As the great battle for health care reform is now being waged in Washington, I have been thinking of the very nature of American politics. While the House of Representatives is finalizing its initial proposal for a new system, the defenders of the status quo are marshaling their awesome forces to do battle. If one distills out all the particulars of the reform package, the essence of the proposed bill is nothing more than a redistribution of some resources, rather than truly fundamental change.
Currently, adequate health care in America is enjoyed by people who fall into one of three categories. In the first, are those who make enough money to afford a private health care insurance plan. Most of the cost of these private plans is paid for jointly by individual families and employers. In the second category are those who belong to a government sponsored health care system, like Medicare. here the costs are absorbed mostly by working taxpayers. And the and smallest group, the really lucky people, are those who have accumulated so much wealth that they can afford the very best health care money can buy, whether they are insured or not. Unfortunately, not all Americans fall neatly into these three categories. Presently there are forty-seven million Americans who have no health care coverage at all and are completely at the mercy of the largess of the rest of us.
But this is not another essay on health care reform alone, but rather on the nature of our policy-making processes. For if it were primarily about health care, there is already a simple and cost neutral way to create a just plan for all of us. If the American people demanded that quality health care for all was a national right, rather than a commodity to be bought and sold in the marketplace, we could restructure the entire system. For once something achieves the status of being a fundamental right, it enters the domain of the common good. Imagine if health care was a cradle to grave right for all Americans, as it is in so many other societies. And imagine further, the savings we would all incur if the profiteering was eliminated. If health care were included in the public safety net we demand from our government, like fire and police protection, the costs would be more than manageable.
Our current system, you see, is based almost completely on a capitalist business model, rather than on a humanitarian one. Health care, like all our other scarce resources is bought and sold in the market place, which creates incredible financial wealth for those who control its distribution. Look at the people and institutions lining up to defeat any substantial reform measures right now: private health insurance companies, private hospital corporations, the American Medical Association, and private drug manufacturers. And what is the one thing that all these groups have in common? Their members and shareholders have gotten wealthy within the current system. Each of these institutions, including a great many physicians in private practice, is engaged in commerce before they are engaged in health care.
The large corporations in this arena have one goal and one goal only in the delivery of health care, and that is to increase share-holder value. The bonuses that are paid out to top management in insurance, pharmaceutical, and hospital corporations, are not earned by expanding the level of care they provide, but rather for generating huge profits while increasing per share value. Quality health care, when and if it is delivered, is a by product of a hugely successful business model, rather than a primary mandate. But what if the "for profit" element was legislated away? In other words, what if the Wall Street bankers and fund managers could no longer call the shots? Better yet, why not establish health care as a public utility? How about elected boards determining doctors' fees, drug costs, hospital expenses? No need for insurance companies at all, if we institute a universal care system that kicks in at birth. Where is it written that our current model, or a facsimile thereof is the only way to go?
Back in the summer of 1787, the authors of the United States Constitution, built into that wonderful document a process for making changes as times and circumstances changed for the American people. These Founding Fathers were so wise, that when they wrote Article V, they actually incorporated a way for us, the residents of the states, to make necessary changes, without having to wait for our national government to take the needed steps. The language is actually pretty clear, ". . . or,on application of the Legislatures of two-thirds of the several States, shall call a Convention for proposing Amendments." Wouldn't it be something if we actually acted like the patriots we claim to admire so much, and used our political process to bring about fundamental change in an area that profoundly affects us all? I don't know about you, but I would find that kind of citizenship infinitely more rewarding than slapping magnetic stickers on the back of my car.
But that may be too much to ask for, after all we are way too stubborn to finally be getting around to a health care system the French and Canadians have had for more than half a century. Who among God's chosen people would want to admit that somebody else, especially the French, had a better idea than we Americans? Well. . . I would, for one.
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