Health Care: The Turning Point

The debate over "healthcare" is a complex one, because the topic is. The problems with the health of Americans go beyond medical care or medical care insurance. For example, someone we know consulted a doctor about his son's allergies, and the doctor told him that because of the environment--chemicals, air pollutions and interactions with natural phenomena--four out of five children now have significant allergies. We know of the immense increase in asthma. And the epidemic in obesity, addressed today by the First Lady.

But the primary topic in Washington is the legislation now being crafted to address medical care insurance. It is widely recognized that costs are too high and coverage is too low. There are rabid injustices in the system that are causing real suffering and even death.

The ongoing debate over how to reform the medical care insurance system is inevitably caught up in the usual Washington political games, as "covered" by an attention-deficit media. The real issues and the real human consequences are often overlooked, as for example in the non-coverage of testimony on the tragedies being suffered because of the current medical insurance system.

Coverage and politics are responding to money--very big money. Nate Silver dissects the influence of insurance company lobbying and campaign contribution bucks on Members of Congress, especially centrist Democrats.

That's because the stakes are very high--higher than most people are willing to admit. It's hard for anyone to dispute that medical insurance costs are bankrupting businesses large and small, and government on every level (they are a major cost for schools, for example.) It's hard for anyone with a pulse to deny that the medical insurance industry, which has become utterly dominant since the last attempt to deal with the issue in the 90s, has instituted all kinds of inequities and perpetrated all manner of injustices. The old argument-- that government medical insurance would mean your doctor doesn't decide on your appropriate treatment and you lose choice--can't be taken seriously after decades in which private insurance companies have made those decisions, driving both patients and doctors crazy.

But the argument--which centers on a government medical insurance plan, similar to what Congress itself enjoys, co-existing with private plans-- is even more fundamental. The argument is about whether companies ought to be in the business of making profits, when their business is providing medical insurance. And that argument can be extended to other approaches to the public good. It represents a practical and philosophical switch from the move towards privatization since the 1980s.

It's important to say just what "profit-making" means. Profit isn't about a business bringing in enough money to pay its employees well, and to run its business, including research and development. What "profit-making" means is running the business to primarily make corporate profits above and beyond the costs of the business, to increase stock value and quarterly reports, to use to acquire other businesses for the purpose of larger profits and paper power, and to spend lavishly on advertising, marketing, lobbying and political contributions, to further enhance and guarantee profits, and big bucks for the few at the top.

Since the age of Reagan, running something "like a business" was sold as a way to increase efficiency and service, and foster innovation. All that makes sense, but it isn't what happens in the real world. If the primary purpose is to create profits, then services aren't made more efficient--they are cut. Employees are not well-paid, they are exploited. Corners are cut. Money goes into selling the illusion of good products and services rather than making and providing them. That's partly why Detroit's commercials were so much better than their cars.

We've seen what happens when products and services crucial to the public good traditionally provided by government entities or as public utilities were privatized: with few and usually temporary exceptions, the results were higher costs, more waste and abuses, all for profit, not for purpose.

No one involved in the medical insurance debate wants to address this point so directly. Proponents of a public option don't make the argument, but assume that people see health and medical care as a special case. For example, Paul Krugman summarizes the objection to the public plan in a recent column: Thus Senator Ben Nelson of Nebraska initially declared that the public option — which, remember, has overwhelming popular support — was a “deal-breaker.” Why? Because he didn’t think private insurers could compete: “At the end of the day, the public plan wins the day.” Um, isn’t the purpose of health care reform to protect American citizens, not insurance companies?

By constructing that question in that way, Krugman rhetorically assumes agreement on the answer. But for some, protecting corporations and their profits is the overriding concern. It is more important than life or death. It is more important than health. For other people, and for the society as a whole.

President Obama is being cagey on the public option. He argues forcefully for it, but refuses to say it is necessary to a law he will accept. This possibly has helped him get concessions from corporations, such as the huge deal he made with drug companies to cut drug costs for seniors. But his arguments for the public plan are compelling, and they go to the heart of the issue, as in his press conference today, when he warned that companies can't continue to make maximum profits by not providing good services. So it seems very unlikely he will support legislation that doesn't include a public plan option.

Recent polls show that an overwhelming percentage of Americans favor a public plan. But a public plan was all but a foregone conclusion in the Clinton administration, until the corporations and their political allies turned the tide. The fight is just beginning, but if reforms that include a public option really happen, it is a turning point in our ability to deal with not only current challenges, but the challenges of the future. It would not mean government runs everything, but that some sense of public good and service may return to important enterprises, and profit-making will no longer be the only value, or the last word in every argument.