« The Blackest Of Rooms | Main | You wanna know why? »

January 14, 2006

Comments

oh, i dunno.... i kinda like our system where i get to explore the nuances of a new insurance bureaucracy every year or so as my employer tries this or that insurer in an constant effort to lower his costs.

it's always a thrill to explore new ways of filling prescriptions (is it mail order? 3-month supply? 1-month? what's the co-pay? generic? do they cover birth control? will they cover my existing prescriptions?). finding new doctors and dentists is always a joy. and i like the way the cost to me keeps going up while the flexibility and choice i'm allowed goes down!

and i like the way it's tied to my job, which i hate but can't quit until i find a new job - because then my wife and i would be uninsured and no insurance company will pick up an uninsured cancer survivor.

it's really a treat. wouldn't trade it for anything.

it's essentially a trap for many people, cleek. limiting professional mobility in a way very few other factors do.

Why would a right-wing nihilist care about those, not of his tribe?

Survival of the Richest is their metaphysical maxim.

I'm not sure the breakdown of China's rural healthcare and the indifference to the resultant human suffering has all that much to do with a conflict between de jure Communist ideology and de facto Capitalist ruthlessness. China's history as a culture goes back 5000 years and, SFAIK, 'concern for the downtrodden' has never been a major feature of it.

Communism, in trying to graft communalism onto a society that had never gone in much for it, had a tough row to hoe from the start. Like their counterparts in Russia, the appeal of Communism in China wasn't "everyone will be equal" so much as it was "Death to the Aristocracy!" - i.e., essentially reactive, vengeful, and envious. The intermittent waves of ideological purification China has endured are cut from the same reactive, punitive model.

There's a reason Marx meant his theory of material dialecticism to apply to Western, industrial countries: evolution from me-first-ism to communalism has to be an organic process, or it just won't take root.

Both Russia and China went from medievalist absolutism to dictatorship of the proletariate before there was any proletariate in the Marxist sense.

The West needed centuries to develop an idea of individual worth, individual autonomy, and internalization of ethos - to not only come up with workable philosophies, to not only see those philosophies became generally accepted, but also to build economic structures and public institutions based on those philosophies.

The East tried to do it from a standing start, in a series of 5 Year Plans. It's frankly amazing they did as well as they did - esp. when you look at the West, particularly the US, and see how easily we-who-should-know-better backslide into economic determinism, Social Darwinism, and pure mean-spiritedness.

US public discourse is cause for despair. It's completely dimwitted. When you can't even begin to discuss healthcare reform without someone yelling "Socialism! Evil!" and thus shortcircuiting the discussion, there's no common ground to appeal to, and no common language to appeal to it with.

More prosaically, the healthcare mess will be hard to address because so much of the current system was never really thought out; like Topsy, it 'just growed.'

How did we get to a place where we were dependent on our employers for insurance? How did we get to a place where healthcare became an investment portfolio item, and the Hippocratic Oath takes a distant second place to shareholder value? How did we get to a place where profitability concerns mean a doctor can't spend more than 15 minutes on a single appointment, where hospitals are severely understaffed, and patients who have insurance wind up paying $5.00 per aspirin, $10.00 per box of tissues, and other wildly inflated charges, essentially subsidizing the uninsured? How did we get from where we were 50 years ago (when malpractice cases were practically non-existant because doctors would never, ever testify against each other) to a situation in which millions of dollars are spent in trials on competing expert witnesses, more millions are spent on hospitals' internal "Quality Assurance" procedures that amount to proactively destroying evidence, and people use civil suits for emotional therapy?

The US healthcare system puts me in mind of Windows code: a very busy, active outer level of activity built on, and shaped by, a structure that's jury-rigged, unstable, and outright rotten. Healthcare reform efforts strike me as tinkering with that outer level, when its the underlying obsolete structure that needs to be re-examined with a clear, cold eye.

The fact remains though, CaseyL that a generation or two of Chinese peasants did have basic healthcare. They may not have access to the historical/socioeconomic barriers to a sound, sustainable system, but they did have access to a qualified doctor.

Now they don't.

What changed is directly traceable to the fact that philosphically it's now OK in China to be greedy.

Capitalism is a system for finding local minima. It optimizes locally, and it optimizes for the system. I think communications and interconnectivity may widen the scope of the optimized domain, but it still feels too local.

Capitalism delivers local truths. The weak are not worth investing in. Economic output usually declines after age 40. As 'The Economist' recently noted the maxim 'survival of the fittest' has always been more true of Capitalism (where Spencer first applied it - approvingly) than of nature (where the long grinding calculations of evolution optimize for gene, gene sharing, and emergent interdependent environment).

Can capitalism deal with the risks of social unrest? What if the poor rebel? The weak may not be powerless as a mass movement. Crushing the weak effectively (see history China, Egypt) may not be consistent with capitalism, and it may be distasteful.

Capitalists like George Soros and Warren Buffett prefer a future that doesn't require crushing the weak. Others may feel that super yachts and island fortresses are a better solution.

I don't know how this will play out. If I had to bet, I'd bet we'll retreat from the new Gilded Age and we'll see a return to a social net that will include adequate (fully depreciated) health care.

Amartya Sen has been pointing out the paradoxes of China in this regard for a couple of decades now. A doubling in life expectancy during the same period of time when Mao's policies were also killing tens of millions (some by murder and more by famine). Sen's other point, that democratic India hasn't suffered a massive famine since the one under the British in 1943, while communist China had the biggest in history in 1959, is the one that usually gets all the attention. But the commies in China (and the commies and Christians in Kerala) have had a better record in increasing life expectancy. The nice thing about Kerala is that they had the advances without the prison camps, mass famines, and cultural revolutions.

It occurs to me that someone might point out that Kerala is in India. Yes, I know.

Getting back to the capitalism/communism thing, someone needs to write The Black Book of Capitalism. "Late Victorian Holocausts" is a nice start, but we need more volumes.

Though I'll hasten to add I think democratic capitalism is, on the whole, far superior to communism. Mostly because of the democratic part, though and when the franchise is limited to one portion of the population, the human rights distinction tends to vanish

Wow. Totally, completely, utterly dissent from this one, Ed.

Edward: what, exactly, do you take the connection between capitalism and not having national health insurance to be? I mean: it's not as though the UK isn't a capitalist country. Nor is it true that poorer capitalist countries can't afford national health insurance: as you pointed out, China afforded it while still poorer, and it's not clear to me that it's the change to capitalism that accounts for the collapse of national health insurance.

(One might think that the opposite was true, in principle: when a poor country stops e.g. subsidizing inefficient manufacturing firms and banking sectors, it might have more money to spend on other things, especially if its tax base increased.)

I suspect that any actual correlation has less to do with capitalism in principle than with the IMF.

von: why? Genuine question.

I suspect that any actual correlation has less to do with capitalism in principle than with the IMF.

That note is suspiciously similar to the whole "What is Communism?" question we usually see around this pointin the debate, mutatis mutandis.

China gives its citizens a few capitalistic crumbs, but what they do not have is a free market economy because their citizens are not free. In fact, you can hardly call their economy a capitalist system since it is mostly unfree anyway. They're basically still communists.

China's problem is that it doesn't have much of a health care system to begin with, and the authoritarians can't command-and-control their way to a system that properly funds it. They could force doctors to stay in the countryside, but that's not going to incent smart people to become doctors.

I also reject your premise that "capitalism is seen by many as the salvation of the species". Human freedom and the rule of law would be much closer to the mark. You can't have a true free market economy when the people are still shackled. I also observe that the term capitalism is sort of a dirty word among liberals and the harder left. Without the rule of law or the proper checks and balances, capitalism is no longer capitalism but anarchy. In an unfree country like China, capitalism becomes distorted to the point that it's hardly recognizable.

As for health care financing, which is the real issue here, universal health care has its own set of problems, as do pretty much any of the other private and governmental financing/subsidy programs. I wish I knew the best answers. The U.S. is an ongoing experiment. We have the best health care on the planet, but the financing of it (and controlling the costs) is disjointed, and we don't exactly have a free market health care system here anyway.

As a side note, my wife worked at a grocery store for about 25 hours a week (she quit about three months ago), and they offered an awesome health plan which covered our whole family. The weird part about it is that the monthly cost of the health care premium exceeded her take-home pay by about two hundred bucks.

Without the rule of law or the proper checks and balances, capitalism is no longer capitalism but anarchy. In an unfree country like China, capitalism becomes distorted to the point that it's hardly recognizable.

And here it is! :)

Also:

We have the best health care on the planet...

No we don't, not by a long shot. We may have the greatest capability for health care -- in the sense that, for those who can afford it our, our medical options and expertise are second to none -- but that's not at all the same thing.

. I also observe that the term capitalism is sort of a dirty word among liberals and the harder left. Without the rule of law or the proper checks and balances, capitalism is no longer capitalism but anarchy.

you observe what your first sentence describes because of what you write in your second sentence.

In this context, what do we think of the case of Tirhas Habtegiris?

(Minor note to self: you've now left apparently fifty posts of complete babble and no content on your blog. Stop at once.)

Charles Bird,

You are confusing capitalism with libertarianism.

Which is common among American right-wingers.

Much like their confusing being “anti-statist” with “right-wing statists.”

Charles Bird,

You are confusing capitalism with libertarianism.

Which is common among American right-wingers.

Much like their confusing “anti-statist” with “right-wing statists.”

I'm not sure it's accurate to blame the uninsured for inflated health care prices paid by the insured. Can't speak for how it is now, but some years ago my significant other held a job in the financial office of a major hospital, and she told me that the hospital was discounting the hospital bills to large insurance companies by as much as, get this, 80%. That's to say, the hospital would get back $2000 from the insurance company on a $!0,000 bill. Evidently this is because of the volume of business and referrals they get for being listed with the insurers. She also said bill discounting was at most a third for those without health insuance, and that basically the _uninsured_ were subsidizing those _with_ insurance.
The new bankrupcy law will make this worse.

Does England count as a capitalist country? I thought they had a big dose of socialism.

Capitalism doesn't have a one to one relationship with freedom. In fact the only way to have a purely free trade capitalist economy would be to have a rightwing undemocratic goverrnment a la Pinochet. If people can vote, they vote in all kinds of limits and mitigationns of capitalism. They even vote for socialist policies right here in Amerrica provided the policies aren't labelled socialist.
By the way I am not a socialist. I'm not an ist of any kind when it comes to the econnommy except maybe a pragmatist.

what, exactly, do you take the connection between capitalism and not having national health insurance to be

The philosophical deifference between feeling each person is obligated to give to the system and the system is obligated to feed the soul of the person (which will encourage some highly qualified doctors to stay in the rural areas) and the feeling that each person is entitled to take whatever they can take and screw everybody else (which of course will drive the most qualified doctors to the urban areas where they can become rich). As the article points out, the emphasis on "profit" is recent in China.

I've worked in an industry that only became focused on profit in the past two decades. Before that, it was focused on quality. The shift has been very eye-opening. Smaller competitors were gobbled up or wiped out, quality of work life has plummetted. The best minds were often convinced (hey, if I have to work under such conditions, why not get paid better) to move into banking or Wall Street. In essence it zapped the soul of what was once a very very pleasant and intellectually rewarding industry to work in. Now, it's profit, profit, profit, profit. It bites.

Wow. Totally, completely, utterly dissent from this one, Ed.

I expected as much. I know that Capitalism has true believers (and given my small business, you'd expect me to be one too), but there is so much more to a quality life than profit, and Capitalism as it's evolved in the US and being copied around the world see nothing else. All this hogwash about Capitalism accounting for quality of life because the market knows to attract quality workers it needs to give them something worthwhile in return is snakeoil. The system is, as systems are wont to do, systematically becoming a self-fulfilling all-consuming monster.

What ticks me off is that as backward and unsophisticated as it was, the Chinese healthcare system had at operated under the ideal that all people were entitled to some basic level of care. Then profit concerns come along and all humanity is tossed out the window.

I'm not saying China is Capitalistic yet. Clearly they are not. (But it's not like we have a good healthcare system here, Charles, really...with so much waste, and so many uninsured, how can you imply that?).

But there is something inherent about the philosophy behind capitalism that is anti-human and this phenonenon illustrates it.

OK, so I'm rambling a bit. Let me boil down my central complaint.

A doctor's, and by extension, a healthcare system's, Number 1 directive is: First do no harm.

In the case of what is happening in China though, a recent emphasis on profit and "living the good life" (the supposed upside of Capitalism) has led to a widespread abandonment of that directive. People who were previously able to get some care can no longer get it. The system broke it's number one rule.

That rule is humanistic...the fact that the road to capitalism made the system break that rule suggests that capitalism is anti-humanistic.

But there is something inherent about the philosophy behind capitalism that is anti-human

capitalism is amoral. unless you can put a price on morality and humanity (which few people do), those things get left out.

If you can lay your hands on it, you might want to read Richard Evans _Death in Hamburg : Society and Politics in the Cholera Years, 1830-1910_, which is unfortunately out of print. It came out during Reagan's administration and many saw it as a case against many of the market reforms that were being carried out.

"I've worked in an industry that only became focused on profit in the past two decades."

Edward_, that shift corresponds to Reagan-era changes in corporate laws that allowed companies to be taken over against their will, via leveraged buyouts etc. This meant that companies' focus had to change from long-term growth and profitability to something called "shareholder value" - i.e., keeping the company stock price on a constant upward curve, by any means necessary, regardless of the impact on the company's overall structure and health.

If shareholders aren't happy with the stock price and pofit performance, someone can come along offering an inflated price if the stockholders vote to let the company be acquired. The stockholders say "Yay!," the company changes hands, and the new owners lay off its employees and sell off its assets.

Companies have run scared ever since. They gobble up other companies themselves, hoping to load themselves down with enough debt that they're not takeover targets; and they're constantly squeezing salaries, R&D, benefits, pensions, and even minor amenities in order to keep the overhead low and the profit margin robust. "Long term growth strategy" is a thing of the past.

I consider this an ironic, unintended consequence of what was originally a "progressive" idea: enable a wide range of people to own shares in big companies, thus democratizing commerce. Unfortunately, the "little guy" usually owns stock via a mutual fund portfolio, and the portfolio is managed by people who couldn't care less about an individual company's, or industry's, virtues - just the bottom line; just how much is the stock worth, and can it be rapidly turned over profitably.

That's also led to quasi-monopolistic consolidation in so many industries, where company policies are made without much regard for the communities in which wide-flung bits of the company operate. Oftentimes, plants and regional offices are shut down and dismantled outright rather than sold - because the parent company doesn't want someone else to come in and run the place; they'd just be competition.

All of which turns classic capitalism on its head. I remember a time when economic conventional wisdom said "Monopolies are bad" - because they lead to inefficiency, bloat, and unresponsiveness to the market. Now monopolies are considered "good" - because shareholders and portfolio managers like them, I guess.

LJ -- the Evans book is back in-print from Penguin as of October last.

"Sure, Mao's China may have had purges, the Great Proletarian Cultural Revolution, the Great Leap Forward, and an oppressive police state, but if you made it through all of that, the village peasants got free health care!"

Dude, that's a really, really disturbing sentiment.

I'm now a little confused--I thought that national health insurance or any sort of governmental safety net was non-capitalist by definition. A lot of conservatives and all right-wing libertarians talk this way, but it isn't limited to them. Karl Polanyi makes the case in "The Great Transformation" that a pure free market is such an anti-human system that all really existing capitalist countries are forced to regulate it, limit its scope, and put social safety nets in place or it would destroy society. Clearly he's thinking of the governmental regulations and the safety nets as things which are imposed on capitalism and which are in conflict with the ideal of the free market. And that term "mixed economy" assumes the same thing, that governmental regulations and social programs are not capitalistic.

Andrew, I looked up and down and didn't see where anyone said what you have in quotes. Maybe it's there and I missed it, but I'll take the blame for saying something like that, though maybe you were aiming it at Edward. My two points were

A) With all the horror (mass killings, gulags, mobs running wild in the Cultural revolution and a record-breaking famine), some of Mao's policies were apparently so beneficial life expectancy actually doubled. It's worth thinking about how that could have happened.


B) Kerala had all the benefits of greatly increased life expectancy and literacy on a very low GDP (or whatever you'd call it when you're talking about a state rather than a country) without the Maoist terror, so you can make gigantic strides forward in a distinctly non-capitalist way without the immense drawbacks and again, it might be worthwhile paying attention to this fact.

From Wikipedia:

"In common usage, the word capitalism means an economic system in which the means of production are primarily privately owned and operated for profit, with the investment of capital being also determined privately; and decisions regarding production, distribution, and prices of goods, services, and labor are determined in a free market and affected by the forces of supply and demand.

Capitalism has also been referred by various sources by the terms free market economy, free enterprise system, and economic liberalism. Although they are largely capitalist, most modern economies are often referred to as "mixed economies" because they have varying degrees of government involvement in economic activity and/or some state-owned means of production."

'Capitalism' is, I think, a term best applied to an economic system as a whole (or to fans of such systems), not to individual firms individually. As Wikipedia says, all systems are to some degree mixed, since there are lots of part of the economy that are not run on capitalist systems. This is especially true if one starts wondering what makes an activity 'part of the economic system'. If, for instance, you count the armed forces as part of the service sector (and they provide a very valuable service from which we derive economic benefits, among others), it's obviously not a part run on capitalist lines, nor should it be. (I, for one, do not want competing armies vying for government contracts, nor do I want the army to be motivated by profit.)

Since virtually all systems are to some degree mixed, it's not clear why a system that deserves, on the whole, to be called 'capitalist' should not include national health insurance. (UK, Canada, France: capitalist systems by any definition, with national health systems.) Indeed, one of the reasons to support national health care is that (a) health care transactions are not at all good cases for normal market transactions (the existence of third parties (insurers) and fourth parties (employers who decide what insurance will be available to employees), all of whose interests can run counter to either doctor, patient, or both, as well as massive information asymmetries prevents this), while (b) private health care markets distort other forms of economic activity, introducing needless friction into the labor market, needless loss of productivity, and needless disadvantages for US firms (cough, GM, cough cough.) So it's a relatively bad case in which to allow the free market to operate, and damages the operations of other markets.

That's why I asked what the connection between no national health insurance and capitalism was. I also don't think the lack of health insurance either promotes or detracts from greed as a human motivation; it just gives it different paths to operate.

Sorry Donald (and Ed) my quote was an attempt to distill what I found truly horrifying about Edward's post, not actually anyone's quote.

Nevertheless, mourning the passing of Mao's China because it produced greater peasant literacy and had free village health care is rather like being sad that Nazi Germany was crushed because progressive animal rights and anti-smoking policies were rolled back. Something to do with forests and trees.

I am certain that Edward would be horrified if a hypothetical right winger were to start arguing about how fantastic Augusto Pinochet was because of the economic growth that the brought Chile.

the Evans book is back in-print from Penguin

Thanks, I think anyone interested in the impact of health problems on society (and anyone worried about bird flu) should read that book.

I thank Andrew for restating his point about forest and trees mildly, but I think it is unrealistic to imagine that Mao's China was something that was completely unique with no connections to patterns of society that existed for much longer (imho, calling dr. ngo to the courtesy phone)

Ok, my turn.

Capitalism is seen by many as the salvation of the species, permitting us to triumph over the forces of nature, ensure long-term prosperity, raise the universal standard of living, and ward off the sort of needless wars that widespread poverty and lack of access to resources incite.

Who are these "many"?, Edward? To me, capitalism is simply an even trade of value for value. Ideally, I mean; what we have here in the US is hardly that. All of those other things are, as far as capitalism is concerned, utterly beside the point. Which is not the same as saying they're forbidden.

Not doing well in a capitalistic system? It must be because you're lazy or stupid or unambitious or because you're a bad person, and therefore if you fall between the cracks and get trampled by the system you really only have yourself to blame.

Much, much projection here. Let's look at an analogue: Not doing well in the stock market? It must be because you're stupid, unambitious, a bad person, etc. Point is, some people fail in the world of capitalism because they're unable, while others fail because they're unwilling. You might project this as being viewed as lazy or stupid, but it ain't necessarily so.

Sure, they'll never have the sort of universal health care they had before

When was this? Was this in the age of barefoot doctors? Best think again, if that's what you meant. Perhaps that program worked as well as move to urban iron-smelting during the Great Leap Forward. Perhaps.

And the poor who would have gotten better care under the old system, and married, and had children, and enjoyed sunsets and laughter...ah, well, sh*t happens.

Facts not in evidence, Edward.

There may be some fair points about exporting our particular dysfunctions as regards healthcare, but I think it's far more likely that we'll do some good. The greed for scratch didn't arise out of an upswing in capitalism brought in by healthcare rats, it's human nature. Corruption didn't hitchhike out of China on the backs of the Kuomintang, Edward. Communism as implemented in the Soviet Union and China has never, ever been about equality of opportunity. That may have been the goal, but it's hard to get there when the entire party apparatus is peddling influence.

Just like us, to a large extent. But you know what? If enough people here want to experiment with communism, there's nothing to stop them. You don't even have to do it politically, you just have to do it.

Well I think Edward's summation of capitalism and the required blame-the-victim mentality is characteristic of one stripe in our political spectrum: the Milton Friedman types, or more currently, the Grover Norquist coterie. The robber barons and Social Darwinists are still with us. Most Americans, however, aren't economic extremists.
You make the statement that in capitalist systems some fail because thhey are unable annd some because they are unwilling. While this is true there are people who are unable because the system is not set up to reward their talennts and virtues, not because they are lacking in talents or virtues. Which is one reason why capitalism nneeds to be mitigated or it is altogethher too soulless and ruthless for citizens in a democracy.

And, I might add, there is much worse that we can do to China than infect them with capitalistic healthcare.

While this is true there are people who are unable because the system is not set up to reward their talennts and virtues, not because they are lacking in talents or virtues.

Which is just about the same as saying they're unwilling or unable, isn't it? If one is possessed of talents that aren't well-rewarded, one can always do something else for cash. But greed for cash is...icky, after all, so maybe it's best to remain pure.

To clarify, I don't hold that people are inherently bad for being unwilling or unable to play the game. I do think that an unwillingness to play the capitalism game juxtaposed with an ongoing expectation to be paid anyways is a tad optimistic, though, and I'd be interested in seeing whether anyone can swing it.

capitalism is simply an even trade of value for value

No one familiar with the history of labor relations in the US would ever make such a claim, unless they were discussing some imaginary world they dreamed up to waste our time.

Point is, some people fail in the world of capitalism because they're unable, while others fail because they're unwilling

A false dichotomy.

If enough people here want to experiment with communism, there's nothing to stop them.

A remarkably uninformed statement. Are you really so unfamiliar with the history of the US as to believe what you just wrote?

No one familiar with the history of labor relations in the US would ever make such a claim, unless they were discussing some imaginary world they dreamed up to waste our time.

Do I need to point out that the main objection to fault-finding with Communism is that it's never been purely implemented? But do feel free to spend your time more constructively, elsewhere. In fact, feel free to completely disregard anything I have to say.

A false dichotomy.

Which would be fine if I'd presented a dichotomy; I didn't claim that those two things comprised the entire universe of possibilities. There may in fact be other choices that I didn't discuss. I invite you to point some out when your quota of critiques has been satisfied.

Are you really so unfamiliar with the history of the US as to believe what you just wrote?

If I'd been speaking in the past tense, felix, I'd have used a slightly different verb form.

But do feel free to spend your time more constructively, elsewhere

Feel free to start spending your time constructively to any degree whatsoever, anywhere.

Which would be fine if I'd presented a dichotomy

Which you did. You gave no other options. Care to think of a few?

If I'd been speaking in the past tense, felix, I'd have used a slightly different verb form.

It is quite naive to think that the reaction today would be any different than it was in, say, 1919.

LJ: I think it is unrealistic to imagine that Mao's China was something that was completely unique with no connections to patterns of society that existed for much longer (imho, calling dr. ngo to the courtesy phone)

dr ngo standing by (well, going to bed shortly, yet back tomorrow), but unsure of what the exact question is.

China's not my area of real professional expertise, but close enough to it (I teach on Southeast Asia, which has lots of interactions with China) for most purposes. Plus I lived in Hong Kong for 18 years and taught predominantly Chinese students, so tried to keep up on events and incorporate analogies from the "mainland".

China's an amazing place, both for better and for worse. Over the past hundred years it's gone from an economy often described (not terribly usefully) as "feudal" to one featuring a thin veneer of modern capitalism, to a Soviet-style "socialism," to the extreme "adventurism" of the Great Leap Forward and the Great Proletarian Cultural Revolution, and back again toward what is most aptly described as "Market Leninism." It's obviously not the Platonic ideal of capitalism, but it sure as hell isn't communism, either.

And whereas the worst extremes of the socialist-communist phase (say 1949-1979, roughly) were extremely bad indeed, and everyone admits that "errors were made" (this is, in fact, officially True in China today), the reaction to it has not been without costs. Yes, the economy as a whole has grown astoundingly - faster than any economy in the world over the past quarter century. But one aspect of this has been a loss of some of the few positives in Mao-era China, including rural health care.

If these were the only two choices, very few of us would disagree with the Chinese consensus today that the new era is better. But many of us might wonder, along with Mr. Johnson [above] whether it might be possible somehow to have both the positives: the rapid "capitalistic" growth of the modern era, and the rural safety net of the earlier period (or of Kerala)?

And democracy as well? That would be nice, even if it doesn't look likely in the near future.

And a pony.

I doubt if this answers your question, but it answers the only questions I felt like dealing with at this hour. If anyone feels like articulating more clearly what he or she would like to know (or would like to hear my thoughts on) about the relationship between modern China and historical Chinese culture, I'll give it a shot.

"Sure, Mao's China may have had purges, the Great Proletarian Cultural Revolution, the Great Leap Forward, and an oppressive police state, but if you made it through all of that, the village peasants got free health care!"

and

I am certain that Edward would be horrified if a hypothetical right winger were to start arguing about how fantastic Augusto Pinochet was because of the economic growth that the brought Chile.

My god, this sort of thinking drives me nuts.

Where in anything I said at all did I argue that Maoism or communism or socialism was fantastic or better or equivalent or even OK???? Where??? I said, quite clearly that the present road to capitalism is hurting people and there has to be a better route.

Why the f*ck can't we criticize capitalism without everyone tripping all over themselves to point out that socialism is worse?

Is it an all-or-nothing proposition? Take capitalism and all the anti-human crap that comes with it as is or own the murder and oppression that came with communism?

Love it or leave it?

Where did that absolutist attitude come from?

Not doing well in the stock market? It must be because you're stupid, unambitious, a bad person, etc.

I know you're saying this dismissively, Slarti, but yes, I know several people who think that way. And fwiw, AFAIK they all vote Republican.

You might project this as being viewed as lazy or stupid, but it ain't necessarily so.

Necessarily, no. Often, yes, at least IME. Worse, frequently by (again, IME) people who will be in positions of power and whose advice will be sought on such matters, or whose opinions will matter.

"The fact remains though, CaseyL that a generation or two of Chinese peasants did have basic healthcare. They may not have access to the historical/socioeconomic barriers to a sound, sustainable system, but they did have access to a qualified doctor."

This is an interesting argument. Who collected the data on Communist successes under Mao? It wouldn't be the Communists themselves would it? I'm deeply skeptical of the magnitude of reported gains in health under Mao.

Also isn't "increased life expectancy" an odd statistic?

Once you kill a bunch of people, they are removed from the statistic.

Hypothetical
Year 1:

You have 100 million people. They each have a life expectancy of 60 years. That is 6,000 million "people-years". Their life expectancy is a bit low because you really only have the resources to fully support 85 million people. At the moment most people are living on 5/6th rations of food and water. This hurts their health.

December, Year 1:

A Communist dictator, Mao, comes along. He see that there aren't enough resources for everyong. He murders 20 million people who don't like him.

Year 2: There are enough resources to fully feed the remaining 80 million people. The life expectancy of the dead people is zero, but they don't get counted. The life expectancy of everyone else goes up five years. You now have increased life expectancy (5 years) but you have decreased expected people years (5,200 million) because you killed off 20 million people.

That isn't a a success in my book. But under life expectancy statistics, it is.


I doubt if this answers your question, but it answers the only questions I felt like dealing with at this hour. If anyone feels like articulating more clearly what he or she would like to know (or would like to hear my thoughts on) about the relationship between modern China and historical Chinese culture, I'll give it a shot.

You did pretty well, given my lack of precision. My feeling is that there is a rather bizarre notion that it was Communism that was responsible for all the bad things, overlooking the background that communism arose from. The same applies for Russia/Soviet Union discussions. Somehow, there is an underlying assumption that they would have had David Hasselhoff and Micky D's if Communism hadn't materialized out of the blue, which I find a bit bizarre, especially coming from some who eschew any other kind of speculation.

With all the horror some of Mao's policies were apparently so beneficial life expectancy actually doubled.

From what, to what, please? And what were the corresponding birth and death rates? Thanks in advance.

I've worked in an industry that only became focused on profit in the past two decades. Before that, it was focused on quality.

So prior to 1985, art dealers sold everything at a loss? Or the break-even point? I find that dubious at best. Or are you saying that dealers are more focused on moving a bunch of mediocre pieces instead of a few really good pieces? I hard;y think capitalism is to blame for that. I would imagine it's more closely related to the average person's lack of connection to current trends in the art world, decreasing the market of potential buyers.

I just always find these anti-capitalism rants ironic coming from you, Edward. You work in an industry that absolutely, 100% relies on capitalism for it to be possible to make any money whatsoever, let alone "excessive profit," absent the patronage of wealthy inviduals (who, again, unlikely to exist in a lot of other contexts). Not a lot of art galleries in pre-capitalist rural China, I'm guessing.

. . . the feeling that each person is entitled to take whatever they can take and screw everybody else . . .

THis is not what "capitalism" is, so I guess I now see where your confusion lies.

You gave no other options.

From which you brilliantly deduced there must be none. Sweeeet.

Where in anything I said at all did I argue that Maoism or communism or socialism was fantastic or better or equivalent or even OK???? Where??? I said, quite clearly that the present road to capitalism is hurting people and there has to be a better route.

Why the f*ck can't we criticize capitalism without everyone tripping all over themselves to point out that socialism is worse?

Edward, I'm simply pointing out that the good old days of Chinese national healthcare probably never existed. For us to be ruining something, that something has to exist in the first place.

Edward,

When you describe Mao's China in terms of "...sunsets and laughter..." and how Mao's China allowed people to enjoy the things in life that Capitalism runs roughshod over, you *are* missing the forest for the trees.

A certain regime in Central Europe had many good ideas--wilderness conservation, animal rights, healthy eating, anti-smoking policies, and the compact car that just about any family could support. You know what? I am still glad that it vanished in flames in 1945. Am I constructing a false dichotomy in this instance as well?

Edward, I'm simply pointing out that the good old days of Chinese national healthcare probably never existed.

I don't think Edward was speaking to your comment, but given that, for example, the National Health Service in the UK wasn't created until 1948, and that China only came out from under the Qing dynasty in 1912, it seems like a pretty high bar.

When you describe Mao's China in terms of "...sunsets and laughter..." and how Mao's China allowed people to enjoy the things in life that Capitalism runs roughshod over, you *are* missing the forest for the trees.

This is what I mean. The mere idea of communism totally blinds people to the fact the millions, nay billions, of people are still living lives under it. Lives in which they do indeed marry, have children, watch sunsets, and hopefully laugh from time to time. The implicit picture in your objections to my saying so is that the Chinese are enduring 24/7 torture like the frozen damned in the corner of Michaelangelo's Sisteine Chapel.

I'd highly recommend watching the brilliant Chinese film "To Live." It will most likely encourage you to approach it with an open mind to know the director was punished by the Chinese government for being so critical. What it demonstrates, and what I know from meeting my many people who lived under the Soviet Union, is that although these governments did indeed oppress their people, that never stopped their people from still wanting to get on with their lives and to grab as much happiness as they could within it and it most definitely never stopped them from expecting to get health care when they needed it. I think people tend to project the worst case stories onto the entire population. It's a very silly approach.

I mean to suggest that the Chinese peasant in the Times story who had to travel two days to die in filthy hospital because his former local doctor fled to the urban areas to make his fortune was in some way better off now that communist economics are waning in China is to, as you say, "miss the forest for the trees."

Because I clearly need to spell it out, I state for the record, I'm happy to see captialism emerging in China. I expect it to bring very good things for the Chinese as time goes on. BUT, I think we've dropped the ball philosphically on Capitalism, allowing it's anti-human elements to grown and take dominance over the previous safeguards against them. Even in this country, we're witnessing an attack on the more sociliastic programs that at one point were essential to move our capitalistic system forward.

I don't know if I am in a posting mood or there were just too many comments which moved me.

In no particular order: Gary if I ask if you are alright you may rightly call me an idiot, but I hope you have someone who can help you in this current emergency.

Anyone else: If you are near Gary (Denver?) Maybe you could check on him, get him to a hospital/a few good meals some medicine.


CaseyL- You said " SFAIK, 'concern for the downtrodden' has never been a major feature of it." Maybe its been honored more in the breach but China has plenty of cultural tradition concerned with helping the downtrodden. Google Mencius sometime the http://nothingistic.org/ link has translations of much of his writing.

Phil- I'm pretty sure Edward wasn't talking about his current job.

Andrew- Edward didn't describe Mao's China that way. Most live do contain some sunsets and laughter, even in the worst regimes.

I suspect you are the type to call foul when someone shows parallels between the Bush regime and the one you mention being glad it vanished.

Most of the issues with capitalism and socialism tend to be based around human limitations in thinking. Captialistic Socialism (Democratic Socialism?) works really well in a small scale, because humans can cope with all the variables, at least enough to make things work. If the set of variables is increased, say for example you have hundreds of multinational corporations based in your country (United States) or you have 1.6 billion people to manage (China), you easily reach the limitations of human thinking. Humans just can't manage that much stuff. Any system, socialism, capitalism, democracy, etc., properly managed will work. Humans just can't do it on the scale that we're trying to do it on.

Andrew- I had to find a fuller reply to your post, I know you will enjoy this. It was written a few years ago by Robert Anton Wilson.

Two recent political leaders allegedly had this nefarious habit.

Both came to power after dubious elections, by non-electorial and irregular methods.

Both nations immediately experienced attacks on famous public buildings.

Both blamed an ethnic minority before forensics had any evidence.

Both led "witch-hunts" against the accused minority.

Both suspended civil liberties "temporarily."

Both put the citizenry under surveillance.

Both maintained secret and clandestine governments.

Both launched wars against most of the world.

One had a funny mustache. Can you name the other one?

I just always find these anti-capitalism rants ironic coming from you, Edward. You work in an industry that absolutely, 100% relies on capitalism for it to be possible to make any money whatsoever, let alone "excessive profit," absent the patronage of wealthy inviduals (who, again, unlikely to exist in a lot of other contexts).

First of all, Frank is right, the industry I was talking about is book publishing, not art.

Secondly, art has been very profitable, compared to other trades, in the Western world since the Renaissance. I think you'll find that preceded the rise of modern capitalism.

Then again, that probably depends on the definition of "very profitable" one uses, but...let's just say, I'm not getting rich off selling art...not even close. In fact, I still do that other work to pay my rent.

THis is not what "capitalism" is, so I guess I now see where your confusion lies.

It serves as a functioning definition in this context. It certainly defines the situation that has led the doctors in rual China to flee to the urban areas.

Edward, I'm simply pointing out that the good old days of Chinese national healthcare probably never existed.

But it improved massively and is now (reverting, I believe, to something like a previous situation) a wreck:

http://www.ph.ucla.edu/epi/Bioter/chinasdisaster.html

thanks for that link jayann.

it illustrates that infrastructure and resistance to let nongovernmental agencies step in are also to blame, but there's no escaping the fact that the initial flight of doctors for better pay is central to the crisis.

I understand the argument that they have every right to seek a better life for themselves and their families. I just don't understand why a philosophy that can do so much good for some people can't be tweaked to avoid doing so much harm to others (and incredibly shortsighted harm, as well):

In 1981, 71% of Chinese had access to state health facilities -- 12 years later the figure was 21%. While absolute government spending on health care has gone up in the reform era, in 1999 China ranked 144th among 191 World Health Organization countries in per capita health expenditures. Further, three-quarters of health spending, according to the World Bank, goes to hospital-based care, with 60% of that going to pharmaceuticals. In short, the rural population and the urban poor and unemployed increasingly cannot access the health-care system. This is a calamity because these persons are at high risk of contracting and spreading infection.

That Bob Wilson, of the several Bob Wilson's (I recommend the friend of my youth, Robert Charles as preferable, frankly), has stuff to say, is always interesting.

He does, however, in his style of simplifying, simplify dreadfully.

As always.

People who tend to take Illuminatus! for instance, as insightful, or deep, or revealing, tend to be about 14 or so. Maybe 16. Although Bob Shea has also had many interesting things to say over the years. Though also not someone I'd recommend as more than quite interesting, quite damn shallow.

Neither, however would I recommed as either deep (past age 14 or so), or particularly relevant to genuine understanding of actual politics, rather than as amusing, stimulating, sidethoughts and worthwhile sidebar commentators and observers.

That's just me, of course. They wrote some great stuff that's very impressive if you're an adolescent, and that is absolutely wonderful. After another time or so, past 12 or 13, comes time to learn the real reality, the real history, and deal with that. Good history, serious history, is quite easily available, although it, always, of course, should always be questioned, doubted, and quadruple checked, just like everything else. (Long discussion of biases and doubts and what to do about each elided here.)

But, again, it's all just my own opinion, and where it offends, well, sorry.

I probably shouldn't comment. I probably should find out if something is actually physically causing my "control" key to bounce so weirdly.

I'm sure that's something I should also do metaphorically, as well as literally. It's surely a useful bit of advice for the ages, even if not constructed that way.

Also, the usual Boulder wins, at about 70 mpr, are banging all the frames in the building impressively, although not unusually.

Happy Sunday morning (just barely, here)! I don't suppose anyone has any actual real lox, and not just nova imitation?

As uusual, I was likely overly and unnecessarily abrasive. It's very very windy here, as is the norm.

Because American corporations as setting up shop in China as quickly as they can buy a building, infecting their system with the systemic healthcare delivery disorders we have here at home.

Um, Edward, as someone who lives in China, I can tell you that American corporations have very little to do with the poor health care in the country. The entire thrust of your post is misguided, since, as Slartibartfast pointed out, there has never been adequate health care for the peasantry. Have you considered that the health care supposedly available in China in 1981 which is, we assume, not available now, might have been quite inadequate even then? I'm sure the amputees I meet while they're begging on the street weren't satisfied with the health care they received before the opening up.

At present, health care in China is divided between two extremes -- wealthy and middle-class urbanites who are almost hypochondriacs in their tendency to go to the hospital ("OH, I have a fever, I should spend the night in the hospital." "OH, I have an upset stomach, I should get a blood transfusion.") and poor people who put off going to the hospital for as long as they can because they just can't afford it. This isn't a symptom of capitalism but a reflection of the fact that China is still poor.

Yes, China has serious problems with their health and welfare system, but these problems flow from the cultural and systemic flaws of China as a developing country rather than from capitalism in general. For example, people simply don't trust each other the way they should. The assumption in all business deals, including transactions for the sake of obtaining medical help, is that the other side has no interest in a fair deal and therefore should be screwed out of as much money as they can be taken for. That's not capitalism as we know it in the US, and is it any wonder that doctors have pursued alternate lines of work in this environment?

The NYT article Saturday says the life expectancy in China went from 35 to 68. There was a population explosion during Mao's time, so that's consistent (but doesn't prove, I suppose) that life expectancy went up. Also, Chinese statistics are what people use in deducing the mortality of the Great Leap Forward, so evidently they're good for something. I'm not a demographer, but I doubt one could fake a doubling in life expectancy.

And gruesome as it is to talk about, I don't think 35-60 million excess deaths (Phillip Short, one of Mao's biographers, gives the smaller figure and I think the 60 million is in The Black Book of Communism) could change the life expectancy figure by a factor of two either because more resources are made available or because the excess deaths aren't taken into account in the life expectancy calculation. (But surely they must be, if the statistics have been used to get the death toll of the Great Leap Forward.) I doubt that putting people in prison and working them to death is an effective way to increase per capita resources and the economic disaster of the Great Leap Forward and the Cultural Revolution were also unlikely to have increased per capita resources for the survivors. The Black Death, Fernand Braudel says, led to increased wages in Europe for the survivors, but I'm doubtful that the same thing happened in Mao's China after one of his artificially induced (and smaller scale in per-capita terms) catastrophes. Back-of-the envelope calculation. Suppose (because I don't want to do differential equations, even simple ones) China's population during Mao's reign was steady at 700 million. A life expectancy of 35 would mean 20 million deaths a year and over 30 years that would mean 600 million deaths. A life expectancy of 70 would mean 10 million deaths per year and over 30 years that's 300 million deaths. Assuming an average death rate in-between, of 15 million, that's 450 million deaths and a savings of 150 million lives compared to the original death rate. The actual population was growing and I don't feel like doing differential equations and anyway, I'd be guesstimating parameters. But it seems unlikely that Mao's gigantic record in causing deaths by famine and political violence could be artificially inflating the life expectancy rate amongst the survivors by a factor of two.

So I don't think the increase is a statistical mirage and I don't think (as did supposedly happen with the Black Death) that Mao's killings could have given the survivors a chance for a more prosperous life. The improvement in life expectancy had to have come from something other than the killing and the famine.

Anyway, we're talking about Mao because of the front page story on the Saturday issue of the NYT was about China. The more relevant example (the one often used by Sen) would be Kerala, the very poor state in India which has had great success in health and literacy without the Maoist horrors.

The NYT article Saturday says the life expectancy in China went from 35 to 68. There was a population explosion during Mao's time, so that's consistent (but doesn't prove, I suppose) that life expectancy went up. Also, Chinese statistics are what people use in deducing the mortality of the Great Leap Forward, so evidently they're good for something. I'm not a demographer, but I doubt one could fake a doubling in life expectancy.

And gruesome as it is to talk about, I don't think 35-60 million excess deaths (Phillip Short, one of Mao's biographers, gives the smaller figure and I think the 60 million is in The Black Book of Communism) could change the life expectancy figure by a factor of two either because more resources are made available or because the excess deaths aren't taken into account in the life expectancy calculation. (But surely they must be, if the statistics have been used to get the death toll of the Great Leap Forward.) I doubt that putting people in prison and working them to death is an effective way to increase per capita resources and the economic disaster of the Great Leap Forward and the Cultural Revolution were also unlikely to have increased per capita resources for the survivors. The Black Death, Fernand Braudel says, led to increased wages in Europe for the survivors, but I'm doubtful that the same thing happened in Mao's China after one of his artificially induced (and smaller scale in per-capita terms) catastrophes. Back-of-the envelope calculation. Suppose (because I don't want to do differential equations, even simple ones) China's population during Mao's reign was steady at 700 million. A life expectancy of 35 would mean 20 million deaths a year and over 30 years that would mean 600 million deaths. A life expectancy of 70 would mean 10 million deaths per year and over 30 years that's 300 million deaths. Assuming an average death rate in-between, of 15 million, that's 450 million deaths and a savings of 150 million lives compared to the original death rate. The actual population was growing and I don't feel like doing differential equations and anyway, I'd be guesstimating parameters. But it seems unlikely that Mao's gigantic record in causing deaths by famine and political violence could be artificially inflating the life expectancy rate amongst the survivors by a factor of two.

So I don't think the increase is a statistical mirage and I don't think (as did supposedly happen with the Black Death) that Mao's killings could have given the survivors a chance for a more prosperous life. The improvement in life expectancy had to have come from something other than the killing and the famine.

Anyway, we're talking about Mao because of the front page story on the Saturday issue of the NYT was about China. The more relevant example (the one often used by Sen) would be Kerala, the very poor state in India which has had great success in health and literacy without the Maoist horrors.

Sorry for the double post. I had to take the Turing test this time (I don't recall having to do this before at this site) and evidently passed with such flying colors I was awarded two postings.

I don't live in China Matthew, so I can only go by what I read, but I'm not certain your statement dismisses my concerns:

Um, Edward, as someone who lives in China, I can tell you that American corporations have very little to do with the poor health care in the country.

Stay with me here. The American corporations setting up there don't have any better answers for what does ail China's system, but they do stand as shining examples of what Capitalism is all about. In that respect, if they could bring over better examples of healthcare delivery solutions, they could serve to help. First they'd have to have better examples though, and currently they don't, IMO.

The entire thrust of your post is misguided, since, as Slartibartfast pointed out, there has never been adequate health care for the peasantry.

[Like banging my head against a concrete pillar!]

Again, the Times article and UCLA article indicate that from that previous position of inadequate health care, since the recent emphasis on profit, things have actually gotten even worse. I'm not sure why folks are continuously ignoring that essential point.

Have you considered that the health care supposedly available in China in 1981 which is, we assume, not available now, might have been quite inadequate even then?

I'm sure it was...but I'm sure that worse than inadequate respresents a problem. Wouldn't you agree?

I'm sure the amputees I meet while they're begging on the street weren't satisfied with the health care they received before the opening up.

Are they any better off now?

I don't know how to make my point any clearer, but I'll try one more time:

What is it about Capitalism that would make things even worse for the poor than they already were? Why do the rich get richer and the poor get poorer? Why hasn't the road to capitalism evolved in such a way that even if everyone can't get richer, at least the poor don't get poorer?

mattstinson,
do stay around awhile. I read a few blogs of foreigners in China and have a few friends who have done stints of work in China (all of them have moved on) but anything you could recommend would be helpful.

I wanted to seize on this point

Yes, China has serious problems with their health and welfare system, but these problems flow from the cultural and systemic flaws of China as a developing country rather than from capitalism in general.

I agree totally, which is why I think it is a red herring to suggest (perhaps by absence, but it is there nonetheless) that the problems of China stem uniquely from the horribleness of communism. Donald Johnson's point about Kerala is quite valuable in this regard.

Unfortunately, there seems to be (imho) a reflexive impulse to defend capitalism, which is certainly strange because if anything capitalism has always been able to defend itself quite well.

"What is it about Capitalism that would make things even worse for the poor than they already were?"

You haven't established that things are in fact worse for the poor in China than they were under Mao. In fact I am fairly certain that they aren't unless you use a hugely sliding scale of 'worse'. If we are going to look at life expectancy, we should realize that it peaked at 68 under Mao and is 71 right now.

You haven't established that things are in fact worse for the poor in China than they were under Mao.

OK. Let's draw this out, regardless of how painful.

Mao died September 9, 1976. Five years after that, 71% of Chinese had access to state health facilities. Twelve years after that only 21% had access. Note, that at this point, we're 17 years past Mao.

So, although it's a handy shorthand for all that is evil and reprehensible about China, it's a bit disengenuous to drag out Mao in a discussion about contemporary China's healthcare crisis.

The question is not whether things are worse for China's poor than they were under Mao, who's been dead for thirty years, but whether they're worse than they were before profit became a central measure in what's good in China.

"Mao died September 9, 1976. Five years after that, 71% of Chinese had access to state health facilities. Twelve years after that only 21% had access. Note, that at this point, we're 17 years past Mao."

A) Statistics captured under communist countries are very suspect. If we believed the reporting in Russia, it was one of the world's most thriving economies right until the downfall of Communism. That obviously wasn't true. The difference between Mao+5 and Mao+8 could easily be openess rather than dramatic change in actual condition.

B) Even presuming that the Communist reported statistics weren't outright lies, we don't know what access to "state health facilities" meant 5 years after Mao vs. now. Did it used to mean that workering class people could get aspirin and forced abortions? That would be pretty easy to provide to 71% of the population. Does it now mean that the 21% who have access can get free open-heart surgery and all the latest cancer treatment? I seriously doubt it, but my point is that "access to state health facilities" isn't something I've seen well defined.

Does it count the enterprise hospitals for example?

C) What about population distribution changes? Chinese people are far more likely to be found in cities (in which the article suggests they are more likely to have health care access through employment) than they were just after Mao.

D) The exemplar case the NYT gives is ridiculous. I don't believe for a second that heart valve surgery (or whatever the equivalent would have been in 1980) was available to any large percentage of the rural population at any time in Chinese history. Whatever access to state health care organizations means it surely never included that level of care for the general population.

I think my wife has already recycled that issue of the NYT, but earlier this week there was also a story about an NGO which has had great success bringing not-for-profit medicine to Cambodia. Again, an example of this sort (not-for-profit medicine helping the poor) might be more useful to discuss than the issue of medicine under Mao, which gets all wrapped up in ideology and whether evil commies ever did any good for anyone.


But anyway, if Mao did improve life expectancy it wouldn't be the first time a near-genocidal authoritarian government pulled off this stunt. The French rule in Algeria initially caused a population crash and then a population explosion, according to Alistair Horne's book "A Savage War of Peace". Go figure. I bet this sort of thing has happened a lot.

But again it's a secondary point. The primary point, I think, is whether we can help bring decent health care to massive numbers of poor people using a not-for-profit system. I think we can, but I only know what I read in the papers.

Not to flog this point too much more, but "had access to state health facilities" is not identical to "received adequate free health care".

And what Sebastian said.

Hard to fake immense increases in population, I would think. Birth rate went up or death rate went down or both. Also, when did the faking of life expectancy stop? Or is it continuing? The life expectancy since Mao hasn't changed dramatically--which suggests it really was 68 when Mao died and incrementally edged upward since. (Which means the economic takeoff compensated for the decline in rural services.) And I'd be interested in why Sebastian would think it was much above 35 back in 1949.

And that aside, what about Kerala? It's well known that very poor places like Kerala can have greater life expectancies than minority groups in rich countries (like ours) even when those minority groups have far greater incomes than the Keralites.

When all the rest is said and done, though, Sebastian and Slarti, we're left with widespread evidence that China's peasant population is indeed in a crisis. So counting the angels dancing on the head of a pin like equivalents of deconstructing how trustworth the data is only serves to suggest Capitalism is not any part of the problem here, but what you've left out of the watering down process (so effective in making sure we Capitalists don't have to look to ourselves for any solutions here), though, remains: Doctors who used to practice in rural areas have fled to the cities. No matter whether you believe the stats or not (and I'll note there's no evidence suggesting the stats are false either), that much at least seems to have contributed to a worsening of access. AND that much is indeed attributable to the recent emphasis on profit in the country.

Doctors who used to practice in rural areas have fled to the cities.

Not arguing there isn't a problem, Edward, just with your characterization of it.

"When all the rest is said and done, though, Sebastian and Slarti, we're left with widespread evidence that China's peasant population is indeed in a crisis."

Sure, but you characterized it as a crisis OF CAPITALISM which was allegedly worse worse than China's Communist past. I seriously, seriously doubt that is true to any large extent. More than anything I think it is a crisis revealed (as opposed to created) by the transformation into a modern economy. Successful capitalism is the thing which is going to make it possible for China to have first world health care for lots of people. How it is distributed is up to China. But having it as an option at all for more than the very very elite is made possible by capitalism.

Sebastian, rather than arguing with amateurs like us, if you're interested in the subject you could try googling various combinations of words like life expectancy, Sen, China, Kerala, and so forth. I've done it and there's a tremendous amount of material online. And you get a self-consistent story--

A) life expectancy in China in 1949 was probably very low. It was probably very low in all dirt poor Asian countries at the time.

B) It'saround 70 now and it doesn't seem to have increased more than a very modest amount in the post-Mao era.
Sen, btw, in one of his articles is quite nuanced. He says on the one hand there was tremendous economic growth in the post-Mao era, which was good, but on the other hand it was still an authoritarian system so it was quite easy for the government to allow the rural health care system to decay. In a democracy there would have been pressure to keep it or improve it.

C) And of course there's Kerala, a place where people are dirt poor and have life expectancies in the mid-70's, because of government commitment to public health. Which shows it is possible for very poor countries to achieve remarkable results.

But anyway, none of us are going to be able to prove anything to each other, because this argument apparently cuts too close to people's basic ideological assumptions. (Mine is that public health measures of a fairly simple sort can probably make a big difference, no matter what sort of government imposes them.)

Grrrrr.....

Successful capitalism is the thing which is going to make it possible for China to have first world health care for lots of people. How it is distributed is up to China. But having it as an option at all for more than the very very elite is made possible by capitalism.

The question is why the road to that sucessful capitalism seemingly can't be travelled down without first making matters worse for the poor? The move toward Capitalism led to the doctors abandoning the rural areas...that's a flaw in my opinion.

If you can't acknowledge that this is a problem, then I'm not sure we haven't reached a hopeless stalemate here.

While I have little to contriubute to the thread, I do like the way that all six ObWingers are participating... it's been a while since I've read a post where that was true.

"Mine is that public health measures of a fairly simple sort can probably make a big difference, no matter what sort of government imposes them."

Absolutely. Any fool can introduce basic antibiotics to a poor population that didn't have them before and see a huge increase in life span. But that is why statements like this mean so little: "It's around 70 now and it doesn't seem to have increased more than a very modest amount in the post-Mao era." Well of course. There isn't much further to go at this point, and China still isn't at the full level of your average functioning Western country.

Life Expectancy Table: (culled from WHO stats)

China 71
US 77
Sweden 80
France 79
South Africa 44
Zimbabwe 37
Sudan 56
Ethiopia 40

China is basically at the bottom tier of the Western countries in terms of life expectancy. Now the statistic is a very blunt instrument and probably shouldn't be used to try to develop a critique of the French system vs. the Swedish system, but really that is exactly where you would expect China to be in terms of domestic technological development and general penetration of technology throughout society. The jump from 35 to 69 represents the easy steps. A jump from 69 to 77 is all of the hard steps.

And once again this turns on "access". Did access to health care in the rural areas under Mao mean that you had access to a someone with a college degree and four years of medical school who could do all sorts of surgery? No. I would tend to bet that it meant you could get penicillin indiscriminately doled out from the state. Do you now have access to penicillin at the marketplace? If so you are probably getting a vast majority of the life expectancy gain that was produced under Mao's rule. You aren't getting it from the state, but you are getting it. It is still available. If you now want a high level doctor or specialist in the rural areas, that is hard to get. But it was impossible to get under Mao because you weren't allowed to just travel where you wanted to go to find a good specialist (to the extent that they existed at all in the Communist regime). If you use this to try to show a significant decrease in rural health outcomes under "capitalism", you haven't been convincing because you are comparing access to a very low level doctor with penicillin in 1960 to access to heart surgeons in 2005. They aren't the same thing. If capitalism was making things worse you wouldn't see Chinese life expectancies in the 70s.

My sense is that Chinese health care did, indeed, improve dramatically under Mao. (That someone is a megalomaniacal monster doesn't mean he can't manage to do a single thing right.) Also, that it has improved a lot for the rich but gotten a lot worse for the poor since his death. (Here I'm relying on a recent article from NEJM which is alas behind a subscription wall, but which I emailed to Seb and Edward, and would be glad to email to anyone else who's interested, unless so many of you ask that I run up against my personal understanding of fair use.)

According to the article, various changes in China have essentially amounted to gutting the previous health care system, without putting anything in its place, thereby making a lot of people very suddenly uninsured. (According to the article, only 29% of Chinese people now have health insurance. Yikes.)

They also decided to privatize their public health services, which makes no sense to me at all -- if there were ever a poster child for something it makes sense to have a government do, public health would seem to be it. (Public goods, easy for people to be free riders, thus unlikely that people will contribute their fair share freely, plainly good for all concerned, etc., etc.)

The upshot is that very good health care is a lot more widely available than before (meaning: it has gone from virtually unavailable to available at prices most people can't pay), whereas basic health care has gone from free to very expensive, in a country where most people are both poor and uninsured.

As I said in my earlier comments, I don't think that this is a necessary feature of capitalism at all, and it's a lamentable feature of chinese health care policy. The article also sounds hopeful, though, noting that China does have the resources to make serious improvements, and probably will improve at least its public health infrastructure in the face of SARS and avian flu.

Thanks for the article, I'll read it soon. Hope you're doing well.

The question is why the road to that sucessful capitalism seemingly can't be travelled down without first making matters worse for the poor?

In short, because the capitalists aren't the first step along that road. Speculators and rent seekers are, and they are anti-productive (considered on any level above their direct self-interest; certainly at any policy level).

They do have a self-interested stake in attempting to attract genuine capitalists and motivate labor afterwards, however. This sometimes generates enough actual production to adequately reward the capitalists and labor after the anti-productive take their cut. We call this success, and comparatively speaking, it may be.

An Alternative to Capitalism?

The following link, takes you to a "utopian" article, entitled "Home of the Brave?" which I wrote and appeared in the Athenaeum Library of Philosophy:

http://evans-experientialism.freewebspace.com/steinsvold.htm

John Steinsvold

The comments to this entry are closed.

Blog powered by Typepad