This article makes a critique of current interpretations of the crises of the western system of medicine and presents alternative explanations for those crises. It indicates that the crises of medicine-reflected in its ubiquitous problems of costs and ineffectiveness-are due to and reflect the crises of legitimation and capital accumulation of contemporary capitalism. The article is divided into six parts: the first two define the characteristics of the crises of western contemporary capitalism and of its system of medicine, with a critique of current theories which try to explain them. Parts three and four contrapose to these theories a Marxist interpretation of the crises, tracing their causes to the needs created by the process of capital accumulation and to the demands expressed by the working population. The needs and demands generated by Capital and Labor are intrinsically in conflict, and are realized in the daily practice of class struggle. The characteristics and consequences of that struggle for health and for the organization, content, and ideology of medicine are analyzed in the fifth part. This class struggle takes place within a political context in which Capital and its social expression, the bourgeoisie or corporate class, have the dominant influence on the organs of the State. The sixth part of the article shows how that dominance determines the nature of the State responses to the crises of medicine. A primary thesis of this paper is that social class, class struggle, capitalism, and imperialism are not passé categories, as most ideologists of capitalism postulate, but rather they are the most important paradigms for understanding the crises of the western system of power and its medicine.
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