no longer allow them to live a decent life and especially as there is no light at the end of the tunnel.

Now, these same pundits add a little air of optimism to their reporting, as the right wing New Democracy Party (ND Party) won with what they call a ‘landslide’ victory on the 7 July 2019 elections; gathering 39.6% of the votes, against only 31.53 for Syriza, the so-called socialist party, led by outgoing Prime Minister Alexis Tsipras, who represents a tragedy that has allowed Greece to be plunged into this hopeless desolation. The ND won an absolute majority with 158 seats in the 300-member Greek parliament. Therefore, no coalition needed, no concessions required.

The new Prime Minister, Kyriakos Mitsotakis (51), son of a former PM of the same party, in his victory speech on the evening of 7 July, vowed that Greece will “proudly” enter a post-bailout era of “jobs, security and growth”. He added that “a painful cycle has closed” and that Greece would “proudly raise its head again” on his watch.

We don’t know what this means for the average Greek citizen living a life of despair. What the “left” was unable to do – stopping the foreign imposed (but Greek accepted) bleeding of Greece; the strangulation of their country – will the right be able to reverse that trend? Does the right want to reverse that trend? Does the ND want to reverse privatization, buy back airports from Germany, water supply from the EU managed “Superfund”, and repurchase the roads from foreign concessionaires, or nationalize hospitals that were sold for a pittance and – especially – get out from austerity to allow importing crucial medication to salvage the sick and dying Greek, those who currently cannot afford treatment of their cancers and other potentially deadly diseases?

That would indeed be a step towards PM Mitsotakis’ promise to end the “painful cycle” of austerity, with import of crucial medication made affordable to those in dire need, with job creation and job security – and much more – with eventually a renewed Greek pride and Greek sovereignty. The latter would mean – finally – it’s never too late to exit the euro zone. But, that’s an illusion, a pipe-dream. Albeit  it could become a vision.

If the ND is the party of the oligarchs, the Greek oligarchs that is, those Greeks who have placed literally billions of euros outside their country in (still) secret bank accounts in Switzerland, France, Lichtenstein, Luxemburg and elsewhere, including the Cayman islands and other Caribbean tax havens, hidden not only from the Greek fiscal authorities, but also impeding that these funds could, crucially, be used for investments at home, for job creation, for creation of added value in Greece. If the ND is the party of the oligarchs, they are unlikely to make the dream of the vast majority of Greek people come true.

Worse even, these Greek oligarch-billionaires call the shots in Greece not the people, not those who according to Greek tradition and according to the Greek invention, called “democracy” (Delphi, some 2500 years ago) have democratically elected Syriza and have democratically voted against the austerity packages in July 2015. Now, that they are officially in power, they are unlikely to change their greed-driven behavior and act in favor of the Greek people. Or will they?

Because, if they do, it may eventually also benefit them, the ND Party and its adherents — a Greece that functions like a country, with happy, healthy and content people, is a Greece that retains the worldwide esteem and respect she deserves — and will, by association, develop an economy that can and will compete and trade around the world, a Greece that is an equal to others, as a sovereign nation. A dream can become a reality. It just takes visionaries.

Back to today’s reality. The Greek Bailout Referendum of July 5, 2015, was overwhelmingly rejected with 61% ‘no’ against 39% ‘yes’, meaning that almost two thirds of the Greek people would have preferred the consequences of rejecting the bailout, euphemistically called “rescue packages”, namely exiting the euro zone, and possibly, but not necessarily, the European Union.

Despite the overwhelming, democratic rejection by the people, the Tsipras government reached an agreement on 13 July 2015 – only 8 days after the vote against the bailout with the European authorities for a three-year bailout with even harsher austerity conditions than the ones rejected by voters. What went on is anybody’s guess. It looks pretty obvious, though, that “foul play” was the name of the game which could mean anything from outright and serious (life) threats to blackmail, if Tsipras would not play the game and this to the detriment of the people.

President Tsipras’ betrayal of the people resulted in three bailout packages since 2010 and up to the end of 2018, in the amount of about €310 billion (US$ 360 billion). Compare this to Hong Kong’s economy of US$ 340 billion in 2017. In that same period the Greek GDP has declined from about US$ 300 billion (€ 270 billion) in 2010 to US$ 218 billion (€ 196 billion), a reduction of 27%, hitting the middle- and lower-class people by far the hardest. This is called a rescue?

The democracy fiasco of July 2015 prompted Tsipras to call for snap elections in September 2015, hélas – he won, with a narrow margin and one of the lowest election turnouts ever in Greek postwar history; but, yes, he ‘won’. How much of it was manipulated – by now Cambridge Analytica has become a household word – so he could finish the job for the troika and the German and French banks, is pure speculation.

Today, the ND has an absolute majority in Parliament, plus the ND could ally with a number of smaller and conservative parties to pursue a “people’s dream” line policy. But they may do the opposite. Question: How much more juice is there to be sucked out of broken Greece? Of a Greece that cannot care for her people, for her desperate poor and sick, cannot provide her children with a decent education, of a Greece that belongs into the category of bankruptcy? Yes, bankruptcy, still today, after the IMF and the gnomes of the EU and the ECB predict a moderate growth rate of some 2%?  But 2% that go to whom?  Not to the people, to be sure, but to the creditors of the €310 billion.

Already in 2011, the British Lancet stated “the Greek Ministry of Health reported that the annual suicide rate has increased by 40%”, presumably since the (imposed) crisis that started in 2008. From this date forward the suicide rate must have skyrocketed, as the overall living conditions worsened exponentially. However, precise figures can no longer be easily found.

The question remains: Is the Greek population dying increasingly from diseases that could be cured, but aren’t due to austerity- and privatization-related lack of medication and health services and of suicide from desperation? Is Greece committing suicide by continuing to accept austerity and privatization of vital services, instead of liberating herself from the handcuffs of the euro and very likely the stranglehold of the EU?  Or is Greece the victim of sheer murder inflicted by a greed-driven construct of money institutions and oligarchs, who are beyond morals, beyond ethics and beyond any values of humanity? You be the judge.

• First published by the New Eastern Outlook – NEO

The Doctor-Patient Relationship Can be Found in the Graveyard of Informed Consent

My master that was thrall to Love
Is become thrall to Death.

— “A Ballad of Death,” by Algernon Charles Swinburne, Poems and Ballads, First Series, 1866

The 21st century is only in its infancy, and the United States has revealed itself to be a truly remarkable country. We have imaginary jobs, an imaginary middle class, imaginary checks and balances, and an imaginary society. We even have imaginary bioethics. At the root of this new and exciting phenomenon is the dismantling of informed consent and the disintegration of the doctor-patient relationship that has followed in its wake.

The privatization of health care has contributed to the weakening of the physician-patient bond, as health care has largely been taken over by the gangster capitalists of the pharmaceutical industry, the health insurance companies, device manufacturers, and hospital administrators. In a KevinMD article titled “The Self-Inflicted Death of the Physician,” an anonymous doctor writes, “For certainly we, as a profession, have handed over our authority to others, not all at once, but slowly, inexorably, over decades. We are just a shadow of our former selves.” Mirroring these sentiments, Linda Girgis, MD, writes in Physician’s Weekly, “The doctor is no longer center stage, unless you are watching a puppet show.”

In what will inevitably foment more unscrupulous behavior, MD/MBA programs are teaching doctors to think like businessmen, an irreconcilable contradiction. Hospital administrators are pressuring doctors to see increasing numbers of patients each day, while the health insurance companies continue to play a major role in stripping doctors of their autonomy by regularly countermanding doctor’s orders. This corporate coup d’état, rooted in avarice, callousness, and sociopathy has caused many clinicians to become unmoored from their traditional moral compass.

Physicians are now compelled to use electronic medical records (EMRs), which force them to waste countless hours doing mind-numbing data entry. If an attending physician decides to employ a medical scribe, nurse, or medical student to assume responsibility for this onerous task, it means that a third party will be in the examination room during patients’ office visits, which if done without the patient’s permission, constitutes an egregious violation of informed consent. It is also common for businesses to change the health insurance plans of their employees each year, which invariably results in many patients having to leave doctors that they have established long-standing relationships with, and who may be critically important to their physical and emotional well-being.

In addition to seeking assistance with EMRs, many physicians opt to bring interlopers into patients’ office visits, either because they prioritize teaching trainees to establishing a sound physician-patient rapport, or because they have figured out that it is much harder to be sued if there is a chaperone present in the examination room. Unsurprisingly, the medical institutions that spend the most money on glossy advertisements boasting of their boundless magnanimity and benevolence are frequently the institutions that are the most eager to bully patients into accepting a culture anchored in authoritarianism and absolute contempt for the rights of the patient.

In a KevinMD article titled “Electronic Health Records Cannot Replace a Doctor Who Knows You,” the authors write: “Ensuring the best medical care is not primarily a technical challenge. It is a human challenge, which requires patients and doctors to be able to form deep and long-standing relationships.” And yet American teaching hospitals are churning out delusional and hubristic creatures who have not been inculcated with a respect for patient privacy and informed consent, and who are incognizant of the fact that once these principles have been jettisoned the majority of their patients will neither trust, nor respect, nor confide in them. The deterioration of this vitally important relationship has resulted in a situation where it is increasingly common for patients to fail to disclose pertinent medical information. The deplorable state of the humanities and the rise of subspecialization have undoubtedly  contributed to this scourge of blindness in American health care.

Commenting on the dangers posed by medical scribes, Ami Schattner, MD, of the Hadassah Medical Center in Jerusalem, said in an interview with The Medical Bag:

I have serious concerns about the impact of scribes on the tender dynamic and intimacy of the physician-patient encounter. Perhaps the word ‘sanctity’ is not too strong when talking about the physician-patient relationship.

In an article titled “Shining a Light on Shadowing,” by Elizabeth A. Kitsis, MD, the author warns of the ethical ramifications of imposing pre-med students on patients during their doctor visits:

Physician shadowing by college students…may involve subtle coercion of the patient. To maintain his or her rapport with the physician, a patient may feel compelled to allow students into the examination room if his or her physician makes the request. However, the patient may resent the intrusion, and feel uncomfortable during the interaction.

Indeed, Kitsis’ words are also applicable with regard to nurses, medical students, residents, and fellows observing office visits. In an article in Medscape titled “What is Medical Ethics, and Why is it Important?” the authors write: “Ethical decisions cannot be avoided. Whenever doctors make a clinical decision, they are almost always making an ethical decision, consciously or not.” It is not even unusual for attending physicians to inform patients of ominous test results with their entourage in tow. While this may be very exciting for medical students it can be perceived as callous, degrading, and inhuman from the standpoint of the patient.

In “Stop the Anti-Doctor Media Bias,” by Rebekah Bernard, MD, the author writes that “Most physicians are dedicated individuals who hold patient care as sacrosanct.” I saw more doctors from 2016 to 2018 than a person would typically work with if they lived to a hundred, and have yet to see a single doctor’s office present me with a choice regarding the presence of observers during my office visits. In what could form the basis of a Kafka story, I had to voice my objections to the same institution and the same departments over and over again ad infinitum. Is this indicative of holding patient care as sacrosanct?

Jeremy Brown, MD, has proposed that doctors be equipped with body cameras, and Myles Riner, MD, supports the recording of physician-patient encounters, arguing in “Should Physicians Record and Share Conversations with Patients?” that “One thing is certain, this approach is certainly indicative of patient-centered care, and I think many patients would greatly appreciate the effort.” Not to be outdone, The New York Times has waxed glowingly on the subject of group doctor visits. Virtual office visits and doctor visits at work also pose a serious threat to confidentiality. So little value is placed on patient privacy that hospitals have even allowed television crews into emergency rooms, resulting in one New York widow turning on the television one evening, only to watch her husband die before her very eyes. Even if medical students attend a few decent lectures on bioethics, this is frequently negated by what they see their attending doing on a daily basis.

When the time comes for doctors to be patients, they often take for granted having the finest insurance plans which permit them to see any doctor without restrictions. This is in contrast with the majority of patients, who are increasingly restricted to narrow networks.

In a KevinMD article titled “Please, be kind to your doctor. We need it.,” Sara R Ahronheim, MD, writes: “But when I go home, I am alone; no one knows your stories, no one sees the tears you cried when I told you the awful things I had to tell you.” No one, that is, except the nurse, medical student, and resident who also happened to be hanging out in the room at the time.

What will become of the younger generation, being mentored as they so often are, in an environment where degradation is professionalism, indifference is empathy, and the most sordid behavior is hailed as “patient-centered care.” Indeed, this practice embodies everything base, ignoble, and treacherous in contemporary American health care. So relentlessly are patients besieged by these indignities, that there are times when I cannot help but wonder if these are really accidents and misunderstandings or the result of knavery and villainy. Teaching hospitals have a sacred duty to inculcate their trainees with a comprehensive understanding of, and respect for, medical ethics. All too often they are derelict in this duty. That so many attendings and their charges are indifferent to the physical, psychological, and emotional vulnerability of their patients underscores the fact that doctors and patients often speak in completely different languages.

This imposition of interlopers during physician office visits — a depraved reality show euphemistically called “team-based care” — constitutes a violation of every foundational tenet of medical ethics: informed consent, confidentiality, patient privacy, patient dignity, patient trust, and the oath to do no harm. Moreover, once trainees have learned to disregard informed consent with regard to nonconsensual physician shadowing, it is highly probable that they will do so again when the opportunity presents itself.

For instance, it is common for medical students and residents to be instructed to do practice pelvic exams on anesthetized patients, and the practice is legal in 45 states. A 2007 study done in Canada — a country with a comprehensive single-payer system — revealed that over 70 percent of medical students had done practice pelvic exams on anesthetized patients, and women have reported pain and bruising from these unauthorized exams.

Teaching hospitals frequently regard their patients, especially those who lack the best commercial plans, as their property. In an online forum on The Student Doctor Network where the ethics of having trainees perform practice pelvic exams on anesthetized patients is debated, AmoryBlaine writes:

It’s surprising how worked up some people get over the issue. You will be naked on a brightly lit table for all to see. A medical student will put a tube into your bladder. We’re about to flay your belly open and remove your uterus and ovaries. But to do a pelvic exam! What a violation! If you get into this habit of being deathly afraid of the patient’s feelings about an internal exam you will never learn how.

Glorytaker writes:

When I was doing OB/GYN as a med student, the attending would have me do a pelvic right after the patient was under and before we started surgery. Of course, we were doing GYN-related surgery and he wanted me to note the difference before and after a cystocele or rectocele repair. We didn’t exactly get permission but it was for teaching purposes.

Any rational layperson would be able to tell you that this is unethical, and yet many medical students and residents would disagree. What does that say about our education system? Perhaps it is this sort of degenerate thinking that led The Stanford Encyclopedia of Philosophy to nonchalantly point out that “The turn of the 21st century has seen doubts surfacing about informed consent.” The fighter pilot that bombs wedding parties in Afghanistan and the impressionable trainee who is taught that it is acceptable to do practice pelvic exams on anesthetized patients have much in common. For they have both been inculcated with a profound sense of blind obedience.

It is common for doctors to do nonconsensual episiotomies and pelvic exams on women in labor, and women are frequently coerced into having pelvic exams in exchange for birth control prescriptions. This is an example of how, with a medical degree and some mental gymnastics, blackmail and rape can be transformed into cod liver oil and brussel sprouts. Writing about the lack of informed consent with regard to Pap smears and testing for cervical cancer, Joel Sherman, MD, has pointed out that cervical cancer is very rare in the United States. In Finland women are given the option of being tested for cervical cancer once every five years. And in an article that appeared in The Milbank Quarterly titled “Cervical Cancer Screening in the United States and the Netherlands: A Tale of Two Countries,” the authors write, “Even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries’ mortality trends were quite similar.” Perhaps this egregious lack of ethics in obstetrics and gynecology should come as no surprise, considering the fact that James Marion Sims, who invented the speculum and who is widely regarded as the founder of modern gynecology, performed experiments on black slave girls.

Will a 25-year-old woman continue to trust her oncologist should she go into permanent early menopause following chemotherapy, and her oncologist failed to disclose this as a common side effect associated with her chemotherapy regimen? What is the likelihood that a cancer patient will continue to trust their doctors should they experience long-term chemotherapy-induced cognitive dysfunction, they are unable to continue with their career, and this too was not disclosed? Indeed, failure to disclose common long-term chemotherapy side effects is standard practice in many American cancer centers. It is also common for school districts to force high school students to undergo genital exams as a requirement to play sports, despite the fact that the scientific rationale behind the practice remains murky at best. And there are medical institutions, such as Memorial Sloan Kettering Cancer Center in New York City, that do not allow patients to change from one doctor to another within any given department, which can leave a patient torn between seeking care at an inferior facility or being the slave of an overbearing scoundrel.

Informed consent is absent in routine mammography screening, as no evidence exists that mammograms provide any benefit, whereas evidence exists that they have caused considerable harm. Obstetrics and gynecology aside, in no other specialty is there greater contempt for informed consent than in psychiatry, where dangerous side effects from psychiatric drugs are regularly withheld from patients and these drugs are even being prescribed for children. Psychiatrist Lawrence Kelmenson writes in “The Three Types of Psychiatric Drugs – A Doctor’s Guide for Consumers:”

Psychiatrists are seen as hard-working, caring, understanding healers, but they’re really snake-oil salesmen, drug-dealers, and master-sedaters. What they do should be illegal. Someday everyone will realize that not only do psychiatrists not heal anything, they’re a major contributor to the recent rise in suicides and overdoses.

Dr. Peter Breggin has echoed these sentiments, and actually specializes in getting people off these drugs.

It is common for patients who are perceived as “anti-authoritarians” to be diagnosed as “mentally ill,” and a number of school shooters were found to be taking powerful psychiatric drugs at the time they unleashed a fusillade of bullets on their classmates and teachers. Informed consent is frequently absent in the treatment of prostate cancer, and tens of thousands of American men have their prostates removed unnecessarily each year, only to fully understand the dire consequences after the damage is irreversible. (Consider the words of Atul Gawande, MD, in “Overkill:” “The forces that have led to a global epidemic of overtesting, overdiagnosis, and overtreatment are easy to grasp. Doctors get paid for doing more, not less.”) These are all examples of how informed consent is routinely disregarded in an unconscionable manner. The Tuskegee Alabama syphilis experiments, as well as medical experiments conducted on the downtrodden of IndiaAmerican prisoners, and on prisoners in Guantanamo are emblematic of the barbarities that can be unleashed when the celestial temple of informed consent lies in ruins.

After undergoing a surgical procedure in the summer of 2016, I was given a prescription for oxycodone, a semisynthetic opioid. Never was the highly addictive nature of this drug disclosed to me. Thankfully, Dr. Google informed me that oxycodone posed a “high risk for addiction and dependence.” Perhaps this might explain why, according to the CDC, “On average, 130 Americans die every day from an opioid overdose.” Many medical blogs delight in reminding us of the fact that the doctor-patient relationship is foundational to sound health care, and yet narcissism, moral bankruptcy, and careerism are endemic to our health care system. The erosion of trust that has followed this satanic cult of medical coercion has led to a situation where it has become harder for physicians to get patients to follow through with their treatment protocols.

The hazing and bullying commonly experienced by many trainees can cause medical students and residents to become jaded, and to lose their sense of empathy. Residents are often so exploited that many suffer from depression and are chronically sleep-deprived, and the brutal military-style training they are forced to endure can lead to many trainees forgetting that “gall bladder in Room 213” is a human being with a name. It is incontrovertible that corporations have undermined the doctor-patient relationship and inflicted catastrophic damage to our health care system. And while doctors must support the fight for single-payer, they must also acknowledge the fact that the cavalier attitude towards informed consent on the part of many American physicians has played a critical role in the dissolution of the public’s trust. Inexperienced patients naively assume that every doctor will have their best interests at heart. All too often, this is sadly not the case. Moreover, once this trust has been violated, it can result in grievous and long-lasting emotional harm. A clinician that is indifferent to the doctor-patient relationship, and who is only interested in scans, pathology reports, and blood tests has been infected with the virus of technocracy and fallen into a morass of charlatanism.

In the Charmides Plato wrote that “The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.” Medical students and residents may learn how to diagnose and treat different diseases, yet are seldom inculcated with an understanding of medical ethics and why it is so indispensable. In “Bringing Hospitality Back to the Hospital: Lessons From a Bartender,” by Cory Michael, MD, the author writes: “People remember how you make them feel. They don’t care how much you know unless they know how much you care.” Medical terrorism and corporatization are the Goneril and Regan of medical sacrilege. Perpetually locked in a deadly embrace, they fuel one another’s nefarious designs. The tragedy is that so many medical students and residents are being seduced, not by the voice of truth, but by the voice of damnation. Let us recall the chilling words of Iago: “When devils will the blackest sins put on / They do suggest at first with heavenly shows / As I do now.” (Othello II.iii.)

Informed consent is a river that separates the consecrated light of morality from the profane and blasphemous abyss of amorality. Once this Rubicon has been crossed, there is no turning back. Those who have strayed from their sacred oath will find absolution not in the ways of the wicked, but in a return to the path of compassion, integrity, and righteousness. Indeed, dignity for the patient and dignity for the physician are mutually interdependent.

The doctor-patient relationship now lies buried in the unhallowed primeval ground; a cemetery where broken tombstones litter the earth with thorns and broken bottles, the land is barren and no flowers grow, and a once-proud beating heart beats no more. Only with a return to this inviolable bedrock of medical ethics can we embrace its resurrection.