To What Extent Should Capitalistic Activity be Practiced within a Public Economy?
In early 2019 Cuba engaged it’s people in the democratic process of writing a new constitution. Among the issues addressed were potential “economic reforms,” such as:
- Opening certain sectors of the economy to “market dynamics.”
- Permitting “limited privatization” (private enterprise), including allowing some private businesses to contract wage labor.
- Permitting more foreign corporate investment in Cuba.
- Closing and privatizing state enterprises that are failing to generate a profit.
- Integrating the Cuban economy with the current global economy
The reason for considering these reforms is that the Cuban people and the Cuban leadership wished that Cuba could enjoy at least a modicum of prosperity. The Cuban people had long suffered from the US Blockade and other US efforts to sabotage the Cuban economy. Before making final decisions, Cuba’s leaders encouraged all Cuban citizens to thoroughly and publicly discuss the above possible reforms.
In the spirit of that public discussion, the following “little economic story” was offered. The story takes place in a fictitious children’s hospital, which could be located, for example, in Canada or Cuba. The characters are fictitious, but they and their comments are based on real people and real experiences.
Deliberations at Victor Hugo Public Children’s Hospital
Early in the morning Dr. H, a pediatric hematologist/oncologist at Victor Hugo Public Children’s Hospital, makes her usual rounds to check on her little patients, most of whom have leukemia. The children are always excited to see her. She is their favorite. Never in a rush, she sits on the edge of each child’s bed, calmly and warmly looks them in the eyes, and tenderly asks them how they are feeling. To those who are feeling glum, she tells a little story to raise their spirits. The children and their parents adore her and trust her, both for her knowledge and her devotion. Each day she wears a different colored flower in her hair. Before going home at night, she returns to say goodnight to each child and places her flower in a vase in the center of the room for all the children to enjoy. This habit, of leaving her flower, started when a little hospitalized boy asked her to leave the flower so that he could remember her when he became lonely and frightened at night. Her visits purposefully provide a moment of deep kindness, a moment of Social Beauty, at the beginning and end of each child’s day.
Dr. H is similarly admired by her colleagues. She is a natural leader. She is hard on herself, but soft on her patients, families, and colleagues. She leads by example. It is easy for her to visualize Social Beauty and how to create it. She understands moral incentive and she lives Social Truth. Her colleagues insisted that she be the chief of the hematology/oncology division. Though she had no interest in power or prestige and did not particularly like administrative work, she reluctantly acquiesced to their wishes, out of a sense of duty. The younger physicians seek to emulate her kindness, humility, patience, work ethic, critical thinking, and altruistic spirit. Dr. H is uncomfortable when directly praised; but when pressed, she reluctantly admits that “I guess I am pretty good at noticing things.” (In fact, she seems to notice things that others either cannot see, or do not want to see, or are afraid to see, or find too stressful to address.) The only criticism ever uttered about Dr. H is that some colleagues say “she spends too much time with her patients.”
On one day the academic pediatricians at Victor Hugo Public Children’s Hospital (VHPCH) held a quarterly meeting. On the agenda was discussion of a proposal by members of the cardiology and radiology divisions to permit at least some private enterprise activity within VHPCH.
The cardiologists wanted the freedom to conduct a private clinic on at least one day per week, so that they could generate more income. On that day they would perform cardiac procedures and charge a “private fee” for that service. They argued that wealthier patients would be willing and able to pay this fee, especially if those patients could be seen sooner than otherwise and treated with extra kindness. The cardiologists also argued that they would be happy to share some of their profits with the hospital in general—meaning that their private clinic would benefit the hospital as a whole, financially. Similarly, the radiologists wanted to schedule private MRI scans on one day per week, to take advantage of the considerable revenue-generating potential of private MRI.
The Chairman of Pediatrics—who had been chosen because of his natural leadership skills and, like Dr. H, was revered by the entire faculty— introduced the proposal and opened it for discussion.
Dr. H was the first to speak. “Let us remember that VHPCH is a Public Hospital whose activities are conducted according to a Public Economy1 model. All of the pediatricians on our staff receive an ample and appropriate salary; each of us is naturally motivated by a strong desire to contribute as much as we can to the care of children; and each of us benefits from the esprit de corps generated by all being similarly committed and motivated. Our colleagues in cardiology and radiology are, in essence, requesting that at least a little bit of capitalistic activity (market practices, including monetary incentive) be permitted within the institution. I have great reservations about injecting capitalistic behaviors into our institution, and I am happy to explain why.”
“Please do,” said the Chairman.
Dr. H: “Let me start by reviewing some history. Some of us have practiced Academic Pediatrics in the USA, both before and after capitalism was introduced into Academic Medicine. In the 1970s Academic Medicine, at public university medical schools in the USA, was practiced according to a Public Economy model (economic altruism, or the Academic Physician Economic Model). All of us were on a salary, which was provided by the state budget. We had an appropriate workload, consisting of a mix of clinical care, teaching, and research responsibilities. We did not charge a fee for our patient care activities, or for our teaching or research—why? because our salary was already paying us to do this work. We worked very hard and altruistically. Our goal was to contribute as much as we could to the care of patients and the advancement of medical knowledge. Our incentive was a moral one, not a material one. Our incentive was the satisfaction that came from helping sick children and advancing knowledge. That satisfaction was enough. We did not feel any need for a monetary incentive. In fact, the idea of monetary incentive seemed counter-motivational to most of us—it made us feel selfish and less inclined to work hard. Spirit was high, because all of us enjoyed an atmosphere of up-regulated expression of our best human capacities. We enjoyed the most precious freedom of all—the freedom that comes from participating in collective public efforts to genuinely look after others; the freedom to enjoy widespread up-regulated expression of the human capacity for kindness—up-regulation both in oneself and in the larger society. Our institution and our work were things of Social Beauty.
But then things changed, in the late 1980s. The capitalist model was forced upon us, undemocratically, without our having any say. We were told that from that point on, the medical school was going to be ‘run like a business.’ It would no longer receive funding from the state. Instead, money to cover all expenses would need to be generated by charging patients a fee-for-service. We were forced to charge a fee for our patient care, and the fee needed to be as high as rules would permit. Salaries were tied to ‘production’—-i.e. to the amount of revenue generated. Physicians were forced to generate net revenues that would at least cover their salaries—preferably many times more than their salary. Those whose revenue generation barely exceeded their salary were shamed for not generating at least 3 times their salaries. Some of our quite entrepreneurial-minded physicians generated revenues that exceeded 5-10 times their salaries, and they were lavishly praised by the new entrepreneurial administration for doing so. Maximal charging was pushed; undercharging was punished. In fact, failure to maximally charge was considered to be a financial ‘crime against the institution.’
A ‘see and drop’ policy, regarding clinical care, was implemented and rewarded. The idea of this policy was to populate a physician’s clinic schedule with new patient visits, as opposed to follow-up visits, because an hour spent with one new patient could generate more revenue (was reimbursed at a higher rate, by the health insurance companies) than an hour spent on 4 follow-up visits. So, physicians were encouraged to ‘see’ as many new patients as possible, then ‘drop’ them (not schedule follow-up appointments for them, or otherwise have contact with them) so that more new patients could be seen.
Under this new capitalistic system, workloads were increased, in order to maximize revenues. Instead of being in clinic on 4 half days per week, with plenty of time to adequately meet patients’ needs (including the answering of post visit phone calls) and plenty of time to teach and do research, we were now required to be in clinic 9 half days per week, with a patient volume each day that forced us to provide rushed care, with no time for follow up patient work and no time for teaching or research. In fact, research was forbidden, unless you had a grant that paid for your research time, or unless you did your research on your own time, after hours.
Our previously practiced altruistic Public Economy model was not just discouraged, it was forbidden. Those who insisted on practicing economic altruism were punished. One of us was sent to a psychiatric clinic that specialized in evaluation of impaired physicians—the reason for referral being ‘impaired ability to comprehend and/or comply with our fee-for-service approach.’ The psychiatry clinic determined that the physician was suffering from ‘pathological altruism.’ Shortly thereafter, that physician was driven out of the institution.
This switch from the Public Economy model to the capitalist model had many adverse (malignant) effects on Academic Medicine. The patient volume that physicians were forced to see grossly over-extended our physicians. Patient care became rushed. Quality of care deteriorated. (Medicine was never meant to be practiced in a rush.) Physicians had no time to follow-up on patients’ needs, except at night and on weekends, on the physician’s own time. Teaching suffered, because there was no time and, besides, teaching did not generate revenue. Since un-funded research was no longer allowed (at least on company time) research decreased. Educational conferences, which had been devoted to discussion of diseases and their treatment, were increasingly replaced with conferences devoted to learning how to maximally charge for our services.
Moral incentive was replaced by monetary incentive. Economic altruism was virtually criminalized. Individual and group spirit diminished. Leadership became increasingly populated by those who most enthusiastically bought into, relished, and cleverly practiced the capitalist model, with its emphasis on revenue generation. Candidates for leadership who were ‘too altruistic’ and too unenthusiastic about revenue generation, were considered to be a liability and a threat to the institution. These adverse results are facts, not opinion.
In other words, the capitalist economic model had malignant effects that rapidly and increasingly worsened as the capitalist mentality and behaviors increasingly invaded (metastasized) and took over the entire institution—crushing and driving out those who wished to practice altruistically, while elevating and rewarding those who practiced entrepreneurship. Increasingly, altruistic behaviors were replaced with heartless behaviors and decisions. The capitalist behaviors and attitudes killed the Academic Medicine we once knew and loved. Social Beauty and the morale it creates were replaced with an ugly social milieu and moral distress. During the 1970s we were physicians who served patients. By the late 1980s we were “providers” who served “clients.” Then, we were transformed into “revenue generators” who serve the “institution.”
Now, you might argue that the above history represents only anecdotal evidence. But, qualitative research and quantitative data collection reveal that these same themes (the negative consequences of the capitalistic transformation of Academic Medicine) have been repeatedly experienced throughout Academic Medicine, both by academic physicians and their patients—not just in the USA, but in many countries. Look at what has happened to the National Health Service (NHS) in Britain, for example.”
“Please realize,” she continued, “that Capitalism is based upon several erroneous premises.2 For example, it is based on an incomplete and excessively negative view of human nature; it erroneously insists on the necessity of monetary incentive; and it promotes an incorrect, perverted understanding of competition. We can talk more about these unfortunate premises later, if you wish—or, I can provide you with an essay2 on this subject, which you can read later, at your leisure. Capitalism, by nature, has malignant characteristics.”
The Chairman then asked, “You have likened capitalism to a malignancy. Could you further explain that comparison?”
“I know malignancies very well,” she said. “Malignancies start small, even un-noticeable and undetectable, but once they get a foothold they tend to inexorably worsen, invade, take over, and potentially kill. They are ruthless, heartless, without conscience. Look what they do to poor innocent children!!! They are diabolically clever in the way they take over and develop resistance to treatment. Malignancies do not obey rules. Malignancy does not permit democracy; it insists on a totalitarian state. Once established, malignancy becomes very difficult to rein in. The only ways to eradicate malignancy are to prevent it from developing in the first place (our best option); or lethally impair its incipient development; or, once it is established, treat it with aggressive therapies.”
She continued, “Capitalism is similar to childhood malignancies. It may start innocently enough. But, once capitalism gains a foothold, the thirst for growth, profit, power, control, and ever-increasing material well-being, inexorably leads to a ruthless, heartless invasion of our Humanity. It is diabolically clever in the ways it seduces and takes over. Inherently, it up-regulates3 expression of the worst capacities of our Human nature (instead of our best capacities), and by so doing, it tends to create a different, less kind and caring human being—particularly among the people it promotes to leadership positions. It transforms motivations. It transforms behaviors. It changes the way people treat one another. It becomes master over Humanity and crushes individual and collective souls. It converts Social Beauty to social ugliness.
Once capitalism establishes a foothold it becomes very difficult to rein in, much less replace. It fights back violently. A major reason for this is that capitalism, by nature, promotes people from the less altruistic end of the behavioral spectrum to positions of power, while marginalizing the more altruistic. Soon, leadership positions become increasingly populated by the least altruistic among us, and those leaders increasingly make poor, heartless decisions that have strong adverse effects that are difficult to reverse. Eventually, capitalism leads to a totalitarian state (which can become necessary to crush inevitable resistance and rebellion), commanded by the wealthiest, most extreme, most sociopathic, most malignant, most deranged capitalists.
Why would we want to introduce such a malignancy into our treasured Public Activity at VHPCH? Why would we want to abandon our successful Public Economy model—a model that has greatly benefitted children throughout the world, at a bargain price for societies? Why would we want to replace our Public Economy model with a capitalist model that has already proven to have adverse effects on patients and those who serve them? Why would we want to replace Social Beauty with social ugliness?
To which one of the cardiologists responded, “I respect your opinion, but don’t you think you are being a bit dogmatic, a bit rigid, and perhaps a bit dramatic? Should you not be a little more liberal in your thinking—more willing to give creative, alternative ideas a chance?”
Dr. H took a deep breath and said: “ If it were a mere opinion, a mere hypothesis, that capitalism is a malignancy, then I would agree that we should be open-minded, rigorously test that hypothesis, and carefully give capitalism a chance, to see if it is truly a malignancy, before concluding that it is. However, capitalism has had more than 300 years to demonstrate its merit. It has been given more than ample opportunity to prove its worthiness to be the predominant economic model for Humanity. It has been tested. And it has failed, miserably, to act kindly towards Humanity and the planet.
There is ample evidence that capitalism, especially global corporate capitalism, has behaved in malignant ways and has had devastating malignant effects on the majority of the world’s people and the earth itself. This has become increasingly obvious to anyone who carefully studies history and carefully examines geo-political-economic-social-environmental problems in today’s world. According to the evidence, capitalism is a malignant economic model. That is a fact, not an opinion or untested hypothesis.”
“Again,” she continued, “I would be more open-minded, more willing to accept your proposal to practice capitalistic activity within our institution, if the notion that capitalism is a malignancy were a mere opinion, only an hypothesis. I feel obligated to make decisions based on fact and evidence. Since it is a fact, backed by ample evidence, that capitalism is a malignancy, and since I see no place for malignancy in the operations of our institution, I need to vote against introducing capitalistic activity into our institution.”
She went on, “Now, I do not want to be authoritarian and oppress those who do not believe that capitalism is a malignancy. If there are those among us who do not think capitalism is a malignancy and who think it would be okay to introduce capitalism into our institution, my suggestion is that we devote ample time to thoroughly debate and better understand this issue. Education, discussion, and creative constructive discovery are what is needed, not suppression of different ideas. I am confident that after kind, respectful, and thorough discussion of this issue, it will become clear that it would be best to not introduce private enterprise into our institution. Although such an introduction might result in some financial benefit for the institution in the short term, the side effects are much too great in the long term. The seductive temptation is best resisted.”
The cardiologist responded, “With all due respect, and in the spirit of evidence-based decision-making, could you please review the ‘ample evidence’ that capitalism has malignant characteristics and consequences—that capitalism is a malignant model?”
Dr. H: “In addition to the already mentioned malignant effect that capitalism has had on Academic Medicine, there is further evidence, outside of Medicine, that capitalism has malignant characteristics—in the history of the world’s geo-political/economic activities. As physicians, we know the importance of taking a thorough history, not only of the present illness, but also a past history. And, good physicians look for familiar patterns. If we take a history of geo-political-economic-social-environmental events, presently and over the past 70 years, it is obvious how malignant capitalism has been. Capitalism, particularly the practices of its giant transnational corporations and the governments who serve them, has brought about ruthless wars, obscene (and ever-increasing) income inequality, and catastrophic environmental degradation.4 For example:
Capitalism, by its own inherent nature, including its perverted and incorrect understanding of ‘competition,’ requires its practitioners to seek and win ‘competitive advantage’ over others—to ‘win the competition;’ ‘to beat others.’ It preaches that those individuals, corporations, and nations who do not adequately look after their own self-interests will ‘lose;’ while those who aggressively attend to their economic self-interests will ‘win.’ For example, Corporate/governmental quest for control of oil has resulted in endless wars in the Middle East. Look at what capitalist powers (particularly the USA) did to Iraq, even before the devastating 2003 Iraq War. I am referring to the Clinton sanctions on Iraq during the 1990s, which resulted in the death of at least 500,000 Iraqi children. When asked about these children’s deaths, Secretary of State, Madeleine Albright, publicly and shamelessly stated ‘the price was worth it.’ Look at what has happened in Yemen. According to the international charity ‘Save the Children’ and data gathered by the United Nations International Children’s Emergency Fund (UNICEF), 85,000 children under the age of five may have died during the war in Yemen—another war perpetrated by capitalist powers in order to control Middle East oil. Look at how many children have been killed in eastern Congo over the past 30 years as transnational corporations (and the governments who serve them) have vied for control of the natural resources in that country. Over the past 70 years it has been estimated that wars waged by capitalistic powers (primarily the USA) have killed 20-30 million people, in 37 ‘victim nations.’4 Does that not seem malignant?
The above wars (atrocities, really) are a predictable outcome of the global capitalist model—a model that espouses and encourages an abusive and incorrect view of Human Nature2, a perverse and incorrect understanding of competition, a need to exploit and dominate others, and a need for continued growth (of the economy) and of consumption. These wars (recent ones in Iraq, Afghanistan, Libya, Syria, e.g.) are the predictable malignant results (repeated patterns) of capitalist powers vying for control of resources and domination of markets. How can an economic model that predictably leads to the slaughter of innocent children not be deemed malignant? How can a model that repeatedly and predictably places profits over children’s lives, without remorse, not be viewed as malignant?
Look at the obscene income disparity that global capitalism has created. Thanks to capitalism, in 2017 half of the world’s wealth was owned by just 8 men.5 This absurd income inequality is an inevitable result of capitalism and has been steadily and predictably worsening throughout the past few decades. The ultra-capitalists have become increasingly powerful, increasingly ruthless, increasingly undemocratic, and increasingly out of control—just like cancers behave. How can this phenomenon not be viewed as malignant?
Look at what transnational capitalist corporations (and the governments who serve them) have done to the environment—in Borneo, for example. Once a source of rich natural biodiversity, Borneo has been slashed, burned, and replaced with rows and rows of corporately owned palm oil trees. And, in the process, the indigenous peoples of Borneo have been ruthlessly displaced, often killed. In a global capitalist economy, profits have been far more important than people and the earth itself. Similar stories are playing out in Papua New Guinea, in the Amazon, and in many other places—at the expense of the environment and indigenous peoples. Furthermore, capitalism’s dependency upon and insistence on ever-increasing economic growth and consumption has led to global warming and imminent catastrophe for Humanity and the Earth. How can an economic system that inherently requires, depends upon, and rewards ever-increasing (and never satisfied) ‘growth’ and harmful ‘consumption’ and aggressive ‘competition’ not be considered malignant? From an environmental standpoint alone, capitalism is an obviously malignant economic model.
The above represent just a few examples of Capitalism’s dismal record regarding issues of war and peace, equitable income distribution, and the environment. All of the above atrocities have been directly due to the unfortunate economic model that the world’s ultra-capitalists (and the governments and armed forces who serve them) have forced upon Humanity and the Earth. The effects of capitalism on the environment and most of the world’s population have been nothing short of malignant, leading to the killing of millions of people, the suffering of billions more, and the destruction of the environment—to the point of potentially killing Humanity and the Earth itself. These poor outcomes of capitalism are as predictable as the poor outcomes of un-treated lethal cancers. By definition, malignant systems predictably and inexorably lead to destruction, devastation, and death—when allowed to continue, un-treated.
If you will permit me, I would like to provide one more example of how malignant capitalism is: Remember the Viet Nam War? The USA and South Vietnam fought brutally against North Vietnam, which was led by Ho Chi Minh, who, with the great support of the North Vietnamese people, sought to develop a Public Economy and a Public Culture for North Vietnam—as opposed to the private capitalist economy and private capitalist culture preferred by the USA and its promoted leaders in South Vietnam. For example, Ho Chi Minh believed that health care is a human right and should be provided at no charge to all patients. He wanted to train large numbers of public-spirited doctors and nurses and build much needed public hospitals, like ours, to altruistically and kindly meet the desperate needs of all the North Vietnamese people. The USA, viewing Ho Chi Minh’s plans and social philosophy as an intolerable threat, waged war. More bombs were dropped on Vietnam than on any country in history. In addition, 20 million gallons of herbicides were sprayed on North Vietnam to defoliate the hiding places of the Viet Cong. Huge quantities of Napalm, Agent Orange, and other lethal chemicals were spread over Vietnam—permanently damaging the countryside and its ecosystems. Nearly 6.5 million Vietnamese soldiers and at least 2 million Vietnamese civilians were killed during the war. Many more were permanently wounded. Despite this ruthless bombing and poisoning, perpetrated by the USA, the war was won by the North Vietnamese. The USA soundly lost and was driven out in 1975. Against all odds, Ho Chi Minh’s idea of a Public Economy and Public Culture had prevailed over the USA’s gruesome atrocities. North and South Vietnam united to become a single sovereign country, with a public economy and a public culture.
But, what happened after 1975? For one thing, Ho Chi Minh, who died in 1969, was replaced by leaders with less ability and less insight. Secondly, although the USA had lost the military war, it followed with a seductive propaganda war that extolled the virtues of capitalism and promised prosperity, if Vietnam were to turn to Neoliberal capitalism and partner with US and Western transnational corporations. Having been bombed and poisoned to the point of economic and environmental ruin, the new leaders of the Vietnamese people and much of the population were desperate and vulnerable to the seductive enticements of capitalism, and they fell prey to the slick allure of capitalist social philosophy. Capitalistic practices and philosophy were introduced and, soon, foreign corporate investment and IMF/World Bank loans poured in. The Public Economy/Public Culture, inspired by Ho Chi Minh, has withered and been supplanted by rampant, ever-increasing capitalism. Vietnam has become one of the most pro-capitalist countries on Earth—complete with the gross income inequality, corruption, and heartlessness that is inevitable with capitalism. Yes, there is now a middle class in Vietnam and 10% of the population has become rich. But, health care is no longer a right and has become inequitable and unaffordable for most. And, Public Culture and altruism have been replaced by capitalism’s cut-throat competition, individualism, hollow “prosperity,” and anxiety.
My point is that it was easier for the North Vietnamese to conquer the bombs, Napalm, Agent Orange, and other atrocities perpetrated by the US military invasion, than it was to conquer the slick, seductive allure and invasion of capitalist propaganda. The power of US capitalist propaganda was harder to conquer than all the military assaults. Such is the malignant power of capitalism.
This is not the only time that the slick, seductive allure of capitalism’s propaganda has overthrown the efforts of sovereign countries to develop Public Economies and Public Cultures. Look what happened to the Public Economy/Public Culture that Julius Nyerere developed for Tanzania during the 1970s. It is very difficult for countries that try to develop a Public Economy/Public Culture to withstand the malignant power of capitalism’s sick social philosophy, slick economic practices, and seductive promises of “prosperity.”
Incidentally, on a different note, there is one other concern that I would like the cardiologists and radiologists to consider: I don’t think it is wise to create a two-tiered system of health care—a system in which the wealthy can enjoy prompt, unrushed, kinder care, while the less wealthy must wait and receive rushed, less kind care. Care should be egalitarian. All deserve the same degree of prompt, unrushed, kind care. The proposal presented by the cardiologists and radiologists introduces a two-tiered health care system.”
One of the cardiologists responded: “Okay, you build a good case for the harm that capitalism can cause and has caused. But, what about the tremendous advances that have occurred over the past one hundred years under capitalism—in technology, science, Medicine, and material standards of living? What about all the people, globally, who have been lifted out of poverty?”
To which Dr. H said, “First of all, many of those advances (in science, technology, and Medicine) were the result of Public Activity, not private capitalist activity. In fact, most of the advances in Medicine have resulted from the dedicated work of modestly salaried physicians and scientists at public universities and other public institutions—that is, those advances have been the product of Public Activity. Secondly, where is the evidence that any reduction of poverty attributable to capitalism could not have been equally achieved, or achieved to an even greater extent, under Public Economies? I would contend that a global network of Public Economies1 would diminish poverty (and increase peoples’ quality of life) to a far greater extent, and more efficiently, than has the global network of capitalist economies. Finally, is the relatively hollow prosperity that capitalism brings to only a portion of the population worth the side effects of capitalism’s sick social and cultural philosophy—especially when there is a better, healthier, more equitable way to raise the living standards and spirits of all people?”
Then, one of the radiologists said, “But, what about our freedom? Should people not be free to create their own businesses and do things in their own way?” What about individual liberty?”
Dr. H: “In my opinion, true freedom, or at least the most important and precious freedom, does not come from the individualism and self-interest orientation that capitalism espouses, requires, rewards, and depends upon. As I mentioned earlier, it comes from participating in collective public efforts, like our efforts here at VHPCH, to genuinely look after others. The most precious freedom is the freedom to enjoy widespread up-regulated expression of the human capacity for kindness—up-regulation both in oneself and in the larger society. This precious freedom is, unfortunately, quite delicate, sensitive, and fragile. It is dependent on a healthy social milieu. It is easily taken away, when that social milieu is invaded by the malignant mentality, motivations, and behaviors of capitalism. Just as Human health is easily destroyed by malignancy, this most precious of freedoms is easily destroyed by capitalism. Such is the destructive power of malignancies. In the past, Academic Medicine (before capitalism was forced upon it) provided wonderful opportunity for this most precious freedom and protected it. Instead of providing that opportunity, capitalism robs us of this most precious freedom.
Let me point out one other thing. To me, the motivation behind actions is of paramount importance. Prior to the forced insertion of capitalism into Academic Medicine, we were uniformly motivated by a commitment to altruistically meeting the needs of children. We were motivated by a moral incentive. We were not motivated by a desire to make money. We did not feel a need for, nor did we want, monetary incentive. That uniformity, that solidarity, regarding motivation, created a wonderful individual and group spirit. It created the Social Beauty that we enjoyed and that benefitted our patients. That spirit is jeopardized when capitalism is introduced—when some members of the group become motivated by monetary incentive, while others continue to be motivated by moral incentive. That difference in motivations is divisive, erodes the spirit we once enjoyed, and diminishes opportunity for the “most important and precious freedom” mentioned above. I recognize that one well-meaning purpose of the cardiologists’ proposal is to generate new and greater income, which can then benefit the institution as a whole. But, for the reasons I have already stated, I think the undesirable side effects of injecting capitalism into Academic Medicine greatly outweigh the benefits. I think injection of capitalism into the workings of our institution would be a big mistake.”
One of the radiologists then spoke up: “Dr. H, I think you have generalized too much in your critique of capitalism—painted it with too broad a brush. I know of many small business owners who are very fine people, who care much about their customers and their community, and who give generously and kindly. The private clinic that we are proposing would be similarly kind and generous. You seem to be suggesting that all business-people are selfish and uncaring. That strikes me as being not only an over-simplification, but untruth.”
Dr. He responded: “You raise a good point. I agree, that there are many wonderful small businesses that kindly meet people’s needs and treat people with dignity and great care. When I talk about “capitalism,” I am primarily referring to large corporate capitalism (e.g. giant transnational corporations), as opposed to small “Mom and Pop” capitalism (small businesses). My criticisms of capitalism are primarily directed at big businesses and apply much less to small businesses. My main concerns about capitalism are its beliefs (the mistaken premises upon which it is based), its ideology, its methods, its motivations, and its serious (malignant) side effects.
Just because some (even many) small business owners have operated very admirably, does not mean that capitalism is okay. In fact, it is my opinion that the many truly kind and altruistic small business owners could feel more fulfilled, and less stressed, if their businesses were a component of a Public Economy. In a Public Economy, they could still lead and manage their businesses, but they would be doing so at the request of the Public and with the financial support, admiration, and gratitude of the Public. Furthermore, in the current capitalist economy, what choice have people had if they want to develop a small operation to meet a community need and to do so in a creative, kind fashion? Have they had the choice of doing so as part of a Public Economy, or has their only choice been to start their own private small business? Those who support capitalism talk about ‘freedom of choice.’ But, do people who would like to develop a small operation to kindly meet a community need have the choice of doing so as part of a Public Economy, or is ‘starting their own business’ their only option?
Another radiologist had this to say: “Dr. H, I don’t think you are giving us enough credit. If we are careful, I think we will be able to control and contain the adverse effects that worry you. I don’t see any harm in allowing a little bit of market dynamics and monetary incentive, as long as we are vigilant and keep it from getting out of hand. In fact, allowing a little bit of such freedom and diversity might be good for VHPCH and our society as a whole.”
To which Dr. H said, “I am all for diversity and inclusion. After all, as physicians we have learned that diversity, flexibility, and adaptability are essential features of healthy human physiology6. But, the wonderful intrinsic diversity and flexibility of human physiology does not include placement of a welcome mat for malignancy. For example, do we think the human immune system’s cancer surveillance system is designed to purposefully and willingly ‘allow a little bit’ of lethal cancer? Or, is a normal healthy immune system designed to try to completely eradicate incipient lethal malignancies (i.e. disallow such malignancies)7? As a hematologist/oncologist, my goal is to eradicate life-threatening malignancy (e.g. acute leukemia) as completely as is safely possible—otherwise, the patient will likely die. After a child and I go to great lengths to eradicate the child’s acute leukemia, is it okay for me to purposefully allow a ‘little bit of leukemia’ to return? Why, after eradicating a child’s leukemia and restoring the child’s health, would we choose to purposefully re-introduce ‘a little bit of cancer?’ To reintroduce malignancy would be criminal, would it not? How is giving cancer a little bit of freedom, a little bit of opportunity, a potentially good thing? The human body should not have to suffer malignancy, nor should Humanity.
By the way, what makes you so sure that you and others would be ‘able to control and contain’ the practices and effects of capitalism—of even ‘limited capitalism?’ Let me state again, malignancy is very difficult to control. Capitalism is malignantly seductive.”
One of the radiologists then said: “The model you prefer is certainly a noble one, but, realistically, we are now practicing Medicine in the context of widespread capitalization of health care, not to mention a capitalist economy in general, globally. Most health care institutions are now practicing a capitalistic economic model. Health care has become very competitive. Those institutions that play the capitalistic game well will win; those who stick to older models, noble and altruistic though they are, will become isolated and will lose. We cannot afford to isolate ourselves from the competitive interdependent capitalistic world that we now live in; we must become integrated with it. Your altruistic model is too idealistic; no longer realistic in today’s world. We must not be afraid to change with the times. Change is difficult, but change we must.”
Dr. H responded: “I agree, that we now live in a world where almost everything has been commodified, including health care, including physicians. As I mentioned earlier, at one time we were physicians who took care of patients; then (at least in the USA) we became ‘providers’ who served ‘clients;’ and, now, we are ‘revenue generators’ who se the ‘enterprise.’ This transformation has sacrificed the human rights of patients (and of altruistic physicians). Their needs have been marginalized, often neglected. Patients have suffered as a result, and so have physicians and Medicine itself. Such is the malignant transformative power of capitalism, which places profit over people. I am fully aware of this context.
In my view, we have an obligation to stand up for our principles, not capitulate to the capitalization of Medicine. It is our duty to practice our altruistic Academic Medicine economic model, exemplify it, teach it, and advocate for implementation of this model not only throughout health care, globally, but throughout general economies, globally. We need to change the current context, not capitulate to it and become integrated with it. Besides, today’s reality does not necessarily need to be tomorrow’s reality. We can change current realities. After all, in 1970 the reality was that 90 percent of children with acute lymphocytic leukemia (ALL) died. We did not accept that reality; we sought to change it. We did not capitulate. Now, the reality is that 90 percent of children with ALL go into and stay in remission. The tradition of Medicine is to continually challenge current realities and create new realities. Rather than capitulate to diseases, we seek to make diseases capitulate to us. If this can be done in Medicine, it can be done regarding economic models and social ills in general.
We have been privileged to enjoy the wonderful experience of working in children’s hospitals that have practiced an altruistic economic model. Our children’s hospitals have been sanctuaries, where this economic model and the Social Beauty it creates have a chance to flourish. We know, first-hand, how well this model works—-not just in theory, but in actual practice. And we have also experienced what happens when Medicine is practiced according to a capitalist economic model. This has positioned us to be strong, confident, and credible advocates for the Public Economy model, not only in health care, but throughout the general economy, not only in our country, but globally.
It would be a huge change for the world to abandon its current capitalist economic model and replace it with Public Economy models. Change is difficult, but we must not be afraid of change. As pediatricians, we have the experience, the confidence, the respect, the credibility, and the duty to take the lead in advocating for replacement of the capitalistic model with a Public Economy model—not just in Medicine, but in the general economy. We must not capitulate to capitalism; we must help bring about the capitulation of capitalism to the Public Economy model. We do not capitulate to childhood malignancies. Why would we capitulate to the malignancy of capitalism?”
One of the cardiologists then said: “But, Dr. H, I still worry that you are being too dogmatic, too rigid, too uncompromising. Dogmatism typically leads to suppression of creativity and imagination, silencing of dissent, loss of individual liberty, and a culture of intolerance, authoritarianism, and oppression.”
To which Dr. H responded: “Our tradition in Academic Medicine has been one of continual creative imagination/re-imagination, evaluation/re-evaluation, discovery, evolution, and revolution, but also conservation. Our understandings of normal physiology, of disease, and of treatment are constantly changing, often in revolutionary ways. We constantly rely on our imagination, curiosity, creativity, awareness, and disciplined critical analysis to come up with new hypotheses, new models, and new treatments, and we dare to test them. We learn to take compassionate, responsible risks, while assiduously avoiding reckless risks. We keep what works and abandon what fails critical analysis. Our tradition is one of a creative, imaginative search for truth—a commitment to discovery, based on collective consciousness. We are not afraid to develop new paradigms and abandon those that have fallen short. There is no place for dogmatism in Medicine, but there is a place for thoughtful conservation.
I think you are misinterpreting my effort to conserve as ‘dogmatism.’ I don’t think I am being dogmatic when I advocate for the conservation of a model that has proven to be healthy; when I resist replacement of our healthy model with a model that has proven to be unhealthy. Nor am I discouraging creativity, imagination, and discovery. The Public Economy model is not fixed in stone, immutable—any more than our understanding of Medicine is fixed, immutable. Public Economy, like Medicine, depends on continual imagination, questioning, creativity, evaluation, testing, discovery, evolution, revolution, and conservation. As in the development of Medicine, development of a Public Economy involves responsible risk-taking and some mistake-making. As in Medicine, those mistakes need to be recognized and better ways need to be discovered. Vigilant awareness, honesty, and creative correction of mistakes is a major way in which physicians learn and improve. Imagination plays a major role in this process. The same vigilance, questioning, and imagination that we employ in Medicine are necessary in the development of Public Economy.
Among the things we should seek to conserve, in Medicine, are the fundamental principles of compassion, altruism, moral incentive, unrushed care, scientific rigor, discipline, hard work, curiosity, imagination, creativity, hypothesis-driven testing, and evidence-based decision making. I feel obligated to conserve these principles. It is not dogmatic to insist on conservation of these principles, nor is it oppressive. What is oppressive is capitulation to capitalism. Such capitulation results in loss of the most precious of freedoms and stymies imagination and creativity. What employs and honors creativity and imagination is the process of transforming a capitalist world into one that embraces economic altruism and creates Social Beauty—the process of continually changing the status quo for the better.
My resistance to introduction of capitalism should not be viewed as a threat to creativity, imagination, free thinking, discovery, and change for the better. On the contrary, it is introduction of capitalistic practices that threatens these and other important principles.
We should be proud of our Medical tradition of being radical (always seeking the root cause of problems), progressive (always seeking positive progress), and revolutionary (always seeking to make changes, small and large, for the better), while at the same time being conservative (preserving that which has withstood critical analysis and has served patients well) and protective (e.g. protecting patients from mis-guided practices). Our tradition has been to be creatively radical, continuously evolutionary, frequently revolutionary, and protectively conservative—all at the same time, with altruism, critical thinking, imagination, evidence, facts, accurate history taking, and moral incentive as our guides. We have proven that this is possible.
By definition, a ‘dogmatic’ person is one who is convinced that their opinion is correct and refuses to consider that other opinions might also be justified. To be ‘dogmatic’ refers to following a doctrine (opinion) that is passed down and not questioned.
As I hope I have adequately explained, my position is not based on a mere opinion that has never been questioned. My position is based on evidence, facts, lots of questioning, and critical examination of real experiences—not on mere opinion. By definition, I am not being dogmatic. I am just trying to carefully meet my responsibility to be appropriately radical, evolutionary, revolutionary, and conservative—which is the tradition of Medicine.
One of the radiologists then said: “As long as we are being honest and upfront, let me say that you, Dr. H, sound too moralistic to me, and this makes me uncomfortable. In addition, I think you are just too idealistic.”
To which Dr. H said: “Well, I grant you that I have a very active, very much alive moral imagination, as opposed to a deadened moral imagination, and I am certainly guided, strongly, by moral incentive, but I don’t think my moral attitude is excessive, too narrow, or too judgmental of other people—at least I hope not. In Medicine, are we being ‘too moralistic’ when we protect children from decisions that are based on littIe or no evidence and have proven life-threatening side effects, especially when better options are available—options based on solid evidence and proven efficacy and safety? Are we being ‘too moralistic’ or ‘too judgmental’ when we encourage decisions that are based on evidence and proven efficacy and discourage decisions based on little evidence and unacceptable side effects—or, is it our obligation to make these judgments? I certainly want to be careful, though, to not be too judgmental; so I am glad that you have raised this concern.
As far as idealism is concerned, I have always thought that in Medicine, pursuit of ‘the ideal’ is one of our major goals—not that we will ever be able to achieve the ideal, but that we should at least strive for the ideal. As Victor Hugo said, ‘Progress is the aim; the ideal is the model.’ Furthermore, idealism nourishes the soul. When one loses their idealism, the soul becomes mortally wounded. I think being sufficiently moral and idealistic is important.”
At this point, a radiologist who had been silent, but had become increasingly agitated, suddenly blurted, with a hint of anger and more than a hint of frustration “Dr. H, I’m sorry, but you do not seem to realize that this socialist public economy model you speak of has been tried many times over the past 100 years and has always disastrously failed, only to be replaced by capitalism. Capitalism may not be perfect, but it is the best system that has ever been developed. Your model naively depends too much on human goodness. It does not take human selfishness into account. It is too idealistic. It will never work.”
Dr. H calmly re-stated what she had said much earlier: “It already has worked. We, in Academic Pediatrics, have been successfully practicing this altruistic Public Economy model for many decades, to the great benefit of children, at a bargain price for society. We have already proven its feasibility and merit. And, we have also documented the negative results when capitalism is injected into Academic Medicine. It is, therefore, factually incorrect to say that the Public Economy model has ‘always disastrously failed’ and that capitalism is the ‘best system.’
Now, one could argue that the kind, altruistic Public Economy model we have successfully practiced in Academic Pediatrics might not work equally well in the general economy, but where is your evidence that our model cannot be successfully applied to the general economy? I see no reason why it cannot be implemented throughout the general economy. My hypothesis is that our model can be successfully applied to the general economy. In the tradition of Academic Medicine, I suggest that we test this hypothesis and fully apply our creativity, imagination, flexibility, ingenuity, and compassion while doing so. Given the life-threatening problems facing Humanity and the Earth itself, I think we have an obligation to test this hypothesis.”
One of the cardiologists then said, “But, Dr. H, physicians are not like most people. Most people are not as idealistic and altruistic as physicians.”
To which Dr. H replied, “That is a rather arrogant thing to say. Furthermore, it is untrue. Most nurses are at least as altruistic as physicians, if not more so. Most minimum-wage-earning care givers in nursing homes are at least as unselfish and altruistic. The same can be said for most teachers, ministers, and most workers in general. It is arrogant to claim that physicians are special, exceptional, and unrepresentative of Humanity.”
Another agitated radiologist then complained: “I’m uncomfortable with your message that we all need to be paragons of virtue. I have problems with ‘do gooderism.’ I don’t want to be a self-righteous do-gooder. In fact, ‘do-gooders’ rather nauseate me, with their sanctimonious ‘holier than thou’ and ‘know it all’ attitudes.”
Dr. H replied: “I whole-heartedly agree with you. I do not like do-gooderism, either. I, too, am bothered by self-righteousness behavior and sanctimonious attitudes. But, I think you are mis-interpreting my message. I am not suggesting that we each must pursue virtue. On the contrary, virtue is not a goal that interests me. I do not purposefully strive to be virtuous. I am not advocating that we ‘aim to be good.’ I am advocating that we collectively contribute to the creation of conditions that up-regulate our best human capacities and allow us to maximally enjoy our individual and collective humanness.”
Then, Dr. H summarized her argument as follows: “In short, please consider that a Public Economy (the Academic Pediatrics Economic Model, or Economic Altruism) creates Social Beauty; while capitalism destroys and impedes Social Beauty.”
At this point the Chairman of Pediatrics thanked the participants in the discussion and asked for a vote. But, Dr. H suggested, instead, that a vote be deferred until all faculty members had had a chance to amply think about the issues raised at the meeting—issues regarding Human Nature, up-regulation and down-regulation of the expression of our many Human Capacities, the concept of competition, the pros and cons of capitalism, the nature and value of Public Economy, etc. She suggested that the group have additional discussion and dialogue regarding these issues before voting on the proposal presented by the cardiologists and radiologists. She thanked the cardiologists and radiologists for raising important issues.
All agreed that more discussion would be beneficial. Dr. H was thanked for sharing her thoughts—thoughts that were new to many of the faculty; thoughts that intrigued and excited most of them and raised their spirits.
As the cardiologists were leaving the room, one of them said, “What is ‘Social Beauty,’ and what is a ‘Public Economy’ and ‘Pubic Activity?’ I have never heard these terms before.” Another cardiologist said, “And, what is ‘moral incentive.’ What is this ‘most precious kind of freedom’ that she is talking about and this concept of ‘up-regulation and down-regulation of Human capacities?’ I, too, have not heard these terms before. She seems to just make up words that are hard to comprehend and do not seem to have any real meaning.”
“Frankly,” said one of the radiologists, “I didn’t understand most of what she said, and it occurs to me that she might be a little crazy. She makes me uncomfortable.”
The Chairman of Pediatrics, who happened to overhear this conversation, joined the cardiologists and radiologists and said: “It is quite telling and quite sad that such terms, particularly ‘Social Beauty,’ seem so new and so strange to so many. Such is the power of the propaganda arm of capitalism, which was largely developed by Edward Bernays—propaganda that not only repeatedly espouses untruths (about History, Human Nature, and the need for monetary incentive and capitalism’s perverted version of competition), but also deliberately blocks recognition of historical truth and Social Truth. Such is the power of malignancy. I think we need to listen to Dr. H. She speaks, and, more importantly, she lives with clarity, strength, and heart. When fighting malignancies, she has an unconquerable mind.”
After the Chairman had departed, one of the cardiologists muttered, “Who is Edward Bernays?” His friend chimed in, “And, who is Victor Hugo for that matter, and why is our hospital named after him?” both shrugged their shoulders and moved on.
Although Dr. H and the Chairman of Pediatrics had recommended further discussion of these important issues, no further discussion occurred. Seduced by thoughts of how increased revenue generation could enrich the institution, the cardiologists and radiologists became increasingly convinced that their proposal should be implemented. They were well-meaning. They imagined that an influx of new revenues would result in a much needed up-grade of equipment and facilities, including the building of a brand new state-of-the-art hospital and a new research building. They also urged another well-meaning change—that the Chairman of Pediatrics be replaced with a particular member of their cardiology division who had demonstrated great entrepreneurial spirit, savvy, and talent. They firmly believed that these changes were in the best short and long term interests of the institution. Their genuine, heart-felt goal was to improve patient care. The minority opinion of the cardiologists and radiologists prevailed.
Two weeks later, a new administration, appointed by the cardiologists and radiologists, dismissed the Chairman of Pediatrics and Dr. H from the institution. Dr. H was thought to be too rigid, too dogmatic, too unwilling to try new approaches, too resistant to change. She was considered to be too moralistic, too idealistic, and a harmful influence that would oppress creativity, imagination, exploration, and progress. She was suspected of suffering from “pathological altruism,” which was “impairing her ability to change with the times.” The former Chairman of Pediatrics was similarly perceived. Both were offered psychological counseling. Neither was given an opportunity to plead their case before the minority group that had assumed power. Though the majority of the faculty disagreed with the changes being made, they remained silent.
One month later, after a sizable donation, there was a name change. VHPCH was renamed Bezos Freedom Hospital for Children (BFHC).
Such is the power of capitalism’s malignancy.
Where are Dr. H and the former Chairman of Pediatrics now? Shortly after their dismissal, both turned 70 years old. Although neither wanted to stop practicing Medicine, they had little choice, but to retire. They have now transitioned from the Medical Clinic to what they like to call the Social Clinic—from providing care for individual patients to serving as physicians for society. Now, as Social Clinicians,8 they are tackling the biggest and most lethal (in terms of total number of people killed) malignancy of all—capitalism. They are guided by a deep understanding of Human Nature, including confidence that the human capacities for goodness, in all of us, can be up-regulated and can prevail. They are driven by moral incentive, their deep concern for children, and an unquenchable thirst for Social Truth. They are aided by their knowledge of History, their “pathological altruism,” their ability to imagine Social Beauty, and their unconquerable minds. They are finding their work in the Social Clinic to be as important and rewarding as was their work in the Medical Clinic—even more so.
One day, while working together in the Social Clinic, they had the following conversation:
The Chairman: “Where do you think we went wrong?”
Dr. H: “What do you mean?
The Chairman: “Well, we failed. We sought to preserve the Social Beauty that was benefitting the children we served; we tried to protect the hospital from the harmful effects of capitalism; but, ultimately, we failed. The cardiologists and radiologists prevailed, and they are now rapidly transforming the culture of the hospital, sending it in a capitalist direction. The hospital is no longer a thing of Social Beauty. Furthermore, we lost our jobs and the opportunities of influence that went with our employment. Our efforts were not effective. We failed to protect the hospital and further its Social Beauty. In fact, matters are now worse.”
Dr. H: “You are right—we failed.”
The Chairman: “But, why did we fail—that is an important question? How could we have approached matters differently? How could we have more effectively influenced matters? Where did we go wrong?”
Dr. H: “I don’t know. Maybe I was too fierce in my presentation of Truth—or, at least my understanding of Truth. Lots of people doubt that there is such a thing as Truth, or at least that Truth is knowable to humans. Such people are uncomfortable with and skeptical of those who claim to know Truth. But, would they argue that malignancy—leukemia, for example— is not truly threatening? Would they claim that it is folly to “know that Leukemia kills.” Does the malignant nature of leukemia not represent a Truth—a knowable Truth? Nevertheless, maybe I should have been softer, more humble, more empathetic and complimentary to the cardiologists and radiologists. Maybe my approach pushed people away. Maybe I, or at least my ideas, were much too threatening, too unsettling. Maybe I should have acknowledged that there are things to admire about capitalism—its emphasis on hard work, dedication, innovation, and creativity, for example.”
The Chairman: “Yes, maybe we were too adversarial, too intent on winning the debate, and, thereby, failed to create true dialogue. Dialogue is always better than debate, and certainly better than argumentation. Maybe we tried to present too much information, too rapidly. Maybe we needed to take smaller and fewer steps, advancing more slowly. On the other hand, the majority of our colleagues fully and quickly agreed with us. It was only a minority—a few of the cardiologists and radiologists—who disagreed. But, that minority prevailed.”
Dr. H sighed and said: “Well, I agree; in the final analysis, we failed. The allure of capitalism won. We need to figure out a better, more effective approach.”
The Chairman: “We probably should not be too hard on ourselves, though. After all, capitalism has been around for at least 300 years, and, to date, no approaches have succeeded in dislodging it from its position as the world’s predominant economic model—despite its malignant nature, or probably because of its malignant nature. As you well know, the fight against malignancy is a challenging one. Malignancy is cunning, very clever. It is extraordinarily powerful.”
Dr. H and the Chairman sat together silently, looking at each other with kind, knowing smiles. Though they were quiet on the outside, their unconquerable minds were fiercely at work.
1For further explanation of the “Public Economy Model,” please see: Notes From the Social Clinic (NFSC): Public Economy.
2For further explanation of the flawed premises and malignant nature of capitalism, please see: Notes from the Social Clinic (NFSC): Problematic Aspects of Capitalism.
3For further explanation of the Up-Regulation and Down-Regulation of Human capacities, please see: NFSC: Up-Regulation and Down-Regulation of Human Capacities.
4From 1945 Until Today—20 to 30 Million People Killed by the USA. By James A. Lucas. Published on Global Research:
5Giants: The Global Power Elite, by Peter Phillips. 2018.
6Please see NFSC: Human Physiology as a Model for Human Economy
7Please see NFSC: The immune System as a Model for Social Organization
8For further explanation of the “Social Clinic” and “Social Clinicians,” please see the following Notes From The Social Clinic:
- NFSC: Welcome to the Social Clinic
- NFSC: Themes and Strategy of the Notes From the Social Clinic
- NFSC: Lessons from the Medical Clinic
- NFSC: The Medical Clinic and the Social Clinic
- NFSC:14: The Social Clinic Movement