46 million Americans make do without health insurance, and many millions more have inadequate insurance (rationing or sometimes denying essential care). Note that everytime a non-profit medical group stages an event to provide basic medical care, non-stop lines of THOUSANDS of our fellow citizens queue-up (http://www.newstin.com/rel/us/en-010-017172734). I cannot sing loudly enough the praises of these doctors, nurses, administrators, and other health care professionals who make these events happen. Please note that these events are about health care not health insurance, the former is about filling a human need in our society, the latter is about profit, power, and wealth for a miniscule few at the expense of many (health problems are the major cause of individual bankruptcies in the US; not to mention the untold physical suffering millions must endure).
Yet, so many in our Congress are hell bent to maintain the status quo. What is the status quo? Continuing to protect the malevolent institutions and practices that have created the most innefficient and inneffective health care system among developed nations. Free market? Hah! No such thing has ever existed under the nation state. Either the market is regulated more in favor of the few wealthy and powerful or more in favor of the majority of citizens. Either way, the market is always regulated. For far too long we have allowed our markets to be regulated in favor of the few who prey on the majority. In this case health insurance companies which are about profit margins and executive bonuses tallying billions of dollars, not health care. In this case drug companies whose business model mirrors that of the insurance companies. In this case for profit medical facilities and payment systems for doctors and others based on procedures, not outcomes. In this case hospitals, doctors’ groups, and other aspects of our healthcare system which refuse to address systemic health care dangers and inneficiencies (certainly there are exceptions to this, including many doctors who sincerely practice not for attaining wealth and power, but for the benefit of their patients). So, there’s plenty of metastic waste to be cleaved from this system. Maybe even enough to facilitate a single-payer system, with a true focus on the consumer of medical care and not all the middlemen siphoning off “profits” which neither provide or add value to medical care. So, being a sometime trusting soul, I ask myself, why our Congress is not acting in the best interest of the majority of Americans? I have two thoughts on this.
Those oppposing reform (Republicans and Democrat Blue “Dogs,” as well as many Democrats proposing the half measures now under consideration) are part of the wealthy, elite, and powerful, who under the skin are Social Darwinists. This term suggests that principles of evolution apply to the society of man. The fittest dominate and horde resources, while it is the natural lot of the less fit to grovel at the bottom of the chain for crumbs, live miserable lives and die young. That’s that and there’s nothing to be done about it. Of course this seems quite reasonable if you are one of the “fit.” In the late 19th and early 20th century impoverished, often immigrant, children of all ages were enslaved in New York city whorehouses to satisfy the sexual desires of patrons (e.g. buggery and worse). With a somewhat routine frequency, these tragic children turned up dead as a result of violent acts commited upon them in the course of their employment (no details needed here). These gruesome deaths were never reported in the papers of the day (similar to todays underreporting of minority/poor violent crimes as opposed to violent crime affecting the wealthy/powerful). Polite (upper class) society did not consider them “proper” discourse among “ladies and gentlemen.” Besides, this was simply the natural “lot” of the underclasses. Nothing to be done about it. I can only conclude that many of our politicians take this view relative to the health care debate.
My second thought on why Congress is doing such a piss-poor job on
legislating health care reform came in an article I came across today (http://news.yahoo.com/s/livescience/20090817/sc_livescience/mostusmoneylacedwithcocaine). They are high on cocaine! This article states that the majority (85-90%) of the paper money circulating in our society is soiled with cocaine. This confirms, what many have long believed, that is that our US war on drugs is an abysmal failure. But, the article also reports that the greatest concentration (95%) of cocaine-laden money is to be found in our national capitol, that’s right you guessed it, where our Congress meets, Washington DC. Whether you hold Social Darwinist world views or are simply high on cocaine, the results could be similar i.e., a disregard for the needs and best interests of the majority of Americans. Ah, but if our “people” in Congress would put down that rolled-up dollar (or is it a fifty?) for a moment and pay attention I may have discovered an additional way to finance health care reform.
Seeing that our war on drugs has failed lets take a new tack. Let’s focus our efforts not on criminalizing drug use and unneccessarily ruining the lives of our citizens by imprisonment (and incidentally creating a US/world market for criminal skullduggery to flourish in), but rather on a model of treatment for these addictions. Richard Nixon had this right with his treatment approach (e.g., the methadone program). So, legalize use of the currently illicit drugs, let the state administer them under clean, safe, controlled conditions, while incorporating addiction treatment into a national health care system. Just like the end of prohibition in the US, this would put an end to a great deal of organized criminal activity, while possibly eradicating most violent street crimes (as has been the case in e.g., Sweden). But how to finance this?
In 2003 the federal government spent 19 billion dollars on the drug war, while currently this year (not 3/4 of the year has passed yet) federal and state drug war costs combined have already exceeded 32 billion dollars (http://www.drugsense.org/wodclock.htm). Gee, stop the failed drug war efforts and finance health care! 40 billion dollars a year in projected savings enough? Don’t think so? Plenty of room for fudging in figures like these, so let’s consider other savings relevant to surrendering to the reality of the drug war efforts. Estimates conclude that state and federal taxpayer costs for imprisoning drug offenders totals about 9 billion dollars a year (http://www.drugwarfacts.org/cms/node/63). OK, so close to 50 billion dollars a year saved by stopping a war long lost and then use these funds to finance a health care system that works. The latest CBO estimates I’ve seen on currently proposed health care reform legislation indicate a shortfall/cost of something like 9-10 billion dollars per year. Gee whiz, with 50 billion a year to play with we ought to be able to expand a single-payer medicare system to everyone, without asking seniors to sacrifice a thing! And this doesn’t even take into account the cornucopia of savings to be gained by eliminating all off the waste (that which does not contribute to best patient outcomes) in our health care system. Seems like a no-brainer to me.
As to our federal elected officials in Congress, I can only hope that they are addicted to cocaine rather than holding worldviews of Social Darwinism. I would have much more respect for them.
{ 5 comments… read them below or add one }
The key question to start with is “What does it cost the nation to have so many million people NOT be covered?”. In the process of attempting to assess that cost, and its sources, one can begin to figure out how to address, and rein in those costs.
Of course, obviously its about people, not costs.
In attempting to explain the nature of the debate to my 13 year-old yesterday, it occurred to me that both Canada and the US find themselves in large boats that are almost too big to turn around. Canada is in a boat that is predicated on socialized medicine, in a way, and embedded within an infrastructure, that will not comfortably accommodate inclusion of private-sector elements, even for those who have the honestly-earned resources to afford it, and need it. It is simply difficult to graft on. The US is in the opposite boat, with a system so heavily embedded within a private-sector model that incorporating publicly-funded services disrupts (or at least is perceived as potentially disrupting) what is currently in place.
I’m not taking sides here; merely noting that the tentacles of both privately-based, and publicly-based, health care systems are not so easy to amend once they have been in place long enough. Kinda reminds me of all the debates I’ve heard recently about when and whether electric cars would ever become a major force. With a world predicated on combustion engines, turning electric seems a virtually impossibility.
Thought you might weigh-in on this post. Nice to hear from you Mark.
Our president keeps emphasizing the question you ask and its paramount relevance to the health care issue, yet this rational analysis seems to get lost or ignored in favor of well orchestrated red herring talking points propogated by the very interests entrenched in the status quo. To further your analogy, it seems, at times, that these entrenched interests have taken armed control of the bridge allowing course correction to starboard, but not a degree to port. Isn’t it interesting, in light of all you’ve said, that the most cumbersome ships are oil tankers?
I’ve heard it said that a young man who does not embrace liberal ideas has no fire and an old man who continues to embrace these ideas is a fool. I can only hope to remain a fool while I breath.
I used to say that the most valuable course one could take at university was probably some sort of course that covered statistics, research methodology and probability, given how many things in life require some understanding of all of these to be able to make reasoned decisions.
I think I will amend that, and suggest that some course on policy-making/development runs a very close second, if not tied for first place. Policy development is a VERY complex beast. Too often more complex than political candidates or other leaders comprehend, and most often way more complex than most voters or activists expect. What I find in my own political milieu is that those of a conservative bent these days often have their hearts in the right place, and know what they want, but simply don’t understand how things work, with the result that they institute, or action for, policies that are counterproductive or blow up in everyone’s face.
I don’t wish to get too far afield here, but with the little bit of hindsight we have available to us now, we realize that, as much as everyone hates despots (again, heart in the right place) wiping the power slate clean in Iraq was maybe not such a great idea/policy, because of the complications introduced. Locally, I often see people get elected with promises of cancelling some big-ticket purchase, or reducing taxes, or changing something in some way. Then, they get into office, only to find out that if they cancel the contract, they are liable for a multi-billion dollar breach-of-contract suit, and that if they lower taxes, they will be unable to assist a region that has suffered a huge natural catastrophe, or buy school texts for the region, or something similar.
Policies involve so much more than simply proclaiming what you want. In the public policy realm, virtually ANY policy has so many implications, and is in touch with the tentacles of so many other concurrent or preceding policies (often in many other areas), that it is foolish to either promise a goal directly, or pursue it directly. So, as I suggested in a much earlier post, people here in Canada say “If I have the money, have earned it honestly, don’t mind spending it, am in discomfort, and could avoid having to wait in discomfort by simply purchasing services, why can I not do that?”. But that begets a question from the other side of “If we don’t have enough health professionals to provide everyone with a personal physician, and the compensation potential of a ready market of clients like yourself is large, how do we assure retention of enough health professionals of quality for those who do NOT have the money, or who do not live where the money is situated?”. What seems like a simple enough, and even fair enough, policy objective at first blush, ends up having far more implications than the policy-change requesters understand.
So, often the seeming resistance to policy change on big issues like health…or war…or the auto industry comes about because folks with good intentions suddenly find out “Oh, I didn’t realize changing/doing/proposing THIS was gonna cause THAT.” Just consider how many congressmen and senators may have harboured more pacifist tendencies – on moral grounds – until they realized how much the employment and welfare of people in their state depended on military contracts. Like I say, some phenomena in the puiblic sphere have VERY big and long tentacles. It becomes a bit like wanting to move that tree in the front yard, only to find out that uprooting it would mean compromising the foundation of your house or ripping up your driveway with no ability to restore the driveway before winter sets in, and nowhere to park on the street.
Some policy objectives can look sooooooo simple at the outset.
The road to hell is all-too-often paved with good intentions. The holisticity of the complex world we live in insures unintended, both foreseeable and unforeseen, consequences. Even in attempts to restore or manage biological ecosystems expert biologists (one of the “hard” sciences) often do not foresee important consequences of their actions. Will human knowledge of the natural laws and contributing variables ever be sufficient to accurately foresee and predict outcomes in the “hard” sciences let alone social science and public policy? I doubt it. Yet to quote the title of a wonderful John Steinbeck novel we must remain “Dubious in Battle.” We must try our best.
As you say there are reasonable people of good will in the conservative camp, so there are in the liberal camp also. But, to be honest, there are those shouting “fire!” in crowded theatres from both camps. Of course attributional error results in a bias on both sides in assigning sinister motivation (sometimes earned and sometimes not).
So what happens if we take action to extract more of the profit motive from our hybrid US health system? More devastation to our job market? Loss of insurance industry jobs and medical transcription/billing jobs in a simplified single-payer system, (just to mention a couple of affected areas). Further downfall of our already devastated economies (not just the US economy)? Insurance companies are closely linked with major world banking institutions and they along with affiliated enterprises employ all too important to recovery consumers. Some states and areas of the world would be hit much harder by the attenuated presence of these for-profit institutions. Though I may not be cognizant of all the particulars that those with expertise in policy matters, such as yourself, may possess, I do get it. So does our president and many democrats in the sense that they propose half measure reforms as opposed to a full-blown single payer system so as not to produce too much shock all at once to the current market system and forces (of course there are political considerations as well).
One thing is certain. Harm will be done, either in continued inaction or in reform actions. One of the important questions here is what will be the lesser of evils? As you have previously commented, what will be the cost of 46 million uninsured if we do nothing? Even existentialists recognize that to not make a choice is in and of itself making a choice (with consequences).
Again Mark, I find your analogies useful. If that tree in your front yard is likely to damage storm sewer and septic lines in the spring when its roots grow, as it does every 3-5 years, causing sewage back-up into houses along the street as well as street repairs that will disrupt the whole block while costing tens of thousands of dollars, would it not be more prudent and in the public interest to inconvenience you than to cause upset to the whole block and repeatedly incur costs that over a 20 year period would replace the cost of your house twice? Sooner or later the chickens come home to roost and we must pay for the sins of the past. If that tree had never been planted we would’nt have to deal with the problem. But it was and now we have little choice.
So, and I know this is in many ways a fruitless apples and oranges question relative to our two complex entrenched systems, but I am curious so I will ask anyway. Though all large bureaucratic systems exhibit degrees of less than perfect functioning, do you believe that your health care system overall serves the best health interests of the majority of Canadians?
One final thought. I disagree with your two educational system recommendations (university courses taken on statistics, research methodology and probability as well as policy-making/development). The latest figures I’ve seen for the US indicate that only one in ten hold bachelor’s degrees. As a matter of policy, some form of these subject courses should be taken as part of earning a high school degree.
“One final thought. I disagree with your two educational system recommendations (university courses taken on statistics, research methodology and probability as well as policy-making/development). The latest figures I’ve seen for the US indicate that only one in ten hold bachelor’s degrees. As a matter of policy, some form of these subject courses should be taken as part of earning a high school degree.”