Problematic Aspects of Capitalism
When the economic model that is called “capitalism1” is examined in the Social Clinic, it appears (at least to this Social Clinician) to be an unwise and harmful economic model. The premises upon which it is based are deeply flawed, and its side effects are unacceptable. In this essay key arguments for capitalism are critically examined, important side effects of capitalism are explored, and an alternative economic model (Public Economy) is introduced.
Regarding Human Nature:
Capitalism is based upon and justified by an inaccurate, incomplete, simplistic, excessively negative, and abusive understanding of Human Nature. According to the advocates of capitalism, human beings are, “by nature,” primarily selfish, and rather hopelessly so. This view of “human nature” emphasizes the negative capacities of human beings and largely ignores, or at least minimizes, the positive capacities of human nature. It is anti-people in that it shows little respect for and little faith in the positive capacities of human beings. In fact, it is an abusive view of Human Nature—much like the cruel, belittling message an abusive husband gives to an abused wife to keep her from believing in her self-worth.
There is a more positive, more complete, more accurate, deeper, kinder, and more helpful understanding of “human nature.” It is this:
Human beings innately have capacities for both selfish and altruistic behaviors. Each of us has our own unique mixture of these capacities, at least regarding the extent to which specific capacities are more easily and strongly expressed. Among people, there is probably a spectrum, regarding the ratio of capacity for and/or expression of altruistic behavior versus capacity for and/or expression of selfish behavior. At one end of the spectrum are people who tend, naturally, to easily and strongly express extraordinarily great innate capacities to behave altruistically (saint-like people, at this farthest end of the spectrum). At the other end of the spectrum are people who tend to easily and strongly express extraordinarily robust innate capacities to be selfish (ruthless, sociopathic mobsters, e.g. at this farthest end of the spectrum). In the exact middle are people who struggle with roughly equal tendencies to be selfish versus altruistic. There is probably a bell-shaped curve regarding the ratio of capacity for and/or expression of these different behaviors, although it is possible that this curve, in actuality, is shifted considerably towards the altruistic end—that is, considerably more than half of people might have a greater innate capacity for and/or tendency to express their innate altruistic capacities than their innate selfish capacities. Perhaps we have been able to survive as a species because this is so.
People not only differ regarding which innate capacities are strongest and/or most naturally and strongly expressed, but also regarding the extent to which they have been taught or otherwise influenced (by their upbringing, role models, education, institutional experiences, other life experiences, and behavioral practice) to express their altruistic capacities versus their self-serving ones. That is, environmental factors, including social factors and practice, can influence whether a person is more likely to express their innate altruistic capacities than their innate selfish capacities, or vice versa. Such factors can up-regulate (increase) or down-regulate (decrease) the expression of an individual’s capacity for altruism; and can either up-regulate or down-regulate expression of an individual’s capacity for selfishness. In that sense, environmental factors are capable of skewing the bell-shaped curve (toward the altruistic, or toward the selfish ends of the spectrum) when it comes to the actual expression of capacities.
Because of the above-mentioned differences regarding the strength of innate capacities and/or the ease and intensity with which innate capacities are expressed, and differences in the social influences that affect such expression, people are drawn toward different types of human activity. For example, Albert Schweitzer, the famous German physician who altruistically dedicated his life to developing a hospital in the heart of Africa, was probably naturally drawn to that challenge. That was his most natural inclination and interest. He probably had a great abundance of the capacity for altruism and this capacity was probably easy for him to strongly express. He was also undoubtedly influenced by role models, his upbringing, his religious beliefs, his education, and other life experiences. He probably had little innate inclination or interest in building a highly profitable business empire, or otherwise expressing his more selfish capacities. That kind of accomplishment, for him, probably would not have created much satisfaction, anyway.
In contrast, other people have strong natural inclinations to acquire wealth and/or obtain power over others, and they vigorously exercise those capacities, with enthusiasm, fascination, and excitement. Such people become either further inclined or less inclined to express those capacities, depending on their life experiences and role models. If a child is brought up in a family dominated by a father who is a ruthless business tycoon, and that child is encouraged and taught how to be a “chip off the old block,” then it is likely that the child will exhibit behaviors similar to the father’s, particularly if the child is sufficiently indoctrinated and not encouraged to think independently and question things. If that same child, however, were to spend summers working in a hospital in the slums of a big city, he/she may learn to exercise innate altruistic inclinations and greatly increase expression of them.
So, how a family or a society organizes itself, teaches itself, and practices certain behaviors can have a tremendous influence on the extent to which its members express their innate altruistic capacities/inclinations, as opposed to their selfish capacities/inclinations. If a society teaches a negative, anti-people view of human nature and insists on an economic model that is based on that view, dependent on that view, and virtually requires and rewards selfish behaviors—then, its people will tend to exercise their selfish tendencies, and their altruistic capacities will be repressed, under-expressed, under-practiced, under-valued, under-supported and will wither. On the other hand, if a society teaches an accurate, positive view of human nature and develops an economic model that promotes expression of the altruistic capacities in all of us, and gives ample practice to those capacities—then, its people and its institutions will behave increasingly altruistically and less selfishly.
It should also be realized that individual human beings need help from their society and culture, if they are to optimize expression of their altruistic capacities and minimize expression of their selfish tendencies. Most of us cannot do this alone. Some people may be able to this without help, because of extraordinary make-up and/or very helpful life experiences. “Religion” helps some people, but has historically failed to adequately affect the big picture, primarily because the prevailing economic model, which has remained inadequately unchallenged, gives huge practice to behaviors that contradict what most of the world’s religions teach. Religions would have far more beneficial effects on individuals and society as a whole, if the economic model that so profoundly affects people’s daily lives were to reinforce and give practice to desired behaviors, instead of promoting and rewarding the very behaviors that most religions warn against.
A related concept is that the more one practices an up-regulated capacity, the easier and more automatic (habitual) that practice becomes. Capitalism, unfortunately, gives great practice to our worst capacities—so much so that those capitalistic behaviors become increasingly entrenched, automatic, and hard to reverse—and an increasing percentage of people are drawn into such practice, largely by default, since there is little or no opportunity to practice an alternative, more positive, economic model. Furthermore, those capitalistic behaviors are abusive to the bulk of the population (predatory debt and heartless excessive pricing, e.g.), and a side effect of this chronic abuse is up-regulation of protective, defensive behaviors (fearfulness, wariness, tension, anger, even outrage) among the abused general population—which is not a healthy state for them or the larger society. In short, capitalism creates a vicious cycle that increasingly escalates unkind behavior. A Pubic Economy, on the other hand, gives great practice to our most altruistic capacities—such that expression of those capacities increasingly becomes easier, more automatic, and more entrenched—and a side benefit of the kind, non-abusive nature of the Public Economy is creation of a state of ever-increasing peacefulness and gratitude among the Public. In short, the Public Economy model creates ever-increasing levels of kind behavior, individually and collectively.
As explained above, Capitalism’s understanding of Human Nature is erroneous, incomplete, simplistic, excessively negative, and abusive. It would seem wise, therefore, to strongly challenge the oft-stated notion that our current economic model (capitalism) is the best that we can do, “because of human nature.” We can and we need to develop a much better economic model—one that is based on an accurate understanding of Human Nature; one that helps all of us to maximize expression and development of the altruistic capacities that we all have. All of us, individually and collectively, would benefit from, and need, such a model.
Regarding the Profit Motive (monetary incentive):
Capitalism is also fundamentally based on the erroneous notion that monetary incentive (the profit motive) is an essential motivator of human work activity.
A very common argument put forth to justify the capitalist economic model is that, “because of human nature (the erroneous view mentioned above),” the profit motive and other material incentives are absolutely necessary to adequately motivate people to perform well. The argument goes that people, “by nature,” are selfish and tend to not work hard or well, unless they are either watched closely or are provided with some form of monetary reward (incentive). The further claim is that any economic model that relies on altruism and is not driven by monetary incentive is doomed to fail, again, “because of human nature.” This capitalist view, like the capitalist view of Human Nature, is inaccurate, excessively negative and is abusively dismissive of human capacity for goodness.
It is not true that people will perform well only if monetary incentives are involved. This view, which is based on an incomplete understanding of Human Nature, disregards and disrespects the human capacity for altruism. Academic pediatricians have already solidly demonstrated that the “profit motive” is not necessary for work achievement. In fact, many academic pediatricians would argue that injection of the profit motive into medical practice is harmful to work achievement. Most nurses, teachers, and dedicated workers of all sorts have, like academic pediatricians, demonstrated that the profit motive is not necessary. Instead, what motivates them is the desire to contribute in a meaningful way, and the satisfaction they feel when doing so.
Regarding Competition:
Another fundamental belief of capitalism is that “competition” is an essential element for a successful economic system. More specifically, the belief is that “without competition, people and companies will not have sufficient incentive to work hard and well.” While capitalism’s emphasis on the “profit motive” stems from belief in a negative and incomplete view of Human Nature, its emphasis on “competition” stems from a perverted understanding of what the word “competition” truly means. This misunderstanding of human nature and the true meaning of competition are two main reasons why people believe, erroneously, that capitalism is the best and “only realistic” economic model for humankind.
It is true that “competition,” properly understood and properly practiced, can be a good thing, at least in sports, and is one way to add excitement, fun, and bring out the best in people as they seek to improve themselves, individually and collectively. However, the key and the difficulty is the proper understanding and proper practice of competition—because competition, improperly understood and improperly practiced, is usually not a good thing and tends to bring out the worst in people.
So, what is the “proper understanding” of competition, and how is it “properly practiced?”
By definition, “competition,” contrary to popular belief, is not about “beating others,” or “being better than others,” or “being the best.” It is not even about “winning” or “losing,” and it certainly is not about “defeating.”
The word “competition” comes from the two Latin words “com” and “petere.” “Petere” means “to seek,” and “com” means “with,” or “together.” So, the word “competition,” accurately understood and by definition, means “to seek together,” or “to seek (new heights) together.”
Thus, “competition” is simply a means by which people can work together (collaborate) to create an atmosphere and a spirit that will encourage and help all participants to reach new heights of accomplishment (do their best), and to enjoy the process of doing so. It is about all helping each other, so that all can get better (and/or have fun), both as individuals and as a group. When competition is properly understood and properly practiced, everyone wins. When competition is improperly understood and improperly practiced, there is only one winner and all others are diminished.
The true purpose of competition is not to determine who is “better,” but, rather, to create a process and an enjoyable atmosphere that will help all participants to become better.
A proper understanding and the proper practice of competition are not easy. Philosophically and psychologically, a proper understanding of competition is difficult to grasp, and the behavioral and emotional goals of its practice are even more difficult to achieve. Competition is a sophisticated concept and is fraught with pitfalls and emotional challenges, even when it is properly understood and properly practiced. The proper practice of competition represents an ideal that is barely realistic in the healthiest imaginable culture and is totally unrealistic in an unhealthy culture (especially a capitalistic culture). When competition is poorly understood and poorly practiced, it tends to do great harm to all concerned—this includes harm to those who are trying to practice competition properly.
Have practitioners of current global capitalism been demonstrating a proper understanding and proper practice of competition? Do businesses in the same industry enthusiastically and collaboratively “seek new heights together” with their “competitors?” Do businesses that “are in competition with one another” strive to genuinely and sincerely encourage, help, and hope for their competitors to reach their maximum potentials? Do businesses and their boards of directors think the process of trying to be the best they can be is more important than the final standings? Do businesses try to avoid focusing attention on their own success? Do they try not to covet the position of more successful businesses? Do they avoid diminishing the accomplishments of others? Is the goal, truly, that all become better?
Or, has capitalism been practicing a grotesque, perverted, cut-throat version of competition? Does the “competition” promoted and practiced in capitalism seem to be all about “winning,” “defeating,” beating others,” “being better than others,” being #1,” scheming to dominate the market (at the expense of others and by any means necessary), boasting about “being best, “exceptional” (even when it is not true),” and hoping that the competition will somehow fail, even purposefully making moves to impair or discourage the competition.
It appears as though proponents and apologists for capitalism have grossly misunderstood the true meaning and purpose of “competition,” and are espousing and practicing an unhealthy, perverted, vulgar version of it—a version that tends to bring out the worst in people. Worse, with this economic model, the success of a business, realistically, depends on how well it executes this twisted, perversion of competition. Under this model, how long would a CEO last if he/she were to insist that the company genuinely (i.e. not as a public relations ploy) encourage, help, and hope for its competitors to reach their fullest potential, versus a CEO that insists that the company aggressively seek full domination of the market at the expense of the competition?
Even worse, this perverted version of competition has been a major cause of wars and the exploitation (of people and natural resources) throughout history. Fear of “competitors,” a perceived need to capture and control natural resources and market share, a perceived need to keep others from obtaining resources and gaining market share, and a perceived need to dominate the global or regional economy have been the driving forces behind most wars and the harmful exploitation of people and the earth. A healthy, accurate understanding of competition could result in a marked reduction of war and exploitation.
Do we really want an economic system that promotes and depends upon such a perverted and unhealthy understanding and practice of competition? Is that the best we can do? Isn’t it possible to develop an economic system that promotes only the healthiest understanding and healthiest practice of competition? Is it even necessary, though, to inject properly understood and properly practiced competition into economic activity, at all—particularly considering how difficult its proper practice is, how many pitfalls it involves, and how idealistic it is to expect people to practice it properly, especially in our current culture? Is it best to limit competition to the realms of sports and games and leave competition out of economic activity?
Regarding Up-Regulation and Down-Regulation of Human Capacities:
As mentioned earlier, human nature consists of capacities for both selfishness and altruism. Expression of each capacity can be either up-regulated (increased) or down-regulated (decreased). An unfortunate side effect of capitalism is that capitalism, by nature, up-regulates (increases the expression of) the human capacity for selfishness and down-regulates human capacity for altruism. Furthermore, capitalism is either unaware of, or ignores, the fact that social influences have the potential to either up-regulate or down-regulate individual and collective human capacity for altruism and kindness. The proponents of capitalism do not seem to grasp this important concept of up-regulation and down-regulation. They do not seem to realize that the Public Economy model, unlike the capitalist model, up-regulates the expression of altruistic capacities and down-regulates the expression of selfish capacities.
Regarding Individualism:
Another fundamental aspect of capitalism is its unfortunate emphasis on and reverence for individualism. Individualism and self-interest seeking are paramount and considered to be virtuous. The individual is more important than the collective. Individualistic private activity is preferred to collective public activity. Individualistic free enterprise and free trade are championed, and both are motivated by quest for individual profit. Contrary to capitalism’s belief, individualism is not the key to a successful economy, nor is it the key to freedom. The most important and precious freedom does not come from the individualism and self-interest orientation espoused, required, and rewarded by capitalism. It comes from participating in collective public efforts 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.
Regarding Free enterprise, Free Trade, the “Invisible Hand” of the Marketplace, Intellectual property, and “Trickle Down” benefits:
A central belief of capitalism is that the “invisible hand” of the marketplace will, and should, regulate the economy and will make the economy work. Allowing the market to solve problems is deemed preferable to democratic public planning. Free enterprise and free trade are deemed to be essential, particularly regarding innovation. And, innovations must be protected by “intellectual property rights.” Capitalism also claims that “trickle down” economics (the notion that wealth created by a few at the top will trickle down to adequately benefit the rest of the population) is appropriate and works—neither of which is true. Another phrase for this notion is “horse and sparrow” economics—meaning that if you give lots of grain to the horses, the sparrows will find plenty of grain in the manure. The truth is: free enterprise, free trade, the “invisible hand” of the marketplace, intellectual property rights, and “trickle down” economics are not necessary or desirable aspects of a healthy and successful economic model.
Regarding Promotion of Unhealthy Leaders:
An important side effect of capitalism is that it elevates people from the more selfish end of the human capacities/expression spectrum into positions of power and leadership, rather than populating leadership with people from the altruistic end of the behavioral spectrum.
Capitalism, which is based on the already discussed negative view of human nature, not only up-regulates heartlessness and down-regulates kindness, it rewards the former and punishes the latter. Capitalism up-regulates and rewards individualism, heartlessness, narcissism, aggressive self-interest seeking, suspiciousness, a perverted form of competition, exaggeration (if not outright lying), avoidance of healthy self-criticism, and resistance to countervailing truths. People with sociopathic proclivities tend to rise to the top, whereupon they behave in abusive, controlling, often violent ways and hire like-minded/like-behaving individuals.
For example: To what kind of behaviors do members of the most financially and politically powerful owe their membership in that group? Was it practice of altruism? Or, was it a willful and enthusiastic practice of cut throat competition and heartless decision-making? Do altruists rise to high positions in powerful corporate organizations? Or is altruism (genuine altruism, not fake “promotional” altruism) viewed as a liability by such organizations? The fact is that, realistically, the big “winners” in capitalism are the people and organizations that are the most aggressive, most cut-throat, most manipulative, most heartless, most self-promoting, most self-interest seeking, and the most narcissistic—in short, the “winners” are those whose behaviors are closest to the sociopathic end of the spectrum. Since those “winners” prefer to elevate like-minded people to positions of “leadership,” the positions of power are increasingly populated with people who have sociopathic proclivities. People at the altruistic end of the spectrum not only don’t win the capitalist game, they do not want to play it.
As a result, the financially and politically powerful increasingly become comprised of people with a mentality and behaviors closer and closer to the sociopathic end of the behavioral spectrum; while people at the altruistic end of the spectrum are increasingly marginalized, or worse.
With these types of people increasingly populating positions of power and “leadership,” it is no wonder that increasingly heartless and increasingly harmful decisions are made.
Creation of a culture of up-regulated heartlessness and violence:
When the financially and politically powerful consist predominantly of people who believe in a negative view of human nature, insist on capitalism, practice a perverted understanding of competition, and exhibit behaviors at the sociopathic end of the spectrum—a further side effect is that they create a culture of up-regulated heartlessness and violence. These powerful people, e.g., deny universal public funded health care, privatize what should be public services, exploit workers, and trap people in predatory debt. Some of these “leaders” have even deliberately created and funded terrorist organizations, and killed innocent women and children with drones—all the while controlling information and mis-educating the citizenry. They create a culture that is hedonistic, hypocritical, superficial, false, violent, soulless, and boring. Ultimately, they tend to create an increasingly racist and fascist society, especially if there is no effective opposition with a practical and healthy alternative plan. Most frighteningly, their ignorance, arrogance, and lack of conscience lead them to seriously consider actual use of nuclear weapons, even pre-emptively, even in response to perceived non-nuclear “threats.”
As mentioned earlier, this abusive culture breeds unhealthy, but predictable, reactions on the part of the abused (the bulk of the world’s population). The general population, chronically subjected to predatory capitalistic behaviors, understandably becomes increasingly wary, anxious, suspicious, guarded, angry, even outraged by the abusive behaviors they experience on a daily basis. This seething emotional undercurrent is made even worse when it seems hopeless that a healthy alternative social existence will ever be possible. The predictable result is some of the abused become increasingly prone to behave with uncharacteristic unkindness, not just towards the powerful, but also towards each other; others become silent, passive, apathetic, and resigned to their plight.
Endless promotion of economic “growth,” ever-increasing consumerism, and environmental disaster:
Another side effect of capitalism is that its emphasis on, indeed its dependency upon, “growth” and consumerism inevitably results in ever-increasing damage to the earth, including climate change. And, of course, it promotes a very materialistic culture.
Corporatization of society and the crushing of individual and collective souls:
Capitalism ultimately and inevitably (unless it is severely regulated) leads to obscene income inequality and rule by the ultra-wealthy corporate class of people—who, as mentioned earlier, are inevitably and increasingly led by people from the selfish-sociopathic end of the behavioral spectrum. Society becomes increasingly corporatized, sterile, cold, uncaring, heartless, and undemocratic, not to mentiom boring. Peoples’ souls are crushed. People become increasingly alienated and disgusted with the corporate culture created by the ultra-capitalists. An undercurrent of seething anger prevails in society. The root cause of this seething outrage is typically poorly understood, barely discussed. Fascism rises, as it becomes increasingly necessary to protect the interests of the ultra-capitalists, through control and force.
Capitalism’s false claim:
One of capitalism’s most erroneous claims is that “Human beings would not be enjoying the wonderful advances in living standards that they enjoy today, were it not for capitalism’s entrepreneurial spirit, competence, and achievement.” This claim assumes that no other economic model could possibly have resulted in the level of efficiency and achievement that capitalism has demonstrated. This claim is not only erroneous, it is arrogant and ignorant. There is an alternative economic model that has contributed more to Humanity than has capitalism, and has done so with great efficiency, at a bargain price for society—the Public Economy-Academic Pediatrician Economic Model.
The Malignant Nature of Capitalism:
A further problem with capitalism, and its most frightening feature, is that it has malignant characteristics. It is a very seductive economic model, with its tempting promises of potential wealth and privilege. It tempts and appeals to our most selfish capacities and quickly rewards those who get sucked in. Like medical malignancies, capitalism dislikes regulation, breaks rules, and illegally invades. Once it establishes a foothold, it becomes very difficult to treat and inexorably worsens. It has the capacity to destroy, and seeks to destroy, normal healthy processes (like true democracy).
To further explain the malignant nature of capitalism, the following dialogue is offered. It is a dialogue (fictitious, but based on real physicians and real experiences) between a pediatric hematologist/oncologist (Dr. H) and a pediatric cardiologist (Dr. C). Dr. C would like their children’s hospital to introduce fee-for-service, profit-making, capitalist practices. Dr. H would like the hospital to continue its Public Economy model, and worries about the malignant nature of capitalism.
Dr. H: Let us remember that our Children’s Hospital is a Public Hospital whose activities, up until now, have been conducted according to a Public Economy 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. Dr. C, you are requesting that capitalistic activity (market practices, including monetary incentive) be practiced within our institution. I have great reservations about injecting capitalistic behaviors into our institution, and I am happy to explain why.
Dr. C: Please do.
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 work load, 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 than an hour spent on 4 follow-up visits. (Health insurance companies paid more for a one hour new patient visit than for four 15 minute 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 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 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 week-ends, 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.
Dr. C: You have harshly likened capitalism to a malignancy. Could you further explain that comparison? It seems unfair to me.
Dr. H: I know malignancies very well. 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.
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.
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 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 decisions that have strong adverse effects that are difficult to reverse. Eventually, capitalism can lead to a totalitarian state (which can become necessary to crush inevitable resistance and rebellion), commanded by the wealthiest, most extreme, most sociopathic, most malignant capitalists.
Why would we want to introduce such a malignancy into our treasured Public Activity at our Children’s Hospital? 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 its opposite?
Dr. C: 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: 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.
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.
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. Such discussion is essential, before any decisions are made. 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.
Dr. C: 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—namely, 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 degradation2. 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 about 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 nations2.” 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 Nature, 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 men3. 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. 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 ‘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-countered cancer. By definition, malignant systems predictably and inexorably lead to destruction, devastation, and death—when allowed to continue, un-treated.
I could go on, but I will stop here.
Conclusion—Replacement of Capitalism with the Public Economy Model:
There are many other problems with the capitalist economic model, but we will stop here. The above list of problems is sufficient to cast appropriate doubts regarding the worthiness of the capitalistic economic model.
Why would we want such a flawed and problematic economic model—one that is based on an erroneous, incomplete, negative, abusive view of Human Nature; promotes an erroneous, perverse, destructive understanding of competition; insists, incorrectly, that monetary incentive is an absolutely essential motivating factor; up-regulates the worst of our human capacities and down-regulates and marginalizes our best capacities; populates leadership positions with people who have repeatedly exhibited behaviors associated with the worst of human capacities; promotes unending quest for growth and increased global consumption; ravages the environment; corporatizes society and crushes individual and collective souls; is undemocratic in its planning and decision-making; is malignantly seductive and destructive; creates social ugliness, rather than Social Beauty; claims, erroneously, that no other economic model is viable or safe; and further claims, again erroneously, that the nation that currently dominates global capitalism, the USA, is the exceptional, indispensable, most competent, most generous, and most responsible nation of the world.
Why have we allowed this sad, dangerous, destructive, abusive economic model to prevail over Humanity and the earth itself for more than 200 years? Surely we can do better than this. Surely, there is a better economic model.
Unfortunately, Capitalism will continue to dominate until a credible alternative economic model, which refutes and corrects the above beliefs, is effectively presented to and embraced by the world’s people. Fortunately, a healthy alternative economic model, the Public Economy model, has already been developed, implemented, practiced (for decades), and proven to be remarkably successful. One example, in particular, has demonstrated the nature and beneficial effects of the Public Economy model—the Public Economy model practiced, internationally, by Academic Pediatricians. The Academic Pediatricians’ efforts are based on: an accurate, positive view of Human Nature; promotion of moral incentive (and refusal of monetary incentive); an emphasis on meeting democratically determined needs and doing so in a non-profiteering fashion; an emphasis on altruistic, non-competitive, non-individualistic, non-hierarchical, non-profiteering, non-exploitative international collaboration; a refusal to accept capitalism’s perverted understanding of competition; and a realization that a Public Economy can up-regulate expression of our best human capacities; while capitalism, inherently, up-regulates our worst human capacities. Finally, the Academic Pediatrics Model creates and protects one of Humanity’s most precious freedoms—- 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—both in oneself and in the larger society.
Academic Pediatricians throughout the world (best exemplified in Canada) have practiced an altruistic Public Economy Model at their own institutions, while also developing a Collaborative International Network of Public Children’s Hospitals that have superbly served the world’s children. Academic Pediatricians see no reason why the Public Economy they have modeled could not be applied to the general economies of any and all nations.
The successful practice of a Public Economy model by Academic Pediatricians suggests that an alternative to global capitalism, including an alternative to global capitalism “with Chinese characteristics,” would be an Inclusive Collaborative International Network of Unique, Creative, Self-Determined and Self-Reliant National Public Economies. Led by the example of academic pediatricians, and guided by the Education of Medicine and the Education of Poverty, rather than the Education of Wealth, such a Network could replace capitalism, create Social Beauty, transform human behavior, and ameliorate the current suffering of Humanity and the Earth itself.
For more details about the Public Economy model, please see “NFSC– Public Economy: Development of a Collaborative International Network of Unique, Creative, Self-Determined and Self-Reliant National Public Economies. The reader is encouraged to compare the characteristics and accomplishments (actual and potential) of the Public Economy model to those of the capitalist economic model.
RMR
1In this essay, and in all other “Notes From the Social Clinic (NFSC),” the term “capitalism” is intended to primarily refer to large corporate capitalism (e.g. giant transnational corporations), as opposed to small “Mom and Pop” capitalism (small businesses). There are many examples of small businesses whose owners have operated in a kind, altruistic manner. The criticisms advanced in this essay are primarily directed at big businesses and apply much less to small businesses.
However, just because some small business owners have operated very admirably, does not mean that capitalism is okay. In fact, it is the opinion of this social clinician that the truly kind and altruistic small business owners could be even happier if their businesses were a component of a Public Economy. They could still lead their businesses, but they would do so at the request of the Public and with the financial support, admiration, and gratitude of the Public.
2From 1945 Until Today—20 to 30 Million People Killed by the USA. By James A. Lucas. Published on Global Research:
3Giants: The Global Power Elite, by Peter Phillips. 2018.
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