Economic Update: Inequality’s Insidious Spread - COVID-19, India, Insurance

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In this week's show, Prof. Wolff presents updates on India's extreme inequality and its lesson, employers squeeze employees with "non-compete" job contracts, and how the profit motive distorts the concept of insurance. In the second half of the show, Wolff interviews Dr Stephen Bezruchka on how deeply and globally inequality endangers health with special attention to the US and Covid-19.


  • 00:00 - 01:14 - Introduction
  • 01:15 - 06:55 - India's inequality
  • 06:56 - 10:03 - "Non-compete" job contracts
  • 10:04 - 14:47 - Insurance
  • 14:48 - 16:12 - Announcements
  • 16:13 - 30:55 - Interview with Dr. Stephen Bezruchka

Transcript has been edited for clarity

Welcome friends to another edition of Economic Update, a weekly program devoted to the economic dimensions of our lives and those of our children. I'm your host Richard Wolff. Today's show is going to be talking about the Indian economy, now that India is becoming the largest country on Earth, by population surpassing China, the non-competition clause in lots of job contracts that's being fought out in this country at this time and then the peculiar capitalist problems of our insurance industry that affect us all in countless ways. And then we'll have in the second half an interview with a remarkable professor of public health Dr. Stephen Bezruchka.

So let's jump right in. Oxfam over in the United Kingdom, one of the most widely studied and respected research institutes when it comes to charting distributions of wealth and income around the world, has just released a report on India. And there are things in there about India I want to talk to you about. But not so much because of the significance, although it's enormous for India, but the larger lesson about the world that is buried in what I'm about to tell you.

Okay, first Oxfam shows that the richest one percent of people in India, and remember it has 1.3/1.4 billion people in that country... The richest one percent own 40.5% of the total wealth. In 2020 India had a hundred and two billionaires. Today it has 166. The pandemic may have killed huge numbers of Indians as well as people around the world but it made more billionaires in that country. 40 percent of the wealth created in India between 2012 and 2021 went to the top one percent. Right? 40% of the wealth created in those eight years/nine years went to the top one percent. Over that same period of time only three percent of the total wealth created went to the bottom 50% of that population. Okay, at the same time 64% - two-thirds of the taxes raised in that country - came from that bottom 50 percent.

All right, what does this mean? It means that India shows the same extreme inequality that you have in the United States and in many other rich countries. And why am I telling you this? Besides that even Oxfam, which has seen a lot, found this level of inequality in such an otherwise poor but emerging economy, called it "obscene," a word I would attribute to the United States for the same reasons.

But why am I talking to you about this? India was a colony, the most important colony the British Empire ever had, more responsible for the wealth accumulated in England than any other part of the British Empire. It was an enormity, it fought very hard in the 19th century and right up to Mahatma Gandhi's leading it into independence after World War II. It fought for and won an independence that inspired people around the world. However, independence politically for a former colony is clearly not enough. Because what it did was enable the same capitalism that produced inequality in the countries that colonized to continue and do the same in the countries that were colonies of the colonizers. The inequality grotesque in UK today is replicated in India. To break out of the horrors of colonialism the greatest of the leaders of Independence knew that getting independence politically - governing yourself, - however important, was only half the battle. You had to also change the economic system. Because if you didn't you'd replicate in your own country what you had to fight against in the colonizer. That's why the most important leaders for independence, and let me name four of them, I could pick many more: Ho Chi Minh in Vietnam, Nelson Mandela in South Africa, Mao Zedong in China and Subhas Chandra Bose in India all argued you have to go beyond capitalism, as well as beyond your colonial status within capitalism, or else the system will resurge inside your independent country. Oxfam statistics about India prove how right those radical leaders of independence movements were.

My second update has to do with struggles over non-competition clauses. 30 million workers in the United States - that's 20% of our labor force - has this in their contract. Here's what it means: when you sign up to work at 'company A' you commit legally, you enter into an agreement never to go to work, or not to go to work for 10 years if you ever leave this 'company A' that you're signing the contract with you promise not to work for one of its competitors or maybe in the same industry or words like that. And you are subject to being prosecuted, tried, sued if you break that contract. And what it means is if you're working for an employer you can't leave and get a better job at better pay with somebody else who's in competition with your employer. It's a limitation on your freedom as a worker to do better. Since you're in one industry with its competitors you can only leave if you find a job in another industry. But in another industry you don't have the experience of this industry which would otherwise get you a higher salary. Employers fight like crazy for this. Because it's basically imprisoning their employees within the company because you're limited in terms of what you can do leaving. Companies don't have to be competing with one another for good workers. And workers are fighting it. It's just another aspect of the endless class struggle between employers and employees - now it's on wages, then it's on prices, then it's on working conditions. And now it's on non-compete clauses.

I would question, if I might, some of the arguments on the workers side who are arguing about liberty. In other words a non-compete clause limits the liberty of the worker. Of course that's correct, that's its point. But if you're really concerned about liberty, what about all the other things workers can't do? They can't take a break if they need it, because the employer can fire them, they can't speak in certain ways, they can't be politically active in certain ways, they can't, in fact, mobilize to form a union. Their liberty is constricted by the very way the job is set up, with a tiny group of people at the top who have all the power and the mass of employees have next to none. Liberty is not what we're talking about here, folks. Class struggle is what we're talking about. And your liberty is always limited when it comes to how you can better yourself if that interferes with the profit of those who run the show. That's why the critique of capitalism is the order of the day.

I want to turn next to the insurance industry, with particular emphasis on health insurance. I want to remind everybody about some basic economics here. Why do we have insurance of any kind? Because unexpected, unforeseen, unwanted things happen to us. And we want, knowing that, that there's a risk of that, to do something that protects us in the event that happens. It either protects us from that happening or it protects us from the bad consequences that might show. So for example if we're worried about fire doing damage to our home or an automobile accident hurting us or other people or you name it we buy insurance - health insurance, car insurance, you name it. Insurance is something societies do. As a community we maintain a fire department. Why? Is there a fire in my house? No. But there could be, there might be. There might even be a fire in the house next door. I want someone to come and put it out rather than risk it coming over to my house. So we collectively pay taxes to sustain a fire department, because it's rational to do it. And the same applies to the possibility of sickness. I can get sick. I want help if that happens. I might lose my job, I might lose the income because I can't go to work because I'm sick or I'm injured or I had an accident. And it's not just that. I'm worried about it with other people, because they might be my employees. If they're sick they don't come to work. They might be my relatives, they might be my neighbors, they might be the children of my neighbors who get my children sick. You understand there's lots of unknowns in the lifetimes we all lead. And protecting us is what rational people do.

But it gets messy if we allow private profit-seeking enterprises to enter in here between us on the one hand and taking care to protect us from the unknown in the future. Why? Well, let's give an example with health insurance. The insurance company is a profit-making enterprise. So here's what they want: they want to get the most money they can that we pay in the premiums, you know, every month or however we do it. And they want to pay out the least in the claims we make. So we have the bizarre craziness that we have insurance companies - health insurance companies, medical insurance companies... Here's how they work: they don't want to sell policies, except to people who are rich and can be sure to pay. And they don't want to sell policies to people who are needy of the very service that the insurance provides. So they pick and choose who to market their insurance policies to - those with the most money who therefore need it least and those with the least likelihood of making a claim, the ones who need it least in other words. They even charge them differently.

We allow profit-making to have the following kinds of result: millions of people who get a cough, get sick over the last three years had COVID but they didn't go to the doctor because their health insurance doesn't make that easily available. That's crazy, that's crazy. Profitable companies limited their policies to people who didn't need it. So those people didn't have the insurance they could have had and might have let them go to the doctor. But the insurance company didn't have them to worry about; those poor people who have trouble paying the premium and who are likely to need it. Profit-making is an irrational way to handle the insurance every society needs. We allow private profit to go in there and run that. And so we have an insurance system that's very profitable but does not protect huge numbers of us from all of the unexpected and unwanted surprises that life brings. That is a very basic flaw of the capitalist system.

We've come to the end of the first part of today's show. Please stay with us. We will be right back with professor and author Dr Stephen Bezruchka. Before we move on I want to remind everyone Economic Update is produced by Democracy at Work, a small donor-funded non-profit media organization celebrating 10 years of producing critical system analysis and visions of a more equitable and democratic world through a variety of media. Like the series Ask Prof Wolff, which is a collection of my responses to questions from Democracy at Work supporters. If you have a question you'd like me to answer go to patreon.com/democracyatwork or our website democracyatwork.info and sign up to support the work we do and submit your question. I try to get to as many as I can and I thank you for getting involved. You can also learn more about all the work we produce, sign up for our mailing list, follow us on social media and join our growing community of supporters who make all of this possible and for whom we are very grateful. So thank you and please stay with us, we will be right back.

RW: Welcome back friends to the second half of today's Economic Update. I am very pleased, indeed I'm honored, to have a guest with us today Professor Stephen Bezruchka. Stephen Bezruchka and I have been corresponding for some time. And he has taught me quite a bit in those exchanges we've had. And I think more than with many people that I learned from he's someone that I think can also be a very important teacher for all of us. So it's doubly pleasing for me to have him share some of his time with us. He is a Professor in the School of Public Health at the University of Washington on the West Coast. He worked clinically as a doctor for 35 years, including three decades as an emergency physician. He also spent over 11 years in Asia, in Nepal, working on public health there. He created the Population Health Forum in 1997, serves on the Board of Directors of the Washington Physicians for Social Responsibility and works with its Economic Inequity Health Task Force. So, first of all Stephen, if I can presume to call you that, thank you very much for your time and for being with us today.

SB: It's a privilege for me to be on the program.

RW: All right, let me jump right in. You have a brand new book, the title of which is Inequality Kills Us All: COVID-19's Health Lessons For The World. Well, what could be a more urgent topic than that? COVID-19 is still with us, COVID-19 is on everybody's mind, has affected every one of our lives in probably more ways than we can count. So if it has important lessons to teach us maybe we can make good things happen out of a bad thing by figuring out what those lessons are and facing them. And the one you stress is the link between economic inequality in a society and its health, including how it handles a virus. Can you explain your basic idea for us?

SB: Well, beginning in 1979 studies began exposing the link between income inequality and various mortality measures in countries around the world. And to fast forward to the present we now have some four to five hundred studies linking income and wealth inequality to measures of health among countries, within countries [in] tremendous detail there, that mostly has escaped other people presenting these ideas. Possibly because they don't feel they have the background to do so. So more unequal societies have worse health outcomes is the general principle - more inequality leads to more problems. So this helps explain why today the United States, we in the United States, die younger than people in over 50 other countries. Those include all the other rich countries and some such as Thailand or Chile. You know, countries we wouldn't think of that people would have longer lives than we do. And this can be using the scientific principles of causality. It's not just an association, inequality causes worse health.

And I put the title to mean inequality affects us all to point out that nobody in the United States can escape the effects of inequality. As an example the oldest old person at any one time is never in the United States. So we are all impacted by inequality. And that is we're dead first among rich nations. And I think most of us, if we knew that, would prefer to live a longer life than a shorter one.

RW: All right, let me pick up on that. Many people, although not so many in the United States, but many people around the world have noted that the United States, what?, clearly one of the richest countries in the normal measure in the world nonetheless suffered numbers of dead from COVID-19, numbers of people who got sick, numbers of people who will be wrestling with the so-called long COVID for who knows how long. So it seems kind of clear, and I want your response, that your point applies very urgently right now that the United States had such wealth, has such a developed medical system but it didn't amount to very much when it came to protecting us from a terrible virus.

SB: That's right. To begin with, we conflate the terms health and health-care. In our day-to-day language we talk about accessing health, paying for health, getting health, ensuring health. But it's healthcare that should be the phrase there. So we think health and health-care mean the same. And therefore health-care must produce health. Now, to achieve our poor health status - we spend almost half of the entire world's health-care bill, it's a 4.1 trillion dollar economy in the United States for 2021. That's one sixth of our total economy is spent on health-care. And it's certainly a great economy for providing jobs and huge pandemic profits. But it hasn't provided health. We have 1.1 million deaths from COVID. You know, the concern is in China. And it'll be an interesting race to see whether China comes anywhere close to us, despite their having three times/four times the population that we do.

So COVID-19 has lots of lessons to teach us. One is that among U.S states in 2020 COVID mortality was linked to the income gap among U.S states. Among 84 countries COVID deaths were related to the income inequality among those countries. I mean, you know, all the nails are hammered into the coffin.

RW: Yeah, it strikes me as, you know, Americans normally would pride themselves; if we spend more than everybody else in the world for so-called health-care and our health outcomes are as mediocre or poor compared to those in these other countries then obviously either we're paying too much or we're getting too little for what we're paying or both. And normally you would expect someone to say "well, something is terribly wrong here." But instead we seem to want to continue to imagine that we are the center of the world's good health. Kind of a strange disconnection from what's really going on.

SB: I think the main lesson is to do away with the idea that it's health-care that produces health. Health is produced, you know, living longer is produced by other factors. One is, as I've already pointed out, more inequality leads to worse health outcomes. And part of the reason is we don't support early life - the period from roughly conception to when you're blowing out two candles on your second birthday cake - roughly half of your health as an adult has already been programmed. So longer lived countries privilege that period. There are only two countries in the world that don't give a working woman who's pregnant paid time off after she has her baby. One is, of course, the United States. And the other is Papua New Guinea - half of a big island north of Australia. Only two countries in the world with populations of a million or more that don't have a national policy of paid maternity leave. That's a disgrace.

RW: How do you account for me - I know you're a physician, you're a professor of public health... But a disgrace on that scale with what you've told us, how it limits how long we live and what you've told us about its role in making us suffer from COVID more than we could have or should have... How does this persist?

SB: Well, it's almost, you know, American exceptionalism is the idea that everything in this country is the best that it ever could have been and will be in the future. And it's all, you know, you can't... This is the greatest country in the history of the world. And that's an innate belief that anybody born in this country subscribes to. Now the people who tend to speak out as I do were not born here. I was born in Canada. I chose to come down here. And by that choice I will live a shorter life. You know, lives are considerably longer in Canada. And so a few other people who are as outspoken as I am have followed the same trajectory. They immigrated here thinking it was the best place in the world. And, boy, were they surprised.

RW: What do we do about this?

SB: It's very clear that most Americans do not know that we're dead first. And first we have to know that there's a problem. Namely, we have to become aware. You and I can harken back to 1957 when the Russians launched Sputnik. They were the first country to launch a satellite into space. And it beamed a signal down on Earth. And, my God, we were caught unawares. You know, we had nothing in the works like that. You know, and the news portrayed this all over. And so what did we do? Well, we set a goal to land a human on the Moon by the end of the next decade. So once people become aware and they're bothered by something then we can have a goal. For example to become the... Well, to stop seeing our health decline let's... You know, our mortality rates are going up absolutely. We need to stop that. Otherwise we'll be like Russia in 1991 when after the former Soviet Union collapsed mortality shot up in Russia. And it hasn't returned to the levels that it was then. And our mortality is doing the same thing, not quite at the same pace as Russia's. But who knows what will happen in the future? So if Russia's example could be broadcast to the American people and then we would set a goal to stop our health decline so we don't live shorter, sicker lives. I think most Americans would buy into that. Then they have to ask the question of 'well, what do we need to do?' So we need to inform people what produces health in a society: a more equitable society - you know, tenants of socialism that you espouse.

I tell my students about worker-owned or about workers being on the boards of directors. On Thursday I'm going to point out for Mercedes-Benz in Germany a third of the board of directors are workers. So, you know, you got to teach this stuff at whatever level you can. Chapter 10 in the book is all about the various things that individuals can do, organizations can do, bosses in workplaces can do, teachers can do. It's something I haven't found in any other publication, very specific things to do. One of them is, of course, to gain fluency. I tell my students to do an elevator speech. You know, blurt out everything that encapsulates the key idea in 10/15 seconds and practice it when you get a marketing call in the evening that's being recorded for quality assurance purposes.

RW: Okay, wonderful. And my only comment: this is very helpful and I urge people to take a look at that book. There's much to learn in there about the problem we face that has to be more widely understood. I do worry that the profiting insurance companies and drug and device makers and doctors in hospitals will be slow to give up the privileges they've won in the name of better public health. But my hope is that in the end the majority will win what it has long deserved. And thank you again Stephen, I really appreciate your taking the time with us. And to my audience, as usual, I look forward to speaking with you again next week.

Transcript by Brendan Tait

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About our guest: Stephen Bezruchka, a graduate of Harvard, Johns Hopkins and Stanford universities, teaches courses in population health in the Departments of Health Systems and Population Health and of Global Health as faculty in the School of Public Health at the University of Washington.He worked clinically as a doctor for 35 years including three decades as an emergency physician.  He spent over 11 years in Nepal, writing the first trekking guide to that country, running a community health project, training Nepali doctors in a remote district hospital and advancing concepts of population health. He focuses on creating greater public understanding of the determinants of health through teaching, talking and writing at various levels from middle school onward.  He created the Population Health Forum in 1997.  He serves on the board of directors of the Washington Physicians For Social Responsibility and works with its Economic Inequity Health Task Force. 

His book:  Inequality Kills Us All: COVID-19's Health Lessons for the World is published by Routledge.  (blurbed by Richard on the back cover)

Links: https://stephenbezruchka.com/

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  1. Oxfam report on India: https://www.bbc.com/news/world-asia-india-64286673
  2. “Non-compete” job conditions: https://www.usatoday.com/story/money/2023/01/19/noncompete-agreements-harm-

Showing 2 comments

  • Susan Mercurio
    commented 2023-02-22 20:29:49 -0500
    Commentators always discuss situations in other countries instead of focusing on the same things in the US. I am not as interested in income inequality in India as I am in income inequality here.
  • Shawn Larue
    commented 2023-02-22 05:24:27 -0500
    I really appreciate the information and advice you have shared with us. Many thanks for sharing this useful and valuable information. https://www.upsers.app

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