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The New Totalitarianism: How American Corporations Have Made America Like the Soviet Union

Free-market capitalism was supposed to save us from the tyranny of faceless apparatchiks. But that's not what happened.

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Insurance bean-counters second-guess every order, requiring doctors to put in extra shifts each week writing letters and making phone calls to fight for their patients' right to care. Every channel they rely on for information on new drugs and treatments -- from the peer-reviewed journals to the medical conferences to the drug information inserts -- has been co-opted by the pharmaceutical companies to ensure that doctors won't ever get important information that might reflect badly on profitable drugs; and this, in turn, undermines evidence-based medicine in favor of a kind of corporate-driven Lysenkoism.

Increasingly, states are also inviting themselves into the exam room, passing laws telling doctors what they can and can't tell you about your own condition (and, in some cases, demanding that they out-and-out lie to you, for reasons that are entirely political and seldom supported by science). And as a patient, your access to this co-opted, compromised care is entirely dependent on what the Politburo apparatchiks at your own employer's corporate HQ have decided you deserve to have.

Again: what we've got here isn't anything like a free or independent system, one in which patients and doctors are at liberty to make appropriate decisions without layers of centralized interference (much of it from people who aren't even MDs). And most of this interference isn't from government; it's from various corporate interests that have subjugated both doctors and patients to a centralization regime in order to extract profits from them. During the Cold War, this is what we were told Soviet medicine was like. Now, we don't have to go to Russia: we can get the same regimented, over-managed treatment from our own free-market health system -- and we'll pay more for it than anybody else in the world.

Education: Testing, Not Teaching

My eighth-grade civics teacher used to terrify our class with grim stories about the education endured by our unlucky peers in the USSR. Communist education, she said, was nothing but rote learning -- no discussion, no critical thinking skills, all aimed at preparing kids for high-stakes standardized testing that would ultimately determine their place in the Party hierarchy. They weren't free like we were to explore our own interests, or choose professions that pleased them. Rather than being treated like full, autonomous human beings being prepared for a limitless future of their own design, they were sorted and graded like potatoes, and tracked to serve the needs of the state. All of the decisions, we were told, were dictated by the central authorities in charge of determining what kind of workers the state would need, and which schools students would be sent to in order to fulfill those goals.

The ironies abound. Even as China has ramped up its efforts to inculcate creativity and critical thought in its students, the United States has voluntarily given up on those values -- our competitive edge over the world for the past 150 years -- in favor of a centralized, test-driven schooling regimen that only a Soviet bureaucrat could love. Increasingly, the doors to the best high schools and universities are closed to everyone but those in the top echelons of society, just as the best schools in the USSR were set aside for the children of the Party leadership. But the greatest irony of all is that, far from being done in the name of the state, this is being done by taking education out of the hands of the state and giving it over to for-profit corporations. Again, the more "private industry" gets involved, the more the outcome looks like something from a 1950s John Birch caricature of the horrors of Soviet life.

 
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