Death and Taxes

13 Feb

Last year, I said, somewhat tongue in cheek, that socialism is about converting hysterical misery into ordinary unhappiness.

This is what I meant. Socialism won’t eliminate the sorrows of the human condition. Loss, death, betrayal, disappointment, hurt: none of these would disappear or even be mitigated in a socialist society. As the Pirkei Avot puts it, against your will you enter this world, against your will you leave it (or something like that). That’s not going to change under socialism. But what socialism can do is to arrange things so that you can actually deal with and confront these unhappinesses of the human condition.

I was reminded of that reading this wonderful piece by Anya Shiffrin about the death of her father.

Last spring, André Shiffrin, the legendary publisher, was diagnosed with pancreatic cancer (he died in December). A New Yorker through and through, he nevertheless decided to spend his last months in Paris, where he and his wife had an apartment and where he had been born. It proved to be a wise move, as Anya explains.

So imagine my surprise when my parents reported from Paris that their chemo visits couldn’t be more different [than they had been at Memorial Sloane Kettering in New York]. A nurse would come to the house two days before my dad’s treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting. Total time at the Paris hospital each week: 90 minutes.

There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, “It turns out there are solutions for the all the things we put up with in New York and accept as normal.”

One day he had to spend a few hours at Cochin. They gave him, free of charge, breakfast and then a hot lunch that included salad and chicken. They also paid for his taxi to and from the hospital each week.

“Can’t you think of anything bad about the French healthcare system?” I asked during one of our daily phone calls. My mom told me about a recent uproar in the hospital: It seems a brusque nurse rushed into the room and forgot to say good morning. “Did you see that?” another nurse said to my mom. “She forgot to say bonjour!”

As Anya goes onto explain, her father wasn’t “getting VIP treatment or had a fancy private plan. Not at all. He had the plain vanilla French government healthcare.” She also points out that health care spending is much lower in France.

French health care couldn’t stop André Shiffrin from dying; nothing in this world could. Instead it helped him and his family confront and deal with his dying, without the distraction and mayhem of our system. It’s not that taxes can save you from dying; it’s, well, here’s Anya:

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.

The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.

Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.

That time was priceless.

In my Freudian (late Freud) moments of despair, I sometimes wonder if the madness of American capitalism isn’t one massive contrivance to avoid the sadness and finitude of the human condition. Filing our insurance claims, haggling on the phone, waiting for doctors, we don’t have time or space to deal with death. At least not properly. That’s what socialism might help us do. Perhaps that’s why we don’t want it.

Socialism is not a flight from the human condition; it’s a direct and unsentimental confrontation with that condition.

28 Responses to “Death and Taxes”

  1. Morgan Warstler February 13, 2014 at 11:35 pm #

    The only reason people are unhappy is they haven’t embraced capitalism, see Guaranteed Income / Choose Your Boss:

    http://www.morganwarstler.com/post/44789487956/guaranteed-income-choose-your-boss-the-market-based

    Using the free market to put our welfare recipients to work for other welfare recipients doing regular service jobs for one another, increases consumption for the poor by 30%.

    Don’t be a fool. There’s a “free market’ way to match wants and talents WHILE we make sure the poor all have the safety net they need.

  2. 21st Century Poet February 14, 2014 at 12:02 am #

    Reblogged this on 21st Century Theater.

  3. Robert Freilich February 14, 2014 at 12:46 am #

    Thank you, Professor Robin

    I try to tell Americans about European social democratic medical care, but they don’t get it. Yah boo and all that. I am sure you have seen it. “We are the champions . . . .”

    This story may help show one or two of them that there is another approach besides this mean spirited social warfare.

    • Alison Farrin February 14, 2014 at 4:53 pm #

      The real cost of France’s medical care is buried in the payroll taxes and the unemployment rate. Nothing is free. Not that our system doesn’t suck, but the free market would solve most of its issues more effectively if government could get out of the way.

      • Steve February 15, 2014 at 7:37 pm #

        there isn’t and would not be a free market without government intervention. (Read up on Teddy Poosewelt)

      • Paweł Krawczyk February 17, 2014 at 3:21 am #

        Well, that’s pretty much what Friedrich von Hayek says as well – that the free market can be only guaranteed by the state. Adam Smith was one of the first proponents of free public education and other public services. But “socialism” is a word so stripped from any concrete meaning nowadays that the title of the article is just misleading. Which socialism? The marxian, revolutionary one, which is still most widespread interpretation of socialism? Do you really believe that a violent revolution, central planning and nationalisation of everything will result in highly effective health services?

  4. Josh K-sky February 14, 2014 at 1:32 am #

    In a related vein, David Palumbo-Liu at Arcade:

    The humanities classroom experience can add to our ability to see just how much part of being human it is to be sad, puzzled, unsure, in ways that are not to be discounted as they are in this age of skills delivery and outcome-based education. Suppressing our feelings of sadness just drives them underground, and deprives us of a moment to reflect on our values, expectations, dreams, and their deferment, displacement, reinvention.

  5. Roquentin February 14, 2014 at 2:01 am #

    I don’t know if you watched Breaking Bad at all, but I assure you the hype and accolades given to the show were all well deserved. More amusing than that, the plotline of a broke high school teacher manufacturing meth to cover his cancer treatment which resonated so well with just about everyone in the US just wouldn’t make sense in other parts of the world. What does it say about us as a culture when that’s the best series we’ve produced in the past couple of decades?

    • Morgan Warstler February 14, 2014 at 2:36 am #

      That we aren’t watching MASH, a comedy set during the Korean War on a laugh track, about Hot Lips and her beta lead Alan Alda.

  6. George Hart February 14, 2014 at 7:22 am #

    Wonderful observations. Thank you. There’s a related perspective in Buddhism, developed by David Brazier (The Feeling Buddha) where absent the veil of Maya we can engage life as it is–everyday, ordinary, sometimes harrowing. And the blogger JM Greer develops the idea that a sane relationship to the earth entails recognizing our limits and death, so we prefer to live insanely (see also Reg Morrison’s ‘Spirit in the Gene’). Socialism, as you say, can perhaps empower more graceful engagement with everyday reality. As David Bakan writes, the ideal life consists of personal agency serving communal good.

  7. jonnybutter February 14, 2014 at 7:50 am #

    “I sometimes wonder if the madness of American capitalism isn’t one massive contrivance to avoid the sadness and finitude of the human condition. ”

    Canny. The stereotype of the harried, emotionally distant father comes to mind. “Yes, I am a gigantic asshole, but…I don’t have *time* to ________; I’m working working working! Providing for my family!”

    I locate the entire conservative/reactionary project in the human being’s extreme aversion to taking responsibility for anything. Let’s face it: a person will do almost anything to avoid responsibility, whether it involves (avoiding) a judgement (‘what does the research tell us to do?”) or an entire political/economic system (“the invisible hand'; arbitrary power of a monarch; the chronic reification of the models we create, et. al.). In this world, the perfect isn’t just a sort of dynamic enemy of the good; the perfect forestalls the good. In other words, since we can’t devise a perfect system, we shouldn’t even try.

    • jonnybutter February 14, 2014 at 8:45 am #

      The problem with this is that it leads nowhere. To paraphrase a line from the movie ‘Hud': before you know it, you end up on the Golden Gate bridge staring straight down, drooling-enchanted by the dream of oblivion. (Not what Buddah was talking about AFAICT).

  8. EA February 14, 2014 at 9:30 am #

    There is a very strong tendency to emphasize form over content in this land. One only has to look to the expeditures in buildings in healthcare and education to understand the nature of this place. I could also enter a severe critque of the sterile and lifeless of the architectural forms coming to dominate this landscape but that is another story. Every campus I set foot on, whether a university or healthcare, there is a never ending expansion and rehabilition process going on. Glitzy buildings filled with all manner of techno-sophiscation and all the warmth of the city morgue. A substitute for the real but a powerful sugguestion that something important must be taking place here.

    Living in the heart of one of of the big east coast cities reknown for its teaching hopsitals, I recently discovered what all this meant, its utter impotence in the face of real human suffering. Rolling into town on any of the freeways, one is unindated with billboards from these institutions proclaiming their miraclous and unrentlently quest to be the best but the meaning and the reality of that message is very different for the prols.

    Several years ago I looked up an old friend and co-worker I had not seen or heard from in some time. Turned out he was in a bad way, healthwise. In just a couple of years he desending from a very healthy and successful plumbing contractor to practically homeless and starving. Knowing the man for 35 years, I knew there was something completely out of character but his neighbors and friends insisted he was now just a drug addict. The long and short was that a pro boxing career had caught up with him with the early onset of dementia, in addition to lung disease due to working with asbestos in the old naval shipyards in his apprentice days. He had gone from having everything to having nothing in a matter of a year or two as his short term memory was almost gone. He was once a strapping 200lbs force to be reckoned with but now a frail 90lbs skeleton. He was only 55. His top of the line BlueCross/BlueShield policy had lapsed due to non-payment after paying on it for some 20+ years without ever really using it. Now care was largely denied to him when he needed it the most.

    When I found him, the first thing I did ws take him to the ER of one of the Catholic hospitals in the center of the city. They basically refused to examine him. I did this with three other hospitals with no luck spending hours on end day after day with not luck. Since he was indigent with no insurance and not signed up for medicaid no one would touch him with a ten foot pole. Doctors basically treated him with total indifference and treated me with total indifference when I would go to great lengths to explain the situation. I even had him committed at one point because I was told he would get a thorough examination if I did. He called me at 3 in morning the next day to say he was on the street. The hospital never did examine him and then pushed him out the door in the cold, in the middle of the night. He had to begged a taxi driver to use a cell phone to call me. And this was one of the big fancy hospitals in town.

    At that point, I decided to head to the hills, literally. My main residence in a very rural community several hours from the city. I took him to see our local country doctor. The moment he laid eyes on this broken down, suffering man, nothing more needed to be said. He took him into care at no cost. Made phones to specialist he knew and arranged for free care. I had offered to pay but they all decined We final arrived at a diagnosis of late-stage liver cancer, early onset of dementia, and mesothelioma. Specialists from Hershey, with the latest and the greatest could do nothing for him and gave him 3 months to live. He went on to live for three more years and did very well for that time and I believe it was largely due the compassion and genuinely humane care he received from this one lone country doctor whose ramshackle office was surrounded by free range chickens (somebody apparently paid him in chickens).

    Real care can not be professionalized or commodified as it must flow from the heart and soul. It can not be faked. When I look at these big fancy new buildings, with all their architectural husksterism and corporate bureaucracies, what they are really trying to mask is the soulessness of the machine inside, their utter inability to understand the human condition and related to us human beings.

    Doctors like our country doc are all but extinct. The new crops are pretty repulsive, wrapped in their degrees and conceits , their esoteric knowledge, metrics and professional standings, their polished visage and oversized egos. For this old guy the practice of medicine was about people not career. I can tell you that he will have the largest attendence at his funeral than anyone around because his care has touched so many lives for so long in this region. He is actually a very humble man – a rare thing these days, one who is not so important that he does not remember your name.

    Left in the big, self-important city, my friend would died an undignified and miserable death, alone either in a gutter somewhere or his rowhome for whom services had long been terminated. In the end he did find dignity and humanity….in the middle of bum-f__k nowhere. After his quiet death, this doctor called to express his heart felt condolences….now that is a care contium for real.

    • adele February 15, 2014 at 6:00 pm #

      I really enjoyed reading this, you touched on so many aspects of what true healthcare is about. I am so glad your friend was cared for while at his most vulnerable.

      I think one of the few solutions left to us as a society is to create health-care cooperatives. What other option do we have to fight back against a system that has been taken over by corporate neo-liberalism?

  9. Brian February 14, 2014 at 9:46 am #

    I was going to make a reference to Schopenhauer, but I’m more inclined to say that this article reminds me of Jeremy Rivkin’s ideas on empathy (and death), and his suggestion that humans are on the way to becoming ‘Homo Empathicus’.

  10. afeman February 14, 2014 at 10:26 am #

    I’m reminded of how much of the US’s ideology of one being the master of one’s destiny, and all that falls from it, masks a terror of how much we are at the mercy of circumstance. I’ve also read that Euro-land tends to have less emphasis on heroic intervention and treatment for the elderly in favor of palliative measures, and wonder how that might mix with these observations.

  11. msobel February 14, 2014 at 10:58 am #

    I was interested in the movie Her, that it is not a dystopian future. There is no sign of poverty, all the problems which beset us are missing (perhaps offstage) but the movie is still a moving story about the human condition.

    Marc Sobel msobel@marcsobel.com 303-440-6403 My Author Page on Amazon

  12. J. Otto Pohl February 14, 2014 at 12:00 pm #

    France is not a socialist state. It was not a socialist state even when the Socialist Party was in power under Mitterand. It has a mixed economy like most other capitalist states in Europe. North Korea is a socialist state and a rather typical one not that dissimilar from the USSR under Stalin, China under Mao, Romania under Ceacescu, Ethiopia under Mengistu, Cambodia under Pol Pot, and Albania under Hoxha. Cuba is also a socialist state and a considerably more attractive option than the states listed above, but certainly inferior to capitalist states like France or Sweden. If you want to defend socialism then you need to defend an actual socialist state not a thoroughly capitalist state like France that has national health care. Also it might be noted that particularly in the case of France much of the wealth of the country is a direct result of colonial and continuing neo-colonial exploitation of countries in Africa and Asia. One need only look at the current exploitation of Niger by France to see where French wealth has come from in the last 200 years.

    • Corey Robin February 14, 2014 at 12:03 pm #

      Fair points all. When I rewrote this for Crooked Timber I tried to acknowledge the disparity between state-delivered health care and socialism per se. I think it’s fair to say that this kind of health care was brought to Europe — and to whatever degree we have it in the US — by socialist or social democratic movements. But that is different from saying it’s socialism per se.

      On Fri, Feb 14, 2014 at 12:00 PM, Corey Rob

      • Roquentin February 14, 2014 at 12:26 pm #

        It’s the rhetorical trick of making sure that any positive characteristics are not associated with the world socialism and making sure any and all negative are. For example, if the healthcare system in France is good, it can’t be socialist simply because it works. It’s a circular, self-reinforcing ideological tautology. The reverse also applies, anything bad that comes from privatization and neoliberal reforms are not inherent in the system, people “just aren’t doing it right” or some other such line. I grow tired of reading such things and usually tune them out after the first sentence or two. Just like seeing “liberty” in the name of an organization, it’s a canary in the coal mine.

      • jonnybtter February 14, 2014 at 1:09 pm #

        I can’t understand why it matters, in the context of the post, that France is not a socialist state. Or that France is not a morally exemplary state, historically.

        The post was really about the US rather than about France. It was pointed out that the US spends much more health care money (double?) for a *much* worse result, and wondered why that would be – a very worthy question! I think CR’s idea of hyper-capitalism-as-excuse makes a lot of sense.

        I’d also point out that every State’s political ethos is aspirational to some extent. The aspiration in France is – or was – to a basic sense of social well-being and cohesion (welfare state), while the aspiration in the modern US is for everyone to have their own personal helicopter so that no one ever has to touch or smell another person when they leave their private home towards a certain kind of what’s called ‘rationalization’ – putting a money-price on absolutely everything, especially intangibles; and on avoiding the idea that collective needs – beyond the family unit – are valid or even exist. The question is not ‘which is a socialist and which is a capitalist, country?’. The US is anti-socialistic. It is even anti-social, really.

        If you want to defend socialism then you need to defend an actual socialist state .

        Why is that? Because you say so? May I use some American Indian societies as a defendable example, even though they have been mostly wiped out? Or do I have to use N. Korea or Cuba? Just wondering.

    • jonnybutter February 14, 2014 at 2:28 pm #

      I can’t understand why it matters, in the context of the post, that France is not a socialist state. Or that France is not a morally exemplary state, historically.

      The post is really more about the US than about France. It was pointed out that the US spends much more health care money (double?) for a *much* worse result, and wondered why that would be – a very worthy question! I think CR’s idea of hyper-capitalism-as-excuse makes a lot of sense.

      I’d also point out that every State’s political ethos is aspirational to some extent. The aspiration in France is – or was – to a basic sense of social well-being and cohesion (welfare state), while the aspiration in the modern US is for everyone to have their own personal helicopter so that no one ever has to touch or smell another person when they leave their private home towards a certain kind of what’s called ‘rationalization’ – putting a money-price on absolutely everything, especially intangibles; and on avoiding the idea that collective needs – beyond the family unit – are valid or even exist. I think it’s not a question of which country is socialist and which isn’t. The US is anti-socialistic. It is becoming simply anti-social IMHO.

      If you want to defend socialism then you need to defend an actual socialist state .

      Why is that? Because you say so? May I use some American Indian societies as a defendable example (like, I think, Paine did), even though they have been mostly wiped out? Or do I have to use N. Korea or Cuba? Just wondering.

    • George Hart February 14, 2014 at 3:21 pm #

      Fantastic site. Thank you.

  13. KD February 14, 2014 at 5:14 pm #

    Nice, but the real problem is all the big piggies at the top with their lobbyists and our do-nothing political institutions. A huge % of Americans would love expansion of the American single-payer healthcare system (Medicare), but the piggies and their friends in Washington have a different idea. A pig can never get too fat! The real challenge of politics in a democracy is how to game things so as to make the voters irrelevant (for example, the filibuster). Robert Caro has devoted his life to documenting how this is done.

  14. adele February 15, 2014 at 3:12 pm #

    Corey,
    you don’t need to convince this French transplant to Brooklyn. My introduction to US style healthcare was brief and thankfully so, otherwise I’m not sure my bank account could handle it.

    A weekend visit to the LICH emergency room (whom so many are protesting to keep open because they can’t get enough mistreatment) for a severe toothpain that was developing into a very visible abscess. After handing over my insurance information (that I have through my U.S. employer) and explaining the reason for my visit I waited over 2 hours in an empty emergency room waiting area only to be told that there was no dentist on duty that day, only a nurse. Waited another 30 minutes for the nurse who didn’t have a clue what to do, so I asked her if I could have a prescription for the pain. After some back and forth with a doctor whom I never saw, she told me that they couldn’t help me because they would need to take an x-ray first to determine what the issue was and since the dentist was not there nothing could be done. I pleaded and she finally came back with a prescription for an antibiotic + painkiller.

    TOTAL COST: $600, of which I paid $500. That needs to be repeated again: I paid $500 for a prescription. The reality of this is still slowly sinking in, I’m still in shock. People have heart attacks in France and it doesn’t cost them that much!

  15. Matt February 15, 2014 at 6:48 pm #

    Reminds me of this passage from Orwell’s “Looking Back on the Spanish War”:

    “The damned impertinence of these politicians, priests, literary men, and what-not who lecture the working-class socialist for his ‘materialism’! All that the working man demands is what these others would consider the indispensable minimum without which human life cannot be lived at all. Enough to eat, freedom from the haunting terror of unemployment, the knowledge that your children will get a fair chance, a bath once a day, clean linen reasonably often, a roof that doesn’t leak, and short enough working hours to leave you with a little energy when the day is done. Not one of those who preach against ‘materialism’ would consider life livable without these things. And how easily that minimum could be attained if we chose to set our minds to it for only twenty years! To raise the standard of living of the whole world to that of Britain would not be a greater undertaking than the war we have just fought. I don’t claim, and I don’t know who does, that that wouldn’t solve anything in itself. It is merely that privation and brute labour have to be abolished before the real problems of humanity can be tackled. The major problem of our time is the decay of the belief in personal immortality, and it cannot be dealt with while the average human being is either drudging like an ox or shivering in fear of the secret police. How right the working classes are in their ‘materialism’! How right they are to realize that the belly comes before the soul, not in the scale of values but in point of time!”

  16. Ralph Haygood March 8, 2014 at 3:35 am #

    Weeks ago, I read the version of this post you contributed to Jacobin and found it cogent and moving. Thanks for writing it.

    I have spent appreciable periods in the United States, Britain, and Sweden, and I have some experience with health care in all three countries. At present, I live in the United States, but you have reminded me that it is imprudent to grow old in this country.

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