To Live and Die in America

To Live and Die in America: Class, Power, Health, and Healthcare, by Robert Chemomas and Ian Hudson. Winnipeg, Fernwood Publishing, 2013. xi, 232 pp. $27.95 Cdn (paper). In this rousing and compact new book, which is a part of Pluto Press's Future of World Capitalism series, Robert Chemomas and Ian Hudson provide a valuable perspective on the political economy of health in the United States over the past 150 years. The book's six tightly organized chapters investigate how economic developments and class struggles have impacted the health of the individual citizen and the country's larger of healthcare. According to the authors, both professors of economics at the University of Manitoba, improvements are desperately needed. They argue that the organization of power and the conditions under which many Americans live and work, just to name two examples, demand immediate action (p. 1). The structure of To Live and Die in America is one that simultaneously enables a long-term history of health and underlines alternative viewpoints on the United States's unique healthcare system (p. 6). In chapters two and three, Chemomas and Hudson problematize the concept of epidemiological They suggest that the nineteenth-century shift from infectious disease to chronic disease was not caused by mainstream medicine's magic bullets as conventional views hold. Indeed, they assert this is unambiguously false and it was class struggles not biomedical advancements that drove the transition. Medical miracles were important, but were eclipsed by the push for better living conditions, eight-hour work day, and higher wages. This is a striking, alternative approach, and certainly intriguing one, yet it seemed overstated to this reader at least. Surely, there's scope for a balanced interpretation between the sphere and the success of the worker's rights movement. Thereafter, Chemomas and Hudson turn to a more affluent stage in American health history: workers had successfully agitated for improved conditions, forcing capitalists to mechanize and chemicalize modes of production to maximize profits. The changes this wrought, however, created an epidemic constitution for chronic disease ... (p. 7), wherein the goods we consume, environment we inhabit, conditions in which we work, and lack of equality, explain the major killers--that is, chronic diseases--of the population. In chapter five, the authors focus more narrowly on the political economy of health and offer a trenchant, albeit one-sided, critique of a market-based healthcare system, especially what they call the medical industrial complex (MIC). After providing background on conflicting class interests and analysis of the access to and efficiency of the US healthcare system, the authors turn to President Obama's Affordable Care Act and criticize it as unsatisfying compromise between reformers and the MIC

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