In the heat of the health care debate, a friend of mine, who knows nothing about blogging, asked me to post this essay for him. It's excellent, and was recently printed in a little local paper called the Kaweah Commonwealth, nestled in the heart of CA wingnut country.
tarantula
Like a massive flood that sweeps away everything loose on the surface, the debate over health care reform is exposing the major fault line in the philosophical bedrock of American society: What things should government do, and what things should it avoid?
That’s the debate within the debate. Progressives argue that access to health care is a basic human right and that government should make it available at a reasonable cost to those who can't afford it—the social responsibility argument. Conservatives argue that health care access is a personal responsibility, not the responsibility of government. Neither side is likely to change its position anytime soon.
I'd like to take a different approach. For me, the central issue is whether we would be better off individually, better off as a nation with the existing health care system, or whether we'd be better off with a reformed one. Approached from this angle, health care reform ceases to be a moral issue and becomes a question of infrastructure.
Why infrastructure? Because it is infrastructure that liberates a nation to realize its full potential. In the 19th Century, massive investment in canals, turnpikes and railroads made it possible for food grown in the Midwest to get to markets in the east, and for manufactured goods made in the east to get to the Midwest. In the 20th Century, even larger investments in the electrical grid, the air traffic control system, the interstate highways and the telephone network united America from coast to coast and propelled us into a position of global leadership. Without these infrastructure investments, all carried out by government, America would likely have remained a loose cluster of underperforming regional economies with very poor prospects for defending ourselves during World War Two.
But physical infrastructure is only half the story. The other half is social infrastructure. Social infrastructure includes the less tangible but equally important services that provide the security and the resources that permit Americans to pursue our individual dreams. Many believe this liberation of individual energy is the real engine of America. Education, defense, the postal service, the financial system, police and fire, and now the internet—these are part of national infrastructure, too. These are just as important as bridges and airports. Universal healthcare needs a place here, too.
Our current health care system retards us as a nation and creates enormous disadvantages for millions of Americans. Everyone is affected. The cost of providing medical care to the uninsured, right now, increases our health insurance premiums by over $1000 per person per year, as hospitals, laboratories and clinics increase their fees to those who can pay to compensate for those who can't. If you receive health benefits from an employer, this means your employer is paying $1000 toward premiums they could be paying to you as salary.
According to a recent Price, Waterhouse, Coopers audit of the healthcare system, poor management, operational gaps, sloppy medical records, duplicated testing and unnecessary surgeries waste as much as $1,200,000,000,000 ($1.2 trillion) every year, about half of our total annual expenditures on health care. American corporations, who spend nearly $10,000 per year per employee to provide them health coverage, suffer a real cost disadvantage when they bid for contracts against European or Asian competitors. Economists from the right and the left are nearly unanimous that our current health care system reduces American productivity and has a significant negative effect on our Gross Domestic Product.
Worse, health care costs (waste included) are expected to continue rising by 8% to 10% annually, a ticking time bomb that’s going to explode in the not distant future.
It's tempting in a free society to believe that the free market will compel the medical industry to heal itself. History suggests it won't. Left on their own, private utility companies were never going to electrify rural America. Quite simply, it cost too much with too little apparent return on the investment. Rural electrification occurred for one reason and one reason only: the federal government made it happen. Similarly, the medical industry has had decades to improve the way it delivers health services, yet things are getting worse. Health insurers routinely deny necessary care, kick people out of the system, stonewall sending qualified payments to doctors and clinics. Corporations have declared they would like to raise individual co-pay for premiums to 25% or higher.
Of the three main strategies for insurance reform—non-profit cooperative, public option or single payer—I favor the public option, although with negotiated, not dictated, fees. Here’s why. The non-profit insurance cooperative is an attempt to reform the system from the veneer; it may succeed in negotiating lower premiums for insurance but it will preserve the current system’s waste because it can do nothing to alter the way health services are delivered. The single payer system would eliminate choice; many people who can afford higher level insurance coverage should have the option to purchase it. The public option has the advantage of keeping private options in the mix yet would give its administrators the leverage to reform the system from the bottom up. The medical industry would remain profitable, encouraging research and development of new instrumentation and equipment, new diagnostics, new procedures.
If we believe that efficient universal health care is an essential part of our national infrastructure, and that individuals and the nation will benefit from it, then it has to be done and government has to do it. The debate over how to accomplish it and at what cost is perfectly valid. We have to remember, however, that when we were electrifying rural America it seemed that investment would never pay off, ever. But it did—many, many times over—by liberating millions of Americans to learn, to invent and to produce. Government sponsored health care reform will yield equal or greater benefits to our descendants. And the nation will be stronger for it.