How good is health care in the free market

What if health care was free?

A society has to measure itself by how it deals with sick, old and marginalized people. For equitable medical care, we should part with outdated principles.

From the www editors

Health is a question of money. This can be seen all over the world, but especially strongly in the USA, where medical care is more expensive than in any other country, where 27 million people cannot afford health insurance at all and where 137 million people are medically indebted. This is also evident in European countries such as Great Britain and Germany, whose health systems are each based on a principle of solidarity in a different way. Nevertheless, the warning calls are louder that the British health service NHS is on the verge of collapse and a system of "two-class medicine" has been created in Germany, as even the ruling party SPD announced. The fact is that privately insured people have faster and easier access to medical treatment than statutory health insurance patients, which is why it is not surprising that a currentAllensbach-According to the survey, 75 percent of those questioned complain that economic interests take precedence over therapeutic interests in treatments. In concrete terms, it means that poorer people in Europe too often cannot afford to get seriously ill.

Health is unevenly distributed

Health is a question of location. The medical infrastructure in the global south is dramatically worse than in the north; the consequences of this gap can be seen in almost every health statistic: higher child mortality, more new HIV infections, untreated mental illnesses, the list is long. But even within a country, the location plays an important role. The migration of doctors from rural Germany to the cities and the lack of midwives, to name just two examples, are evidence that the place of residence is one of the deciding factors in whether, how well and how quickly accidents or illnesses are treated.

Health is a matter of power. Whether in Germany, Great Britain, the USA or elsewhere: marginalized people all over the world find it difficult to get medical care, not least because the medical system is based on a narrow picture of a healthy body and mind. Many people who do not meet these norms see themselves exposed to incapacitating experiences, stigmatization and incorrect treatment - whether out of unwillingness or ignorance does not matter. Trans people, for example, not only have to fight against prejudices and gaps in knowledge on the part of many doctors, but also have a much lower life expectancy, as documented in the 2019 volume "Trans & Care", edited by Max Appenroth and María do Mar Castro Varela. The more difficult socio-economic factors are decisive for the physical and psychological state of health and the quality of life of trans people, which is why it must be a task for society as a whole to better protect their interests - even in a wealthy country like Germany.

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Comprehensive participation

There are many countries in the world where health care is worse than in Germany, there is no doubt about that. In terms of prosperity and economic strength, however, the situation is devastating. The nursing emergency is getting bigger and bigger, there is a lack of apprenticeship places, skilled workers and resources - the consequences of the privatization and cutback policy can be felt everywhere. Every few months, when a nurse is invited to a talk show to report on the grievances, or a new study is published (currently 17,000 positions for doctors and nurses are not filled), there is a brief outrage - apart from that, I find out Mostly the subject of ignorance.

A fundamental debate about how participation, participation, provision and justice should be designed in a comprehensive sense is therefore overdue. We, the editors of what happened if, try to contribute with a question that can be interpreted in several ways: What if health care was free?

In this context, free should mean that money should not be a decisive factor in access to medical treatment. But Frei also means that it is time to rethink old norms and dogmas. Who can call themselves sick? Who is stigmatized as sick? Who actually determines what health means? And how can we separate the concept of health from the concept of disease in order to also include the serious influence of social and political factors on individual health care?

A post-capitalist ideal

These questions about exclusion and equity in health care were the focus of a conversation that www-Editor Asal Dardan led with three people who view the topic in different ways: the trans activist Max Appenroth, the feminist journalist Nicole Schöndorfer and the cultural scientist and wheelchair user Gesa C. Teichert.

Precisely because illness is often reduced to an individual problem - or even an individual failure - and is too seldom associated with poverty, racism or other forms of discrimination, we would like to address the structural grievances of the current system. The very fundamental question arises: How sensible is it in an affluent society if the individual's fate, life, if the basis of existence is measured under economic premises and allocated according to earnings? So is health a good that should be traded in the market? That is distributed according to supply and demand? Or is health a little more in the direction of a general human right, and alternative notions of order of medical care than the current system of doctors, hospitals, health insurance companies and the pharmaceutical industry is not only conceivable, but worth striving for?

These thoughts connect with others that we have already discussed in our magazine, with the idea of ​​free passenger transport, for example, or with the plan of an unconditional basic income in a world where the work will be increasingly taken over by robots and the question arises according to the nature of the relationship between capital and labor: labor breaks away from capital, ideally, and becomes something that is released for self-realization, a Marxist ideal.

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Align medical research with needs

Free health care is thus a post-capitalist ideal, an idea of ​​a society that is not primarily or exclusively organized according to market principles, but negotiates the issues of the good life differently and solves them differently than through money. In her article for, the doctor Kirsten Schubert describes what this health system of the future could look like what happened if. Schubert not only has experience as a doctor, but also as an organizer. She is co-founder of the Health collective Berlin, a group of around 20 people who are currently building a multi-professional, low-barrier and patient-oriented social and health center in the Neukölln district of Berlin.

Paul Schnase, who studies political science in Münster and is part of the Universities Allied for Essential Medicines(UAEM) is an initiative founded by students in 2001 that advocates fairer access to medical care, especially to medicines. Schnase explains in his text why research should be geared towards needs rather than profit.

In Germany, the health issue is also a particular challenge because the proportion of older people continues to grow. More nursing staff is needed, better facilities, a more modern infrastructure, and all of this will probably only happen if the nursing professions as a whole are upgraded, if they are politically viewed for what they are: life-changing.

Healthy handling of data

One consequence of demographic change is that more and more younger people are finding themselves in the position of having to look after their parents and relatives. While politics is called upon to create institutions that alleviate personal constraints, a moral question also arises for those affected: Do children have responsibility for their sick, elderly parents? And if so, where does this responsibility end? Our author Georg Diez thought about this in an essay.

When we talk about the future of health policy, completely different questions arise, for example privacy and surveillance. Will our health insurance contributions depend on our fitness values ​​in the future? Who should have access to our health data? And what are they already being used and abused for? Anna-Verena Nosthoff and Felix Maschewski, who wrote the current book "The Society of Wearables" on this topic, analyze in their contribution for what happened ifhow close self-optimization and external control can be and how important data sovereignty is.

Illness usually means dependence on other people and on a system that repeatedly tends to lose sight of the individual and which at the same time often ignores the socio-political background of illnesses. We want to look at how a good, sovereign and dignified life can become a reality for as many people as possible - without being restricted by questions of money, location and power.