Real Health Care Reform & why we didn't get any

this was written nearly two years ago for my Tribune blog.  unfortunately, nothing has changed since that time....
 



Bait and Switch:  What would real "health care reform" look like? 

It's obvious that the present "health care reform" which Republicans are threatening to repeal was no reform at all.  It was a "health insurance" bailout, with further steps to assure that every health care dollar will be channeled through monopoly corporations which control nearly every member of Congress and the President of the United States. 

The one non-negotiable part of "health care reform" which would have actually made a difference was the so-called "public option" - Medicare for all who want it, but especially for those who can't afford private health insurance, or don't want it in any case, for whatever reasons.  (Did you know that many fundamentalist Christians refuse to buy insurance because they consider it "gambling"?  And many more don't want it because it's a bad deal for them, with huge co-payments, no choice of treatments, and because most licensed medical providers are simply extortionists - demanding money or proof of payment up front, or they simply let you die). 

What is wrong with our state and federal governments?  Why can't they simply and directly "reform" our health care system?  We've spent millions of man- and woman-hours, billions, nay, trillions of dollars creating, attacking, "reforming", and opposing the systems we have (this in addition to whatever resources have actually been spent in providing and paying for legitimate health care goods and services).  Yet, the system continues to collapse, public opposition to the existing corporate providers and their  agents in Congress and the White House continues to grow, and taxpayers continue to see half or more of our health care dollars wasted on corporate bail-outs, boondoggles, and outright fraud and malfeasance. 

Where and when will it stop?  Do we have to have a political revolution, a total economic collapse, and a totalitarian police state before we can provide people with a simple and fool-proof  health care system?  Why do we have to be the only country in the world which doesn't have one? 

Let's enumerate some of the many outright lies used to defend the present criminal establishment.

(1)  Most people are happy with the system we have - private "health insurance coverage" in which providers can charge whatever they like, and provide whatever products or services benefit themselves (the providers), while forcing patients to pay for them under penalty of law.  Under this system, being "insured" means that the bills are transferred to a private insurance company which has the means to fight unjust or exhorbitant charges in court, thus "negotiating" rates which are roughly 1/4 what an uninsured patient will be forced to pay - even if it means confiscating her pension funds, home, or other assets. 

(2)  No one likes or wants "government control" or a "government takeover" of our health care system.  No one wants to be protected by consumer protection laws, which state that no one can be forced to pay for unwanted or unneeded goods and services, and that prices must be fair and based on real costs to the providers, plus some reasonable rate of profit, not to exceed a mark-up of, say, 100%.  We all love our doctors and hospitals, and thus are more than happy to simply sign over everything we own and have worked for our entire lives whenever we have an accident or serious illness. 

(3)  We all hate Medicare and Medicaid, and wish to see them abolished as quickly as possible.  The same goes for Veteran's Hospitals, the Indian Health System, National Institutes of Health, municipal and county hospitals, clinics, etc.  All of these are "socialized medicine," and thus to be opposed at any and all costs.

Research and teaching hospitals run by major universities might be OK, since they're part of the "education system", and we all know that "education" is a good thing.  But, if you're like UCLA, you will tear down one of the largest (and best) hospitals in the country, and replace it with one which can only treat one-tenth as many patients - but in a much more healthful and comfortable "environment." 

(4) We must "let the markets work" - by requiring everyone "practicing medicine" to spend $100's of thousands of dollars attending a "medical school" which will only admit a handful of super academic achievers who promise not to do anything which might jeopardize the corporate profits of all the major healthcare providers and suppliers.  Any drugs or procedures which are not "approved" by the AMA, Hospital Associations, state regulatory or licensing agencies, the FDA, the DEA, and hundreds of other regulatory and enforcement agencies are prohibited.  This is what we mean by "letting the market work." 

Above all, there shall be no right to self-medication, or the right to choose among different medical theories or treatment philosophies. 

============

Sound extreme, or like a parody?  Read it closely.  That is what we have, today, and what nearly everyone in Congress and other "leadership positions" likes and defends.  And in those few cases where they don't, the party machines bludgeon them into line.  "It's all about compromise," we're told.  But the principles of corporate rule and state-protected monopolies on everything are never compromised.  We are expected just to suffer and obey. 

The Democrats refused to even introduce a bill for Single Payer heathcare - Medicare for All, when they had a filibuster-proof majority in Congress as well as a sitting President.  Actually, there have been many such bills submitted over the years - most recently by John Conyers, Dennis Kucinich, and other members of the so-called "progressive caucus" and their Senate counterparts.  But it was the so-called "Blue Dogs", led by our own Max Baucus and some other "conservative" Democrats who effectively vetoed any real health care reform.  After bailing out their insurance and pharmaceutical lobby patrons to the tune of $100's of billions per year, what incentive did they have to do anything for the people who voted for them? 

I have long marveled at the Montana Democratic Party's subservience to people like Baucus, Schwinden, and now Schweitzer and Tester, although the latter two at least pretended to support progressive and populist causes - including Single Payer Health Care - in their campaigns.  I don't believe that Baucus has ever represented himself as being anything but a tool of corporate interests, ranging from the banksters and drug cartels to the nuclear industry, logging, mining, and oil-coal cartels, and of course any and all warmongering and profiteering.  How he can even pretend to be "democratic" is beyond me - except that the Democrat tradition in Montana includes everyone from William Andrews Clark and Marcus Daley to Mike Mansfield, who ended his career on the payroll of Goldman, Sachs - the greatest banksters and clearing house for corporate criminals in recent history. 

Social Libertarianism

[Here's the existing first chapter for my book on Social Libertarianism , mostly written before 1998-- PHS]

         Manifesto
    Social Libertarianism: A New Synthesis for the 21st Century

               New Hope for providing Health care, Education, and Welfare

     Those who closely follow the arguments in favor of various reforms or changes in public policy might observe a certain irony in the fact that voters will not hear of changing public education from a single provider, monopolistic, socialistic system to a diverse, competitive, market-serving single payer ("voucher") system.  At the same time, they reject as "too socialistic," a wise, fair, and universal single payer system in medicine, such as Canada's, where costs are much lower, and services and customer satisfaction very much better than what all but the wealthiest people receive in the United States.  What is "too socialistic" in medicine is apparently "not socialistic enough" in education, even though the two services are equally vital and should be provided universally, equitably, and at an affordable cost. 
      One of the basic concepts of Social Libertarianism is "market socialism" -- a familiar concept to most economists and public policy experts.  It is practiced widely in other parts of the world -- especially Eastern Europe, Scandinavia, and Asia.  Yet, most Americans have no idea that it is possible to use the market mechanism, careful definitions of property rights, and the price system in order to create policies and programs which satisfy social needs in an efficient, incentive-driven fashion.  Government no longer needs to be the problem.  Voluntary, community-based institutions can replace vast, centralized bureaucracies.  Worker and customer-owned cooperatives can replace elitist, power-and-profit driven corporations in the provision of public services, much as credit unions and food co-ops have replaced commercial banks and grocery chains for many discerning, community-minded consumers seeking quality products or services at an affordable price.  More importantly, such institutions provide a meaningful form of ownership and other rights to participate in the policies and practices of the providers. 
     The problem, it seems to me, is that the public no longer has good information about alternatives.  Instead, the corporate media continually brainwashes us with an elitist, right-wing, anti-welfare agenda.  More recently, a broader tendency towards mergers and monopolies has gone unchecked, threatening to take over or eliminate what is left of diversity and competition in public and non-commercial broadcasting as well as public education.  Even public universities, once the citadels of free inquiry, creative thinking, and free expression, have often become political pawns offering little more than professional training in which careers, future incomes, and "upwardly mobile" lifestyles have taken precedence over the quest for knowledge and the betterment of society as a whole. 
     "The Left" in general has been largely discredited in the public mind, along with the very idea of the welfare state, public health, and collective responsibility for other necessities of life and well-being.   Even such venerable institutions as public libraries, museums, symphony orchestras, and other parts of our cultural infrastructure have suffered drastic cuts in public support, including eliminating many of the incentives which private citizens once had to support them.  Only the police, prisons, "national security," the legal and other well-organized "professions", along with corporate subsidies, seem to have maintained a blank check on public funding, growing at rates which rival the spread of AIDS, poverty, and the distrust of government, itself.  Now, they are fighting desperately among themselves over a public budget "commons" which can only shrink with all the tax cuts and "entitlements" which leave little to supply the needs of anyone but the rich and powerful.
     "Market socialism" may sound like an oxymoron for those who think that "socialism" and "free enterprise" are mutually exclusive.  In fact, it is the logical synthesis of more than 200 years of sophisticated economic thinking.  It resembles the Swedish model, with high standards of living for even the poorest members of society, a progressive business community, and a much more egalitarian distribution of income and public largess.  It should no longer be a secret that a person earning $100,000 a year in the United States gets, on average, about $10,000 a year in tax-supported subsidies or benefits, while a person making $10,000 or less gets, on average, less than $5000 in benefits from the government/taxpayer.  Most government programs are regressive, meaning that everyone is taxed at what is close to a flat rate when we include social security, sales, value-added, and property taxes, while benefits (contracts, government payrolls, subsidies, medical payments, etc.) overwhelmingly end up in the pockets of the middle-to-wealthiest members of society, not the poor-to-low-income people.  It is the welfare of middle-class professionals and large corporate stockholders which is being served.  And that is why our version of the welfare state is bankrupt, even though it can't meet more than a fraction of the genuine human needs which it was supposed to provide for.
     In fact, we do not have a welfare state in the United States, nor have we ever had one.  There is no longer any clearly-articulated policy for progressive taxation and a more egalitarian distribution of income, like the Democrats and Progressives once maintained.  Even our best-known welfare institution, Social Security, is highly regressive, transferring wealth from the working poor to the wealthy retired.  Politically speaking, virtually nothing can be done about it.  In the case of Medicare and other government-support for high-wage, high tech medicine, our government pays more to subsidize the medical industry and professions than other governments spend (per capita, and as a percentage of GDP) to maintain a comprehensive national health service or insurance plan which covers everyone for all health care services.  And nearly every government welfare program is riddled with perverse incentives which exacerbate the problems, such as penalties against marriage and families, against working, and against home-based businesses.  It is virtually impossible, legally, to create cooperative day-care facilities or other community services staffed by parents or other clients.  Public schools closely mirror the socio-economic status of the neighborhood, perpetuating poverty and ignorance rather than helping to eliminate them. In nearly every case, we are presently subsidizing idleness, illness, and ignorance rather than productivity, wellness, and education. 
     Suffice to say that we desperately need to reform, recast, and most of all, rethink our welfare system so that it does its job in an affordable, incentive-driven fashion.  And this is just as true of education, health-care, and maintaining the cultural infrastructure as it is of social security, taxation, and the labor market.  I know of no one who believes that we presently have a good system, and one which should be maintained at any cost.  But every cry for reform is now interpreted as a demand for lower taxes by a wealthy, empowered minority.  Reform, itself, has been discredited.  Most of us would benefit from higher taxes to support better services and a better quality of life for everyone.  Means-testing for all government services would immediately liberate far more tax money to serve genuine human needs than any tax increase under the present system could possibly provide.  True reforms should give everyone a large incentive to work and produce more, perform public services, become better educated and more discerning cultural consumers, and improve our health outcomes by cleaner, healthier lifestyles and comprehensive strategies to implement preventive medicine, better, safer food, and a clean and healthful environment. 
     It costs a few dollars in education and training to prevent AIDS, but a million dollars or more to treat an AIDS patient and extend his or her life by a few years.  It costs less than a third as much to provide a year of appropriate post-secondary education or training as it costs to incarcerate a young person for a year.  Indeed, education is generally viewed as an investment, which provides a large return, rather than a welfare expenditure.  Yet, we continue to lavishly subsidize the prison industry and health-care providers rather than make investments in education, preventive medicine, and employment or job-training opportunities.   
     Why do we keep doing this?  Is it because people are making money by playing on our fears, weaknesses, and stupidity?  We are not taught to think that everyone deserves education and culture (or even a just society), yet we are certainly taught that criminals "deserve" to be locked up where they can only learn to become even better criminals.  We have created whole classes of "economic criminals" and the legal professions (including enforcement and corrections) that defend and prosecute them.  They have grown exponentially as governments increasingly regulate, prohibit, and control every aspect of our personal and working lives.  This is called "socialism," even though it is based on no known socialistic principles.  It more resembles fascism or a police state -- some kind of totalitarian/authoritarian system of the Right, not the Left.
     Even many public education advocates insist that everyone "deserves" free, universal, compulsory public education in giant, gang-ridden, factory-like schools, as chaotic and dangerous as the streets which surround them, while claiming it would be a grave injustice to pay a poor student's tuition at a better school -- even one which may be based on more progressive or humanistic principles.  By now, we should be wise enough to know that decentralization and choice in education -- i.e., market socialism -- can only create a myriad of new opportunities both for teaching and for learning, while preserving publicly-supported  and mandated education in perpetuity.   As monopoly state socialism is discredited everywhere else, some people still seem to think it can work in education.  It should be clear by now that the defenders of the status-quo are only protecting their immediate short-term career and economic interests.

     Market socialism represents a newer, more enlightened thinking which combines the humanistic, egalitarian, utilitarian philosophy of the progressive movement with an understanding of how people actually behave in the marketplace and the larger world.  We can only maintain the free market structure of people pursuing their own interest in a context of good information, good citizenship, diversity, choice, decentralization, and cooperation.  Social welfare is defined as the summation of individual welfares, rather than being in conflict with it. 
     It is this principle of "social welfare" combined with "consumer sovereignty" which makes possible a true "market socialism."  No one should have to rely on the charity of a faceless bureaucracy, as we do today for nearly any kind of government service.  But for those services deemed beneficial and essential, the government can and must subsidize the consumers so that they may purchase, at a reasonable and competitive price, whatever it is they need from those who are set up to provide it.
     Basically, it's the same principle as Food Stamps -- the one unquestionably beneficial and cost-effective government welfare program.  If you don't have a sufficient income to purchase a decent quality and quantity of food, the government will give you coupons (means-tested "vouchers") to purchase whatever you think you need from any approved provider.  The providers still take cash, and charge the same price whether you use a credit/debit card, cash, or Food Stamps.  This is one obvious criterion for an efficient system.  Why can't we have the same kind of programs for medicine and education? 
     Health care has been 2- or 3-tiered all along.  Those with good insurance or other "third-party payers" are charged far more than cash customers, or those receiving Medicare or charity will pay, and the quality of service often reflects one's economic status.  This is not an efficient or fair allocation of public resources - as indicated by the fact that the cost of medical care has been increasing far beyond the rate of inflation for reasons which cannot bear close scrutiny or informed criticism. 
     We already have an excellent model for a single-payer medical system in Canada.  Canadians choose their own doctors and hospitals, get whatever prescriptions or other products and services they need, and the government pays the reasonable and necessary costs, rather than providing a blank check for whatever the providers demand.  Every working person pays a tax (proportional to income, or progressive) which covers the total cost of the system.  Even if you're a foreigner paying cash, the cost of a service, prescription, or hospital stay is much less than it would be in the United States.  Consumer satisfaction with the system is nearly 100%.  Doctors and other medical providers may be paid somewhat less than ours, even though the overall standard of living is higher, but the average quality of health care, health statistics, and other measurements of how well the system is doing remains somewhat better than ours. 
     So why don't we do that, here?  There is no reason except politics and the effectiveness of the present medical cartel to maintain a system which benefits themselves.  This de-facto cartel includes doctors, the AMA, hospitals and hospital associations, regulatory agencies, pharmaceutical companies, medical schools, private insurance companies, and the like.  They are smart, rich, and powerful, and they have allowed nothing to happen so far which might reduce their wealth and power.  It is no secret that more than half of those who work for this cartel provide no health care.  In similar fashion, less than half the money now spent on public education goes to teacher's salaries and benefits.  All the rest goes to salesmen, contractors and suppliers, corporate profits, administration, and bureaucracies of one kind or another. 
     There is very little argument about what is wrong with our present institutions in medicine, education, or other public services.  The corrective measure, in every case, is a gradual and systematic move to implement a consistent program of market socialism in the provision of essential public services.  This may or may not involve "privatization," depending on how we understand it.  The idea is not to create more opportunities for corporate profits or other private gains, but to structure incentives and otherwise utilize market mechanisms to attain maximum efficiency, equity, and client satisfaction in the provision of essential public services.  If we are expected to be loyal, civic-minded supporters of our society and government, then we need a bigger stake in it.  Why are incentives supposed to be good for millionaire investors, but not for impoverished workers or consumers?  If government is nothing more than a conspiracy of the rich to protect their "property" from the rest of us, we've got a revolutionary situation at hand, and eventually, the vast majority will prevail whether by peaceful or other means. 
     The underlying principle of socialism -- a government which serves the long-term interests of the people, and distributes wealth and power accordingly -- is sound.  But so is the economic theory, developed over centuries, which explains how people behave in the real world, pursuing private wealth and personal security without much concern for others, or the future of the country as a whole or the global ecosystem.  By putting the two together, we can get twice the benefits from our taxes, and prove to the world that we Americans are truly the progressives and reformers who have the best government, and the best system for maintaining freedom, prosperity, and ecological sustainability.
     We are once again at that point in history when some are stridently predicting the end of the world, while others are building the foundations for a new millennium.  We need to comprehensively rethink government, its structure, missions, and programs.  It's primarily an educational rather than a political task.  We must all work together to improve the human condition, instead of denouncing every effort to promote the general welfare -- the constitutional mandate which needs to be addressed before we go any further down this pathway to oblivion.