March 8th, 2010
I’m convinced that failure to legislate access to health care for all Americans is a means of giving aid and comfort to the enemy. Where’s the Patriot Act when you really need it? Between 1956 and 1998, the conflict in Southeast Asia (Vietnam War for my fellow oldsters) caused the deaths of approximately 58,193 military personnel. Now, in this country each year, some 45,000 American non-combatants die for lack of health insurance. When did being uninsured become more hazardous than wartime service?
In war, you know the identity of your enemy. Nicholas Kristoff asks an excellent question in this Op Ed piece for the NY Times, “Do We Really Want the Status Quo on Health Care?“. It identified lack of health care as part of the current status quo. The next question to ask here is just who or what is the enemy, taking out so many non-combatants each year? Is it health care costs? Certainly a single payer system would go far towards cost containment since the private sector is guilty of price fixing in setting values upon products and services – be it a mortgage or an MRI. Health care constitutes more than 17% of our gross domestic product for other reasons.
It’s a bit ridiculous to claim it is ‘overuse’ of services as we hear from the ‘party of No’. The last time I checked, people in the market for entertainment chose Disneyland over a visit to an orthopedist. Services are certainly not ‘overused’ by those without insurance and the many people who are ‘under-insured’. The latter individuals forgo many exams and medications due to co-pays and the need to cover that next health insurance premium which is really retained for catastrophic coverage. Nor are services ‘overused’ in the quest for a proper diagnosis in a culture of health care that is oriented to the control of symptoms instead identification of their source. Drugs may be ineffective for their intended purpose and many lead to serious adverse effects as well. Seeking out multiple physician opinions to obtain health care with a good outcome is not ‘over-use’ but a necessity until medicine matures sufficiently to return to cure-oriented treatments. This is well understood – and feared – by many Americans. I personally know one, very well insured person, who suffered a stroke rather than see a physician for check-ups to learn about having chronically high blood pressure and silent kidney damage.
If it is ‘just’ about sickness, then we need to utilize the renewed Patriot Act in order to force Congress to legislate universal health care. The enemy must find it incredibly comforting to know that Americans require huge amounts of health care because we are an exceedingly ill nation.
- One quarter of children have a chronic health condition.
- Nearly half of all adults have a chronic health condition.
- Our seniors, comprising more than 12% percent of our population will predictably require care and ‘end of life’ services. Medicare exists to provide them with a considerable degree of coverage for their conditions without the attendant blame for needing health insurance which is accorded to younger Americans without the funds to pay for it.
We are a nation of patients. Debating about caring for the sick is entirely based upon a premise that our country is first an economic system rather than a constitutional entity. The health care debate centers around the notion that offering a cost-effective public system of medical coverage to its citizens is unfair to industry because it removes a share of potential consumers from the marketplace. All discussion of competition between insurers (not even providers of care) relegates the science of medicine to an equal rung on the marketplace ladder with, say, that mysterious metal coil we call a ‘Slinky’. Are these really products and services we wish to consider identical to the marketing of toys within the marketplace?
If you can’t afford bread, it will be provided to you. However, you may have to ration those loaves carefully to last you for the requisite period necessary. Can a lesser tier of insurance provide a ‘half-cure’ for a disease? Ask any physician if you should take seven days of antibiotics for an infection which requires fourteen days of medication to achieve a cure. Patients have been known to cut short the length of treatment time for many infections in the hope that rationing their medication for their current illness will save costs for new prescriptions for their next illness. We know now that this approach merely leads to the growth of antibiotic resistant infections and far greater illness (not to mention costs) than had we assisted them with the full price of earlier treatments. Seizures are quite difficult to control in many patients without a minimum level of drug support and often combinations of drugs. The nervous system may not recognize the notion of ‘compromise’ based upon income. Should the acquisition of seizure medications be dependent upon the same economic system that markets Slinky toys? Does our national identity become so lost if medical care is provided to all that it is better to consign 45,000 people each year to death for lack of medical insurance? Any war with that level of annual casualties would have the public taking to the streets in protest. Of course, this figure doesn’t even factor in deaths due to being ‘under-insured’. Again, how much compromise can one safely make with costly high blood pressure medications?
As with most issues which appear to be full of contradictions, philosophy dictates that we must check our assumptions. The ‘right’ side of the legislative debate (or the wrong side for purposes of this blog post) relegates the art and science of medicine to a commodity instead of a life preserving or life-saving practice. If medicine is strictly a commodity then it will remain available only to those with sufficient income for a comprehensive tier of medical insurance. The minimum wage only offers sufficient income to deprive earners of federal medical coverage granted to the ‘legally’ poor. The majority of insured Americans will eventually find themselves ‘under-insured’ in a marketplace where every buyer is guaranteed to need their full investment back when they get sick. With the escalating numbers of sick and disabled Americans, no insurance company can be considered a sustainable entity as fewer healthy people purchase their policies.
Since capitalism invites unsustainable businesses to go out of business, should medical care be considered part of that process at all? Medical care for humans isn’t a ‘choice’ as it is with veterinary care for pets. One can put down a sick Doberman or withhold treatment but is that option open to you with Aunt Edith? It would seem that regarding medical care as a commodity is the surest way to create death panels based upon income levels alone. Only the poorest, the elderly and the wealthy will be able to access care unless the insurance risk pool grows to include everyone AND we begin to deal with the excessive rates of illness. Controlling environmentally induced ailments will not just slow the rate of inflation but reverse it.
Let’s move on to another radical assumption about ourselves as Americans. Requiring a basic level of wealth in order to access health care services says that we are first and foremost consumers, rather than citizens. Our last administration was fond of terming us, “consumers” and the presidency as akin to the CEO of America. As consumers, we become subservient to corporations which claim they must not be required to compete with a government capable of offering the same essential medical services to its legal residents at a lower cost, i.e. Medicare. Why can’t they compete? Is there some reason corporations are supposed to be underwritten by the government to ensure the availability of customers or a particular profit margin? If the products and services of a company are out of range of most consumer’s wallets, wouldn’t any company naturally diversify or go out of business? Isn’t it corporate welfare to consign American citizens to the mercies of private insurers with no other options? Does that even guarantee any level of competition will exist?
By the time G.W. Bush left the gubernatorial chair of Texas, medicaid payments were so reduced that doctors could not afford to maintain a practice in poorer areas. United States ‘consumers’ were crossing the Mexican border to obtain services from clinics in Mexico. The government failed to meet even the meanest corporate standard of payment for essential services and certainly health care professionals are entitled to a living wage! A definite end to any government challenge to business.
No economic system should be confused with determinations of basic morals and ethics. Canada and European nations don’t classify medicine in the same category as other commodities. For the average commodity such as housing, food and clothing, one budgets according to one’s income. Those who can’t own, rent. Those who can afford to do so choose lobster over tuna. The cost differences between various brands of clothing is quite broad. Consumers choose accordingly but still remain housed, fed and clothed for the most part. Citizens in dire straits however, do receive food, clothing and housing. Why then is medicine assigned a lower rung on the ladder of necessary products and services? National identity is at the heart of this debate, not capitalism and competition. Further erasing the notion of competition being at the heart of this debate – revealing as such a position may be – true competition no longer appears to be part of our major industries. Price fixing is common today, as I recently found when looking at independent and assisted living facilities. Astonished by the notion that a small room in such a facility was deserving of a monthly, $2,100 price tag, even with a meal plan. I was informed by one manager that it was only fair not to undercut the prices of their competition too greatly. The presence of government options with little or no profit margin restores an absolute value to such products and services once more. All we’ve known in recent decades is relative value – the minimum profits agreed upon by trade associations without regard for demand in relation to production costs (varying according to quality).
Price fixing is the purposeful undermining of capitalism in order to restrict ‘fairness’ to corporate entities instead of the consumer. It restricts efforts to promote increased quality among similarly priced services wherever there appears to be sufficient numbers available to feed at the shared trough. Only when the numbers of ‘consumers’ available to take these small rooms in senior communities decreases, can a fall in charges can be expected. These ‘homes’ have many rooms going empty which is not, apparently, a threat to their continued operation. This is not a function of competition but of tacit agreement between corporate entities that one must take every last penny from a consumer’s wallet before declaring one’s profit to be at an acceptable level. Rooms go empty rather than be accorded an actual value which would be within the means of far more consumers and still be profitable for the vendor.
I had a similar experience with used car dealers. None would disclose what a car was worth until they learned of how much money I had to spend – carefully calculated by them according to my income. The worth of the car appeared to change with each successive journey the salesman made into his boss’s office during negotiations. I believe Saturn became a popular car based upon its sales policy of one price for all customers. Imagine that – a product with a singe value accorded to it regardless of consumer income. Comparing that view to that of the salesman in that assisted living facility is the best illustration of how capitalism has mutated into a form of gangster capitalism. When politicians begin expounding about maintaining a ‘free marketplace’, we must remember that the marketplace is never free when profit margins are pre-determined by official or unofficial trade associations. Instead of increasing quality and advancing new technology, vendors band together to break any newcomer so foolish as to actually exceed their level of service quality for the money in a sustainable manner.
Capitalism was supposed to spur the pursuit of excellence in industry. Progress depends upon it instead of solely relying upon tax incentives for industry to embrace new developments as older – and often hazardous – products and services are banned.
We must further go to the nature of our justice system which promises injuries can be redressed. With so much illness either known or suspected to be the result of pollution – a byproduct of industry which is largely ignored by government regulators – how can we permit it to go untreated? How can we wrest the costs from the victims of pollution? We’ve seen lead removed from paint and the outrage over of imported toys possessing that toxic ingredient. We’ve seen anti-smoking legislation reduce cardiac events by one third in participating municipalities. Pollution emanating from many uncontrolled sources is also causing asthma, heart disease, autoimmune disorders and cancers among other disorders. Why is the individual held responsible for their medical treatments when causation goes undeterred? This is an issue of justice as much as it is one of national identity. Are we citizens or consumers? If the elderly are allowed medical care, it is ageism to declare younger citizens to be dispensable in all matters medical.
Obviously, the real enemy is sickness. We have consistently failed to meet it on the honorable battlefield of medicine because – that’s right – we left the field of battle to lobbyists and their corporate sponsors telling dying people that it is better to be dead than participate in ‘socialist’ medicine. What, pray tell, should we do when reaching retirement age? Commit hara-kiri rather than accept evil, government-sponsored Medicare?
We know that voters began demanding universal health care, preferring a single payer option just one year ago, before slogans and tea parties began to frighten the average person into believing they are better off without health care than with an incomplete plan of action – as if any taxes paid towards that effort would ever even approach the charges of the average health care plan in America. That would not be the case if healthy Americans were paying reasonable premiums to, say, Medicare instead of a private insurer where overhead would automatically be greater lest an American CEO be left behind. Paul Krugman gives an excellent synopsis of the insurance game lest anyone remain in denial of how this process works.
Sickness may be the enemy but ignorance and denial leaves us without the weapons to fight it. We are thus far unarmed in a battle which is not about life. It is about ideologies which are counter to both the ideological basis upon which we are governed and to capitalism, our presumed economic system. There isn’t much more you can get wrong in politics.
Once the public realizes that freedom of speech does not ensure accuracy of content, we may begin to take our personal responsibilities more seriously, having fiddled while the District of Columbia burned. But don’t expect treatment at your local ER for your wounds unless you have great insurance. When Massachusetts voters decided that, having attained universal health care for their fellow Bay Staters, the remainder of the country could go without lest any part of that cost devolve upon them, it was clear that Americans no longer wondered about what was to happen the day AFTER tomorrow.
Perhaps the new conservatives they elected will be happy to suspend their health care once their state’s allotments no longer cover their citizens. Pretending you aren’t part of a larger nation is always a mistake. It takes an entire nation, not a village. Villages are razed all around the globe daily by the bullies and their minions- who also don’t think about the day after tomorrow.