In a recent column, David Brooks takes up the critical issue of "the missing fifth" -- the 20% of American men between the ages of 25 and 54 who just aren't working. Actually, in our collapsed manufacturing areas and "inner" cities, the rate of men in the prime years not working is often closer to 50%. I have abiding admiration for the breadth and depth of David Brooks' domestic socioeconomic commentary. He is one of the few regular commentators who has a concept of "social capital" -- which is to say, the ways that political arrangements do or don't provide the social supports and infrastructure that keep communities and people productive and even happy. As he underscores, it is becoming almost impossible to build productive social supports -- even targeted job training -- because ever-larger billions are being usurped by health care spending.
The smart thing, he urges, would be for the nation to have a debate about ways to shift money from ever-increasing "health" expenditures "toward programs that spark reinvigoration."
The only problem with this suggestion is that it's too polite. There is no way for anyone to fully, deeply, and conclusively appreciate the core corruption of the United States as it now stands -- and will fall -- without fully, deeply and conclusively appreciating the corrosive and corrupting role occupied by the medical industrial complex.
We all know the stats: the United States spends 16% of its GDP on health "care," almost twice the average for other developed nations, to come out 36th in longevity and have a limping, chronically ill, medically shackled population seen nowhere else.
What remains little recognized within these stats, however, is the extent to which the poor, the unemployed, the disabled, even men in their "prime years" if they live in powerless communities, have to be made into commodities for the single purpose of feeding this ever-growing sector.
Any predominant economic sector -- and in the United States, what is now called "health care" is the predominant sector -- has to have a massive, assured and growing level of products or commodities to provide its ever-growing income. In health care, these commodities are human beings. What we see as a result is not simply the endless waste of over-medicalization and useless procedures -- end of life "care," especially, routinely borders on vivisection, especially for groups like the homeless who don't have anyone to call a halt to futile "procedures" -- but that that the medical industrial complex instinctively and knowingly operates on the basis of assuring that millions of people become chronically ill who don't have to. If anything is well proven today, after all, it is that most chronic illness -- the predominant illness of our time -- can be avoided or greatly delayed by teaching proper self-care to people at risk.
The case for massively preventing diabetes, our single most expensive illness, is unassailable. The federal government, itself, in a famed study that involved 3,000 men and women with very high blood sugar -- of all ethnic and income groups -- showed that teaching them to lose modest amounts of weight and start modest amounts of exercise was twice as powerful in preventing their progression to outright diabetes as putting them on standard medication! Yet, barely a fraction of the some 80 million Americans with high blood sugar receive the proven education and health coaching that can give them years of health. Obamacare may somewhat change this -- but not much. Even though it has more emphasis on prevention, as long as "prevention" is kept within the medical industrial complex, it will be instinctively wrecked. New York State, for instance, with the worst diabetes crisis in the nation, requires diabetes educators to have a Masters Degree to be reimbursed from public health insurance. This not only assures that there is a limited supply of diabetes prevention educators, but that there are almost none in the poor communities where they are most needed.
But, far from requiring a masters, it has also been proven over and over that effective diabetes educators can be trained in a few months, even among people without a high school degree. Typically, the more health educators come from the very communities where chronic disease is rampant, the better they are at reaching those who need to be reached. And, contrary to the widespread notion that health education is a women's field, I have also found, over many years of training community health educators, that men who redirect the street smarts they often gained dubiously to the enhancement of a community mission like this become astounding health educators.
The solution is obvious and quite simple: the nation could achieve marked degrees of improved health and jolt employment in its collapsed communities by having local community groups train local residents as health educators. This strategy, moreover, would pay for itself in the huge savings both from prevented chronic disease -- and from those already ill learning about improved self-care that keeps them out of the hospital.
I once calculated that if merely the $10 billion in "stimulus" money that was tossed to the National Institutes of Health to repetitively "study" health had been used for diabetes prevention, we could have employed 200,000 of the unemployed for two years at a modest, but helpful $25,000 a year, and quickly trained them; even if they each only managed to reach and teach 50 people with high blood sugar a year, at the end of two years, 20 million of the nation's 80 million pre-diabetics would have received proven preventive education.
Given that things are effectively this simple -- train the unemployed, do proven chronic disease prevention, save billions -- the fact that we don't do it demands our full attention. How can a nation allow itself to have a $2.3 trillion annual health bill bankrupting it even while the core misuse of these trillions -- the refusal to educate and empower people to take true care of themselves -- massively produces more illness? The unavoidable fact is that the populations who have most been made into commodities for the medical industrial complex are minorities, and the poor and powerless of all ethnic groups. They are at the bottom and we can hardly bother to notice, much less protest, how prejudicially they have been treated as being incapable of learning to care for their own health.
The resulting disaster is now so big and endemic to how the country functions financially and "socially" that the debate we need to have is just as big. By saying the health "care" system is core to our corruption as a nation, I mean specifically that our largest financial sector, instead of promoting the guiding American ideals of life, liberty and the pursuit of happiness, is allowed to be the lead underwriter of unnecessary illness, widening despair and once salvageable lives shackled to disability in horrifying numbers. The debate required is one as vigorous, pointed and determined as that over slavery. No more than you could have a nation half slave and half free, can you have one, by policy, half sick and half healthy.