Terrorism and the Health-Care Crisis


Charles K. Fink 

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 January 31.” 

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 1 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 advertizing 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 Congress- person 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.        Z 


Charles
K. Fink teaches philosophy at Miami-Dade Community College.