What You Should Think About Public Health

“To wish to be well is part of becoming well.”


Many political insiders seem to be expecting a 2008 race in which a Republican and a Democrat both run hard on a theme of “I’m not Bush.” Though a real clash of ideas cannot be ruled out before the contenders are selected, a contest of hollow sloganeering and character assassination may be as likely as the framing of substantive differences between the candidates. This makes the impending primary process all the more important — it may be the high point of the process in terms of focus on actual policy positions.

When it comes to health care reform, there is little serious commentary from the Republican side. Most candidates are happy to shrug at public unrest.  The party faithful are thought to be more upset by the emergence of a new government program than news that no action is being taken to address the issue. There is some rhetoric about the importance of allowing market forces to solve the problem, but at this point in history that can only be interpreted as a denial of facts.  If market forces were a remedy for this particular problem, then how did it become so much more severe during decades of acquiescence to those very forces?

On the other hand, the core of support for the Democratic Party is concerned about the problem.  They are also largely unwilling to believe that medical self-sufficiency is a wise policy when it comes to cancer patients, accident victims, etc. Even talk of a true universal health care policy is not a problem on that side of the mainstream aisle. Yet, for better or for worse, there is a wide range of opinions.

Near the start of this blog I wrote that Senator Barack Obama has gone farther in politics without personally disappointing me than any other modern leader. While I would not go so far as to say that my disappointment with him is deep, it was disheartening to see such a principled figure conceding that his approach to health care reform would be influenced by the agendas of insurance providers and pharmaceutical producers. Perhaps he is being honest where others opt for political spin, but it seems to me both Senator Edwards and Representative Kucinich are sincere in their declarations of intent to implement a truly universal system.

Many Americans continue to define right and wrong strictly in terms of legality or illegality. This is not absolute — most people are some combination of stickler, pragmatist, and outlaw. Yet willingness to drive 10mph over the speed limit or retain the proceeds of a bank error is not at all the same as the vision to support significant political change. While there is a (clearly bankrupt) ideological basis for contending that profit should drive health care outcomes, there is also a natural tendency for people to believe that the way things are is right simply because it is the way things are.

The way things are right now involves a form of legalized racketeering. At the level of major enterprise operations, the insurance industry provides a service by pooling resources so that unfortunate outcomes do not have an economic ripple effect by disabling otherwise sound businesses. At the level of household economics, the insurance industry continues to collect profits while doing less and less to minimize the lasting economic drag caused by unfortunate outcomes. A case can be made that life, home, and even automotive policies still do more good than harm. To make the same case for health insurance requires a willful obliviousness to reality.

In the very best cases, health insurance adds little to the cost of receiving health care even as it promotes regular checkups and other preventative activities. Such best cases are endangered, if not already extinct, in the modern business environment. More typically, health insurance adds tremendous overhead to the cost of receiving health care even as it discourages consumers from making optimal health maintenance decisions. For most who are fully insured, fees associated with responsible screenings and checkups may act as a disincentive to making the best personal choices.

Then there are those many Americans who are less than fully insured. Catastrophic health insurance — low cost plans that only activate in cases of serious injury or severe illness — do even more to deemphasize prevention. For the millions who either lack the funds to obtain insurance or the will to dedicate so much money to the cause, the reckless trend is increased further. The most cold-hearted of analysts may argue that there is some sort of justice in the suffering of those who did not act with ideal forethought to provide for themselves. Yet the entire nation suffers not only for this major waste of human capital but also for the increased medical demand generated by underutilization of preventative capabilities.

“Things as they are” in the health care sector are more problematic still due to the role of private insurers. Estimates vary, but there is no credible dispute that hundreds of billions of dollars are spent each year to maintain vast bureaucracies of these corporate middlemen. Not a dime of that money goes to actually preventing or curing ailments. Resources greater than those required to sustain the war effort in Iraq are consumed simply counting the beans involved in medical commerce. This does wonders for the wallets of executives overseeing this parasitic industry, but very little for the well being of sick or injured Americans.

It is fair to argue that a single government bureaucracy would, in efforts to minimize waste and fraud, require its own bean counters. However, the ridiculous bloat of health maintenance organizations and insurers sucking the lifeblood, both literally and economically, from working Americans is clearly an order of magnitude greater than what would be required to oversee the administration of a health care system in which basic preventative and curative services were provided based on human needs rather than opportunities for profit.

Doing so would not eliminate profit where it continues to serve some useful purpose. In fact, profit incentives would be refocused on areas where real good would follow from their pursuit. Big pharmaceutical companies would no longer be rewarded for producing slight variations on old medicines then stimulating demand for a new brand name product. Yet a shift away from that form of profiteering would merely free up their tremendous resources to pursue much more beneficial endeavors.  Truly helpful products would continue to enjoy widespread demand from truly helpful physicians.

Ultimately the national health care debate comes down to recognizing that fundamental truth — it is the purpose of physicians to be helpful. Any reasonable compromise would still allow for elite clinics where the most gifted physicians could charge a premium for their services. Any reasonable compromise would still allow supplemental insurance plans for wealthy citizens unwilling to mix with “common” Americans in terms of medical commerce. Yet any reasonable compromise also would marginalize one huge service industry that adds no real value at all to the economy.  Any reasonable compromise also would drive another huge industry to restore clear focus to producing value while producing pills.

What America lacks in the realm of health care is not the human resources to improve outcomes nor the economic muscle to get the job done. What America lacks is the political will to cut out the cancer of private health insurance and rehabilitate the system of private pharmaceutical manufacturing. Insofar as we do have the national will to stop spending more to get less, there is a strong force driving us toward those very changes. Success will involve overcoming the tremendous influence two key special interests have on the political process, but surely there is plenty of strength to be found in struggling on behalf of the general interest.

As the Democratic primary season unfolds, so too may unfold the future of American medical commerce. With a range of proposals from modest subsidies to outright socialization of the sector, this is an area of great uncertainty. Still, this much is certain — any comparative analysis of public health reveals that this nation has a serious problem. It also reveals that many other nations have thrived through decades of relying on serious solutions to this same problem. Resistance to any effective course of action really overcome the desire to solve that problem here?


2 Responses to What You Should Think About Public Health

  1. kgraff says:

    Sometimes I wonder if the most humane thing to do would be to negotiate how much blackmail would be acceptable for some of the private interests to withdraw from health care.

  2. Demonweed says:

    It is a tricky situation. If human ethics were perfected (or at least catapulted much advanced of today,) HMO employees would be quick to abandon their posts. Imagine waking up to find yourself a 21st century slaveholder. Parasites of unsalvageably corrupt markets may not be as evidently and profoundly wrong as slave owners, but they are evidently and profoundly wrong. If they were to cease all their current work, society would benefit. If they were to work in some constructive pursuit, society would benefit twice over.

    Then there are the “rugged individualists” and similar unfortunates, their minds vandalized by the most unscrupulous sort of popular pundit. Millions of Americans with a passion for talking about limited government fail to accompany that with any serious interest in learning about the consequences of political choices. Heck, after being attacked by twenty men with boxcutters, the political response predictably led to the slaughter of tens of thousands of innocents abroad and thousands more of our own bravest citizens. Millions of Americans still stridently support continuity of that policy. The best argument for it is nonsensical speculation from “experts” who should have no credibility after their transparently misleading declarations during the rush into that long-lived bloodbath. Yet even the clarity of hindsight is not enough to separate passionately devoted belligerents from dedication to the cause of killing.

    If 2008 is a year of sweeping change, things still will stop long short of ideal reform. Sen. Obama’s health care proposal, in this regard no different from Sen. Clinton’s, does not go beyond regulating the price gouging out of health insurance and subsidizing the industry by way of providing discounts for the poor and free coverage for the indigent. Depending on the details, perhaps in the end insurers will add value to society by chasing the revenue to be had in enrolling the indigent and other citizens on the fringe. Still, it is hard to believe the persistent half-myth about corporations outperforming government would apply to insurers vs. social services. The pragmatic position here is that some payola for professional bloodsuckers will be required in order to liberate the bulk of the nation from the burdens of paying almost equal shares to fund valuable medical care and valueless corporate profiteering.

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