We all know what a perfect solution is; it's the scheme that delivers a completely satisfying result, ties up all loose ends, punishes the guilty, rewards the virtuous and leaves everyone wondering, "Why didn't we think of that before?"
Many people claim that there are no perfect solutions. They are wrong. There are lots of them. The problem is that in real life one cannot easily overcome the inertia of institutionalized perversity that blocks implementation of the obvious right choice. Perfect solutions rarely come to fruition in real life, but they abound in literature. Novels with happy endings were the rule in earlier times, but the most prevalent manifestation in modern fiction is what I like to call the perfect movie. I love perfect movies.
These are often cited as someone's favorite film because of the gratifying resolution that allows the viewer to leave the theater smugly satisfied, with a warm, fuzzy feeling all over. Napoleon Dynamite comes to mind as a recent example, but I recall the Alec Guinness classic The Ladykillers as the first movie I fingered as typifying the genre. There are lots of movies with happy endings, but a perfect movie can only be one where all the loose ends are tied up in a neat bow and everyone gets exactly what they deserve. There are no ambiguities, morally unsatisfying consequences or ominous portents to provide grist for a sequel. At the end, it's all said and done and you know that it could not have concluded in any other manner and still engendered as good a feeling in the viewer's mind. By this standard, a James Bond movie is never a perfect one because the evil organization or villain survives at the end to bedevil 007 another day, but Pulp Fiction or Kill Bill (both parts together) arguably are because, well, everybody's either dead or satisfied. Being perfect doesn't necessarily mean nice, compassionate or humane. Perfection in concept means that it works very, very well, and one might hope, optimally.
This is why we turn away from politics and toward fiction to find clean, simple solutions to complex problems. This is why the best answer to the health care crisis in the United States of America is not something that is hammered out in a Congressional committee or the board rooms of corporations, but a serious Gedankenexperiment in social policy. You have to visualize the optimal, desired result first, formulate a practical strategy to achieve that end and then put the plan into action. Yes, it is wishful thinking, but with a worthwhile purpose. We know that what we want can be achieved because many other nations, arguably all the developed ones except this one, have succeeded. They have universal health care and we do not. One might think that getting health care for the people would be easy to do, a classic "no brainer". We thought that electing a President and enough senators and members of Congress who are right-thinking would get the job done, but we were wrong. Clearly, the first session of the 111th United States Congress has been something of a bust for advocates of universal health care. It's time to put on our thinking caps and dream some more before flailing away again in futile agony. We can't waste our time with pie in the sky, though. We have to get serious and fix this thing.
Many perfect movies I have seen achieve their neat conclusions through the efforts of a protagonist who does the right thing at the right time with such consistent regularity that it connotes godlike prescience. It can be dumb luck, as showered upon Bruce Willis's character in Pulp Fiction, or a gradual transformation from being clueless to a mature understanding as experienced by nerd-turned-masterfully-competent-hero Napoleon Dynamite. We all marvel at Miss Marple's innate ability to perceive the essential dynamic that drove an unlikely person to murder, her ingenious forensic methods and her clever ruses to trick the culprit into self-incrimination. Damn, she's good! But, we all end up thinking, "How does she do that?"
Agatha Christie starts with the premise that Marple is a genius, but doesn't tell us much about how to be that smart other than to admonish us to be observant. In one of my favorite perfect movies, Cold Comfort Farm, it's easier to understand how the smart protagonist connects the dots. The heroine arrives on the scene beset by daunting personal challenges. Everyone else is just as messed up as she is, but they don't realize it. They are all grotesquely dysfunctional and abjectly miserable because it's all they have ever known and they can't visualize what it would be like if they had a decent existence, let alone enriching, gratifying lives. I eschew the term "normal" because it connotes a false premise, that the norm is necessarily desirable or good. Sometimes, the norm is horrendous and execrable, but stoically endured because there seems to be no alternative. However, sometimes, an objective outsider can walk in and fix chronic problems quickly and efficiently with a modicum of effort because the answer is simple and obvious, at least to the outsider if not to the general population. This scenario is best illustrated in movies like Cold Comfort Farm where every viewer sees the situation through the eyes of the rational protagonist.
That's enough inane chatter to weed out the slight of intellect, the blindly self-righteous and those inured to the charms of language. Those of you who are still with me like to think and don't mind going deep. The little wheels are already going around in your head and you're chuckling to yourself, "Oh! That's his angle! He's saying that people don't know what's good for them." Well, yes, it is, and no, they don't. On Cold Comfort Farm, the protagonist, played by Kate Beckinsale, assesses the emotional and social deficiencies of her relatives and then methodically fixes their lives, one by one, culminating in finding happiness for herself by choosing a mate, a man whose life is made happy and put on track by being paired with her. Things are set right. We know that her solutions are correct because they are obvious. Unkempt, alienated misfits are cleaned up and socialized. The hardhearted are humanized. The lonely find love, of course. It all makes sense.
Got it yet? Americans are agonizing over what to do about health care because they don't know any better. Corporate apologists have worked their dim-witted dupes into a lather about "preserving capitalism and free enterprise" in a sector of the economy that has no business being conducted for profit. Disingenuous sociopaths have been allowed to ramble on and clutter the public's attention with fake issues, like hysterical fantasies about death panels and limiting the right of injured people to sue incompetent and negligent doctors for damages. They act as if addressing these fake issues would in any way diminish the pain and agony visited upon the population by greedy corporations. Everyone on Capitol Hill is all balled up in how to subsidize private health insurance companies instead of figuring out how to deliver health care in spite of the efforts by those same insurance companies to thwart that effort. Like the farm's residents, we're fretting about things that don't matter at all and ignoring the simple, clean solution.
I'm not going to reiterate my usual catalog of particulars taken from the European and Canadian models to make my case this time. Let's try something different. Let's imagine the final objective, and then work backwards from that, through the implementation, all the way back to where we are now. In other words, how do we get to our Utopian paradise from the current state of chaos and institutionalized misery, where the quality of health care received depends solely on the amount of money one has. Rich people get excellent care; poor people get almost no care.
Ooops. I started ranting about what's wrong with the current system again instead of following my own prescription of visualizing the desirable result. OK. Here we go.
In a perfect society, you and health care providers discuss and decide on courses of treatment to meet your needs. You don't discuss the costs or what kind of insurance you have. You just get treated. The providers get paid and have equally happy, secure lives.
Uh-oh. That sounds like what they have had in Scandinavia for several decades. It was a lot like that for Germans in the mid 1970's when I was serving there in the U.S. Army. It has not changed much since then. It's pretty much the same for Canadians. That last link is an ordinary Canadian, just a regular guy, who speaks frankly about what he has experienced as a user of health care services in his country.
I'm aware that most people will skip reading Wikipedia articles because they think that's old news and the there is nothing to learn there. Don't do that. Let me direct your attention to the detailed description of the financing of the Finnish system. If you read that short segment carefully, you will see that all the pundits running around and waving their arms in panic over the anticipated huge costs of health care reform here are idiots. Finns are well off, but not so rich that we Americans couldn't afford to set up a system like theirs.
The key to what's different here from Finland is that they pay for it with general taxation and user fees. Sure, you have to pay a little when you go in for treatment, but most of the cost is borne by the society at large. It's like -- you know -- an insurance pool. Duh. Notice that there is no mention of health insurance in Finland. They don't have any. That's because it's pointless to inject a third party between health care providers and patients to rake a sizable cut off the top of premium dollars (typically about 30% in the USA) and reduce the amount of care provided by denying payment when it thinks it can get away with it. There is no structural reason to have health care administered by a for-profit entity. Not only is there no way for the third party to improve the health care provided, it's guaranteed to make it worse. At the very least, the bureaucratic overhead of accounting for services given and payments made will be a burden for everyone.
Once you clear your head of the notion that cost is as an obstacle to getting decent health care, you are free to think realistically about delivering it. So, how could we do that? Again, it's kind of obvious. We have more resources for providing health care than any nation on earth. If we give all health care providers leave to provide health care, and pay them, they will. It's what they want to do. Who's stopping them?
It's insurance companies. They tell the providers, "No. Don't treat that person because we will not reimburse you." It's that simple. Health insurance companies are engaged in the business of denial of medical care. It's no coincidence the 70% of premium dollars they dispense to providers for their customers' health care is called the "medical loss ratio". Anything they don't get to keep is a loss, and their objective is to make profits, so the less care provided, the better it is for them. If we do away with health insurance companies, all that will be left is health care providers and patients. We will all manage quite nicely, thank you.
Let's skip to the chase, for good this time. What do we want, then? How about this: Free, universal health care for all! The next time you hear some hysterical dunderhead squeal, "But, but, but..., the cost is prohibitive! How are you going to pay for it all?" just tell them to shut up. We already are paying for it, but at least 30% of the money is being diverted. It's really not an issue because much poorer nations than ours manage quite nicely. As shown in SiCKO, the health care in impoverished Cuba is better than ours, and the proof is that they live longer and have lower infant mortality than we do.
Now that we have the premise that everyone gets the care first, and the first step in the plan is to put health insurance companies out of business, we need a way to do that. Here is where you come in. Remember, it doesn't matter much how we do it, but a viable solution has to completely remove private entities from the health care system. We could just pass legislation and set up a national health service as they did in Great Britain in 1948, but we saw how that went this year. No. It's time to think out of the box now.