Why Health Cares For Profits Not

Before inventing the Nobel Prize in economy, economists should have consulted philosophers to find out what the subject was all about.

Democracy is not just about one man one vote, it is also about democratic institutions. The later not only turn around some limitations of the plain voting of the uneducated masses, but also allow to go where the profit motive cannot reach.

The medical system is a self regulating democratic institution in France. This is the real secret of its all around performance.

The medical system in the USA is not so much a democratic institution, as it is a plutocratic plot. It goes without saying that democratic institutions are pillars of democracy, whereas plots undermine them.

The way out of the USA health quagmire is to out-compete the profiteers by confronting them to health as a democratic institution (similar to the US DOD, which is the institution in charge of defense).

Studying the French health care system, which succeeds to be endowed with all the qualities of the system in the USA, plus much more, should help.

WHY HEALTH CARES FOR PROFITS NOT.
July 28, 2009 by Patrice Ayme

ECONOMY IS NO PLUTONOMY.

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[Disclaimer: although having always been covered permanently, with "excellent" private health insurance in the USA, the author prefers to use, whenever possible, the French system, paying out of pocket - French health care is that much better! So the author is in a good position to debunk the cynical propaganda of health care profiteers who exploit the American people.]

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BETTER TO BE RICH AND STUPID RATHER THAN POOR AND RIGHT, SAY THE CYNICS ( = DOGS, in Greek).

Politically, it has long been fashionable in the USA to speak of "progressives" and conservatives". But it is not clear what, if anything, the American "conservatives" conserve, and the "progressives" have not been progressing. That is probably why new distinctions are in order, namely between those who are pro-plutocrats, and will say whatever, however stupid, to help the hyper rich they serve, or are, and those who are not paid to be stupid (Clearly Obama has been toying with these notions).

As Paul Krugman puts it in his blog (July 25, 2009, "Why markets can’t cure healthcare.") "There are no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence."

The reason is simple: for health care you need insurance (because costs are enormous for only a haphazard few). But, if insurance and "care" are private, the sick represents a "loss" so private insurance and "care" will "basically spend a lot of money on socially destructive activities" (Krugman). This is nevertheless the conceptual foundation of for-profits health insurance and Health Maintenance Organizations. As the Nixon tapes demonstrate, the day before Nixon created the contemporary health care system in the USA, with presidential fiat, and tax dollars, Nixon confessed the system would rest on gouging the Public.

(Paradoxically, the attack against private health insurance, as we will see, needs to be nuanced: private French health insurance companies are doing great, but precisely because they do not insure basic, primary health care, which is taken care of by a different system .)

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SMITH OUGHT TO HAVE LEARNED MORE THAN FRENCH:

Fundamentally, economy literally means housemanagement . The word, and the idea, came from Greek philosophers, not from people who can make up an equation or two. Because normal people do not understand differential equations, it is easy to blow them out of their minds by throwing equations in their faces. But, more important than the equations are the idea behind the equations. Equations without ideas, that’s called irrelevant math, it should not be called housemanagement.

Another thing economics is not, is profitmanagement (a loose translation of this is plutonomy, dear to plutocrats, and their banker valets: they used to celebrate it).

Adam Smith, having apparently confused his mastery of French with a mastery of economics, grabbed the word "laissez faire" from the French self christened "Economistes", and thought that this "invisible hand" had solved housemanagement, for the better. Adam Smith did not invent the theory of the "invisible hand", either, it was written down before Smith was born (by Mandeville who subtitled his famous Fable of the Bees, with: "Private Vices Public Benefits" –this striking formulation pretty much extols the naivety of it all).

Well, "laissez faire" and invisibility of manipulators do not provide necessarily with the best housemanagement. Every country that has established a government insured health care system has long known that.

Dr. Krugman said that knowledge is inside a paper of Dr. Arrow. But such knowledge was in European country wide practice before Dr. Arrow, the American, was born. It’s not because a bushman learns to write that he invented writing, however good it feels. As Reagan put it:"An economist is someone who, on being shown that something works in practice, wonders if it would work in theory." (When it does they give each others’ the "Nobel" prize.)

There is a more general economic principle that ought to be at work here. Handsome profits to some individuals do not necessarily add up to an overall profit to society. It is a grievous mistake to believe it does. To push it to the extreme: some murderers profit from murder, but society rarely does. The "invisible hand" (a theory written down before Smith was born) can easily turn into the "black hand" (a deadly terrorist organization of a century ago).

This philosophically grotesque mistake, "Private Vices Public Benefits", is nevertheless the pillar of American free market theorists. Why? Because those theorists find it neither grotesque, nor a mistake. This is something Europeans overlook about the American intellectual tradition: what looks sometimes naive and waddling, is often a cover-up for very sophisticated plutocratic or imperial exploitation schemes.

"Laissez faire" invasions of Indian lands and the "invisible hand" of plutocrats supporting dictators (most famous example: the crucial support of many American business leaders for Hitler), worked just fine, thank you. Fine as far as spreading the influence of the strange government in Washington is concerned.

One should not forget that the most prominent underlying reason for American Independence was probably not a problem in Boston with the tea, but rather the English desire to prevent the Colonists to go West and South to steal Indian lands.

Jefferson, for all his lofty rhetoric, was a bloody partisan of civilization, not to say plutocracy, or slavery, and, when he was president, gave the native owners of the land no quarters, starting a tradition of successful plunder unequalled by any other European colony (although Russia conquered Siberia the rough way, Siberia was much more empty than North America, once the Tatars were out of the way; there is a difference in how much the government got bloody hands).  

Ever since American theory has been partial to "laissez faire" and "invisible hands". But now the situation has changed, as the "American frontier" has met the frontiers of well established nations (and the Moon’s hostile dust).

It should become an axiom of house management  that profits that are systematically not profitable to the overall society should be made unlawful.

That would generalize the reasoning about crime to a more abstract level, on a secular basis, (this secular, hence more sturdy, basis is by opposition to those who believe, like Collins, the NIH nominee, that "moral law" is based on superstition, and otherwise does not exist, the moral calculus error that led the Catholic Hitler in the usual Catholic rage against the Jew).

A good example of this would be Goldman Sachs: "what is good for Goldman Sachs is bad for America", Paul Krugman observed. That badness for America ought to be good enough to outlaw the sort of trading Goldman Sachs engages in. Cocaine is bad for health, so it is outlawed, so why not outlawing Goldman Sacks? What does this sort of "firm" do besides diverting precious capital to high frequency trading sheltered by well rewarded politicians? Diverting so much precious capital allows this Gold Man to sack Americans, diverting jobs overseas where the invisible hands hid them in places so polluted that, invisible or not, nothing can be seen.  

The truth is that the house, in "housemanagement", is now the civilization itself. To manage civilization, in the first order, profits are completely irrelevant. Profits are there to motivate children, or marginal activities. The core of civilization does not use the profit motive, but higher pursuits.

Civilization is a concentration of intelligence sustainable if and only if it achieves an energy balance providing it with enough food, water, and appropriate shelter, while keeping enemies at bay. It is not made by the stupid, for the stupid. It is made by the intelligent, for the intelligent. It is not made for profits, or even with money, in its first order approximation.

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WHY DON’T BLUE DOGS SELL THE DEPARTMENT OF DEFENSE?

"Blue dogs" used to call themselves yellow. There was a philosophical school in Greece that said that man was not much better than a dog. Now a large part of the democratic party defines itself in this literally cynical way. By itself, this says a lot. How do you argue with the self glorified lowest of the low?

That the core of civilization is psychologically motivated by higher ideals is in particular why the plutocrats do not completely run the Defense Department (they try to profit from it, but so do we all). Defense is mostly run by the government of the civilization itself, in a public manner. There are no DMOs (Defense Maintenance Organizations). Defense is not a question of free market and lowest bid ("My name is Buffet, "friend" of president, and I have a strategic nuclear submarine made in China to sell to you, capable of eradicating dozens of millions of people with its cheap Pakistani crew, please profit from this cheaper deal, free market does best.")

If the so called "Blue Dog democrats" want so badly that the USA go to the dogs, I recommend, indeed, the total free market approach for defense, as they already do for health. (Bush-Cheney tried this with Halliburton, Black Water, etc...) After all, waiting for all Americans to die of natural diseases from the breakdown of their health care system may take too long...

OK, let’s leave the dog house. That profits are not the best guide is why there should be no giant HMO system to the exclusive extent they are developed now. Health is too serious a subject to be left to profit alone. In a way, it’s similar to the bank profit scheme.

To keep bankers honest, and profitable to the economy at large, they will have to be carefully watched over by civilizational governance. Bankers have a fiduciary duty, and ought to be treated as officers of the republic, subject to a fiercer ontology ("do not harm civilization" by wanton self interested use of capital"). Doctors are already submitted to the Hippocratic oath, but profits interfere with it.

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FRENCH HEALTH CARE: AN INSTITUTION SELF ORGANIZED AROUND THE HEALTH MOTIVE:

Let’s be reminded that slavery, and racial slavery at that, started as a "free market" in the USA. That the plutocrat is free to enslave others and profit from them does not necessarily advance overall freedom.

Just as it would be grotesque to have the "free market" rule defense exclusively, it ought be the same for health care.

In a country such as France, the health care system behaves as a tightly self regulated beast. It is like a giant hospital system functioning as one unit. It uses one computerized "Vital Card", that has all the medical information of the patient, produced and modified with each medical act (such as purchasing prescribed medications in a pharmacy). Doctors cross refer and consult each other on a casual basis, so any patient is never far removed from any specialist.

It is a misrepresentation to believe that the elected French government directly rules the medical system. It does not. Instead, the set of all administrators, doctors, nurses, researchers, technicians, midwives, "aides soignants", hospitals, cliniques, University Hospital Centers, research health institutes, etc... have constituted themselves in a giant democratic institution, which is both highly consultative and hierarchical. That institution has studied nearly all imaginable solutions, and presents "protocols" for nearly all situations, that careful dedicated research has established. Those "protocols" are recommendations that lower level practitioners find handy to follow because they are the best (and they provide legal and administrative coverage).

In France, the financing of health is also nearly independent of the government (although it runs a deficit that the Federal government has to bridge). Aside from being in possession of an intrinsic efficiency advantage, because of the absence of the exaggerated motive since its compensation is determined from its interaction with the public (which agrees what it should be), the Public system has its enormous mass to handle pharmaceutical companies (which have to spend all their persuasion not on marketing products to consumers, but to negotiate with the appropriate committees in the medical system which decides on drug approval and reimbursement schedules).

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FIRST ORDER: PUBLIC. SECOND ORDER: PRIVATE.

Can the profit motive co-exist with public health care? Yes. But it should be the junior partner, because only the massive structure of Public Health can provide with the protocols. In France, most doctors are in private practice (although the latter is smoothly integrated in health as a democratic institution).

Why do we want the profit motive in health care? Because, private enterprise, made by definition of small groups, can innovate by trying some breakthrough treatments or methods that the massive Public system will be less capable of, per its mass.

In France, nine out of ten citizens have supplementary PRIVATE health insurance, because they prefer their health care gold plated, beyond the basic universal generalized health care guaranteed by the French constitution. So, paradoxically, and contrarily to legend, much more French citizens have private health insurance than Americans do! This demonstrates that the argument that a Public health plan would terminate private plans is completely erroneous. It would terminate abuse, that’s different.

An argument has been made by ex-Senator Frist (a heart transplant surgeon): Canadians do not do medical research, so their health care system is cheaper, because it is parasitic, while American heroes do all the research, that the Canadians use for free. I do not know the Canadian system enough to have a firm opinion, one way or another (although there seems to be medical research in Quebec, from what I saw on Quebec TV). Frist’s argument seems suspiciously close to the usual chest thumping found in forest gorillas (Canada has also only 33 million citizens, in 2009).

This is a variant of the argument that pharmaceutical companies ought to sell their products at high prices in the USA, because they do all the research. That may have been  true 25 years ago, but now, in the USA, most of their disposable capital of "big pharma" is spent on marketing, and financial maneuvers (as proven by the dearth of new drugs).

That argument, that American health care ought to be rich, because it does all the research, is obviously not true for France, where medical research is first class, from discovering tissue groups (the He-La system) in the 1950s (allowing transplants) to discovering electronic stimulation to cure neurological diseases (Parkinson, etc...) and making the first artificial spinal disks, or the first hands, arms and face grafts, more recently.

Paradoxically, the very gigantism, and careful institutionalized power of the titanesque health system in France allows it to be much bolder than the American health care private mess.

To start with, because everybody knows that the primary motive of the entire French system is health, everybody trusts it to a degree inconceivable in the USA (law suits are nearly unknown in French health care).

The French doctors who did the first chancy grafts (hands, arms, face) in France could do them because they were not afraid to be sued in case something went badly wrong (those grafts were not necessary to extend life, while being more prone to rejection because of more immunological reactions caused by skin and harder to do because of the necessity of fine neural growth; because of the nature of anti rejection drugs, transplants are always dangerous; the French doctors found new methods to lower the immune response, independently of drugs, thus making these elective grafts possible) .

Why is French health care bolder? Because it has the entire French medical establishment and hierarchy behind it, in a carefully considered hierarchical pyramid (no credible doctor can have been found second guessing the crack medical teams backed up by the highest medical authorities’ top committees, for the good and simple reason that they are all in it). The entire French medical hierarchy had studied thoroughly, and then allowed cautiously, the medical experimentation that happen inside the "systeme de sante’". No judge would ever find anything against them: the judicial system in France is another democratic institution, similar to the medical establishment, with ultimate seriousness, professionalism, independence, self regulation, and pride (most of the time!). Those huge beasts respect each others... Besides to sue the Public health system would not be appreciated by the public: best to fix it direct.

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NIXON’S GREATEST SHAME IS NOW PLUTOCRACY’S LINE IN THE SAND:

So, to fix health care one needs the rock, the ground, of a Public Health system first. It is an insurance to the doctor themselves, and a cognitive source (from those carefully pre-established protocols). It also allows to transfer patients and teams quickly . Health, in first approximation, ought to be Public health. The USA, thanks to Richard Nixon, has a, your-money-or-your-life, or at least, your-life-or-your-house, profit jungle where health is compromised.

Watergate was bad, truly a shame, but what Nixon did to health care was far worse. (No wonder it is now defended by dogs, apparently turning blue from lack of thinking).

To transit from this unhealthy jungle to the solid ground of Public health care can only be done by beefing up the existing Public system enough so that a groundswell of support can carry it even further in the future.

But the plutocrats know that if they lose that one, and health cannot stay the tremendous source of astronomical profits it is for them right now. Soon banking, high frequency trading, and even higher education would follow (higher education enables the rest of the machinery through networks of all sorts).

Should this malignancy of encroaching civilization occur, and devour the stupendous profit machine, the USA would become a bigger version of France. A common populace with an attitude could not be far behind.

The hyper rich Americans hate this perspective: next thing they know, the French and American governments , all too happy together, would plot, hand in hand, to take away their tax heavens.

Plutocrats would have to flee to Putin’s Russia. But alas, that crafty one has already bought himself a 30 room multi heliports chateau in the Saint Tropez area, ha! Thus, if all plutocrats’ roads lead to France,  it’s understandable hyper rich Americans want to keep it that way, enjoying the human fulfillment of France’s Cote d’Azur for themselves any time they please. If the USA became too similar to France, American plutocrats would not feel as special anymore. Ah, what a cruelty it would be, what a lessening of the American spirit!

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Patrice Ayme

http://patriceayme.wordpress.com

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P/S: In a related scandal, the CFTC (Commodity Futures Trade Commission) has just discovered that, as I alleged, and contrarily to what Paul Krugman claimed, speculators caused the oil price spike in 2008. It was the "laissez faire" and the "invisible hand" at their best. To argue otherwise was, as Obama would dare put it, stupid. Same problem with health. Talking without knowing is as if walking without standing.