Health care reform – like pigs to the slaughter
Modern health care in America has four parties: patients, insurers, drug companies and device manufacturers, and doctors. Congress and the Obama administration made a political calculation in health care reform legislation to appease two of these four parties. Guess who won out?
Simply put, huge industries recognized a once-in-a-generation moment to profit through arbitrary legislation. Drug companies negotiated longer patent protections for a small monetary concession. Expect drug companies such as Genentech to profit handsomely. Insurers used their senate insiders to force young, healthy Americans to buy into a ponzi scheme insurance system. Politicians found a way to avoid real reform and kick the can down the road. Every powerful interest won with health care reform (save, perhaps medical device manufacturers). How could Americans have allowed the most rapacious members of society to steal their future savings over such an important issue?
The answer has everything to do with the fundamental structure of our political system. While America has a representative democracy, politicians must only answer to their constituency once every election cycle. Politicians recognize less than 50% of the population actually votes and 60% of voters already have a political affiliation. Simply put, elections are designed to gain the votes of 20% of the nation’s population. Whichever party wins over half of the up-for-grabs voters wins. These undecided voters cast their vote based on hot-button issues – abortion, gun control, race, gay rights – instead of more immediate economic concerns. Politicians know that come election time, they can alway polarize the public over a single issue. They just need the big donors to contribute so they can fill the airwaves.
These powerful campaign contributors are the real rulers of America. These board of directors and CEOs of major corporations shape and write legislation. These corporate overlords answer to no one. How else could the CEO of Bank of America have helped push the entire US economy to the brink of collapse and still almost held on to his job?
So, backroom deals with the heads of major organizations rubberstamped this health care bill through Congress. The American Medical Association, a state sponsored monopoly, sided with the administration over the vocal opposition of its ever dwindling members. How can the public believe in an agency which represents less than 17% of physicians and whose membership is significantly padded by medical students and residents? Likewise, the AARP endorsed health care legislation despite the possibility of signficant cuts to Medicare. AARP membership stands at 40 million. Why would almost 15% of America’s population volunteer to have their benefits cut?
The greatest surprise with health care legislation is how so many Americans blindly placed their faith in a corrupt government. The whole scene is all too reminiscent of pigs to the slaughter. They do not have to be prodded or forced to violate their self interest. Instead, they go willingly. Some push and shove their way to the front. Others run to catch up. But they all go along in the end.
In its current form, there is one significant fiscal benefit to the pending healthcare legislation. By introducing the principle of universal coverage into the national debate, cost control will instantly become a central concern of the US government. Despite the complaints of the right-wing, cost control already exists. It just happens to be asymmetric. The rich, obviously, face to little to no cost control on their healthcare. Unfortunately, middle class and working class individuals are used to hearing that their health insurance has denied them coverage for one test or a particular doctor. In the hospitals, the situation gets worse. Some patients find out that they were treated at an out-of-network hospital a little too late when they get their bill (this can occur even if the patient is brought unconscious to the ER by ambulance, with no say in the matter).
So, as the cost explosion in American medicine continues unabated, companies drop coverage, or fewer things are covered. Despite the fact that the taxpayer is on the hook for numerous parts of the healthcare system (federal employees, Medicare, Medicaid, etc.), the taxpayer has to pay more for a variety of healthcare services as prices rise. The taxpayer, though, has little to no say on prices more generally.
By making healthcare an issue for public debate, cost becomes much more important. The proposed insurance exchanges and public subsidies, and even continued employer-sponsored health insurance, depends on affordability. The cost of healthcare services affects that afforability directly, as does the overall effectiveness of various medical interventions. The naysayers may want to focus on what is wrong with the Democratic bills, but the current system is a fiscal mess, without any potential for cost control beyond slowly worsening coverage.
At the very least, by establishing the principle that we are all in this together, we have more of a chance to address the cost and the effectiveness of modern medicine than we have had up until now.
I would not want to pretend that the healthcare bills will fix all of our ills. They won’t, but they might make the day when we finally address cost come that much sooner, which is actually to our, and our children’s, benefit…