Health Insurance Industry: How Karl Marx Can Help Us Understand the Health Care Crisis

In order to rethink fundamentally the debate surrounding health care reform, we need to first understand what exactly health insurance is and what it insures. With external objects, such as a home, a car, or a boat, we know exactly what a policy insures: a home, a car, a boat, respectively. We insure for the recovery, whether by repair or replacement, of the products that we buy in case of damage or loss.

How About Your Health Insurance?

With health insurance, if we are lucky to have it, we are able to secure funding for the necessary cost of recovering our health from a catastrophic disease. In this sense, there seems to be no difference between a car policy, for example, and a health policy. However, this does seem quite right.

In the case of a car, we understand without a doubt that it is an external object that is physically separate from us. The same with homes, boats, and other things. Unlike these objects, however, our health is not external. It is what makes us function, what enables us to lead productive, meaningful lives. It allows us to be who we are. It is inconceivable to even imagine that our health is somehow external to us. So then can we talk about the health insurance industry in the same ways as we talk about the property insurance industry?

How Then Is Health Insurance Even Possible? Enter Marx.

In order to understand this problem, I propose that we use the Marxian concept of "alienation." Karl Marx uses this concept to understand the relationship of labor to its product in his manuscripts from 1844, This concept is useful in helping us understand how our health undergoes the same process of "alienation" from ourselves in a dialectic process that makes health both ours, but at the same time not ours. Let me explain.

Let us agree first that to work is human nature. As humans we are defined by the work we do. In fact, we are our work, and our names often reveal that. We are Smiths, Masons, Coopers, Shoemakers, Millers, etc.

However, as soon as these products enter the cycle of being bought and sold for profit, the relationship we have with these products undergoes a fundamental change. They become something alien to us and take on a life of their own, complete separate from us. So as they accrue value, the workers who produced them see their ownership in them diminish while at the same time seeing their own value in proportion to the value of their products diminish. According to Marx, "[t]he greater his [worker's] activity, therefore, the less he possesses. What is embodied in the product of his labour is no longer his own. The greater this product is, therefore, the more he is diminished."

This is precisely how the process of "alienation" starts. The worker starts to be "related to the product of his labour as to an alien object." The "alienation" of the worker in his product means not only that "his labour becomes an object, assumes an external existence, but that it exists independently, outside himself, and alien to him, and that it stands opposed to him as an autonomous power."

So as the worker works, the more he produces through his work, the more alienated his activity becomes from himself. It becomes a "commodity as it enters a fundamentally different relationship, "a commercial relationship, a relationship of exchange, of buying and selling." Thus, our work, that which defines us, that which is our nature, becomes the source of profit, not for us, but for those who control it.

Our Health Has Become a Commodity For an Entire Industry.

This process of "alienation of labor" helps us understand just how the health insurance industry works today. Our health, that which enables us to work, becomes alienated from us. We insure our health as if it were an external object just like a car, a home, or a boat.

The way the health insurance industry is set up in today's America, the "industry" insures our health only as long as it is productive. Our health is wrested from us, made into an external object, with which to draw enormous profit, not for us, but for those who control the "industry." It is literally "alienated" from us having undergone the transformation from something intrinsic to us to an external product. The health that is insured , however, is not the whole of our health, from good to bad, but only that part that is productive. Only that part that makes profit. Only that part that generates profit.

The word "industry" itself is apt in describing our current insurance system. Under "industry" we assume that there is a concrete, external object produced through human labor that is insurable. The word itself propagates the idea that our health is capital, curiously not our own, but rather the capital with which the industry itself becomes wealthier and wealthier. The recent revelation of the outlandish salaries of the insurance companies' executives reflects that. Somehow, we feel deep down that this is not right. That our health is not a commodity. That is why there is a great outrage at these exorbitant salaries.

Hence, the problem with this model is that, as Marxian model of "alienation" points out, our health maybe insured, but we are not. As soon as we are not able to produce that desirable external object, our health, we are no longer insurable. And why not? Because we are no longer the owner of our health. The insurance companies are. Those that profit from owning our health are. Hence, the healthier we are, the less ownership we have of our health. This is the Marxian dialectic is at work.

Can You Really Be Alienated From Your Health?

In my opinion, it is absurd to think that our health is something that can be alienated from us, commodified by a whole industry for its profit. Commodities exist solely for the profit of the owners. However, insuring our health is not like insuring a car, a home, or a boat. There is no pretense about these objects being external. If we lose them, we do not die. On the other hand, if we lose our health and our insurance because we are no longer healthy, we die for the simple fact that we cannot afford the care necessary.

It is time to fundamentally rethink the structure of health care. First of all, we need to move away from the notion that our health is something to be insured by an "industry." The notion that it is any part of an industry is a fundamentally wrong. "Health insurance industry" itself is a misnomer. Health is not a commodity. It cannot and ought not to be commodified. Our health should not be used for profit.

We need to take back the ownership of our health. Let's bring the care into "health care" instead of giving it to an "industry." Our lives depend on it.

Comments

[JayPhilosopher]

This is a brilliant analysis. I think every worker gets it.

Those who are living on the income from their stocks and bonds are satisfied to regurgitate repetitive anti-communist slogans rather than try to understand the world in a scientific way. They prefer to see the little genocides and holocausts of capitalism as historical accidents rather than processes intrinsic to the system.

[wblack]

How long have you had this delusion that every person who opposes socialism is rich? Did you ever consider that a healthy dislike for being enslaved, beaten into submission, having ones freedom of speech, tongue, or even ones life cut short and ending in a mass grave might have something to do with it?

Then there is that in extractable moral issue of slavery -- how do you look yourself in the eyes and lie that one away?

The alleged goals of socialism were: the abolition of poverty, the achievement of general prosperity, progress, peace and human brotherhood. The results have been a terrifying failure—terrifying, that is, if one’s motive is man’s welfare.

Instead of prosperity, socialism has brought economic paralysis and/or collapse to every country that tried it. The degree of socialization has been the degree of disaster. The consequences have varied accordingly.

[JayPhilosopher]

All we need do is substitute the word "capitalism" for "socialism" in your silly little rant and we get near historical truth.

[Newbie71]

Some of us who are living on the fruits of our hard work also like to regurgitate repetitive anti-communist slogans, too - precisely because we understand the world in a scientific way. Tell me more about the "genocides and holocausts of capitalism". I'm intrigued.

[tbone99]

for example:
http://www.telegraph.co.uk/news/worldnews/southamerica/brazil/6315611/Amazon-tribe-has-just-five-members-left.html

[tbone99]

Not to mention that capitalism is made up of boom and bust cycles. yet there is no memory of these in America - there is only the eternal optimism of getting something for almost nothing ( resource and laborwise)and selling it for many times over. In essence it is a pyramid scheme.

It is like a cake walk- when the music stops many people are left without basic needs as the insiders who run the music grab a cake ( made by the workers) and say "I won!"

The fact that they have arranged the number of chairs, strong armed cakes from the community, and set the music ,lets them walk away with a cake every time.

[abbeysbooks]

Correct. and Hitler's regime designed the Volkswagon, made the trains run on time, built beautiful highways in Germany, bred the Doberman, and many other positive things while he was in control. Capitalism too does what you say. But all you have proved in what the Hindu teachings say: that all action leads to good and evil.

[abbeysbooks]

This is just beautiful. Now expand it and write a book. Quick while it is timely.

[wblack]

Yeah, if you call perverting the human thought process by accepting a falsehood in order to intellectually accept the consequence of human slavery, imprisonment, strangulation of free speech, and mass murder of all who oppose these evils -- then sure ... that's beautiful. Ok.

[abbeysbooks]

Marx is one of the great 3 intellectual minds of the 20th century (Freud,Einstein) so it is impossible to understand certain developments without some understanding of each one of these. Let me try a little to help you. When a person grows their own food in their garden or small farm, eats it with the family, puts it up for winter, sells locally to neighbors, barters for other things, this is not alienated labor.

However if this farmer (as many did in the 30's) sold his farm to a big agriculture company and then stayed on to farm it using machine combines, tractors etc because now it wasn't just his small farm it was thousands of acres around his old farm. He was and is paid for his labor, and he buys his food etc with that money. That is alienated labor.

A person making homemade crafts and selling them at fairs, talking to customers, meeting people who love what she makes, is not alienated labor. However, if she designs some things and sets up a small factory for others to make many many ofthe same design, she is creating alienated labor for thepeople who reproduce her designs.

[wblack]

Yeah, sure, I notice how beautifully homey and crafty, the former soviet cities are, filled with wondrous art, art, and more art, from delicate enameled wall to stained glass work of art, and filled with happy, happy and quaint jolly artsy folk ... Oh. hold it! That's not true! All those cities are barren concrete industrial slag heaps where workers are crammed four to a room the size of a broome closet and sleeping on insect ridden cardboard mattresses between shifts at the one-size-fits-all left boot factory ... The right-boot factory may exist somewhere but no one has ever seen it nor can they get there, maps and telephone books are classified, and there is the problem of travel papers ... come on, join the revolution -- slam your right foot into that left boot and lets make some art!

[JohnGrrr]

Fascinating concept and discussion. Thank you for your insight. Clearly you have devoted much thought to many diverse components of what we call 'The Health Care Industry", esp as it applies to late-stage life scenarios. That's where the REAL profits are to be had (or stolen, along with any shred of self-respect that may remain by that point.)

I had to read it twice, but there's alot of moving parts to this piece.

I like the term Marxian...mere mention of Karl Marx brought out the 'ism' zealots (only a few, thank goodness).

[lipai]

ms. shin,

this was a lot of fun to read. very insightful and made me reconsider another approach to other issues. i've read through a lot of posted reactions to this, and i understand the confusion. i would like to make one suggestion: if you would reconsider exploring more of how one's health is "externalized" (for example, how different parts of the body or different treatments are priced through cost, or that the premium itself might be the externalized "value" of health that health insurance companies manufacture consent to their resour--ah­em--custom­er base, etc.). i think this would help with some of the confusion. thank you very much for this article.

[wblack]

There is no confusion -- Marx asks you to accept a set of false premises in order to force unworkable arguments to succeed. This in itself is only dishonest -- the true evil begins when these arguments are used to enslave and murder tens of thousands at the hands of the uncivilized criminals and thugs who invariably rise to the top of any socialist collectivist system. The smoldering ruins and mass common graves of the slain are all that remains of every country that has implimented Marxist ideology.

[lipai]

Thank you for your reply, but I would like to differ from the argument.

1. The confusion is not with Marx, but with the logic in the article itself. In fact, my criticism in the post has really nothing to do with Marx.

2. Marx does not promote false premises. If you read anything by Marx, he goes into very specific detail as to the processes of wealth creation (from resource to profit) in his writings, especially the tome of Das Kapital.

3. Marx and Engels, in the Communist Manifesto, do not advocate violence nor murder nor enslavement nor ruin, as you suggest in your post. Though they state that there is a "revolution", this term has been in contention for the past 160 years.

4. The fact that you condemn Marx because of those that claim to act in his name as proxies of the Communist movement, by your argument, one must also condemn:

Christiani­ty--Crusad­es, evangelical proselytizing, collaboration with Nazis, Spanish Inquisition, etc.

Capitalism­--colonial­ism, corporate colonialism, child labor, slave trade, etc.

5. The use of a Marxist perspective is but another crucial way of determining how deeply dysfunctional the US healthcare insurance system is. What started off as a fringe problem, has grown into one of the epic questions of this country's destiny. It is imperative for us to understand the full dimensions of this question by exploring as many perspectives possible.

So please, to quote McNamara, reconsider your reasoning.

[smartlouella]

I have no idea what this just said - it was very confusing. However, using Marxist ideas to explain anything in a free America is fodder for Republicans.

No wonder they're screaming Marxism.

[Yuna Shin - Huffpost Blogger]

That is exactly my point.

None of the people that throw out these terms, whether they be "Marxism," "communism," "socialism," or "fascism," seems to understand what each of them means. They are all lumped together to mean simply, "we oppose," and made catchy with the terms that we, as Americans, are conditioned to oppose without understanding them fully.

My point here was to use the Marxian theory of how capital comes into being and how it is used. After all, we live in a capitalist society, and it is important that we understand what capitalism is and how it works, not only from those who view it positively, but also from those who look at it more critically. So I have attempted to draw a parallel between what happens with capitalism and what is happening with American health care with the use of Marx's concept of "alienation."

Also, I also use "Marxian" as opposed to the more familiar "Marxist" so as to distinguish Marx's economic theories from his political theories respectively.

[wblack]

Yes, but Marxism fails because it is based on a false premise.

[wblack]

There is no difference between the principles, policies and practical results of socialism—and those of any historical or prehistorical tyranny. Socialism is merely democratic absolute monarchy—that is, a system of absolutism without a fixed head, open to seizure of power by all corners, by any ruthless climber, opportunist, adventurer, demagogue or thug.

When you consider socialism, do not fool yourself about its nature. Remember that there is no such dichotomy as “human rights” versus “property rights.” No human rights can exist without property rights. Since material goods are produced by the mind and effort of individual men, and are needed to sustain their lives, if the producer does not own the result of his effort, he does not own his life. To deny property rights means to turn men into property owned by the state. Whoever claims the “right” to “redistribute” the wealth produced by others is claiming the “right” to treat human beings as chattel.

[tbone99]

Not only are we alienated. from our health through insuring it, we are alienated from our very bodies in the way that we keep working to gain money despite messages from them that tell us we are tired and need to rest , we are hungry and need to eat and we hurt and need to seek care.

We have become divorced from our bodies and the culture promotes seeing it as a tool of production- we no longer identify with it as "us" but as machine. we think we can use it 12 hours a day , day after day , without joy or play - our only goal recognition for our work, or money in the bank. We tare taught to think we just need "fuel" , like energy drinks or bars instead of recognizing thru real food our relationship with other people and the earth.

When we are sick we do not seek to listen to what our body is trying to tell us but instead use pills and surgery to keep it "producing"

[abbeysbooks]

Very nicely said. We are indeed alienated from our bodies.

[Newbie71]

I'm not sure that's an argument in favor of Health Care Reform - unless your vision of Health Care Reform means that everyone pays all of their own bills.

[gs-425]

The works "Karl Marx" and "help" have no place in a sentence in a free republic.

[tbone99]

It can't be too free if certain words cannot be used.

[wblack]

In a Marxist State no one is free -- and forbidden language gets one shot by the Thoughtpolice. Be careful where you tread -- or you'll be walking over the mounds of American's mass murdered by socialist thugs, bulldozed over, planted with trees and called "The People's Park."

[JazzSax UT]

it must be nice having a closed mind.

[wblack]

Marx has been used to enslave, murder, and destroy more people than any other single philosophic construct. The smoldering wreckage of every socialist-­collectivi­st state is testiment to the evil that is Marxism.

[PlaceboStudman]

With health insurance, if we are lucky to have it, we are able to secure funding for the necessary cost of recovering our health from a catastrophic disease.

This should read:

With health insurance, if we are lucky to have it, we are able to secure funding for the necessary cost of THE HOPE OF recovering our health from a catastrophic disease.

But with the current state of medicine and technology today, there is not even close to a guarantee that you will come out on the other side of the "repair" as good as the original condition, as there is with a car, house, boat, etc.

Unfortunately, I seem to be the only one who is acutely aware of the fact that all we are paying for is hope

[sociocanuck]

Impressive piece. I think you lost me a couple of times, but I'm committed to reading it until I understand the point being made.

Frankly, any argument that involves Marx without being either a complete misinterpretation, or an attempt to undermine it through not-actual­ly-compati­ble concepts from whacky libertarian or right-wing-hero "thinkers", will pretty much always get my attention. Even if I don't understand it at first.

I recognize this complete describes my political bias, but I offer no apologies. ;)

[wblack]

Marx is all wrong: The worker does not remain attached to the physical product of his labor -- the worker has exchanged his skilled labor for an agreed upon dollar value -- the worker then retains this value. Money is frozen value that can be saved, or used to purchase food, clothing, shelter, or luxury items -- the point being that the worker is not diminished by his work, the worker is enriched by his work. This is the nature of ownership and the freedom it imparts is the power of self determination and individual choice.

This fundamental freedom, the right to self determination allows you to elect not to buy insurance, or to select among the many varied insurance companies. See: it is the government intervention into business that has caused this problem.

[JudgeCCrater]

How about if we use Franz Kafka instead? That would be more accurate.

[Yuna Shin - Huffpost Blogger]

A great thought. Navigating through the Kafkaesque world of American health care. Brilliant.

[wblack]

I see where you are becoming confused, you are reading Marx. I'll cut to the chase and show you where the stolen concept Marx uses to pervert the value of labor comes in.

The worker does not remain attached to the physical product of his labor -- the worker has exchanged his skilled labor for an agreed upon dollar value -- the worker then retains this value. Money is frozen value that can be saved, or used to purchase food, clothing, shelter, or luxury items -- the point being that the worker is not diminished by his work, the worker is enriched by his work. This is the nature of ownership and the freedom it imparts is the power of self determination and individual choice.

Ayn Rand says: "Capitalism demands the best of every man—his rationality—and rewards him accordingly. It leaves every man free to choose the work he likes, to specialize in it, to trade his product for the products of others, and to go as far on the road of achievement as his ability and ambition will carry him. When men are free to trade, with reason and reality as their only arbiter, when no man may use physical force to extort the consent of another, it is the best product and the best judgment that win in every field of human endeavor, and raise the standard of living—and of thought—ever higher for all those who take part in mankind’s productive activity."

[Neal Jansons]

I see where you are becoming confused, you are reading Rand. (see how condescending that is?)

The problem with your little fairy tale is where capital comes in. It trades for labor the same way it trades for any other raw resource: maximizing value, minimizing cost, and reaping economies of scale. However, there is greater demand for jobs than there are jobs, so labor must compete for any job while capital is able to min/max. Capital also possesses monolithic power while labor must organize in order to gain any leverage, and this is often suppressed by capital because they are trying to min/max on labor the same way as they would on iron or shipping.

The thing is, labor is people. Since there is an uneven power dynamic, labor is generally not able to min/max in their negotiations in the same way, and in situations where they begin to be able to, capital will try to 1) bust the union or 2) outsource.

The payoff of all of this is that by trying to maximize their investment in labor, capital exploits labor.

Your argument would make sense if the worker's work enriched them to a greater degree than they paid into the system, but it doesn't. Capital profits, not labor. If labor profits they get pay-cuts, because they are a resource, and no "good capitalist" pays more for a resource than it is worth.

[wblack]

Neal your whole argument would make more sense -- if you actually understood how to use all that business and marketing management terminology you are throwing around, your lack of comprehension makes your post unintentionally hilarious.Your obvious intent is to dismiss individuals and concrete instances with the blurring effect of dehumanizing terminology -- this allows very generalized statements to appear more applicable than they might actually be in reality.

Your entire set of arguments fail to prove universal effect,

The very obvious reality you are occluding is that"labor" is not a universal unit with the same attributes at all times -- individuals vary in skill, knowledge, experience. and expertise -- and the value of their services varies accordingly.

Your 3rd paragraph argument is specious -- the individual need not remain in an exploited relationship and very few people actually do.

Your summation draws a false conclusion --based on over generalizations it cannot be proven to actually apply to anyone at any time.

[wblack]

Capitalism has been called a system of greed—yet it is the system that raised the standard of living of its poorest citizens to heights no collectivist system has ever begun to equal, and no tribal gang can conceive of.

Capitalism has been called nationalistic—yet it is the only system that banished ethnicity, and made it possible, in the United States, for men of various, formerly antagonistic nationalities to live together in peace.

Capitalism has been called cruel—yet it brought such hope, progress and general good will that the young people of today, who have not seen it, find it hard to believe.

As to pride, dignity, self-confidence, self-esteem—these are characteristics that mark a man for martyrdom in a tribal society and under any social system except capitalism.

[nantucketsunset]

I wanted to agree with you because I sense you are on the side I'm on, but I must confess that I couldn't follow your argument. (In the sense that I couldn't figure out what you are trying to say.)

I appreciate that for some people who think in certain ways, expressing the insurance debate in a "marxist" framework may be helpful, but this has not clarified anything for me. It doesn't add up, but perhaps I do not understand the terminology of your academic field well enough.

However, it does us good to be exposed to diverse voices and frameworks, so I'm glad you've been given a platform from which to express your argument.