Economic Update: Today's Medicare for All Battle with Dr. William Bronston

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In this week’s show, Prof. Wolff discusses US deaths from Covid, poverty in the US labor force, US and Canada cooperate against immigrants, US warfare vs China's peacemaking, Amazon profits from cutting back on "free" shipping. In the second half of the show, Wolff interviews Dr. William Bronston, advocate for single-payer health care in the US.


  • 00:00 - 01:28 - Intro
  • 01:29 - 03:15 - COVID deaths
  • 03:16 - 06:04 - Poverty in the US Labor Force
  • 06:05 - 09:36 - US and Canada cooperate against immigrants
  • 09:37 - 11:01 - US warfare vs China's peacemaking
  • 11:02 - 14:42 - Amazon profits from cutting back on "free" shipping
  • 14:43 - 15:51 - Announcements
  • 15:52 - 30:23 - Interview with Dr. William Bronston

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.
In today's program, we're going to be talking about a number of particularly medical issues—the impact of covid deaths in the United States [and] who was affected. We're also going to be talking about poverty in the United States, about the problem of immigrants—as they are being held back by the leaders of the United States and Canada—military strikes by the United States, and the contrast between that and the global activities of China. Finally, we'll be looking at Amazon's free delivery which is going down the tubes and then we'll have an interview with Dr William Bronston, a leading physician with the struggle for a universal single-payer health system in the United States.

So let's get busy, we've got a lot to cover. Covid deaths in the United States have been studied now systematically state by state across the 50 states of the United States with a report issued in the very important British medical journal called The Lancet. In this study one reality is hammered home—that the income, class, racial and educational inequalities of the United States were made worse by covid. In other words, covid deaths are higher among non-whites than whites, among poorer people relative to richer people [and] more among the poorly educated compared to those with much education and more among people who voted for Donald Trump than among people who didn’t. Put all of that together…think about it—the United States doesn't have a medical insurance system that covers everybody more or less equally. We may believe abstractly in one person one vote or all men created equal…all non-men likewise. Whoa, but when it comes to the real rubber meets the road taking care of peoples' health—we're not equal. We suffer unequally, we die unequally and we will again unless the lesson in The Lancet about who took it on the chin from covid is understood.

My next update has to do with the civilian labor force here in the United States. Poverty in the US labor force…it currently numbers about 166 million people. A bit more than half of the American people are in the American labor force. I wanted to look in to how they're doing in terms of their wages—not all the noise of the daily news coverage, if there really is much of that, but what it really amounts to and I don't have the time to do a comprehensive thing—but I narrowed it down to give you an idea. Ten percent—the bottom 10% of wage earners in the United States—that's 17 million people—are earning an average of $12.57 an hour. So, I did the arithmetic—I multiplied that hourly rate…the bottom 10% of our people—17 million wage earners—I multiplied them by 40 hours a week—if they can even get that regular a job—50 weeks a year—if they can even get that regular a job. That would earn them about $25,000 which turns out to be the poverty line for a family of three. Well, if it's a family of three, one of whom is earning $12.57, well that works out to just shy of 50 million people in the United States trying to live—many of them children—on a poverty level wage. One of the richest countries in the world is condemning 50 million people to abject poverty and if you think about the millions more that don't have a job—for a hundred different reasons—who are living on that amount of money—or less—then please keep in mind the Elon Musks with their tens of billions and the Bill Gates and the Warren Buffetts. All the folks…the people who live on more than they can possibly spend side by side—often a few miles away—from the 50 million people. Those of you who take religion, ethics, and morals seriously—don't you have a problem here? Don't the rest of us in the US right now?

Then there was the meeting, a very few weeks ago, in Canada between Joseph Biden and Justin Trudeau of Canada. Here's what they told us and again the ethics...the morals…they can't allow immigrants into their respective countries, they said. There's no room at the inn it turns out—for the poor families from Guatemala and Honduras and Mexico and Costa Rica. No, no, no—they have to be kept out. These two great leaders—they were figuring out how to do it but we know of course what's really going on. These two “great” leaders…they're pandering to anti-immigrant feelings. That's the nicest way of putting it.

Let's take a look at those…shall we? If you keep immigrants out, you're supposed to be believing that that keeps out low-wage desperate people (which it does) and that they, therefore, will not be able to fill all those jobs washing dishes…washing the cars…doing the poorest lowest paid work in the society. There is some of that—that happens—if you keep out immigrants because they start at the bottom (most of them) but you know capitalism has a way of dealing with that. As wages go up—because you've kept out the poor immigrant—you think nothing else changes? Don't be naive. Capitalists are very clear that the wages at the bottom in this country…if they go up…pose a problem for their profits. That's why they're so eager to pay immigrants low wages. That's why they are so eager to not pay the immigrant at all— knowing that the immigrant families are afraid to go to the police and complain because then they might get looked at as immigrants and deported. So, if wages go up because you've kept out the immigrants—the way Biden and Trudeau are busily doing—capitalists are going to see that as a problem. You know what they do when the wages go up? They respond in one of two ways. They either move the job out of the United States—so instead of bringing the poor person here to work at a low wage you move the job to where the poor person already lives. Then you can pay him the poor wage…can't you? If that doesn't work—you replace the worker—with wages going up—by a machine…a computer…a robot… artificial intelligence. Capitalism treats workers that way. If you can't get the wage bill down by cheap immigrants, go to where the people who are poor already live or replace them with a machine. The problem isn't immigration. The problem is a system that works this way and that's the message of this program or tries to be.

I want to also to update a contrast. The United States is now busy militarily in the Ukraine, in China (around Taiwan in the South China Sea), and recently with renewed bombing in Syria. Seriously?…and the contrast—over the same period that these events are happening—the People's Republic of China brings together the warring groups within Islam…the Shiites on one hand, the Sunnis on the other…Saudi Arabia on one hand, Iran on the other…in a peace agreement—exchanging embassies, promising to get along with one another so we have less military conflict. The United States leaders may dismiss all of that. They do want to hide the difference, don't they?…but the rest of the world isn't missing it. Not at all…they're focusing on it and it would only be naive of Americans to misunderstand that.

And naive is another thing I want to end these economic updates with today—this has to do with Amazon…Amazon came up with a clever ploy a few years ago…free delivery. It was clever. Why?…because on a mass basis—the way Amazon is set up—they could afford to do that more cheaply than any of their competitors who are smaller and cannot take advantage of what we call the economies of scale. Now that they've done that they've established a massive reliance on the delivery system associated with Amazon. They confront—like we all do—the declining problems…the problems are not declining…the system is declining and that makes a lot of problems. One of them is inflation and another one is rising interest rates and in that situation where everything becomes more expensive, everybody is on desperate urgency to try to cope. People do without medical care…dilute their medicines… switch from better products to cheaper products…from better food to less good food…from adequate clothing to not so adequate. We all accommodate. We all struggle. How do corporations…and capitalists…struggle? Well, if they have to pay higher prices, if that begins to squeeze their profits, well then they react in the way a capitalist always does.

Here's what Amazon is doing. It's cutting back on the free delivery. You're going to have to start paying extra if you want fast delivery otherwise you're going to get slow delivery…there'll be extra charges…there'll be delays…there'll be special circumstances…they'll be those who get it and those who don't. In other words, capitalists are in a position most of us aren't—they can squeeze us. So Amazon is following in the path of, you know, the big oil companies. When they train the American people to no longer stop at a gas station and have somebody come out and service your car…no no no…you get out and you service your own car and we pay you nothing. We save on paying the young man or woman trying to work through high school or college and working at the gas station. Isn't that how we did it?…or the airlines over the last two years who now charge you if you burp during the flight or if you need the toilet or if you need to put a suitcase up above you. Come on…we're watching Amazon follow the path of other leading capitalist employers in using the inflation as a timely occasion and excuse to squeeze the rest of us. It will hurt. It will cost. Each item is little but the accumulation is as devastating as anything else coming down the pike.

We've come to the end of the first half of the show. Please join me to listen to an important interview with Dr. William Bronston when we return.

Before we move on I want to remind everyone that 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 long-form lecture series I host called Global Capitalism, designed to help others understand current economic events and trends so they can explain the impact and effects capitalism creates across the globe to others. Global capitalism is available on our website democracyatwork.info. There you can also learn more about everything we produce, sign up for our mailing list, follow us on social media, and support the work we do. Please stay with us. We will be right back.

Welcome back friends to the second half of today's Economic Update. I am both proud and excited to bring to the microphones and cameras today's guest, Dr. William Bronston, a physician who has a remarkable reputation and history that I want to share with you. Before that, since I know him, let me welcome Bill to our program.

WB: I'm exhilarated Richard, thank you, sir.

RDW: Okay. Dr. William Bronston is a specialist in psychiatry and child development. He's famous for organizing medical personnel into unions and for helping mobilize parents in a federal class action suit for crimes against humanity…a suit brought against the governor and the State of New York for their administration of the infamous Willowbrook institution that I'm sure many of you have heard about. His new book, Public Hostage, Public Ransom: Ending Institutional America tells that Willowbrook story and links it to today's struggle for universal single-payer health care instead of the disastrous Medicaid system. For the last many years, he has been working from his home state of California for a truly Democratic medical system in the United States.

So let me jump right in…What is the status right now—because I know you're deeply involved in it—of efforts to bring a Medicare for all program to the United States?

WB: Richard, the situation is critical because the fascist elements in this country—the Republican Party and the capitalist system—are driving aggressively, fiercely to try and make it impossible for there to be a truly publicly funded, publicly accountable democratic health care delivery system. We do not have a health care system in the United States. We have a medical service system that's a wealth transfer operation. You cannot buy health—it's not for sale. Our whole notion of medical care and health care has to do with ending illness—not promoting wellness. The objective here is fundamentally inimical to the commodity basis for which medical services are currently grounded and have been grounded for over 100 years and fought for fiercely by the capitalists…by the oligarchs…by the pharmaceutical cartels…the hospital cartels…the insurance industry in order to make it massively profitable and to monetize suffering and death—end of life situation.

So that's kind of what the situation is right now and there's a massive effort supported by the Biden Administration to further privatize Medicare without people knowing that they're being shifted into a system where they will be trapped in narrow networks…will be refused services without any real capability of altering that even with sharp appeals. It's called ACO REACH and my organization, the Physicians for a National Health program, has been battling that tremendously, you know, in the last few months but it's upon us right now and it's a turning point in the history of health service delivery in the United States.

RDW: Is this part of the old issue—been around for a long time—that says that preventive care is more important than curative care but because curative care has got the profits built into it we don't do what is the more important way to go.
Have I got that right or is there a mistake there?

WB: I think that there's something more profound that's at issue—that's hard to really grasp—if we had a true healthcare society there would be a much more profound democratic community and sense of each other and relationship between each other in society. That's what the oligarchs cannot tolerate. They can't tolerate a unified caring progressive mass public in order to essentially need and obtain and access well-being. It's not just…it's not just prevention…it's not just savings…it's not just the hundreds of billions of dollars that would be released back into the economy—that would come from a universal healthcare system—it has to do with a blocking [of] democracy…blocking the capacity of the people to understand the commonality of their needs and their issues and their activity politically in the society. I don't know if that makes sense but that's my understanding of the situation. It's cultural and it's deep and it's fierce.

RDW: I’ve always wondered how Americans understand and tolerate the fact that almost every other advanced industrial country and many countries beyond that group have in fact chosen to do much more in the way of a national funded healthcare system than the United States. What is that about?

WB: Again it's tremendously deep. I think first of all that our system—which has been in operation for close to 100 years of commodified medical care—has resulted in a profound conscious and unconscious universal fear and insecurity in the general population. All of us have no idea what's going to happen to us if something goes wrong and there is an enormous stigma in something going wrong in our society. If you're sick or disabled in some way that puts you in a whole different category of status in terms of caste relationships in the society. I think that people in this country are so isolated, so alienated, so incapable of identifying with the commonwealth of their brothers and sisters of the rest of us in society that it cripples us from being able to challenge the barbarity of the commodity monetized system of illness and death in our society. It paralyzes people. People have no grasp. They have no confidence that they—as a solo individual in a solo society—can challenge the system. It's just unimaginable to them and they feel that because something's wrong with them that they have a legitimate basis of having to pay to get better. I mean it's the profound disease in our society you know, is monetary dependency.

RDW: Tell me, did the pandemic change anything? Was that horrible experience—and I don't mean to imply that it's over since I understand that it isn't—but has the period since early 2020 changed anything in the balance of the struggle for and against a nationally-funded universal health support system?

WB: The impact of the pandemic is absolutely breathtaking. We lost, you know, a million people or more. People lost their jobs and with their jobs being lost, those of them that had medical coverage of some sort through their work lost all that. That exposed the enormity, first of all, of the lack of a competent massive public health capacity to respond to a situation like that because everything is commodified and the public health system has been defunded since the 1980s. Since the Reagan Administration, there’s been a replacement of clinicians with administrators and so you have a situation that's compounded the illness and essentially ravaged the general society and only magnified the inherent fear and insecurity that's already there. It exposed the fact that there was no ground of a well-organized, government-driven, publicly-driven intervention system in the society. So it was…it was an enormous rip-open of the wound of the medical delivery system and of the fragility of health care. It also impacted our morbidity and mortality statistics so that now we're about 39th or 40 or 41st in the world in terms of death and sickness in all areas as a result of the impact of that disease…only uncovering the already fragile situation created by the diversity of our society because obviously people of color and people in poverty are the ones who die first…die earliest…get sick first…get sick longest…you know and so the situation here is…it's barbarous. It's barbarous and somehow we have to figure out a way to move the public to change this monstrosity.

RDW: You know there's a recent article in the British medical journal, The Lancet, that systematically goes through and demonstrates state by state across the 50 states how the covid disaster killed more people at the lower end of the income…more people who are non-white…more people with less higher education…I mean clearly reaching the conclusion which is listed in the article that the covid disaster worsened the already serious income, economic, racial, and other disparities of American society. It is a sharp lesson. It's of course interesting that it had to appear in a British journal but that's the way things like that go.

WB: Let’s look at the reality. The reality is that it only essentially accelerated the effort on the part of the oligarchy to privatize the system and to drive it home…they don't care about illness and death if illness and death are not profitable. I mean profitable in the billions of dollars then it doesn't matter. The medical delivery system now is so currently alienated. The workforce is so essentially reduced and shrunken down as a result of people leaving the field because essentially they're forced by corporate ownership of the delivery system to live with a computer between them and the people they're taking care of so you don't really get an eye to eye contact with your nurse or your doctor or your dentist that's really meaningful. There's no relationship there that comes between the general public, the patient population, and the delivery system. That has to be changed.

Then we're dealing with a debt pile that everybody is suffering that is absolutely astronomical and in any universal system we must buy out, negotiate and buy out all the medical debt that people are burdened with right now. It's fundamental. We need to change the workforce. We need to expand it. We need to make it culturally competent. We need to distribute it by virtually globally budgeting all health professional education so that we can assign the students whether they're sociology students or psychology or doctors or nurses or dentists or med techs to urban and rural deserts that exist now—where there's inadequate coverage…where people have to go to a large medical center…a huge carbon footprint area—in order to get services rather than getting them in their home and in their streets the way we used to when we were younger. I'm 84…so you know…I remember when my mother would call my pediatrician. He would come to the house and take care of me and I would immediately get better before he got there you know and so that has to be reestablished. We need to re-democratize by mobilizing neighborhood assemblies and partnerships with the local public health system and an expansion the state level of public health services and public health domination of the management of the delivery system in order to address these issues. That means savings, investments, and prosperity beyond our imagination. The question is can the people essentially build up the courage and the unity around a model which I've tried to establish—which we can talk about later—in order to address this transformation that has to happen.

It is a revolutionary liberating agenda for sure.

RDW: I wish we had more time…we don't…a quick final comment from you…we have socialized many things in our society—our parks that everybody goes to and that we fund collectively, our schools, our roads, our harbors, our mail system—what is the anxiety about socializing something as important as the health system? But we don't…Bill, I realize the clock is bearing down on me. This is a question I'm going to bring you back to answer…so save your answer. Thank you very much for sharing both your medical history, your medical expertise, and your insights into the current crisis of this country. Really—it's a pleasure having you here. I hope my audience shares with me the appreciation for your work, your insights, and as always I say to my audience, I look forward to speaking with you again next week.

Transcript by Barbara Bartlett

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About our guest: William Bronston, MD was born and raised in Hollywood, attending UCLA then USC School of Medicine, Children’s Hospital of Los Angeles as an intern, and finally a residency at Menninger School of Psychiatry specializing in child development and psychiatry. Expelled after 2 years for organizing a Kansas AFSCME mental hospital union and coordinating the first multiple hospital health worker seizure rather than striking to advance worker rights and benefits.

A decade followed in New York where he worked at the infamous Willowbrook State School for 3 years helping mobilize parents to file the Federal Class Action suit for crimes against humanity against the Governor and NY State for its administration of this American concentration camp for children and adults with disabilities.  His new book, “Public Hostage Public Ransom: Ending Institutional America”  tells the illustrated documentary story of Willowbrook’s barbarity and its forced closure, whose story arc culminates in 2022, calling for universal single payer health care, for system change and exposing the utter anti social evil of all Medicaid funding.
Returning to California in 1975, he was appointed to become the Medical Director of 2 CA State departments serving for the following 25 years. During this time he produced 20 years of biennial, all teen-youth film festivals to advocate media career education in the Sacramento Capital region, and North American, high school systems. His current total focus is now to establish the comprehensive transformation of our corporate totalitarian medical wealth transfer system with the most imaginative and democratic population based health care policy model as the centerpiece of socialist rightful health care in our society.

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