We, the collective we, the national we, the “we”‘ we call America, we have the health care system we want. Our health care industry is a product of our society. It is a reflection of us. If the industry were imposed on us by some dictator then we might have a defense. But as a democracy we believe we have some influence over social outcomes. I’m not being sarcastic. Honestly, look at the situation. If we accept the premise that we are a democracy with the ability to control outcomes, it’s only logical – it is the way we want it.
And what is the outcome. While it’s difficult to firmly nail down certain specifics, some national level statistics are frequently used to compare nations. What we know is we spend the most on health care, about 17% of our Gross Domestic Product compared to 10% and 11% or less in every other nation. But we get the least, covering only about 80% of our population compared to 100% coverage provided through national health care systems.
One recent fact that continues to amaze me is in France pharmaceuticals are free, free. Yet Americans, while paying the highest prices in the world, consume more drugs on a per capita basis than the French. Could the fact that, in America, drug companies are allowed to market directly to the public, but European countries prohibit the mass advertising of pharmaceuticals, have anything to do with it? Yet remember, we, through our government, made a choice to enable drug companies to marginalize doctors by appealing directly to the “consumer.’ (Emphasis on shift from patient to consumer).
Another detail, a Harvard study released a few months ago concluded that the overhead rate for the health care industry averaged 33%. Meaning, that 33% of the cost of delivering medical services is for non-medical or administrative expenses. During Hillary Clinton’s health care reform attempt in 1993 one report identified that figure as 38%. So we’re getting better. Still any self respecting capitalistic enterprise would be shamed by a 33% overhead. Public schools, with all their political issues, run around 9 or 10%. Simply put, it means that, even by capitalistic measures, our health care industry is a very inefficient operation. But wait, overall, how does it perform. Perhaps the 20% without access to health care really don’t need it. So, overall, are we healthy, as a nation, than other nations? Not really. The United States has the highest infant mortality rate among first world nations. A few years ago we compared a little behind Cuba. And life expectancy? At 77 we have the lowest life expectancy among first world nations. Japan is tops reaching almost 81. In America’s defense it could be pointed out that a high infant mortality rate will lower the life expectancy statistics. A statistical anomaly.
Before going any further, I need to acknowledge that health care, medicine, is not quite like any other consumable commodity. Health is life and death, function or dysfunction. We have developed the ability to heal many things. To have that ability and withhold it speaks volumes about the morality of the society that follows such principles. And we Americans have done just that, formed an industry designed to withhold service to maximize profits. Profit motive meets cost control. ‘Managed’ health care places a value on ‘cost management’. It is the foundation of the denial of service. Morally repugnant true, but it’s a morality formed by the consensus of Americans. By deduction, most of us, more or less agree that we think greed is good, even from our doctor. And I’m sure many of these same people would get 3 bids and select the low bid brain surgeon. You think so?
There are some of us, me included, that don’t agree that greed is good. We don’t believe health care systems should be designed so some may profit from the misery of others. We don’t believe people are just another exchangeable commodity. We do believe in the value of honoring a social contract that we will help each other, as best we can. You scratch my back I’ll scratch yours works. But we who believe this must be in the minority because our point of view is not the prevailing point of view.
Vincent Navarro, in a recent Counterpunch piece (3/6/08), recounts a long history of failed attempts to change the health care industry in this country. He takes on the question of why this miserable situation persists. In a nutshell, big money drug companies buy politicians and corrupt the process. I can see this situation occurring briefly until revealed, but persisting for decades suggests something more. I believe the answer lies within the structure and values of our society.
We are a highly individualized society. Politically we favor the right to ignore our neighbor. Competition is in, cooperation is out. The consumer focused economy with all of its attributes has successfully infiltrated even the most human, most personal areas. Medicine and health are now just another consumable, another widget with the moral importance of a spoon. The anti-government, anti-public systems ideology has decimated our infrastructure, our roads, sewers and similar public systems. Health care is one of those victims. But to suggest that by simply changing the President and Congress we Americans will suddenly accept a nationalized health system ignores the reasons why earlier efforts failed.
In his piece Vincent Navarro provides an example of how a single payer system was created in the Canadian province of Saskatchewan in the 1960’s. Canadians as a rule have a greater sense of collective identity than Americans. And the cold northern isolated plains enhances that sense of cooperation. People know from experience that life is better through working together, helping one another. A cooperative health system seems very consistent with the points of view you might find in Saskatchewan. But across all of America?
You will find greater degrees of solidarity in certain regions of America; New England, Minnesota, Texans, the Mormons of Utah, the liberals of San Francisco. But America in total is a large and diverse place. For decades attempts have been made to establish a national health care system. The level of social cohesion in America has proven to be insufficient to support an overt system of cooperation. No doubt too socialistic, ideologically speaking.
Failure to recognize the limits of our thin veneer of social identity is not without consequences. By most measures the health care situation has worsened in the last 15 years since Hillary’s effort in 1993. California greeted the 21st century by closing 64 hospitals in 5 years while our population grew by over 3 million. Now wait, hold that thought. Why is it worse?
In a word, globalization or global capitalism. I know, it’s complicated, but the effects of globalization have forced open a number of weaknesses. There are many in America who believes in globalization, promoters of free trade among them. If we, America, are going to compete on the global market, we America need to be at least equally efficient and effective as our competitors. Basic Capitalism 101. We spend 17% of GDP and cover 80% of our population, with a high infant mortality rate and low life expectancy.. We need to reduce the cost impact on the GDP to around 11% while expanding coverage to 100%. In my humble estimation, not one of the candidates has a proposal that even begins to take on this challenge.
So what can we do? The lack of national social cohesion, the seriously entrenched moneyed interests, and our political process, for these reasons I believe the proposals from the candidates will not succeed. We need to move the solutions closer to home, closer to our regional identities. We also need to accept that there’s no one perfect solution. There are a number of models to choose from. All work to some degree or another. In a democracy it should be up to the people. If most of the people believe more taxes for health will help provide the quality of life they want, then so be it.
Considering these facts, if Congress wants to move forward on working toward a solution to this vexing problem, Congress should pass laws giving the states both the rights and responsibilities. The money currently spent by the federal government supporting health care should be turned into block grants and given to the states, with the only string being it must be for health. Let the people of each state decide how they want to solve the problem. Some states may choose a health system modeled after France; others may go the other direction. Some may embrace the profit motive and default everything to insurance companies; some may choose to eliminate all for profit health care and insurance companies. Some states will be more efficient than others. These states can become models, an example the others can follow. Like Vincent Navarro’s example of Saskatchewan, start on a local level and grow from there.
The social crisis of the 30’s gave us Social Security. What crisis will be sufficient today to get people to bury their differences and agree on a national system?