The Fauci and the Furious (w/Richard Wolff)

From Fauci to Mangione to Sayed, something deep is stirring.

Video: Richard Wolff and Richard Eskow.

As Professor Wolff and I discussed in this conversation, Republicans are exploiting public rage by directing it against an individual rather than a system. It’s not necessary to idealize Anthony Fauci to see what’s going on here. People are furious about a system that has exploited and sickened so many of us. By focusing that furyon Fauci, they’re drawing attention away from a greed-driven healthcare economy that gives us so little but costs us so much.

That rage made Luigi Mangione a folk hero when he was arrested for shooting an insurance executive. That’s a shocking indicator of public desperation. In a more hopeful sign, primary voters chose public health physician Abdul El-Sayed as their Senate candidate in Michigan.

As John F. Kennedy said in 1962, “Those who make peaceful revolution impossible will make violent revolution inevitable.” Here’s hoping for a peaceful revolution that benefits all of us.

Selected quotes and a transcript are below.

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Selected Quotes

Eskow:

“Fauci represents an otherwise faceless elite that is controlling their lives.”

“For-profit health holds people hostage to an economic system that could literally take their lives at any time.”

“There are two things you can do about this sick system: You can find a scapegoat like Anthony Fauci, or you can fight for a better system.”

“If the institutional leaders of this country are determined to close off all avenues for peaceful change, they’re playing with fire.”

Wolff:

“I have all my life marveled at and felt completely horrified by the spectacle of healthcare being organized as a capitalist enterprise.”

“They argue that whatever maximizes profit maximizes the quality and the quantity of healthcare. If you believe that, the rest follows. But if you don’t believe that, the result is an abomination.”

“That’s how capitalism works. It makes everything subject to its logic, if not directly, well, then indirectly.”

“It’s the same system that produces inequality. And I think that, underneath, it’s tearing the country apart.”

Transcript (lightly edited):

Richard Eskow: I’ve been fascinated, and horrified in many ways, by the interrogation of Anthony Fauci by Republicans in the United States Senate. Fauci is, of course, the former NIH director, former health czar, and go-to person for both Donald Trump and Joe Biden during the COVID epidemic. It certainly led me to ponder a lot of things.

He’s also become the source of all sorts of demonization on the right, much of which, as others have pointed out, is self-contradictory, that he downplayed the pandemic but also didn’t do enough to protect American lives, et cetera, et cetera. But I think the underlying issues, first, the pandemic itself, and second, Dr. Fauci and people’s feelings toward him, have gone largely unnoticed or unremarked upon.

With the timeliness of the Fauci inquisition upon us, and we’re speaking on Thursday, August 6th, the Senate is considering a contempt of Congress action against him for pleading the Fifth Amendment, which is itself an extraordinary sight: a top American scientist and government official pleading the Fifth after receiving a blanket pardon from a past president.

But all that aside, I’ve given you a hint of the context in which I view these Fauci hearings. To start off, what’s yours?

Richard Wolff: Mine is kind of simple, and maybe too simple, but I’ve marveled all my life, and felt completely horrified, by the spectacle of healthcare being organized as a capitalist enterprise. In other words, undertaken by people who are both self-consciously and publicly engaged in a profit-maximizing activity. Once you make it a capitalist enterprise, it’s governed by the rules of that kind of enterprise.

And that kind of enterprise depends on generating a market for whatever it is you make, and saving money in the production of it. If you marry, as we do in America, a capitalized healthcare system with the advertising business, well, what do you get? You get exactly what we know we get. And, by the way, this does not exist in many other countries. You get direct-to-consumer advertising by the device maker, the drug maker, the practitioner, the hospital, whatever it may be. They’re all busily advertising, making money.

So the only way to believe in this system, if you’ll pardon my editorializing, is to believe the following nonsense: that whatever maximizes profit maximizes the quality and quantity of healthcare.

If you believe that, the rest follows. But if you don’t believe it, the rest is an abomination. I don’t believe it, and therefore, for me, it is absolutely an abomination. I live in New York City. My doctor is located on Park Avenue, a very ritzy area of the city. Why? Well, it turns out more doctors are concentrated along Park Avenue than anywhere else in the world. That’s not a rational distribution of healthcare, that’s the opposite: irrational.

Why? Because it’s very prestigious. They all want to be able to say, “I’m a doctor, and here’s my address on Park Avenue.” That’s worth a great deal in building up a doctor’s practice. So the doctor will spend the big bucks to have an office on the first floor of a building on Park Avenue. It’s very typical, if you walk down the avenue, it’s one doctor’s office after another.

Similarly, a drug that’s advertised on the evening news or in the pages of magazines that come to your home is going to be the drug you hear about, that you talk about, that you ask your doctor about. They’re building demand, that’s why they have an advertising budget.

And if you know anything about the economics of healthcare, I’ll give you one example. It’s a standard joke we use to explain this to economics students. We ask them to name a well-known over-the-counter medication. They do, Tylenol, or whichever one it might be. Then I show them a statistic: what does it cost to make the little pill in that jar? The answer is three cents, six cents, ridiculously low.

What does it cost to distribute it? Five cents, ten cents. What does it cost to advertise it? A dollar. And what does the final price cover? So it turns out, if you understand advertising, the healthcare industry charges enough money to pay the advertisers, and it’s the people who pay for that. This is craziness.

It means that promotion by the producer generates the profit maximization, but in direct relation to how much money you’re prepared to spend on advertising. It has nothing to do with the science of healthcare, or with any kind of healing mentality. It’s crazy.

If you go into a drugstore, one of the big chains, CVS or Walgreens or any other, you’ll see how the shelves are lined up. Whatever is advertised is at eye level, so you’ll go and pay for it. It’s so blatant that the big chains will put Tylenol on the shelf, and right next to it, the generic equivalent, the exact same medication, at a markedly lower price, under the store’s own name. Because it’s so crazy, even within capitalism, you can make a profit without all the rest of it.

And then, when you add that Americans are financially pinched, well, then they’re either going to do without medication or buy the cheaper version. And the minute you allow cheaper medication, you’re inviting a real problem with criminality in how these medications are composed, using the same materials but altering the process to save money.

I read the other day that there’s now a serious problem in the number of Americans who, in polling, say they’ve forgone a meeting with a medical practitioner in order to save money. That number has gone off the charts. And there’s your proof of what suffers as a result: medical care.

Richard Eskow: I was going to point this out, and I will now, because it’s very important to the context in which I view all this. I think, in many ways, the hostility toward Fauci as an individual, it stands for many things to me, it’s a proxy for many things.

But one of the things it’s a proxy for is the fact that Americans are in a deep state of anxiety, understandably so, about their own healthcare, for exactly the reasons you mentioned. US statistics on healthcare have always been far worse than those of any other developed country, both in terms of life expectancy and other measures. The number of people who have turned down or avoided needed medical care, as you just mentioned, has always been much higher here, and is now rising even further.

And while rank-and-file people may not necessarily want to, or be inclined to, ascribe this to corporate greed, although I think more of them do than liberals and centrists are willing to admit, I think there’s a profound anxiety, and I think Fauci has become representative, to them, of an otherwise faceless elite that’s controlling their lives.

So if they can take vengeance through their elected officials on Fauci, it brings them some sort of catharsis. And to me, this ties into the fact that drugs were unaffordable. Everybody who’s an adult now remembers, somewhere viscerally, even though we seem to have collectively forgotten it, that more than a million Americans died from COVID, and that many of those deaths were unnecessary. They didn’t have to happen.

People will remember the famous story from that time about a young teacher who, quote-unquote, “had health insurance.” I put quotes around it because I was once at a conference, health economics is one of my own areas, where someone asked, “What do you estimate is the number of people in the United States who are underinsured?” I said, “One hundred percent.” Nobody in this country has adequate insurance, if you define insurance as protection against financial catastrophe. Some people may have resources elsewhere, but the insurance itself doesn’t provide that protection.

So you have that uncertainty, that fear. And let’s be candid, the initial response to COVID under Trump, through a project I forget the name of, was better than one might have expected, I guess. But it was carried out through Abbott Laboratories and other private corporations, so it had to take their interests into consideration.

A lot of Americans may not know this, but we let an awful lot of people in India and elsewhere die in order to protect our patent rights. And people may or may not know that the NIH, which Fauci directed, is deeply embedded with drug corporations. There are studies pointing out that many of these privatized, patented drugs were developed at public expense, using public resources.

Then the NIH allows drug companies to patent them and overcharge everybody, especially Americans, for them. Even insulin, developed for diabetes: the three scientists who discovered it in the 1920s gave the patent away. They each had to take a dollar to make it legal. I think you and I talked about this once, I did the math in my head and figured that dollar would be worth about $53 today, adjusted for inflation. A little more now, but that’s roughly it. They had to structure it that way as a legal formality.

And patent gamesmanship is still being used to overcharge people for insulin, people are dying of diabetes because of it. So we have this whole context where the for-profit system you describe, extending to doctors, pharmaceuticals, hospitals, diagnostics, and so on, holds people hostage to an economic system that could literally take their lives at any time. And on some level, they must know that.

So if Dr. Fauci gets his roasting, however unfair it may be, setting that aside, there are going to be people who take satisfaction in it. Along with the Rand Pauls of the world, who hate any government intervention in human lives. Add to that the fact that public health is a collective endeavor, and we are not a collective country. And add the fact that yes, serious mistakes were made in the management of COVID, we probably should have opened schools sooner, et cetera.

What we’re seeing, I think, is a deep well of frustration erupting now, one that runs much deeper than one personality, or even one pandemic.

Richard Wolff: Yeah, and I think we shouldn’t be surprised. I agree with everything you said. This is a government, particularly under Mr. Trump, but the Democrats did it too, that likes to find scapegoats the moment its polling shows there’s an issue like the one you just described: a suspicion about the healthcare system, an anger, a resentment. That’s a message they can use. So, let’s find the appropriate scapegoat.

If American income and jobs have been under duress for the last 30 years, let’s blame poor immigrants from Central America, as if they had anything to do with that, other than wanting to do exactly what every ancestor of every native-born American came here to do. Unbelievable scapegoating. And I think that’s exactly what happened with Fauci.

To show you how insidious it is, I’ll tell you a story. When I was teaching at Yale years ago, I got to know scientists working in the medical school, at the local hospital, which is owned and operated by Yale, or in one of the university’s academic departments. They were being made to sign agreements, as a condition of their appointments, that if they discovered anything of commercial value while employed as a Yale professor, the university would be a part owner of it.

In other words, university finances have become built into this whole apparatus. That’s how capitalism works, it makes everything subject to its logic, if not directly, then indirectly.

As to your point about people avoiding care because they don’t have the money, I’m sure that was well understood when insurers, some years ago, decided to convert policies that once allowed you to visit a doctor three or four times a year at no cost. They changed it: now there’s a copay every time, $10, $20, $30. And the same thing was applied to drugs.

They must have known, because it takes only a moment’s reflection to see, that if something is free, people will take advantage of it in a way they can’t or won’t if it costs money. And even if the cost is small, what happens? The additional profit generated isn’t significant on its own. But if a significant number of people don’t go, aha, that was the point. They don’t want them to come. They don’t want them to discover they have a serious illness, because then they’ll have to pay out the claim for it.

The longer it’s postponed, the longer the premiums collect interest without having to be paid out. This is grotesque, but the logic is right there in the capital. They’re doing what a good businessman does: if you have to shell money out, you minimize it; if you’re taking money in, you maximize it. It’s disgusting.

And then to watch Mr. Fauci be, it’s like watching a poor Honduran family get grabbed by ICE, having the children yanked away from the parents, stuck in a detention center where they aren’t properly fed, housed, or clothed. It’s disgusting. This treatment of immigrants had nothing to do with solving the problems of the American working class. And yet it’s the acceptable way, under our existing system, to cope.

And if they find Fauci guilty, and do what, put him in jail? What in the world does that accomplish? Is it going to make the CDC behave any differently? Is it going to change the drug industry? It does nothing. Nothing.

Richard Eskow: Well, it will, theoretically, make people frightened to intervene on behalf of public health for fear of being held accountable for it later. On the point about financing, I think it’s worth adding some context, because health profit-seeking is really multiple economies preying on each other.

You have the drug economy jacking up prices horrifically. With the multiples you mentioned for over-the-counter medications, when you get into prescription drugs, something that might cost pennies on the dollar to manufacture might retail for $1,500 a month. The multiples get insane.

Then you have insurance companies preying on top of that, marking up prices as much as they can to the buyer, usually an employer, or, on the ACA marketplace, an individual, and chalking the difference up to loss. Inadvertently, I wrote about this at the time, the Affordable Care Act encourages that, because it allowed insurers to charge a fixed percentage over cost as profit. So why would you control costs if lowering them meant reducing profit?

So you have that dynamic, but also a pain threshold beyond which buyers simply won’t buy. You have for-profit hospitals. You have the buyout of physician practices by large corporations. Everybody is contending against everybody else. Nobody is pursuing the improvement of public health.

And to top it off, on your point about prevention and public health, there’s no money in it for insurance companies, who are supposed to be the financial intermediaries, because they operate on one-year contracts. There’s a good chance that employer or individual will sign with somebody else next year, or move to a different plan, an HMO or whatever. So why should an insurance executive put money into making sure I get all the tests I need to preserve my health? It won’t help them, it’ll help some other insurer down the line. It’s not their problem.

So you have this insane system. All of which, if you’ll permit a seemingly radical pivot here, gets me to one of two things you can do about this sick system. And we won’t even get into the kids, the distancing, and all the rage over that.

You can find a scapegoat like Anthony Fauci and cheer in the town square as they call him a witch and burn him at the stake, metaphorically speaking. Or you can fight for a better system, which gets me to this week’s primary elections.

Richard Wolff: Right.

Richard Eskow: Because a physician, a public health physician, no less, who, unlike some other victorious candidates in Michigan, doesn’t describe himself as a democratic socialist but seems closely akin to that movement, he calls himself, I was corrected on this, “a capitalist who understands how capitalism works.” Okay, whatever. But he has very left-leaning ideas by US political standards. He’s pro-Medicare for All.

He won despite a massive outpouring of funds in favor of his primary opponent. Some of that money came from pro-Israel groups, but some of it, no doubt, came from health lobbies and others. Also, in Michigan, I believe two democratic socialists won House primaries against mainstream Democrats, and a democratic socialist defeated an incumbent mayor in Ann Arbor, granted, a progressive city.

So, despite the media’s yeoman efforts to proclaim otherwise, you have this juggernaut of the left continuing to move forward, with Medicare for All as one of its key issues. I don’t know about you, but I see the Fauci roast and the victories of the left as two sides of the same coin, ideologically speaking. Am I making too much of the connection?

Richard Wolff: No, no, I think you have to make that connection. No matter what the media says, I don’t believe the shift in public opinion, away from supporting Israel and toward being more supportive of Palestinians, which is real and important in this country, would, on its own, have offset $60 million spent on the other side, plus the endorsements of Senator Schumer and House Minority Leader Hakeem Jeffries. He wouldn’t have won on that alone.

I think there are other factors. One is this: nobody could have missed the roasting of Fauci, and yet here’s a doctor running in Michigan who’s making sense about what happened and admitting the system is broken. All my doctors here in New York admit it’s a broken system. They take different positions on what ought to be done, but nobody defends it. Nobody.

Here’s a third factor: I think you’re beginning to see the MAGA coalition break apart as its different factions no longer cohere, and when they don’t, it’s around blatant issues, like the ones we saw in Michigan. For example, Tucker Carlson and Marjorie Taylor Greene can’t go along with the Israel line anymore. That’s done, and it will fracture the coalition.

The second and more important factor, I think: Michigan is very much a working-class state, built around Detroit, the center of our automobile industry, weakened now, but still significant. People there are reacting to the decline in working-class conditions of life. They’re angry about it, and they’re not going to vote for conventional politicians, because they rightly sense those politicians have presided over 50 years of decline for them.

They don’t want them on the Republican side either, that’s why they went for Mr. Trump. He was at least something different. Having a senator with a name like Mamdani’s is something different too. It’s like people here in New York voting for someone named Zohran Mamdani...

Richard Eskow: Right.

Richard Wolff: ...something they never would have done before. But it worked as a signal: “I’m not your regular politician.” For the mass of people, that’s what all the ugly, naughty racism of Mr. Trump signaled to a whole swath of the working class, finally, somebody who isn’t the usual Clinton or Bush, boringly self-repetitive.

And I think they’re winning on these grounds. The more different a candidate is, even names you’d have thought would be childishly easy to attack...

Richard Eskow: Right.

Richard Wolff: ...turn out to be badges of positivity for them.

Richard Eskow: So what’s the Democratic Party’s response to these victories, to the win and immense popularity of Zohran Mamdani, to the victory of Abdul El-Sayed in Michigan, and to the wins of these other candidates carrying an even more, let’s say, politically loaded label, socialist?

For some of them, the response is to line up behind these candidates. But from more and more of the mainstream Democrats, what we’re hearing is that “these people have no place in our party.”

Richard Wolff: Mm-hmm.

Richard Eskow: So this is setting up an internal conflict within the Democratic Party. And obviously, the Democratic Party as an institution is deeply beholden to large donors. But if I were a health insurance executive, or a pharmaceutical executive, bankrolling the Democratic Party, I’d also bear in mind another story in the news this week, which I have to approach carefully: the pretrial hearings of Luigi Mangione.

Richard Wolff: Right.

Richard Eskow: Because here you have a figure who is startlingly popular, according to the last polls I’ve seen, for allegedly committing the murder of a health insurance executive.

Richard Wolff: I’m...

Richard Eskow: It brings to mind the quote attributed to John F. Kennedy, probably written by Ted Sorensen or Schlesinger or somebody, that those who make peaceful revolution impossible make violent revolution inevitable. It seems to me that if the institutional leaders of this country are determined to close off all avenues for peaceful change, which you and I support, they’re playing with fire.

Richard Wolff: Yeah. And let me add, even setting aside these electoral races, the economic inequality in this country is literally off the charts. The Bureau of Labor Statistics released a graph a couple of days ago, via Axios, showing the share of total income that goes to labor relative to what goes to capital.

When you take the revenue from anything, a hamburger, a software program, part of that revenue pays wages and salaries, and the other part goes to the owners, the employer.

Richard Eskow: Right.

Richard Wolff: And the line showing what goes to the non-supervisory worker bounces around, but it’s unmistakable, and the graph starts in 1947.

Richard Eskow: Mm-hmm.

Richard Wolff: It runs to the present, and it’s just an endless story of decline. You’re literally in a country that celebrates capitalism for making the already-richest person on Earth, Mr. Musk, even richer, and in that same two-week period, shows a decline for the working class, roughly 170 million Americans, going into the toilet. It’s the same system producing both results. And I think that’s what’s tearing this country apart underneath everything else.

Richard Eskow: I think that’s a great point, and maybe one we can revisit. I haven’t seen that graph in a while. I know that in 1968 there was a dramatic split that began and widened over the following decades, and the last I saw, the working-class line had flatlined. But now it sounds like it’s nosediving, and it’s literally life and death.

Richard Wolff: RJ, I’ll make a note, and when we’re done today, I’ll send you an email with the piece I did that has that graph in it, so you can see it.

Richard Eskow: Great. And maybe we’ll discuss it next time. So, as always, Richard Wolff, thanks for such a fascinating and engaging discussion, and thanks for coming on the program.

Richard Wolff: My pleasure. These are important conversations, and I think we do a service by exploring them and making explicit the feelings and thoughts a lot of your audience has already generated for themselves.

Richard Eskow: Well, I certainly hope so, I aspire to that.