How I got here
I am a retired Canadian physician.
As long as I can remember, I wanted to be a doctor. My brother was born with severe hemophilia for which there was no treatment at the time. To my young mind, doctors had the power to stop suffering, and I wanted that power.
Like most people, I thought the purpose of the medical system was to relieve suffering. Experience taught me that the appealing image of modern medicine is window dressing for an industry that purposely limits the help it provides.
Over the four decades I practiced medicine, the service sector was systematically starved of funds. Piece by piece, the task of caring for the young, sick, injured, frail, and distressed was removed from schools, hospitals, clinics, and social agencies, leaving individuals and families to find and pay for vital supports.
People wait too long for the care that is available. One distressed young man languished on my waitlist for three months, then killed himself before I could see him.
I was in constant battle with agencies and insurance companies to obtain life-preserving support for my patients. Once they got it, if they got it, there were more hoops to jump through to keep it from being cut off without warning.
Shifting responsibility for care-giving from society to individuals transforms waged jobs into unwaged work in the home. This increases the burden on families, and women especially, who must do more with less and increasingly come up short.
When people break under the strain of impossible demands, they are labeled as morally weak, physically defective, or ‘mentally ill.’ Service providers are assigned to get them back on their feet as quickly as possible, then return them to the same conditions that broke them.
Why not give people what they need? Why are vital services rationed when the country produces more wealth every year? I spent decades researching these questions.
In fact, society can afford to give everyone what they need and more. In 2018, the monetary value of all goods and services produced in the world was ten times greater than it was in 1950. Instead of using this wealth to raise living standards for everyone, the capitalists took it for themselves. As a result, inequality has grown to the point that fewer than 10 individuals now hold as much wealth as the poorest half of humanity.
Why is this allowed when it is clearly so harmful?
The answer is simple. Capital could not be accumulated if everyone claimed their share of what society produces. To create one billionaire, millions of people must be impoverished.
I discovered that the amount of funding for social support, also called the social wage, depends on the balance of power between the two classes. Capitalists want to pay as little as possible, while workers want everyone’s needs to be met.
As workers gained ground during the 1960s and early 1970s, social services expanded, living standards rose, and inequality lessened. After the global recession in the mid-1970s, the capitalist class regrouped and launched their neoliberal campaign to increase productivity and ‘shrink the State.’ Social supports were dismantled, living standards fell, and inequality increased.
To prevent the majority from laying claim to the global wealth, systematic rationing is used to hold down wages, force people to compete for necessities, and restrict social support. Every social institution accepts this system, this rationing, and this inequality. The result is an artificial scarcity, socially constructed to maintain capitalist rule.
In 2019, the Ontario government ordered 1.2 million doses of the Fluzone HD vaccine to protect seniors. That is enough vaccine for only half the senior population. And instead of making this limited supply available through local pharmacies, seniors must request the vaccine from their doctor, if they have a doctor, and if they can get to the doctor.
Making social support difficult to get is a form of ‘demand-control:’ acknowledge a need, profess to meet that need, then place barriers in the way of meeting it. Those barriers deepen inequality and increase suffering.
When people must wait for something, those with money and connections find a way to the front of the line. This practice is widely condemned as unfair, yet the deeper injustice is the wait line itself, which goes largely unquestioned.
Rationing is more than a means to contain cost, because the expense of hiring managers to deny care can exceed the cost of providing it to all who apply.
Rationing is politically necessary. Rationing demonstrates that access to social support is not a right; one must be ‘approved’ or deemed worthy by a higher power. There follows a shaming process of distinguishing the ‘deserving’ from the ‘undeserving’ who are ‘out to scam the system,’ when the real scam is the system of rationing itself.
Professional associations of service providers complain about increasing demands, inadequate resources to meet those demands, and rising levels of professional burnout. However, they do not challenge the need for rationing; they quarrel over how best to apply it.
Debates rage over how long a wait is acceptable, how professionals and agencies could “do a better job with the resources we have,” and how professionals can improve their ‘work-life balance.’ Demands for more funding, more staff, and more services are typically dismissed as unrealistic.
In addition to rationing access to care, service providers are expected to police behavior.
People in need do not appreciate being dismissed or forced to wait, so they press their demands. This pressure is treated as criminal. Notices posted in medical facilities and social agencies warn that “abuse of staff” will not be tolerated. In other words, if you do not wait quietly, if you cannot contain your rage and humiliation, we will call the police on you.
As a physician, I was legally required to report to authorities any ‘fraudulent’ attempts to acquire medical care and certain ‘unacceptable’ thoughts and behaviors.
One time, I called 911 after my patient told me that she planned to kill herself. The police arrived and took this tiny woman to hospital in handcuffs on the false premise that someone who is dangerous to themselves must be a dangerous person. After waiting for hours to be assessed, she was discharged to the street with a specialist appointment in two months.
I became a physician in order to relieve suffering, yet I was locked into processes and procedures that increase suffering. Instead of becoming an agent of health, I had become an agent of damage control for an utterly damaging social system.
Systems of rationing and social control pit service providers who are overworked against service users who are not getting their needs met, when both groups would fare better if they joined forces to challenge these systems.
We have entered an epoch of crisis and revolt, war and revolution. The majority want a society that meets their needs and the people in power refuse to change their ways. Increasingly, youth are rebelling, workers are striking, and nations are shaken by massive anti-government demonstrations.
We have a window of opportunity to end thousands of years of class rule, unite on a global basis, and chart a new course for humanity.
Models of cooperation abound in nature. We already have the tools to connect everyone on the planet. Together, we could devise global answers to global problems and, at the same time, support everyone to organize their lives as they see fit.
People are not ‘problems’ to solve, they are problem-solvers. The human story is one of continual change, revolutionary at times, as masses of people struggle to replace what does not work with what works better.
For me, the bottom line is this: Everyone deserves to get what they need, when they need it, and in the form that they choose. My purpose in life is to do my part to make that happen.
Am I a communist? That depends on what you mean. If communism means that a few impose their will on the many, then I want nothing to do with it. That is what we have now.
If communism means that everyone is treated as equally worthy to contribute to society and equally worthy to get their needs met, then I am all in.