Terrorism and the Health-care Crisis
Which is a greater threat?
by Charles K. Fink
Z magazine, September 2002
There are, of course, greater threats to humanity than terrorism.
It is telling, however, to compare how the United States allocates
resources in response to these threats. Approximately 3,000 people
died in New York and Washington as a result of terrorism in 2001.
But that same year three million people died worldwide from AIDS,
according to the World Health Organization. This figure includes
1.3 million men, 1.1 million women, and 580,000 children under
15. According to a story carried in Newsday, April 27, 2001: "United
Nations Secretary-General Kofi Annan yesterday called for creation
of a multibillion-dollar global trust fund for treatment and prevention
of the world's AIDS pandemic. Annan's plea, issued as the annual
meeting of the Organization for African Unity convened in Abuja,
Nigeria, resonated in Congress as Secretary of State Colin Powell
testified before the House Appropriations Committee.
"On the subject of HIV/AIDS," Powell told the committee,
"it is a pandemic of the worst kind. It is not just a health
crisis; it's an economic crisis. "It's a crisis of survival
for not only families, but in some cases for whole nations, who
see up to a third of their population already affected by this
terrible disease." Powell said the AIDS pandemic is one of
President George W. Bush's "first priorities. We have been
meeting on this regularly over the last two weeks. "
However, neither Powell nor other members of the Bush administration
would talk of dollar amounts. The Administration's proposed budget
calls for a reduction in domestic AIDS care expenditures.
Annan called for creation of a "war chest," as he
called it, funded by the world's richest nations to the tune of
$7 billion to $10 billion a year. Current combined AIDS donations
from all sources to Africa and other beleaguered nations comes
to roughly $1 billion. Advocates for global health recently called
for several billion dollars a year from the United States.
On March 15, 2002, the New York Times reported: "Mr.
Bush was seeking $38 billion in additional financing for the Pentagon
on top of the $328 billion Congress authorized for the current
fiscal year, an increase of 11.6 percent. " The result: a
military budget for 2002 of $366 billion. This is larger than
the combined military budgets of Europe, Japan, South Korea, Australia,
Russia, China, and all potential enemies or "rogue"
nations, such as Iran, Iraq, and North Korea. Why would the United
States spend hundreds of billions of dollars on the military,
but devote a comparative pittance to AIDS relief?
The AIDS epidemic is one aspect of the health crisis ravaging
the Third World. According to the World Health Organization, tuberculosis
killed 1.7 million people in the year 2000, and malaria killed
more than a million, mostly in Africa. These are treatable diseases.
According to Food First, every year 12 million children die from
hunger or treatable diseases and at least 700 million people are
chronically malnourished. According to the World Health Organization,
2.4 billion people in the Third World do not have adequate sanitation
facilities and over a billion do not have access to clean drinking
water. As a result, 2.2 million people, mostly children under
5, die from dehydration caused by diarrhea. Perhaps 5,000 children
under 5 (or 18,000, according to Ramsey Clark) die each month
in Iraq because of the combined effects of war and economic sanctions.
Most of these deaths are due to contaminated water.
In 2001, the Pentagon approved production of the F-22 Raptor
Stealth Fighter Jet. Each plane will cost taxpayers $20 million
and the entire fleet will cost $70 billion, according to "NPR
News" (May 28, 2002). Despite complaints that the F-22 Raptor
serves no legitimate military purpose-the United States already
has by far the most advanced Air Force in the world-funding for
the project is unlikely to be cut. Lockheed Martin, the corporation
awarded the contract, has virtually guaranteed congressional support
by hiring 1,200 subcontractors in 46 states. This is a familiar
strategy. Rockwell won congressional support for the production
of the B-1 bomber by employing 5,200 subcontractors in nearly
every congressional district in the country.
According to World Vision, just 50 cents could feed a hungry
child for two days. A rehydration tablet costing a penny could
save a child dying from dehydration. For $4.6 billion, the amount
of money devoured by the U.S. military in three days, all people
in the world could have access to clean drinking water. According
to the UN, no more than $40 billion a year would be needed to
meet all the basic needs of the poor. According to Derrick Jensen,
for what the military spent in 2.5 hours in 1990, "smallpox
was eliminated back in the 1970s. For the price of a single B-1
bomber, about $285 million, the government could provide basic
immunization treatments, such as shots for chicken pox, diphtheria,
and measles, to the roughly 575,000,000 children in the world
who lack them, thus saving 2.5 million lives annually" (The
Culture of Make Believe).
There is a health crisis in the United States, one that puts
over 40 million Americans at risk. On February 9, 2002, the New
York Times reported: "At least two million people lost their
health insurance in the last 13 months as unemployment rose and
growing numbers of consumers decided they could not afford steeply
rising costs. Health care economists said that at least 40.4 million
Americans, based on conservative estimates, were uninsured by
California has the largest number of uninsured, 6.3 million,
according to two-year-old Census Bureau statistics, which were
adjusted late last year and recently published. Texas was next,
with 4.4 million. New York had 2.8 million, Florida 2.6 million,
Illinois 1.6 million, Ohio 1.3 million, and New Jersey I million.
The reason for this crisis is that health care in the United
States is not distributed according to the medical needs of Americans.
It is distributed according to socio-economic status.
At a conference on biomedical ethics sponsored by the University
of Miami, Dr. Steve Miles from the University of Minnesota, related
the story of a woman who approached him with the following dilemma.
She was suffering from heart disease and breast cancer, and was
taking prescription medication for both. She told Dr. Miles, "I
cannot afford all the medication that I am taking. So my question
is: Which is worse, to die from heart disease or to die from breast
cancer? Because I have to choose."
Victims of the American health-care crisis, though they may
far outnumber the victims of terrorism, are comparatively invisible.
The propaganda machine has been, as usual, quite effective
in distorting public perception. According to a survey conducted
by "NPR News" (June 5, 2002), "when asked about
the two most important problems facing the nation, 10 percent
mentioned health care, ranking further behind problems such as
the economy (37 percent), terrorism (29 percent), war (21 percent),
and crime (16 percent)." NPR's corporate loyalties were obvious.
Its coverage began: "Adding prescription drug coverage to
Medicare is a hot topic again on Capitol Hill. Such a benefit
would cost hundreds of billions of dollars, but no one knows where
that money would come from." No one knows? Or is NPR unwilling
to say? NPR raised the possibility of making cuts in foreign aid,
but pointed out, correctly, that such cuts would be woefully insufficient.
(Less than 1 percent of the federal budget is devoted to foreign
aid.) Predictably, NPR did not raise the possibility of making
cuts in military spending, which, if brought down to levels comparable
to other nations, would be more than enough to add prescription
drug coverage to Medicare. In fact, it would be enough to provide
prescription drug coverage for all Americans. Last year Americans
spent $156 billion on prescription drugs, according to "ABC
News." In the year 2000, shortly before the "war on
terrorism," America spent $343 billion on the military, compared
with $60 billion spent by Russia, $45 billion by Japan, $42 billion
by China, $34 billion by the United Kingdom, $27 billion by France,
and $23 billion by Germany. Nor did NPR make the obvious indictment
of the capitalist system: that money that could be used to provide
health care for needy people is instead diverted to wealthy people.
Drug manufacturers blame the high cost of prescription medication
on research and development. But the pharmaceutical industry actually
spends more money on administrative costs and advertising than
on research. Even more disturbing: on average, 18.6 percent of
the cost of drugs is pure profit for corporate shareholders, by
far the highest profit margin of any industry in the nation, according
to Congressperson Bernie Sanders. Add to this another disturbing
fact: the vast majority of new drugs developed in this country
over the past six years, about 80 percent according to the FDA,
are minor modifications of existing drugs (so-called "standard"
as opposed to "priority" drugs), developed, not for
the purpose of improving human health, but for the purpose of
increasing market share. Add one more fact: taxpayers subsidize
research and development for the pharmaceutical industry through
the National Institutes of Health-whose budget this year is $23
billion-and yet, unlike shareholders, have no right to a return
on their investment. According to Dr. Barnadine Healy, former
head of the NIH, "There's no other industry in which you
have so much public investment in the fundamental knowledge that
enables...the development of the commercial industry itself"
("ABC News," May 30, 2002).
Consider one example reported by the New York Times on June
5, 2002: "Attorneys general from 29 states accused Bristol-Myers
Squibb yesterday of illegally profiting through several fraudulent
schemes to keep lower-priced generic versions of Taxol, a life-extending
cancer drug, off the market...." The states' lawsuit says
Bristol-Myers and American BioScience filed a "sham court
action" that helped delay the availability of a cheaper version
of Taxol, a drug that can cost up to $10,000 for a course of treatment
lasting several months.
New York's attorney general, Eliot L. Spitzer, said the companies'
actions had cost state governments, patients and their insurers
"many, many millions of dollars." The lawsuit seeks
to recoup the extra money that the plaintiffs contend that state
governments and cancer patients were forced to pay for Taxol from
December 1997 to April 2001, when several companies began selling
generic versions of the drug and the price fell.
Taxol, which is known generically as paclitaxel, was discovered
by government scientists at the National Cancer Institute. The
government spent more than $32 million to develop it, according
to the states' lawsuit. Later, the government granted Bristol-Myers
the exclusive right to sell Taxol in the United States for five
years, starting when the Food and Drug Administration approved
the drug in December 1992.
The states' lawsuit contends that Bristol-Myers illegally
extended the five-year period by fraudulently obtaining two patents
from the United States Patent and Trademark Office. Taxol cannot
be patented, but delivery methods can. The lawsuit contends that
Bristol-Myers misused the patents to keep generic companies
from selling a lower-priced version of the drug.
This, incidentally, is not the first time that Bristol-Myers
Squibb has been sued for such machinations. On May 30, 2002, "ABC
News" reported: "BuSpar is an anti-anxiety drug manufactured
by Bristol-Myers Squibb. After the company had had a monopoly
on the drug for years, the patent on BuSpar was set to expire
on November 21, 2000, which meant a cheaper generic version was
supposed to be approved by the FDA and available to consumers
the next day."
Just hours before its patent on BuSpar expired, Bristol-Myers
Squibb got a new patent on what the drug becomes after you swallow
it. The law is written in such a way that Bristol-Myers was able
to then keep the generic drug off the market, claiming that it
would violate its new patent. There was no innovation involved-only
an innovative legal strategy.
Drug companies such as Bristol-Myers Squibb do not exist for
the purpose of enhancing human health; they exist for the purpose
of making money. Health-care spending is largely a matter of subsidizing
such industries and ensuring the profitability of investment for
stockholders. There may or may not be Americans destined to die
from future terrorism. In a system that allocates health care
on the basis of socio-economic status, rather than on the basis
of medical need, there will inevitably be Americans who die because
they are poor or uninsured.
Charles K. Fink teaches philosophy at Miami-Dade Community