Title: What is Fascism?

Author:

Section/SPIG: Medical Care

Issue Date:

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What is fascism? It was certainly a question of hot debate at last year's meeting. I would submit that it is a breakdown in the state's ability to maintain the consent and loyalty of the governed, which necessitates the open use of ideology and force to reestablish control. Although we all think of goose-stepping troops when we hear this word, the ideas and practices which pave the way to overt fascism are more subtle. In times of peace and economic prosperity, the U.S. government, whose primary role is to protect the profits and interests of American capitalism, can persuade working people and professionals that their personal prosperity and happiness are aligned with the success of capitalists. However, when capitalists must fight wars to maintain control over resources and to decrease jobs, wages, and social services to maintain profitability, it is harder to maintain the illusion that all Americans are in this together. Some of the time-tested ideas that are brought out to reinforce the idea that the system is not the source of peoples' problems are:

• racism and nationalism – our problems are the fault of those of another race or national origin;


• extreme patriotism – it is unamerican to question government policies;


• antiscientific thought – you must believe what you are told and not use rational thought to draw your own conclusions; and


• individual responsibility for failure – if you are not happy, employed, educated, etc., it is because you are stupid or mentally impaired.

When all else fails, naked force comes into play – the decrease of civil liberties, strike-breaking, police brutality, and criminalization of school discipline.

As health workers, we should examine trends in health care and research which subserve the needs of the public, patients and science to the needs of the U.S. government and American capitalism. Much attention has been paid at our meetings to the sacrifice of public health funds to the campaign to immunize against smallpox or fight bioterrorism, and the total collapse of drug safety controls and unbiased drug research to pharmaceutical profits. Overt racism in research is again evident in the current scandal in New York City over the use of black and Latino foster children for HIV drug trials without consent or oversight. The current emphasis on the high prevalence of "mental illness," from the Surgeon's General Report of 1999 to the current Harvard study declaring 30 percent of us to be impaired, is not only a boon to drug companies but attributes people's unhappiness to their own inherent defects. The government has redefined torture and enlisted military doctors to participate. Health care for the poor and nonwhite is glibly abandoned as we see in Tennessee's cutting thousands off Medicaid, Arizona banning health care to immigrants, or state and local governments allowing thousands to languish for days without food or medicine in New Orleans.

All of us as individuals and in our organization fight against each of these trends separately, but we should also begin to view them as a pattern of ideas and practices intended to drive our loyalties away from patients and public health and toward being protectors of the interests of the state.