AT WHAT COST

A study of the disastrous collision of capitalism and public health.

Capitalism gives off a fusty air, so many leaders prefer the term free market to describe the system that dominates global economies—and whose flaws are no secret to scholars, including Freudenberg, an expert on public health policy. Since the peak of the so-called “welfare state” in the 1960s, writes the author, the U.S. has adopted neoliberalism, whose strategies of deregulation, tax cuts, privatization, and austerity grant capital markets supreme authority. After the introduction, Freudenberg presents six long chapters on the dismal state of what he calls “the pillars of health.” Our global food system has largely eliminated famine, replacing it with an epidemic of overnutrition, obesity, and diet-related diseases, the result of an avalanche of low-quality, superprocessed, calorie-dense quasi-foods. Education leads to better health, but declining government support has led to an explosion of private enterprise. Charter schools suck money from public funds with the promise of a cheaper, better product, but they have not delivered. For-profit colleges verge on scams, and adolescents are becoming addicted to their electronic devices at the expense of human interaction, a situation that causes depression and anxiety. In the sole chapter that focuses exclusively on health care, the author discusses the war on cancer. He shows how pharmaceutical companies, in their obsessive search for a “blockbuster drug,” churn out wildly expensive chemotherapeutics that may or may not prolong life a few months. In his conclusion, Freudenberg works hard to project optimism. Unions remain moribund, but low-paid workers continue to organize to press for better conditions; others have launched cooperative business ventures. Though the federal government is consistently gridlocked, the author describes state and city programs that provide child care, family leave, affordable public transportation, and living wages. Ultimately, these efforts must coalesce into a mass movement with political clout, and Freudenberg remains hopeful.

A grim, well-researched case that capitalism is wildly dysfunctional but that reform is possible, if not imminent.