On health care reform

I feel like there’s a foundational question that we’re not debating in the midst of the health care overhaul:

Is healthcare something that should be designed to make profit?

If the answer is yes, then the forces of capitalism drive the system to one goal, and one goal only: higher profits for the companies delivering healthcare. These include the insurance companies, HMOs, medical suites, individual doctors, hospitals and any other entity involved in the byzantine American healthcare industry. There is only one way to get higher profits: get more money in, for less money out. This equation explains nicely the current state of American healthcare. We pay more for healthcare than any other nation, and have healthcare benefits that rank 37th in industrialized nations. We are on par with Costa Rica, a nice place to visit, but I wouldn’t want to get sick there. The system, as it is currently designed, is doing precisely what it is designed to do. It is charging more money, and delivering a cheaper product. Any economic system designed to make a profit will inevitably make profit the primary focus. This also explains the financial crisis involving sub-prime mortgages and credit default swaps. But I digress.

What a profit-driven system doesn’t do, has never done, isn’t designed to do, is consider the well-being of individuals above the need for profit. The idea that forcing companies to “compete” for our healthcare dollars will drive down costs and simultaneously provide better care, is ludicrous. Just look at cable television, high-speed internet or cell phone plans. These are highly competitive industries, but I haven’t seen those costs going down. What happens is that companies competing figure out ways to attract customers through advertising, and then lock those customers into long-term commitments. Do we really want to base our healthcare decisions on advertising campaigns designed by profit-driven corporations? Are we naive enough to believe that we’ll be told the truth? Do we want our healthcare plans to come with high-speed mumbo-jumbo disclaimers at the tail-end of advertisements aimed solely at our wallets? Are we customers, or are we individual citizens with an inherent right to good health care?

But anything else is un-American, say the Republicans and Blue Dogs. It’s socialism. Really? Is it socialism to have governments pay for the police and fireman? Or should we hand those jobs over to private industry too? How would we feel about having to sign up with a for-profit fire department, competing with other fire department companies, all designed to pay their workers as little as possible, spend as little as necessary on their equipment, hire as few people as necessary (so the employees work longer hours)? Only the Libertarians and right-wing fringe like that idea. And yet we are led to believe that keeping healthcare profit-driven is “mainstream”. It’s only mainstream because we’ve never known anything else. Slavery was once mainstream too.

Governments, and the people they represent, routinely make the distinction between services which belong in the private sector and services that don’t. This decision usually revolves around the question of whether or not a service is “essential”. Essential services are removed from the private sector because governments know what I stated earlier: profit-driven enterprises never put individual well-being first. That’s why we pay for these essential services with our taxes: they’re essential and we don’t trust private companies to deal with us equally and fairly. They’re not supposed to. They’re supposed to make money, which is a different goal. I believe this is what the healthcare debate should be about: removing healthcare from the private sector or not.

Sure, governments at all levels can be criticized for the inefficiency of the delivery of those essential services. But the solution is not turning those services over to the private sector. The fact that the single-payer option is “off the table” is a sign of conservative Republican victory. The last decade has seen the relentless demonization of government, and the beatification of private industry by the Republican right. We have been brain-washed into believing that whatever the government does, it does poorly. But for the past decade or so, we have had a government in place, on the Federal level at least, deeply cynical about government and invested in the demise of government-run programs.

But guess what? The government is us. That’s what the American Revolution was about. Of the people, by the people, for the people, remember that? And that neatly describes the kind of healthcare I want too: of the people, by the people, for the people. Now I have, of the company, by the company, for the company.

Is anything more essential than healthcare? No. So let’s take our health, our well-being and our lives out of the hands of companies designed to put dollars before people. Let’s hand it back to the people who should be the true custodians of this basic human right: us. Republicans and Blue Dogs like to imply that having the government involved in healthcare takes healthcare “out of your hands”. But in a rhetorical feat Orwell might admire, they have got it exactly backwards. Putting healthcare in the government’s hands puts it back in our hands, because then we can elect the people who will make decisions about our healthcare. When was the last time you had anything to say about the way your healthcare was delivered to you? Can you elect the CEO of your insurance company? Your HMO? Your hospital? If you’re lucky enough to afford healthcare, you’re only choice is the same one you face when buying cable: what’s cheapest? And yet the profits for the companies keep going up. If I have to pay higher taxes in order to live in a country in which every citizen has access to good healthcare, fine. I’d rather see my dollars go there, where cost controls can be enforced, then to the CEO, who spends my dollars on his vacation to Aruba.

Doctors, policemen and firemen belong in the same category: individuals who deliver an essential services too precious and important to be subject to the whims and ulterior motives of the marketplace. Let’s make sure they get paid well for a job well done. And let’s make sure we are the ones paying them.

On healthcare reform, originally published  Wednesday, July 29, 2009