May
2006
Tell Me Where It HURTS
I am reasonably convinced that social historians will one day look back at these years and wonder what really ailed us so long and prevented us from fixing our broken U.S. health care system. They will be astonished by the the sclerosis of will and imagination that allowed 45 million Americans to go with no health care coverage at all and that left another 20 million seriously underinsured. They will puzzle over the fact that we spent more than twice the proportion of our national wealth that other industrial nations spent on health care–now 16 percent of GDP–yet our outcomes (life expectancy and other measures of healthiness) remained so much worse.
Of late the Paul Krugman, a Princeton economist and regular Op-Ed contributor in The New York Times, has been pounding away at the insanity (literally) of going on like this. What Krugman and other clearsighted observers cannot stand is the sheer irrationality, not to say inhumanity, of the “system” we maintain. But from another perspective, the U.S. health care system is actually quite rational. It does, after all, generate very positive outcomes for the business of health care. And as long as people are willing to accept that large insurance companies and bloated for-profit hospital chains, laboratories, health maintenance organizations, and pharmaceutical companies are legitimate businesses, there is little chance of making things better for the uninsured, the underinsured, and the millions more who cannot afford the “coverage” they have.
Krugman and others, for example, deplore the 30 cents on every health care that are spend on administrative overhead–all those insurance “managers,” all those high-paid hospital executives, etc. etc. But as long as the public is willing to grant that profitiing from illness and risk is legitimate activity, these interests will fight like hell to keep their slice of the pie and even increase that slice, as we saw Big Pharma do during the creation of Mr. Bush’s nightmarish Medicare prescription drug plan.
Because the business of health care is still regarded as legitimate and proper, other businesses that desperately need systemic reform aren’t speaking out, or aren’t speaking out loudly enough. Ford Motor Company is closing 33 U.S. plants, mainly because of the crushing burden of its health care costs, which average $1500 for each vehicle produced in the United States, yet we do not see William Clay “Bill” Ford walking the halls of Congress and demanding Medicare for all. Even Wal-Mart, which has far more to gain than any other company from a rationalized health care system, says nothing at all while silently dumping hundreds of thousands of its “associates” onto state Medicaid rolls.
What is needed–and here people of faith have important values to contribute–is a massive delegitimation of excessive profiteering from illness and from human vulnerability. Then, just possibly, our elected leaders will begin to find their spines and begin to challenge the prerogatives of the health profiteers. Then, just possibly, the nine out of ten business leaders who are not in the health care field will be willing to say “enough is enough!” and start pushing hard for a single-payer system or some variant that will work.
Sure, if we turn the system upside down we will have to find something for all those now employed in health care “administration” to do. That’s only fair and right. But solving that challenge is a walk in the park compared to continuing to suffer under a for-profit health care regime that costs far too much and delivers far too little–and that delivers only anxiety and ill-health to the growing millions of the uninsured.