Editors’ Note: Recently, the Alliance of Middle Eastern Socialists organized a panel discussion on “health care and alternatives to capitalism” in Los Angeles. The presenters were the following: 1. Maureen Cruise, Registered Nurse and director of Health Care for All, Los Angeles Chapter. 2. Dr. Ignacio Guerrero, family practice provider and libertarian socialist. 3. A Clinical Laboratory Health Care Worker. 4. Omar Abbas, biomedical student and researcher. The panel was moderated by Frieda Afary of the Alliance of Middle Eastern Socialists. Below are the presentations by three of the speakers as well as comments by the moderator. Omar Abbas’s presentation is in the process of being developed as a longer article for another journal and will be reprinted on the Alliance site after his article is published.
Transforming Wealth Care to Health Care
Registered Nurse and director of Healthcare for All, Los Angeles Chapter
Several years ago, while traveling in Spain, I acquired an infection and needed medical care. I went to a small clinic, waited 5 minutes, saw the doctor and obtained a prescription. On my way out I stopped at the reception desk and informed the sole employee there that I was ready to pay. She looked at me, smiled and remarked “You must be American”. I concurred and knowing that other European countries often had small fees for tourist care, I stated the obvious, ‘yes, I am a tourist”. She continued to smile and nodding her head said to me, “In Spain you are a human being.” No Charge.
Ever since then I have wondered what am I in my country? What are we in The US under a capitalist pay to play insurance system?
As a visitor in Spain I received care. In my country, 50% of “go fund me” requests are desperate appeals to complete strangers begging online for contributions to pay for medical care. ..so someone doesn’t die.
In Spain, as a tourist I was not denied treatment. Despite the fact that in the US about 70% of all health care costs are publicly funded, and we all pay into this system whether we are insured or uninsured, Americans experience millions of denials of care every year.
Health Care is considered an individual benefit available to some and not to others, a commodity to be bought and bartered for. If a person gets sick here, they lose their job, and their health insurance. They are likely to lose their savings, and their homes…and often their lives.
The US has a system of WEALTH CARE relying on a kind of ‘disaster opportunism” to exploit our human need at our most vulnerable for financial gain.
A triad of “for profit” medical financial complex industries control our system. Insurance, Hospital associations, Pharmaceutical corporations determine the care we receive. There is no cap on what can be charged and no bottom limit to the level of services we can be denied.
Wealth care extracts resources away from health care by using people as profit centers. We are “income generating units” when we are paying for policies and “medical losses” when we need care. Ever escalating profit maximization, means a goal of more profit tomorrow, more next week, more next month…. we all know the Wall Street drill. Relentless exploitation is bending the arc ever upward for stockholders and CEOs enrichment at our expense.
Universal Insurance does not guarantee Health care. Insurance is a business devoted to profits, a Wall Street financial instrument that values some lives over others. The client is the shareholder..not the patient. Our health is a commodity. We are mislabeled “consumers in a marketplace”, deceptively implying choice.
Was there a choice for the farmworker parents of the 2 year old who swallowed a coin and had to wait hours in a Central valley ER to find a doctor who would remove the coin. The 2 ER docs at that facility were temps working for a for profit company that staffs ERs in underserved areas. They refused to treat the toddler because they would not be paid.
Did 12 year old Diamonte Driver have “consumer choice” when his untreated tooth abscess killed him because his mother couldn’t afford the dentist and the ER where they sought care doesn’t do dentistry?
Wealth care promotes the immoral policies of “delay, deny, and hope they die”. For wealth care to succeed, good health care must fail. They are in direct conflict. Any reform that retains the for profit insurance industry is already a failed health care plan. Any form calling for incremental alterations is suspect.
Our system is failing the 99 percent for the financial benefit of a very few.
Americans continue to suffer from enormous medical debt, bankruptcy, foreclosures, homelessness, reverse mortgages, destruction of credit, preventable disability, mental stress and emotional fatigue…because we got sick
Lack of portability and transparency, limited provider choice, job lock, trading wages for health care benefits, skyrocketing out of pocket payments, routine denials of care and refusal of reimbursement for services rendered, all plague us.
Dealing with insurance policies, hospitals charges, drug companies is like telling the blind to read the fine print. We are all traveling blind.
30 million people remain without any coverage at all. 30 thousand die every year due to lack of access to health care. Here in California, that averages to 9 persons a day, every day, losing their lives because they cannot access necessary care. It is no surprise The US leads the wealthy nations in preventable death.
Nadaline Sarkasian died at 17 years of age because someone sitting at a computer for Cigna insurance refused her life saving surgery, calling it “experimental”. Alec Smith, Shane Boyle, Kevin Houdeshell each died because they couldn’t afford life saving insulin which skyrocketed in price by 350%. Cancer patients end up losing everything they have, shredding their family security, losing their homes, in massive debt….because they got sick….and still some die because they could not keep up with the treatment costs.
Dr. Martin Luther King Jr. correctly noted that injustice in health care is the most shocking. The system we have is unjust, unequal, divisive, expensive, exclusionary, unsustainable, destabilaizing, immoral, cruel….barbaric really….and simply bad for our health.
SO WHAT IS HUMANISTIC HEALTH CARE ?
Begins with at least two essential concepts;
1st- Quality Health care is a universal human right.
Rights belong equally to all. Rights are not bought nor sold, they cannot be denied nor rescinded. As a right that each person enjoys, there is a collective public responsibility for caring for those in need. We are all temporarily healthy or temporarily sick.or on our way out permanently. We all need good care in this journey.
2nd– A healthy population is a social good benefitting everyone. As far back as 1888 when the first national health care system was implemented by Kaiser Wilhelm and his conservative Imperial Chancellor Otto von Bismark, the impetus was that a nation’s strength and security lies in supporting a healthy and economically stable population. no duh!
As Paul Wellstone said “ We all do Better when we all do better!”
- Humanistic Health care relies on some indisputable observable facts:
* Quality health care within a single payer system provided by public funding has been successful all over the world for over 100 years. Tunisia, Vietnam, Rwanda have recently adopted Health care as a national service. The world Health org. has declared non profit state sponsored health care as a goal for all countries.
* Outcomes are significantly better.
* Costs are a fraction of what we pay.
- The benefits to physical, social and economic well being of a population are expansive and bolster every sector of society.
- Socialized financing of health care prevents the devastation of induced poverty, loss of home, and ruined lives ….because someone got sick.
- No one in Europe knows what medical debt is. Neither should we.
WHAT DOES A SINGLE PAYER Universal system look like?
* It serves rather than uses people. honoring …basic human dignity. Nurturing one another. Responding to suffering. Caring for our mutual well being.
* It Publicly finances the delivery of quality treatment and those services designed to maintain optimum wellness.
* It is not for profit.
* It is one standard of high quality care. Guaranteed to all equally. No more tiered care …penthouse care for some and bargain basement care for others.
* It is comprehensive, covering all needs,
* It is “first dollar” free – no individual burden of premiums, copays, deductibles, means testing
*It is Accessible to all -removes barriers of geography, employment, race, class, economics .
* It allows individual choice and flexibility, eliminating networks.
* It Expands alternative modalities of care.
- Places decision making in the partnership of client and provider.
no more insurance industry practicing medicine without a license.
* Providers are able to use professional judgement rather than being tethered to insurance industry computer generated algorithms.
- It is sustainable by eliminating bureaucratic waste and profit.
- Relies on price controls, bulk purchasing, global budgeting.
* It is transparent and publicly accountable
- It is sensible, rational, effective. inclusive.
- It is the only system that makes any sense if we are seeking secure quality care for all.
Everybody in. Nobody out.
HOW DO WE GET THERE ?
You are doing it right now….Showing up!
- Educate ourselves/others -websites, read, question. Healthy CA & HCA
- Public awareness- we are creating a mass movement. crowd canvassing, door knocking, tabling, texting & phone banks to build a critical mass.We have people power “The master’s tools will never dismantle the master’s house.”
- Networking with partners across issues. Invite speakers. attend rallies. Heath care intersects with every other issue.
- Continuous pressure on office holders to support specific bills. CA SB562, Sanders SB 1809, House Bill HR676. Several states have signal Payer legislation in the works. Do the legislators and party machine leaders in these states want single payer? No, across the country we are being met with “all talk and no walk”.
- Remove obstacles to single payer…that means removing some of the folks sitting in our legislatures. That means working to elect real representatives coming from outside party machines. MARIA ESTRADA campaign 63AD. Very important to replace our nemesis Rendon. This would send a message across the state to all the others who sat in complicity, silently betraying us with “oh well” inaction.
Country after country has made the transition. Remember that in Spain and across the planet, people are treated as human beings. I want that reality here, now, sooner than later.
The Reverend Martin Luther King, Jr. wrote that given the way the capitalist system works, we know that the system will not change the rules, we are going to have to change the system. “ But to get there we do have to make the journey….and like all worthwhile journeys we must do it together.
There has never been a better nor more critical time to JOIN THE MOVEMENT…We need one another NOW. Some how, some way. DO IT!
Because TOGETHER WE ARE GOING TO CHANGE THIS SYSTEM.
On the Possibilities of Critical Family Practice
Dr. Ignacio Guerrero
I will speak mostly based on my experience working as a family-practice provider in the community setting in Los Angeles, California, over the course of two years.
- Labor and class struggle in the community clinic setting
Community clinics, which are dedicated to attending to patients from vulnerable populations who are insured with mostly public social programs such as Medi-Cal, are certainly not free from the contradictions of capitalism. They are governed by pyramidal decision-making power structures, even if they are nominally “non-profit” enterprises. Vast differences exist in terms of salary, benefits, vacation, and sick time as well as general power and autonomy among different classes of workers, particularly if we compare medical assistants to the “professionals,” including physicians (or doctors), physicians’ assistants, and nurse practitioners. I recall a friend once likening the practice of medicine and nursing to a military command hierarchy. This is not altogether untrue. Medical assistants, or M.A.’s, are increasingly used in the community-clinic setting to replace more highly trained registered and licensed vocational nurses (R.N.’s, LVN’s), as they are “cheaper labor,” being less formally skilled. They are paid poorly and typically do not even have labor contracts. In contrast, depending on the institutional setting, providers may have more or less say in the “management” of the “company,” though in private clinics, the potential gains from rent-seeking (or profit-seeking) behavior are often greater, in the sense that doctors can invest in the “company” and thus in their own greater exploitation, and that of the workers.
I do not believe that community clinics should be considered companies in any sense. This dynamic yields the well-known alienating demands for a “fifteen-minute appointment” with a target quota for X number of patients seen in a given shift or day. In turn, the practice of patient care in a sense comes to resemble an assembly line, leading to a greater or lesser degree of instrumentalization and bureaucratization of the patient(s) and their medical, psychological, social, and economic struggles on the part of providers. The recent shift to “electronic health records” (or EHR) has only made this impersonal dynamic worse. When the “census” (or total patient count) is not high enough, management will demand various means of speed-up. Without the healthcare workers’ having a union to resist management, this power-dynamic inevitably leads to increased stress among M.A.’s and providers alike, although on the other hand, of course, more patients may be served in this way. Yet burn-out is real in the healthcare industry; the physician suicide rate is more than twice that of the general population, and even higher than suicide rates in the military, according to the findings of a May 2018 study. While I cannot find statistics on U.S. nurses, a U.K. study showed that female nurses have a 23% higher likelihood of completing suicide, compared to the U.K. women in general. And that’s with the National Health Service, or NHS!
- Working with Patients from Vulnerable Populations
Who are vulnerable populations? Those oppressed on grounds of class, gender, race, ability, sexuality, formal education, immigration status, national origin, and incarceration status, among other factors. Vulnerable populations can also include those subjected to violence and trauma, the uninsured, the malnourished and food-insecure, people who are illiterate and/or do not know English, homeless people, those with substance abuse issues.
The patients I have seen are mostly insured through public programs, reflecting their class as low-wage workers. Many are undocumented immigrants. Even so, class stratification is seen, in the sense that specialists will be more open to seeing patients with commercial rather than public insurance, and even among the latter, they were preferentially favor certain insurance companies affiliated with a given program over others: having an especially poor insurance status will cause that patient to have to wait especially long if they need any referrals, as such insurance is ‘unattractive’ to specialists, presumably due to low reimbursement rates. It is worse for patients who are altogether uninsured, since they must pay for all costs related to specialists directly out-of-pocket. Controlling the diabetes of a homeless patient is especially difficult, given this person’s typical lack of access to refrigeration to store food and insulin, as well as lack of the consistent food intake diabetics need in order to take their medications as prescribed in turn so that they avoid low blood sugar (hypoglycemia), which is potentially life-threatening.
Studies have shown greater hospitalization rates for low-income patients toward the ends of the months, when one’s disposable income has run out. Food insecurity exacerbates chronic disease, and vice versa. Some forward-thinking practitioners have called for hunger to be included as a vital sign, alongside heart rate, respiratory rate, temperature, blood pressure, and pain level. Poverty and disability mutually reinforce each other, as well. Oppression and discrimination produce constant trauma, such that the allostatic load (or degree of stress) borne by vulnerable populations is generally higher than more privileged patients, with possibly deleterious effects in terms of immune-system function and control of conditions related to the sympathetic nervous system, including hypertension (high blood pressure), diabetes, and mood disorders, such as anxiety and depression. Plus, being subjected to adverse childhood events is correlated with having a much shorter overall life expectancy (approximately 20 years), with poverty itself being an independent risk factor for premature death. One well-known study from 2015 shows that, relative to white children in the Emergency Department, Black children are less likely to receive any analgesia (pain medication) for moderate pain, and much less likely to receive opioids for severe pain, such as that associated with acute appendicitis.
In terms of the overall population, many diseases and conditions go undiagnosed and untreated—especially psychiatric ones. This is especially the case for socially excluded patients. So in many ways, the existing healthcare system both reflects and reproduces the white-supremacist, authoritarian-capitalist fundamentals of existing society. Implicit bias is a definite problem among healthcare providers; I understand that the rate among us has been found to be about the same as the rate in the general society. (See Project Implicit.) In this light, it makes sense to argue that oppression should be considered a social determinant of health.
Yet in practice, I have often found it difficult to integrate adequate consideration for environmental, racial, gender, and class influences on the determinants of health of my patients. I would like to reflect more on how this could be done. I think there should be a much greater emphasis in family practice on the importance of plant-based diets and regular and aerobic exercise for the prevention and treatment of dyslipidemia (high cholesterol levels), hypertension, and diabetes, as well as in the prevention of cancer.
There is a pressing need for movements to bring about a holistic and comprehensive sense of social or societal health which would facilitate healing for individual patients and communities alike, critically incorporating communal, feminist, and ecological dimensions. For example, a transition to walkable cities would greatly reduce both local pollution, which adversely affects human health and ecosystems, as well as the carbon emissions worsening global warming. Together with patients and communities, healthcare workers can propel this reconstruction at the intersections of public social health and ecology.
Changing the Perspective of Health Care from the Inside Out
By a Clinical Laboratory Health Care Worker
With today’s toxic balance of frequently changing political scenery and an overload of information coming from the technological advancements we so cling to, it’s easy to feel overwhelmed and lost in the issues. It leaves a person vulnerable to falling for capitalism’s trap of deceit with distractions; finger-pointing and turning against each other: our comrades, our coworkers, our neighbors; our peers. Many choose to ignore and survive day-by-day expecting nothing will ever change. Others choose to become active with local organizations. One may have led you to reading this today. I was first introduced to the idea of Socialism in 2004 by FoxNews. I was waiting for the arrival of the Weapons of Mass destruction that we were promised; the proof that the Iraq War was just. FoxNews had begun accusing questioners of the war of having ideologies that “reeked of Socialism”; so falling for that Red Herring; I was like, “What is Socialism?”
By 2012 I had been to my fair share of demonstrations; taken part in Occupy Los Angeles, learned a lot about Socialism, and was introduced to the Socialist Party USA (member since 2015). More recently, I’ve joined fellow Comrades in the ever growing Democratic Socialist of America. During this same period, I had begun my transition into my second career as an allied healthcare worker. Hence, my transition of becoming a leftist (or a card carrying socialist) parallels my transition of becoming an allied healthcare worker, giving me a unique observational perspective of an industry that’s been at the forefront of the question “Universal Healthcare, or Privatization?”. The Healthcare System of America is the shining example of capitalism in healthcare. We know its bleak statistics on patients, but what about its effects on Healthcare workers?
I have been an allied healthcare worker since 2010 when I began this journey into my second career after witnessing my mom’s decline of health (related to her age) and the many healthcare workers who assisted with her care. Not just doctors: nurses and their staff, physical therapists, dietitians, radiology technicians, phlebotomists; and forgive me if I left any department workers out; there are so many. The healthcare industry doesn’t just provide care for the sick; it provides work: people’s livelihoods. And when people are doing their job with a sense of purpose and personal gratification; they’re not only helping themselves, they’re helping the community they serve and a notable, significant difference is made.
I love my job. I love caring for the sick. It is the reason I sought-out a career in healthcare and it’s the reason that most, not all, healthcare workers do. Currently, I am a Clinical Laboratory Assistant at a community hospital; a not-for-profit (unfortunately, non-union) organization. I’ve worked there for several years.
Since I began my second career, I’ve worked for several Clinical Laboratories. One of them was a $14 billion dollar corporation where I worked alongside many hardworking phlebotomists; including one who lived out of her car. At the time, phlebotomists were paid $14 an hour. Currently, the CEO makes $11.6 Million a year; or approximately $5,576.92 per hour (assuming he works 40 hours a week); this after giving themselves a 7.9% raise.
Prior to working at the corporate lab, I worked for a large healthcare-clinic serving the under-served (mostly immigrant; but also, poor and working-class communities). This clinic relied heavily on donations and government subsides. There I often worked with people who worked two jobs; This is something found frequently amongst allied healthcare workers. They would have a full-time job at a clinic and a part-time job elsewhere, or a part-time at a clinic and a full-time job elsewhere.
Something else you can find frequently within the healthcare-worker community is a sense of blame and finger-pointing in the workplace which unfortunately results in a change in the healthcare-worker’s original purpose; or intent. Something often referred to as a “calling”.
Whether it was my experience at a Technical Trade College where I obtained my Medical Assistant License, or at the Community College I attend now for my nursing program; one thing that remained consistent was the answer to the question, “Why Healthcare? …specifically, why patient-care?” The answer almost always began with the student giving a personal account of their “calling” to healthcare: They had a sick family member whom they cared for. Or they witnessed a loved one in a critical care environment, when it occurred to them; I can do that. I want to do that. I don’t just want a job. I want to make a difference.
Unfortunately, if you flashed-forward to today and asked some of those same students in their current positions, “why healthcare?” you wouldn’t hear about their purpose or calling. You’d hear about the money and their frustration with not making enough, or needing another job to supplement their income; after all there’s always healthcare jobs, they may not pay enough, so just get two. What’s worse and more harmful is that you’d hear about the stress of their job. If you dug deeper, you’d probably hear about their frustration with fellow employees not “picking-up enough of the slack”; that sense of blame and that finger-pointing.
I lived this example while working for the Clinical Lab. There, they would ask us to document the patient’s wait times. This company sold its laboratory services to their prospective Doctor clientele by promising the doctors that their patients would never wait more than 15 minutes to complete their visit to a one of their offices; it was their mantra. They would sign-in and we would document when that patient left. Over the number of years I worked for this corporation, I personally witnessed people waiting upwards of 2 ½ hours to have their labs done. And the frustration, finger pointing, and blame that fellow lab workers would put on each other; when in-fact, we were simply understaffed.
At the end of the day we would do the “Patient Wait-Time Report”. I’d standby and watch my fellow coworkers lie; nobody ever waited over 15 minutes. According to the reports; many waited ZERO minutes.
You see; if you put anything over 15 minutes on that report you would hear about it from management in the form of a location performance improvement report (which would later be used to determine potential raises, or lack thereof). So essentially this billion-dollar corporation was asking its employees to lie on the wait-time reports. Later, I found out location managers were compensated through a bonus-system based on wait-time reports.
So why is this significant to the discussion of Healthcare alternatives?
Because it’s a direct result of a healthcare system that is purely reliant upon the dictation of profiteers; Capitalism in healthcare. Profiteers who make upwards of 392 times more per hour than the workers that do the actual work and care for the patients.
How is this system better when workers with patient’s lives in their hands are asked to take on the pressure of wait-times. The term wait-times may sound familiar to some that are familiar with the wait-time scandal of The Department of Veteran’s Affairs (VA). It’s this type of pressure that’s applied to healthcare workers that makes for an undesirable patient experience (as seen at the VA; and the Lab I worked at). It’s this type of pressure that’s applied to healthcare workers that can often result in a hostile work environment. A sense of blame which evolves to a change in the healthcare-worker’s original purpose; or intent; that “Calling” that we had.
I know because I’ve seen it extend its ugly hand from the Multi-Billion Dollar, S&P 500, Forbes poster-child corporation; to the free community clinical settings, to so called “not-for-profit” hospitals.
As healthcare workers, we not only have a commitment to keep to our patients, we have a commitment to keep to each other. We need to remind each other of our original intent; our calling to patient-care.
We need to redirect the fingers pointed at each other and point them at the now obviously failing system of capitalism. We need direction and reinforcement from our comrades and communities that an alternative exists. And we need to send a crystal-clear message to the profiteers of healthcare that their days are numbered.
Healthcare workers have the unique opportunity to demand a change in system from the inside-out. By speaking and working with each other in solidarity; by putting the patient first; not the wait-time report; By demanding extra staff; not extra hours.
By reminding each other of our original purpose; our intent. I engage my coworkers in this conversation as frequently as possible. I invite them to Healthcare For All events and demonstrations. I encourage them to think outside the social-norm; reminding them of the margin; THE DISTANCE that the profiteers keep from us; 392 dollars to each of our 1.
I invite and encourage all readers of this article to reach out to any and all healthcare workers that you know; the medical assistant that takes your blood pressure in your doctor’s office, the phlebotomist at the Lab’s office; YOUR DOCTOR / NURSE PRACTICIONER / PHYSICIANS ASSISANT, your nurse. Engage them in the conversation: Dare to insist that Healthcare is a human-right. Challenge them to consider Healthcare-For-All as a public-health issue; as preventative measure. Educate them on the margins kept between profiteers and healthcare workers; use it as evidence that the money is there; this is a realistic and economically sound alternative. Remind them that we already have Universal Healthcare; it’s called MediCare. We need to put an end to profiteering in healthcare and it needs to start by making MediCare available to everyone.
Presentation by Omar Abbas will be published later
Comments by Frieda Afary, Moderator
The problem with the existing medical system is not only that it is not free and discriminates based on class and race and gender, but that it fragments human beings into body parts and does not see the whole human being (body and mind). It also does not allow for time to address the specific needs of each individual. Instead of addressing root causes of problems, it mostly addresses symptoms of illnesses through the use of medication and surgical options.
It is the fragmentation of the human being under capitalism that Karl Marx targeted in his Economic and Philosophical Manuscripts (1844) and Capital (1867) where he opposed capitalism as a mode of production is based on alienated, mechanical, mostly mindless labor. Marx argued that this labor process alienates the human being from their products, process of labor, other human beings, and the human potential for free and conscious activity. This alienated labor, because of being undifferentiated or homogeneous human activity, is expressed by value or money and is measured by a social average which Marx called “socially necessary labor time.”
Furthermore, once labor produces value, the goal of production becomes the expansion of value as an end in itself. Capitalism keeps trying to reduce the socially average time needed to produce a commodity or to perform a task, not to make life easier for humans but to allow for the creation of more value. This analysis illuminates what today’s speakers referred to as speed up and an assembly line system of work and health care.
Capitalism cannot be overcome until alienated labor is abolished. Such an abolition would require an end to the domination of abstract time or a socially average time. The socially average time acts as the boss standing over people and telling them that they have to do their work within the average time or else get fired. (Also see Peter Hudis. Marx’s Concept of the Alternative to Capitalism. Haymarket Books: 2012)
Understanding the abolition of alienated labor and abstract time as essential for abolishing capitalism can have immense ramifications for health care:
First, the idea of reducing time spent with a patient to a minimum, will no longer dominate the doctor-patient or nurse-patient relationship. Each patient will get the time that they need based on their individual needs.
Secondly, when the alternative to capitalism is seen as the end to a labor process which fragments human beings, humans will not be viewed as body parts fragmented from each other but as whole human beings whose health requires a holistic understanding of the person. Instead of simply addressing symptoms of problems with drugs and surgery, time and effort will be spent on understanding the person as a whole and finding treatments that might be more time-consuming but are more effective and not toxic or invasive.
Thirdly, within the context of society as a whole, issues like good nutrition, exercise, healthier human relationship, more satisfying jobs will have a great influence on human health.
Therefore, I would say, the key to developing an alternative to capitalist health care or wealth care is whether we see the abolition of capitalism as simply the abolition of private property and limiting or abolishing the market, or whether we see the abolition of capitalism as an end to alienated labor and the fragmentation of the human being. The former would keep alienated labor and its ramifications but will only try to improve the distribution of wealth. The latter aims to create the conditions that would allow humans to have control over their lives and work and hopefully begin to lead a thoughtful existence which would also greatly improve their health.