Health Care Soap Box

What blog today would be complete without a health care rant? Clearly, I am a liberal and I support President Obama's intent to make health care in this system more available and affordable for everyone. I have no idea if this bill will do that or not, especially since the details of what the legislation will do seem to have been lost in the vitriolic battle to pass it or not. In any case, my pondering here is less about liberal vs conservative and more about status quo and risk -- possibly inspired by recent book readings.

I see two basic assumptions at work when it comes to running a large system:
1) Government CAN NOT run X, at least not efficiently/effectively/within budget/etc
2) Private business CAN run X, at least better than government/for less money/etc

These are independent assumptions, but often conflated, as in the health care debate. But as with so many false dichotomies in today, they are exactly that: a false dichotomy. Whether or not the government (at whatever level) can or can not run something (e.g., the energy industry, health care, school systems, the military) and how effective it is at that task is an independent assessment from what private industry could or could not do. I was struggling for examples where one or both ran a large, complex national system extremely well, but I couldn't think of one. In any case, saying "government can't run health care" does not imply that "private industry can run health care:" it simply means that that person does not believe government can run it. They are perfectly within their right and the realm of logic to ALSO conclude that private industry would fail at that task.

The health care debate so often seems to invoke the fallacious "Gov't can't do X implies Private Industry can do X" conflation. But why? What evidence supports this implication? I welcome readers to respond with evidence both for and against government and private industries ability to administer health care in this country.

But as I believe most of us can agree that our health care system needs SOME kind of fix, I offer the following to those who think that government is axiomatically incapable of AND THUS private industry is eminently qualified:

To me, as a liberal and naive in many ways to macroeconomic issues, I see this when it comes to health care: by and large, private insurance companies have run the health care system and our access to it for the last many decades. Those decades have seen dramatic rises in premiums, even as the "riskier" customers are expelled from the covered population. Shouldn't the resultant decreased risk LOWER premiums? Why charge ever higher premiums when the overall risk decreases? If the higher premiums do not result from the need to cover higher risk, then what do they cover? Has medical technology become so advanced that the costs have risen that much? Where is the capitalist market to keep those costs down through innovation and competition? If there's no innovation and no competition, what are we paying for? Are doctors being paid that much more? Do the premiums cover a larger population -- and if so, wouldn't the increased population result in more insurance subscribers?

These last many decades have seen America become one of the most obese and unhealthy of industrialized nations, even as our vaunted "health care system" has grown larger and larger. If insurance companies are truly worried about rising costs, why do they not spend more effort in preventing the preventable diseases that account for the bulk of health care spending: diabetes, coronary heart disease, obesity related disorders, nutritional deficiencies, etc? By actually improving nutrition for this country instead of buying into the Monsanto propaganda that corn in all forms is somehow healthy and diverse, you could actually create a population with dramatically fewer incidences of preventable illness. I see no evidence that the "health care" companies are pursuing such a course -- even when it makes obvious and irrefutable sense: a truly healthy population is inherently low risk and requires overall less medical care, thus fewer payouts from insurance companies. The insurers and doctors, by encouraging health instead of treating sickness, would automatically lower risk and reduce their own costs. At that point, they could keep premiums fixed, make more money, and appear better as average salaries increased over time. Unfortunately, there is far more money to be made, at least in the short term, from treating sickness instead of encouraging health. I don't believe these companies are inherently evil -- I just think the next quarterly profit report is more compelling than the benefits of a truly overall healthy population in a decade's time.

This is all really to say this: I don't think private industry is by default the best at running anything it attempts (mortgage industry, anyone? energy industry, anyone?) simply because it's private industry instead of "government". At least with government, there's a semblance of citizen ownership in our ability to choose our representatives. Exactly how much power do I have to choose a CEO, unless I've already lined his pockets by buying stock? I don't believe government will necessarily be any worse at health care than private industry -- and they could be a lot better. At the very least, let's have the honesty to say that the free market has performed poorly in this regards and the courage to try something new. At best -- it's a success and we've done something amazing here. At worst -- the conservatives take back the majority and repeal the entire thing.

If the veil of ignorance was dropped over your (the general "your") eyes and you had no health insurance in a country where adequate care is impossible to obtain without it, would you choose the status quo, guaranteeing you no health insurance, or would you risk a change for a better?

And on a more philosophical note:

There seems to be this notion these days that "government" is the dreaded OTHER, while private industry represents the PEOPLE. That, in fact, has rarely been the case and our country was founded on the principle that government was the PEOPLE. If we have let that principle ebb with the ever increasing flow of profits, then it is time, as with all tides, for a change. We, the people, have a gravity of our own: let us use our political mass wisely, to choose or unchoose representatives who will govern selflessly, who will show us that government can be a force of growth and progression, who will show us that our experiment in democracy has not in fact failed.