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Healthcare: What’s Missing?

Between the pseudo-fact that Russia is furtively running the USA, and keeping up with the shape-shifting of our newly seated President in Charge of Sales, the healthcare debate has remained on its burner and it’s getting hotter. With few exceptions, we know what the Democrats want and we know what the Republicans want. As usual, something is missing. What does everyone else want?

Members of our two ruling parties have a tightrope problem. How to balance obedience to party with valid representation of a majority of their constituents. If obedience seems too strong a word, it’s only a step up from adherence and since there is a clear price to be paid for violation of either one, the difference is trivial.

Much of this is unfair for what are we to expect beyond own-party support from a politician? To be even fairer, a politician aligns with a party in accordance with previously held convictions. But surely there is something unsettling to an outside observer when every decision, every vote, comes down to a party line vote. How many times can we hear the same refrain that the voting proceeded along party lines?

The problem can be stated this way. If every vote is basically a party line vote, how could it have taken into consideration the majority of the constituency? Since our two ruling parties share election results that do not vary greatly from 50/50, it’s plausible that vote totals in Congress would reflect this randomness with spillover votes being closer to 50/50 in both parties. Why is there so much order and so little randomness? The conclusion to be drawn is that party member votes cannot be consistent with both majority representation of a constituency and party line orthodoxy simultaneously.

About those politicians that align with a party in accordance with previously held convictions. Supposedly the donor class also aligns with parties according to its convictions. Or does it? There was a time when corporations could be criticized for making outsized contributions, say $800,000, to a particular party. What are you attempting to do, buy favor? The reply could be simply, no, we like them.

But then something else started happening. That corporation might give $800,000 to one party, and $500,000 to the other. That gave the game away, but it was too late.

Maybe what we need is “bi-partisan” support for an ongoing healthcare system. Oh, what a great term! How excited we are to hear it. It shows the system is working. The parties are putting aside their small differences and working for the greater good. Reaching across the aisle. And somehow the public is expected to relish this occasional dish.

This brings us back to the beginning. Small differences do exist — or how would we distinguish them — between parties that are themselves mere extensions of a dominant donor class representing big business. They’re two sides of the same coin getting tossed.

Worse, there’s never a need to change the coin. What the public really relishes, the dish of last resort, is the mirage of the next election. By the miracle of ballot rejection the little people can wring some democracy out of the system. It’s a fond delusion. Robot’s parts are easily interchangeable. The next fella or gal will be wearing the same red or blue. And don’t forget the flag lapel pin, costume jewelry worn to impress the terminally naive. The same will not be different.

Most people seem to want national healthcare, only they should say it that way. Single-payer is a poor term, a needlessly abstract piece of contractual jargon similar to terms like primary, secondary, co-pay, and co-insurance. Opponents of national healthcare should like the term single payer because of its lack of emotional appeal and explanatory value.

We find these corporate, political opponents wherever the giving of healthcare can result in a profit. Their accumulative profits, wrung out of a system of quasi-forced participation in sink or swim fashion, are put to use in preserving their industry with generous “incentives” awarded to both parties. Healthcare lobbyists have spent billions to influence Congress and federal agencies. Why would they do that?

They could claim they are uniquely positioned to provide for the health needs of the public, and merit the business by fulfilling those needs. Yes, this could be claimed but with thinking caps on the cross-purposes would be quickly caught out. Health industry profits come at a cost to someone, and it’s not them. It’s the end user. We’re all in life for the health but only a few are in it for the profit.

Indefensible at the social level, their’s is basically a “facts on the ground” counter argument to socialized medicine. It would be difficult and disruptive to dismantle the for-profit health industry. Yes, a lot of people work in the industry but many could transition to a new system.

Pharmaceuticals would still be around, as would hospitals. So would insurance, just not the health kind. Obama was one who used the word, disruptive. Before his election he said single-payer (that term again) was the way to go. We know how quickly that changed. After he took office single payer didn’t make the noise of a dropping pin. When pressed on the subject he made the somber assessment that single-payer would be worth pursuing if we were starting from scratch. That’s a remarkable statement!

According to Wikipedia, as of 2009 fifty-eight countries had universal healthcare. Did they all start from scratch? Hardly. Many of them enacted universal coverage in very recent years, others in fairly recent years. Some have universal coverage in combination with private coverage.

Monday’s New York Times reports the lament of Charles Krauthammer that Republicans have given up the idea of a purely free market healthcare system.

“They have sort of accepted the fact that the electorate sees healthcare as not just any commodity, like purchasing a steak or a car. It’s something now people have a sense the government ought to guarantee.”

Where did this sense come from? Might it have come, in part, from the unanimous agreement among all UN Member States to try to achieve universal health coverage by 2030, as part of the WHO’s Sustainable Development Goals? Or from the aforementioned 58 countries that already have it? Or from people’s common sense?

It’s not a question of government money because all 58 countries are less wealthy than the United States. It’s a question of where the money is directed. Some countries don’t find it essential to put a gun in everyone’s hand and send them around the world. Some countries consider healthcare to be a right that the state is obliged to provide. We all have our priorities.

A tactic used among national healthcare opponents is to tabulate the deficiencies in the systems of foreign countries that have adopted it, as if that mattered. This is misleading. It compares something “there” that isn’t “here”. It also isolates the worst features “there” without bringing into comparison the worst features “here”. What’s more is the unstated assumption that the worst features “there” are endemic to the system and would, of necessity, be present in one we could have here. Have they forgotten about American exceptionalism?

Our world-class dysfunctional and expensive healthcare system can never find itself in a crisis that would require its remaking the way Wall Street did, judging from the way they are handled. Wall Street’s disappeared in a week and all it took was trillions of dollars because the right people wanted it that way, and disruptive doesn’t even come close to describing what fell upon the little person. National healthcare remains outside of congressional choice because the right people do not want it. And who are the right people? They are our democracy, of course.

More articles by:

James Rothenberg can be reached at:  jrothenberg@taconic.net

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