capitalism

Essay: Some Conflicts of Interest Have Little Conflict

R. Horton

Let’s say you make a lot of money in some industry or another, and you’re lucky enough to get an appointment to an agency that regulates that very same industry. Your regulatory decisions could affect your bottom line, and so you have a conflict of interest and you should either be forced to give up your job as a regulator or get rid of all your financial interests in the industry with the provision that you may never acquire financial assets in the industry again. And if you’re a doctor on the payroll of a pharma company, your employment status most definitely affects your medical decisions.

That’s a pretty simple and obvious concept to anyone who doesn’t work in industry. People who work in any given industry tend to think “outsiders” wouldn’t know enough about the industry to regulate it, so of course you’d need someone with major conflicts to understand what really needs to be done. And so it goes.

But other people are described as being conflicted when they really don’t have any conflicts at all. Let’s say you are a researcher, and you apply to a corporation for funding for your research. Congratulations, you now have a huge grant from Megacorp Inc. to fund your lab, materials, research assistants, etc. in hopes of developing new products. You are now just a handsomely rewarded employee of Megacorp Inc. Your only interest is in developing new products for them.

It’s true that some will describe you as conflicted because they think you should be looking out for the public good, but that really isn’t in your job description. You’re just developing products.

And this is why we need public funding for research. So we can demand that researchers we are paying work for the public good and not in the interest of for-profit corporations.

man next to doctor
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Essay: A Non-Capitalist Approach to Biomedical Consent

R. Horton

Ask anybody about bioethics in the old days, like forty years ago, and they’ll talk all about autonomy and consent. It was all about how people didn’t have to do what you thought was good for them and how you couldn’t touch patients, even to help them, without it being some kind of battery or something. Everybody talked about all these famous examples where people were treated without wanting to, but most people only go to the doctor when they want and need to get treated. Most people these days only refuse treatment because they can’t afford it.

I’m sure a lot of them can’t afford the treatment but also don’t need it. It’s hard to argue with a doctor about that, though. If you want to feel better, stay healthy, live longer, or whatever; you’re going to listen to the doctor. You are paying the doctor to know more about it than you do. And the doctor may or may not be making money off every service you buy. It’d be good to know who makes money off what, wouldn’t it? It would also be good to know in advance exactly what everything would cost. It would be even better to be able to prepare costs.

In the early days of bioethics, it wasn’t all about costs, because most people could afford their healthcare bills. Money was a concern, of course, but people didn’t panic from fear that their life savings would be wiped out anytime they got sick. It wasn’t at the front of everyone’s mind, so when someone refused treatment, it was because they didn’t want to live longer, didn’t think the treatment worked, or something like that.

But now it’s all about costs. Can a doctor ethically prescribe you treatment knowing you can’t afford it? Can a doctor ethically not tell you about treatments you can’t afford? Should doctors help patients set up Go Fund Me accounts? How can anyone just stand by and let people die because they can’t afford insulin?

In the past, we didn’t notice how much autonomy and consent were tangled up in financial concerns. Most patients didn’t know doctors received so much money from industry. Most patients trusted their doctors, hospitals, and so on to have their best interests in mind, not to be focused on profit front and center. But things have changed, and bioethics can’t afford to have many debates that don’t deal with patients’ ability to access needed care.

So, if you are dealing with public health ethics and planning for pandemics, you might want to consider how many patients will walk around shedding viruses simply because they can’t pay for a visit to the hospital. And if people are forced into quarantine at hospitals, you might want to consider who will get the bill for that. It’s the same with vaccines. At least some people are opposed to vaccines because they think, right or wrong, that they are just being made to create more profit for pharmacy companies, clinics, and doctors. It’s just another way, they think, to get in people’s pockets.

I’m not saying that no one writing in bioethics is dealing with these topics. Great work is being done. What I’m saying is that all work in bioethics must include a discussion of economics and an expressed concern for how access to medicine can be guaranteed for everyone who needs it. You can have lots of detailed and technical disagreements over how much medicine is actually needed and what are the best ways to deliver needed medicine without bankrupting an entire country, but the focus should be on creating a society of healthy, financially secure people. That’s all anyone wants, I think, and anyone who doesn’t want it isn’t really worth my trouble.

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The high cost of low taxes

R. Horton

No one likes paying taxes, and I’m no exception. I’m far from being in the top one percent of earners, but I’ve also had to pay federal, state, and local taxes all my life.

Anyway, I’d prefer to keep my money and spend it on other things. Some costs, however, are best to be borne by the public rather than by individuals. The move to lower taxes is not about reducing what we pay for services. Rather, it is about a shift from public payments to privatization. When the government does not fund basic services, the services are then provided by businesses for profit. This means the burden of payment for necessary services shift to the less wealthy while control and profits shift to the wealthy.

For example, roads benefit all of us. The alternative to having the government spend money on roads is to let private firms build the roads and charge whatever costs the public can bear. I do not happen to think this is the best way to build a modern, efficient, and functioning society. Our country needs a mobile workforce. Denying citizens this mobility is to deny what I view as a basic human freedom: the ability to move and seek better opportunities and living conditions. While I agree that people who build roads should be paid for the effort, I do not believe the construction and maintenance of roads should be driven purely by considerations for profit. When we don’t pay for roads through taxes, we pay for them through tolls.

Nor do I think education should be operated for this reason. As school funding is cut, schools must turn to corporations for sponsorship. School lunches are provided by the big food industry, and the logos of major industrial players abound in the school lunchroom.  When asked to provide more healthful alternatives, the industry lobbies our government to circumvent regulations by declaring that the tomato sauce on a pizza is a vegetable. Further, education materials, from textbooks to video lessons, are prepared by corporations and include advertising and other forms of blatant indoctrination.

And when universities lose government funding, they also seek corporate sponsorship for their research, faculty positions, and buildings. Rather than providing a forum for intellectual discovery and exchange, universities become the mechanism for generating increased profits. This means scientific research is aimed only at supporting industry and basic research is stifled. Fields that are not seen as contributing to “the economy” are constantly under attack. The arts and humanities must constantly fight to survive and themselves must rely on corporate donors to stay afloat.

A vibrant and thriving society, however, needs free intellectual and artistic expression. Relying on corporate donors suppresses dissent or even basic disagreement. This impedes intellectual progress and, more importantly, moral progress.  Of course, the higher tuition fees that result also limit educational opportunity for most of us. Higher tuition and reduced financial aid mean more students graduate heavily in debt.

It is appropriate that some health care be provided for profit and that only those willing and able to pay for it should receive it, and this is the situation even in countries that have “socialized medicine.” A health care system that is entirely privatized however creates two contradictory and unworkable conditions: 1. Health care providers make the most profit by providing unnecessary tests and treatments. 2. Insurance companies make the most profit by denying access to as much care, necessary or not, as possible. Basic health care does the most to improve life quality for a society, but it is the least profitable care to provide. Public funding for access to basic healthcare ensures that everyone has a better chance to live and be productive.

Prisons are necessary in any civil society, but prisons are increasingly built and operated by for-profit companies. Some people need to be removed from society, but it is best that no one profit by increasing the number of people incarcerated. Incarcerating people should be something we do only when no other alternative is available, and it should create a burden for all, not an opportunity for profit.

When taxes are lowered, and public spending is reduced, these basic services do not become free. On the contrary, we pay more for them (unless you are a person who makes enormous profits from them). For most of us, lowering taxes too much limits our freedom and increases our financial burden for obtaining basic services. Certainly, wasteful government spending should be eliminated and taxes should be reduced when appropriate, but public funding for basic services is essential. The United States is currently experiencing a massive move toward privatization, which is hurting our mobility, education, and health. It is also resulting in a growing prison population that is inconsistent with a just society.